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Tuesday, May 02, 2006

More Important Than Money, Part II

By Michael Waddoups
Utah State Senator, District 6

The insurance industry made approximately $100 billion in profits this past year. A major study by the AMA, reported in the Dow Jones Newswire, stated
Consolidation among health insurers is creating near-monopolies nationwide, with the most dominant players grabbing more market share by several percentage points per year.... The AMA study used a Department of Justice benchmark, called the Herfindahl-Hirschman Index, to gauge the level of market competition. A score above 1,000 shows "moderate" market concentration, while a score above 1,800 is considered "highly concentrated".
According to the study, 95% of the 294 markets under scrutiny were “highly concentrated,” with scores above 1,800. 67% scored above 3,000.

The Wall Street Journal has recently reported on the CEO of United Healthcare, which is now under SEC investigation (and who enjoyed a compensation plan of over $1.6 BILLION over the last decade).

Here are two paragraphs from the investigative report:
Dr. McGuire's story shows how an elite group of companies is getting rich from the nation 's fraying healthcare system. Many of them aren't discovering drugs or treating patients. They're middlemen who process the paperwork, fill the pill bottles and otherwise connect the pieces of a $2 trillion industry.

The middlemen credit themselves with keeping the health system humming and restraining costs. They're bringing in robust profits-and their executives are among the country's most richly paid as doctors, patients, hospitals, and even drug makers are feeling a financial squeeze. Some 46 million Americans lack health insurance.
These special interest groups have big law firms, powerful lobbyists and seem to only care about profits.

Once again, living in America means you can take ownership of your society, community and living conditions. Are we willing to live with the system we have allowed to evolve? I believe it is time to insert some responsible supervision into the model.

Elected officials should be the voice for working families, small business and employers who are being hammered by escalating energy costs, runaway insurance premiums and double digit healthcare costs.

It is time to say that enough is enough.


Anonymous RX said...

Profits are a part of capitalism and the system we have - even large profits. I don't believe going after the insurance industry is going to be the solution to the problem. The solution lies in 1) increasing individual responsibility for paying for their healthcare costs via Health Savings Accounts (HSAs) and 2) increasing government coverage for those who are unable to pay or for whom their costs exceed their ability to pay (Massachusetts model).

5/02/2006 3:39 PM  
Anonymous Anonymous said...

I believe the biggest issues cost, and choice can be alleviated in two ways. First an effective model like Massachusetts that will get the uninsured coverage so that we who are insured can stop paying those costs associated with health care. Second people need to understand that more choice is possible but it will NOT cost less it will cost more, in the history of a free market there are very few instances of getting more for less. If people want more choice they will need to pay higher premiums.
Finding a way to get all Utahns some type of coverage is more important and will reduce costs for the entire system.

5/03/2006 11:55 AM  
Anonymous Side effect said...

While I agree with some of your sentiment about Capitalism, we can't forget the responsibility that comes with that freedom. Healthcare is not a product for those of privilege or for comfort alone, but a necessity of life for everyone. We may not be able to successfully envision a social healthcare system that would be appropriate for the United States or the State of Utah, but our efforts should work toward helping to manage accessibility and cost effectiveness for all consumers of this industry. Imagine if we had to go through the same challenges of ability to pay to receive other services such as law enforcement, fire fighting, or public education. All these systems could run on the same theory of capitalism, but then where would our society be. Perhaps people who work in healthcare and related industries should be given the same excuses for being underpaid that these other professions are. At least then we'd have more of these professionals working because it is meaningful to them to keep people healthy and not just because it provides a healthy paycheck.

5/03/2006 12:07 PM  
Blogger J. Allen said...

There have been a lot of great comments to your postings Senator. Aside from a few, obviously emotional responses, it appears that there are a good number of intelligent people that have a good idea of what they are talking about. It also appears that a large majority of the comments are not favorably disposed to your position senator. I doubt the sampling of respondents to your comments is accurately representative statistically of your constituents due to the design of this forum. You probably have more supporters than is represented here. However, even given a large margin of error, this isn't looking very favorable.

Personally, I am yet to hear you give what even sounds like an honest, open, transparent response to the question of your motives. You seem to refuse to address the questions of your interest as a member of a board for a company in competition with Intermountain Healthcare. I'm not asking you to go on the defensive; I'm asking you to quit being political and answer the questions. I'm tired of the dancing around the issue of whether or not the point of this "crusade", as some have called it, is a direct affront on Intermountain Healthcare. Is it or is it not? If it is, let us all quit referring to Intermountain as "certain mega-corporation", and "local non-profit monopoly". Lets call it like it is. If you have an axe to grind, quit hiding it under the cloak of trying to prevent a general nation-wide health system "train wreck". I think most everyone believes (rightfully or not) that you do have an axe to grind against IHC. If not, please prove it. Be transparent. I will gladly change my opinion of your motives, and I hope all others who intend to be objective will too.

I agree with a need for investigation and believe that is why the supporters of Intermountain Healthcare gladly supported the creation of the taskforce. That would imply that there was nothing to hide. However, the investigation needs to be for the purpose of understanding the healthcare system in Utah in general and not just the processes of one major player, Intermountain. All players, large and small should be included. From what I can see, it seems that the taskforce is doing just that. But, with you as it's chair making the types of statements that you are, it appears that you are not in line with the taskforce; you seem to be coming to different conclusions. This doesn't help the perception that you have a self-interested agenda. If you can't tell, I'm trying to give you the benefit of the doubt and prove that you are an honest public servant who is truly seeking our best interest. Please take the opportunity and prove it to the many of us who have asked. Give us a reason to stand with you.

5/03/2006 12:27 PM  
Anonymous Anonymous said...

Senator Waddoups,

Utah should be proud of the moral and intellectual standards contributed to the healthcare industry by our local healthcare and health insurance industry leaders.

You are right enough is enough -- you need to leave well enough alone!

As the largest private employer in the State of Utah -- Intermountain ought to be supported instead of fired upon.

Elected officials should be the voice for ALL working families. Mine included.

I have selected a plan that has no premium, because I am willing to assume the risk associated with my family's health. I have a catastophic plan and I pay as I go for the rest. I do not expect the government to solve my insurance problems. People need to take responsibility for their health and stop whining about the costs.

We live in the greatest country in the world and have access to world-class medical care. Try living in a third world country where access to clean water is a daily challenge.

We need to adopt an "attitude of gratitude" for what we have instead of complaining about what we don't have.

Education is the key!

5/03/2006 12:39 PM  
Anonymous rshill said...

I have not agreed with the Senator very often but on this matter I advocate his request for an investigation. It is not just Utah that needs to have a change. I feel the healthcare business is as much out of control as the oil business - and I am a healthcare worker. Massachusetts may have a good idea - we will have to evaluate it.
I think the not-for-profit hospitals contribute an enormous amount of charity care for those that are uninsured but they cannot sustain this increase and continue to make the budget when so many are losing insurance. I believe for profit hospitals need to pick up the pace.
I also think that consumers and the legislature need to question the high cost of healthcare equipment. As a nurse manager I am appauled at the cost of furniture and equipment if it is labeled for healthcare use. A typical blood pressure monitor costs well over $6,000! A shower chair made of PVC piping will cost upwards to $500! (How much does PVC piping and mesh really cost?)
The investigation called for should not just include insurance and hospitals. Anyone making huge amounts of profits attributed to healthcare need to be looked at.
I appreciate this health care task force as I see many issues being brought to the forefront that should have been addressed long ago.

5/03/2006 12:46 PM  
Blogger J. Allen said...

I must apologize Senator for not walking my talk. I failed to disclose my own interests. I am a Utah resident, but not a member of your district, so I don't suppose you have an obligation to answer to me directly. I am a registered nurse, thus, obviously very interested in this topic. I am also an employee of Intermountain, so there is an obvious loyalty there. But lest anyone think I am overly biased I would state that I agree that the company may not be perfect. I am also willing to accept that there may be flaws in the company to be concerned about. I have seen nothing however from working in the company on different levels to indicate that there is anything inherently wrong with the way Intermountain conducts it's business. For all intents and purposes everything I have seen from the custodial services to the General leadership is in accordance with their goal to provide true "Healing for Life". And, in general, I think they are being very successful at it. Don't ruin a good thing.

5/03/2006 12:46 PM  
Blogger RH said...

I agree that there needs to be something done about huge health care profits. The answer is easy Get rid of for profit healthcare. Why do we allow people to make a profit off the sick and vulnerable? For profits donate very little to indigent health care and even count their bad debt as a "donation" to make themselves look better. I'd rather that profit money be put back into the organization than go to stock holders.

5/03/2006 1:42 PM  
Anonymous Anonymous said...

I believe that the consumer needs to be educated. Pricing on health care services should be available to all so we can shop for quality lower cost alternatives, instead of hospital systems and providers who will not allow cost comparison's. We would also need infection rates, complication rates and information reguarding malpractice claims to make these decision. None of which are readily available. If hospital systems would be truthful as to how they price such as what is included in the room charge that would be helpful. For years Americans just have gone to the Doctor and did what ever they were instructed. We need to be better consumers and question products used, what interest the MD has in pharmacy, medical supplies or facilities that they use.
I don't think HSA are the answer the majority of Utahn's do not have the cash to put away to pay medical bills. Look at our average wage and savings amounts. We live pay check to pay check and having 5000 in a HSA is not going to happen for the majority. One catasrophic health event would ruin the average Utah family.
Yes corporate greed has ruined america and that includes the Health care industry especially for profit organization's. I have worked in healthcare for 25years the first 15 in a for profit facility. I do not support the for profit health care industry and I beleive they are the biggest problem

5/03/2006 2:03 PM  
Anonymous L.Mason said...

I would like to believe that an investigative process could in fact initiate changes in such a massive and complex problem as health insurance. I hold a pessimistic view of such because I think the expectations of individuals are unrealistic. Frankly there are some things that nature should be allowed to do-----we intercept much of that process with the demand for medical treatment "at any and all cost". I do not propose to have an answer to the problem but I think every individual has a responsibility to determine what they are willing to contribute. The demand for highly technical testing and pharmaceutical medication is generated by the public. How many unnecessary visits to medical facilities are there? I am not opposed to treatment when there is a genuine need but I am oppposed to medical visits for every cough, fever, ache, pain, and mental stressor. The idea of getting something for nothing should apply to the healthcare industry as it applies in other areas of our lives. I believe we need to be more responsible about what we request from healthcare. The issue of liability for providers is such that I believe they are forced to refer patients for expensive testing when it is not truly necessary but the potential liability of not doing so forces their hand.
Profits and monopolies? Let's have at Questar, Pacificorp & the oil industry.
I do have a point of reference in that my spouse was a terminal patient for a number of years. The astronomical costs even with health insurance led to personal bankruptcy. There is indeed a reason to define quality of life. A system that supports aborting a fetus and subsequently fights to keep a 26 week neonate alive at all cost is a system of contradiction. As long as there is a paying public for face lifts and tummy tucks, the demand for every kind of health care will not diminish. Good luck. I hope an investigation will address these issues but my supposition is that it will only support the political motivations of those doing so.

5/03/2006 2:05 PM  
Blogger chuck said...

Again both Mr. Waddups and Mr. Davis are great at posing generalities trying to create a problem that may or may not exist in Utah. I appreciate the research that has been done but I don’t get the relevance. How about answering the following questions.
1. Exactly how many people in Utah have “lost” coverage? Please exclude those who choose not to carry it.
2. Exactly how many providers have been “excluded” from the health care system in Utah
3. How do the costs of healthcare in Utah compare with the rest of the nation
4. What is the average “first pay” or “copay” in Utah compared to the rest of the nation
5. Publish the comparison of costs, copay, and income with all of the providers in Utah
6. Establish one verifiable case of conspiracy to control costs and name those involved.
7. Exactly how many people in this state have been turned away from or cannot gain access to healthcare in the past 5 years.
8. Exactly how much have healthcare costs gone up in this State compared to the cost of medications, technology, and labor costs.

Make it real and stop with the national generalization statistics. I don’t live there, I do live here.

5/03/2006 2:06 PM  
Anonymous Anonymous said...

Utah is one of two states excluded from the AMA study.

I agree that were the HH index methodology applied to Utah the formula would indicate that Utah is a "highly concentrated" market.

Regulators consider many other factors when assessing whether or not an entity is in violation of antitrust legislation.

I must agree with you that there are several "middle men" drawing down more than a reasonable share of the healthcare dollar.

I am in disagreement with the last sentence that you quote from the WSJ. WSJ has run a number of articles inferring that docs, drug mfgs, hospitals, and health plans are drawing large profits. In many cases the articles use inductive and inferential logic.

Another point to consider is that many of the WSJ articles call for profit entities into question. Granted, there are exceptions to this pattern. In many cases the not for profit groups are not discussed, but in public opinion may inadvertently become lumped into the mix.

Unemotionally, respectfully,

Honest Uncle

5/03/2006 2:18 PM  
Anonymous Marc R. said...

It is interesting that Senator Waddoups wants to break up Intermountain Healthcare, a non-profit company, and cites United Healthcare's (a for profit company) CEO compensation as justification. Another example of outrageous compensation is that of the CEO of IASIS (the company that Senator Waddoups represents by being a board member). I wonder when he publicly will call into question his compensation?

I would really like to see apples compared to other apples. When non-profit companies delivered most of the healthcare, it seemed costs were more contained. The shift in healthcare over the past few decades has been to make it a capitalistic venture. America grants its people this opportunity and can be seen today when physician's aren't just satisfied making just their six figure incomes from treating patients, they now need to invest in brick and mortar, expensive equipment and more office staff and compete with the other guy down the street for the really big healthcare bucks. Forget the fact that neither guy is busy because of the redundant services they offer. They will say they’re doing it for the good of the patient. More choice, blah, blah, blah. Yet they rarely, if ever, apply for non-profit tax exemptions because that would hurt their ability to make the really big bucks. What these guys complain about and what Senator Waddoups is buying into hook, line and sinker is that Intermountain Healthcare makes it difficult for them to make more money because the ability to charge more is restricted by Intermountain’s size [and efficiencies]. Well good for Intermountain Healthcare!

The people on both sides of this debate want the same thing….. more money in their pocket! One group wants more money in their pocket by being able to charge more for their services. The other side wants more money in their pocket because of less waste and more efficiency in the system. These two ideals are in direct competition with each other. I would like Senator Waddoups to explain which side of the fence he is on and to justify his position with facts and reason rather than emotion and antidotal stories.

Please keep in mind that non-profit companies invest their surpluses in the community through lower rates and better facilities (i.e., better care). For profit companies pay their surpluses to shareholders in the form of dividends.

5/03/2006 4:42 PM  
Anonymous Anonymous said...

Healthcare is hardly the same as other areas of business. To treat it so would only show a great lack of understanding. If I'm a doctor and I want to abuse my responsibility as a care provider all I have to do is build all of the facilies I need so I can do all of the best money making care I can do. Then I refer any patient that doesn't have insurance or needs a procedure that doesn't make me any money to IHC because I know they have a policy to provide care even if the patient doesn't have the ability to pay for it.
If Intermountain then says to that Doctor "Hey, you are taking patients who can pay and leaving us with patients who can't pay. If you do that we will be out of business. You are taking away our ability to provide charity care. The only way we can stay afloat is to no longer allow reimbursements from our insurance to go to you." While I don't know if IHC does this or not I still have to ask the question is that wrong? Which side of this story is really predatory? I do know that many doctors do this. Many hospital systems do this. They build facilities and design them for certain procedures based on how much money they can make. They do refer patients that aren't considered good financial risks to non-profits like IHC because their mission stipulates they must provide care regardless of the patients ability to pay. If you remove IHC's ability to compete against such antics no one will be left to pick up the load except tax payers. Government run hospitals are not usually pictures of effciency and quality.
As Americans we live on the blood of those who gave their lives for our country, our freedom and our justice system. Each time we take a side of an issue, each time we represent and issue, without being unbiased and representing all sides we are disgracing our country and those who fought for it. We are taking the first baby steps, intentionally or unintentionally, towards the corruption that occupies so many other countries today because everyone is not represented equally.
Are there other problems in health care? Yes, but I have not heard those who are asking to break up IHC, who call IHC monopolistic show concern for the issues I've raised above. In fact I haven't heard much about fixing health care at all from them except for going after companies. This should bother all of us.

5/03/2006 7:38 PM  
Anonymous Anonymous said...

Did you know that the for-profit hospitals of HCA/Mountain Star (Ogden Regional, Lakeview, St. Mark's, Timpanogos & Mountain View Hospitals) give 1/4 of all their income to stockholders from around the country every quarter. Did you know that the CEO of HCA makes many millions of dollars each year in pay and bonuses? Did you know that the CEO of IASIS (Pioneer Valley, Davis Hospital, Jordan Valley Hospital and Salt Lake Regional), a company smaller than Intermountain Health Care, makes many millions of dollars each year in pay and bonuses? The For-profit Hospitals and Insurance companies are sucking money out of Utah. Let's investigate these practices and put the light of day on them.

5/03/2006 7:45 PM  
Anonymous Anonymous said...

Why do you keep talking about a Monopoly in Insurance? There are many insurance companies in Utah including: Blue Cross, Intermountain, DMBA, EMIA, PEHP, United, Aetna, Altius, Cigna, and many others. Saying there is a monopoly is just plain incorrect.

5/03/2006 7:57 PM  
Anonymous roger said...

There are healthcare organizations that need unscrupulous practices exposed. From the viewpoint of an American citizen who takes ownership in his society, community and living conditions, the federal government shouldn't be the overseer. We are reasonably assured things would be worse. Perhaps there could be direction at the state level. Citizens have more input and our positions can be better stated at the state level. One basic question is should people be allowed to profit from health care delivery? Certainly people profit from the infrastructure(equipment, pharmaceuticals, suppliers, etc.), but should there be profit in caring for our sick and afflicted? A significant portion of our healthcare dollars are spent on those who haven't had a concern for their health and have participated in lifestyle choices which lead to situations and diseases which cost the system billions of dollars. Should taxpayers and those paying healthcare insurance premiums, co-pays, and out of pocket expenses help support those who have made these choices? Locally, Intermountain Healthcare has been managed in a way to provide the best service possible at the best cost possible. Nationally, other systems pattern after Intermountain and attempt to acheive the same results clinically and financially. I am not aware of unscrupulous practices by Intermountain Healthcare. I also don't necessarily agree with those who say the taxpayers(Massachusetts) and those meeting their healthcare responsibilities should pay for those aren't. What is a Privately Owned Health Care Task Force anyway?

5/05/2006 11:50 AM  
Anonymous Marc R. said...

"Consumers are offered a variety of services that are generally considered to be of high quality and reasonably priced," Argue wrote in his 200-page report,
made public Friday afternoon. "Intervention by the Utah legislature to promote competition in these markets is not necessary, and, as a general matter, competitive markets are more likely to be harmed than helped by regulatory directives."

No wonder Senator Waddoups was undermining this report before it was written.

5/05/2006 4:45 PM  
Anonymous Anonymous said...

It is apparent to me that this blog has been infiltrated with IHC-trained propaganda minions. You all have the same talking points and are aggressive in attempting to assassinate one's character because of their beliefs.

Your lies, half-truths and distortions are just as transparent as IHC's attempts to tell us how wonderful and good they are through billboards, full page newspaper ads, and a barrage of television and radio advertising.

IF they’re so good, they don’t need to advertise. People will know it in their hearts.Did Mother Teresa put up billboards telling the world how charitable she was? Did she buy full page ads to distort and misrepresent the “accolades” showered upon her by national organizations and media? (Read most recent newspaper ads).

Sounds like to me Hitler's infamous evil propaganda genius Goebbels has been resurrected (a free gift to everyone) and is alive and well--and working at IHC.

IHC's true colors came out a few years ago when they paid for nearly 1,000 of their 26,000 employees to be bused to the capitol for a "spontaneous demonstration of average citizens' outrage."

You’re doing the same thing here on this blog. Or, perhaps, we should rename it the "IHC Clog."

1/08/2007 10:39 AM  

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