HealthReform.Gov: Insurance Companies "Prosper," Families Suffer and CMS Gets Even Slicker With the Facts

The Disease Management Care Blog doesn't know just how it happened, but its email address has ended up on the HHS press release list. It likes to think that it's because of the DMCB's sprawling internet Wikio Top 5 readership, but more likely it's because it signed up to receive automatic alerts from CMS about its ongoing demos.

The DMCB spouse points out that it certainly isn't because anyone in charge at HHS is actually paying attention to what the DMCB has been posting (here and here). As usual, she's right: if that were the case, they wouldn't have released today's HHS FOR IMMEDIATE RELEASE 'Press Release' about this fiasco of a report.

Titled "Insurance Companies Prosper, Families Suffer: Our Broken Health Insurance System," the report is all of 1286 words. While the DMCB salutes the folks at HHS for their break with a habit of issuing text that routinely exceeds 1286 pages, this bullying demagoguery reflects poorly on the former State Insurance Commissioner with a reputation for moderation.

According to this manifesto, the White House's plans for 'reform' (i.e. what the President and the Congressional Chair-Mandarins seem so far unwilling to compromise on) will:

'Increase government oversight, enforce medical loss ratios, increase public scrutiny and leverage exchange participation.'

It could also increase red tape, lead to regulatory uncertainty and, no matter how much they bully, do little to slow down the relentless medical cost inflation or change the fact that 'billions' in insurer profit is the result of single digit returns spread over very large reserves and regulated surpluses.

'End arbitrary limits placed on coverage by insurance companies.'

Benefit packages are regulated by the states, many of which have run amok by being unable to say no to any constituency and blowing past limits on medical services that strain the definition of 'medically necessity.' Federal meddling could only make it more complicated. And here's some apostasy: caps on benefits, like it or not, are also one way to cap the cost of health insurance: why not contemplate their reasonable use, especially if costs are truly out of control and if (and that's a big if) consumers are aware of they entail?

'End denials of coverage based on health status.'

We've been through this. Without an accompanying universal insurance mandate with teeth, the only persons who will want coverage are those with poor health status. Right now, despite shifting polls, the chances of Congressional approval of a mandate looks about as good as Ms. Sebelius posting a comment on this blog that thanks the DMCB for its erudition.

Create competition among insurers with a health insurance exchange.

While the DMCB likes 'competition,' it's the big insurers with big reserves and big surpluses that are able to survive the inevitable underwriting cycle.

Ensure value in our health care system by rewarding quality, efficiency and coordination.

The DMCB asks if that's the case, then why are the majority of these initiatives being assigned to pilots (whatever they are) and 'demos,' a political morass where good ideas go to die?

Lower premiums, based on a Congressional Budget Office report that estimates streamlining and the entry of more people in the market will lower individual costs by 14 to 20 percent.

Oh? The DMCB went to the CBO Director's Blog and found this November 30 quote about Senator Reid's proposed Patient Protection and Affordable Care Act:

"Average premiums in this (the non-group market) would be higher than under current law primarily because the typical insurance policy in this market would cover both a substantially larger share of the average enrollee’s costs for health care and a slightly wider range of benefits."

Crossing swords over what the CBO said or meant and when that happened aside, however, the fact is that projections about future health insurance are like looking at a blurry chest x-ray from an moving and uncooperative emergency room patient at 2 AM: guesses built on assumptions made up of shadows.

Last but not least, in watching the accompanying video, it really appeared to the DMCB that Ms. Sebelius spent less time addressing the points above and more time trying to portray how 1) CMS can be the watchdog agency that will bring the insurers to heel if only wearegiventhepowertodoso, and 2) righteous the President's agenda for health care reform is. Watch it and draw your own conclusions here.

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Coda: Carl Mecurio has a pair of worthwhile posts on the topic with a different spin over at the Corporate Research Group (CRG) Blog. He agrees that insurers make an easy target, that the rhetoric is, well, rhetoric and that the individual market is in need of some serious work. He also provides some important insights about Pennsylvania's adultBasic. In the meantime, the DMCB isn't sure if the Administration's health reform proposals will a) just spread the underlying cost inflation over a larger pool and hide it with unsustainable deficit funding or b) jump off a political cliff by imposing an unsustainable mandate. Well worth a look.