Health care reform legislation at the federal level includes an individual mandate that would require all U.S. citizens to buy health insurance or face fines.

The Freedom of Choice in Health Care Act, which would release residents of a state from such a mandate, has already been filed or prefiled in 30 states. A question on whether to guarantee freedom of choice will be on Arizona’s ballot this fall, and lawmakers in five more states have announced their intentions to file the legislation. A citizen-led initiative has also been announced in Colorado.

It’s encouraging to see state legislatures pushing back against a one-size-fits-all approach to health reform. When a patient is freed up to choose providers, to choose the design of his own health care methods, at that point there is better health care and better cost.

We applaud the legislators standing up for freedom rather than a centrally controlled choice.

The states in which the Freedom of Choice in Health Care Act, promoted by the American Legislative Exchange Commission, has been introduced to release residents from an individual mandate are Alabama, Alaska, Arizona, Arkansas, Florida, Georgia, Idaho, Indiana, Iowa, Kentucky, Louisiana, Maryland, Michigan, Minnesota, Mississippi, Missouri, Nebraska, New Hampshire, New Mexico, North Dakota, Ohio, Oklahoma, Pennsylvania, South Carolina, South Dakota, Tennessee, Virginia, Washington, West Virginia, and Wyoming.

States in which legislators are considering introducing the act are Kansas, Montana, North Carolina, Rhode Island, and Utah.

Insurers ranked on payment records – The Boston Globe
Physicians in Massachusetts got paid in an average of 22.8 days by Blue Cross-Blue Shield, 32.8 days by Tufts, 39.7 days by Harvard Pilgrim Health Care, 42 days by Fallon Community Health Plan, and 56 days by MassHealth, according to the Athenahealth ranking of days claims spent in accounts receivable.

On its ranking of “denial rates,” the percentage of claims rejected or sent back for rework, Tufts denied 4.9 percent, Harvard Pilgrim 5.4 percent, Fallon 5.7 percent, Blue Cross-Blue Shield 6.2 percent, and MassHealth 23.8 percent.

Representatives of the Massachusetts Executive Office of Health and Human Services, which oversees MassHealth, didn’t return phone calls yesterday.

A good example from the Boston Globe why the public option isn’t better for patients and medical providers.  The Massachusetts Medicaid program, MassHealth, paid considerably slower than any private payers to the providers, and denied a significantlh higher % of claims, as the graph below shows.  A public option will slow the payment structure down and make providers have a harder time keeping running, leading to indirect rationing.

HT:  Patient Power

United States Senator – Jim DeMint
“Under the Health Care Freedom Plan, Americans would be able to keep the care they have now, but if they are uninsured or unhappy with their current plan, they could access a voucher to purchase health insurance anywhere in the country. This will create a true, competitive market for health care that will lower costs and increase quality. And it levels the playing field so all Americans – regardless of their employment benefits or employment status — have the same access to quality health care.”

“The Democrat bill will cost taxpayers trillions of dollars when we can solve this problem without adding a single dime to the deficit. By repealing the failed financial bailouts, we can give every American a tax benefit that provides them with access to quality, affordable health care coverage.”

Another bill, this one with more positives, has been introduced by South Carolina senator Jim Demint.  The link above is to his site, and a fuller explanation of his bill.

From what I can tell, this will be a huge step in the right direction, and we’re working hard to make sure health care sharing ministries’ members are able to take advantage of the tax credit in the bill should it pass.

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

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.