Remaining Audience Questions from Physician-Economist Seminar:
2) For Professor Dow: I run a family practice medical group here in Oakland. I would like to differ with you about rate setting. The vast majority of my practice’s reimbursement is set by contracted arrangements with insurance companies. If I want patients, I must accept these rates. It seems that rate setting is also an essential element in the current system. Currently, rates are often unfavorable to primary care and favorable to specialists. Since primary care holds down costs, government should participate in reviewing rate setting for the benefit and cost savings of the whole country.
3) How many more people will be without insurance if nothing is done about health coverage? How do we counteract the greed of the insurance companies?
4) For Professor Jacobs: What leverage is available to us in the effort to get the best possible legislative action out of congress NOW?
5) For Professor Dow: Which private insurers are “non-profit”, and how are they doing in decreasing cost compared to for-profit insurers?
6) For Professor Dow: Is something like your limited program for uninsured persons of less than 200% poverty level on the table now in congress?
7) Dr. Kahn: What, if anything, in the present health care reform can move us toward a single payer system? And what can we do to further that?8) Doesn’t the proposal of Mr. Dow essentially do the cherry-picking for the private insurers? Wouldn’t this put the low-income people into the public option, thereby relieving private insurers from covering them? And aren’t the low-income people more lemon flavored than cherry flavored?
9) How would taxing the insurance companies who offer so-called “Cadillac” plans to union members affect the union members’ plan? Would we pay more than we are now? Would our benefits be cut?
10) Health care reform has been focused on financing. Yet how will any of these proposals address a system of medicine focused on disease management (dispensing pharmaceuticals) and not health promotion?
11) For William Dow: If one can’t cover a risk, it’s necessary to buy insurance. Some entities are large enough to self-insure. In the case of health care insurance, companies mark up cost of health care by 130% to 150%. The U.S. government is large enough to self-insure and provides Medicare at 103% of the actual cost of health care. Most people can’t wait to get on Medicare and 70% want single payer or a strong public option. Why not open Medicare to all? Bring down the cost of Medicare with healthier people and eliminate the high cost of private insurance and their nasty practices.
12) How about expanding nationally the Massachusetts Plan?
13) Does the Healthy San Francisco program serve illegal (undocumented) individuals?
14) For William Dow: Dr. Dean contends that countries with universal coverage either have a public option OR the health care/insurance industry is treated like a “utility.” Is this true? (Germany as an example of utility.)
15) If profits of insurance companies have been rising, why are profits not a focus of cost containment?
16) For Professor Dow: Re countries that contain costs with no public option - how do they contain costs?
17) In California, PERS negotiates prices – why can’t a public option do so at a national level?
18) Is it possible that for-profit insurance companies would have to lower cost of premiums if there is a public option?
19) How much does the government pay to the insurance companies or the health provider for each Medicare recipient?
20) For Ken Jacobs: Why not wrap in ALL health care into the new system, such as: workers comp (medical portion); property insurance (medical portion); car insurance (medical portion); travel insurance (medical portion). In other words, remove the costs of all the underwriting, administrative and legal costs of these items and move it into the support of a new universal option.
21) I understand that we currently spend about 60% of total health care spending on the last 18 months of life. What ideas are under consideration for reducing that percentage?
22) Obesity and lifestyle factors cause a fraction of the population to consume more than its share of health care. How can we motivate people to make better lifestyle choices?
23) For Ken Jacobs: Can employer responsibility encourage companies to compete by offshoring more work to countries that don’t require health care contribution and have lower wages?
24) To Professor Dow: the compromise you suggested based on Health San Francisco sounds appealing. Does it have an advocate in the current debate in Washington?
25) How does having health insurance guarantee good health care? Insurance companies make administrative and profit-based decisions to their “covered” customers, which lead to poor health care decisions, more serious health consequences.
26) For Ken Jacobs: Will the threat of a trigger for public option control costs of private insurance coverage?
27) Why should we expect that employers should design and choose health care options for the American people – employers have zero expertise in this arena.
28) Obama claimed that his plan would not increase cost to government because savings would cover the costs. Can someone explain how possible this is?
29) For Dr. Kahn: A Norwegian-born citizen now living in the US says that Norway’s health care system is great if you are under 55. If you are over 55, many treatments, including for heart disease, are not options. Does anyone know if Norway and or other countries with socialized medicine have age restrictions on care? Would a US system have to revert to such policy to control costs?
30) What is the value of a Baucus proposal to allow premiums based on age to be five times more?
31) Why is public care NOT Cadillac care if you define Cadillac care as having access to the best docs? Look at UCSF!
32) What is the fuction of delay and denial used against patients with insurance coverage? Will we require in the end unaffordable (22% of income) underinsurance?
33) For Professor Dow: Health insurance companies say they make cost more affordable because they insure healthy and non-healthy people. Insuring mostly healthy people drives up profit presumably. Does the public option for only low income people run additional risks because low income populations may also carry many high risk individuals? Is this population less healthy than other groups?
34) What are your thoughts on rate regulation of premiums (similar to ultility rate regulation) in lieu of a public option.
35) The most lucrative area for cost control in our health care system is found in the 20%+ insurance premiums which go to non-health care administrative costs. What do you think is the most salable to the insurance companies? a) telling them there is a new competitor on the block called the public option, or b) mandating that they change their business model to “non-profit” – like the Bismarck model used in France, Germany, Switzerland, etc.?
36) I would argue that the current Medicaid program would make a poor public option because few providers actually accept Medicaid, especially the specialists. We could end up with fewer uninsured, but more underinsured. We need a strong public option in terms of quality as well. Would you agree?
37) The current health care system is unsustainable. We pay more and get less. What can we do to encourage other leaders to vote for health care reform?
38) For Professor Dow: It seems to me that your scenario of allowing low-income people to buy into medicare (up to 150 or 200% of federal poverty level) rather “stigmatizes” the public option. Perhaps a way to introduce it by “stealth”, but not in tune with the ultimate foal of incorporating all into an equitable system. Doesn’t this approach merely widen gaps?
39) Question for Dr. Kahn: What happens to your $400 billion total or $1,000 per person per year totals when you factor in the time the individual spends on the phone/paperwork with the insurers, doctors, hospitals, etc?
40) Senator Feinstein is concerned that expanding Medicaid to cover the uninsured would bankrupt states which share in that cost. Is that a valid concern?
41) States pay a big share of Medicaid – states are broke. So how is it realistic to let a lot of poor people with deferred health maintenance into Medicaid?
42) True or false: Insurance coverage does not equal health care (insurers delay and deny.)
44) True or false: 10% is an internationally accepted amount of income to spend on medical care (about what I spend as a complicated Medicare patient.) But the House plan assumes 23% of income for a plan that may not even cover them well.
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