Thursday, September 3, 2009

What Karen Ignagni Said, Meant & Should Have Said in the New England Journal of Medicine

Karen Ignagni of America’s Health Insurance Plans (AHIP) has an article-editorial in the latest New England Journal of Medicine. AHIP is the trade organization that represents the U.S health insurers.

There isn’t much that is new here. In fact, it's so boilerplate, the Disease Management Care Blog wonders if one of her staffers wrote this for her.

She argues the nation’s insurers want to build on the strengths of the current system. AHIP's members are prepared to cover all Americans based on the guaranteed issue of a standard transparent benefit without medical underwriting. AHIP wants clinical as well as cost-effectiveness data to inform decision making. Government subsidies may be necessary to make sure no one falls through the cracks. They really don’t want a public plan to happen because of cost-shifting.

The DMCB thinks she really means that the members of her organization would be happy to have everyone in the U.S. mandated to buy insurance from their members, even if it means that the benefit package and its price will be heavily regulated. Anything and everything that blunts cost inflation would also be very welcome. Government subsidies would be very very welcome. They really really don’t want a public plan to happen because of cost-shifting.

What she should have said is that the United States has a choice to make. It’s going to insure its working citizens with either: a) a regulated public-utility style commercial system that controls costs through a combination of provider negotiating and relying on evidence-based and cheaper alternatives or b) a government system that squeezes costs through imposing price controls. AHIP members don’t want a public plan because only the top tier of Americans will be able to afford private health insurance and the rest of us will eventually end up being in the equivalent of a Medicaid plan.

1 comment:

Marian Cutler said...

Having read the AHIP/NEJM piece, one is left to wonder which "strong system" her association members want to build on. Would it be the highly profitable small business? Maybe the public sector/union business which gets water from a stone leaving insurers eeking out covering expenses? Or, the cobbled together Medicare/Medicaid business which is constantly tagged and fined for violating network agreements (not having enough specialists within defined geographies).

As you pointed out, she should have said the industry/her members can't wait to get ahold of 46 million more paying members. Especially the 25-30 million (or so) who are healthy, low users of healhcare and therefore provide bottomline cushion.

Equally so, AHIP should come out aggressively against a public option. Currently, there are not enough doctors accepting Medicare/Medicaid patients for one simple reason: Federally mandated reimbursement rates are insulting.

In some metropolitan markets (NYC, LA, DC, the obvious list of large, heavily populated cities), doctors have leverage and negotiate reimbursement deals for 130-150% of Medicare rates. But what about the vast majority of Americans who don't live in a metropolitan market?

Public option, if it caught on, would be predicated on a system consisting of spit, glue and hope. Is that reform?