Insurance reform + medical provider reform = health care reform, right?  Utah health insurance reform has been center focus for the state, UAHU and private insurance carriers over the past 24 months.  Mike Oliphant (UAHU board webmaster) runs a small Utah based health insurance website http://www.BenefitsManager.net as well as http://www.HealthInsuranceSource.net. Mike’s viewpoint provides a unique analysis which comes from being a “fly on the wall” observer in countless state session and insurance meetings. “Utah has been thrust into a state insurance reform pressure cooker which isn’t necessarily negative where I am an insurer, insured and patient”.  Several interesting changes took place with H.B. 188 passage earlier this year which seems all too familiar to the ongoing federal health care reform attempt under Obama’s administration. The spirit of the bill allows private Utah market place remedies. It essentially guarantees a Utah health insurance carrier a "no loss" or "no gain" premise over competing carriers that operate within the “Utah Insurance Exchange portal”. On the surface it would seem unattractive to a carrier’s consideration (voluntary at this point). But you have to understand the carriers’ goal is to cover their administration fees and maintain a 3% profit. The Utah health insurance reform model claims this can be accomplished now by legislation and the watchful eye of the state’s risk adjuster board. The medical claim risks are essentially shared equally among the participating carriers. Therefore, the carriers can focus on administration efficiencies more so than competition over a fluctuating market share. Insurance carriers such as SelectHealth have efficiencies and risk management experience polished by long tested actuarial tables with health statistics and claim trends. Is it a bad idea to share that experience with a national carrier such as Humana? Would it surprise anyone to know that maternity NICU and anti-depressants represent the highest utilization in health insurance costs for medical and pharmacy in Utah? Compare this to Texas which suffers from abnormally high levels of diabetes and liver disease per capita.

The other half of the “health care reform equation” is medical provider and billing practices. The state claims this is on the agenda. It is popular belief among Utah legislators that reform stops with the insurance carrier. However, how can the insurance carrier continue to bear the risk and re-distribution of health insurance premiums back out the door in claims without provider billing reform?  Add to this obstacle a continuing shrinkage of the insured populace. Obama’s administration proposes mandatory participation in a health insurance policy by employers of all sizes, self employed and unemployed populace. The logic being to shore up the unhealthy with healthy premium.  When analyzing the Massachusetts’s system, you actually pay a penalty if you have no proof of coverage.  The benefit level and health insurance price is nowhere close when you compare Utah health insurance quotes through benefitsmanager.net or dental insurance quotes at http://www.dentalinsuranceutah.net. Utah premium is easily half. This insight comes from a Utah health insurance agent whom often interacts with employers and residents looking for affordable coverage, making sure claims are paid correctly, implementation and explanation of the many policy procedures and putting a complex SelectHealth insurance language in understandable terms. Yet legislators claim agents to be of no value all in the name to save 3-4 off of Utah health%

With the latest announcement of hospitals agreeing to contribute $155 billion, where are the costs going to be shifted for this donation? In Utah, studies conducted by BenefitsManager.net revealed that cost shifting already exists in the ER.  There is apparent lack of legislators in Utah and on the federal level proposing TORT REFORM.  It is factual that a majority of US senators and representatives are lawyers. To push liability insurance premiums down that absorb as much as 15% in expenses with most medical providers is significant. Take 15% off total medical expenditures in US and you will see savings in the trillions.

If we go down the path of nationalized health care reforms, will we at some point be forced to address usage and ration? Will we have to define when to refuse further care for patients receiving critical illness treatments, intensive care unit, disease management, neonatal intensive-care unit for?  SelectHealth documents that the single most expensive bills are NICU for newborns and seniors in acute / intensive care / pre-hospice.

Without TORT REFORM, medical provider costs will never drop. Liability insurance costs are approaching nearly half of the operating expenses for specialty care physicians, units and facilities.  Humana health plans state that their costs of medical liability and defensive medicine accounts for nearly 10 cents out of every premium dollar collected.  Compare that to Humana’s reported pharmaceutical claims of 15 cents out of every premium dollar collected.  Or better yet, 21 cents out of every premium dollar collected is paid back to physicians for physician treatments.

Limbaugh already on her case. Sick. there is a related post at http://iamsoannoyed.com/?page_id=588

Well the Democrats do have the numbers to pass this without Republican support.  Do they have the will to do it against what a Majority of Americans really want.  70% of Americans do not want the Fed Govt taking over a large portion of the economy as someone wrote.  I would say a majority of Americans probably want reform in healthcare, but they definitely do not want a single payer solution because it would turn out to be worse than the disease it is claiming to fix.  I do not have a link to the exact numbers of the numbers who support or don't support various reforms,

karela, if you have a link to some survey, report, etc. that cites your 70% claim then please post it so we can read all about it.