Kansas Health

[Nina Owcharenko, "Provide alternatives to employer-based health care plans," The Atlanta Journal-Constitution, 31 August 2006.]

Heritage Foundation senior analyst Nina Owcharenko suggests moving toward tax credits and away from employer-based coverage as a way to alleviate the problem of the uninsured:

The current system, which is dominated by tax-favored coverage offered through the workplace, has made health insurance affordable for middle-class Americans and made practical sense when workers stayed with one employer until retirement.

But today's workforce is much different. Fewer of us stick with one job or work for one employer throughout our careers. Meaning, each time we change jobs, our health plan changes, and probably so do our doctors. Fewer employers, especially those with small businesses, can afford or offer coverage.

Some argue for expanding government-run health care programs, such as Medicaid. But not only do most workers prefer private coverage over public coverage, public programs already find themselves overextended and fiscally unsustainable. Medicaid is the largest line item in state budgets and is squeezing out other important state services, such as education and transportation. Plus, the more people depend on government-run health programs, the more control the government has in the personal health care decisions of its citizens.

To fill in the gaps of the current health care system and prevent more workers from joining the ranks of the uninsured, we need to create an alternative for those who don't have employer-based coverage. A system of health care tax credits would give those workers a tax break, similar to the one given for employer-based coverage, to purchase private health care coverage of their own.

Those who own their coverage can take their plan with them when they change jobs or quit working. They choose the plan and doctors and services they want. And insurers and providers are accountable to them, not to their employer or government bureaucrats.

[Devon Herrick, "Health insruance is better to own than rent," The Dodge City Daily Globe, 23 March 2005.
Greg Scandlen, "Choice is revolutionizing health care," The Wichita Eagle, 28 September 2004.]

[Alan Bavley and Lynn Franey, "More go without health coverage," The Kansas City Star, 30 August 2006.]

Right on the heels of news that Wichita ranks among the most expensive cities to obtain health insurance, new Census data reveals an increase in the uninsured - with the South and West seeing the greatest growth:

About 37 million Americans were poor last year, and 46.6 million lacked health insurance. The percentage of uninsured Americans, 15.9, was the highest since 1998.

The growth in the uninsured showed up in all income groups, according to the Census.

People with household incomes of $25,000 to $75,000 were the hardest hit.

There were 247.3 million people with health insurance in 2005, an increase of 1.4 million from 2004. But the number without insurance also grew, from 45.3 million to 46.6 million.

The South and West saw the greatest growth in the uninsured. In much of the Northeast and Midwest, the percentage of uninsured remained steady. The 2004-05 average was 10.9 percent for Kansas and 12.4 percent for Missouri.

[Matthew Hisrich, "The Uninsured in Kansas - A Closer Look," The Flint Hills Center, 28 July 2006.
Matthew Hisrich, "Greatest increase in uninsured found among wealthy," The Flint Hills Center, 10 May 2004.]

[Editorial, "Reveal health care costs," USA Today, 30 August 2006.]

An editorial in today's USA Today draws a link between consumer-driven health care and the move toward price transparency in health care:

No sensible consumers would purchase a new car or refrigerator without knowing the price, or without asking a few questions about reliability.

Yet they'll undergo cardiac surgery or a hip replacement with little thought of the actual cost of treatment, and with virtually no information about their hospital's track record with that procedure.

Traditional insurance, whether government- or employer-based, shields patients from the true costs of care. If someone else is paying most of the bill, patients have little incentive or ability to demand lower prices. Hospitals and doctors face little pressure to publicize their fees or to lower them.

Faced with rising costs, however, employers are pushing workers to shoulder a larger share with higher premiums, deductibles and co-pays. Plans combining low premiums, high deductibles and employee-funded health savings accounts are gaining popularity. Because those plans force people to spend more of their own money, they have more incentive to shop around. But they can't do that without better data.

While hospitals and doctors are dragging their feet, the government and insurers are taking steps to make health care costs more transparent:

• Last week, Bush signed an executive order requiring four federal agencies to compile and release information about the quality and price of health care provided to people they cover.

• In June, Medicare started posting on its website how much it pays for 30 medical procedures in each of the nation's counties, along with data on how many of the treatments each hospital performed last year. In general, the more experience a facility has with a procedure, the better the outcome for the patient, studies show.

• Aetna, which covers 30 million beneficiaries, will make physician-specific information on fees, clinical quality and efficiency available to its members in seven states.

With the right tools, patients can find better values. More honesty about price and quality can lower costs and achieve better outcomes.

[Mary Katherine Stout and Matthew Hisrich, "Price transparency important," The Salina Journal, 12 July 2006.]

["The Waiting Game," The Wall Street Journal, 29 August 2006.]

Unreasonable waits are widespread under the single-payer system to the north:

Last week Ottawa-based Decima Research released results of a poll designed to answer the ultimate question in Canada: "How many wait too long for health care?" The firm says its survey of 3,070 Canadians "reveals that more than one in three Canadian households has tried and failed to get timely access to at least one health service within the last three months."

Nearly half (46%) of those waiting to see a specialist said they experienced an "unreasonable" wait time, as did 30% of those waiting to confirm a diagnosis. Of those who sought emergency hospital treatment, 44% said their wait was too long.

The Vancouver-based Fraser Institute's "Waiting Your Turn" annual report has documented Canada's waiting-time crisis in health care for 15 years. In 2005 it found "total waiting time between referral from a general practitioner and treatment, averaged across all 12 specialties and 10 provinces, was 17.7 weeks."

At issue here is whether it is better to ration a scarce good using prices, as a free-market system would do, or using time, as is inevitably the case with nationally financed systems.

[Charles W. Van Way, III, MD, "The Strength of a Really Bad Idea," The Flint Hills Center, 8 May 2004.]

[William Lottero, Robert Seifert and Nancy Kohn, "Losing Ground: Eroding Health Insurance Coverage Leaves Kansas Farmers with Medical Debt," The Access Project, July 2006.]

A recently-released report from The United Methodist Health Ministry Fund and The Kansas Farmers Union reveals that many farmers in Kansas face significant medical debt even if covered by traditional insurance:

Overall, about one respondent in six (17%) reported having medical debt. However, this statistic conceals a significant difference between the experience of respondents age 65 and over and those under 65: Only five percent of those 65 and over reported medical debt, while nearly a third (29%) of the non-elderly respondents said they had debt. These findings combine to raise the question of whether the health insurance covering many of the younger families in farming adequately protects them from financial risk.

Such findings suggest that farming families in Kansas might be better served by consumer-driven health care products like health savings accounts, with high-deductible coverage that has clearly defined maximum out-of-pocket costs. Too often, the fine print of traditional coverage includes co-insurance that can lead to incredibly high liability.

Fortunately, there are signs that HSAs may become more popular among farmers. Earlier this year Cargill announced a program whereby the company offers to set up and contribute to HSAs for farmers willing to guarantee a portion of their grain will go to the company:

"The program, which company officials say is the first in the nation, is aimed at helping farmers who are struggling with rising health insurance costs while guaranteeing business for Cargill in an increasingly competitive grain market."

[Devon Herrick, "Health Savings Accounts: The Future of Health Care for Kansans," The Flint Hills Center, 14 February 2005.]

[Andi Atwater, "Ranking for Wichita is flawed, insurers say," The Wichita Eagle, 27 August 2006.]

A new ranking from eHealthInsurance places Wichita among the most expensive cities to obtain health insurance, but the numbers are under dispute:

The best and worst rankings -- Wichita made the bottom five of the nation's 100 most populous cities -- are being published in today's Parade section.

EHealthInsurance.com is an online broker of individual health insurance plans. Officials said the company has more than 140 insurance carriers nationwide representing some 5,000 plans. The site provides insurance quotes for individuals and businesses who enter their personal information online.

However, the company does not necessarily represent all of the insurance providers available in a given market. In Wichita, that translated to two carriers when the company surveyed itself last March for its report dated July 19. That report is the basis for the information in Parade.

Industry officials say Wichita has at least a dozen choices when it comes to buying personal health insurance.

EHealthInsurance officials say the report is still a viable tool. Bob Hurley, vice president of customer care, said these types of reports go a long way toward promoting price transparency for consumers.

"I think the value of transparency we're starting to bring to these markets is critical," Hurley said. "Consumers never had one place to go to see three carriers. Hopefully someday we'll have six carriers.

"But there's tremendous value in bringing that to the market, (even) if there needs to be a footnote saying it's only plans available on our Web site."

[Mary Katherine Stout and Matthew Hisrich, "Seeing Through the Cost of Health Care: Consumer-Driven Price Transparency in Kansas," The Flint Hills Center, 6 July 2006.]

[Dave Ranney, "Firm’s Medicaid advice may backfire for state," The Lawrence Journal-World, 28 August 2006.]

The Lawrence Journal-World's Dave Ranney peels another layer back in the ongoing Medicaid financing mess in his latest column on the subject:

Ten years ago, state welfare officials fell head-over-heels in love with Maximus, a Virginia-based consulting firm that knew how to coax millions of federal dollars out of the nation’s Medicaid program.

The company’s experts helped the Kansas Department of Social and Rehabilitation Services take in an additional $26 million in 1996 alone. Millions more soon followed.

Maximus, it seemed, could do no wrong.

Now, Medicaid wants — and is taking back — a lot of its money that it gave Kansas.

SRS isn’t happy. Earlier this month, SRS Secretary Gary Daniels announced the department had dropped its “maximization” contract with Maximus.

“It seems they’ve become somewhat of a lightning rod for (auditors),” Daniels said. “We decided it would be best if we managed our own affairs.”

A recent report by the National Academy for State Health Policy noted “the federal government has allowed and even encouraged state fiscal practices that it later determines are problematic.”

But the report also surmised that states “are engaged in a constant game of ‘catch me if you can’ in an effort to maximize receipt of federal funds.”

Tom Lenz, regional administrator at the Centers for Medicare and Medicaid Services’ office in Kansas City, Mo., said he understood the state’s frustration.

“It’s true, (federal) guidance wasn’t always crystal clear,” Lenz said.

But, he said, states shouldn’t expect the federal government to ignore past transgressions.

“When the current administration came in, it decided we needed to enhance the oversight of Medicaid program and strengthen policies as to what’s allowable and appropriate,” he said. “That’s what we’re doing.”

[Matthew Hisrich, "Shutting down Medicaid shell games," The Kansas City Kansan, 26 July 2006.]

[John Goodman, "What Causes Health Care Inflation?," NCPA Consumer Driven Health Care Blog, 24 August 2006.]

NCPA president John Goodman points out a new NBER study that demand is driving rising health care costs:

In the decades prior to the establishment of Medicare and Medicaid, health care spending was relatively moderate, and never rose above 6 percent of GDP. With the expansion of government insurance, however, health care has steadily claimed more and more resources - rising to more than 16 percent of GDP today.

Despite this temporal association, many economic studies suggest that technology is the cause of as much as 65 percent of the growth of medical spending. Now a new study by Amy Finkelstein of MIT sorts through new evidence and finds that the problem is with demand, not with supply. Third-party insurance is responsible for more than half of the growth of health care spending.

A clear implication (but not one made by Finkelstein) is that spending can potentially be slowed by shifting from third-party insurance to individual self-insurance through individually owned health accounts.

Read the full article

Read the coverage in Business Week

[Richard B. Warner, "The Real Culprit," The Flint Hills Center, December 1997.]

[Julie Schmit, "Could walk-in retail clinics help slow rising health costs?," USA TODAY, 24 August 2006.]

Consumer-driven innovation in health care delivery is gaining steam, as this recent article from USA Today indicates:

The clinics, about 150 nationwide, provide convenient but limited service at a low cost. They treat common ailments only — such as strep throat, ear infections and allergies — and offer an alternative to packed doctors' offices and pricey emergency rooms.

While the clinics vary by company, most treat 25 to 40 medical conditions and charge $45 to $75 a visit. MinuteClinic pioneered the industry in 2000. It has the most clinics, 87, and is being bought by CVS.

HealthPartners, a Minnesota-based health maintenance organization, analyzed two years of MinuteClinic claims data and found total costs about 25% less for MinuteClinic treatments compared with those done at doctors' offices or urgent-care clinics.

The clinics save even more if they keep patients out of emergency rooms, which can cost hundreds of dollars per visit, and which frequently treat the uninsured.

Most clinics do or will take insurance, are walk-in and are open evenings and weekends. They advertise short waits and 15-minute exams, and some give out pagers so clients can shop while waiting. Prices are posted — at MinuteClinic, on an electronic sign, as in a fast-food restaurant.

The retail clinic threat is already sparking change. Several health care providers, including AtlantiCare, the biggest in southeastern New Jersey, are opening their own limited-service clinics in stores.

The American Academy of Family Physicians recently encouraged its 94,000 doctors to expand office hours and same-day appointments. “Hopefully, we'll be able to compete,” says Larry Fields, a physician and head of the AAFP.

[Devon Herrick, "The Changing Face of Health Care," The Salina Journal, 3 July 2006.]

[M.L. Baker, "Coming: Insurance Debit Cards That Reveal Health History," Extreme Nano, 23 August 2006.]

UnitedHealth just announced that they will be delivering on a concept that has been discussed for some time in consumer-driven health care circles - a debit card that patients can use to pay at the time of service that also contains health care data:


Patients covered by UnitedHealth Group will soon receive patient identification cards that they can use as debit cards for medical expenses and that doctors can use to access patients' personal health information electronically.

The new cards, which will carry the MasterCard logo, can be swiped like a credit card at a doctors' office or other certified health provider. But in addition to providing payment, the cards can be used to confirm eligibility for services and provide access to personal health information at the point of care. The cards should be broadly available early in 2007.

UnitedHealth is working on a feature that uses the cards to interface with its electronic systems and determine precisely how much the patient owes at the time of the doctor visit. Besides collecting copayments and other patient-billable expenses easily, doctors' offices can use the cards to submit and process insurance claims more quickly, says UnitedHealth.

The cards will be tied to health savings and flexible spending accounts (HSAs and FSAs), tax-protected funds that generally must be used for health-related expenses. UnitedHealth, whose subsidiary Exante Financial Services is handling this, will also offer credit lines that can cover medical expenses not covered by health insurance and that exceed amounts in an individual's accounts.

"By combining health and financial information, we have greatly simplified a series of fragmented and time-consuming experiences for health care consumers," said John Prince, CEO of Exante Financial Services, in a statement.

[William Short, "HSAs treat ills of health care payment system," The Kansas City Business Journal, 25 March 2005.]

["Financial organizations banking on HSAs," United Press International, 23 August 2006.]

A new survey reveals that the majority of financial organizations see health savings accounts as a solid investment:

Eighty percent of financial organizations either offer Health Savings Accounts (HSAs) or plan to in the next year, a new survey says.

Fifty-four percent of the 137 financial organizations surveyed by financial services firm Walters Kluwer said they were currently offering the accounts, while another 26 percent said they plan to offer them within 12 months.

Generating new accounts and increasing cross-sell opportunities were cited by more than two-thirds of respondents as reasons these organizations were offering or planning to offer health savings accounts.

Other reasons cited by organizations included increasing deposits (62 percent) enhancing commercial account relationships (41 percent) and generating fee income (28 percent).

[William Short, "Mini-meds can help HSAs succeed," The Dodge City Globe, 17 August 2006.]

["NPR Examines Kentucky, West Virginia Revisions to Medicaid Programs Under New Federal Law," Kaiser Daily Health Policy Report, 23 August 2006.]

The federal system of government in the United States ideally should allow for 50 "laboratories of democracy," in which public policy can be adapted to local preferences and all can learn from the successes and failures of the others. In the case of the federal-state joint program Medicaid, however, federal regulation has up until recently made such experimentation virtually impossible. New rules are now in effect, though, that are opening the door to creative approaches to solving the currently unsustainable design of Medicaid:

NPR's "Morning Edition" on Tuesday examined revisions to the Medicaid programs in Kentucky and West Virginia, which are the first two states to revise their programs under a new federal law that allows states increased flexibility in determining benefits and out-of-pocket costs.

The complete segment is available online in RealPlayer.

[Michael Bond, "Reforming Medicaid in Kansas: A Market-Based Approach," The Flint Hills Center, 2 February 2006.]

[Book Forum, "Crisis of Abundance: Rethinking How We Pay for Health Care," The Cato Institute, 29 August 29 2006.]

The Cato Institute is hosting author Arnold Kling next Tuesday for a forum on his new book, Crisis of Abundance: Rethinking How We Pay for Health Care:

Why do so many pundits say that America's health care system is in crisis? Economist Arnold Kling says that the fundamental challenge in American health care today is that we have many highly trained specialists and advanced technologies but do not know when their use is appropriate or how we should pay for them. He calls this a Crisis of Abundance. Kling argues that markets could do a better job of allocating these resources, and he advocates cutting government health care budgets by two-thirds and reducing third-party payment as a way to encourage better medical decisions.

If you can't make it to the Cato Institute, watch this forum live online.

[Richard B. Warner, "Medical Care Inflation," The Flint Hills Center, August 2003.
Richard B. Warner, "How Would You Like Your Medicine?," The Flint Hills Center, 24 July 1999.
Richard B. Warner, "The Real Culprit," The Flint Hills Center, December 1997.]

[Harley Gordon, J.D., "Financial Planners Risk Lawsuits for Failing to Recommend Realistic Plans for Long-Term Care," The Journal of Financial Planning, August 2005.]

Stephen Moses of The Center for Long-Term Care Reform reports in the latest LTC Bullet that financial advisers face significant risk if they do not adequately alert clients to the costs of LTC:

As long-term care planning becomes more and more important, the risk to financial advisors, including lawyers, financial planners, and insurance agents, of failing to cover it becomes much greater. If they carelessly neglect to advise their clients of the need to plan and insure for long-term care, they can be vulnerable to accusations of malpractice. And now it is starting to happen!

[Harley] Gordon's newsletter for his Certified in Long-Term Care graduates (CLTC E-Alert - Putting Advice in Writing, 8/15/2006) reports the following:

"The obvious has happened.

"A story in Registered Rep detailed the travails of a registered advisor who recommended long-term care insurance to his clients. The problem is that he did not put it in writing assuming the clients would take note. They didn't, but the children did. They sued the advisor for malpractice after both parents were diagnosed with Alzheimer's. The article made a number of points that are relevant to financial service professionals, first among them is that failure to discuss a plan for long-term care and protect the plan with long-term care insurance is grounds for professional malpractice. Other points addressed in this first rate article:

* Always put the advice in writing. The article stated that if the recommendation had been clearly stated in a letter, it is unlikely an action would have been filed.

* Check your E&O policy carefully. When the advisor put the claim in the carrier denied coverage claiming that although the policy would have covered an action brought by the clients there was a specific exclusion for third party plaintiffs, in this case the children who filed the suit.

"The full story, "Scary Story," by Janet Arrowood can be read here.

[Stephen Moses, "Its time to end welfare for the well-to-do," The Kansas City Kansan, 26 April 2006.
Stephen Moses, "Estate Recoveries Needed to Help Pay for Medicaid," The Wichita Eagle, 27 September 2005.
Stephen Moses, "Nursing home system in need of reform," The Pittsburg Morning Sun, 22 May 2005.]

[Editorial, "Granite Caring: Stephen's program shows promise," The New Hampshire Union Leader, 22 August 2006.]

The Flint Hills Center has highlighted New Hampshire's Medicaid reform proposal as an example of a possible course for Kansas policymakers to follow. Here's an editorial from a New Hampshire paper praising the early success of the program:

Though it is too early to draw definitive conclusions about the success of Health and Human Services Commissioner John Stephen's Granite Care program, early signs are good.

Granite Care is the name given to Stephen's overhaul of state Medicaid services. One of the intentions was to move Medicare recipients from nursing homes to less expensive and more comfortable home-based care.

In the first six months of the program, 67 additional Medicare recipients went to home-based care -- a good number for a six-month tally.

Granite Care recalls the welfare reform debate of a decade ago. Both drew criticism from activists who claimed the reforms would hurt aid recipients. We now know that welfare reform did exactly the opposite. Granite Care appears to be producing similar results: providing more compassionate aid at a lower cost.

Of course, the program will have to be monitored over a longer period of time, but so far the indicators are positive.

[Aparna Mathur, "Medical Bills and Bankruptcy Filings," The American Enterprise Institute, 19 July 2006.]

As NCPA President John Goodman points out, a slew of recent research undermines the claim made last year that medical bankruptcies outpace all others. The latest is a study from AEI:

The idea that more than half of all bankruptcies are caused by medical debt comes from a study by Harvard associate professors David Himmelstein and Steffie Woolhandler, published on the Web in February 2005 by the journal Health Affairs.

Both Himmelstein and Woolhandler have long advocated creating a single-payer system of national health insurance in the United States. The purpose of their study was to convince middle-class voters that they need socialized medicine to truly be secure from health-related financial catastrophe.

When the article came out it generated much controversy because the authors used a very broad definition of medical-related bankruptcy. In response, Health Affairs published more than 30 letters to the editor - as well as a follow-up study by researchers critical of the Himmelstein-Woolhandler study's methodology.

Fortunately, a new study by Aparna Mathur surveys the literature and puts matters straight. Dr. Mathur, a research fellow at the American Enterprise Institute, found that only about one-quarter of bankruptcy filers have debts that are primarily medical in nature. Far more common are bankruptcies related to credit card debts.

[Sally Pipes, "Buyer Beware the Kerry Health Plan," The Flint Hills Center, 6 October 2004.]

[Devon M. Herrick, "Inject competition into health care," The Baltimore Sun, 17 August 2006.]

NCPA scholar Devon Herrick writes in this recent column that interstate competition for insurance would improve the outlook for consumer prices:

Sponsored by Sen. Jim DeMint, Republican of South Carolina, and Rep. John Shadegg, Republican of Arizona, the Health Care Choice Act would increase access to individual health coverage by allowing insurers licensed to sell policies in one state to sell policies in any other state.

Why is this important? Under the current system, many localities have only one insurance product available, so the consumer is forced to buy an overpriced product or forgo insurance altogether.

The state markets are simply not competitive. Under current law, each state has the right to regulate health plans sold within its borders, which means 50 states have 50 sets of regulations. And because each state insurance market is protected from interstate competition, legislators mandate that insurers cover services that drive up premiums. Proponents often claim that a given mandate costs very little - but they add up. Some estimates suggest these mandates have priced as many as one-quarter of the uninsured out of the market.

The Health Care Choice Act would allow consumers to shop for individual insurance on the Internet, by phone or through a local agent. Residents of any state would be free to choose among policies from any insurer that offers them.

["Kansas Health Insurance Mandates Exceed National Average," The Flint Hills Center.
Matthew Hisrich, "State Mandates Reduce Insurance Affordability," The Flint Hills Center, 28 June 2004.]

["HSAs Growing Apace To Reach 3.6 Million Accounts By January, 2007," Press Release, Information Strategies, Inc., 17 August 2006.]

A new survey reveals that health savings accounts have staying power in the marketplace:

Defying critics and demonstrating resilient expansion, Health Savings Accounts (HSAs) continued their strong growth trajectory with indications that this fall’s sign-ups will blow past estimates.

Information Strategies, Inc. quarterly survey of more than 150 HSA custodial advisors indicates that total accounts will pass 3.6 million by January 2, 2007 managing $5.2 billion.

In its latest survey, ISI found substantial growth in deposits, particularly from industry leaders such as HSA Bank reporting 7,000 new accounts in this quarter raising its total accounts to 157,814.

Other custodians report similar increases. It is the new custodians reporting for the first time that indicate growth in HSAs has not slowed but rather deepened.

Based on its collecting of data from more than 150 custodians and reflecting some changes in HSA purchaser patterns first reported in May, ISI is estimating that 1.7 million total accounts will have put away $2.4 Billion in deposits by the end of the second quarter.

From the end of April to the beginning of July, almost all providers reported an increase in the total number of HSA accounts with average deposits growing to $1,940 for those accounts opened more than a year and $1,090 for those opened less than a year, on average. All banks reported an increase in deposits with $1,200 being the average deposit for each account, though deposits ranged from $450 to $2,316.

Much of the deposited money is staying in the account. The majority of banks surveyed said at least 40% of deposited funds are staying put. Blackhawk Bank, for example, estimates that less than 10% of the money deposited into its HSAs is actually being spent.

[Kenneth Daniel, "AFL-CIO to attack health savings accounts," The Kansas City Kansan, 17 February 2006.]

[Kevin Freking, "Doctors taking less Medicaid patients," Associated Press, The Seattle Post-Intelligencer, 16 August 2006.]

A new study shows that low reimbursement rates are serving to discourage physicians from accepting Medicaid patients:

Many people who rely on government health insurance for the poor have to search harder to find a doctor and increasingly are going to large practices, a study shows.

Officials say Medicaid's reimbursement rate is the biggest reason that it is getting more difficult to locate doctors who take new patients under the program. On average, reimbursements are 69 percent of what Medicare pays and even lower compared with what private insurers pay.

Doctors frequently complain about the administrative hassles. For example, physicians often have to get approval before prescribing medicine or conducting tests.

Overall, the percentage of physicians not accepting new Medicaid patients has risen from about 19.5 in the mid-1990s to about 21 over the past few years. The change was much more pronounced among solo and small group practices.

Such "rationing" is the often unspoken method for controlling costs in government-run programs. According to Michael Bond in his Flint Hills Center study "Reforming Medicaid in Kansas: A Market-Based Approach":

Health care is very complicated and no bureaucracy can effectively design a rationing system to control usage in a manner that contains costs while preventing negative health outcomes.

Bond suggests that state officials work instead to empower Medicaid beneficiaries with accounts they can use to act as genuine consumers in the marketplace.

[Michael Bond, "What's wrong with Medicaid in Kansas?," The Flint Hills Center, 26 December 2005.]

[Sally C. Pipes, "Arnold's Raw Deal: Gov. Schwarzenegger tries to sell price controls," The Wall Street Journal, 16 August 2006.]

Pacific Research Institute president Sally Pipes takes Governor Schwarzenegger to task for trying to impose price controls on pharmaceutical companies in this recent column:

Gov. Arnold Schwarzenegger is promoting his new discount drug plan as a "voluntary" agreement between pharmaceutical companies and the State of California. But it's more like a raw deal.

The California Prescription Drug Initiative calls upon drug manufacturers to offer five million low-income Californians huge discounts on prescription medications--up to 40% on brand-name drugs and a whopping 60% on generics.

Presumably, drug companies should offer these discounts out of the goodness in their hearts. But if they don't comply? Well, then they'll be coerced by the Terminator.

There is a better way.

The market economy remains the best supplier of human needs--including health needs. It has made the United States the world leader in the research and development of new medications and in health care overall.

Rather than pushing for socialist price controls, Gov. Schwarzenegger should pursue free market ideas. He should support the federal legislation proposed by Rep. Shadegg (R., Ariz.) which allows people to shop for insurance across state lines. He could make health insurance premiums tax deductible. And he could promote changing the tax code in California so that contributions to Health Savings Accounts are not subject to state income tax.

Such policies would help people afford the drugs they need without creating economic distortions. And there would be no strong-arm tactics required. Of all people, Arnie should know better than to give someone a raw deal.

[Kenneth Daniel, "The roles of doctors drugs in health care costs," The Kansas City Kansan, 26 January 2006.

Matthew Hisrich, "Sebelius is practicing black-market politics," The Wichita Eagle, 10 December 2004.
Matthew Hisrich, "Drug importation," Letter to the editor, The Kansas City Star, 9 December 2004.]

[Fred Schuster, "Health-care transparency," Letter to the Editor, The Kansas City Star, 15 August 2006.]

U.S. Department of Health and Human Services Kansas City Regional director Fred Schuster announces the launch of a new tool for health care consumers in this letter, as well as making the case for a new approach to health care generally:

The U.S. Department of Health and Human Services is resolving to find ways to increase the quality of care while reducing costs. To do so, we need to do three things: People need to know how much their health care costs. They need to know the quality of the care they receive. And they need to have a reason to care. None of these things exist in our current system.

Consumers should be able to go to an Internet site, type in the name of a medical procedure and make the comparisons. They should be able to see a facility rated by quality, cost and how many patients undergo that procedure there each year.

As a first step, the Centers for Medicare and Medicaid have posted on their Web site 30 of the most common medical procedures by state with their costs (http://www.cms.hhs.gov/healthcareconinit).

Transparency in health care is empowering you with information you need when considering a medical procedure.

[Mary Katherine Stout and Matthew Hisrich, "Seeing Through the Cost of Health Care: Consumer-Driven Price Transparency in Kansas," The Flint Hills Center, 6 July 2006.
Mary Katherine Stout and Matthew Hisrich, "Price transparency important," The Salina Journal, 12 July 2006.]

[Andrea Petersen, "Covering Long-Term Care," The Wall Street Journal, 13 August 2006.]

The Wall Street Journal reports that while consumers have thus far shown only limited interest in long-term care coverage, new products may increase demand:

Firms are rolling out policies that allow consumers to get their benefits -- or a portion of their benefits -- in cash, making it possible for people to pay for informal types of care, including assistance from friends and family members.

New "shared care" plans let couples pool their combined benefits: If one person exhausts benefits, he or she can pull from the spouse's policy.

Recent government actions are also spurring the development of new long-term-care products. A new "partnership" program that is in the process of being rolled out nationally will allow those who buy certain long-term-care policies to protect some of their assets and still become eligible for care paid for by Medicaid. Also, recent legislation passed by Congress is likely to open the door to a slew of new products that meld long-term-care insurance with an annuity or life-insurance policy. These could give consumers new tax breaks.

[Stephen A. Moses, "Project Proposal: Controlling Medicaid Long-Term Care Costs," The Flint Hills Center, January 2004.]

[Gary S. Mogel, "Premium cuts stifled on HSA-linked plans," Investment News, 14 August 2006.]

A recent article in Investment News reports on the disappointment of some in early price savings on HSA-linked high-deductible health insurance plans, but hints at greater savings in the near future:

"When we did our census earlier this year comparing best-selling products, premiums looked like they were about one-third less," said Larry Akey, a spokesman for America's Health Insurance Plans, in Washington. The census was of the group's 1,300 members.

Many early HSA adopters were hoping for cuts of 50% or more, according to observers, based on the fact that when there is a $1,000 to $2,000-plus deductible in insurance, the premium often is at least halved.

"If consumers expected immediate large drops in cost, those were unrealistic expectations," Mr. Akey said.

"Because insurers have only one mature year of claims experience with high-deductible plans, they're using actuaries' best guesses," said Amy Chambers, senior legal counsel for Priority Health Managed Benefits Inc., a health insurance plan in Grand Rapids.

Insurers are tentative about pricing the policies, because they are uncertain about how the higher deductibles will affect policyholders' involvement in health-care decisions and how they access benefits, she said. After insurers develop additional years of claims data, pricing should become less conservative, Ms. Chambers added.

"It's fear of the unknown," Mr. Travis said. "These policies are still very new."

There is evidence that high-deductible health plan premiums are coming down, Ms. DeWitt said.

Premiums have decreased as much as 40% after a switch from a health maintenance organization or preferred provider organization with first-dollar coverage and low co-payments, Ms. Chambers said.

"This is a young market, and early rollout of a product in any field has pricing adjustments to go through. In the individual and employer markets, the perceived high level of pricing is offset by its value as an affordable health plan," Ms. DeWitt said.

"So the pricing discussion is relevant, but it's not a barrier to adoption."

[Devon Herrick, "Health Savings Accounts: The Future of Health Care for Kansans," The Flint Hills Center, 14 February 2005.
Brian Moore, "Governor's new HSA option leads to savings," The Kansas City Kansan, 14 December 2005.]

[Jeff Donn, "Hope balanced against cost," The Associated Press, The Kansas City Star, 14 August 2006.]

The Kansas City Star reports that a surge in the cost of treatments of undetermined effectiveness is not significantly affecting demand. What could cause such a situation to arise?

In the last decade, an array of expensive new treatments has given some patients their first real fighting chance against common diseases once routinely called “terminal.”

These treatments include biotechnology drugs for cancer and mechanical implants that help the heart pump blood. Some of these therapies, like the biotech drug Gleevec for leukemia or implanted defibrillators for some heart problems, can work wonders.

The trouble with many treatments, though, is that average patients gain only months of life, studies have found. A lucky few may survive for years.

Faced with a lethal disease, more than a third of Americans now would want “everything possible” done to save their lives, up from just over a fifth in 1990, according to a poll by the Pew Research Center for the People and the Press.

In a system dominated by third-party payment of health care where consumers are shielded from the actual cost of treatment, it should not be surprising that cost factors so little into their decision-making process. Further, companies can develop products knowing that even if too few private paying consumers would take them up on their offer, insurance companies and government agencies are willing buyers. Thus, the fact that patients are even faced with such decisions is evidence that something is awry in the system. Encouraging actual consumers to weigh costs and benefits is the only way to restore sanity to health care.

[Greg Scandlen, "Choice is revolutionizing health care," The Wichita Eagle, 28 September 2004.]

[Lynn Gresham, "Hot market for voluntary medical benefits," Employee Benefit News, August 2006.]

Insurers have long been frustrated with the lack of interest from consumers in long-term care insurance. Part of this, of course, arises from incentives built into Medicaid, which offers relatively easy access to eligibility and coverage for LTC expenses. Insurers have not given up on LTC insurance, however, and hope that HSAs and consumer-driven health care will erode the entitlement mentality and apathy toward LTC costs that currently dominates the market:

One reason that insurers are sticking with LTC is that they are optimistic that health savings accounts will breathe life into moribund sales, since LTC and other voluntary product premiums can be paid with HSA funds.

"Carriers are hopeful that HSAs will have some positive impact on LTC sales, but it won't be gangbusters because employee interest is limited," Brazzell says.

[Kenneth Daniel, "Consumer directed health care growth," The Kansas City Kansan, 4 January 2006.]

[Stephen A. Moses, "Medicaid Commission Overlooks Private Financing Options," Health Care News, The Heartland Institute, 1 August 2006.]

Steve Moses of the Center for Long-Term Care Reform, who is currently finalizing a report on long-term care in Kansas for The Flint Hills Center, offers his review of a recent meeting of The Medicaid Commission in this Health Care News column:

The Medicaid Commission--a 30-member committee appointed by U.S. Health and Human Services Secretary Michael Leavitt--convened in Dallas in mid-May to pursue its congressionally mandated objective of fixing the federal health care program for the poor before it implodes financially.

Since being established by Leavitt in May 2005, the commission has met approximately once every two months. At this sixth meeting, roughly two-thirds of the way between its founding and its expected final report, the outlines of the commission's likely findings and recommendations became clear. But some witnesses and commissioners worried the majority is ignoring its fiscal mandates.

Dennis Smith, director of the Center for Medicaid and State Operations, warned that the program, especially its long-term care (LTC) component, is growing beyond its means.

"Everybody can agree that Americans should prepare for their own retirement needs," Smith said. "LTC insurance is one solution, but it hasn't grown for many reasons. We need lots of good discussion on how to stimulate the private sector."

Yet the commissioners rarely addressed incentivizing private financing alternatives. Their focus was nearly exclusively on how to make Medicaid-financed care more attractive and more affordable.

Without addressing these matters, the commission risks attacking symptoms instead of causes with its recommendations, proving ineffective or worse. Yet no one on the commission and none of the witnesses in Dallas raised these concerns, though I tried to do so in two minutes of "public testimony."

Voting members of the Medicaid Commission who are more favorable to private financing alternatives, such as Galen Institute President Grace-Marie Turner and Robert Helms, director of health policy studies at the American Enterprise Institute, have expressed concern that some of their requests to invite witnesses have not been honored.

The Medicaid Commission may be drifting toward conclusions and recommendations that will make Medicaid even less sustainable financially in the future than it is today--exactly the opposite of its mandate.

[Stephen Moses, "Its time to end welfare for the well-to-do," The Kansas City Kansan, 26 April 2006.]

["Help with long-term care insurance offered online," The Dunkirk Observer, 8 August 2006.]

The state of New York is working to reduce the burden of paying for long-term care through Medicaid by making it easier for citizens to shop for adequate coverage. Perhaps it is time Kansas policymakers took similar action:

Long-term care insurance shoppers can go online effective immediately to compare sample premium rates. Consumers logging onto www.ins.state.ny.us, clicking the consumers icon and then scrolling down to the Long Term Care section can retrieve personalized LTC insurance premium rates by submitting the type of policy they would like to purchase, their age and the number of days they are willing to pay out-of-pocket for LTC services before a policy will begin to pay benefits.

This is just one of many new initiatives being implemented to inform the public about the advantages of purchasing long-term care insurance when planning for the family’s financial future.

To help make long-term care insurance more affordable, 20 percent of the total amount of premiums paid for qualified policies can be used for a tax credit on New York state income tax returns.

[Matthew Hisrich, "Staying the Course: Medicaid Reform in Kansas," The Flint Hills Center for Public Policy, 31 January 2004.]

["HSA Bank Reports Accountholder Balance Growth in 2006," Press Release, HSA Bank, 8 August 2006.]

As a counter to concerns that people are not taking advantage of the opportunity to save for medical expenses using HSAs, HSA Bank just issued a report indicating that balances are rising significantly:

HSA Bank announced today that its accountholders' average balances have increased by more than $350 to nearly $1,940 during the first six months of 2006. HSA Bank attributes the increase in balances to both a greater number of accountholders saving their HSA funds and an increased level of contributions to individual accounts.

In the first six months of 2006, nearly 52 percent of accountholders saved at least half of their HSA contributions. The average contribution surpassed the average distribution in 2006 by more than $100 per month, an increase of more than $40 during all of 2005.

"These statistics demonstrate that HSA Bank accountholders are learning how to manage their accounts and in many cases are able build savings for future health care costs," said Kirk Hoewisch, president of HSA Bank.

[Devon Herrick, "Health Savings Accounts: The Future of Health Care for Kansans," The Flint Hills Center, 14 February 2005.]

["Too successful: the hospitals forced to introduce minimum waiting times," The Daily Telegraph, 7 August 2006.
Helen Disney, "Curing European Health Care," Wall Street Journal, 9 August 2006.]

Right on the heels of news that Britain is warning against "over-performing" by treating patients too quickly and imposing minimum waiting times for medical care, Helen Disney reports that changes are afoot throughout Europe to move away from state-directed healthcare:

A combination of demographic changes, increased consumer demand, rising medical costs and the resulting bankrupt welfare systems makes further market-oriented reform of European health systems highly likely.

In fact, many countries are already introducing steps that would have been heretical a few years ago. Some examples:

- In Slovakia, health insurers and providers have been given for-profit status to spur competition, rather than rely on a single state provider; these changes have helped the annual health-system deficit by cutting costs and increasing investment.

- In Sweden, with free-market forces at play, nurse pay has shot up, outstripping those in the rest of Sweden's health-care sector by 50 percent; almost all union organizations in the Swedish health-care sector now support reform.

- Britain has allowed contracting with private-sector vendors to provide set numbers of standard elective surgeries; this keeps prices down and allows patients to be treated more quickly.

- The U.K. government has endorsed a set of policies known as "Patient Choice," which allow patients to choose their own hospitals and gives them more control over when and where they are seen by a doctor.

[John McClaughry, "Patient Power - A Health Care Reform Agenda for Kansas," The Flint Hills Center, May 2004.
Richard Warner, "How Would You Like Your Medicine?," The Flint Hills Center, 24 July 1999.]

[Christopher Lee, "Thompson's Medicaid Reforms Could Benefit His Employers," The Washington Post, 8 August 2006.]

Not only is Tommy Thompson's Medicaid overhaul proposal a flawed approach to reform the troubled program, but his motivation in presenting it is now coming under fire:

Thompson, who served during President Bush's first term, is on the board of Centene Corp., a St. Louis-based company that operates Medicaid-funded health maintenance organizations in Indiana, Kansas, Missouri, New Jersey, Ohio, Texas and Wisconsin. His proposals to move more Medicaid beneficiaries and uninsured people onto such plans could improve the company's bottom line.

Thompson also is chairman of the Deloitte Center for Health Solutions, part of Deloitte & Touche USA LLP, a consulting firm that has contracted with states to help improve their Medicaid programs. If Thompson becomes a driving force behind revamping Medicaid, states who hire Deloitte may feel they are contracting with a player. Ditto for clients' perceptions of the law firm Akin Gump Strauss Hauer & Feld LLP, in which Thompson is a partner and which has health-care and insurance industry clients.

Thompson also is a part-owner and board member of VeriChip Corp., which makes microchips that store data and can be implanted in humans. The company might benefit if Medicaid were to embrace electronic medical records.

"An important part of our strategy has been to attract key thought and opinion leaders, and Secretary Thompson has played an influential role in shaping this country's healthcare policies," Scott R. Silverman, CEO of VeriChip Corp.'s parent company, said in a July 2005 news release. "We look forward to him assisting the company to make the VeriChip an important part of the healthcare landscape."

[Robert Tanner, "Governors wrestle with Medicaid changes," Associated Press, 7 August 2006.]

A number of states are tackling major Medicaid reform, but for the most part the nation's governors seem content to meet once a year and either talk big about far-off plans or simply bemoan about the growing problem:

For most governors, what's happened so far are just baby steps — but they are steps toward change.

- Massachusetts created universal health insurance by requiring everyone to carry insurance, with a combination of subsidies and penalties to make coverage more affordable and encourage people to buy it.

- Florida tried to rein in costs, starting in two large counties, by shifting many Medicaid recipients into private managed care. Medicaid recipients choose a managed care group to coordinate their care and the state pays a premium to the group. Companies will get more money for sicker patients.

- West Virginia aims to encourage Medicaid families to make healthier decisions and save money by reducing benefits if they refuse to sign contracts promising to show up for doctors' appointments and use the emergency room only for emergencies.

Most programs are not yet in place or too new to assess whether the change is for better or worse, or even if they work. Democratic Gov. John Baldacci's overhaul in Maine — which brings state and businesses together to get more people on insurance — is one of the oldest, though so far has failed to enroll the numbers of uninsured that it aimed for.

[Michael Bond, "Reforming Medicaid," Testimony before The Kansas Health Policy Authority, The Flint Hills Center, 18 July 2006.
Michael Bond, "Create a Real Kansas Medicaid Market," The Wichita Eagle, 10 February 2006.]

["DoctorPricing.com Makes Price Transparency Available to Health Care Consumers," Press Release, DoctorPricing.com, 7 August 2006.]

A new service based out of Overland Park allows consumers to comparison shop for physicians by location and by specialty:

As health savings accounts continue to become a preferred option for health care consumers, a great need is being created for transparency in pricing within the health care industry. With over 4 million health care consumers taking charge of their own health care costs via HSA’s, and even more consumers remaining uninsured -- the number of patients who are price sensitive to routine medical procedures is growing exponentially.

In an effort to address the needs of those consumers, a team of health care industry, insurance, and technology professionals have created a solution -- DoctorPricing.com.

“We know that the greatest drawback to the consumer driven health care movement is that consumers have no way to comparison shop for routine health care procedures,” said, William Short, President. “DoctorPricing.com is the final piece of the puzzle when it comes to consumers taking power for their own health care decisions back in to their own hands.”

Doctorpricing.com is a comparison shopping engine that is free to use for health care consumers and providers. With a current database of over 700,000 physicians, doctorpricing.com is already the premier doctor search on the Internet.

[Mary Katherine Stout and Matthew Hisrich, "Seeing Through the Cost of Health Care," The Flint Hills Center, 6 July 2006.
William Short, "HSAs treat ills of health care payment system," The Kansas City Business Journal, 25 March 2005.]

[Christopher Lee, "Ex-health chief offers new Medicaid plan," The Boston Globe, 4 August 2006.]

It's still too early to say for sure if Tommy Thompson's proposal to overhaul Medicaid suffers from a case of over-centralization, but early indicators suggest that's likely the case:

The former Wisconsin governor, who garnered national attention in the 1990s for his state's welfare-to-work efforts, has his eye these days on another large entitlement program: Medicaid.

Jointly funded by state and federal governments, the 40-year-old program pays medical bills for low-income, elderly, and disabled people. Thompson is set today to call for overhauling Medicaid by shifting responsibility for long-term care of the burgeoning elderly population to the federal government, while leaving states to focus on acute care for those under 65, particularly children.

"The federal government is the only one large enough to handle this growing problem," said Thompson, who will address the National Governors Association tomorrow in Charleston, S.C.

It's too often an unfortunate side-effect of working in D.C. that all of the problems federal policy creates are viewed as having their solutions in more federal policy. What Medicaid needs is less federal control, and more freedom for states to craft policies appropriate to their individual needs. What long-term care needs is less government intervention and more individual responsibility to cover the costs.

Thompson would do well to read Nobel-prize winning economist Milton Friedman's Capitalism and Freedom, in which he states the following:

[G]overnment power must be dispersed. If government is to exercise power, better in the county than in the state, better in the state than in Washington. If I do not like what my local community does...I can move to another local community, and though few may take this step, the mere possibility acts as a check...If I do not like what Washington imposes, I have few alternatives in this world of jealous nations.

The very difficulty of avoiding the enactments of the federal government is of course the great attraction of centralization to many of its proponents. The great tragedy of the drive to centralization...is that it is mostly led by men of good will who will be the first to rue its consequences.

Government can never duplicate the variety and diversity of individual action...In the process, government would replace progess by stagnation, it would substitute uniform mediocrity for the variety essential for that experimentation which can bring tomorrow's laggards above today's mean.

UPDATE: The verdict is in - Thompson is misguided.

[Stephen A. Moses, "Project Proposal: Controlling Medicaid Long-Term Care Costs," The Flint Hills Center, January 2004.]

[Karen Pallarito, "Bank on HSAs for Healthy Deposits," HealthDay News, Forbes, 3 August 2006.
Thomas M. Anderson, "Save on Health Care: How to make the most of a pretax health savings account," Kiplinger's Personal Finance, August 2006.]

Forbes re-printed a HealthDay News piece on health savings accounts that discusses their tremendous growth, and makes the following recommendations for interested consumers:

Here are some other things to look for when you're starting your HSA:

- Easy deposits. Can you or your employer deposit funds electronically -- for example, via payroll deductions?

- Easy withdrawal. Does your bank offer a checking, debit or credit card option?

- Attractive interest rates. Look beyond the potential return on investment products. Does your bank offer a competitive compound rate on liquid funds in your HSA?

- Ability to check your balances. Can you do business with your bank online?

Kiplinger's offers similar tips:

[T]o get the most out of an HSA, it pays to follow a few simple strategies. Many banks and insurance companies offer HSAs, so pay attention to setup, administrative and investment fees that can whittle away at your account's tax-free earnings.

Access to your money is often by check or a debit card tied to the account. Some firms offer a credit card for times when medical bills exceed the HSA balance. Don't use the credit option, which typically costs 9% to 12% in interest. Instead, work out a payment plan with the health-care provider. Bargaining may "freak them out," says Bailey, but it works. He saved 10% on a routine dental cleaning just by asking for a discount.

[Devon Herrick, "Health insruance is better to own than rent," The Dodge City Daily Globe, 23 March 2005.]

[Laurie Dale Marshall, "Medicaid return," Letter to the editor, The Lawrence Journal-World, 3 August 2006.]

In her response to my earlier letter, "Medicaid woes," Kansas Health Consumer Coalition director Laurie Dale Marshall states that she believes I am "suggesting that Medicaid is a failure and is a misuse of public funds, citing the return of Kansas Medicaid money as the tip of the iceberg."

Of course, my letter says nothing of the sort. What it does say is that policymakers in Kansas cannot solely blame federal officials for their accounting problems and avoid restoring Medicaid to financial stability. Here's how my letter ends:

Unless Kansas policymakers institute reforms that address the fundamental flaws plaguing the program, Medicaid will remain on a course to bankrupt the state. Federal officials are open to and interested in creative solutions to Medicaid’s financial troubles, leaving the responsibility to follow through squarely on the shoulders of leaders here in Kansas.

For a lenghtier explanation of the current accounting problems facing Kansas Medicaid, see the op-ed "Shutting down Medicaid shell games." This viewpoint is consistent with all of the work of The Flint Hills Center on Medicaid - that the program was intended as a safety net for the truly needy but too often fails to provide quality care and is currently in deep financial trouble. Anyone genuinely seeking to empower Kansas health consumers must face up to the fact the Medicaid needs significant reform if it is to remain viable into the future.

[Michael Bond, "What's wrong with Medicaid in Kansas?," The Flint Hills Center, 26 December 2005.]

["CMS takes steps to improve coverage and sustainability of care for dual-eligible beneficiaries," Press Release, The Centers for Medicare and Medicaid Services, 27 July 2006.]

CMS announced that it is introducing new policies to improve the financing of long-term care:

These policies include new incentives for people to buy private long-term care insurance, improved rules governing the transfer of assets to prevent inappropriate use of taxpayer funded programs, and improved coordination of care for those with both Medicare and Medicaid coverage, the so-called “dual eligibles” who are in managed care plans.

CMS administrator Mark McClellan issued some strong statements regarding LTC finance as part of the announcement:

“Medicaid is truly not equipped to pay the long-term care expenses of every American,” said Dr. McClellan. “We must preserve the program for the future and for those who are its intended beneficiaries.”

The new policies focus on public-private partnerships:

“Partnerships between consumers, the private insurance industry and Medicaid will help people better plan for long-term care needs they may have in the future,” said Dr. McClellan. “The Partnership program, we believe, will encourage people to accept personal responsibility for their future long-term care needs by purchasing insurance, and will reduce the incentive to transfer or hide assets that can be protected legally,” Dr. McClellan said.

[Stephen Moses, "Its time to end welfare for the well-to-do," The Kansas City Kansan, 26 April 2006.
Stephen Moses, "Estate Recoveries Needed to Help Pay for Medicaid," The Wichita Eagle, 27 September 2005.
Stephen Moses, "Nursing home system in need of reform," The Pittsburg Morning Sun, 22 May 2005.]

[Editorial, "Asking For A Crisis," Investor's Business Daily, 31 July 2006.]

John Kerry's health care plan went over about as well as a lead balloon in the last Presidential election, but he's decided to give it another shot for old time's sake:

Sen. John Kerry introduced his universal medical insurance plan Monday. Haven't we been down this dead-end road before?

Of course we have — in 1994, when Hillary Clinton, then the first lady, now the junior senator from New York, came out with her plan to nationalize the health care industry in America.

Actually, we've been down this road to nowhere twice before. In 2004, Kerry campaigned on a universal health care scheme.

In both instances, the public — and in 1994 Congress — rejected the universal health care proposals.

Somehow Kerry has convinced himself that "every day since Election Day," when he lost to President Bush in 2004, "the health care crisis has grown steadily worse."

Yet, as we have noted on this page before, there is no crisis.

To say there is one is to resort to a cheap scare tactic. The only crises are those at the individual and family levels when someone without insurance becomes gravely ill. Sickness and injury can be tragic, but making a federal case out of misfortune is not one of Washington's duties.

Want a real crisis?

Absolve people of their duty through a universal third-party payer — the government — and watch a problem erupt. With little or no money coming out of their pockets, people will overuse the system, sending costs even higher through increased demand. The strain placed on medical professionals will make waiting times unbearable. With no mechanism for self-rationing in place — such as personal responsibility or cost — the government will ration care.

[Matthew Hisrich, "A better alternative to Kerry plan already exists," The Topeka Capital-Journal, 8 August 2004.
Matthew Hisrich, "No crisis ahead for uninsured," Letter to the Editor, The Wichita Eagle, 30 June 2004.]