reduce medical bills

Study Spotlights Provider Market Power to Negotiate Higher Payment Rates

J Roberts

Read how physicians and hospitals are joining together to increase their market share and purchasing power to better negotiate more favorable levels of reimbursement. This is a trend to watch, the net results may lead to an increase in health care premiums and out-of-pocket costs.

HFMA

An underlying driver of higher insurance premiums—the growing market power of hospitals and physicians to negotiate higher payment rates—has gone largely unexamined, according to a Center for Studying Health System Change (HSC) study published online today by Health Affairs.

Funded by the California HealthCare Foundation, the study examined the growing market power of many California hospitals and physicians, finding that providers are using various strategies, such as tighter alignment of hospitals and physician groups, to negotiate significantly higher payment rates from private insurers.

“Provider market power is the elephant in the room that no one wants to talk about in the national healthcare reform debate,” said HSC Senior Consulting Researcher Robert A. Berenson, M.D., of the Urban Institute, a coauthor of the study with HSC President Paul B. Ginsburg, Ph.D., and Nicole Kemper, M.P.H., a former HSC research analyst.

“Health insurers have been squarely in the crosshairs and blamed for the high cost of private insurance, while the role of growing hospital and physician market power has escaped scrutiny,” Berenson said.

The study also points out that California offers a cautionary tale for reform proposals that encourage hospitals and physicians to form tighter relationships through accountable care organizations.

“Reform proposals that encourage hospitals and physicians to integrate have the potential to improve quality and increase efficiency, but the savings may not be passed on to private payers if provider market power to command higher prices goes unchecked,” Ginsburg said.

The authors conclude that “unless market mechanisms can be found to discipline providers’ use of their growing market power, it seems inevitable that policy makers will need to turn to regulatory approaches, such as putting price caps on negotiated private-sector rates and adopting all-payer rate setting. Indeed, some purchasers who believe strongly in the long-term merits of increased integration of care delivery believe that price regulation may be a prerequisite for payment reforms that encourage integration.”

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Healthcare Spending Expected to Have Outpaced GDP Growth

J Roberts

Healthcare Financial News

Healthcare spending is on track to grow faster than the nations GDP for 2009. Unfortunately, we’ve seen this trend for the past few years and 2010 will promise nothing different. One thing is for certain, to combat the increased expenditure in medical services, employers and health insures alike are passing more costs onto employees and consumers.

Growth in U.S. national health expenditures (NHE) is expected to have increased faster than the growth in the gross domestic product (GDP) in 2009, according to a report issued today by the Centers for Medicare & Medicaid Services (CMS) and published online by Health Affairs. In 2009, NHE is projected to have reached $2.5 trillion and grown 5.7 percent, up from 4.4 percent in 2008 (the latest available historical year), while GDP, with the economy still in recession, is anticipated to have declined 1.1 percent. Health spending estimates for 2009 are projected because data for all of CY09 are not yet available.

The projected acceleration in growth for 2009 was due in part to faster spending growth for the Medicaid program (9.9 percent, up from 4.7 percent in 2008), reflecting increasing growth in enrollment associated with the recession. Also contributing to the acceleration was faster growth in the use of a variety of healthcare services as many people sought treatment for the H1N1 virus and an expected increase in the take-up rate for coverage provided through COBRA in response to the government’s subsidies for COBRA premiums. As a result of NHE growth outpacing GDP growth in 2009, the health share of GDP is expected to have increased from 16.2 percent of GDP in 2008 to 17.3 percent in 2009, which would represent the largest one-year increase in history.

Spending growth in three of the major healthcare sectors is expected to have accelerated in 2009. Hospital spending growth is expected to have increased 5.9 percent in 2009, up from 4.5 percent in 2008, and reached $760.6 billion. Physician and clinical services spending growth is expected to have increased 6.3 percent in 2009, up from 5.0 percent in 2008, and reached $527.6 billion.

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Help With Medical Bills

J Roberts

Read what others who have serious medical illnesses and conditions are doing to help relieve some of the financial burdens associated with high cost treatment and medical care. Like the services mentioned in the below article, Medical Cost Advocate can assist you with reducing your high dollar medical claims.

By M.P. MCQUEEN

A diagnosis of cancer or other serious disease can be devastating to one’s financial as well as physical health — even for people with insurance. But there are a handful of programs that can help ease the monetary burden.

The programs, run mainly by nonprofit and charitable groups, offer financial aid to patients with specific life-threatening or chronic diseases to help cover the cost of co-payments, deductibles and other medical expenses. Patients usually must meet specific income and treatment guidelines.

Patients typically are referred to the programs by the financial counseling or patient-advocate offices of big hospitals and treatment centers. But you also can seek them out online.

Cutting Cancer-Care Costs

The CancerCare Co-Payment Assistance Foundation (at 1-866-552-6729 or CancerCareCopay.org) helps eligible patients cover the cost of insurance co-payments for treatment of specific cancers. The program, founded in April 2008, now lists seven diagnoses eligible for assistance: breast cancer, colorectal cancer, head and neck cancer, non-small cell lung cancer, pancreatic and renal cancer and glioblastoma.

Some diseases have a $10,000 annual limit on aid, others have a $5,000 limit, says John Rutigliano, chief operating officer of nonprofit CancerCare. Most people who qualify receive between $2,500 and $5,000.

He says these days more employees are bearing a larger share of the cost of care, with higher co-pays and deductibles.

Since the CancerCare program began, about 7,000 people have applied for co-pay assistance, and about 80% of them have received aid. Half of those who received aid were on Medicare and the other half were privately insured.

The foundation rejects less than 7% of applications, mostly because applicants’ income exceeds guidelines. The cutoff for assistance is 400% of the federal poverty level — slightly above $43,000 for an individual and $58,000 for a family of two.

Nancy Francisco of Crystal Falls, Mich., received financial help from CancerCare when she was diagnosed with glioblastoma, a type of malignant brain tumor, early in 2009.

Mrs. Francisco, a 45-year-old registered nurse and electronic medical records technician, became disabled as a result of the illness and treatment. Her husband is her full-time caregiver. She continued her health-insurance coverage under her former employer’s Cobra plan, but out-of-pocket expenses for treatment exceeded $10,000. CancerCare helped her with a $10,000 grant, says the mother of three, which helped cover co-pays for chemotherapy and IV transfusions.

“I couldn’t believe there was help,” says Mrs. Francisco, who learned of the program from her hospital social worker and pharmacist, who also helped her fill out the application.

Other Options

Other groups offering financial assistance for the treatment of cancer and other diseases: HealthWell Foundation HealthWellFoundation.org, which helps with co-pays and premiums for patients with group and individual insurance, Medicare and Medicaid. The Leukemia & Lymphoma Society’s Co-Pay Assistance Program (leukemia-lymphoma.org) helps with private-insurance premiums.

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Tired of fighting medical providers? Hire a negotiator

J Roberts

 Check out Aaron Crowe’s recent article about Medical Cost Advocate which recently appeared on WalletPop.com. One thing is for sure, Aaron is right on when he states, “…one of the worst bills to receive is a medical bill.” Medical Cost Advocate is the resource that can assist you in reducing your medical bills.

Aaron Crowe

Of all the bills that arrive in the mail, one of the worst has to be a medical bill.

Whether from your insurance company or medical provider, the expensive bills are difficult to understand and patients don’t know if they’re getting ripped off.

Add in the fact that by a conservative definition, 62% of all bankruptcies in 2007 were because of medical bills, with 92% of those debtors incurring more than $5,000 in unpaid medical bills, and a hospital bill is enough to send you back to the hospital.

With an 80% success rate of getting patients’ bills lowered, Medical Cost Advocate, or MCA, negotiates with medical providers to get lower bills. It’s a service that makes everyone happy, said Derek Fitteron, CEO and founder of MCA. Patients pay less and doctors get paid.

“It’s not a lose situation for the doctor,” Fitteron told me in a telephone interview from his office in New Jersey.

With most of MCA’s negotiators being attorneys, they know how to negotiate a lower bill by providing data showing how much the same procedures cost across the country, and get the doctor paid soon instead of having to send out multiple bills to patients, Fitteron said.

I recently wrote a story for WalletPop about a Web site that lets customers bid for prices on health care before they visit a doctor. MCA turns that around and helps people lower their bills after their care. It’s rare for people to know how much something will cost before walking into a hospital, Fitteron said.

“When you go in for work, or a procedure, you don’t know how much it’s going to cost,” he said.

MCA doesn’t charge upfront fees for its service, but charges 35% of whatever savings it gets. Customers don’t pay if no savings are found. Once a settlement is reached, the customer’s credit card is charged to pay the medical provider and MCA’s 35%.

Here’s an example on the company’s Web site on how the process works:

If you submit a bill for $750 and MCA gets it reduced by $170, you’ll pay the difference, or $580 to your medical provider. MCA’s 35% cut of the $170 savings is $59.50, making your net savings $110.50.

Most bills submitted to MCA are for $1,000 or more, although they can be for as little as $200.

The most typical bills it gets are for elective surgeries, Fitteron said, such as gastric bypass and cosmetic surgeries that out-of-network providers must do because in-network doctors aren’t covered under most insurance. Large surgeries that are known about ahead of time are also popular bills submitted, he said.

Either through deductibles, co-insurance payments or uninsured or partially uninsured medical procedures, the typical family spends $1,500 per year on out-of-pocket medical expenses, Fitteron said. For 10% of Americans, those expenses add up to $14,000, he said. That’s a big enough reason to submit a bill for review.

Fitteron recommends getting a tax deferred health spending account through work to help pay medical bills, and for checking what coverage you have before you have to go to a hospital.

If they have the time before a major operation, for example, people should check how much insurance coverage they have for it, Fitteron recommended. Out-of-network prices are like the first offer a car salesman makes, so it’s worth negotiating.

He cited a recent MCA case that dropped a Florida woman’s hospital bill from $53,000 to $22,000 for knee replacement surgery. She had catastrophic, high deductible medical insurance, and her insurer only paid $3,000 — what it was legally obligated to pay under her insurance plan.

After MCA determined what the “market oriented rate” for a knee surgery was and received some support from the hospital, the bill dropped dramatically.

It’s one less bill to worry about when the mailman arrives.

Aaron Crowe is a freelance journalist in the San Francisco Bay Area. Reach him at www.AaronCrowe.net

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How to Cut Your Doctor Bill

J Roberts

J. Roberts

Looking to reduce your out-of-pocket expense on your medical bills?  Read the article posted in Forbes Magazine about reducing medical expenses through negotiations.  As the article states, the rise in out-of-pocket health care costs is providing incentive to people to bargain down prices with their doctor, hospital or other health care professional. In many instance though, patients doesn’t want to jeopardize an established patient/ physician relationship. That’s where Medical Cost Advocate can assist. Like the article indicates, we offer bill negotiation services to help reduce cost without having the patient get involved. At Medical Cost Advocate we understand the value of the patient physician relationship. We work collaborately with each physician or health care professional in all our negotiations to achieve true savings to you, without comprising your established relationship.  Follow the link to Forbes Magazine online and read the article about reducing your doctor bill. We think you’ll be surprised at just how often physicians and health care professionals are willing to negotiate. Then visit our website and learn more about what Medical Cost Advocate can do to assist you in negotiating your medical bills.

http://www.forbes.com/forbes/2009/0803/medicine-surgery-costs-cut-your-doctor-bills_print.html

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Senate Report Finds Insurers Wrongfully Charged Consumers Billions

Doug

Another in the continuing series of reports about routine underpayment of health care for out of network coverage by the insurance industry.  Consumers need an Advocate to help reduce health care bills.

By David S. Hilzenrath
Washington Post Staff Writer
Wednesday, June 24, 2009

Health insurers have forced consumers to pay billions of dollars in medical bills that the insurers themselves should have paid, according to a report released today by the staff of the Senate Commerce Committee.

The report is part of multi-pronged assault today on the trustworthiness of private insurers by Commerce Committee Chairman John D. Rockefeller IV (D-W.Va.). It comes at a time when the insurance industry is battling efforts to offer consumers a public alternative to private health plans.

At a hearing this afternoon, Rockefeller’s panel is slated to air allegations by a former industry insider that insurers have put profits before people’s health.

The report released this morning alleges that insurers have systematically underpaid for so-called out-of-network care. The issue has been brought to light in past litigation and investigations, including a probe by New York Attorney General Andrew Cuomo.

Cuomo described it last year as “a scheme by health insurers to defraud consumers by manipulating reimbursement rates.” A dozen insurers have reached settlements with Cuomo agreeing to change their practices.

Many Americans pay higher premiums for the freedom to go outside an insurer’s network of doctors and hospitals. When they do, insurers typically pay a percentage of what they call the “usual and customary” rates for the services. How insurers determined the usual rates had long been opaque to consumers and difficult if not impossible for them to challenge.

As it turns out, insurers typically used numbers from Ingenix Inc., which was a wholly owned subsidiary of the big insurer UnitedHealth Group. As such, Ingenix had an incentive to produce benchmarks that low-balled usual and customary rates and shifted costs from insurers to their customers, the report said.

Making matters worse, Ingenix got all of its data from the same insurers that bought its benchmark information, the report said. Insurers that contributed data to Ingenix often “scrubbed” their data to remove high charges, and Ingenix further manipulated the numbers, removing valid high charges from its calculations, the report said.

Cuomo found that insurers systematically under-reimbursed New York consumers by up to 28 percent, the report said. Earlier this month, New York’s Department of Insurance issued a regulation prohibiting insurance companies in New York from obtaining data on usual and customary charges from anyone with a conflict of interest.

In March testimony to Rockefeller’s committee, UnitedHealth Group’s chief executive expressed regret that there was a conflict of interest inherent in his company’s relationship with Ingenix, the report said.

But chief executive Stephen J. Hemsley also said UnitedHealth stands by “the integrity of the Ingenix data” and the way UnitedHealth “used the data to make reimbursement decisions.” He said the company worked with Cuomo to transfer its databases to an independent, nonprofit entity.

Ingenix bought one of its original databases in 1998 from the Health Insurance Association of America, a precursor to the industry’s main trade association and lobbying group.

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Tallying the Cost to Bring Baby Home

Doug

Another informative article from the Wall Street Journal about the lack of pricing transparency and how difficult it is for consumers to get an estimate of charges, understand the cost, and their portion of the payment.

By ANNA WILDE MATHEWS

Bringing my newborn son home was a joy. Figuring out the hospital bill wasn’t.

Cedars-Sinai Medical Center in Los Angeles provided excellent care and thoughtful treatment during my uncomplicated traditional delivery in December. Then the invoices started coming. The hospital sent one for me, and another for my baby. The doctors billed separately. The total charge for three days: $36,625.

People lucky enough to have good health insurance, including me, don’t have to come up with such sums. Insurers typically pay a lower, negotiated price for hospital care, and patients pay a portion of that amount. Even people without insurance often get sharp discounts from list prices on their hospital bills.

Still, consumers have a big financial stake in the cost of care. People who get health insurance through their workplaces have been paying higher premiums in recent years, and more people have been enrolling in plans that include very high deductibles. A recent survey by the International Foundation of Employee Benefit Plans found that two-thirds of employers are increasing, or considering an increase in, workers’ deductibles, co-insurance and co-payments.

It’s important for patients to get good information about what they have to pay and why. That’s not easy. Before my son was born, it was difficult to figure out what I was going to owe. And I struggled after the birth to learn whether the amounts I was told to pay were appropriate. I could have done a better job at calculating some of my costs. But often, information wasn’t available, or was hard to decipher.

My own health plan is a so-called PPO, or preferred-provider organization, which means I pay less when I use doctors and hospitals that have contracts with Aetna Inc., the insurer that administers my employer’s coverage. For hospital and surgery services from these providers, I am on the hook for 15% of Aetna’s negotiated price. I also have a $400 annual deductible. Fortunately, there is a $2,000 cap on how much I might have to spend out of pocket each year for my in-network care.

From the Wallet

    Having a Baby? How to Prepare for the Hospital Bill

My research started before my due date, with a call to Aetna. I asked the customer-service representative how much the birth would cost me, and she didn’t answer the question directly. She did confirm that Cedars-Sinai was in my network. Aetna’s Web site offered typical maternity costs for other Los Angeles-area hospitals, but there was no such listing for Cedars-Sinai.

The Aetna representative did say that I had $1,370 remaining before I reached my out-of-pocket maximum for the year. So I decided to set aside $1,370 toward maternity costs, and hoped that I’d have some of that left over for a crib.

It didn’t turn out that way. In fact, I owed a total of $2,118.90, a sum I arrived at only after adding figures from five separate documents. Why the difference? Along with dark hair and blue eyes, my son was born with his own $400 deductible. Also, the maximum annual out-of-pocket charge for the two of us was $4,000, double what mine alone had been. I should have re-read the fine print of my plan.

Before paying the bills, I wanted to double check them to make sure I’d actually received the services I was billed for. At my request, Cedars-Sinai sent itemized invoices, with 14 items listed for my baby and 34 items for me, not including doctors’ fees.

Those charges I could decipher seemed stunningly high. A “Tray, Anes Epidural” cost $530.29. (After inquiring, I learned this was the tray of sterile equipment used to give me an epidural anesthetic injection.) An “Anes-cat 1-basic Outlying Area” was billed at $2,152.55. (I was told this was the cost of the hospital’s resources related to the epidural.) These items were in addition to the separate anesthesiologist’s charge of $1,530 for giving the epidural. Even though the pain-killing epidural shot felt priceless during my 20 hours of labor, I was amazed that its total cost could run so high.

To decipher other items, I decided to check out consumer services that advise people about medical bills. Candy Butcher, chief executive of Medical Billing Advocates of America, wondered why the hospital listed a price of $2,382.92 for my recovery, when I hadn’t had a Caesarean section. It turned out the charge was for the 90 minutes I spent in the birthing room after my delivery. I recalled lying exhausted there while a kind nurse checked my vitals and cleaned me up. Important help, for sure, but was it really worth that much money?

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Bargaining Down the Medical Bills

Doug

Below is a recent New York Times article suggesting that consumers take responsibility for lowering the cost of their health care bills.  Most consumers find it difficult to negotiate with health care providers because they don’t have the experience or don’t feel comfortable discussing finances with their physician.  We recommend using experts like Medical Cost Advocate, which leverage health care market data and use experienced negotiators to reduce consumers medical bills.

 

 By LESLEY ALDERMAN

 

When money is tight, everything is negotiable — including your health care bills.

 

As the economy sheds jobs and more people lose their health insurance or are forced to switch to less generous plans, doctors and hospitals are becoming accustomed to patients who are struggling financially. According to the American Hospital Association, half of their members reported an increase in the number of patients needing help with their bills. And that was in November, before the national unemployment rate hit 8.1 percent.

 

“It’s rough out there,” said Dr. Jacques Moritz, the director of gynecology at St. Luke’s-Roosevelt Hospital Center in New York, who also has a private practice in Manhattan. (Full disclosure: He delivered my son five years ago, but my insurance at the time covered me in full.)

 

Lately, Dr. Moritz said, “The first thing I say to my long-term patients is, ‘Do you still have a job?’ ” If patients say no, or otherwise indicate that paying will not be easy, Dr. Moritz says he assures them that bills are negotiable.

 

And keep in mind that doctors, hospitals and medical labs are accustomed to negotiating. After all, they do it all the time with insurers. A hospital may have a dozen or more rates for one procedure, depending on whether Medicare, Medicaid or a private insurer is paying the bill, said Ruth Levin, corporate senior vice president for managed care of Continuum Health Partners, a nonprofit hospital system in New York. Your request for a special arrangement will hardly confound their accounting department.

 

And it is usually in everyone’s interest to avoid dealing with a bill collector.

 

If you recently lost your insurance or have a plan with minimal benefits, here is what you need to know if you want to seek a price break from the doctor, hospital or lab.

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A Healthcare System Out of Balance

J Roberts

Why is the price of healthcare for the same procedure dramatically different from one hospital to the next? Why aren’t American’s aware of this? To find out more read the article from The Boston Globe about difference in pricing at Massachusetts Hospitals.

As his patient lies waiting in an adjacent exam room, Dr. James D. Alderman watches while an assistant reaches into a white envelope and pulls out a piece of paper that will determine where the man will be treated. Big money is on the line. of Massachusetts and Harvard Pilgrim Health Care. The gap is even more striking for many individual procedures, which can be two or three times more expensive in one hospital than in another.data shows, but now the escalating prices that hospitals and doctors charge is far more important. A recent Massachusetts study concludes that the price of inpatient care at hospitals is rising by 10 percent a year, while overall use of hospital beds is declining. obtained by the Spotlight Team. The health official who provided the information asked not to be identified for fear of professional retaliation. Though Partners’ rates are not the highest – that would be Children’s – Partners has more effect on statewide costs because its revenue is five times larger.’We were willing to take the risk of challenging payers,’ said Partners chief financial officer Peter Markell, adding that Partners should not have to apologize for a successful strategy. ‘If you are never willing to challenge them, of course they are going to jam it down your throat.’That willingness to get tough turned Partners’ main insurance contracts from money losers a decade ago to the company’s largest source of profit, Partners officials say. Extrapolating from Partners’ internal tally of its insurance revenues, the Brigham and Mass. General receive at least $500 million a year more from the three biggest insurers than if they were paid at the lower rates typical of their rivals. Likewise, Partners’ 6,000 physicians are paid 15 percent to 40 percent more than most other Massachusetts doctors, based on Blue Cross rates, while the company’s community hospitals earn at least 10 percent more than their peers., Tufts, and Harvard Pilgrim. officials discount Partners’ role, while Baker at Harvard Pilgrim says there is a meaningful but hard-to-measure ‘Partners effect’ on statewide insurance costs. And Partners officials themselves have said in the past that their goal was to ‘reset the prices’ paid to hospitals even if it drives up insurance premiums.rates obtained by the Globe.’Shouldn’t there be some correlation between what you get paid for doing something and the quality of what you do?’ asked Beth Israel chief executive Paul Levy last month in remarks at the Massachusetts Medical Society.; the two closely track. The Blue Cross data show that about 10 hospitals – four Boston teaching hospitals and six community hospitals – are paid at least 30 percent above the state average, while 12 hospitals make at least 20 percent below average, including Cambridge Hospital, which earns about half as much per procedure as the Brigham and Mass. General.

Alderman, an interventional cardiologist, plans to open the patient’s clogged coronary artery by inserting a flexible tube with a tiny balloon at the tip. Usually he does the procedure, called angioplasty, at MetroWest Medical Center in Framingham. But he sometimes operates in Boston as part of a research program. One time of every four, by the luck of the draw, Alderman and his patient go to a big teaching hospital in the city.

If the white slip of paper directs him to do the procedure in Framingham, the insurance company will pay the hospital about $17,000, not counting the physician’s fee. If Alderman is sent to Brigham and Women’s Hospital in Boston, that hospital will get about $24,500 – 44 percent more – even though the patient’s care will be the same in both places.’It’s the exact same doctor doing the procedure,’ said Andrei Soran, MetroWest’s chief executive. ‘But the cost? It’s unjustifiably higher.’Call it the best-kept secret in Massachusetts medicine: Health insurance companies pay a handful of hospitals far more for the same work even when there is no evidence that the higher-priced care produces healthier patients. In fact, sometimes the opposite is true: Massachusetts General Hospital, for example, earns 15 percent more than Beth Israel Deaconess Medical Center for treating heart-failure patients even though government figures show that Beth Israel has for years reported lower patient death rates.

Private insurance data obtained by the Globe’s Spotlight Team show that the Brigham, Mass. General, Children’s Hospital, and a few others are, on average, paid about 15 percent to 60 percent more than their rivals by insurance companies such as Blue Cross Blue Shield

This payment pattern has become a driving force in the state’s galloping healthcare costs, and it raises hard questions about why certain hospitals and physicians receive premium pay for care that is no better than that of their competitors. Until now, the growing pay gap has not been subject to public scrutiny because contracts between insurers and hospitals typically include confidentiality agreements.

But an ongoing Spotlight Team investigation of healthcare in this state found scores of payment disparities for routine procedures in which there is no obvious difference in quality. Consider:

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Healing U.S. Health Care

Doug

Health care reform is expected to be a top agenda item for the incoming Obama administration. 

Author:
Toni Johnson

Health experts agree the U.S. health care system needs an overhaul, as a way of shoring up the economy and U.S. competitiveness. But a battle is brewing over the president-elect’s designs for a public-sponsored insurance plan.  Check out this article by Council of Foreign Relations Staff Writer, Toni Johnson

With the onset of the global economic crisis, some experts feared health reform would be knocked off the incoming administration’s agenda, but instead interest has intensified. “Many people say the government cannot afford a big investment in health care,” writes Jonathan Gruber, an economics professor at the Massachusetts Institute of Technology. “But this represents a false choice, because health care reform is good for our economy.” (NYT) President-elect Barack Obama agrees, noting in early December that health care “is part of the emergency,” and health care reform has to be woven into the overall economic recovery plan (Atlanta Journal-Constitution). The stimulus proposal currently being discussed includes government aid for health care (NYTimes) costs to employers, workers, and states.

Health care reform discussions focus largely on improving access and lowering costs. Obama’s health care plan would create a public-sponsored insurance plan similar to the one provided by the government to members of Congress. It targets individual buyers and small businesses, two segments that have had trouble affording private insurance. Nearly 16 percent of the U.S. population has no health coverage. Insurance companies have balked at the public insurance plan, saying it would underpay doctors like other government health plans and shift costs to private insurers (NYT). Instead, the insurance industry wants the government to mandate that everyone must have health insurance in exchange for a pledge not to refuse coverage regardless of health status. Obama’s plan would mandate the industry cover everyone without requiring that everyone obtain insurance. That could allow some people to wait until they are sick before buying, the industry argues.

The value of rationalizing the U.S. health care sector has been accepted for some time as an important step in keeping U.S. industry competitive, as this Backgrounder explains. C. Fred Bergsten, director of the Peterson Institute for International Economics, and Raymond C. Offenheiser, president of the charity Oxfam America, say universal health care can provide U.S. workers with a safety net against the impact of trade deals (Miami Herald). Princeton economist Ewe Rheinhardt says the health care sector will soon be the largest in the U.S. economy, making it a good taxpayer investment (NPR). He and others say that past efforts to pump federal stimulus money into public works projects – dams, roads, bridges – often wound up missing the crisis, as the projects (and stimulus) get caught up in local planning and bidding battles. But shifting to health care investment, writes BusinessWeek columnist Chris Farrell, feeds a sector of the economy already growing, and would relieve a major source of economic insecurity “for anyone handed a pink slip during the recession.”

A November 2008 Kaiser Foundation report notes that access to employer-sponsored health insurance has been on the decline (PDF) among low-income workers. Meanwhile, the fiscal crisis is reducing the number of people who can pay (BusinessWeek) their doctor’s bills and insurance premiums. Even if the widely acknowledged systemic problems are left aside, these problems will worsen during a recession. The situation could push more people into government health care programs such as Medicaid. President-elect Obama’s economic stimulus proposal would allow laid-off workers without insurance to apply for Medicad for the first time. The Democratic victory in November has ignited a debate to what extent U.S. health care will become a government-run program. Pete DuPont, a billionaire former Republican presidential hopeful, warns of a coming “Europeanizing” of American health care (WSJ). But analysts suggest the European-style “single-payer” system is now virtually off the table (LAT).

Obama’s health plan hopes to tackle rising costs by allowing importation of cheap medicines from developed countries and increase access to new generic drugs as a means to lower costs. This would cut into drug company profits, however, and will be certain to meet opposition. And as this CFR Backgrounder points out, some experts also worry importing more drugs from other countries will challenge the already taxed Food and Drug Administration, the agency charged with drug safety. Expanding the number of people covered also presents another challenge: The United States has a shortage of doctors (NYT) and other medical professionals.

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