Notes from Bloomberg Government’s Cost of Health Care Event

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Right now health care is the hottest debate topic. The senate GOP drafted a bill to repeal the Affordable Care Act (ACA) also known as Obamacare. Bloomberg Government held a timely event where the moderator, US Senator Cassidy and an expert panel discussed the current ACA repeal and the future of healthcare.

 

Congressional Interview : US Senator Bill Cassidy R – LA

Senator William Cassidy hailed from Louisiana. He was a medical doctor. He was from the Republican party. He voted for the failed ACA repeal. He gave his congressional insight behind the ACA repeal, the GOP plan and his professional opinion as a medical doctor. Senator Cassidy said 37% of ACA went to three states (NY, CA and MA). Supports Graham-Cassidy Act. Mentions the former Collins-Cassidy (Patients Freedom Act). Won’t get a CBO (Congressional Budget Office score that told how many people would be knocked off of the Medicare rolls) before Friday.

The moderator Mr. Arook mentioned ‘regular order’ for the Graham-Cassidy Act. Regular order phrase came about during Tuesday’s US Senator John McCain’s speech (McCain also voted for the GOP health repeal).  Senator Cassidy said that he wouldn’t defend the current GOP process but he’s promoting and pushing the Graham-Cassidy Act. Cassidy said private plans, TRI-Care, VA, Medicare and Indian Health weren’t touched by this current Senate health care bill (though he thought that the Indian Health should had been touched). Senator Cassidy ended his conversation with a price transparency example. Gave NOLA.com example of a lady who ha bloodwork done and received a $300 bill. 6 months later only to learn that the same procedure offered down the street for $34.

 

Questions

The first person mentioned that he was a behavioral specialist. His question was about essential services for mental health. Cassidy replied that essential services were only 4% of the total budget. Florida Senator Rubio said that we had state mandates. Mental health parity law. Cassidy said in the ‘spirit of federalism (10th amendment rendering power to the states)’ states can do something different.

The second question was what’s the base set? Cassidy responded with high-deductible health plans. IRS regulated that high-deductible health plans must have significant benefits. The third question was which three states comprised of 37%. Senator Cassidy replied NY, CA and MA. The raw numbers seemed to show this. Two of the three were the most populous states so that wasn’t abnormal just a talking point to rile up people.

The fourth question was about having a health savings account (HSA) but with a high-deductible. Cassidy commented having an HSA with a high-deductible was better than the bronze level plan on the exchange. Okay, wasn’t Senator Cassidy comparing apple to oranges? It seemed like the HSA with a high-deductible seemed like the gold plan. Cassidy referenced former Indiana governor Mike Pence’s Hoosier Care prefunded health care plan. He continued by saying that when a hospital bought a health care practice, the prices went up. The costs went from part B to Medicare part A.

The fifth and final question was about the rising cost of drugs. Cassidy mentioned price transparency and the catastrophic part of Medicare Part D. There should had been a negotiated discount to help the patient got the same discount as the other payers.

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Panel

The panel comprised of five field experts.  Dr. Richard Bankowitz, Executive VP of Clinical Affiars, America’s Health Insurance Plans; Richard A. Deem, Senior Vice President, Advocacy, American Medical Association; Katherine Hayes, Director of Health Policy, Bipartisan Policy Center; Dr. Alice M. Rivlin, Senior Fellow – Economic Studies, Center for Health Policy, Brookings Institute.

Dr. Richard Bankowitz began the conversation. He said that the Skinny repeal (what the Senate GOP called the current health care repeal bill) wasn’t good. Hayes chimed in saying that McConnell’s slow pace wasn’t good. Didn’t think that the House would had passed the skinny repeal. Deem opined that by ridding the mandates but keeping the preexisting conditions did harm which was anti-medicine. Dr. Rivlin agreed with her colleagues. She further emphasized that the problem was doing it with one party. Agreed with McCain’s regular order comment.

The moderator, Alex Ruoff said ‘unpack’ a lot throughout this event. He did countering talk about the 2010 ACA partisan approach where the Democrats had the majority and didn’t want to work with the Republicans. Hayes said when it’s partisan-only, you got the extremes from each party. Mr. Ruoff then asked about the price of health care. Dr. Rivlin proffered that there were a lot of drivers. The US doctors and health care professionals were paid better than others in different countries. They were incentivized to use more services versus getting healthy. Deem mentioned the shift to aging population. Hayes said that there had been an unwillingness to shift health care costs. She continued saying that the drug price reduction started with delivery services reform needed to know delivery and quality of care versus costs. It won’t be easy.

Dr  Bankowitz said he saw medicine going in two different directions.  Moving away from fee to service which was the right way but the increased price of drugs was the wrong way. Pharma had embellished its patent protection to bolster costs (meaning that it fluffed up the actual costs of being damaged from patent infringement to protect themselves.).

The moderator chimed in saying that Obama shifted from fee for service to fee for quality. Ms. Hayes remarked that people thought that was wrong but we were testing. We were a heterogeneous society. Care in the cities differed from care in the rural areas. Deem then mentioned actuarial risk and actuarial value. Dr. Rivlin commented that she didn’t think that we were trying hard enough with pay models. Keeping people out of the hospitals and their investors dislikes this.

Regarding actuarial risk, Dr. Bankowitz said that until 6 months ago, he never heard of actuarial risk. Hayes did say that at the staff level of the Trump Administration HHS, they were looking at pay reduction reform. Dr. Rivlin said that there needed to be more bipartisan pay reduction reform support. We were not a very healthy country. Deem said 80% of Americans were pre-diabetic and didn’t know it. Prevention was now calculated by the actuary. Going from pre-diabetic to diabetic cost an extra $14,000/year. Deem continued stating that data was so important. He also said that pay data models needed to be more transparent. Rivlin gave an example of data transparency with pediatric asthma because it was a clear example. Problem was that Medicare didn’t cover for non-medical costs. Hayes  used managed care when mentioning that Chronic Care Act. She went further highlighting Minnesota Managed Care. Dr. Bankowitz mentioned Ohio Medicare Advantage as a bright spot. Then we went to questions.

Questions

The opioid epidemic was the first question. Deem said that there were 30,000 deaths annually. It was stretching public healthcare. Hayes stated that as long as they were talking about taking $850 billion out of the Medicare budget, the hospitals would be stretched.

The second question was tort reform (law). Deem said that it was on the table. Rivlin spoke with former president Obama about two things. She said that reform would be big for GOP because they thought that was important and the second thing she discussed with him was tax exclusion. Dr. Bankowitz commented that the underlying problem was low value care. More wasn’t always better.

The third question was about entitlement programs – Medicare, Medicaid, and Social Security (to a lesser extent). Dr. Rivlin answered saying that yes, she was concerned. She was a budgeteer. His two little girls (from the behavioral specialist question. He had two little girls) would be supporting an aging population. We needed to pare back unnecessary health costs. Deem mentioned McCain’s regular order speech. Still had two silos.

The fourth question was regarding business, insurance and medicine. Deem said doctors discussed 1 hour of medicine and 2 hours of administrative paperwork. Rivlin opined that digitized records would be huge.

The Bloomberg Government event was thorough giving everyone different perspectives. It also cleared the partisanship because most of the professionals outside of Capitol Hill were against the Republican plan. The Skinny repeal failed in the US Senate leaving the Affordable Care Act intact.

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