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February 4, 2008
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IN
THIS ISSUE
Editor's
Column: Change And What Will Not Change
Blues
Defend Tax Break At Senate Hearing
Keep
Heat On Senate For Anti-Smoking Bills
MSMS Supports
Tanning Facility Regs
Learn
How 'VEBA Is Shifting Michigan's Gears'
HHS
Secretary Seeks To Expand EHR
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Editor's
Column: Change
And What Will Not Change
By
JOSEPH WEISS, MD
The call for single-payer national health insurance has become
loud enough to reach the ear of every voter. Do those who
advocate single-payer know what they will get, and what will
not change, though it should?
What will we get?
1) Cutthroat strife between doctors. Each specialty from
family practice to retinal surgery will fight to keep its
share of the dollar pie. Allegiance to one’s specialty
society will intensify as each society becomes the vehicle
for advocacy vital to survival.
Specialty societies will spend millions for lobbyists, as
reimbursements worth tens of millions of dollars will ride
on the placement of a comma on page 624 of a rider attached
to an energy bill. Since the total dollars available for
health care services will hardly expand from year to year;
what one physician specialty gains will come at another
specialty’s loss.
The AMA will suffer. As physicians’ loyalties transfer to
their specialty, and as the cost of dues for that specialty
society increase to pay lobbying costs, interest in the
AMA will wane. This attitude will be self defeating, as
the AMA provides the best way to develop compromise among
conflicting physician claims. Only the AMA can bring to
Congress a comprehensive alternative for individual specialty
squabbling and demands for increased reimbursement.
(2) Decreased choice and increased rules. Presently, conditions
in Southeast Michigan aside, if a physician does not care
for a health plan, that physician can leave the health
insurer. If there is only one plan, there is no chance
to walk away from it and still practice medicine. Not only
must you work for one boss, you must follow all the rules
that the administration lays down as conditions of employment.
Thus, pay-for-performance becomes not an option but a rule.
(3) rationing of care- At present what a patient can pay
for health care determines how much care that patient will
receive. Under single-payer, what medical care patients
receive becomes a government decision. Once more,
intense lobbying will ensue as advocates for each disease
head to Capitol Hill to ensure their group, such as scleroderma,
kidney transplant, myasthenia gravis, etc., receives attention
for drugs, surgery, physical therapy and laboratory testing.
Limiting the money spent combined with a single decision
maker will make possible decisions on what age to no longer
fund procedures such as kidney dialysis, coronary stenting
and hip replacement among other end-of-life procedures.
(4) Mindless decisions. We will see more of the arbitrary
decisions government can make with its power of the final
word. Recent examples include the Veterans Administration
refusing to give its cancer statistics to the National
Cancer Registry and the Medicare order to Sinai-Grace to
stop the ICU checklist that proved effective in stopping
intensive care related catheter infections.
What will continue?
Delay in making decisions on health care policies. Months
of lobbying will lead to months or years of congressional
hearings which, in turn, will yield further delays as rules
are subject to comment, debate, and changes in financing.
What is unknown?
How single-payer national health insurance will change the
distribution of doctors between urban and rural and between
medical specialties. Will we all be made into family practitioners
with the numbers among us in specialties determined by
quotas or lotteries?
You may want to remain in medical practice just to find out
what will happen and feel, first hand, its effect.
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Blues
Defend Tax Break At Senate Hearing
By
PAUL NATINSKY
LANSING - The Senate Health Policy Committee under Chairman Tom George,
MD, listened Jan. 30 to Blue Cross and Blue Shield of Michigan describe
a new study it commissioned that the insurer said shows it spends
more than $300 million per year on its “social mission.”
Blues
Vice President Mark Cook said BCBS’ social mission spending
included discounted services to hospitals, partially subsidizing
Michigan’s MIChild program for poor children and direct
charitable contributions.
The
new study comes after a study commissioned by a consortium
of insurers provided an estimate that the Blues receive
a tax break of more than $120 million, about $40 million
more than the Blues estimated.
The
Blues’ tax-exempt status is partly determined by a requirement
that the insurer provide insurance to all who request it.
BCBS rates must be approved by the state, unlike rates
for commercial carriers, which are essentially just filed
with the Office of Financial and Insurance Services.
House
Bill 5282 would allow BCBS to retain its tax break, while
shifting its sickest and most expensive subscribers to
a high-risk pool subsidized by a surcharge to all insurers
based on their market share. The Blues estimated their
market share at 61 percent.
Other
bills in the package would allow the Blues to expand the
types of insurance it is able to sell through its subsidiary,
the Accident Fund.
Other
insurers in the marketplace oppose the bills as anti-competitive
and likely to raises rates. Representatives from the Michigan
Association of Health Plans, which represents HMOs and
other managed care plans in the state testified in opposition
to the bills as did a the representative of a coalition
of insurers in the market. Others opposed to the bills
include AARP of Michigan, the Consumers Union and Michigan
Attorney General Mike Cox. Cox is scheduled to testify
Wednesday and has been the most outspoken critic of the
package, accusing the Blues of placing profits ahead of
its mission.
A large
portion of testimony focused on the 34 states that employ
a high risk pool. Joe Aoun, a Northville attorney speaking
for the Coalition for Access and Affordability in Michigan,
representing commercial insurers, said that states with
high-risk pools all require their Blue Cross plans to pay
state taxes.
Sen.
George repeatedly asked whether prohibiting what he called “re-underwriting,” meaning
raising rates upon renewal for those who become sick while
insured. Responses were hesitant, qualified and varied,
although most, when pinned down agreed it would.
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Keep
Heat On Senate For Anti-Smoking Bill
House
Bill 4163, which aims to ban smoking in nearly all public
workplaces—including bars and restaurants—faces
a tough road to move out of the remote
Senate Government Operations & Reform Committee. Senate
Majority Leader Mike Bishop (R-Rochester),
who also chairs the Committee, previously has said that
he favors leaving the decision to go smoke-free up to
business owners. This is why grassroots action in the
Senate is so important now.
KEEP
THE HEAT ON THE SENATE -
Use the MSMS Action Center (www.msms.org/action)
to send an electronic message to your state senator and
the Senate Majority Leader to support a healthier Michigan
by passing the workplace smoking ban.
If
the bill were to pass the Senate and be signed into law,
Michigan would join 31 other states that already have adopted
some form of workplace smoking ban. Also, it would give
Michigan one of the strongest smoke-free laws in the country.
MSMS,
the Campaign for Smokefree Air (CSA), and the American
Cancer Society support HB 4163, introduced by Rep.
Brenda Clack (D-Flint). Through its Future
of Medicine Wellness Work Group, MSMS is a member of the
CSA, along with the American Cancer Society and 240 other
organizations. For
more information or to join the CSA, visit www.makemiairsmokefree.org.
For
more information about state legislative advocacy, contact
Colin Ford at MSMS at 517-336-5737 or cford@msms.org. Or
visit www.msms.org/advocacy.
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MSMS
Supports Tanning Facility Regs
As
part of the 2008 MSMS Legislative Agenda (www.msms.org/legagenda)
and the Future of Medicine goals of wellness and prevention,
MSMS is supporting House Bill 4146, which addresses the
risks of indoor tanning in Michigan. The bill, introduced
by Rep. Frank Accavitti (D-Eastpointe), specifically would
require parental consent for anyone under 18, larger warning
signs in tanning facilities listing potential
health consequences, a signed informed consent form for
all customers, and licensing by the state. For more information,
visit www.msms.org/advocacy,
or contact Joshua Richmond at 517-336-5788 or jrichmond@msms.org.
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Learn
How 'VEBA Is Shifting Michigan's Gears'
MSMS will be one of the first organizations in the state
to host a multi-stakeholder event to discuss the new
Voluntary Employee Beneficiary Association (VEBA), the
health reimbursement arrangement created in the UAW agreements
that will place the UAW in charge of purchasing health
insurance for its members. On Thursday, April 3, from
1:00 to 4:00 p.m., MSMS will welcome physicians, administrators,
and other health care professionals to the Rock Financial
Showplace in Novi for a close look at VEBA. Speakers
will include Darcy Hitesman, Esq., Hitesman & Associates,
PA; Mark Gaffney, Michigan State AFL-CIO; Thomas Simmer,
MD, BCBSM; and others. To register, visit www.msms.org/eo or
call 517-336-5784.
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HHS
Secretary Seeks To Expand EHR
US Health
and Human Services Secretary Mike Leavitt proposed a $150
million incentives plan Jan. 31 to push doctors toward
adopting electronic medical records in their practices.
Leavitt told a crowd of 80 at Des Moines University that “electronic
records are key to improving patient care, cutting medical costs
and reducing errors,” according to a report in the Chicago Tribune.
The newspaper reported that he said, only 15 percent of physicians
at small practices have access to electronic medical records.
Leavitt said he envisions a system that eventually allows patients
to go online and research a physician's track record and costs.
Leavitt’s speech was part of a 40-city tour to outline a five-year
inititative that would pay incentives to doctors in smaller practices
who begin filing patients' health history electronically. He said
those who do so would get more Medicare money, though he did not
specify how much.
A dozen communities nationwide can apply to be in the pilot program.
Physicians would have to buy their own technology, with upfront costs
for implementing computer systems ranging from $20,000 to $40,000.
Leavitt said creating incentives for doctors to implement the technology
would help cover the cost of the investment.
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