CMA Capitol Insight is a biweekly column by veteran journalist Greg Lucas, reporting on the inner workings of the state Legislature.
The Health Benefit Exchange…
(…To restate the obvious) has a huge impact on how California weathers what is routinely called federal health care ”reform.” It’s been said here before, but “reform,” like any number of other words, is in the eye of the beholder. So what can boringly – although accurately – be said is that the exchange has the final word on what form the implementation of the Patient Protection and Affordable Care Act takes in California. A visit to the exchange’s website is illuminating. Less than 22 months from now, the exchange’s five-member board will select various health plans – there’s already a list of 10 potentials – that small businesses and individuals can select. As a result, the exchange says, it will “increase the number of insured Californians, improve health care quality, lower costs and reduce health disparities through an innovative, competitive marketplace that empowers consumers to choose the health plan and providers that give them the best value.” Quite the promise.
More Exchange on the Exchange
Staff of the California Medical Association attend every meeting of the Exchange – and they would want a plug here on the appropriateness of hazard pay for such duty. Their reports are far more informative, but the most recent post on the Exchange’s website is a letter sent by the Exchange and several state departments including the California departments of Insurance, Health Care Services and Managed Health Care (Is there a department of “unmanaged health care?”) to the Honorable Kathleen Sebelius, Secretary of the U.S. Department of Health and Human Services.
Opening the Envelope
In polite government-ese, the Exchange and the other affected departments say in their letter to the Honorable Kathleen Sebelius that what the federal government is doing “offers a balanced and thoughtful framework for defining essential health benefits,” BUT, ”additional clarity is needed…for assuring that future adjustment can be made to improve affordability, minimize gaps in service and account for changes in medical evidence or scientific advancement.” A “‘One-Size-Fits-All’ approach…might prove unworkable and potentially costly for states, purchasers and consumers,” the Exchange rightly writes.
Getting Up a Nice Head of Steam
California’s health care problem solvers say the Golden State has “significant concerns” (“significant” being closer to “abominable” in a bureaucracy letter) about that whole nutty carrier flexibility thing. “The proposed carrier flexibility could undermine the Affordable Care Act’s goals in three ways,” the Exchange writes. “1) Consumers would be less able to compare coverage options across products, benefit levels and carriers. 2) The potential for adverse selection is aggravated if carriers attempt to manipulate benefits in a manner that attracts a healthier population to achieve an underwriting advantage. 3) The California Health Benefit Exchange – based on an active purchaser model – may be less effective if carriers have flexibility in benefit design not subject to Exchange negotiations.” Carrier flexibility would also “seriously undermine and erode their ability to effectively monitor and enforce carrier compliance with essential health benefits.” (Isn’t something that’s undermined, by definition, at a minimum seriously eroded?) Stay tuned. If an answer is going to be provided as to whether there’s undermining and erosion in the fed’s Health Benefits Bulletin as it relates to carrier flexibility, it will be found here at Capitol Insight.
Warren’s Words of Wisdom
Speaking of “significant concerns,” consider these words from Warren Buffet: “Should you find yourself in a chronically leaking boat, energy devoted to changing vessels is likely to be more productive than energy devoted to patching leaks.”
What if Mitt Romney Was Your Neighbor?
This from a recent “Chris Matthews Show.” The guests are talking about the – at least for the moment – frontrunner for the GOP nomination for president. National Journal’s Major Garrett says this: “I had a conversation…with Peter Hart, a very successful Democratic pollster, and he has a question he likes to introduce to people about presidential candidates: ‘If they're your neighbor, what words come to your mind?’ Do you know what words came to most people's minds (for Mitt Romney)?” Garrett asks his media colleagues. After a brief pause, he announces: “High hedges.” Of the hedges, Kathleen Parker of the Washington Post quickly says: “Neatly trimmed.” Continues Garrett: “(This) contrasts from the people I've talked to who know Gov. Romney really well, that he's exceptionally personable, generous and has a warmth about him. But like we've all encountered in American political life, there are some people who are that way naturally but they (don’t) project that. They don't carry that off on a national stage, or even a statewide stage in Massachusetts. I think that's one of the big impediments for Governor Romney.” According to Garrett, when Hart asked a similar question about the most recent President Bush, the most common response was: “BBQ and beer.”
Up to one-third of the patients in burn wards in major hospitals in the South, Midwest and West – the nation’s most active methamphetamine regions – are there because they hurt themselves trying to make meth, a recent Associated Press survey found. Most of those patients are uninsured. The average treatment cost per day: $6,000. The high rate of injuries is attributed to growing use of the “shake-and-bake” method of producing meth by combining unstable ingredients in a 2-liter soda bottle. Any error – as simple as taking the cap off too soon – can cause the concoction to explode, “searing flesh and causing permanent disfigurement, blindness or even death,” says Associated Press.
Says the wondrous English poet W.H. Auden: “A doctor, like anyone else who has to deal with human beings, each of them unique, cannot be a scientist. He (She) is either, like the surgeon, a craftsman, or, like the physician and the psychologist, an artist. This means that in order to be a good doctor a person must also have a good character. That is to say, whatever weaknesses and foibles they may have, they must love (their) fellow human beings in the concrete and desire their good before (their) own.”
Erma Bombeck says: "Never go to a doctor whose office plants have died."