Reform Needs Healthy Life Incentives

June 29, 2009

Wall Street Journal

by Scott E. Harrington

Much of the debate over health-care reform has focused on whether there should be a government insurance plan to compete with private plans. This focus is understandable given the stakes. Because equal competition between a public insurer and private plans is impossible, public coverage would crowd out private coverage and make a public, single-payer system inevitable.

Another important issue is the scope of regulation that will likely apply to private health plans regardless of whether a public plan is created.

Given budgetary and affordability concerns, the insurance market proposals by House Democrats and Sens. Edward Kennedy and Chris Dodd would permit some variation among plan benefits and cost-sharing provisions, such as deductibles and coinsurance percentages. The proposals otherwise would impose a regulatory straightjacket that would put upward pressure on health costs, thus undermining a major reform objective and creating additional pressure for government-mandated cost controls. Whether legislation being developed by Senate Finance Chairman Max Baucus will go as far isn’t clear.

The House Democrat and Kennedy-Dodd proposals do all they can to prevent health-insurance premium rates and coverage terms from reflecting the health status — and thus health-related behavior — of any insured person. Health status would not be permitted to affect coverage decisions, terms or pricing. Age-related variation in premium rates would also be significantly constrained in relation to risk.

Benefit design and marketing of coverage would be regulated in an attempt to keep insurers from rewarding healthier people. Retrospective “risk adjustment” would be employed to reallocate funds from insurers that experience lower medical costs to those with higher costs. If an insurer were to attract relatively more healthy people — or keep more people healthy — it would run the risk of paying some or all of the gains to competitors.

The proposals’ strong aversion to having insurance rates or coverage terms related to health status reflects the view that either the need for health care is immune from individual control, or that a person should not be financially responsible for behavior that contributes to poor health, or both. These views are difficult to reconcile with the consensus that unhealthy behavior contributes significantly to obesity, diabetes, heart disease and cancer, and thus accounts for a substantial proportion of health-care costs.

Regulation that seeks to divorce insurance rates and coverage terms from health status would deter potential innovation that might provide meaningful financial incentives for healthy behavior and lower costs.

Incentives for healthy behavior have traditionally been weak under employer-sponsored health insurance, in part due to federal and state regulation that constrains the ability to reward healthy behavior. Turnover among employees and policy holders also reduces incentives to make long-term investments to promote healthy behavior.

Health-care reform should seek to encourage rather than discourage private innovation to provide incentives for healthy behavior. Safeway’s program offering employee premium discounts related to tobacco use, weight control, blood pressure and cholesterol levels is a good example.

The Democratic proposals would retard or even strangle such innovation. Rather than strengthening incentives to invest in the long-term health of policy holders, they would make it more difficult to earn a reasonable return on such investment. They also send a message that a healthy lifestyle earns no financial reward for reducing medical expenses.

Financial incentives for healthy behavior have the potential to significantly reduce costs without reducing quality. A failure of health-care reform to permit or incorporate such incentives would make coercive government measures to control costs more likely. These controls might include limits on provider reimbursement, comparative-effectiveness or cost-benefit criteria that must be met for care to be reimbursed, or budget caps. The results would be less health — more obesity, diabetes, heart disease, and cancer — and eventually less health care.

An aversion to having health-insurance rates and coverage linked to individual behavior may be on the verge of becoming national policy. If that happens, the unintended consequences could be very costly.

Click here to read the full Opinion piece in the Wall Street Journal.

Key Health Care Senators Have Industry Ties

June 12, 2009

Marketplace

by Associated Press Writers, Larry Margasak and Sharon Theimer

Influential senators working to overhaul the nation’s health care system have investments and family ties with some of the biggest names in the industry. The wife of Sen. Chris Dodd, the lawmaker in charge of writing the Senate’s bill, sits on the boards of four health care companies.

Members of both parties have industry connections, including Democrats Jay Rockefeller and Tom Harkin, in addition to Dodd, and Republicans Tom Coburn, Judd Gregg, John Kyl and Orrin Hatch, financial reports showed Friday. .

Jackie Clegg Dodd, wife of the Connecticut Democrat, is on the boards of Javelin Pharmaceuticals Inc., Cardiome Pharma Corp., Brookdale Senior Living and Pear Tree Pharmaceuticals.

Dodd is filling in for ailing Sen. Edward Kennedy, D-Mass., chairman of the Health, Education, Labor and Pensions Committee, which will soon start work on a health care bill.

Other publicly available documents show Mrs. Dodd last year was one of the most highly compensated non-employee members of the Javelin Pharmaceuticals Inc. board, on which she has served since 2004. She earned $32,000 in fees and $109,587 in stock option awards last year, according to the company’s SEC filings.

Mrs. Dodd earned $79,063 in fees from Cardiome in its last fiscal year, while Brookdale Senior Living gave her $122,231 in stock awards in 2008, their SEC filings show. She earned no income from her post as a director for Pear Tree Pharmaceuticals but holds up to $15,000 in stock in Pear Tree, which describes itself as a development-stage pharmaceutical company focused on the needs of aging women.

The annual financial disclosure reports for members of Congress are less precise. They only require that assets and liabilities be listed in ranges of values.

Dodd sought a 90-day extension to file his report covering last year, giving him until mid-August to submit his report, but released his report Friday to The Associated Press.

Bryan DeAngelis, Dodd’s spokesman, said, “Jackie Clegg Dodd’s career is her own; absolutely independent of Senator Dodd, as it was when they married 10 years ago. The senator has worked to reform our health care system for decades, and nothing about his wife’s career is relevant at all to his leadership of that effort.”

DeAngelis said that Mrs. Dodd has hired a personal ethics lawyer to avoid any conflicts of interest and is not a lobbyist.

Other reports showed:

_ Rockefeller, D-W.Va., reported $15,001 to $50,000 in capital gains for his wife from the sale of a stake in Athenahealth Inc., a business services company that helps medical providers with billing and clinical operations.

Rockefeller is honorary chairman of the Alliance for Health Reform, a Washington nonprofit whose board includes representatives from the UnitedHealth Group health insurance company; AFL-CIO labor union; the AARP, which sells health insurance; St. John Health, a nonprofit health system that includes seven hospitals and 125 medical facilities in southeast Michigan; CIGNA Corp., an employer-sponsored benefits company; and the United Hospital Fund of New York.

_ Coburn, R-Okla., is a practicing physician. He reported slight business income, $268, from the Muskogee Allergy Clinic last year; $3,000 to $45,000 in stock in Affymetrix Inc., a biotechnology company and pioneer in genetic analysis; $1,000 to $15,000 in stock in Pfizer Inc., a pharmaceutical company; and a $1,000 to $15,000 interest in Thomas A. Coburn, MD, Inc.

Under Senate ethics rules, Coburn can’t accept money from his patients.

_ Gregg, R-N.H., disclosed $250,001 to $500,000 in drug maker Bristol-Myers Squibb Co. stock and $1,000 to $15,000 each in stock in pharmaceutical companies Merck & Co. and Pfizer, the Johnson & Johnson health care products company and Agilent Technologies, which is involved in the biomedical industry.

_ Kyl, R-Ariz., the Senate minority whip, reported $15,001 to $50,000 in stock in Amgen Inc., which develops medical therapeutics. Kyl’s retirement account held stakes in several health care businesses, including the Wyeth, Bristol-Myers Squibb, GlaxoSmithKline, Pfizer and AstraZeneca pharmaceutical companies; medical provider Tenet Healthcare Corp.; CVS Caremark prescription and health services company; Genentech, a biotherapeutics manufacturer; and insurer MetLife Inc.

_ Harkin, D-Iowa, has a joint ownership stake in health-related stocks. Harkin and his wife, Ruth Raduenz, own shares of drug makers Amgen and Genentech, Inc., each stake valued at $1,001 to $15,000; Their largest health care holding, Johnson & Johnson, was valued at $50,001 to $100,000.

_ Hatch, R-Utah, a member of the Finance and Health committees, reported owning between $1,001 and $15,000 worth of stock in drug maker Pfizer Inc. He spoke to two pharmaceutical industry conferences last year. Sponsors of the conferences donated $3,500 to charities instead of speaking fees, as required by Senate rules.

Like millions of Americans, several senators took a financial hit in 2008. A sampling:

_Sen. Dick Durbin, D-Ill., lost some $100,000 in equity in his home in Springfield and $35,000 in his Chicago condominium. Durbin, who released his tax returns, reported losing $32,259 in various investments last year, including more than $10,400 in Berkshire Hathaway and $5,535 in Fidelity stock.

_Kennedy in 2007 had four trusts each valued between $5,000,001-$25 million. In 2008, only one trust was still in that category while the rest had slipped in value to $1,000,001-$5 million.

_Hatch’s investments suffered from the banking crisis. In 2007, he reported assets of between $2,002 and $30,000 in Countrywide Credit Industries Inc. stock. His 2008 financial disclosure lists the value at less than $1,000.

One of Dodd’s investments showed a vast improvement.

A new appraisal more than doubled the value of his vacation cottage in Ireland, which has been subject of a Senate ethics complaint filed by a conservative group questioning if the undervalued property was really a gift.

The property is valued at 470,000 euros, or about $660,000, on Dodd’s disclosure report.

The previous year’s report valued the seaside home, located in County Galway, at between $100,001 and $250,000.

DeAngelis, the spokesman, said Dodd and his wife decided to have the property appraised because they felt it was time to update the information.

Click here for the full article from Marketplace.