It is legislative season again.  I am always nervous between January and May of each year, as you never know what the various state legislatures might put in place for Workers’ Compensation.  This year is no exception, as legislators and commissioners are out to “tweak” the system again in various states.

In my home state of Tennessee, SB 3886, has both a House and Senate bill for consideration.  This bill is making its way through the process, and is rumored to have support of the Lt. Governor.  To summarize the bill very quickly, it basically says that a workers’ compensation PPO in Tennessee must be able to produce a workers’ compensation contract between the provider and PPO on demand.  Also, the contract must be between the PPO and the provider, and that contract cannot be assigned to another entity including another PPO.  Thus, a PPO in Tennessee could not lease any other PPO; instead, they would have to be direct contracted in the state.  For example, if Coventry or Focus are not directly contracted in any given county or MSA, they could not lease another network to fill in that gap.

The word on the street is that this bill has legs.  As always, only time will tell.  But, I do know that providers in Tennessee are really tired of bill disputes when it involves lease networks.

In the state of Texas, new rules for “medical billing and processing” is underway which seems to indicate that providers are going to have to be informed of exactly who is accessing them under the voluntary and informal system.  This of course is outside of the HCN model that Texas has adopted.  Some PPOs already inform their providers of anyone accessing them via website or other electronic means.  Proposed 133.4 would require electronic notification to the providers of who is accessing them for discounts on a quarterly basis.  There is also an “800” number requirement for providers to call into.

For Texas, these proposed rule changes are 35 pages of legal speak, that will require a lot of interpretation.  Yet, it seems the intent is that providers need to know who is accessing them.  My understanding is that these proposed rules/regs will probably go into effect.  Stay tuned.

Both Texas and Tennessee seem to have the same intent, which is to eliminate silent PPOs in workers’ compensation and to provide the medical provider with assurance that there discount to a PPO is being given for the stated purpose.  By the time May gets here, who knows what will have passed in these two states or any other, but hold on its always a wild ride this time of year.

As I was getting ready for the day, I flipped on Fox News and heard Hillary’s live speech in Ohio.  As Ohio has some economic problems, she is focused on the economy and playing to the fears of people in that great state.  In her speech, she gave an example of a man that has to drive 70 miles every day to work, and thus suggested he can’t afford his gasoline cost.  Hillary seemed to show great empathy for this him.  Thus her solution was very simple.  Elect Hillary and she won’t let this happen to him.

First, Hillary has no control over the price of gasoline or oil just as George Bush has no control.  Second, the guy in her example can simply move.  Yes, that would cost him money to move, disrupt his family, and cause him an overall major change in life.  Yet, it is not Hillary’s job to make his life easier.  We became a great country because of individualism.  It was not because the government cared if it cost us too much to live 70 miles from our job.  What is my idea for this man?  MOVE if you can’t afford the drive or find a new job.  I have moved for jobs many times in my life, so can everyone else if that is what is needed to take care of your family.

We just have to quit looking for the government to take care of us.  In Ronald Reagan’s words, the government is the problem.  For the life of me I don’t understand why this country is moving toward socialism, it is a poison proven by history.

As the 2008 campaign rages on, I continue to refine my thoughts on how healthcare can change.  This is important, because it is clear that between reality of healthcare, the media, and the secular progressive mindset of the country at the moment, a new healthcare agenda is going to be set for the country starting in 2009.   Below are my current thoughts on how real change can occur.

First, take the purchase of healthcare out of the hands of employers.  I believe that individuals always make the best decisions.  As an employer, I am making the healthcare insurance decision for my employees.  Yet, I can’t but help to think that it would be best if each person could make their best deal by purchasing their own insurance in a competitive environment.  Also, it would be great to see insurance companies price their policies based on healthy lifestyles.  For example, if you want to smoke, great and good for you.  Yet, your insurance carrier may charge you more, which would be their right.

Also, it certainly is a cost burden for employers to shoulder such a large cost of healthcare insurance.  With an Obama Presidency (or Hillary) I feel sure my corporate and personal taxes are going to go up.  Having relief as an employer in the area of healthcare would certainly help me grow the company, thus creating more jobs and ultimately revenue (isn’t that the idea anyway?). 

Second, I believe we need to require all American’s, by law, to purchase Healthcare insurance.  I know, this is simply something my most conservative friends disagree with, and significantly.  Yet, Americans seem to always choose their cell phone over healthcare, and for those of us that have to pay for the uninsured, it just does not seem fair to me.  I would prefer that the government have no involvement, but a new era of Big Government is now upon us with the current congress and a more probable Obama presidency.  Thus, having the government support private insurance, is much more preferable to a government ran single payer system.

Third, and this is the federal government’s big role and only real role, provide a voucher system to American’s on a sliding scale that would allow the purchase of healthcare insurance for the most disadvantaged or disabled.  This is in direct support of the second point above.   In response, insurance companies will via the free market develop cheaper policies focused on simple coverage.  In my mind, vouchers are the only way in the end to keep the government out of the private sector.

Fourth, develop a risk pool for highly at risk individuals that need coverage.  Insurance companies would then bid on the business from the pool.  For Insurance companies to maintain their business license in any given state, they must pay a small amount of all premiums into the pool.  I will have more on this later in other posts.  The basic idea however, is that all insurance companies contribute to the risk pool for the at most risk individuals.  The Tenncare fiasco in Tennessee during the 1990s should make everyone stand up and pay attention to setting this up correctly.  Who is at risk or not being accepted by insurance companies would have the potential to be a gross mess if not administered properly.  Of course, given the opportunity, government will make a mess.

Fifth, we need major tort reform.  It is time we get lawyers out of healthcare.  As mentioned above, I watched the Tenncare mess in Tennessee turn into a healthcare system ran by the lawyers.  They were always trying to require more coverage.  I don’t think we are all entitled to gold plated healthcare, but basic healthcare insurance is something we should all purchase.  Also, law suits in many cases are just out of hand, and medical providers need relief, which in turn will help reduce healthcare costs.

There is more that can be done than just the above, but I believe it would be a good start.  What are your thoughts?

If you are looking for something fun to read (and don’t have anything else to do) check out this blog post at http://agonist.org/ian_welsh/20080218/obama_and_health_care (The Agonist).  Here is an excerpt:

“I remain befuddled and bemused at the way Obama supporters seem to think their man is particularly progressive. He’s a centrist, who chose Joe Lieberman as his Senate mentor and whose voting record is not significantly different from Clinton’s, including on key issues like the occupation of Iraq. He has very effectively built up a large following, whom he will betray in 2009 and 2010 with triangulation to the right. If he does pass a health care bill, as Mike says, it will be a massive insurance company sell-out like the drug benefit.” 

So, Obama is a centrist?  This is the guy that wants to raise the top tax bracket to over 39% and raise Social Security withholding taxes on high wage earners.  According to the Wall Street Journal’s senior economic advisor, Stephen Moore (http://www.glennbeck.com/content/articles/article/196/6255/), upper end earners may end up paying over 50% of their income in Federal taxes (income, social security, and medicare).  Obama is the same guy that wants to sit down and talk to our enemies in the world, which would prop up those regime’s leaders.  I also think this is the same guy that wants to help people pay for college, pay bad credit card debt, make sure everyone is guarenteed health insurance, etc…. He just wants to help us all. 

If Obama is a centrist, we are all in trouble if a “left of center” person is ever elected President.

As most of you know today, an industry-wide investigation into the reimbursement practices of health insurers has been launched by New York Attorney General Andrew M. Cuomo.  From this, a threatened law suit is in play against Ingenix regarding Ingenix’s Usual and Customary database which it sells and most insurers use, to set reimbursement rates for out-of- network medical expense.  The AG described the U&C rates as “defective and manipulated.”

So, how could U&C be a problem in the commercial group health world?  Once a plan member goes out of network in some plans they will have the lesser of 80% of billed charges or U&C rates covered under the plan, but will pay higher premiums in exchange for the “right” to go out of network.  So, a $100 bill that is generated from an office visit to an out of network provider would lead to an $80 payout from the carrier to the provider leaving the plan member to pay $20.  Yet, if U&C takes the $100.00 bill down to $60 (being the lesser), then the patient could be on the hook to pay $40 instead of the $20.  In other words, the patient will be balanced billed.

The main problem with this potential suit to me is not if Ingenix’s data base of rates are perfect, but the fact that the AG of New York could be taking away a control mechanism for keeping medical costs down.  As usual, individuals in the government don’t completely understand how the system works, and that valid controls are in place.  Using U&C simply helps to control unfair billing.  The legal system will determine the validity of the U&C rates, but the concept is a good one.

On the other side of this of course is the fact that carriers need to represent correctly their plans and understand the states they are working in.  With so many laws and rules/regulations it is a challenge to keep up with them all.  So, I understand and agree that the AG has to defend the citizens against anything that is unfair.

Also, more than likely, Mr. Cuomo saw that attacking the insurance industry is good politics.  The last time this happened in New York the situation gave them a new governor, Mr. Spitzer.

Well, it is all set and the Presidential election is going to be John McCain vs. Hillary or Obama.  At this point it simply means the country is going to move left during the next 4 years.  Although McCain is a Republican, he is not a Reagan conservative.  Thus, with Hillary fully believing in socialism and Obama even more to the left of Hillary, we are almost guaranteed to move to a more liberal agenda.

McCain is a good man.  He has really served the country well in both the military and in the Senate.  However, he is really weak on domestic issues including important ones such as the security of the border.  However, foreign policy is strength for him.

A lot of the conservative talk shows are really bashing McCain, which I think is unwarranted.  I am not giving up my conservative ideas, but I will vote for McCain even though he is nowhere close to the benchmark of Ronald Reagan.  He is what he is, a slightly to the left of center Republican.  However, I do believe he will control spending and not support major new social programs.  Thus, he will be my candidate.  I hope other conservatives will at least choose the lesser of the evils instead of staying home on Election Day in November.

Well, I finally made up my mind.  Tomorrow in the Tennessee primary, I will cast my vote for Mitt Romney.  As I take my right and privilege to vote seriously, I studied all the candidates with great zeal.  In the end, my two choices were Mitt Romney and John McCain.

To be honest, I am not sure that either of these two gentleman are the best that America has to offer.  Yet, these are the only two that have a realistic chance of winning the Republican nomination.  Both have qualities that I admire, such as McCain’s military service and Romney’s executive experience.  Yet, I feel that Romney is a stronger conservative, at least in his rhetoric.

As for their positions on healthcare, I can’t say I am completely comfortable with either.  McCain seems to not really know that much about the subject and Romney’s plan in Massachusetts has had marginal success.  The good news is that both don’t desire government programs such as Hillary’s or Obama’s.

So, tomorrow night I will be kicked back in my chair watching the results role in.  At the least, it’s always fun to watch American politics in action.  If you want to share your thoughts on who you voted for and why, I would love to see your comments.

Hmm, this is one of those posts that I might see totally different in 6 months, but feel the need to get this one off my chest.  I keep hearing the media talk about how bad the economy is right now, or is expected to get in 2008.  Yet, I wonder how many of these talking heads on TV or people in general remember what a really bad economy looks like?

I am old enough to remember Jimmy Carter and his “Misery Index”.  I also remember my parent’s generation of the late 1970’s paying around 15% interest rate on a mortgage. During this same time period, a gallon of gas adjusted for inflation was still higher than it is today.  I also remember the feeling that America just could not do anything right and the Soviets were going to take us over.  The late 1970s and 1980-1982 resulted in some real economic down times.  The unemployment rate in 1982 peaked at 9.7% as a result of the Carter years. See http://www.bls.gov/cps/prev_yrs.htm

The “stock market crash” of 1987 hurt a lot of people, but it was the market correction that led to a major market boom. The 1990-1991 recession under George H. Bush was pretty mild as far as recessions go, but it was a recession.  The market does correct itself.  I bought my first house in 1990 with an interest rate of 10%.  I sure don’t miss the 10% rate, it was painful.

Yet, in 2006, the unemployment rate was 4.6% and around 5% in 2007.  When I went to college, this was considered full employment.  In other words, anyone that wanted a job had a job.  Home ownership is still at a high, and interest rates on mortgages are still incredibly low.  Sure gas is high, but as I said earlier it’s still not higher than in the early 1980’s adjusted for inflation. It may be true that the economy is in for a downturn.  We may even see a recession.  Yet, a recession is a necessary part of capitalism.  I guess the bottom could drop out one day and Chicken Little will have been right all along.  However, for goodness sake, let’s all keep in perspective that the economy is still in great shape overall.  Todays younger generations just have not seen a bad economy.  It will come, but is it now?  I don’t know, but I do know this.  The economy, according to my public education from high school, is basically sound.  We have a financial lending crisis going on, but not an overall economic downturn.  The GDP was 5% growth in the 3rd quarter and .5% in the 4th quarter of 2007.  Those numbers are not a recession.

Only time will tell, but I can tell you I will take 2007/early 2008 any day over the Jimmy Carter years and early 1980s.  We can thank Ronald Reagan, and a brave congress, for cutting taxes which saved us all at that time.

I have always wondered how I could be so differently wired politically than some of my best friends.  We make our livings in the same field (healthcare related), share similar hobbies, went to the same schools, etc…. but look at politics totally differently.

So, I was intrigued by seeing the following survey http://www.medpagetoday.com/PublicHealthPolicy/HealthPolicy/tb/8084 results of a telephone survey, a joint venture between the Harvard School of Public Health and the Kaiser Family Foundation, which was conducted from Nov. 1 through Nov. 11, 2007 and responses were statistically weighted to reflect the U.S. population. 

The researchers also considered data from 10 other recent surveys by national media polling organizations. Among the findings:

• 43% of Republicans approved of Bush’s handling of health care compared with 14% of Democrats
• 44% of Republicans rated the nation’s health care system as excellent, but only 20% of Democrats gave it those high marks
• 66% of Republicans are dissatisfied with the cost of health care in the U.S. compared with 89% of Democrats
• 58% of Republicans are satisfied with the quality of care in the U.S. but only 20% of Democrats feel that way

So, take a look at how differently Republicans and Democrats view healthcare.  For example, the survey found that 58% of Republicans are satisfied with the quality of care in the US.  Yet, only 20% of Democrats are satisfied.  So, are we all being treated by the same healthcare providers?  Maybe not when you account for age, education, income, etc… However, I would assume with some reason that we are seeing the same providers, both Democrats and Republicans.  Instead, I think politically, we are just wired differently.  We all bring our own experiences, biases, and backgrounds into the healthcare and political arena.  I don’t see how a 38% difference can be accounted for other than bias of being in favor of our healthcare system (Republicans) or not in favor (Democrats) long before any treatment occurs.

Another example from above is that only 44% of Republicans rate our U.S system as excellent.  I think that number should be higher, but there are improvements to be made for sure.  Yet, it seems amazing to me that only 20% of Democrats would rate our system as excellent.  So, again, I guess we are just wired differently???

I was sent a link yesterday to a website that allows one to answer basic questions regarding national issues and then it compares your responses against the positions held by the presidential candidates.  At the end of the test, ”your” candidate is chosen.  Here is the link:

http://www.wqad.com/Global/link.asp?L=259460

I don’t know how accurate the test is, but for me it was accurate.  Let me know your thoughts regarding the results of the test and who you support.