Comments on: :: The Real Obstacles To Health Care Reform: A Checklist http://www.healthplanlaw.com/?p=353 ERISA Group Health Plan Administration Thu, 12 Aug 2010 17:18:07 -0600 http://wordpress.org/?v=2.8.6 hourly 1 By: Scott MacEwen http://www.healthplanlaw.com/?p=353&cpage=1#comment-18765 Scott MacEwen Thu, 31 May 2007 18:50:45 +0000 http://healthplanlaw.com/?p=353#comment-18765 Roy, I got to this article a bit late but wanted to respond. I could go into detail of the abuses of the system from carriers/administrators to brokers/consultants to providers... but we always seem to leave out the individuals and their compliance and lifestyle when we talk about "fixing" healthcare. The obstacle to healthcare reform is us! Lifestyle issues drive 70% of the claims that are incurred in our system. These are things that can and should be changed over time and financing should be aligned with appropriate behaviors. If 15% of people are driving 85% of the cost, then why do we make it difficult for the healthy population by raising their rates and changing their plan designs to shift more cost? Basically there is blame to go around...I perform oversight for employers on their TPA's and carriers...and I can tell you they miss a lot when it comes to identifying those at risk...and they do not apply the clinical resources that are needed in order to truly change beavior..and cost. We have met the enemey...and he is us! Scott Roy,
I got to this article a bit late but wanted to respond. I could go into detail of the abuses of the system from carriers/administrators to brokers/consultants to providers… but we always seem to leave out the individuals and their compliance and lifestyle when we talk about “fixing” healthcare. The obstacle to healthcare reform is us! Lifestyle issues drive 70% of the claims that are incurred in our system. These are things that can and should be changed over time and financing should be aligned with appropriate behaviors. If 15% of people are driving 85% of the cost, then why do we make it difficult for the healthy population by raising their rates and changing their plan designs to shift more cost?
Basically there is blame to go around…I perform oversight for employers on their TPA’s and carriers…and I can tell you they miss a lot when it comes to identifying those at risk…and they do not apply the clinical resources that are needed in order to truly change beavior..and cost. We have met the enemey…and he is us!
Scott

]]> By: Roy F. Harmon III http://www.healthplanlaw.com/?p=353&cpage=1#comment-18142 Roy F. Harmon III Wed, 16 May 2007 03:31:37 +0000 http://healthplanlaw.com/?p=353#comment-18142 Louise, Yes, I think you have a point - but I haven't finished the list yet. I would like to develop the idea of redundancy of services further in more space than this comment permits. It is one of the more important and persistent issues in health care policy, don't you think? And, as you suggest, a focus on premiums, like a focus on public financing, reduces the distribution of health care services to a simple question of how much we are willing to spend. That is ridiculous. Thanks, Louise, Roy Louise,

Yes, I think you have a point – but I haven’t finished the list yet. I would like to develop the idea of redundancy of services further in more space than this comment permits. It is one of the more important and persistent issues in health care policy, don’t you think?

And, as you suggest, a focus on premiums, like a focus on public financing, reduces the distribution of health care services to a simple question of how much we are willing to spend. That is ridiculous.

Thanks, Louise,

Roy

]]> By: Louise F, Pongracz http://www.healthplanlaw.com/?p=353&cpage=1#comment-18108 Louise F, Pongracz Mon, 14 May 2007 21:23:57 +0000 http://healthplanlaw.com/?p=353#comment-18108 Roy: I am a huge fan of your daily column but I think that lack of accountability for public funds misses the issue a little. The real issue is why we are willing to allow public health care money to be flushed away through lack of accountability (although I question whether on a percentage basis the error/fraud rate is really that much greater than for private insurers) and to allow private health care dollars to be spent by insurance companies with 15% and 18% administrative fees, with cumbersome and costly claims paying and administrative systems, grand new buildings, public sponsorship for PR -- I'm delighted to know that insurers are good corporate citizens, but do we need them to spend our healthcare dollars naming sporting areas and public plazas after themselves? Finally, I think we all focus far too much on the cost of health insurance PREMIUMS and far too little on the costs of providing care (e.g. do we need eight sophisticated heart facilities within 15 miles as we have here in Philadelphia?). I look forward to reading more of your thoughts on this -- and other -- topics. In our benefits department, your daily article is a "favorite" on nearly everyone's home page. LFP Roy: I am a huge fan of your daily column but I think that lack of accountability for public funds misses the issue a little. The real issue is why we are willing to allow public health care money to be flushed away through lack of accountability (although I question whether on a percentage basis the error/fraud rate is really that much greater than for private insurers) and to allow private health care dollars to be spent by insurance companies with 15% and 18% administrative fees, with cumbersome and costly claims paying and administrative systems, grand new buildings, public sponsorship for PR — I’m delighted to know that insurers are good corporate citizens, but do we need them to spend our healthcare dollars naming sporting areas and public plazas after themselves? Finally, I think we all focus far too much on the cost of health insurance PREMIUMS and far too little on the costs of providing care (e.g. do we need eight sophisticated heart facilities within 15 miles as we have here in Philadelphia?). I look forward to reading more of your thoughts on this — and other — topics. In our benefits department, your daily article is a “favorite” on nearly everyone’s home page. LFP

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