Jan 23, 2018


10/26/2009
Brian S. King
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Thanks to the L.A. Times for its support of amending ERISA to provide meaningful remedies when insurers act in bad faith in denying claims.  When there is no accountability for behaving badly in a competitive environment, you guarantee that bad behavior will increase. 

Category: Keyword Search: healthcare reform

10/19/2009
Brian S. King
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Short answer: no.  At least, nothing in the bills currently being debated in Congress will do anything to provide remedies that provide for more health insurance accountability when they wrongfully deny claims or rescind coverage.  In fact, the pressure on insurers to become more aggressive in dealing with claims may increase as a result of the proposed legislation.  Lisa Girion has the story here in the today's L.A. Times. 

Category: Keyword Search: healthcare reform

10/13/2009
Brian S. King
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Sadly, I think there is a lot of truth to the title of this op-ed piece, "health reform is corporate welfare."  I especially like the "cherry lemon socialism" concept.  

A non-frivolous argument can be made for the idea that profit making corporations should be allowed to do everything within their legal power to try and shift losses to taxpayers and keep profits for themselves.  One can argue that avoiding accountability for their losses is part of the market competition.  If they can do it better than their competitor, they may survive while their competitor may not.  This is the kind of clear eyed realism that so many conservatives are so proud to embrace.  You'll find these hardy souls are often quick to ridicule liberals who try to avoid cold-blooded, survival of the fittest, thinking.  However, especially for those who adhere to pure market thinking, the idea that taxpayers should be made to subsidize the losers and the winners should be allowed to keep their profits is most offensive.   

I hope Congress has the cajones to stand up to the health insurance industry and put in place some mechanisms to provide for meaningful corporate accountability as well as effective healthcare reform. 

Category: Keyword Search: healthcare reform

8/27/2009
Brian S. King
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Earlier this week this L.A. Times story gives us an idea about the answer to this question.  Many months ago America's Health Insurance Plans, the lobbying group for health insurers and other payers of health benefits, decided they needed to get in front of the forthcoming legislative parade about how we deliver and finance healthcare in this country.  Smart move AHIP.  Many think healthcare payers will end up with a "bonanza" and a "financial windfalll" at the end of the Congressional process.  Any legislation that passes will likely provide universal coverage which will add tens of millions of people to insurance company customer lists, taxpayer subsidies to assist the poor in paying premiums, and more lenient requirements for payers on the amount of insurance they must provide per premium dollar. 

Insurers aren't out of the woods yet.  If the public option ends up in a final blll that passes Congress, there could be some rain on the insurer's parade. 

UPDATE: Kristof's column today is a must read.

Category: Keyword Search: healthcare reform

8/22/2009
Brian S. King
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Comments whether restricting medical malpractice claims should be a part of our national healthcare reform debate have heated up in the last couple of weeks.  I commented on the issue here and here.  Andrew Sullivan's blog has also been discussing the issue.  This post contains some pretty definitive information to show that medical malpractice reform doesn't hold much promise for curing what ails us. 

Category: Keyword Search: healthcare reform

8/12/2009
Brian S. King
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Steven Perlstein, business columnist for the Washington Post, comments on Charles Krauthammer's healthcare reform proposal here.

Category: Keyword Search: healthcare reform

8/9/2009
Brian S. King
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Charles Krauthammer's Washington Post column from a couple of days ago purports to wield the sword that will cut the Gordian Knot that is our healthcare conundrum.  The second part of his solution, eliminating the income tax break provided to employers and employees for medical benefits provided through work, isn't a bad idea but it is a far cry from solving the problems of our current system.  But it's the first part of his solution that got my attention.

Krauthammer claims that reforming medical malpractice will eliminate the supposed scourge of defensive medicine that is plaguing our country.  Krauthammer, who is a physician himself, wants to do away with our current, fault based medical malpractice system and substitute a new "social pool" that will be used to compensate victims of medical malpractice.  A panel of medical experts will be substituted for a jury as the deciders of whether medical malpractice has occurred.  Krauthammer asserts this will eliminate the "lawsuit lottery" that he claims trial lawyers make their living playing.  They will just be cut right out of the picture.  To avoid the moral hazard that would accompany eliminating negative consequences for medical malpractice he proposes that negligent physicians will have to forfeit their licences.  

I have questions.  What about the Seventh Amendment to the Bill of Rights?  You know, the one that says that every person with a civil suit with an amount in question over $20 gets the right to trial by jury.  Do we just sort of set that aside?  In fact, it's really not a close call that of the original items in the Bill of Rights, the Seventh Amendment right to trial by jury has been, by far, the most eroded and bypassed.  I would expect a conservative, strict Constitutional constructionist like Krauthammer to at least mention that.  In any event, that seems to me, if nothing else, a formidable political, legal and practical barrier to his proposal.   

Next, is Dr. Krauthammer aware that the Institute of Medicine has stated medical malpractice killls more people per year in this country than car accidents?  No?  That's not to mention how many people are seriously injured through medical malpractice.  In fact, very few of those individuals or their families ever recover anything by way of compensation in medical malpractice claims.  How do we deal with the greatly increased costs associated with compensating for injuries and death of all people injured or killed due to medical malpractice?  Is a "relatively small tax on health insurance premiums," as Dr. Krauthammer says, really going to cover that expense?  I doubt it.  Does anyone really even know how much such a compensation system would cost?  Krauthammer makes no attempt to provide an answer to that.  He just assumes it won't be much but unless you grossly undercompensate medical malpractice victims, I'm confident he's wrong.  

The best way to deal with medical malpractice is to take meaningful steps to reduce its occurrence.  That means training physicians more effectively. 

   

Category: Keyword Search: healthcare reform

7/17/2009
Brian S. King
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You can find here a summary of the healthcare reform bill passed out of the Senate Health, Education, Labor and Pensions Committee earlier this week.  Thanks to Rob Liebross for the link. 

Don Levit will be interested in the references to MEWAs near the end of the report.



Category: Keyword Search: healthcare reform

7/16/2009
Brian S. King
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Tom Tomorrow hits home.  h/t to Melody

Category: Keyword Search: healthcare reform

7/13/2009
Brian S. King
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Wendell Potter pretty much identifies a few of them. 

Category: Keyword Search: healthcare reform

6/30/2009
Brian S. King
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The New York Times editorial from yesterday provides one of the most concise summaries I've seen for the reasons we need the public option as part of whatever emerges from our our healthcare reform debate.  Take a look.

Insurance companies aren't inherently evil.  They are important components in the way we deliver and finance medicine.  But, left to their own devices, there are many reasons and ways for them to avoid providing universal coverage.  That's the simple truth and there's no getting around it.  The public option seems to me to be the best way of dealing with that reality. 

Category: Keyword Search: healthcare reform

6/23/2009
Brian S. King
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Drew Altman, the President and CEO of the Kaiser Family Foundation, has some insightful comments about the aspect of the healthcare reform debate he believes is being neglected: insurance market reforms.  He makes a number of good points.  One of the surprising things I learned is the fact that across the political spectrum there is majority support for eliminating the ability of insurers to underwrite applicants for health insurance.  People support the idea of requiring that health insurers be required to take all risks even if it may mean the consumer pays more in premium.  The willingness of folks to accept that potential sacrifice is key to getting universal coverage off the ground in the negotiations.  

Category: Keyword Search: healthcare reform

5/14/2009
Brian S. King
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Over the next few months we'll likely see passage of new laws relating to how we deliver and finance healthcare in this country.  One of the issues that is being hotly debated is whether the reforms should include the option for folks to choose a healthcare plan provided through the government.  That "public option" could take the form of extending Medicare or some other type of government healthcare plan such as that provided for federal employees or those in the military.  Private health insurers have made it clear they don't like the idea of having to compete against such a government plan.  They may have some good reasons for feeling that way.  How such a public option would affect both citizens and private insurers will depend on the details of the proposals.  It's far from clear that a public option will be included at all in the final form of the legislation.  One of the best discussions I've seen about the public option is this from the Anonymous Liberal blog. 

I am confident that the political will doesn't exist for a single payer plan and I'm not sure it would be the best thing for the country even if it were a more realistic alternative.  But given my own experience on a day to day basis wrangling with health insurers and self funded plans about denied medical claims, I'm skeptical about proposals that achieve universal coverage by simply extending the status quo through tax credits or subsidies.  The amount of money we spend on lining the pockets of health insurance executives and shareholders is mind boggling.  Compared to a single payer system, there are a number of ways in which our capitaliist approach to health insurance is inefficient. 

Reforming our national healthcare delivery system is extraordinarily complex and I don't have any great insight into more than a few angles of it.  While a single payer system would likely dry up a significant portion of my law practice, I wish we were debating it more seriously because I think there are some aspects of it that would create a lot more cost efficient way of getting healthcare provided to those that need it most.  For example, see this excellent Phillip Longman article on the VA healthcare system in The Washington Monthly from a few years ago.    



Category: Keyword Search: healthcare reform