health insurance plan in michigan

The ACP Advocate Blog by Bob Doherty

• Twas the Night Before Christmas ...
  Twas the night before Christmas, and through DC town,
  The ladies were picking out their inaugural gowns
  And Detroit's "Big Three" had nary a care,
  Because all knew Obama soon would be there.
  
  Their CEOs would soon be snug in their beds,
  While visions of bail out danced in their heads.
  And I had just donned my New York Mets cap,
  To head home for dinner and a long winter's nap.
  
  When out on the Mall there arose such a clatter,
  I turned the corner to see what was the matter.
  Away past the Tidal Basin I flew like a flash,
  As fast as my middle aged legs were able to dash.
  
  The moon on the breast of the new-fallen snow,
  Gave the lustre of mid-day to objects below.
  When, what to my wondering eyes should appear,
  But Barack Obama and running mate Joe!
  
  With a teleprompter and oratory, so hopeful, not grim,
  I knew in a moment it could only be HIM.
  More rapid than eagles his coursers they came,
  Barack whistled, and shouted, and called them by name!
  
  "Now Rangel! Now, Pelosi! Now, Reid and Baucus!
  On, Teddy! On, Henry! On, Democratic caucus!
  Our time has come! We must get on the ball!
  We have money to spend! We must spend it all!"
  
  As dry leaves that before the wild hurricane fly,
  When they meet with an obstacle, mount to the sky.
  So up to the Capitol the coursers they flew,
  With a stimulus bill full of money, and Obama too!
  
  And then, in a twinkling, I heard on the roof,
  The prancing and pawing of each lobbyists' hoof.
  As I drew in my head, and was turning around,
  The lobbyists arrived with a leap and a bound!
  
  They were dressed in Brooks Brothers, from head to foot,
  All had arrived for their share of the loot.
  A wish list of projects they had in their grip,
  For the good of the people, they happily quipped!
  
  Barack's eyes twinkled! But he didn't seem so merry.
  His cheeks began to redden, a bit like a cherry!
  His gleaming smile turned to a frown,
  His demeanor headed decidedly down.
  
  The stump of a cigarette he held tight in his teeth,
  And the smoke it encircled his head like a wreath.
  (He had tried to quit but had to confess
  He resumed his bad habit because of the stress).
  
  All they want is money, he grumbled to himself,
  Who do they think I am, some jolly old elf?
  Still, the people need jobs, he thought in his head
  $850 billion should do it, he finally said.
  
  So he handed out his gifts to all who were near,
  to doctors and builders and road engineers!
  He then said goodbye with a twitch of his nose,
  (And the next day, even the Stock Market rose)!
  
  As he sprang to his limo, to his team gave a whistle,
  And away they all drove away like the down of a thistle.
  But I heard him exclaim, 'ere he drove out of sight,
  "Happy Christmas to all, and to all a good-night!"
  
  With apologies to Clement Clark Moore, I hope you enjoyed this Washington version of the famed verse I will now be taking a holiday hiatus, resuming with my blogging on January 5.
  
  No question to our readers today, just my best wishes to you and your loved ones for joyful holiday season and prosperous New Year! And I invite you to post your own holiday wishes to your fellow ACP Advocate readers.
• Say it ain't so ... CBO
  Last month, I blogged about the important role the Congressional Budget Office (CBO) will likely play in determining the fate of health care reform.
  
  I am reprising this topic because the CBO just released a 200 plus page report, on options to fund health care reform. But as Robert Pear writes in The New York Times, "many of the health care proposals championed by President-elect Barack Obama and other Democrats would carry a high price tag and would generate only modest savings."
  
  By and large, the CBO projects savings from proposals to cut payments to physicians and other "providers" or impose new mandates on them. Approaches that rely more on carrots than sticks to create positive incentives for change are assumed to increase spending.
  
  For instance, CBO says that paying for a medical home for chronically ill beneficiaries will increase Medicare expenditures by $2.1 billion over five years. It acknowledges that "the medical home concept has the potential to improve the health and health care of chronically ill Medicare beneficiaries" but "cannot estimate whether the net result ... would be to increase or decrease spending."
  
  Giving primary care physicians a 5% Medicare payment bonus for adopting health information technology will increase Medicare spending by $370 million, says CBO. But imposing a 5% pay cut (penalty) on all physicians who do not adopt health information technology (HIT) would save $65 million. Mandating that "providers" use HIT as a condition of participation in Medicare would save over $2 billion.
  
  When it comes to price cuts, CBO has no trouble projecting savings. Reduce fees to physicians in areas with unusually high spending? $4.9 billion saved. Cut Medicare pay rates for primary care physicians who do not meet benchmarks for vaccination? $530 million saved. These are just a few of the dozens of pay cuts CBO says will save money.
  
  The CBO does not make policy, and its new report is just a set of options, not recommendations. Still, my fear is that CBO report may make it easier for Congress to pay for health care reform through payment cuts and mandates on physicians and hospitals because the agency will "score" them as saving money.
  
  At the same time, the Patient-Centered Medical Home and other innovative delivery system reforms may not get the funding needed because CBO "cannot estimate whether the net result would be to increase or decrease spending."
  
  Today's question: How do you think ACP should respond to the CBO report?
• Is Obama's health reform plan a back door to single payer?
  The health plan touted by President-elect Obama during his campaign is not a single payer, Canadian-style, national health insurance plan. Yet, there are some who worry - and others fervently hope - that it will end up being the back door entry way to a single payer system.
  
  Let's begin by recounting all of the reasons why the Obama proposal is not a single payer plan.
  
  It doesn't eliminate private insurance, it subsidizes it. People who don't have access to affordable coverage through their employer would receive federal subsidies to buy coverage through a "National Health Insurance Exchange." The Exchange would allow people to choose from hundreds of different private health insurance plans, just like federal employees do. No one has to switch plans though; anyone who has private insurance through an employer, and likes it, could keep it.
  
  Obama proposes to mandate that people buy coverage for their children, opening up more business growth opportunities for the insurance industry. America's Health Insurance Plans (AHIP) has proposed to expand this to an "enforceable individual coverage mandate" for everyone, not just kids, to buy coverage.
  
  But the Obama plan also grows government's role. Obama proposes to expand enrollment in government-run (public) plans like Medicaid and the State Children's Health Insurance Program.
  
  And, in addition to giving subsidies to individuals to choose from hundreds of private insurers, he would give them the choice of enrolling in a public plan, similar to Medicare. Robert Pear reports in yesterday's New York Times that the public plan, according to HHS Secretary-designee Tom Daschle, would be "modeled after Medicare" and would have "tremendous clout to bargain for the lowest prices" from health care providers.
  
  AHIP argues that because of cost-shifting, the new proposed new public program could lead to higher costs for people who already had private insurance.
  
  The insurance industry's biggest concern is that the government plan will undercut private insurance. As a result, enrollment in the public plan would grow over time, while private insurance enrollment would contract.
  
  This - coupled with the planned expansion of Medicaid, SCHIP, and the inevitable growth of Medicare associated with an aging population - could get the country to a single payer system, or something close to it.
  
  It wouldn't be a single payer system created by legislative fiat, but one that comes from "competition" (fair or unfair as it may be) between private insurance and public coverage.
  
  ACP members who favor single payer will be encouraged by this scenario. Others, who distrust giving government so much control over health care, will view it with dismay and trep