Healthcare Reform - Part 2

美國參議院還有另一個委員會Finance committee改革健保. 雖然委員會名稱不是Health care, 卻是健保改革的核心. 財政委員會的重要性絕不亞於健保委員會, 舉凡Medicare, tax revenue, 如何找錢, 找誰要錢, 如何運作健保, 都跟財政委員會的息息相關.

為什麼改革健保必須改革財政呢? 原因很簡單, 試想, 如果健保品質好, 開銷低, 甚至越來越便宜, 甚至有一天會接近免費又質優, 誰會喊改革? 不分中外, 現狀問題是健保很貴, 越來越貴, 負擔之重, 人人自危…

v 健保搶食社會資源, 排擠效應之大, 搶食其餘領域所需資源. 現狀美國健保支出佔GDP 16%. In short, health care is draining the resources that other places need it.

ü 如果坐視任由發展, 未來10年健保支出將成倍數成長.

ü No kidding, getting sick may lead to bankruptcy both at the society level and individual level

ü Cost of health care reform is1 trillion dollar over 10 years (100 billion dollar a year)…那是多少錢? To put in perspective, 美國建保產業是 2 trillion per year, 難怪歐文同學精英前仆後繼想成為Healthcare MBA. ^_^

ü 改革的長遠目標是健保自給自足, 短期內用徵稅補足財政缺口 (surtax on top 1%~2% wealthy), 眼下經濟衰退, 徵稅談何容易

v Do we want to make sure everybody have insurance? If the answer is yes, under the employment based system, there will be “Employer Mandate”

ü 要求雇主二擇一 : pay for employees health insurance or pick up the cost (繳錢給政府)

ü 現狀下, 轉換職場跑道可能喪失健保, 或者保險不足 (因為雇主提供不同健保方案)

ü What is in it for me? (推動任何事情, 都得把這個研究透徹)

· Good for employees because the employers have to continue provide healthcare after healthcare reform, can’t drop its employees

· 對公司僱主的好處, 在於確保立足點平等, 企業想省成本, 必須在本業上有本事, 營運更有效率來省錢, 而非經由拒絕提供員工健保來省錢. 比方說開超市的廠商就要找到品質好的貨源, 精準的供應鍊管理, 有效率的結帳系統, 來開源節流, 而非滿腦子想砍健保福利來省成本. 同樣的, 做晶圓的跟做肉圓的也是一樣, 尺寸要大, 要圓, 良率要高…

Employer mandate is also good for employees because this mandate puts all market players in a straight jacket. By requiring all employers paying the same amount, companies have to be good at what you do as a business. Businesses can’t get an edge by getting away from lowering cost by not providing employees health insurance.

民意代表靠政治獻金, 獻金又來自遊說團體, 遊說團體背後金主又多是…
反改革必定會影響現狀既得利益者, 會坐以待斃才有鬼. 健保改革戰中, 哪些遊說團體有魔王水準呢:

… Lobbyists for Health Insurance companies AHIP (American Health Insurance Plans)

ü Big Health Insurance Companies (Aetna)

ü 妥協誘因: 新客源, 雖然單客利潤下滑, 但新客人數暴增.

ü 堅決反對: Public insurance option (kill the government option)

(>) 不知道 FedEx, UPS, DHL 可不可以高喊 廢除 USPS?

… Lobbyists for Drug Companies

ü 同意support healthcare reform, chip in捐款Medicare (donut whole)

ü 政治象徵意義大於實質財政意義 more symbolic than about dollars

ü 妥協誘因: 要求多使用Brand name drugs 少用 generic drugs

ü 損益比:

· 對製藥產業而言利多

· 對百姓而言, 強制購買brand name藥品較貴

… Lobbyists for Hospitals industry (Hospital Association)

ü Hospital is where most actions take place, most money is spent (“節流”勝敗在此)

ü Current “Fee for service” model rewards volume, emphasizes quantity not quality; so much treatment is redundant, wasteful, adds more risk to patients but adds marginal value

ü 扭轉根本: Change the payment model Ö change pattern Ö change results

Reward Quality “Do More with Less”, Efficient, Safe, Clean…etc

ü 醫院同意 cut $ 150 billion in the next 10 years

ü Getting in return: 4,500 million new paying customers

ü 政治象徵意義大於實質財政意義 less noise, more support (politically moving forward)

………AMA (American Medical Association) 這個組織很兇猛, 所以給三個圖章

ü Used to be the single most effective killer for health care reform

· Late 1940s~ early 50s, AMA failed Henry Truman’s reform attempt

ü 今日AMA doesn’t represent all the doctors, medical community divided along SPECIALTY lines

(a) Specialist (surgeons…) represented by AMA

· Against strong public insurance option (might not be enough $ for doctors)

· High tax for wealthy (加稅減薪, 不跳腳難阿)

· 卻仍然參予談判, 因為條件交換

o Would like to see malpractice reform (醫療訴訟改革…etc)

o Change in Medicare law, won’t face a steep cut in annual medicate fee cut

(b) Primary care doctors (paediatrician, family, OB/GYN) , in favor of

· Healthcare reforms

· Figuring out a way to regulate insurance corp.,

· Emphasize quality

· Everybody has insurance

下一篇來聊聊 why do healthcare costs keep on sky rocketing, and how can we cut healthcare cost? 為什麼多數產品 服務都逐漸打價格戰, 唯獨這個豁免於外??