health


THE MICHIGAN CHRONICLE


healthcare reform: a thought experiment


Saving the ‘good’ in the lever, and watch $6 million in medi- cal services pour out.


By Jane M. Orient, M.D., http://www.aapsonline.org/


Some have suggested piece-


meal repeal of the most obnox- ious features of the Affordable Care Act (ACA). The risk of this approach is comparable to that in cancer surgery: you might not get it all. In 906 pages of arcane statutory lan- guage, a lot can be hidden.


I suggest instead that we


wipe the slate clean with a total repeal, and then con- sider reenacting any features that most agree are good. This would be the most efficient method because the list of items is shorter. Much short- er.


The most popular part is


probably the elimination of “pre-existings.” You can’t eliminate the uninsurable condition of course, only the insurance company’s abil- ity to deny coverage to people who have it. How would such an isolated law work?


In a free market, coverage


for people with pre-existings might well be available, with- out any law — if insurers could simply charge a premium re- flecting their risk, or limit the potential payout. The premi- um, naturally, could be very high. That would be a strong incentive to buy insurance when young and healthy, and resist temptations to spend the premium money on iPods and new cars instead. But for many it is already too late.


The U.S. already has the


equivalent of fire insurance for those whose house is burning down. It is called Medicaid. Roll into the emergency room desperately ill and the hospi- tal will treat you, and probably enroll you in Medicaid — likely after you have spent through any assets and lost your SUV and your home.


To prevent such personal


tragedies, how about a law that simply said: “Insurance com- panies must take all comers, without price discrimination for pre-existing conditions.” This is called “guaranteed issue” and “community rating” (GI/CR).


GI/CR would work well,


if insurance were a magical money multiplier (MMM): put $100 in the slot machine, pull


Quality Home Health Care Services of Michigan hosts diabetes event


Thanksgiving and the rest


of the holiday season are right around the corner. For many, that means time for family, friends and good food. But for more than 7 percent of Michigan’s population, deli- cious holiday fare are nothing more than table decorations. For more than half a million people, indulging in holiday staples could make them sick.


November is American Dia-


betes Month. As this honor- ary time falls during the holi- day season, it is especially important to educate our- selves and our families on the importance of adhering to the dietary needs of those with diabetes.


On Monday and Tuesday,


Nov. 22-23, Quality Home Health Care Services of Michi- gan hosted two consecutive installments of “I’m Diabetic… Pass the Pumpkin Pie” at the Northwest Activities Center in Detroit and the Warren Parks and Recreation Building in Warren, respectively. Each day, from 2 to 4 p.m., attend- ees enjoyed a free slice of diabetes-friendly pumpkin pie while a QHHC dietitian pro- vided nutrition tips and an- swered questions about ways to adapt popular holiday food items for those with the dis- ease. A representative from Great Lakes Medical Supply was also on hand to discuss additional


diabetes-related


issues and concerns. Free hypertension and blood sugar screenings were provided, and each participant also received free diabetes-friendly recipe cards.


For more information,


please call Quality Home Health Care Services of Michi- gan at (866) 270-2558.


Paid Actor Portrayal


The problem is that if a lot of healthy people who don’t


expect to need medical ser- vices decline to feed in their premiums, knowing they can always do so as soon as they get sick, premiums will have to escalate rapidly. This is called adverse selection (only sick people sign up), or the death spiral. It has happened every time GI/CR has been tried.


This popular part of ACA is


impossible without the hated and unconstitutional individu- al and employer mandates.


What about doing away with


limits on lifetime coverage? Limiting out-of-pocket expen- ditures? Doing away with co- payments? All of these have the same problem: lack of an MMM, such as a money tree or the Philosopher’s Stone that


turns base metal into gold. The more we require insurance to pay out, the more money has to be poured in, with the in- evitable loss to administrative overhead.


How about “giving doctors


incentives to be more effi- cient”? In a free market, that is called the profit motive. In the ACA, the “incentives” are sticks painted to look like carrots, involving vast new reporting systems, with pay- ments funneled through man- aged-care mechanisms. The choice is freedom — or ACA bureaucracies. Which of the some 159 new bureaucracies do we want to keep?


What about “affordability”


provisions? Since prices are going up, in ACA “affordable” means forcing someone else to pay. It’s a matter of redis- tributing money from those who earn more than 400 per-


cent of the federal poverty level (around $88,000) to those who earn less. Americans are di- vided into winners and losers, guaranteeing constant fights over one’s share of a shrink-


ing pie. One part everyone might


favor is the one about allowing people to keep their insurance plan and their doctor if they


like them. Oh, that’s not in the bill.


That was just a presidential promise. The ACA has rules for “grandfathering” some plans — a good term since they are not expected to have a long life expectancy. ACA also appears to be designed to drive independent doctors out of practice, and it virtually out- laws new doctor-owned hospi- tals.


If we continue to scour


through the ACA looking for isolated good points that will make things better or less costly, rather than worse and more expensive, I predict that our thought experiment will lead to what in mathematics is called the “null set.”


So far I have found no such


provisions. Reach Dr. Jane M. Orient at


http://www.aapsonline.org/.


November 24-30, 2010


Page C-8


I feel much better knowing that


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†Based on Medicare’s Plan Quality and Performance Rating 2009 Survey conducted by the federal Medicare program (2008-2009).


HAP Senior Plus (HMO), HAP Senior Plus (HMO-POS) and Alliance Medicare PPO are health plans with a Medicare contract. Alliance Medicare Rx (PDP) is a stand-alone Prescription Drug Plan with a Medicare contract. Alliance Medicare Rx (PDP), Alliance Medicare Supplement and Alliance Medicare PPO are products of Alliance Health and Life Insurance Company, a wholly owned subsidiary of Health Alliance Plan. Alliance Medicare Supplement is not connected with or endorsed by the U.S. government or the federal Medicare program.


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