How can I evaluate the healthcare plans of both presidential candidates when so many independent policy organizations produce such different assessments?

[Guest lwiener1]

As a law student trying to write a neutral paper on the theoretical goals and financial implications each presidential candidate's healthcare plan, I am having substantial problems dissecting the numerous analyses I've read.

Ideally, I would like to see if it is possible to find the most compelling aspects of each plan, and construct a broad overview strategy that seeks to combine the best tools with optimum goals. How can I start this admittedly ambitious task when the numbers derived among all of my research just don't agree?

[JanetM]

Lesson number one - everyone has an agenda. Good luck finding neutral unbiased paper on either one of their views.

Am not cynical, just realistic.

[Ron Snyder]

As a former law student myself, I wonder how you got tricked into such an impossible task.

While I am not neutral as to the election, neither party's approach to health care makes any sense.

Bush's plan: (1) Health Savings Accounts (HSA)- does nothing to extend coverage or to control costs. My rich clients love having another IRA that they can get money out of tax-free, but it does nothing.

(2) Community and rural health centers- have not even kept up with providing medical care for urban and rural poor. Worth continuing, but no solution.

(3) Medicaid waivers- moves money from one pocket to another. Does not address real problems.

(4) Encouraging generic drugs-this is meaningless unless it is possible also to allow competition by allowing importation or reimportation of drugs from Canada, etc.

(5) Medicare Prescription Drug Benefit- This unfunded benefit does nothing and costs little today, but will become another federal boondoggle like Medicare itself. It should be repealed or replaced with a wider solution addressing unconsionable practices by the drug industry.

(6) Tort Reform- Having the Federal government pre-empt state regulation of malpractice awards is unnecessary and unwise. Many states have already reformed, and others will do so as necessary.

Kerry's plan: (1) Cut Premiums- Government subsidy, not matter how funded, will cost more than we can afford. Bad idea.

(2) Mandatory Coverage- Whether this is done through the government or through employers (they are assuming a combination of both), it will cost a lot and eliminate jobs. Not a good idea, and would be obviated by a "living wage" law.

(3) Cut the Cost of Prescription Drugs through re-importation, etc. Good idea; needs to be passed.

(4) Cut Waste And Inefficiency- While this is a good idea, another federal iniative will do less than competition to accomplish this objective. The marketplace is a better place to improve efficiencies.

There is my short, "neutral" analysis. There are already many insurance companies competing in the marketplace to provide affordable health care. A living wage (as some communities have passed) would go a long way toward allowing all people to afford health coverage.

Health care is going up because a lot of money is spent on R&D, because people are living longer, because our cultural values have changed to create an unrealistic expectation that life is worth preserving at all costs, because we don't exercise enough, because we don't eat healthy food and are obese as a nation. Neither candidate is interested in addressing the fundamental problems facing us.

Rationing is a fact of life in every health care financing and delivery system. Our economically-based approach is just as rational and fair as any other system.

I'm voting for Kerry, but only because I believe that he'll never get his plan through Congress.

[david rigby]

I always recommend this starting point when searching for information:

http://benefitslink.com/buzz/new.html

[Guest lwiener1]

All responses were much appreciated (even the cynical/realistic one). I understand fully that seeking a truly neutral analysis is like sticking my head in the ground. I'm a Kerry supporter overall, but there's a neutral interest-based gene that seems to coarse through my body - looking to find solutions that make sense for all parties involved.

That being said, I appreciate the comments by vebaguru - because I, too, see major problems (both theoretically and politically) for both health policies.

I guess I start with what is the incentive for everyone involved:

a) the employee- to have a job that provides health coverage so that one feels secure in working hard and having care available if illness were to arise (for oneself or family).

b) the employer- to retain good hardworking employees whom appreciate good benefits, and the employer sees healthcare as an attractive feature as well as a vehicle to keep employees efficient and productive.

c) health-insurers- to provide a service but also to make a profit. i stop short of labeling such organizations "bad" when they deny claims; i prefer to see them as capitalists who have no incentive to do anything different.

d) the government- the only mechanism possible to regulate the needs of all three.

I know, very simplistic. But, in reading an article in Saturday's NY Times, it seems that both sides of the aisle (Kerry and Frist) may be on to something with providing a "ceiling"-like secondary insurance. If an insurance company had less incentive to deny claims merely because of cost, wouldn't they spend less on administrative denial processes and focus more on improving their product? Premium increases could slow dramatically, while an HMO could still reel in a profit. Wouldn't competition then shift towards providing more outstanding lower-to-middle range care, with better in-network providers and more preventative care services?

With lower plan costs, employers would have their incentive to provide the benefit - and see their employee workforce thrive. If production increases, so wouldn't business and job-creation? And, of course, we have a happier, healthier employee who contributes to the economy instead of draining other resources like unemployment and mandatory walk-in care in hospitals.

What part of this scenario doesn't satisfy the greatest # of players? I know the bottom line on taxpayers would be enormous, but isn't it the same money - only being utilized better? There must be some plan that is attractive to all interested parties (save the very wealthy, of course).

What am I missing? or is it just the very wealthy????

[jeanine]

c) health-insurers- to provide a service but also to make a profit. i stop short of labeling such organizations "bad" when they deny claims; i prefer to see them as capitalists who have no incentive to do anything different.

There are plenty of non-profit health plans who don't have a capitalist interest in denying claims. To state that health plans deny coverage solely to make a profit indicates that you don't understand how one part of the equation works and that is how individuals use their health coverage. First, not everything is covered by every plan, nor should it be. Many employers choose to provide less rich coverage to their employees in order to be able to afford to provide them anything at all. Second, some people expect any medical service to be covered regardless of whether it is truly medically necessary or even effective.

The biggest flaw of Kerry's plan (from my perspective) is that he proposes that the federal govt will re-insure all claims over $50,000. Do you know what that means? That means the federal govt will in effect control all transplants, most cardiac surgeries, most cancer treatments, and many chronic diseases. Couple that with Kerry's proposal for mandatory case management and you have almost a complete picture of govt-sponsored, govt-controlled health care.

[Guest lwiener1]

It seems to me that to confine your response to "non-profit health plans" is an insulation against the more general point. Sure, there are legitimate reasons for health plans to deny claims (eg- not falling within a plan description, not a medical necessity, etc.). But insurers/ employer plans devote an inordinate amount of resources for finding reasons NOT to insure people that have legitimate claims.

A quick browsing through westlaw or lexis uncovers a littany of legal actions against insurers for denying claims in a bureaucratic, and more importantly - "arbitrary and capricious" manner. The fact that so many successful actions surfaced only begs the question of just how many beneficiaries had neither the resources nor the know-how to fight a denial of a legitimate claim. It ALSO underscores that this incentive on the part of insurers not only taxes the system (which is intended to provide health maintenance, "non-profit" or otherwise) but also leads to considerable transactional costs in the form of litigation.

Now that might be GREAT for a future lawyer like myself, but it certainly doesn't serve the overall purpose of these health organizations or their professed mission - to improve the general health of their insureds. All private health-related entities, such as voluntary hospitals, HMO's, and the like have a non-profit related function to them. Does this mean that they are not in the business of succeeding and expanding their reach, which certainly leads to "profits" within the margins? I would think not.

I am not faulting their incentive to do so; rather I am searching for ways that they can accomplish this without compromising their reason for existence. And Kerry's now immaterial notion of catastrophic coverage would not, as some claim, put procedures such as heart surgeries in the hands of government - as this was an essential scare tactic by its critics. Rather it would provide the financial resources to the relevant employer/ plan to provide the needed coverage through their normal carriers and healthcare providers.

My point is only bolstered by the fact that prominent Republicans (such as former Speaker Gingrich and present Majority Leader Frist) are now pushing a similar concept under a different name - now that the elections are over of course. They prefer to call it "re-insurance", and these same government funds that Kerry spoke of would travel not directly to the Employer's plan (the more efficient route of course), but through all the traditional middlemen - the larger insurance company, their benefit managers, and so forth. Typical to see that this plan would entitle every entity to get their "piece", but I wouldn't say unreasonable from a political standpoint. Whatever crafting that is needed to address the root problem (healthcare premiums rising faster than any other economic indicator) is a step forward in the field of healthcare.

[jeanine]

A quick look through Westlaw or Lexis will only give you examples of claims being denied. A better way to look at this is to find out how many claims WEREN'T denied. For every claim that is denied there are thousands of claims that are paid. Medical necessity, plan language, eligibility, standard vs experimental treatment--the plan usually has a different interpretation of what this means versus the enrollee. That's what these lawsuits boil down to and the plan is not necessarily arbitrary in its decision-making process. Check out the history of the Nadine Fox suit in California. Her attorney suceeded in the estate's claim for treatment the plan dubbed experimental. Several years after the fact, the only supporting study of the treatment's efficacy was completed debunked.

As for Kerry's plan not being a big government take-over, if any claim over $50,000 is re-insured by the federal govt, and the fed govt requires case management of this types of claims, how has the govt not taken over? The fact is, certain illnesses will always exceed $50,000. By default, the fed will control the delivery & payment system for them.