If Grady Fails--The Crisis At Atlanta's Grady Health System Is A Symptom Of Bigger Problems In The U.S. Health Care System

Thursday, November 29, 2007
Brian Klepper joins us again today this time with a post on Atlanta's Grady Health System. Grady is an inner city safety-net hospital now going to extraordinary lengths to remain open. Brian makes the point that the Grady situation is by no means unique but instead represents a national issue as safety net hospitals struggle to maintain health care for the uninsured while being underpaid by their

"Health Wonk Review" Is Up

Wednesday, November 28, 2007
The latest edition of "Health Wonk Review" is up over at "Health Care Renewal."I must say it is a very well done and interesting review of some of the best in recent health care posts--this time crafted by Dr. Roy Poses.

The Last One is Gone--CIGNA Buys Great West Life Health Insurance Business

The recent announcement that CIGNA has purchased the U.S. health insurance business of Great West Life for $1.5 billion in cash struck me as more than the minor headline it was back on page C5 of the Wall Street Journal.The last one is now history.Metropolitan, Prudential, John Hancock, Mass Mutual, Hartford, Pacific Life, Phoenix Mutual, and so many more, are all out of the medical business.I

One Heck Of A Budget Mess and Lots of Ugly Consequences--But Watch The Pork

With the Congress set to come back to attempt to break the budget impasse in the few weeks before the holidays, many in this town are ready to see the Congressional Democrats and President Bush agree to disagree and let the budget problems slide for a year under a series of lengthy continuing resolutions (CRs).The problem with CRs is that they only allow the agencies and programs to continue at

"Cavalcade of Risk" Is Up

Wednesday, November 21, 2007
The latest edition of the "Cavalcade of Risk" is up over at "Colorado Health Insurance Insider." This edition includes some of the best posts from the last couple of weeks in insurance, finance, and investing.

California Policy Cancellation Scandal Heats Up As Republican Candidates Propose Health Reform Based On An Individual Health Insurance System

Monday, November 19, 2007
All of the leading Republican candidates for president favor health reform based on the individual health insurance model instead of the more common employer-based system.Apparently, a number of health insurance companies would like to derail those Republican health reform plans by scaring the heck out of consumers and voters picking the year before the election to hold a policy cancellation

SCHIP, Medicare Physician Fee Cuts, and Medicare Advantage--We're Getting Down to Crunch Time

Friday, November 16, 2007
Since September of 2006, I have been pointing to this year-end as the time that would require some big budget decisions impacting SCHIP, the scheduled 10% Medicare physician fee cut, and corresponding Medicare Advantage cuts to health plans to pay for the doc fix.Guess what? New Year's is just over six weeks away.For now, each of these issues is bogged down in the overall budget stalemate between

VEBA's--The New Growth Opportunity

Thursday, November 15, 2007
With word that Ford workers have followed those at GM and Chrysler in ratifying their new labor contracts we may be at the cusp of the next big growth opportunity in the health plan business.GM alone will transfer as much as $50 billion in long-term retiree health care liabilities to the Voluntary Employees Beneficiary's Association (VEBA) and Chrysler and Ford will also set up the structure over

Health Wonk Review Is Up

Maggie Mahar does a particularly good job this time of accumulating some very good posts from the best of the health care blog world.This is also an opportunity for you to check out her new and excellent health care blog, "Health Beat" which is "a project of the Century Foundation."

Part D Medicare Drug Plans See Major Price Increases--Why?

Wednesday, November 14, 2007
The Part D Medicare drug program's weighted average monthly premiums will increase 17% in 2008 and 23% since the program's January 2006 inception. The 2008 increase is well above basic pharmacy cost trend meaning the insurers are doing some rate catch-up. The average is weighted by actual enrollment.Premiums for the top two Part D Plans (PDPs) by enrollment are up dramatically. According to a

Giuliani Puts His Foot In It With the Claim He Would Have Only Gotten Quality Treatment For His Cancer in the U.S.

Monday, November 12, 2007
There is this myth that all of the extra money we spend on health care at least gets us the best care in the world. Study after study debunked that long ago and the fact that someone running for president doesn't understand that claim is a myth is inexcusable.But Rudy Giuliani actually has a radio ad in New Hampshire that repeats the myth.All Giuliani's remark did was give opponents of a market

Report: "Health Insurer Tied Bonuses to Dropping Sick Policyholders"

It's hard to imagine a worse headline for the health insurance industry just as we are heading into what will be a fundamental debate over who should run our health care system.It is even harder to imagine a dumber thing for the insurance industry to do than continue to argue and litigate the notion that an insurer can cancel--or rescind--an insurance policy for a misstatement of fact on an

Sometimes It's the Little Things--The NCQA Announces an Agreement Between Providers and Payers to Better Pay for the Quality of Care

Thursday, November 8, 2007
Particularly in this election season we tend to focus on the big health care reform plans. It is natural to want to see a big fix to a big problem. But everyday things are going on in the market that can make a difference. Make no mistake, these good works will not replace the need for systemic health care reform but it would be wrong to think just big policy changes are the only answer.A case in

What Will It Take to Get a SCHIP Bill This Year? The Budget Outlook Deteriorates Even More

Wednesday, November 7, 2007
Democratic and Republican negotiators are hard at work to get an agreement on the State Children's Health Insurance Program (SCHIP) extension.The current SCHIP bill failed to get a veto-proof majority in the House.President Bush has said there is no way he will sign a SCHIP bill with a tax increase in it--the current bill would increase the per pack cigarette tax by 61 cents.The only way the

The Best Places To Get the Inside On the Workers' Compensation Market

Tuesday, November 6, 2007
Workers' Comp has always been a unique niche in the health care business.If WC is on your mind, I was reminded again today how important it is for you to be a regular visitor on Joe Paduda's "Managed Care Matters." While Joe is also a great source on all things health care, his perspective on WC is a must for those in that business. It's the real insider view that I always enjoy. His recent post

Romney Says There Are Already "Pots of Money" in the States to Pay For Health Care Reform---Where?

Mitt Romney says states could implement comprehensive health care reform without having to raise taxes.However, states trying to replicate the Massachusetts health plan would likely have to raise taxes in order to pay for it. That is the conclusion of a November 3rd Boston Globe article. Here are some points:Massachusetts had something other states don't have--a $610 million uncompensated care

Medicare Buy-In For Retirees--Private Options Make It an Even Better Idea

Monday, November 5, 2007
"We should act now to let companies and unions buy their early retirees into Medicare." That's the point of a Washington Post op-ed today by Democratic Congressman Rahm Emanuel and the president of the Democratic Leadership Council, Bruce Reed.These two former Clinton aides are arguing that:"The troubles at GM and Chrysler--and Ford, which reached a tentative labor agreement this weekend --

"Medicare Advantage: Wrong Way to Spend $54 Billion"--The AMA Goes After the Medicare HMO's Money

Thursday, November 1, 2007
The American Medical Association (AMA) in an editorial in its journal, American Medical News, has pulled no punches in its argument that Medicare HMO plans (Medicare Advantage) need to be cut in order to find the money to fix the upcoming Medicare physician fee cuts--10% in 2008 and another 5% in 2009.Without a doubt their attack on "excess payments" to insurers is self serving--as about all

Why Consumers’ Checkbook v CMS is a Sideshow--Bush Administration Refuses to Release Provider Data

Brian Klepper joins us again today with another one of his welcome posts. This time he points out the hypocrisy in CMS, which has been calling for market transparency, refusing to provide provider data to a consumer group.Why Consumers’ Checkbook v CMS is a Sideshowby Brian KlepperThere are people who call for market solutions as the answer to every societal problem, but who then work to restrict