http://aarp.org/aarp/presscenter/pressrelease/articles/medicare_physician_payment_reform_act_release.html

The study cites several reasons, but among those are:  Utilization for neurological testing was 40% higher than the medial states surveyed (32 states).  The study showed that providers bill for more services at time of visit. The study goes on to cite many examples that are similar.

However, one of the major problems in LA is that the major PPOs have pulled out of the state due to litigation concerns.  I talk to clients that are still experiencing problems from bills where discounts were taken years ago, and these were legitimate PPO discounts.  Until LA gets it together regarding allowing the PPO industry back into the state, medical costs are going to remain high. 

Sometimes the bill review industry, carriers, and TPAs understimate the benefit of PPOs.  However, look no further than LA to see that significant savings can be achieved from valid PPOs.

For more information on the study see the following article on the recent study from Risk And Insurance:  http://www.riskandinsurance.com/story.jsp?storyId=256570095 

The public option has been written about in this forum, and it remains a poor choice to decrease healthcare costs, and is a budget buster for sure.  Intrastate Insurance plans that could be purchased by anyone anywhere are a great tool to reduce costs.  Yet, the plan that seems to be shaping up is the idea of nonprofit privately or publicly ran cooperatives to compete with the big insurance companies.

However, there is one MAJOR problem with this idea which is championed by the “gang of 6”, or at least so it seems as of today.  The problem is that many states already have nonprofit insurance companies, e.g., Blue Cross Blue Shield in many states.  So, what good would the creation of another non-profit do?  I don’t know, open up competition between all the current insurance companies and let new ones enter the market place.  That is the way to create competition.

Obama is a master speaker.  He really is about as good as it gets.  In contrast, George W Bush’s speaking skills were probably about on my level, which is not that good (ha).  So, give one to Obama for being an excellent sales pitch guy.  The late Billy Mays would have been proud of Obama’s sales skills on TV. 

One more positive, Obama at least mentioned Tort Reform.  I am pleased that it even came up in his speech, a bone thrown to Republicans and Conservatives, but at least it was in the speech. 

Now, I still have issues with his plans that just don’t pass the common sense test.  First, if we add 47 million Americans that are uninsured into the delivery of care system (which would be outside of Emergency Rooms), how will the current healthcare work force handle the influx of patients?  By the very nature of this problem, we will see longer waits, all of us, to get into a doctor.  I feel sure many doctors won’t even accept a government insurance plan, but in time most of them would.  Yet, I see a real common sense problem here.

Second, Obama says it won’t cost anything.  What????? Is he kidding?  Do any of you out there believe him?  Do you believe any government program will have a net zero cost?  There is just no way.  He and Nancy Pelosi are budget busting minded when it comes to healthcare.  What he said last night defies the physics of logic.  All government programs grow and grow and grow. 

Finally, if there is so much waist in Medicare and Medicaid, then do it now.  Why do we need a major overhaul of healthcare to reduce fraud and waste in a government ran program.  Doesn’t  that just mean government can’t control costs now?

Give Obama his due, he is a great salesman and orator, but that is it.  This President has quickly moved into Jimmy Carter range, and at least with Carter I knew he was sincere about his beliefs.  As of now, I don’t see that with Obama yet.

As we get closer to tonight, one thing is clear.  The Senate could not pull together enough votes to give Obama his win in Healthcare as he wants it.  We are watching with a front row seat the decline of a President that spent ALL of his political capital on a social program that American’s don’t want as a majority.

President Obama over reached and incorrectly read the election results from last November.  He never had a mandate, he instead was the anti George Bush candidate.  As a whole, this is still a  just to right of center country. 

As I have learned working with State Governments, it is never over until it is over, but the public option at least is starting to drop off the radar as an option.  I am keeping my fingers and toes crossed. 

http://www.foxnews.com/politics/2009/09/09/poll-public-disapproval-obamacare-jumps-percent/

The latest from Fox News this morning http://www.foxnews.com/politics/2009/09/09/obama-seeks-game-changer-health-speech/ has The President still expecting to push for the full “Government Option”.  I don’t believe public support is there for this, but we shall see.  One thing for sure, this President is staking his entire Presidency on Healthcare reform, and the way he wants it.   In my mind, for the Country to succeed, the President is going to have to fail at how he wants Healthcare reform.

Below is the latest from SIIA.

SIIA Legislative Update – Healthcare ReformSeptember 8, 2009  Information Disclaimer Note: Congressional developments regarding health care reform are fluid and SIIA lobbyists are continually meeting with Members of Congress, key staff members and other industry stakeholders, which generate ongoing intelligence.  In order to keep our members informed in “real time”, we will report relevant information as we become aware of it.  Given that the political process is inherently unpredictable, information communicated in previous reports may be superseded in subsequent reports.  Should you have any questions in between reports, please contact SIIA’s Washington, DC office directly at 202/463-8161.  Senate Finance Committee’s “Bipartisan Working Group” Develops Reform FrameworkFor months, a bipartisan group of Senate Finance Committee Members headed by Senator Baucus and Senator Grassley, Chairman and Ranking Member respectfully, have been working to reach an agreement on reform provisions that would satisfy both Democrats and Republicans.  Specifically, their efforts have been to produce a package that is relatively less expensive, limits government-regulation and preserves the employer-based and private marketplaces.   Official Committee movement was delayed as negotiations continued and the Congressional August Recess was spent with provisions being developed behind closed doors.   Senate Leadership has imposed a deadline of September 15 for the group to reach an agreement.   Early this morning, SIIA’s Government Relations Staff received an advance copy of the framework the Committee’s negotiators are working off of.  SIIA’s staff also learned that a formal agreement could be reached in the next few days.   Details of the framework are as follows:  No Government-Run Option – Instead, the establishment of cooperatives is proposed.  The “co-ops” would serve as non-profit, member-owned insurance companies and be allowed to operate in one or more States.  State-based “Health Insurance Exchanges” are also proposed, with tiered benefit levels and with separate Exchanges for individuals and small groups.   No Employer Mandate – Instead, employers that do not offer coverage with more than 50 full-time employees, would be required to pay would be required to pay a fee for every employee who receives a tax-credit for use in an Exchange.  Any employee that is offered coverage through their employer is ineligible for the tax credit for health insurance through the Exchange (unless coverage offered by their employer is more than 13% of an employee’s income).  Medicaid eligible employees may leave an employer’s plan, whereas the employer would not be required to pay a fee.   Individual Coverage Mandate – All citizens would be required to obtain health insurance (either purchased, provided by an employer/spouse’s employer, or through public program).  The penalty for non-compliance would be $750-idv/$1500-fml for taxpayers under 300% of FPL, $950-idv/$3800-fml for taxpayers above 300% FPL.   Insurance Market Reforms – Health insurance plans in the individual market would be required to offer coverage on a guaranteed basis and would be excluded from denying coverage based on pre-existing conditions.  Plans would be prohibited from imposing lifetime limits and premium variance would be limited to certain criteria, with no variance being more than 7.5:1. Small Business Tax Credits – A sliding scale tax credit has been proposed for business with less than 25 employees and with less than an average wage of $40,000.   Excise Tax on High-Cost Coverage – An excise tax of 35% has been proposed on insurance companies and administrators (including self-insured plans) for any coverage above $8,000 for individuals and $21,000 for family plans.  The tax would apply to premiums above the threshold.  Employers would be required to disclose the value of coverage.    SIIA Urges the Self-Insurance Industry to Make our Message HeardSIIA urges all those in the self-insurance industry interested in preserving the way we do business and the benefits we provide to 75 million Americans covered by self-insured plans, to use the resources provided in SIIA’s Grassroots Toolkit and contact their Members of Congress to voice our message.  The threat to the self-insurance industry and the employer-based system under which we operate in has never been more significant.  Now is the time to voice our powerful and unified voice to politicians in Washington that we will not stand for any proposals that would cause significant damage to our industry and to those lives we cover.  SIIA’s Grassroots Toolkit can be found at www.siia.org/grassroots.  If you have any questions, or would like any further information, please contact SIIA’s Government Relations office. 

It’s a noble idea, as most of the healthcare reform ones are, until you examine the details under the hood.  Yet, this one is pretty easy to debunk.  The states can’t afford more people on the roles of Medicaid.  Senator Baucus’ idea is simply one of transferring the financing of healthcare reform to the states and away from the Federal Government.  I don’t know what it will take for all of government officials to understand that the taxpayers just don’t have more money to throw at the giveaway programs.

http://www.politico.com/news/stories/0909/26742.html