Wall Street confirming " Intelligent rationing".
Message 12148198
ÿÿÿ I believe that only intelligent rationing will save our excellentÿ
ÿÿÿÿ Health Care System, and not theÿ
ÿÿÿÿ indiscriminate ,across the board type practiced by Medicare,
ÿÿÿÿ HMOs and Socialized Medicine.
ÿÿÿÿ This rationing however must be excercised directly by theÿ
ÿÿÿÿ patient.He must be the one having controlÿ
ÿÿÿÿ over what is being rationed: rationed to him and to othersÿ
ÿÿÿÿ ( through what he pays for others); by paying with hisÿ
ÿÿÿÿ savings and hard earned, tax exempt? moneysÿ
ÿÿÿÿ for health care just like any other insurance. Then he can
ÿÿÿÿ get any coverage he wants.He can decide also how much he is
ÿÿÿÿ willing to pay to support others through the voting process.
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ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ Companies Consider Lettingÿÿÿÿÿÿÿÿÿÿÿÿÿÿ Feb. 8, 2000
ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ Employees
ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ Handle Their Health-Benefits
ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ Decisions
ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ By RON WINSLOW and CAROL GENTRYÿ
ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ Staff Reporters of THE WALL STREET JOURNAL
ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ After long relying on managed-care companies as their
ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ weapon against health costs, U.S. employers are
ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ considering a fundamental change in strategy: turning the
ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ fight over to their employees.
ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ While most health-benefits decisions now are negotiated
ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ between companies and health plans, a growing number
ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ of employers are looking for ways to retreat from their
ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ middleman role and let workers make their own benefits
ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ decisions -- and bear more responsibility.
ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ The idea is driven by a confluence of forces: the
ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ backlash against managed care, the popularity of 401(k)
ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ retirement plans, the rise of Web sites that help
ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ consumers make decisions -- plus a recent resurgence in
ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ health costs despite the efforts of managed care. Behind
ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ the trend, too, is a growing feeling that the nation's vast
ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ health-care market won't work with full accountability
ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ until patients themselves hold the purse strings. "Let the
ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ consumers be the gatekeepers," says the health-benefits
ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ director at Honeywell International Inc., Brian Marcotte.
ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ "Long term, it has to be the consumer who drives
ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ efficiencies."
ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ Obstacles Remain
ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ Putting employees in the driver's seat won't happen
ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ overnight. Policy makers and companies will have to
ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ wrestle with daunting questions on such issues as
ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ tax-code changes, shortcomings in data on quality of
ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ care, and affordable coverage for high-risk patients.
ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ But some of the obstacles are wearing away. One that is
ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ fading is the long-held view that health-benefits
ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ decisions are just too complex to be left to consumers. In
ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ addition, it's possible that Congress or a court ruling
ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ will expose employers to legal liability in malpractice
ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ cases, something that could spur some companies to look
ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ for an exit strategy from the health-benefits business. The
ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ bottom line: Some employers have now embarked on an
ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ experiment that, while still in its early stages, is likely to
ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ change the health-care system as radically in the coming
ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ decade as managed care did in the last.
ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ In one new strategy, employers provide a set amount of
ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ money for each employee's health benefits, thus capping
ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ the company's costs. Employees use the amount to
ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ purchase a health-insurance plan, picking from a wide
ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ menu ranging from no-frills managed care to a
ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ traditional fee-for-service plan. Those who want
ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ more-generous coverage than can be bought with the
ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ company contribution can pay the difference themselves.
ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ By analogy with pensions, this approach is known as a
ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ "defined contribution" health-benefits system.
ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ Quick Response
ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ Xerox Corp. is already using it, with an added twist: If
ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ employees spend less than their allowance, they can use
ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ what's left over to enhance a related benefit, such as
ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ disability or dental insurance. The market effects have
ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ been striking. After a health-maintenance organization in
ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ the Southwestern U.S. raised rates significantly last year,
ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ 65% of its 1,100 Xerox enrollees switched to different
ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ plans. "People migrated out of the high-cost HMO on
ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ their own," says Cathy Diamond, health and welfare
ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ manager at Xerox.
ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ The case suggests one of the advantages for consumers:
ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ a generally much wider range of choices in health plans.
ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ At Carlson Cos., a travel and food-service company in
ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ Minneapolis, workers have nearly 30 doctor groups and
ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ hospital groups to choose from. Carlson employees
ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ receive a health-care allowance, which they can spend
ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ to enroll in any of the groups. Carlson benefits director
ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ Charles Montreuil notes with satisfaction that when one
ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ such group raised its rates steeply, "our employees
ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ flooded that care system with phone calls -- they didn't
ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ put the burden on me."
ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ The Xerox and Carlson approaches are similar to a
ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ voucher-style program that federal workers have long
ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ used to choose their health plans and that some
ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ politicians, most prominently Bill Bradley, would like to
ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ expand. For employees, the downside of choice, of
ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ course, is that they may choose badly. But they have
ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ help. Carlson uses a buyers' coalition to select the plans
ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ and medical groups, negotiate rates and provide data on
ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ quality to help employees make their choices. Xerox
ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ contracts such chores to outside companies that set up a
ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ virtual market where employees, armed with their
ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ health-care allowance, shop for plans. In addition, if the
ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ 401(k) experience is any indication, helpful Web sites
ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ are sure to pop up. Some already have.
ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ Out of Pocket
ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ Ingersoll-Rand Co. takes a different approach to
ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ promoting consumer choice. One option it offered
ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ employees for the current year was a low-cost
ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ catastrophic illness insurance plan that kicks in when a
ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ family's one-year medical expenses reach $5,000. The
ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ plan comes with a $500 use-it-or-lose-it
ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ medical-spending account to encourage checkups, but the
ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ $4,500 gap between the cash and the insurance means
ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ that workers are responsible for the cost of their routine
ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ care.
ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ The idea is that if a doctor recommends, say, an MRI
ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ exam to check out an ankle injury, an employee paying
ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ out of his or her own pocket will consider whether it's
ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ worth it. "If the plan pays for everything, people are
ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ going to consume everything," says the company's
ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ human-resources director, Beth Powers. "People don't
ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ pay attention to stuff unless they have some stake in it."
ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ Just 4% of Ingersoll-Rand's 25,000 U.S. employees
ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ chose this plan. Ms. Powers thinks many of the rest
ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ missed a bargain. For those who spend less than $1,000
ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ a year on medical care -- more than half of employees --
ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ the plan is cheaper than the more popular "preferred
ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ provider" plan, she says. More employees eventually
ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ will go for the new approach, Ms. Powers believes:
ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ "We put this in as the product of the future."
ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ Not everyone applauds this trend, though. Some fear that
ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ employers just want to wash their hands of health
ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ benefits and push more costs onto employees. And even
ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ some supporters worry it could go too far. Kenneth
ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ Abramowitz, a Sanford C. Bernstein analyst who is an
ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ ardent advocate of consumer choice, blanches at what he
ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ calls the "Yellow Pages" approach: telling an employee,
ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ "Here's $5,000 and the Yellow Pages. You figure it out."
ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ Moreover, a similar movement fizzled once before, says
ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ Charles Blanksteen, vice chairman of Active Health
ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ Management Inc., a Web-based company in New York.
ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ As a consultant in the 1980s, he designed
ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ defined-contribution systems for several companies. But
ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ health-care costs rose faster than company contributions
ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ and became too much to bear for lower-income
ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ employees, who eventually dropped their insurance. At
ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ that point, Mr. Blanksteen says, "The companies blinked
ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ -- and had to pony up more money."
ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ Employers on the leading edge of this movement say they
ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ have no intention of taking a cut-and-run policy.
ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ For one thing, with the labor market tight, employers are
ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ loath to tamper too much with their benefit programs.
ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ Xerox met a storm of employee protest after news
ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ reports suggested it was planning a Yellow Pages
ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ strategy. The company says it doesn't plan to change
ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ health benefits further until there is "something that
ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ would offer employees more flexibility and more value."
ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ For another, many companies known for innovation in
ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ health-care purchasing remain convinced that their clout
ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ is crucial to changing the market, and they want to keep
ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ their hands in, not only to control costs, but also to
ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ pressure doctors and hospitals to improve the quality of
ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ care.
ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ The 401(k) Model
ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ Still, some employers are inspired by the success of
ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ 401(k) plans, which let employees control investment of
ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ their retirement funds. There were concerns that
ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ employees lacked the knowledge and judgment to do
ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ this, but firms sprang up to help employees manage
ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ money, and 401(k) accounts have proved highly popular.
ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ Some health-benefits managers are convinced the same
ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ will happen with health care. A key reason: the Internet.
ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ Many companies already use Web sites to help
ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ employees make health-benefits decisions and sign up
ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ for plans. Now, entrepreneurs are developing
ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ Web-based services that would greatly reduce the need
ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ for a hands-on role for employers and provide
ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ consumers with new tools to navigate the health-care
ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ system and take decisions into their own hands.
ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ Take eBenX Inc. The Minneapolis firm is developing an
ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ Internet health mart where consumers would be able to
ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ pick from among competing insurers, spending vouchers
ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ from their employers plus some of their own money, if
ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ they choose.
ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ Relative Value
ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ In a critical feature of the program, eBenX plans to sort
ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ participants according to 10 levels of health risk: the
ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ young and healthy in category 1, and older people with
ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ chronic ailments in 9 or 10. It will assign vouchers
ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ different values according to a person's risk and invite
ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ insurers to bid for consumers in each category.
ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ Assuming it can sell the idea, the firm believes its health
ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ mart will squelch the usual objections to individual
ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ purchase of insurance: Prices are high because there's no
ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ group clout and it's only the sick who want to buy.
ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ Health insurers no longer would have an incentive to
ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ compete just for the good risks, but would have a
ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ financial incentive to take on the chronically ill.
ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ This particular system hasn't been tested in real market
ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ conditions yet, but investors are enthusiastic. The
ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ company went public eight weeks ago at $20 a share and
ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ the stock has more than tripled.
ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ Another kind of cyber-mart is under development by
ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ Hewitt Associates, a Lincolnshire, Ill., benefits
ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ consultant. In September, it staged an eBay-style online
ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ auction in which 50 health-maintenance organizations
ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ competed for three employer accounts on price and
ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ quality indicators. On average, says Tom Beauregard,
ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ who developed Hewitt's concept, employers saved 2%
ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ in the pilot test over rates they would have been charged
ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ after traditional negotiations. Hewitt's long-range plan is
ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ to expand its auctions to include patients, who would be
ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ able to purchase not just benefits packages but also
ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ individual services from doctors and hospitals.
ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ Through another Web service, soon to be launched by
ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ Franklin Health Inc. in Upper Saddle River, N.J.,
ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ consumers will be able to build a customized health
ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ record and gain access to data on the quality of
ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ providers that is now generally available only to
ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ insurers. Other software products will let consumers
ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ perform "what if" calculations, plugging in different
ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ premium payments, deductibles and anticipated medical
ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ expenses to find out what level of benefits to buy --
ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ much the way financial-planning software aids investors.
ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ These and other emerging services offer some assurance
ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ to employers that they could turn health -- benefits
ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ decisions over to employees without leaving them
ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ stranded.
ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ Employees' Experience
ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ It's hard to know what consumers would think of such an
ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ approach. But one Xerox employee who says she
ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ benefited from the company's defined-contribution
ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ system is Charlene Stephens, a 33-year-old editorial
ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ assistant in Rochester, N.Y. When her HMO raised its
ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ rates, she found another plan that saved her $600 a year
ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ in premiums and eliminated the hassles of getting written
ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ referrals from a "gatekeeper" doctor before seeing a
ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ specialist.
ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ Ms. Stephens had to switch doctors, but her daughter and
ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ husband were able to keep theirs. "You really don't give
ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ up anything unless you have a real strong relationship
ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ with your doctor," she says.
ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ At Carlson, Dave Hinze, an accounting manager, values
ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ the freedom of choice his plan offers. His and about 30
ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ other Twin Cities employers contract with numerous
ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ "care systems" -- doctor and hospital groups -- and
ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ publish a booklet that rates them on customer service
ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ and puts them in one of three price groups.
ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ Mr. Hinze chose a care system that was close by, in the
ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ midrange on costs and top-rated in customer service. His
ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ monthly allowance didn't quite cover it, but he got it by
ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ paying an extra $50. As he sees it, "To save $50 a
ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ month, no one is going to put up with inordinately long
ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ waits and doctors who don't treat them with respect."
ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ Liability Issue
ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ The budding trend to let employees handle their
ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ health-care benefits just as they do their retirement
ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ money comes as consumers' role in their own health care
ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ is growing anyway. For instance, drug companies, to
ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ dodge managed care's attempts to curb use of expensive
ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ medicines, increasingly advertise directly to patients.
ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ And within managed care, employers have had to offer
ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ employees more choices because of resistance to
ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ restrictions. "Patients have a lot more to say about their
ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ health," says Ingersoll-Rand's Ms. Powers. "Whether we
ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ want it or not, this is how the market is going."
ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ Still, most people see only a gradual transition to greater
ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ consumer control -- perhaps over the next decade -- as
ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ policy makers, the market and employees themselves get
ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ used to the idea. One major hurdle is the tax code. Many
ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ experts believe that shifting the tax deduction for
ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ medical costs to employees from employers is a
ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ prerequisite for a fully consumer-driven system.
ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ Another legal issue could accelerate the idea:
ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ Legislation or a court decision that would allow
ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ employers to be sued over the consequences of their
ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ health-plan decisions. Congress is weighing such a
ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ measure, and a related issue is pending before the
ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ Supreme Court.
ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ Adding new liability for companies could prompt some
ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ to scuttle their health-benefits programs and send
ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ employees into the market to fend for themselves. Says
ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ Margaret O'Kane, head of a managed-care accrediting
ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ organization called the National Committee for Quality
ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ Assurance: "If employers find themselves in the path of
ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ the trial lawyers, I think you can expect a massive
ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ bailout."
=====================================
Message #55 from Tunica Albuginea at Nov 30 1999 6:08PM
Louie G, sorry, didn't mean to disregard your post.
I just got to it.
I think that the y2000 budget will be helpful to HRC and
give them time to strengthen from previous write-offs.
Build their computer and Internet programs.
Re-negotiate firmer contracts with HMOs.[ Will any survive? :-) ].
Build their local medical practices though excellent care.
I believe HRC is a core holding in healthcare.
They are private practice at it's best. The best that
America can offer.
Socialized Medicine and HMOs ( a form of Socialized Medicine
since they are both premised on the principle of
rationing ) will fail.
I believe that only intelligent rationing will save our excellent
Health Care System, and not the
indiscriminate ,across the board type practiced by Medicare,
HMOs and Socialized Medicine.
This rationing however must be excercised directly by the
patient.He must be the one having control
over what is being rationed: rationed to him and to others
( though what he pays for others); by paying with his
savings and hard earned, tax exempt? moneys
for health care just like any other insurance. Then he can
get any coverage he wants.He can decide also how much he is
willing to pay to support others through the voting process.
Understanding that if he abuses his body ( just like when you abuse a car ),
it will cost you more to fix it.
And so he will be more careful with driving,drinking,smoking,getting fat and sedentary etc. etc.
But to achieve this we must use the free market as in Canada's Premiere
Mr.Klein did in the example I posted previously.
I believe this is what HRC's doctors and management stand for.
In the last 10 years the true horrendous costs of HealthCare
have been hidden from Americans though artificial HMO Health
Care Rationing. These will now pop up in 2000.
There will be a giant sucking sound in the stock market
next year: that will be the sound of money leaving the stock market to pay
for MUCH MORE EXPENSIVE Health Care.
HRC will be a prime beneficiary of this money flow,
all IMHO,
TA
Message #50 from Louie G at Nov 23 1999 6:07PM
Hi Tunica,
What does all the political wrestling mean for HRC?? Your opinion would be appreciated.
Thanks
Lou</> |
