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[tvoivozhd <tvoivozd AT infionline.net>]

ONE---There is absolutely no comparative cost information available to 
consumers on hospitals in their vicinity. Comparison shopping as would 
be made in buying a new car is an impossibility.

TWO---There is no way of foreseeing exactly what life threatening event 
is coming your way

THREE---If you are lying on a gurney in a hospital emergency room there 
are no options other than to die---you sure as hell aren't going to 
carefully balance your odds of survival there against riding in an 
ambulance to a hospital 100 miles away for cheaper treatment---whether 
you are conscious or unconscious doesn.t matter.

It is true that healthcare should be financed by general taxation, not 
by employers for two very good reasons---healthcare should require being 
tied to a capricious and unpredictable employer---and employer-provided 
Social Security and healthcare contributions make those employers 
non-competitive in global markets.


latimes.com <http://www.latimes.com/>
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http://www.latimes.com/news/nationworld/nation/la-na-health31jan31,0,933948.story?coll=la-home-headlines 



 Healthcare Overhaul Is Quietly Underway

By Ricardo Alonso-Zaldivar
Times Staff Writer

January 31, 2005

WASHINGTON — Emboldened by their success at the polls, the Bush 
administration and Republican leaders in Congress believe they have a 
new opportunity to move the nation away from the system of 
employer-provided health insurance that has covered most working 
Americans for the last half-century.

In its place, they want to erect a system in which workers — instead of 
looking to employers for health insurance — would take personal 
responsibility for protecting themselves and their families: They would 
buy high-deductible "catastrophic" insurance policies to cover major 
medical needs, then pay routine costs with money set aside in 
tax-sheltered health savings accounts.

Elements of that approach have been on the conservative agenda for 
years, but what has suddenly put it on the fast track is GOP confidence 
that the political balance of power has changed.

With Democratic strength reduced, President Bush, Senate Majority Leader 
Bill Frist (R-Tenn.) and House Ways and Means Committee Chairman Bill 
Thomas (R-Bakersfield) are pushing for action.

Supporters of the new approach, who see it as part of Bush's "ownership 
society," say workers and their families would become more careful users 
of healthcare if they had to pay the bills. Also, they say, the lower 
premiums on high-deductible plans would make coverage affordable for the 
uninsured and for small businesses.

"My view is that this is absolutely the next big thing," said former 
House Speaker Newt Gingrich, whose consulting firm focuses on 
healthcare. "You are going to see a continued move to trying to get 
people involved in the process by owning their own health accounts."

Critics say the Republican approach is really an attempt to shift the 
risks, massive costs and knotty problems of healthcare from employers to 
individuals. And they say the GOP is moving forward with far less public 
attention or debate than have surrounded Bush's plans to overhaul Social 
Security.

Indeed, Bush's health insurance agenda is far more developed than his 
Social Security plans and is advancing at a rapid clip through a 
combination of actions by government, insurers, employers and individuals.

Health savings accounts, known as HSAs, have already been approved. They 
were created as a little-noticed appendage to the 2003 Medicare 
prescription drug bill.

HSAs have had a strong start in the marketplace. Although regulations 
spelling out how they would work were not issued until mid-2004, as of 
Sept. 30, about 440,000 people had signed up. And more than one-quarter 
of employers say they are likely to offer them as an option.

The accounts are available only to people who buy high-deductible health 
insurance, either through an employer or individually. Consumers can set 
aside tax-free an amount equal to their deductible. Employers can 
contribute to workers' HSAs but do not have to. Unused balances can be 
rolled over from year to year, and employees take their HSAs with them 
when they switch jobs.

The idea that losing one's job would not automatically mean losing 
protection for medical costs has bipartisan appeal. "Portability" was a 
key feature of President Clinton's ill-fated healthcare reform plan. But 
the GOP approach is significantly different: Whereas Clinton would have 
required all employers to chip in for universal health insurance, Bush 
wants to leave responsibility primarily to individuals.

"This is certainly getting a lot of attention from employers," said Jack 
Rodgers, a healthcare analyst for PricewaterhouseCoopers LLP.

One reason is potential cost savings to employers.

A typical catastrophic health insurance plan carries an annual 
deductible of about $1,600 for an individual when purchased through a 
large employer. That means the worker pays the first $1,600 of 
healthcare expenses each year. By contrast, under the more 
comprehensive, employer-provided health insurance programs common today, 
the company begins to pay after about $300 in expenses have been 
incurred. Deductibles for families are considerably higher under both 
types of plans.

"There's an issue about whether these things will work," Rodgers said. 
"[But] we could end up coming back 10 years from now and everybody will 
have high-deductible plans and [health savings accounts]."

Sen. Ron Wyden (D-Ore.), who agrees with Bush that individuals should 
take more responsibility for controlling health costs, is nonetheless 
skeptical that HSAs, coupled with high-deductible insurance, will prove 
workable as a substitute for the present system.

"I think the American people are going to want more of a safety net than 
the administration has been willing to commit to this far," Wyden said.

Still, catastrophic health insurance is gaining credibility as a policy 
option.

The California Medical Assn. supports a plan that would require all 
residents of the most populous state to carry at least high-deductible 
coverage — just as automobile liability insurance is often mandatory. 
White House spokesman Trent Duffy said Bush was not contemplating such a 
requirement at the federal level.

But the existence of health savings accounts may make it easier to enact 
state mandates such as the California proposal.

Despite the record federal budget deficit, Bush on Wednesday proposed 
additional tax breaks and subsidies for HSAs, particularly for 
low-income families. He also called for a tax credit to help small 
businesses offer the plans to their employees. The low-income aid would 
be worth a maximum of $3,000 per family.

"Health savings accounts all aim at empowering people to make decisions 
for themselves, owning their own healthcare plan," the president said. 
Consumer-driven decision-making is more likely to control costs than 
having bills paid by a third party, such as an employer, he added.

"If a third party makes that payment, [the consumer] never gets to ask 
the question [about cost]," Bush said. "He just accepts the decision. 
And all of a sudden, when you have consumers starting to ask questions 
about cost, it is a governor on cost, at the very minimum."

During his confirmation hearings, incoming Health and Human Services 
Secretary Michael Leavitt called for renewing the national debate over 
the future of the healthcare system and spoke of "the transformational 
need of detaching healthcare and employment."

Critics say that Bush's vision represents wishful thinking at best, and 
at worst, a perilous new direction in national health policy.

"One danger with this is that people will not get needed care because 
they want to save a few thousand bucks," said Rep. Pete Stark 
(D-Hayward), a leading lawmaker on healthcare.

"Healthcare isn't like buying a Chevrolet," Stark added, disputing 
Bush's assertion that individual patients can be empowered to control 
costs. "You can go to Consumer Reports and read about the new Malibu, 
but if I asked you to describe a regimen of chemotherapy for someone who 
has colon cancer, you'd be out of gas.

"We are talking about highly technical services that 99% of the public 
doesn't even know how to spell the names of," he said. "Secondly, there 
is no uniformity within the medical community as to what services ought 
to be used. It's a 'by guess and by gosh' sort of practice."

The combination of HSAs and catastrophic insurance is too new for any 
definitive data on how consumers are faring.

A study released Thursday by the Commonwealth Fund, a private foundation 
that supports research on healthcare policy, found that people with 
high-deductible policies were more likely to have trouble paying medical 
bills than those in traditional insurance plans. They were also more 
likely to skip care because of cost.

The study did not look at the combination of high-deductible plans with 
HSAs, but the report cautioned that the savings accounts might not solve 
all the problems.

Many experts believe HSAs could quickly become one of the main ways to 
obtain health insurance for people working in small companies or buying 
coverage on their own.

Workers at large companies with standard health plans may be less likely 
to experiment with HSAs, although many large employers are already 
requiring their workers to shoulder a bigger share of health insurance 
costs. The existence of a government-sanctioned alternative to the 
traditional system might accelerate that trend.

"We are not trying to do one big change for the whole country, all at 
once — like what sunk Hillary-care," said Grace-Marie Turner, president 
of the Galen Institute, a research organization that promotes 
conservative, market-based health reform.

"We want to let people choose this if it meets their needs, and not rip 
out the underpinnings of the current system."

But even the most ardent backers of HSAs concede that the country is not 
fully ready for them. They say critics such as Stark are correct to 
point out that there is little information available to consumers for 
comparing the costs of various medical options.

In a recent article in the New England Journal of Medicine, Frist called 
for what would amount to a healthcare information revolution. Within the 
next decade, he said, patients should be able to gain online access to 
performance rankings and prices for doctors and hospitals.

"Increased access to more accurate information about care and pricing 
will make possible … the transformation of the healthcare system," Frist 
wrote. "Whether selecting their physician, hospital or health plan, 
consumers must be able to choose what best meets their needs."

A comprehensive system of healthcare information would be costly to 
create, and perhaps challenging for patients to navigate. On Thursday, 
Bush proposed some initial steps, such as computerized medical records 
and standardized information technology for medical offices.

His vision of an empowered patient calling the shots may stand little 
chance without a new information infrastructure.

Gingrich acknowledged: "You can't have an informed marketplace in a 
setting where you don't have any information."