Healthcare Town Hall

• The CBO’s premium impact estimate has motivated various press coverage, including some skepticism and some comparison to previously-released research.
• New research indicates that the U.S. healthcare system absorbed $36.4 billion in uncompensated care during 2008.
• We’ve talked before about anachronisms in healthcare; this historical view of healthcare reform adds another layer.
• Another CBO analysis looks at the effect of the stimulus bill (we have discussed previously the kind of downstream impact we might see from the American Recovery and Reinvestment Act…for example, we’re just getting started on EHR).

Reform Bob Dobson, EHR, John Pickering, Will Fox

We’re seeing lots of concern over the fate of reform (with some questioning if it is even reform we’re attempting). Analysts are viewing the delay as a silver lining, a tactical opportunity, or even a welcome timeout. Whatever your perspective, there is surely more to come.

One of the reform priorities that has not yet been fully fleshed out has to do with cost—how do we pay for reform, and how do we bend the cost curve over time. What people sometimes forget is that the rate of cost increase has decreased in the last three years (though unfortunately a decline in the cost trend still leaves us with hefty increases in terms of total dollars). Meanwhile there are plenty of good ideas for continuing to bend the curve in a more affordable direction.

Here’s one. Milliman principal John Pickering has developed a new approach to insurance design—market-based insurance design—that brings price competition to providers.

Consumerism, Cost, Reform John Pickering, market-based insurance design

Milliman experts and their research are increasingly a part of Congressional discussions of healthcare reform. On Tuesday, AHIP President and CEO Karen Ignagni cited research by Will Fox and John Pickering in her testimony before the Senate Health, Education, Labor and Pensions Committee:

A December 2008 study by Milliman, Inc. projects that this cost shifting essentially imposes a surtax of $88.8 billion annually on privately insured patients, increasing their hospital and physician costs by 15 percent. This study concluded that annual health care spending for an average family of four is $1,788 higher than it would be if all payers paid equivalent rates to hospitals and physicians. The transfer of these costs to those with private coverage cannot be sustained and is critical to addressing concerns over affordability.

Read more…

Cost, Fragmented system, Government, Long Term Care, Reform Bruce Pyenson, Congress, cost shift, John Pickering, Kate Fitch, Long Term Care, Susan Pantely, Will Fox

Milliman Principal John Pickering testified before the House Ways and Means Committee on Wednesday about cost shifting and other healthcare reform issues. Here is an excerpt involving John, North Dakota Congressman Earl Pomeroy, and Commonwealth Fund President Dr. Karen Davis.

You can view the full transcript of John’s testimony on the Ways and Means Committee website.

Electronic Health Records, Fragmented system, Reform Commonwealth Fund, Earl Pomeroy, John Pickering, Karen Davis

Milliman principal John Pickering was quoted by CNN Money today in an article about how the underinsured are affecting the cost of healthcare for all Americans. In John’s words:

“If the underinsured can’t pay the bills, the hospital either writes it off as bad debt or shifts the cost to its charity care program,” said John Pickering, principal and consulting actuary with consulting firm Milliman Inc.

“It’s a vicious cycle,” said Pickering.

John and fellow Milliman principal Will Fox have conducted key analysis for AHIP on the shifting of costs across the healthcare system.

Underinsured AHIP, CNN, John Pickering, Underinsured