Last night by a vote of 219-212 the U.S. House of Representatives passed HR3590, which was previously passed by the Senate on Christmas Eve.  They passed the bill without amendment so it now goes to President Obama’s desk.  He is expected to sign the bill on Tuesday.

The bill contains in individual mandate to purchase health insurance, but it also includes an exemption from the penalty for members of health care sharing ministries.  We are thankful for this island of freedom that remains in the legislation for pro-life Christians, and encourage people of faith to seek out information on these ministries and consider joining.

The individual and employer mandates do not take effect until 2014.

The most controversial piece of the Kennedy/Dodd bill, now being marked up by the Senate HELP committee is the “public option” that many congress members are insisting be a part of health care reform.   SEIU recently linked to a [warning pdf link follows] survey done by the Wall St. Journal and NBC on a myriad of issues, with SEIU claiming that “76% of Americans support public health insurance option.”

I went to the survey this morning and had to get to page 21 of the results to get to this alleged 76% support of public insurance.  Here’s the question that was asked:

In any health care proposal, how  important do you  feel  it  is  to give people a choice of both a public plan administered by the federal government and a private plan for their health insurance––extremely important, quite important, not that important, or not at all important?

76% of respondants did answer “extremely important” or “quite important.”  Note the key word in the question though:  the touchy/feely word “choice.”   Giving people a choice is what 76% of those surveyed are in favor of–not the public plan in general.  I believe that if you asked “How important do you feel it is to give people a choice of both an employer provided plan and a private plan that employees own that isn’t tied to their jobs” you’d get at least as high of an answer.

American people want choices.  And nothing in that question even implies that the public option will limit choices, even over time.

Why do I say that the numbers on this question are skewed because of the word choice?  Here’s a question asked just a bit later:

Please tell me which ONE statement you agree with more on the issue of creating a new public health plan administered by the federal government.

(Some/Other) people say it would help lower health care costs because it would compete with private health  plans.   This new public plan would provide coverage  for  the uninsured and all Americans would have an option for quality affordable health care.

(Some/Other)  people  say  that  patients might  not  always  have  access  to  their  choice  of  doctors  and  the government would  lower  costs by limiting medical treatment options  and decisions that should be made instead by patients and doctors.

Note first that this is not necessarily a true dichotomy.  Someone could believe both of these statements are true, and to some degree I’d argue that they both are true.  But when asked to choose, 42% chose the second option, that the public option would limit choices that “should be made instead by patients and doctors.”  So 42% (much more than the 24% who aren’t allegedly clamoring for this plan in the first place) believe that the government is going to supersede doctors in the public option.

The Obama administration says it wants to “keep insurance companies honest.”  And to do that, they’re going to set up a plan which will force, by law, doctors to accept Medicare+10% as a non-negotiable fee structure, while the insurance companies  have to negotiate prices with the doctors that allow providers to make money.  On the other end of the transaction, insurance companies have to charge enough to balance their books, while the government can set premiums that are subsidized by the taxpayers.  So in this schema, “keeping the insurance companies honest” = charging less than they can afford and paying less to doctors, further driving up the cost of private insurance and then allowing it to cascade upon itself.

Under this schema the public option will quckly become the only option.

Health care sharing ministries are a non-insurance option for health care, which means that we’re not the biggest fans of the insurance companies.  But the insurance companies are not being dishonest. They are serving their customers the best they know how in order to keep their customers.

The problem isn’t that they’re dishonest.  The problem is that we’ve set up a system where they’re working for the wrong customer.  If insurance were privately held, rather than an employer benefit, the customers would do all the work necessary to “keep the insurers honest.”  But because the patient is an afterthought in the employer provided model and has ownership over almost no decisions, the system is broken.

But it won’t be fixed by driving the private market out of business.  It needs to be fixed by putting the patient back at the center of the transaction.  And patient centered health options like HSAs and health care sharing ministries are much better ways to do that than a “public option” that quickly becomes the “only option.”  We need more choices, not fewer, and as the survey indicates, a public option will give us fewer choices.

Better for Congress to swallow the hard pill and figure out a way to level the tax policy playing field for all health care expenses, whether provided by employers or not.  Whether insurance or not.  Either eliminate the tax deduction for employer provided insurance, or provide the same tax deduction for all health care expenses, even those paid for with cash out of pocket.

At that point, when the patient is at the center of the health care world, both providers and third party payers will be kept honest by the one who they’re actually working for:  the patient.  And the patient will get the best quality care for the lowest cost.

So Congress–keep the insurers honest!  Don’t pass the public option.  Don’t mandate purchase of products.  Change the tax policy so all health care is treated equally, and let the patients reform the system from the bottom up.

Here’s hoping for patient centered health reform!

A.M.A. Opposes Government-Sponsored Health Plan – NYTimes.com
The opposition, which comes as Mr. Obama prepares to address the powerful doctors’ group on Monday in Chicago, could be a major hurdle for advocates of a public insurance plan. The A.M.A., with about 250,000 members, is America’s largest physician organization.

While committed to the goal of affordable health insurance for all, the association had said in a general statement of principles that health services should be “provided through private markets, as they are currently.” It is now reacting, for the first time, to specific legislative proposals being drafted by Congress.

This should be good news for those joining in opposition against an expansion of government and a further limiting of freedom in the health care industry.  The AMA opposing a government competing “option” will help the opposition to the plan, and be better for patients.

Judd Gregg gives health reform a go – Carrie Budoff Brown – POLITICO.com
“I stepped back one week and said, ‘Let’s hold it. What would I do if I could do what I thought was most effective?’” Gregg said in an interview. “I was just saying to myself, ‘What would I do if I had a magic wand?’ I sat back and thought about the ideal.”Gregg’s proposal is built on a pledge to make sure that every American obtains a minimum standard of insurance; such a standard would aim to provide “peace of mind” by covering a major medical event and preventive health services, the lawmaker said.

This is another proposal from the GOP side of the aisle that includes a mandate of some sort (everyone should have some form of insurance).  There are a lot of ways to handle health care without insurance, health care sharing ministries being one way, and Senator Gregg will hopefully notice us and others along the way.

The whole confusing of insurance coverage with health care access in the sphere of rhetoric doesn’t make this easier, and we’ll keep trying to make our voice known.  Senator Gregg, give us a call and we’ll show you how over 100,000 Americans are paying their own health care bills through a community, non-profit, non-insurance ministry.

More insurance isn’t the answer here–more freedom and more choices will bring the changes we want in price and access.

HT:  Ryan Ellis.  (via Twitter)

There’s been some clarification out on the alternative GOP plan from Coburn, Ryan et. al., and here are two links regarding the updates.

First, at the Galen Institute, is a response by Charlotte Ivancic, counsel to the House Budget Committee and health policy advisor to Rep. Paul Ryan clarifying the thrust of the bill.  Second, a correction of the critique from Michael Cannon at CATO.

It is nice to see friendly dialog going back and forth on this issue–one where we need a truly sound, patient centered alternative to the mandates and such that are currently being discussed at the White House and Congress.   One that explicitly protects the non-insurance based ministry of health care sharing ministries (over 100,000 patients nationwide) to their members is certainly preferred.

…but they’re not written by me.

Cato@Liberty had two good posts this morning by Cannon and Tanner that give a healthy, friendly look at the Coburn/Ryan Patient’s Choice Act.

My two cents:  the battle isn’t over, guys!  Put out some reform ideas that don’t include mandates and price controls.  Find a way to encourage private charity again and to move the government out of the picture–not further in.  Those ideas are out there!

Shortage of Doctors an Obstacle to Obama Goals – NYTimes.com
The officials said they were particularly concerned about shortages of primary care providers who are the main source of health care for most Americans.One proposal — to increase Medicare payments to general practitioners, at the expense of high-paid specialists — has touched off a lobbying fight.

Family doctors and internists are pressing Congress for an increase in their Medicare payments. But medical specialists are lobbying against any change that would cut their reimbursements. Congress, the specialists say, should find additional money to pay for primary care and should not redistribute dollars among doctors — a difficult argument at a time of huge budget deficits.

This article notices implicitly that it is the Medicare reimbursement for primary care doctors that is causing the shortage.  The government cannot control the supply of health care services–in particular the skilled labor of physicians.  Citizens have to want to enter into the long educational track to be a doctor, and the reward (above average salaries) at the end is part of the reason so many in the past chose to be doctors.

But the hours, the pay, and the Medicare dollars are better for specialists, so given the choice most students have opted against primary care.  And passing a health care reform that banks on people getting access to doctors (some of whom will retire if forced into a government run system) when there are no doctors is problematic.

There are market based solutions to this problem.  Patient centered health solutions like HSAs and Health Care Sharing Ministries put the doctor and patient at the price point, rather than a third party payer or government agency.  Retainer based medicine (aka concierge care) allows patients to contract with doctors for primary care, ensuring good preventative care while preserving the doctor/patient relationship.

The government is the problem in health care–and the solution we’re being sold is more of the problem.  We need more market based initiatives if we want to see quality go up, supply go up, and prices go down.  And simply raising the Medicare reimbursement rate for PCPs will be too slow and certainly a non-market solution that will lead to some other shortage.

This is where indirect rationing comes into play–which is the the more likely source of rationing from the governmentin the near future.  Direct rationing is where the government tells you you can’t have something.  Indirect rationing is where the government fixes the prices so low that supply falls away.  The latter, I believe, is more dangerous because it works slowly and is almost always unanticipated just as this PCP shortage is.

Solution?  As always it’s to get the government out of health care.

HT:  John Goodman

The accusation is that the uninsured (which includes HCSM members, btw, that pay near list price for medical services) cost-shift to the insured and that this cost-shifting drives up the cost of health insurance.

It certainly may–though I’m not convinced that there is cost shifting as a group (considering both the uninsured deadbeats and the uninsured paying list price for services altogether) –but if it does, this study from AHIP (note this is a PDF) shows that it pales in comparison to the cost shifting due to Medicare and Medicaid by a factor of 5.  Medicare/Medicaid actually increase the price for other patients by 18%.

When was the last time you heard about cost-shifting due to government programs listed as one of the problems we need to solve with the coming health care “reforms?”

Just one of the good data quotes:

When broken down, we estimate the cost shift adds $1,512 annually, or 10.6%, to the premium of a family of four.  Of this cost shift amount, we estimate employers pay $1,115 and subscribers $397 annually.  The cost shift also increases member cost sharing by approximately $276 annually.

Yet again, this shows why private charity is better, and that the uninsured are not the problem.   We need to keep an eye on the reforms that are coming out of congress, because a government sponsored insurance plan (one of the more popular ideas right now) will only exacerbate this problem and further drive up costs for employers and private market payers, like cash patients including HCSM members.

HT:  Greg Scandlen via NCPA blog

Would the Health Reform Prescriptions Offered by President Obama and Congressional Leaders Help Patients?
STATEMENT ON HEALTH REFORM

From the Health Policy Consensus Group1

President Obama repeatedly has reassured the American people, “If you’ve got health care already, and probably the majority of you do, then you can keep your plan if you are satisfied with it. You can keep your choice of doctor.”2 Research shows 82 percent of Americans rate the health care they receive as good to excellent.3

At the same time, there are serious problems of cost, value, and access throughout our health sector. It is vital to address these problems. But any health reform proposal to change what needs fixing also must preserve the freedom, innovation, and quality of American medical care that people value. We believe a better functioning, more competitive, and transparent marketplace would cover more people and deliver the higher-value care we seek.

We are gravely concerned that several of the proposals offered by the President and the Congressional leadership would make matters worse, not better. These flawed prescriptions for radical change should not be accepted as part of any serious and sustainable health reform proposal:

* A new government health insurance plan

* An employer “play-or-pay” mandate

* A uniform, government-defined package of benefits.

* A mandate that individuals must purchase insurance.

* A National Health Insurance Exchange extending federal regulatory powers over private insurance.

* Federal interference in the practice of medicine through a federal health board, comparative effectiveness review, and other government intrusions into medical decision-making.

We explain below why we believe these ideas would diminish individual Americans’ freedom and control over their personal health decisions.

This is a good bunch, one with whom we’re honored to stand.  If you haven’t already done so, sign the Do No Harm petition.

GOP stumbling in health care fight – Carrie Budoff Brown – POLITICO.comThere’s no Republican plan yet. No Republicans leading the charge who have coalesced the party behind them. Their message is still vague and unformed. Their natural allies among insurers, drug makers and doctors remain at the negotiating table with the Democrats.

The Alliance of Health Care Sharing Ministries is a non-partisan organization.  The quote above demonstrates that there are partisan divides over how best to “solve” the health care “crisis.”

Whenever the federal government addresses itself to a problem it is important for us, the citizens, to look closely at the situation and determine exactly what caused the problem.  All too often the “solutions” that we see coming from the federal corridor are patches that are addressing problems that previous “solutions” caused.

The democrats have clear plans that they’re offering right now–and they’re well defined and able to be spoken of in small soundbites and marketed that way.  You can see more about those plans, and the harm they’re doing at the Do No Harm Petition.   All that’s left is for them to decide which of these ingredients will be in the final plan and introduce the bill.

The Republicans, as the article amply points out, have no set solution.  Part of the reason for this is that it’s hard to market a solution that is merely an undoing of previous “solutions.”

Here is part of what needs to be done:

If the health care debate is going to be solved and completed, we need to move past the myth that coverage=health care. Insurance coverage is not health care. Health care is the services that doctors provide. Health care is people working to improve the health of others. And this works best in the context of personal liberty.

A five point plan to reduce the cost of health care quickly:

• Reduce the scope of the FDA. Allow Americans who want to (with appropriate disclaimers provided) try experimental treatments/medicines. The FDA is not a catch all, and we need to move past the era where no one gets well without government permission. Doctors should be held accountable, but shouldn’t be tied to whatever research the government has approved–the government will always be slower than the private market, and health care needs to be de-politicized.
• Eliminate the favored treatment in the tax code of employer provided insurance. This can be done most simply by taxing the benefit, but many way of equalizing the treatment of health care costs in the tax code. That if you buy insurance by yourself you deduct only from Fed W/H, and only above 7.5% of AGI, and that if you get it through your employer it’s tax free, even with respect to FICA provides horribly perverse incentives in health care spending.
• Deregulate the insurance market as much as possible. 10-30% of health insurance costs come from state and federal mandates
• Give incentives to doctors and hospitals to provide non-governmental charitable care. Not through direct funding (like Medicare/Medicaid) but through using private charity. The Arizona system of non-refundable tax credits for charitable donations to organizations that replace the work of government is a great way to do this. We need to wean our providers of Medicare before it goes broke.
• Open the way for consumer directed health care, both religious and not (like Health Care Sharing Ministries) that re-engages the consumer in the health care decision, moves the third party to the side, and protects the doctor/patient relationship while restoring objective cost measures to the industry.

These 5 points are certainly not a perfect catch-all, but they are likely the fastest way to lower costs while increasing liberty and access. The only other way to lower costs is to ration, and a national health care plan or national insurance mandate will do just that, and the former at an increased cost. The tax treatment of employer provided insurance is a particularly difficult pill to swallow, but when your appendix ruptures it is no time to look for the painless solution.