Tag: connections

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National politics

Delving Into “Six Steps”

Joe Jarvis is a doctor and a candidate for the Utah legislature. I was very interested in exploring the six steps to bring about true health-care reform in Utah that he outlined in the Salt Lake Tribune. He has been kind enough to answer some of my questions and I want to share what I have learned from him and from digging into his sources.

Health underwriting

Every critically ill or injured person will be treated in our health system whether they have health insurance or not.

The realization that doctors and hospitals are obligated under the law to treat people in need should really change the way we look at the issue of universal coverage and the underwriting process. It deserves to be one of the areas we look at to make fundamental change to improve our health care system.

Unsafe hospital practices

Another cause of inefficiency in the system. Dr. Jarvis pointed me to studies by the Institute of Medicine demonstrating the statistical results of accidents and poor industry practices. (I say statistical to make it clear that the above link does not lead to grotesque images of hospital injuries.)

Inappropriate care

Inappropriate care seems to be the symbol of all that is wrong with our system. It appears to be a direct result of a medical industry that is being controlled by the insurance industry which is more interested in avoiding legal repercussions than in keeping people healthy

Perverse incentives

Dr. Jarvis quoted an article from the Wall Street Journal on April 5. I was unable to find that article to confirm the numbers he quoted (“if everyone in America went to the Mayo Clinic, our annual health-care bill would be 25 percent lower (more than $500 billion) and the average quality of care would improve.”) I did find an article from April 7th in the Wall Street Journal, More Choices Drive Cost of Health Care, that appeared to be the same except that it had different numbers ($50 billion saved over 5 years). (Follow the link here to see more than the free preview.) While I could not verify the numbers he quoted, the concept that we must eliminate the perverse incentives that drive the health care system is sound.

Market-based health policy

Dr. Jarvis argues that “health care is not subject to market forces, such as a lowered price increasing demand. No one ever had an appendectomy because the price was right. The occurrence of illness and injury primarily determine demand for health services.” While I would agree with him in the case of an appendectomy there are services (lasik, orthodontics, or well child checkups for example) where demand will rise as prices fall. Besides that, the WSJ article cited above indicates that many people, fueled by a “more is better” attitude, will indulge in available health services that are unnecessary. This would probably not be the case if they had to pay more than a token amount for those extra procedures. Also, at times when the patient is not the driving force behind extra procedures the findings are that

More office visits, hospital stays and diagnostic procedures likely indicate poor coordination among doctors and facilities that can lead to worse care and outcomes.

So far I am not convinced that real market forces do not have a significant role to play in radically improving our health care system.

Benefit denial

I had never previously considered the cost associated with claim denials, but Dr. Jarvis provided some eye opening data. In his article he stated that “Claims costs are at least 10 percent higher in Utah than would be optimally efficient.” He was gracious enough to allow me to look through the data he used to arrive at that figure and answer my questions to help me understand what I was seeing.

Here’s what I learned; the claims cost is the percentage of the insurance company’s revenue that is spent in evaluating and denying claims – it does not count the cost of claims paid, just the cost of processing the claims. The 10% figure is a bit misleading. Let me try to clarify the numbers. The most efficient insurance provider in Utah is apparently the Public Employees Health Plan (PEHP) which spends nearly 4% of revenue in processing claims. The data from the other major health insurance providers (IHC, Blue Cross, Altius, and UHC) shows that they spend between 12% and 19% of revenue on the processing of claims. To put that in perspective, PEHP spends 1 of every 25 dollars in claims processing while the other providers spend between 1 in 8 and 1 in 5 dollars. That is 3 to 5 times higher than optimal. It is a difference of 10% of their revenue but it is not evidence that they spend 1.1 times the optimal amount on claims processing.

Conclusion

Even where I do not fully agree with the details of Dr. Jarvis’ claims about these six steps I do agree that all six of these steps are important issues to address if we are to come up with a decent approach to improving health care in our state. I also agree wholeheartedly with Dr. Jarvis that the system requires a major overhaul, not just some tinkering if we are to avoid the looming crisis in the health care system.

Categories
politics

Spinning Our Wheels

I have been expressing my frustration in comments about the way the federal government seems to be doing little or nothing useful in the way of increasing our homeland security. At the same time, our president is demanding more leeway to ignore the protections guaranteed by the Constitution. I found a very good statement of what is happening from Glenden Brown in his post Problem Solving (again!).

. . . many people seem to believe that doing something is the same as solving problems. The thinking seems to be “If I’m taking action, I must be solving the problem.” Such thinking misleads people into frantic activity when confronted by a challenge, activity that as often as not accomplishes nothing other than keeping them busy.

That is a perfect explanation of how our legislative bodies work. When they identify an issue they rush to do something in an effort to ensure that they are not accused of laziness or neglect. With that kind of mentality it’s no wonder that government would be known for overreacting anytime they chose to do something about an issue.

Categories
politics State

A Novel Approach

As the clock starts in our efforts to reform out Utah health care system I was encouraged by this Op-Ed in the Salt Lake Tribune.

Making health insurance affordable – forcing carriers to offer so-called “affordable plans” – will not result in affordable health care. . . . our priority must be to restore the health-care provider/patient relationship by providing the patient with cost and performance information and making him responsible for his own care. The government does not tell its citizens what house, car or flat screen to buy, but there is an assumption that when it comes to choosing a health-care service, we are incapable of intelligent decision-making and need intermediaries.

Only when the patient is armed with relevant information regarding cost and a providers performance will that patient be able to make informed decisions. Armed with such information, a patient will shop quality and price, which will drive down costs. (emphasis added)

What I really love about this is that it comes from a completely unexpected source – this article was written by the executive director of the Utah Association of Health Underwriters. Along with her valuable diagnosis, Ms. Smith also offers this idea as a possible approach to explore:

For example, an insurance company might give the patient a benefit credit equivalent to the average price of a knee replacement surgery and the patient would shop around with the information given. Based on this data, he might choose a surgeon with a long record of solid outcomes and a lower price than the benefit credit his insurance has given him.

The insurance company could allow him to keep the change in his Health Savings Account for future health-care needs. This practice is already happening on a small scale in several areas where a hospital lists a global price for a heart bypass and gives a 90-day warranty. No extra charges for pain medication, Band Aids or physical therapy – all are included.

This does not require a mandate for our citizens, and might serve as an incentive to bring some people into the insurance pool. It also allows for comprehensive health insurance plans that keep the patient as the one making decisions about how the insurance money gets spent.

As if that was not enough, Cameron drew my attention to an Editorial in the Deseret News written by a doctor talking about how he improved his practice by dropping insurance plans. Though the article is not explicit on the point, it sounds like he eventually dropped all insurance plans and now only deals directly with patients.

{Many physicians} feel that it’s their mission to serve as many patients as possible rather than to provide the best care possible. Most significant, today’s doctors are preoccupied with the bureaucracy of insurance companies. . .

To be sure, physicians are not entirely to blame. With insurance companies dictating how much doctors can charge for services as diverse as a routine checkup or an appendectomy, a doctor has only one route to more income: increase volume.

Does anyone else want to help ensure that these perspectives do not go unnoticed by our illustrious task force?

Categories
Local meta politics State

Party Shenanigans

I would think that people who are politically involved enough to be elected as delegates and precinct chairs for the Republican party would want to be contacted by candidates so that they could choose who they would support. That is at odds with the assertion that the Utah County Republican Party promised not to give the emails of their delegates to the candidates. The water becomes extra murkey in light of the fact that there is evidence that some candidates do appear to have those email addresses. Kip Meacham has links about this as it develops plus his own experience as a precinct chair. The story is also being followed at Out of Context. This is definitely a case where people need to keep the issue in the public eye and put pressure on the party to not interfere with a fair political process – if some candidates have the email addresses then they should be released to all Republican candidates.

If delegates do not want to hear from candidates then they should not accept the position of being delegates – but I don’t think that’s what is happening here. If candidates want to try spamming the delegates to win the primary then I think the delegates are smart enough to vote against those candidates at the convention – but I don’t think that’s what’s really happening here either. Maybe it’s my own personal bias here, but this seems like exactly the type of thing I would expect from a party that has no significant opposition (meaning another solid party to counter them) which has grown accustomed to simply dictating who will come before the citizens on the ballot for their perfunctory approval.

I sure hope to see the Utah County Democrats grow to the point that they can regularly get their candidates elected – forcing the county Republican party to stop talking and start listening. We also need to see more active Republicans like Kip who will stand up to their party and say publicly that this is unacceptable.

Categories
politics

The Wide Middle

I just discovered The Wide Middle today and I think that the concept of “open source public policy” is an example of how more political discourse ought to take place – based on the assumption that we agree on more things than we disagree on and that we can find solutions where we identify problems. I hope that the discussion takes off – I certainly plan to contribute where I can.

Categories
culture politics

Liberal No More

What happens when a lifetime of experience gets processed in a period of introspection and begins to overwhelm a long held youthful idealism? David Mamet comes up with this:

What about the role of government? Well, in the abstract, coming from my time and background, I thought it was a rather good thing, but tallying up the ledger in those things which affect me and in those things I observe, I am hard-pressed to see an instance where the intervention of the government led to much beyond sorrow.

But if the government is not to intervene, how will we, mere human beings, work it all out?

I wondered and read, and it occurred to me that I knew the answer, and here it is: We just seem to. How do I know? From experience. I referred to my own—take away the director from the staged play and what do you get? Usually a diminution of strife, a shorter rehearsal period, and a better production.

The director, generally, does not cause strife, but his or her presence impels the actors to direct (and manufacture) claims designed to appeal to Authority—that is, to set aside the original goal (staging a play for the audience) and indulge in politics, the purpose of which may be to gain status and influence outside the ostensible goal of the endeavor.

Strand unacquainted bus travelers in the middle of the night, and what do you get? A lot of bad drama, and a shake-and-bake Mayflower Compact. Each, instantly, adds what he or she can to the solution. Why? Each wants, and in fact needs, to contribute—to throw into the pot what gifts each has in order to achieve the overall goal, as well as status in the new-formed community. And so they work it out.

There is so much more good stuff in this article. Thanks to David Boaz for citing this – he also has more worth reading on the subject. I just could not pass up that description of how central direction can often disrupt a system that it is meant to organize.

Categories
politics State

Proud To Pay My Share

I liked the sentiments expressed by Chad at UtahOpinions about paying a fair share for government. It’s easy to accuse those who advocate for smaller government of being stingy, selfish, or just not wanting to work for the best good of society, but many people feel like this:

Believe it or not I am proud to pay taxes to support our national interests (i.e. national security, immigration, roads, airports, etc.). But my pride ends there. . .

It is also a reminder to me why I joined the Republican party in the first place. As part of the Republican platform are these statements:

    • I BELIEVE government must practice fiscal responsibility and allow individuals to keep more of the money they earn.
    • I BELIEVE the proper role of government is to provide for the people only those critical functions that cannot be performed by individuals or private organizations and that the best government is that which governs least.
    • I BELIEVE the most effective, responsible and responsive government is government closest to the people.

Huh? You mean Republicans stand for these principles? Well, at least I know I do and I thought Republicans did.

Chad does a nice job of breaking down how much he’s paying in taxes for various government programs. Like Chad I’m proud to pay my fair share for government. I won’t go to any lengths to minimize my tax burden, I just take whatever deductions are simplest and that makes it easy for me to forget why most people find tax season such a headache – I do my taxes in a matter of two hours because I don’t do any financial contortions to reduce my tax burden.

That does not stop me from doing anything I can to remind my representatives that I’m looking for government to do as little for me as possible – I’d rather be responsible for my own success or failure without paying for a government safety net (with all it’s inflations of inefficiency) for everyone regardless of the legitimacy of their need.

Categories
National politics

No Good Delegate Answer for DNC

With the debate over the role of super-delegates and the delegates from Florida and Michigan in choosing their nominee, the Democratic Party finds itself in a no-win situation. Without the unpleasant idea that the super-delegates might have to publicly buck the democratic primary voters to give the nomination to Senator Clinton, we would not hear the Clinton Campaign calling to have the delegates in those states that she won (Clinton was the only major candidate on the ballot in Michigan) seated to make the race more level.

If the party chooses not to seat delegates from those states they open the door for Republicans to attack them for not backing up their “make every vote count” rhetoric.

If they do choose to seat delegates from Florida and Michigan they face a whole range of paths to bruise themselves. First – any delegate seating will undermine the authority of the party to affect the primary schedule (that power struggle is what started this whole mess). If they choose to accept that defeat they then have to choose how to seat the delegates. They can take the existing results and hear people cry fowl who chose not to vote, or who chose to vote in the Republican primary, based on the fact that their votes would not count in the selection of the Democratic nominee. If they chose to hold new primaries in those states they have to cover the costs or persuade the states to pay for a second election and they have to choose who to allow to participate. Michigan has open primaries so they run the risk of having people vote in their new primary who already voted in the Republican primary (the reverse of what Markos advocated as Michigan arrived). If they choose to limit their primaries in any way it can only be an arbitrary line.

Interestingly, if this same eternal nomination fight were happening in the GOP most of the problems outlined above would not exist because they chose to respond to the states that abandoned the party calendar by only stripping half their delegates so the original votes can stand and represent the votes taken without undermining party authority.

When I went searching for the Daily Kos link above, I thought it was funny to discover that Markos made many of the same arguments I just made on this issue. He recommends seating the delegates from both states and splitting them 50/50 between Obama and Clinton. Why don’t we just award an extra 200 delegates for each state that obeyed the party rules with the same 50/50 split condition while we’re at it? A 50/50 split is meaningless in deciding the nominee. It expands the pool of delegates, but adding 200 delegates to the delegate count of each candidate only means that there is a larger convention. Getting 1191 delegates to win the Republican nomination is just the same as getting 2025 delegates to win the Democratic nomination – the numbers may differ, but it all comes down to who gets 50% + 1. Besides that, the 50/50 split is unenforceable – either they have a choice, or they have no vote to cast. There’s no point in inflating the numbers to say “Welcome to the convention, check your seat for a number – odds vote for Clinton, evens vote for Obama.”

Categories
National politics

Mapping Politics

Thanks to the observations and perspective of Obi wan Liberali I think I can accurately place some political parties on my 2 dimensional political spectrum.

Labels on the Political Spectrum

Not only can I place the labels for our two major parties and some other political philosophies but I would also go on to say that the Republican party (GOP) started off approximately level with the Democratis party (DNC) vertically and that GOP party leadership seems to have been drifting downward. American society as a whole seems to have been drifting leftward – a trend which is also visible when looking at the GOP candidates. If left unchecked, these two forces would combine to land the GOP in the area of Fascism – though I don’t believe that it will be left unchecked.

The supposed breakup of the Reagan coalition is more like the abandonment of the Reagan position (somewhere near the intersection of the GOP, DNC and Libertarian positions on this spectrum) by the party that once represented that position, leaving most moderate members of that quadrant undecided on who to support.

Categories
politics

Political Spectrum

I liked the discussion over at KVNU’s For The People about how labels can be misleading regarding someone’s political philosophy. As always, there are quizzes to help someone figure out their own philosophy. KVNU linked to The Political Compass. Another popular one is Worlds Smallest Political Quiz.

I’ve seen both of them before, but it’s always interesting to see how I score on a particular day. As I took each test I was reminded about the biases inherent in one, and the frustration that I always feel because of the vague questions on the other. The other thing that caught my attention was the way that their scales are not directly compatible with each other. Here are my two scores from the same time today:

Political Compass ScoreWorlds Smallest Political Quiz Score

After looking at the results I wondered what it would take to accurately compare the two. So I did some manipulation.

Continue reading “Political Spectrum”