Health Care Reform & Essential Benefits
Posted by Valley Insurance Associates, Inc. on Wed, Nov 16, 2011 @ 11:40 AM
Part II
Maybe we should copy Singapore instead of Massachusetts.
Singapore spends less than 4% of its GDP on health care…U.S. spends 17%…according to Economists, matching this performance in the U.S. would free up a $2 trillion annually for other purposes…
In Singapore roughly 1/3 of health spending is paid directly by individuals (who usually carry “catastrophic coverage,” as well). These payments are made through earnings, as well as mandatory health savings (and retirement) accounts. Employees are required to contribute 20% of earnings to these accounts, to which their employer must add an additional 13% annually.
In the U.S. about 90% of spending is via an insurer, an employer or a government entity (State or Federal).
In Singapore public (government managed) hospitals provide 80% of acute care, which serve to set affordable care levels with which private providers must compete. In the U.S. the tables are completely turned and the private care providers set the marketplace…
Rules require training of new Family practitioners over the more pricey specialists…
Health care outcomes are purported to be superior to that of the U.S.
In the U.S. the law of health care politics is: “Every dollar of health care waste is someone’s dollar of income.”
“As a stable advanced democracy, we’re so overrun by groups with stakes in today’s waste that real efficiency gains are perennially blocked.” Matt Miller - The Washington Post.
At what level of government should mandates be determined?
Currently Lawsuits alleging that the Federal Government is violating the Constitution by creating mandates and forcing them upon States without providing funding for those mandates are pending in various arenas.
The most prominent suit was filed in Florida with these States participating: FL, IA, KS, ME, OH, ID, WI…
Curiously, Wisconsin has as many or more State mandates as any other State in the Union. Many would think this to be nothing more than a grasp for Federal money…or a partisan political move…as opposed to a struggle for autonomy of governance…
In the end, the pressure in the U.S. to include any one particular benefit as “essential” will come from special interest groups and not from the at large consumer. The consumer will be left to attempt to discriminate between what is essential and non-essential, based on their personal viewpoint and needs.
The challenging question is not to simply provide a list of covered services and exclusions, but to clearly lay out the process by which what is left in and what is left out is determined.
Should all benefits be standardized?
Should states or other “purchasing entities” be allowed to add benefits above the federal mandates?
In conclusion the public will need to be educated to the fact that even if a treatment is essential for some it may certainly not be essential for all. If we do in fact end up with a connector system similar in scope to Massachusetts’ a detailed description of the manner in which a reatment decision will be made (type of procedure, where it is done and for what indications) and a specific list of exclusions should be mandatory, but currently is not. Without this information it will continue to be business as usual…including annual double digit increases…
This is the second segment in a two-part blog series on Health Care Reform; click here to view part one.
David Brand writes bi-weekly in his Benefits Blogged column. He can be contacted via email at dbrand@viainsurance.com.