Monday, January 22, 2007

A Response to Cost? Who Cares?

Fellow alumnus and fellow blogger ( http://grindstonehc.blogspot.com ) John Kelly responds to my recent posting as follows:

The article on “Cost? Who Cares?” ends on the note….nobody cares enough to do anything about it.

On the contrary, I think folks are doing things about it…maybe not what we “desire” or is deemed good policy, but to say nothing is being done entirely misses the phenomenal change that some of us are experiencing.

To wit:

- I’ve spoken with a couple of banker friends…one of their fastest growing lines of business is to set up easy to administer Health Saving Account instruments that link to invested savings and back to employer funded medical savings accounts. This way, it is easier for businesses to “cost shift” some of the cost of first dollar health care to employees. Simultaneously, the feds have ushered in sweeping tax code changes (with the new congress hungry to do more) that allow for tax deductibility for these very same financial instruments.

- Walmart has seen a 300% increase in it’s generic prescription medication mail order business…much to the chagrin of retail, surgi-center and hospital sponsored retail pharmacies
‘brown-bagging’ for medications is not only encouraged, but required by several insurers as a means to bypass traditional provider mark-ups on medications administered in the providers facility.

- MedPAC is mid-stream in a major overhaul of the provider pay for performance system. Current discussions put the phase in on a 5 year timetable…sooner if congress gets a backbone and makes it legislative mandate versus regulatory reform snail-pace efforts.

- Employers shift more costs to employees every year, move jobs overseas to avoid paying health benefits and are demanding (not asking) narrow network insurance products with 20-30% discounts.

That’s just top of mind changes……..I could go on for pages.

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