Image Courtesy aflcio2008 on flickr

Senator Jim Cooper (D) of Tennessee has been one of the most prominent politicians traversing the country on the idea of healthcare reform. In his early presentations on the subject, the approach was a hard line push to get universal coverage (covering the uninsured) with NO FOCUS ON CUTTING wasted expense that could have paid for the program. Cooper is clearly the most articulate and knowledgeable politician I have run across with an in-depth perspective of healthcare AND business. I am convinced that he has a hand in the movement of the healthcare reform to something that will be more beneficial to Americans that earlier plans.

The modifications that have been made in the past few weeks are significant. Socialized healthcare (a wholly government run program) is giving way to government incentives for consumerism coupled with universal healthcare (getting the uninsured covered), and more ethical treatment of members by health plans (no pre-existing conditions and protection from being kicked off of a plan for large claims).

It is encouraging to see that questioning of Senator Cooper and other prominent members of congress have started to take root in D.C., either as a result of that meeting or others. I hope the plan is not finished evolving. Private business needs to get behind the idea of making healthcare more efficient and some are fighting for the opportunity to do that through organizations like SIIA.

For far too long, companies have been passive about healthcare as an outsourced expense and did not get involved preferring to push the burden of understanding this to the insurance companies. The insurance companies obliged and took the power that came with that responsibility.

The government is pushing employers to get involved. Getting employers MORE involved and not less involved is what we help us drive the cost down while improving quality. If employers continue to wholly outsource their healthcare without actively addressing it, look for us to wind up back at the sort of option that Senator Cooper had originally presented.

Lots of interesting bits and pieces in the Presidential Speech last night. Lots of things people wanted to hear like no more pre-existing conditions and no getting dropped from insurance plans if you have a serious medical condition.

I LIKE these statements.

But what do they mean?

Follow the logic…

No more pre-existing conditions and no getting dropped = more costs covered by your private insurance = higher premiums = more employer cost control by raising deductibles to keep their part of the premium down = more costs passed to the consumer.

It’s the way to legislate into a more consumer-directed solution.It’s an assbackward way of doing it, but it should work. Whether all of the parts of government healthcare reform work according to plan or not remains to be seen, but this is one piece that no doubt will DRIVE UP THE COST TO THE CONSUMER and force the issue of consumerism in the private healthcare market.

In a recent survey conducted by Hewitt Associates, about 20% of employers said they are planning to stop offering health benefits over the next three to five years.

Sad… as if we need another player in the health care game to quit! See Workforce Management for more details on the study.

Equally as interesting as those planning on leaving the game are the priorities of the employers who plan to continue to offer benefits. “Promoting employee accountability” was ranked as the number one component of employers 2009 health care strategies. “Offering competitive benefits” and “managing health risk” came in at second and third.

What I have to say is directed at those who plan on dropping benefits and those who plan on keeping benefits and promoting employee accountability:

LET change:healthcare HELP!!! Our site and online tools help employees save money (which saves the employer money) and make smarter healthcare decisions.

The problem is apparent… we are asking employees to be responsible for their health and healthcare when they still do not know what health care really costs, they do not have enough skin in the game ($20 co-pays are not going to increase responsibility) to care, and those who are on CDHPs are lacking the tools to understand how to save money and make better decisions.

The message to employees is simple … we want you to get engaged.  There are tools out there (if we are working with your employer) that will show you simple and tangible ways to save money on your healthcare… tools that will show you what your peers paid (the network price) for services and prescriptions you need, allowing you to proactively research costs and quality, allowing you to become an active participant in your healthcare.

The action for employers… call change:healthcare.  We want to help you preserve your benefits and engage (keep) your employees. We want to help you save 30% on your healthcare.

Healthcare does not have to be daunting and saving money does not have to be hard.  Let us show you how we make both of these things simple!

Dr. Stanley Feld, “Top Health Blogger” by Wellsphere, claims that the healthcare reform agenda has already been set by Obama and Daschle.  You can read his post here.  He has some good points regarding reform and the need to involve physicians in the process.  However, his post struck a chord with me when he wrote about everyone believing that doctors are at fault, and that the government is out to change the way that doctors practice medicine.

I feel that most people agree that the quality of care in our system needs to improve.  Some might agree that reimbursement patterns must shift to reward high quality healthcare and wellness.  Few might agree that doctors are going to have to change the way they practice medicine, whether its integrating information technology and electronic medical records, or estabilishing stronger doctor patient relationships.  I would like to hear your opinions…

In the meantime, I wrote a response to Dr. Felds opinion piece.  It is available below:

“Dr. Feld,

I respect your opinion on the involvement of patients AND physicians in healthcare reform and policy. But without reading the by-line, about half way through your piece, I could tell you were an MD incapable of writing an unbiased piece on healthcare reform.

Problem: Unfortunately, not all doctors are out to service the best interests of their patients and some are most concerned with the thickness of their wallets. When I go to the doctor, why can’t he tell me about how much the services will cost?

Problem: We pay doctors only when patients are sick. You don’t make money if you keep me healthy, now do you?

Problem: The average patient does not understand medicine or the CONFUSING healthcare system.

The worst part of it all – is that I would argue that most MDs do not understand the system either. While I agree with you that “Socializing” healthcare is not the appropriate answer to our problem, I whole-heartedly disagree that the government is trying to “FORCE DOCTORS TO CHANGE THE WAY THEY PRACTICE MEDICINE.”

Let’s not equate “changing the way doctors practice medicine” with “changing incentives and reimbursement.” This is about keeping more people healthy and increasing the quality of care delivered. This is about rewarding physicians for delivering high quality care and keeping their patients healthy. This is about asking doctors to do their job efficiently and accurately. If to do this doctors have to change the way they “practice medicine,” then I might argue that they entered medicine for the wrong reason to begin with.
Transparency. Accountability. Competition. – Its time to make some changes in healthcare!”

Once again I had the privilege this morning to hear Sen. Bill Frist speak, this time at a breakfast held at Lipscomb University.  Though last time the topic was highly focus, today the slate was clear and anything to do with health care was on the table.  Although our time was limited, Frist managed to cover a lot of important topics and share his vast amount of experience and knowledge with us in the crowd.

The conversation began with a reminder that the US, compared to other countries, ranks poorly when it come to life expectancy and infant mortality, despite spending twice as much as other comparable countries.  Why is that?  Well consider what makes up health and life expectancy: 40% Life style and Behavior, 30% Genetics, 15% Socioeconomic status, 10% Health Services and Technology, 5% Environment.  Unless you have been living under a rock, its no shock…  we live in a country where our life style choices are not the greatest, a large portion of our country is obese and many people do not regularly exercise.  Add poor lifestyle choices to our lack of desire to change our behaviors, its no wonder we rank so low.

Anyways, from there we managed to discuss cost shifting, Medicare and the pending 10.6% reimbursement cut,  and the uninsured among other things.

My most important take away was his belief in consumerism and the public sectors ability to affect change.  In most all markets, with very few exceptions, competition and consumerism drive down or at the very least maintain costs.

Transparency… the new industry buzz word… connects right into this and refers to the idea that information regarding cost, quality, outcomes, and experience should be readily available to all consumers of healthcare (cost and quality being the top two, considering they are what we are having the hardest time controlling).

By making the industry more transparent, especially how much a physician is really being reimbursed for their services and how much a procedure will cost them before having it done, consumers have a better idea of the true cost and quality of the care they receive.

Wonder what the result is?? Well it’s believed that transparency in the industry will make consumers more inclined to take responsibility and accountability for their own health and health care. Now here’s the reality,  not everyone is going to care about how much their health care cost – Just like not everyone is going to care about “global warming”.

However the industry just really needs to see an emergence of “the prudent shopper”… the group of people that begin talk, begin taking note, and begin to care about their health care and its cost.

If you think you might be the next “prudent shopper” of health care, visit www.changehealthcare.com and see what you think… tell us what you think! We are moving into the world of transparency and engaging consumers… be part of that change.  That’s my advice.

Transparency, accountability, and competition… I must say – I am always happy to keep my feet moving, rather than be left behind.