McCain Plan Would Tax 100% of Health Insurance Costs

October 23, 2008 / Michael D. Miller MD / Economics & Financing, Federal Healthcare Reform, Health System Reform, Politics, Private-Employer Based Health Insurance / 1 Comment

I had a revelation tonight at an event about women’s health issues in the Presidential election at the Kennedy School of Government’s Institute of Politics. One of the speakers was Gail Wilensky – a Senior Health Care Advisor to Senator McCain’s campaign. I asked her a question about how Senator McCain’s proposal to eliminate the tax deduction for employer provided health benefits would effect non-profit organizations since they don’t pay taxes.

Gail Wilensky’s answer really shocked me. I’ve been doing health policy work for about 20 years, and following the election’s health issues for the last year. What she said was that it wouldn’t matter whether the person worked for a non-profit or a for-profit company, since the employee would be the one paying tax on the entire cost of their health insurance – whether it was their contribution, or dollars coming from their employer.…

More on Employer-Based Health Benefits

September 25, 2008 / Michael D. Miller MD / Access to Healthcare, Politics, Private-Employer Based Health Insurance / No Comments

A couple of weeks ago in writing about ERISA, I included some data on the stability of health benefits provided by large companies. The Kaiser Family Foundation just released their 2008 Employer Health Benefits Survey. Below is the updated chart from my earlier post.

Large Companies (>199 employees) Offering Health Benefits:
Eligibility, Take-Up and Coverage Rates

The Kaiser Family Foundation’s Report also included an interesting table that provides some insight into what I wrote earlier this week about the differences in employer health benefits between high and low turn-over industries. The relevant information from the Kaiser report’s Exhibit 2.3 is below:

The Granularity of Employer Provided Health Benefits

September 22, 2008 / Michael D. Miller MD / Economics & Financing, Health System Reform, Miscellaneous, Private-Employer Based Health Insurance / 2 Comments

After writing last week about Pitney Bowes’ experience in creating positive financial returns by providing quality health benefits for their employees, I attended a panel of alumni and faculty from the Yale School of Management that discussed the topic “Do Consumers Make Rational Healthcare Decisions?” (I’m told a video podcast will be available soon.) While their consensus on this question was no, their discussion and Q&A included employer provided health benefits.

Professor Fiona Scott Morton noted that the value employers get from providing health benefits depends upon their industry – specifically whether the company retains employees or has a high turn-over rate. …

Value of Employer Provided Health Benefits

September 18, 2008 / Michael D. Miller MD / Access to Healthcare, Economics & Financing, Health System Reform, Politics, Private-Employer Based Health Insurance, Public Health / 4 Comments

I recently heard Michael Critelli, Executive Chairman of Pitney Bowes Inc., talk about what the company has learned about the value of providing quality health benefits and services to their employees.

Because they have a workforce that is divided between their offices and customers facilities, Pitney Bowes has been able to conduct a natural experiment and see how providing access to different health and wellness services can effect their employees and the company’s costs. What they found was that providing a good quality health benefits package in conjunction with healthy food and exercise options, etc., has reduced health care costs for their employees that work in their own offices compared to employees who work off-site.…

Health Reform Evolution

May 12, 2008 / Michael D. Miller MD / Economics & Financing, Health System Reform, Medicare, Politics, Private-Employer Based Health Insurance / No Comments

Placing health reform in an historical context shows how the debate has evolved. For example, the National Bipartisan Commission on the Future of Medicare was formed to address Medicare’s projected insolvency – at a time when the overall focus for health reform was on cost containment. However, while the Commission met and deliberated, the booming economy shifted the debate away from cost containment towards access and coverage expansion, and the Commission’s 1999 final report, proposed adding an expensive outpatient drug benefit to Medicare.

Comparing two more recent perspectives on the future of the US healthcare system also illustrates how thinking about health reform evolves.…

1 of 100 Adults Gets Free Government Health Care

April 21, 2008 / Michael D. Miller MD / Access to Healthcare, Delivery of Healthcare, Economics & Financing, Medicaid, Politics, Private-Employer Based Health Insurance / No Comments

A recent report from the Pew Foundation indicated that 1 out of 100 adults in the US get free government health care with no premiums, deductibles or co-payments. The reason this report didn’t get more media attention was because the 1% of Americans getting free government health care are behind bars – as in prison or jail.

The Pew report indicates that for the first time, more than 1 in 100 adults in America are in prison or jail. That’s over 2.3 million in state or federal prisons or local jails, and the numbers and percentages have been growing. (See the Department of Justice chart below)

This data is an interesting launching point into other aspects of our current health care system’s problems:

First, health care costs for people behind bars represent about 10% of the costs of incarceration.…

Principles for Health Reform & EBM

March 13, 2008 / Michael D. Miller MD / Comparative Effectiveness, Economics & Financing, Health System Reform, Politics, Private-Employer Based Health Insurance / No Comments

The National Federation of Independent Businesses (NFIB), just launched their health reform campaign called Solutions Start Here. Their 10 small business principles for healthcare reform includes:

Evidence-based:
The healthcare system must encourage consumers and providers to accumulate evidence and to use that evidence to improve health. Appropriate treatment choices and better wellness and preventive care should be key outcomes.

Current information and decision systems make it difficult to accumulate, interpret and use evidence affecting treatment decisions. One result is overspending on treatments and underspending on prevention. Decision-makers must understand the impact of their decisions on both costs and outcomes. Such an understanding must be based on solid clinical and economic evidence.

…

US Healthcare Costs & The Economist

January 29, 2008 / Michael D. Miller MD / Economics & Financing, Medicaid, Medicare, Private-Employer Based Health Insurance / No Comments

The January 26th issue of The Economist had a short article about growing healthcare costs in the US. It pointed out (referencing CMS as a source), that healthcare costs had increased 6.7% from 2005-2006, but that Medicare spending had increased 18.7% What these numbers reflect, (but the Economist article only implies), is that because Medicare Part D started in 2006, spending growth shifted from private spending (and Medicaid) to Medicare. Looking at the actual data shows this to be the case:

Public sector healthcare spending increased 8.2% in 2006 compared to 2005; Greater than the 7.1% the previous year
Private sector healthcare spending o increased 5.4% in 2006 compared to 2005; Less than the 6.1% the previous year

Looking closer at the data is even more interesting.…

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