Posts Tagged ‘Public Option’

Reconciliation as a last resort? Yes, it should be.

Author : OurHealthCareSource.com

OurHealthCareSource.com serves as an information source for those who are interested in helping shape a new system of health care delivery.

Feb 24th, 2010 | by OurHealthCareSource.com

So there are some Democrats threatening to use reconciliation to get a health care plan passed (CNN article). Well, first things first. Let’s get through the President’s summit and see how it goes. Who knows what surprises may be in store? They may actually be “welcomed” surprises for a change.

This entire debate has been one surprise after another. As a result of this summit, we may actually see a few members of the minority party decide that the President’s plan (albeit not perfect) is currently the best option we have given the times. What do the Dems have to lose? Reconciliation should be used as a last resort and quite frankly, that is exactly what they seem to be doing. All we ask is – just do something – and do it soon – and don’t make it a band-aid approach.

So much debate and finger pointing and arguing and going back to the table threatens to completely dilute any meaningful reform. Despite the fact that the majority of Americans have said that reform is what they want and what America needs. Meanwhile, another $25-billion in Medicaid relief has been included in the President’s budget proposal to states that are seeing current enrollment numbers rise due to our economic environment.

The President’s plan has some really good aspects that will change the course of the health care system today and we finally have the momentum to actually make the health of our nation better. Why stop now?

Why stop when it includes a meaningful expansion of Medicaid so that our most vulnerable citizens can get the monetary relief and care they need to stay healthy? Why impede the development of an insurance exchange to make it easier for Americans to purchase health care? Why prevent important insurance reforms from taking place? Why dilute a requirement that says all of us have to buy coverage to ensure the health care system will be there when we need it and not bankrupt the nation in the process? And why in the world would we want to encumber a real focus on managing high-cost chronically ill populations?

All of these things that make a lot of sense are included in the President’s plan, and can be passed with or without reconciliation.

It will be interesting to see what plays out with the President’s health care summit. Perhaps some consensus can be met that may not address everything, but will at least garner enough votes to put something meaningful in place that we can build upon over the next decade.

A couple question to our readers – Do you think imposing reconciliation is the right way to go? Do you think the President’s health care summit will prove productive?

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Health Reform is a Civil Rights Issue

Author : Toni Bigby

Consumer Advocacy at CareSource Over 11 years of experience working with Ohio’s Medicaid program promoting the importance and availability of health care coverage for Ohio’s underserved populations; Responsible for working with statewide consumer advocacy groups to advance key initiatives to provide value-added benefits to CareSource members; Charged with engaging members to bring their voice to the forefront to inform internal business operations

Jan 18th, 2010 | by Toni Bigby

Martin Luther King, if he had been given the time, must eventually have tackled the health care issue as an essential civil right.  As a nation, we’ve focused so much on the tactics and details—public options, mandates, “Cadillac plans” and so on—that we may be forgetting why increasing health care accessibility is important to us as a nation.

So this is just a reminder for all of us: without health care, personal growth and success are limited indeed.  Children with sensory or behavioral problems are not treated, or whose simple illnesses are not cared for, cannot learn.  Adults with a chronic disease (like diabetes or asthma) can earn a living—but only if they have the care and medications they need.  Families that lose a parent to a disease that could have been cured if caught earlier, suffer consequences that can hardly be measured – stability, opportunity, potential.

If we are serious about equal opportunity, education, stable families, social justice at any level, we must embrace health care accessibility as an essential civil right.

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The “Public Option” is NOT Revolutionary… Actually, It’s Been Working Great For Years

Author : Bobby Jones

Chief Operating Officer, CareSource More than 30 years experience in both Medicaid and Medicare; Strong proponent for public sector health care at both the state and federal levels; Proven track record for driving operational efficiencies with an extensive executive leadership background in health plan operations for national managed care organizations; Holds a bachelor's degree in Finance and Business Economics from Wayne State University and a master's degree in Public Administration from Eastern Michigan University.

Nov 6th, 2009 | by Bobby Jones

You’ve probably noticed that the health care reform debate has shifted from health care reform to health “insurance” reform. Despite its efforts to work collaboratively, the insurance industry is the simple target to blame for the health care mess we so urgently need to fix. (There is no single villain, of course. It’s the entire system that’s broken.)

However, that may explain the “co-op” approach passed as part of the Senate Finance Committee bill. But, as 30 Senators pointed out in a letter to Senate President Harry Reid, co-ops (as currently written in America’s Healthy Future Act) are pretty much a non-solution:

The Senate Finance Committee included a cooperative approach to insurance market competition. While promoting more co-ops may be a worthy goal, it is not realistic to expect local co-ops to spring up in every corner of this country. There are many areas of the country where the population is simply too small to sustain a local co-op plan. We are also concerned that the administrative costs associated with financing the start-up of multiple co-op plans would far outstrip the seed money required to establish a public health insurance program.


There’s another point made further down in that letter that really is something to think about:

The major differences between the public option and for-profit plans are that the public plan would report to taxpayers, not to shareholders, and the public plan would be available continuously in all parts of the country.


Guess what? We’re already here. Established and ready to serve. A health plan that is accountable to taxpayers. CareSource, the nation’s second largest, not-for-profit Medicaid health plan and a number of other organizations like us around the country have been helping Americans get the care they need at the right place, at the right time and at a lower cost.

My point here is that even though the health care system is broken, there are still a lot of working parts, including a number of proven, experienced and effective non-profit insurance companies in place that can help get a “public option” off the ground. The best part – we can do it fast and transparently.

And while 47 million Americans now have no health care at all, speed and honesty is a big part of what we all need.

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More Is Not Better – The Story of Fragmentation of Care

Author : Craig Thiele, M.D.

Chief Medical Officer, CareSource Over 16 years of clinical leadership experience with a strong background in case and disease management. Oversees clinical and quality initiatives at CareSource and manages medical policy, clinical care guidelines, utilization parameters, and quality assurance for its health plans.

Nov 4th, 2009 | by Craig Thiele, M.D.

It’s the Fragmentation, People

I heard a story that didn’t surprise me, but may surprise you, especially if you haven’t heard much about fragmentation of care. It was called “The Telltale Wombs of Lewiston, Maine,” on National Public Radio. At the start, the story seemed to be pointing a finger at doctors for providing services (especially surgeries) that their patients don’t really need, sometimes with negative results. This point of view has been around awhile, and frankly, does not do justice to a complex situation.
In the end, here’s what I heard that concerned me:

“(Dr.) Elliott Fisher…compared Medicare recipients with similar levels of sickness in areas throughout the whole United States. Fisher looked at places where elderly people used relatively few health care services and compared them with places where elderly people used a lot of health care services.

‘The patients in the high-spending regions were getting about 60 percent more care; 60 percent more days in the hospital; twice as many specialist visits,’ Fisher says. ‘And yet when we followed patients for up to five years, if you lived in one of these higher-intensity communities, your survival [rate] was certainly no better, and in many cases a little bit worse.

This is probably because of something called fragmentation of care. In high-use areas, it’s often the case that many different doctors play a role in the care of a patient; many specialists are responsible for overseeing only a small part of the person. This increases the amount of treatments, tests and hospitalizations that people get, and exposes people to more risk of harm from medical error and side effects.”

For most Americans, fragmentation of care is a difficult idea to accept: It’s hard to understand that more care isn’t necessarily better for you.

But study after study has borne out the truth of this completely anti-intuitive conclusion. In fact, Fisher and other researchers estimate that almost one-third of the care given in our country today is that kind of care — care that may not help.

In some studies, it is estimated that the United States spends more than $2 trillion on health care every year. If 10 percent of this care provided is unnecessary, this would cost $200 billion. Some estimate it may be as high as 30 percent, or roughly $600 billion.

What lesson should we take from this about health care reform overall? It seems to me that whatever the final form it takes, reform must confront and solve these issues, including fragmentation of care. Whether we go with “exchanges,” “co-ops,” a “public option,” Medicaid expansion, or a combination of all of them, attention must be paid to avoid fragmentation by coordinating care.

It seems too obvious to point out that non-profit insurers like CareSource have been improving outcomes and controlling costs through care coordination for years now. We certainly hope that Congress, in its wisdom, will put that experience to work.

Ask your health care reform questions here

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Paying for the Sins of Others

Author : Toni Bigby

Consumer Advocacy at CareSource Over 11 years of experience working with Ohio’s Medicaid program promoting the importance and availability of health care coverage for Ohio’s underserved populations; Responsible for working with statewide consumer advocacy groups to advance key initiatives to provide value-added benefits to CareSource members; Charged with engaging members to bring their voice to the forefront to inform internal business operations

Oct 2nd, 2009 | by Toni Bigby

“Funny or Die”, the comedic website developed by Will Ferrell, Adam McKay and Chris Hench posted a hilarious video about the health insurance industry called “Protect Insurance Companies PSA”.  Obviously satiric, the clip showcases many Hollywood personalities supporting the need for health care reform to protect Americans from the interests of greedy health insurance executives.  The clip ends with a call to action to support the public option, and email your Congressman.

The only unfortunate thing about this video is that it lumps all insurance companies together.  But there are some insurance companies – ours for instance – that actually support reform efforts that offer the uninsured an array of affordable health care options from which to choose.  Look, the truth is we are embarking on a new era in health care.  The entire health care industry – providers, hospitals and insurance companies alike – will be completely revolutionized once reform is introduced.  And the legacy insurance companies who have profited unscrupulously will find it hard to adjust because they’ve operated the same way for years.

The insurance companies of the future – those that are non-profit, customer-focused first, and genuinely engaged in finding ways to decrease spending while increasing quality – are the companies ready to thrive in this new era.  Do we stand to benefit?  Of-course we certainly hope so.  But I’d rather have a system that rewards transparency, honesty, inclusion, wellness and empathy than one that rewards profitability and size.

Public option, co-op, exchange, expanded Medicaid and/or individual mandates …whatever shape reform ends up taking, there are a handful of progressive companies ready to embrace this new world.   Will Ferrell and team are funny indeed!  I just hope they know there are some insurance companies out there that support his team’s ideals and don’t make us all pay for the sins of others!

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