The Alan Katz Health Care Reform Blog

Health Care Reform From One Person's Perspective

HHS’ Technology Problem Presents a Real Opportunity

Posted by Alan on March 27, 2010


Opportunities sometimes arrive unexpectedly, usually alongside a problem. Health care reform will be no different. A problem facing the Department of Health and Human Services in implementing  a standard database of health plans brings with it an opportunity to eliminate unnecessary spending in the current system and unleash a new wave of sales innovation.

As reported by Tony Romm, writing for The Hill’s technology blog, Hillicon Valley, in less than 60 days HHS must develop a “standardized format” to present health plan information to consumers. Roughly a month later, federal officials are supposed to launch a website providing this information to consumers on a state-by-state basis. In other words, HHS has until July 1st to build what the Hill calls “a central, online health insurance information hub.” The feds will maintain the insurance information site until the states implement their insurance exchanges in 2014.

90 days is not a lot of time to build a new high-tech tool, especially for a bureaucracy like HHS – a heavy-user of technology, but not a dedicated technology organization. But building the quoting engine is the least of their worries. The tough part of the job is be coming up with a way to feed disparate data into a single platform. And when it comes to how insurance companies present their rates and benefits, “disparate” understates the case.

Today health insurance companies are free to develop rate tables in any format they desire. They also have tremendous discretion in how they describe the benefits they offer and to some extent, what benefits they describe.The Babel-esque result is that providing apple-to-apple comparisons among carriers is an extremely labor intensive, subjective task. The idea of creating a standardized information hub is designed to bring some order to this chaos.

And, fortunately, HHS doesn’t have to start from scratch. Quoting systems are a highly-evolved, well-established technology (I’ve been involved in developing more than a few over the past few decades). Several companies have already built effective small group and/or individual quoting systems in use in multiple states. Some of the best known are Connecture, eHealthinsurance, HealthConnect, Norvax, and Quotit. These firms and their competitors already do what HHS is supposed to deliver: provide consumers and their brokers information about available health plans from multiple carriers using a single interface and presenting the carriers’ distinctive information in a common format.

HHS will be hard pressed to meet their tight deadline building a quoting system from scratch. Obtaining one from an established vendor is the only way they’ll deliver what the new health care reform law demands on time.

Enter opportunity. HHS is unlikely to simply lease a third-party quoting system. Instead they will buy a system. Then they will seek to make their purchase the industry standard. One way to do that would be to make the system open source – available for anyone and everyone to build upon.

The biggest operating cost incurred by quoting system providers like those mentioned is not building the quoting technology: it’s inputting and maintaining the rate and benefit information. Each company is required to translate the unique templates and descriptions used by the carriers into a standard format. From an industry point of view this is nonsensical, especially when one realizes the eventual result is pretty much the same: a report displaying carriers’ rates and benefits.

What’s happening with quoting insurance rates is reminiscent of what occurred in the auto industry when the government required them to deploy catalytic converters. Each car company spent many millions of dollars creating a proprietary device. Yet do you know anyone who has purchased a car based on the design of its catalytic converter? Think of how much automobile manufacturers would have saved if they’d come together to create a common device. This would have freed them to compete not on an invisible commodity built into every car, but on design, price, quality and a host of other more meaningful elements.

Similarly, the quoting system vendors are spending considerable sums taking the same information and translating it into their proprietary platforms. The arrival of standard formats and of open source programming will free them to devote their energies on building what truly differentiates them: the myriad products and services they’ve built around their proprietary quoting systems. It is the case management, marketing, HR, client-communication, and other applications with which they’ve surrounded their quoting systems that makes each one unique and adds value.

These are entrepreneurial companies we’re talking about. Dollars currently spent on translating carrier information into their proprietary platforms will be diverted toward creating new ways of helping brokers assist and support their clients. Meanwhile the standards will help carriers reduce their administrative costs. By making the quoting system architecture open source other entrepreneurs could enter the field, bringing their new approaches to the market.

The Department of Health and Human Services cannot duplicate in three months what these enterprises have spent years refining. Nor should they try. Instead, HHS should quickly pick one of the current systems and establish it as the industry standard.

Will this cost-saving opportunity change the world? No. But when it comes to wringing costs out of the health insurance system, any opportunity is welcome.

19 Responses to “HHS’ Technology Problem Presents a Real Opportunity”

  1. about 20 newspapers and blogs have published my suggestions as to medical care reform.
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  2. Douglas Thompson said

    A Government proposal for Change-Health Care Reform Act

    March 2010 may stand out as a monumental month for change with the Obama Administration-Americans can look forward to changes in the current health care system through the passing of the Health Care Reform Act. Though there are many details that need to be ironed out, there are many changes that have been established.

    There are two factors that will have the largest impact for Americans and America’s health brokers:
    1) The fact that as of 2014, it is required by law for employers to offer affordable health insurance plans to all employees.
    2) As of 2014, all Americans will be required to acquire health insurance.

    Employers-For businesses over 100 employees, there may not be many changes. The difference may be that part-time employees will be offered aid with a percentage of hours in relation to full-time employment. This will offer benefits to those who do not have that same opportunity currently as a part-time employee. With businesses under 100 employees, there will be opportunities for credits from the government to offer aid with those employees. A percentage will be paid, based on payroll that will pool to help those who acquire insurance through an exchange, where many of America’s health brokers will provide different affordable insurance plans for all individuals.
    What is the incentive for employers to offer insurance?
    Employers will face a fine of up to $2000 per employee for not providing insurance coverage to an individual employee. These fines can be diverted if the employer offers an alternative means to acquire insurance (which would require assistance through the exchange).
    Individuals-As of 2014, all Americans (with the exception of certain special case individuals) will be required to carry some form of insurance. Insurance will either be offered through employment or affordable insurance can be purchased through the exchange. America’s Health brokers will offer many new plans and opportunities to acquire cheap health insurance.
    What is the incentive for individuals to acquire insurance?
    According to the law, there will be a penalty assessed to all Americans who fail to acquire health insurance by the year 2014. The fine will be originally set at $695 per person, per year. This will hopefully be enough to encourage those who are not insured to carry some form of low cost health insurance.
    America’s health brokers will be seeing some changes that could affect them. Pre-existing conditions will no longer be applicable in denying insurance to children. As of 2014, America’s health brokers cannot deny health insurance to anyone due to a pre-existing condition. There are other factors that will change certain policies and conditions.
    The Health Care Reform Bill is an opportunity to reorganize the condition of care that is offered in the United States. There are many issues that riddle the care of many Americans, so hopefully this will provide solutions to some of the larger issues. One key aspect is the fact that all Americans will have the opportunity to have health care. This will be advantageous in many aspects: Prescription medications, preventative care, and treatment.

  3. Douglas Thompson said

    Health Care Reform Act-intent for Change

    For many years, America’s health brokers have been offering health insurance to individuals, small businesses and large businesses for decades, yet the enrollment statistics have revealed a steady decrease on an annual basis. The number of uninsured Americans is estimated to be as high as 30 million, and the Health Care Reform Act offers a solution. Not only will there be a higher enrollment number for America’s health brokers, but as of 2014, it will be required by law for every American to obtain health insurance. Every single American will be impacted by the New Health Reform Bill, making it one of the most important measures of the 21st Century.
    Businesses
    The main focus will be on businesses of 50 or more employees, in which they will be required to offer individual health plans, as well as family plans to all employees or face some stiff fines from the government. The amount comes to $2000 per uninsured employee, though there are exemptions to this fine. If you as an employer assist an individual with acquiring a personal health insurance plan through an open market called an exchange, then it would result in no fines. This only applies to an individual who makes a certain amount under the Federal Poverty Level, and the premiums are over 8% of his annual income.
    America’s health brokers can rest easy in the fact that there will be expanded coverage, though there may be more competition. With the rise in individuals who will have health insurance, there may not be as large of a risk as one may assume. Though the new bill will require America’s health brokers to enroll individuals with pre-existing conditions, there will also be a new population of young individuals who will be insured with fewer health problems.
    It is understood that larger companies already provide a group insurance plan (HMO, PPO) that covers all areas of needs for the population of employees. These policies will change very little, but there may be some changes in where the funding for the new health care plan will come. It is proposed that those making a certain amount of money, both individuals and couples, will be taxed at a higher percentage than others. This will provide money that can be used for the exchange and making sure that all individuals will be offered an affordable health plan.
    There are still a few years before the plan goes into full effect, though some of the measures will be enforced immediately. There will be plenty of time to sort out the details and iron out the difficulties. As for the plan, anyone who does not have health insurance as of January 1, 2014, will be penalized a certain amount of money, and this amount could become worse if health insurance is continuously neglected. There has never been a better opportunity for America’s health brokers in terms of acquiring a new customer base-a broader customer base. Also, there has never been a better time in history for individuals being provided with the resources for the necessary medical treatment. This is a very unique time, with history in the making. Finally, there will be health care for all.

  4. I just heard Barack Obama speak on the newly passed Health Care Bill (1:00 PM, PDT, give or take). Among his comments: “I looked at the sky and saw that it hadn’t fallen. I looked at the ground and saw that no cracks had opened up…” Our President then condemned the Media, other “Naysayers”, and just about all of those who have disagreed with his HCR battle since he began this “campaign”.

    I heard the man who wears the title “Our President”, but did not hear anything presidential. I would not be surprised to hear those comments from a CEO in industry (you name it). It is very disappointing to hear such divisive words from the “Leader of the Free World”.

    President Obama has among his “charges” the duty of attempting to end Partisanship in America, and to bring this country together. Instead, he is acting like a little boy in a schoolyard saying “I told ya so!”

    This speech just happened. I haven’t yet heard any pundits and their “After the speech” analysis.

    These jubilant, rebellious, “in your face” words will most certainly not bring this country together; in their strongly partisan bias they may just tear America further apart.

    What a shame, that the President lost a wonderful presidential moment, to help heal this country’s “divide”.

    • I just read this: “(CNN) – National Republicans praised President Obama Thursday and declared that he has “kept all his promises” and is “truly the greatest president ever.”

      No, this is not an episode of “The Twilight Zone.” It’s an April Fools Day joke from the National Republican Senatorial Committee.”
      – – – – – – – – – – –

      Oh, that’s really funny . Good grief, doesn’t the GOP know when to shut up? Disgraceful. No class. These two parties deserve each other.

      My Pesach (Passover) prayer is, “Dear God, please make the Democrats and the Republicans go away to a “Boot Camp” to learn how to work together like grown up adults this November, and please let the independents, moderates, and centrists win at the election polls so that they can work to bring this country back together. Amen.”

  5. James S. Thornton said

    Spencer, I am actually quite surprised on how much we agree on things. There are clearly quibbles we still have, but in terms of the Big Picture, my question is, why have we been arguing!

    I would love to see Medicare extended to lower ages, perhaps on a year by year basis, but my understanding is that the insurance industry did not like this idea because it would cut into their client base and ultimately lead to a single payer system, albeit one where those who could afford it could pay for additional supplemental insurance for things not covered by Medicare, or perhaps to lower wait times for certain elective procedures, or what have you.

    As far as the exchanges go, I did a little comparison shopping of different plans on my own, and I must say, the terms were all different, coverages different, HSA eligigility features, deductibles, different provider networks–just very, very hard to compare apples to oranges. I keep hearing over and again, find the plan that works best for you. But comparison shopping when each company uses different language and highlites different features and costs and benefits–you would need a supercomputer and software to run complex risk analysis scenarios to come close to knowing which plan is, in fact, best for you and your family. And even if you find such a plan, how can a consumer check on the strength of the company offering the plan?

    Some fed role in creating an apples to apples comparison, setting minimum coverage standards, and mandating solvency of the insurer so you don’t pay a policy for years only to find the money runs out when you need it…I do think some kind of oversight to make the process more consumer friendly is necessary.

    As far as illegal aliens go, we will have to agree to disagree here. We are all immigrants to this country; some of us got here while it was still just land by crossing the Bering Land Bridge during the Great Ice Age. Some of us came in waves of migration when certain favored ethnic groups were allowed in, and others were shunned. You mentioned Ship of Fools in an earlier post. If it had been within you power to sneak some of these people in illegally, perhaps you would have lent a hand. I know there are some Jews today, and non-Jews as well, who would have definitely done so.

    But beyond the moral argument that people in desperate straits will do what they can to help their families, there is the pragmatic argument. If 10 million illegals are in this country and denied all access to insurance, aren’t we just cutting off our nose to spite our face by preventing them the ability to buy into the exchange? Otherwise, if one of these people is hurt in a car wreck, of by some machine accident during fruit picking, or what have you, they will be taken to the hospital and their emergency care will be picked up by the tax payer. Wouldn’t we reduce our natl expenditure by have them pay into the system themselves and covering some of the expenses they might incur? Given the paranoia of deportation, I do not think they would abuse the system and draw attention to themselves.

    But these are not huge disagreements. For the most part, I think we are on the same basic side. I do think that people who no longer feel they can’t leave a company because of joblock may at last be free to start new businesses and stimulate the economy in new and unexpected ways.

    I am sure there will be unforeseen negative consequences to these first steps towards reform; but there are likely to be unforeseen positive consequences, too. I think that the Tea Partiers and those who are fund raising by fueling fears of Apocalypse are not doing the nation any good. I say, Buck up, try not to be so frightened by change, see if there is some good that can come of this that will make our country stronger and more unified than it has been in many many years. Perhaps I am corny, but I do think there are many Americans of different ethnic backgrounds who would truly enjoy and benefit from friendships that transcend race and religion, and that there is the potential for tremendous cross polinization of ideas that comes from fusing differences into novel approaches. You see this in music, comedy, fashion, and many of the most creative fields.

    I think anything that can get more of us to feel this a country that blesses us all will only make us more unified, stronger, and a more potent force for good in the world.

    • James,

      The insurance industry did cry in its beer about Medicare taking over the over 65 market. They have had this same complaint since 1965 It is fallacious. They have done extremely well marketing Medicare Supplements, which ostensibly, pick up the deductibles and co-payments Medicare requires. Actually, they do a very good job of picking up those “gaps”.

      While the Feds have dictated that Physicians cannot charge over 15% of the Medicare Allowable charge, Med Sups pick up that 15% leaving the Medicare Beneficiary with literally, not virtually, literally nothing to pay. The first day Hospital Deductible, and co-pays for 90 days of hospitalization, are covered. Long Term Care benefits suck. Medicare, and the new HCR Bill, shouldn’t attempt to cover even one day of long term care. Let the insurance companies handle that. I could expound more on this particular issue, but it would bore most and take too long.

      Regarding the Exchanges, your comments about them, and the confusion you see, it is for those reasons that we, the Agent Community, have a “reason d’etre”. We know and understand those issues, components, and the convoluted questions that can arise because of the intricacies about the exchanges, and we, the Agent Community, earn what we are paid by being experts in this field and advising our clients how they can best purchase coverage.

      I could address more, but at this point prefer that we continue discussing Illegal Aliens, and other issues when we can each elaborate to a larger extent. Suffice it to say at this point that my father, my aunts and uncles, my wife’s father (Filipino) and mother (Ukrainian), all immigrated here, legally. It was considered to be obscene, by all of them, for anyone to come here illegally. They struggled, worked hard, learned the language, and studied to become legal citizens. They always expected others to do the same. MY father escaped Hitler, in 1933, went to Perugia, Italy, learned Italian, and graduated highest in his class, three years later, for the University of Perugia, highest in his class. My father-in-law came here from Mindanao in 1953, learned to speak five languages fluently (Spanish, Tag-a-log, Russian, English, and Chinese), never asked anyone for a “handout”, and became a very successful man, manager of the largest farm labor camp in the country, for Giamarra Grapes, in the San Joaquin Valley. I know of no one who was given a “pass” because they wanted to better their lives. They simply earned it. It has already been shown that Illegal Aliens account for over 20% of our escalating Medical care costs. Enough. We cannot afford it. I DO NOT suggest that we harm the Illegals. I do suggest that we send them back to their country of origin, and let them apply for citizenship, and come here as must all others. I do believe that we should imprison all American Employers who pay Coyotes, or the Illegals themselves, to come here. They do so to enable themselves to pay “Slave Wages”. Let them be tried, and when found guilty, go to prison, with their businesses being sold and the profits put into a special fund to help educate those who apply for citizenship legally, and help them become citizens.

      James, the only reason I can think of for our arguing is that you have perceived me as being really “Dark Red”, and I you, “Dark Blue”. 🙂

      I’d much prefer our discussing things in a cohesive, conjoined manner, attempting to arrive at a common and agreeable result, than arguing. I think that we, and all others who are our “collegiate members” at this wonderful site, can achieve a great deal if we simply work together. 🙂

      We do live in what I consider to be, as do you, the greatest country on Earth. Let’s work together to make IT better.

      Your friend,

      Spence

  6. Nosedoc said

    Alan, once this system is up and running, we will all be able to compare state to state, identifying those with inadequate competition in the health insurance market? I’m sure the public would like to see statistics illustrating the percentage of market share in each state as well.

    • Hey there Doc,

      I’m also curious to know how many other states, as in Washington State, have, and have had for years, a Basic Health Plan for those who are not able to afford private market coverage, a High Risk Pool Plan being established by Obama Care, which already exits, and has for many years, for those who cannot qualify medically for other coverage because of serious pre-existing conditions (I.e. Cancer). Also, How many other states already have a Pre-Ex rule that requires that carriers accept a risk and cover that risk nine months after the effective date…we actually had a woman who bought Blue Cross after she became pregnant and canceled it after giving birth, telling BC that she thought they were great and would buy it again after she becomes pregnant, again. That’s when the state legislature tightened up the law. It was written up in the WSJ.

      Having rules such as this mandated to follow Federal Law is, IMO, a good thing, and I am 100% in favor of a mandate that requires that everyone MUST

    • Hey there Doc,

      I’m also curious to know how many other states, as in Washington State, have, and have had for years, a Basic Health Plan for those who are not able to afford private market coverage, a High Risk Pool Plan being established by Obama Care, which already exits, and has for many years, for those who cannot qualify medically for other coverage because of serious pre-existing conditions (I.e. Cancer). Also, How many other states already have a Pre-Ex rule that requires that carriers accept a risk and cover that risk nine months after the effective date…we actually had a woman who bought Blue Cross after she became pregnant and canceled it after giving birth, telling BC that she thought they were great and would buy it again after she becomes pregnant, again. That’s when the state legislature tightened up the law. It was written up in the WSJ.

      Having rules such as this mandated on a Federal Basis are a good thing as long as there is also a mandate that requires that everyone MUST purchase coverage, or sign up for whatever it is for which they qualify. It is the only method in which to insure that the Risk Pool stays “healthy”. There is much in this new HCR Bill that I do not agree should be there, I.e. a 40% tax on Cadillac Plans, any form of a Public Option, any method of Government administering any form of this coverage, except Medicare and Medicaid, and tax on the so-called “Rich”, who may be in an upper-income bracket today, but will not be in another 5 years ($200K isn’t “High Income”, not today. If the major income producer in a family earns $120K, and the spouse earns $80K, they just hit that bracket…that is not high income…certainly doing well, but “High”? Compared to the many earning $500K and more? Hardly. And if they are funding four children to go to college…zip…there goes a lot of that income).

      While I am 100% opposed to “stealing” money from Medicare to pay for over half of this Bill, hopefully, those kinds of foolish mistakes can be amended long before they are to take place.

      Those are a lot of questions and statements, but I think that they are important, especially in understanding why so many states (now 13) are suing the Feds for passing this bill without having given it far more thought and research. States Rights have been “messed with”. Nonetheless, we must now work with this Bill to make it better. So, thoughts?

      • Nosedoc said

        I’ve been saying from the beginning that the primary problem is the high cost of premiums, mainly a reflection of over-consumption of health care services and durable medical equipment, rather than the high number of uninsured. I share your sentiments about a mandate to purchase coverage and a tax on “Cadillac plans” which I don’t believe exist for small businesses,even though the amounts in premiums paid would frequently surpass the threshold (i.e, any plan with out-of-network benefits).

  7. G. Weightman said

    Is it possible that the choice of quoting system vendors has already been made? Check out the political connections of the eventual winner to find out.

  8. Underwriterguy said

    Picking a new air tanker will seem easy compared to picking a tech infrastructure in 90 days

  9. This appeared in today’s issue of the WA Post:
    – – – – – – – – – – – – – – – – – – – – – – – “Overall, 46 percent of those polled said they support the changes in the new law; 50 percent oppose them. That is virtually identical to the pre-vote split on the proposals and similar to the divide that has existed since last summer, when the country became sharply polarized over the president’s most ambitious domestic initiative.” http://www.washingtonpost.com/wp-dyn/content/article/2010/03/28/AR2010032804094.html?wpisrc=nl_headline
    – – – – – – – – – – – –
    The percentages vary a bit from pollster to pollster but the results are the same. The strong majority of the American electorate is not happy about this new law. Thus, any discussions that we have regarding the issue of “How do we move forward, in light of the fact that the law was passed WITHOUT the consensus of the voting public, should take this national discontent into consideration.

    This is not to imply that comments should be presented as angry or “told ya so”, but should address just how the law can be changed, modified, amended to accommodate and incorporate the wishes of at least the unquestionable majority of the electorate.

    • James Edward Hicks III said

      This is a democratically elected representative form of government. Polls are not elections and polls have a statistical error depending on the sample size. The poll numbers do not suggest a strong majority but barely a majority at best. The people will get a chance to change representation in November. Until then let’s try to keep this in perspective.

      • James Hicks,

        Please reread my post. The numbers do not lie, nor are they even slightly off. I am not suggesting that we ignore the law. I AM suggesting that we precisely keep things in perspective and consider that the majority of Americans do not agree with this law in our progressing to alter those sections of the law that aren’t popular with the Majority.

        Unless your numbers (from where I cannot imagine) demonstrate that Rasmussen, Gallup, the Washington Post, CNN, MSNBC, and others have been falsely presented, please, let’s keep this discussion civil, as the previous Topic clearly suggests, and not belittle anyone presentations as long as they are accurate.

        You may not like polls. I think that they are valuable, and I won’t go into a soliloquy about how Congress voted this through on a strictly razor thin edge of party line only votes (with a number of Democrats voting against this bill) unless you feel that you must push the issue. And Puleeze, don’t give me that November and change crap, Mr. Hicks. I’ve been listening to that “line” for over 44 years. It rarely actually happens. Civics Class never told the truth, and I have 40 years of working in politics to back that up. I can be a very courteous and balanced debater, and a tough person with whom to simply attempt to intimidate. So, let’s not play that game. Please, Sir, do not make this personal.

        You seem to be too quick on the trigger to want to discredit others’ accurate comments. What is the point of doing so? Or, do you simply wish all others to think as do you? Please, you cannot alter, nor minimize facts. So, let’s attempt to work together. You don’t make light of my comments, and I won’t make light of yours.

        • James S. Thornton said

          Which features of the health reform act do you believe are the most unpopular?

          Are there features that you believe a majority of the public would like to keep?

          Do you think the popularity of the act as a whole will remain mired in its current state of 50 percent against, 46 percent for, over the long term, or do you think these numbers could change significantly in either direction before November?

          Do you think if, by some unusual circumstances, enough Democrats are thrown out of office in November, there will be enough of a shift in power to override a veto by President Obama?

          Or do you favor trying to get the act ruled unconstitutional by appeals to the Supreme Court?

          If the healthcare reform is somehow repealed, by one means or another, what do you propose replacing it with, and what do you think the odds are that this would prove significantly better and/or more accepted by the population?

          What do you think the odds would be that Congress, having spent so much time on this over the past 100 years, would opt to punt it down the road for a while longer, perhaps a decade or so. Would the preservation of the pre-reform landscape, in your opinion, leave our country better or worse off than before?

          How do you personally feel about the fact that the Kaiser Family Foundation (one of Alan’s many fascinating links) revealed that the top 1 percent of earners in our country consumer 22.9 percent of every health care dollar spent in the country (*data from 2006) whereas the bottom 50 percent divide amongst themselves 3 percent of the total expenditures.

          I don’t mean to sound incendiary here with terms like economic justice, but from a purely pragmatic point of view, do you think it is good for a society to encourage a widening stratification in economic classes? I think if you were to look at the social class that is doing most of the fighting in Iraq and Afghanistan for the rest of us, you would see a relative paucity of men and women from the upper crust, at least outside the officer’s ranks.

          I am interested in your opinion on these questions if you are interested in answering them. Thanks.

        • James,

          I’ll answer these after each one, denoted by a bracket an asterisk [*…].

          Which features of the health reform act do you believe are the most unpopular? [ * Medicare funding reduced by $500Billion. Inclusion of any long term care benefits. 40% penalty tax on plans with higher benefits. The taxing level of those considered to have higher income, already $50K higher than the figure used for many months. The keeping of the back-room, deals (Big Pharma, AMA, The Unions, The Cornhusker deal, Louisiana purchase, and other such “bribes”. The Health Insurance Exchanges may be a major problem if the Government intends to rate and/or administrate them. The Public has little to no faith in the Feds managing anything; witness Medicare, Medicaid, Social Security, VA Hospitals…there has been a plethora of negative articles written about these failed systems, they don’t want to see another failed government system destroy the Exchanges. Their needs to be a Public/Private Partnership to give some assurance that they will work. There are others, but those come to mind quickly.]

          Are there features that you believe a majority of the public would like to keep? [*Absolutely, including me. Guaranteed issue, no Pre-X disqualification, and the inclusion of the mandate that all must purchase or enroll in whatever plan they can afford and for which they can qualify. The mandate to purchase will help counter the negative effects of GI and no Pre-X by enlarging, substantially, the Risk Pool. No Cancellations or Rescissions due to claims history. Again, there are others, but these come to mind at the top of the list.]

          Do you think the popularity of the act as a whole will remain mired in its current state of 50 percent against, 46 percent for, over the long term, or do you think these numbers could change significantly in either direction before November? [* I expect to see some significant changes to components of the law, specifically those just mentioned, and that should ease the concerns of many. If those changes, improvements, are made sooner than later I expect to see those numbers change to the positive.]

          Do you think if, by some unusual circumstances, enough Democrats are thrown out of office in November, there will be enough of a shift in power to override a veto by President Obama? [*No. I expect to see some changes, and to see more seats that are up for grabs go to Republicans, but not in a wholesale manner, nor would I applaud such a move. The balance, IMO, must be close enough to maintain “equity”. It should be close enough to assure to a greater degree that the American electorate is properly represented. I would not cry if Nancy Pelosi, Harry Reid, Barney Frank, Christopher Dodd, or Charlie Rangel never saw Public Office again…that said, losing Rangel, Dodd, Reid, and Pelosi would be great. I do NOT expect to see Pelosi looking for work. She represents a district in California that is likely to reelect her. Oh, and there are a number of Republicans I’d like to see not “rehired” as well.]

          Or do you favor trying to get the act ruled unconstitutional by appeals to the Supreme Court? [*I think that move is up to the individual states. I have enough understanding of constitutional law to be considered dangerous. Should the Supremes rule the act unconstitutional, we go back to the drawing board, Fine by me. Should it not be ruled unconstitutional, Fine by me. We continue the now onerous job of amending the act. I don’t see any real gains, frankly, and after all of the time and money spent on this “push”, we’ll probably be better off to now attempt to fix what needs fixing, rather than toss the whole thing.]

          If the healthcare reform is somehow repealed, by one means or another, what do you propose replacing it with, and what do you think the odds are that this would prove significantly better and/or more accepted by the population? [*Very interesting question. My “druthers” would be to see a full expansion of Medicare to include all ages, with a mandate that everyone, EVERYONE, must be covered. Additional coverage should be made available (as it is now, though I’d allow a greater range of choices) through the private sector. Medicare has been our socialized program of choice since 1965. It should be strengthened, fixed, and should cover everyone. The private market has a lot of room “to play”, and it could offer a win-win situation. My personal opinion, only, though I do know that a number of my colleagues feel as do I. Carrying Long Term Care insurance should be a mandate as well…our long term care delivery and funding system is now approaching $250 Billion per year. Only 10% of the public has bothered to purchase any of the excellent plans available, and its inclusion in the Health Care Reform Bill is a joke. It’s laughable. Long term care insurance should continue to be offered as a private sector offering, and the actuarials need to be far more realistic. A mandate to purchase will greatly grow the risk pool and result in lower premiums.]

          What do you think the odds would be that Congress, having spent so much time on this over the past 100 years, would opt to punt it down the road for a while longer, perhaps a decade or so. Would the preservation of the pre-reform landscape, in your opinion, leave our country better or worse off than before? [* Worse off. But, then, I’ve been saying that since the beginning. The insurance companies should have had their legs broken years ago for rating a group based on the claims history of an individual or two. Denying benefits for a pre-x, rescinding a policy, etc. The problem is that while we had no hesitation to mandate that all drivers carry auto insurance, we have not required that all persons carry health insurance, as the risk pool has been far too low to afford the “money-in, money out” dynamics, which greatly harms the risk pool needed to balance money in claims out. To have one work, the other must be working as well. I have always been a strong advocate for major Insurance Reform. I represent my clients…the insurance consuming public, not the companies. The companies would like to cut all agents out of the distribution system, if they could. They THINK they’d make more money. They wouldn’t. They need us to educate, and market these products to the public. The public does not trust the companies, they trust their agent. Insurance Reform is way passed due.]

          How do you personally feel about the fact that the Kaiser Family Foundation (one of Alan’s many fascinating links) revealed that the top 1 percent of earners in our country consumer 22.9 percent of every health care dollar spent in the country (*data from 2006) whereas the bottom 50 percent divide amongst themselves 3 percent of the total expenditures. [*I’m not surprised. The upper half can afford the extra care. The poor cannot. How do I feel about it philosophically? I was raised to believe that those who can excel should, will gain more, AND can then help those who cannot help themselves. It’s how I’ve lived my life. I do NOT believe that Illegal Aliens should be granted a single cent in any entitlement from a country that they have illegally entered. It is a ludicrous concept. As is the lack of prosecuting and imprisoning those jerks when they are found guilty, the American Employers who break the law and engage in “the slave trade” by hiring coyotes to bring them Illegal aliens, or hire the Illegals directly themselves.]

          I don’t mean to sound incendiary here with terms like economic justice, but from a purely pragmatic point of view, do you think it is good for a society to encourage a widening stratification in economic classes? I think if you were to look at the social class that is doing most of the fighting in Iraq and Afghanistan for the rest of us, you would see a relative paucity of men and women from the upper crust, at least outside the officer’s ranks. [ * Which is why I am a very strong believer in our reinstating the Draft, as they have in Israel and Switzerland. No one gets a free ride in those, and a multitude of other “Free-World” countries, and they shouldn’t get a free-ride here.]

          I am interested in your opinion on these questions if you are interested in answering them. Thanks. [ * I’ve tried my best in a “relatively” short amount of time and space. Were I to elaborate on those items mentioned, and add the others that are also important, we’d have some reading material that would equal at least a quarter of the recently passed HCR Bill.]

          James, I would now be interested in your responses.

          Spence

  10. Meg McComb said

    You have the same questions I do. I can’t answer them, so perhaps Alan or other readers help shed some light? Per previous post, my goal is to understand enough so that I can help my insurance clients through the changes.

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