Advancing transparency in healthcare: A call to action

by former Sens. Bill Frist (R-Tenn.) and Tom Daschle (D-S.D.)
The Hill- 06/12/15

How much does health care cost?” It isn’t an easy question to answer. Your yearly check-up, a colonoscopy, or trip to the emergency room doesn’t typically come with an obvious price tag. And it isn’t just finding out the price of a service or product that’s difficult; it’s also difficult to determine the quality of the care provided. In fact, Princeton Economics professor Uwe Reinhardt has likened “shopping” for healthcare to trying to find a purple sweater in a department store while blindfolded.

Greater transparency and access to information about the prices and quality of health care would be beneficial to consumers, providers, policymakers, and stakeholders alike. To achieve the Triple Aim of better population health, an improved health care system, and a lower rate of cost and spending growth, we must take the blindfold off.

We think the following steps are necessary to spur the movement to greater transparency.


New Evidence Health Spending Is Growing Faster Again

The Wall Street Journal, Washington Wire, Jun 11, 2015
Think Tank
by Drew Altman

Like Californians waiting for the record drought to lift, health cost watchers like me have been waiting for health spending to begin to grow more rapidly again as the economy strengthens. It looks like that may now be beginning to occur.

The U.S. Census Bureau has published new estimates of health spending based on their somewhat obscure but important Quarterly Services Survey. Analysis of the survey data shows that health spending was 7.3% higher in the first quarter of 2015 than in the first quarter of last year. Hospital spending increased 9.2%. Greater use of health services as well as more people covered by the ACA appear to be responsible for most of the increase. People are beginning to use more physician and outpatient services again as the economy improves. The number of days people spent in hospitals also rose.

Overall, as the chart above shows, the increase was much larger in first quarter of 2015 than in the first quarters of 2014 or 2013.


Free market ideology doesn't work for health care

Costs imposed by 'medical industrial complex' defy reason

by Wendell Potter
Center for Public Integrity, Commentary, June 8, 2015

In my column last week I suggested that one of the reasons Americans tolerate paying so much more for health care than citizens of any other country — and getting less to show for it — is our gullibility. We’ve been far too willing to believe the self-serving propaganda we’ve been fed for decades by health insurers and pharmaceutical companies and every other part of the medical-industrial complex, a term New England Journal of Medicine editor Arnold Relman coined 35 years ago to describe the uniquely American health care system.

One of the other reasons we tolerate unreasonably high health care costs is gullibility’s close and symbiotic relative: blind adherence to ideology.  By this I mean the belief that the free market — the invisible hand Adam Smith wrote about more than two centuries ago and that many Americans hold as a nonnegotiable tenet of faith — can work as well in health care as it can in other sectors of the economy.

While the free market is alive and well in the world’s other developed countries, leaders in every one of them, including conservatives, decided years ago that health care is different, that letting the unfettered invisible hand work its magic in health care not only doesn’t create the unintended social benefits Smith wrote about, it all too often creates unintended, seemingly intractable, social problems.


Letter to Senator Rod Monroe

from Benjamin Gerritz, HCAO Vice-President

June 5, 2015

Honorable Senator, 

I am writing you to urge you to support HB2828 for a healthy Oregon.  

As a lifelong Oregonian and your constituent, I take great pride living in a state where our legislation is known for propelling our country forward.  This was true with the passage of the Motor Voter Bill this session.  I appreciate your leadership in passing this important Bill and I am asking you to continue to exercise leadership through passing HB2828 funding the Bill with $400,000.  

This Bill will help bolster common sense solutions for making Oregon's healthcare more accessible and cost effective.  It is a sound approach given our current growth in healthcare expenditures is simply not sustainable.  Too many Oregonians are struggling with paying rent let alone the high costs of insurance premiums and copays when they get sick.  This is translating to people avoiding care which we pay a fortune for in the end with unnecessary emergency room visits.  HB2828 is a common sense opportunity to create a healthier Oregon.  A healthier Oregon increases productivity.  Increased productivity supports a thriving economy.   

Funding this Bill not only makes sense in terms of Oregonian's health, it will also benefit local businesses.  Our current approach to health care makes it challenging for our business community to project budgets with costs continually fluctuating.  This makes it difficult to allocate additional dollars for economic opportunities.  HB2828 would produce solutions for resolving this so employers could put more money into creating jobs.

Studies of healthcare financing conducted in other states have demonstrated that high quality care could be offered to people at a cost savings of $1,000/yr.  For Oregon, this would mean $4 Billion in annual savings.  A large amount of money that could help significantly with funding for our schools.  

I understand that balancing our state's budget can be challenging.  Tough decisions have to be made about where funds ought to be allocated.  In making these decisions, I hope our Oregon continues to move our state forward for our people and our economy.  Passing and funding HB2828 at $400,000 will produce solutions for our state's healthcare while bolstering our revenue and leading to the creation of new and needed jobs.  

Thank you for your time and I look forward to expressing my appreciation for your yes vote on HB2828.

Solidarity Always,

Critics fear Trillium sale to Centene Corp. will hurt Lane County patients on Oregon Health Plan

Centene agrees to buy the parent firm of the operator of the Oregon Health Plan in Lane County for at least $80 million

by Sherri Buri McDonald
The Register-Guard, JUNE 5, 2015

Running the taxpayer-funded Oregon Health Plan in Lane County has become highly profitable for a private doctor-owned Eugene company, and critics worry that the Fortune 500 corporation that wants to buy the Eugene firm will squeeze out even more profits at the expense of tens of thousands of OHP clients, newly released documents show.

Centene Corp. has agreed to buy Eugene-based Agate Resources, the doctor-owned parent of Trillium Community Health Plan, for $80 million to $130 million, according to state documents released Thursday in response to a public records request by The Register-Guard.

The state has blacked out the identities of Agate’s 217 individual owners and the payouts they would receive if a sale went through. But the combined payout to the owners would be an estimated $128 million, according to the documents.

Dr. Thomas Wuest, president of Slocum Orthopedics & Sports Medicine in Eugene, is president of Agate Resources and of Trillium, according to filings with the state Corporation Division.

The state Insurance Division is deciding whether to approve the sale, which would be the first instance of an out-of-state company buying one of Oregon’s 16 Coordinated Care Organizations, or CCOs. The CCOs administer OHP, the state’s health insurance plan for low-income residents, in their respective territories.

Ten of the 16 are for-profit companies, and the rest are nonprofit, said Stephanie Tripp, an Oregon Health Authority spokeswoman.

Trillium has been the CCO in Lane County since 2012 and now manages health care for 100,000 clients of the Oregon Health Plan — the state’s version of Medicaid.

Twenty-five to 30 percent of Lane County residents are on OHP, Trillium CEO Terry Coplin said.

As Trillium’s caseload has swelled, so have its revenues and profits.


NY Assembly passes bill to create universal health coverage

by The Associated Press , May 27, 2015

ALBANY, N.Y. (AP) — The New York Assembly has voted 89-47 for legislation to establish publicly funded universal health coverage in a so-called single payer system.

All New Yorkers could enroll if the bill became law, but an identical bill hasn't advanced in the state Senate.

With no patient premiums, deductibles or co-payments for hospital and doctor visits, testing, drugs or other care, New York Health would pay providers through collectively negotiated rates.

It would take insurers out of the mix, funded instead through a progressive payroll tax paid 80 percent by employers and 20 percent by employees.

Waivers would be sought so federal funds now received for New Yorkers in Medicare, Medicaid and Child Health Plus would apply.

Assemblyman Richard Gottfried, chief sponsor, predicts it would save New Yorkers more than $45 billion annually.

Assembly Republicans doubt that estimate.