Some cool Individual Health Insurance images:
not as cranky as he pretends to be….
Image by Esthr
J.D. Kleinke – disappointed but still hopeful idealist on health care.
As J.D.Kleinke points out, “Over the past few decades, the steady expansion of the health insurance enterprise to pay for almost all our routine care has created de facto buyers’ clubs – large, bureaucratic, breathtakingly inefficient, and often hostile-to-their-members buyers’ clubs – that take 20 percent off the top in transaction and other administrative costs without adding much in the way of real value.” Kleinke believes it would make more sense to pay for routine care in a way that encourages direct consumer involvement and price/performance discrimination, while catastrophic care is more appropriately a matter for insurance. Among other things, it often involves situations where individuals simply can’t be well-informed, empowered buyers. . For almost everyone but the seriously ill, though, the insurers are not the right ones to be in charge. As Kleinke says, “Most people will take paternalism from their doctors, but they won’t take it from an insurance company!”
The challenge is that some people want to control their own health care, and others don’t. But a critical mass of empowered individuals is likely to change the system for everyone over the long run.
So how do those individuals get empowered? Right now, they are underinformed and have little market clout. But employers can help – and have an incentive to do so. Kleinke’s betting on that among other developments at Omnimedix Institute, the non-profit organization he founded in 2004 to research, test and disseminate ways for consumers to manage their own medical data, with a focus on personal health records (PHRs) as a key mechanism. Omnimedix is working with a group of large employers (led by Intel Corporation) to develop and roll out a free, portable, public-utility-type PHR designed to break up what he calls “the classic health-care IT logjam.”
“There are hundreds of commercial PHR vendors,” Kleinke says, “all hamstrung by the absence of a viable business model. None of them is near the critical mass necessary to force open the health care institutions’ legacy information systems – such as they are – the way Quicken opened up the banking institutions. We think we can be most effective working with a group of large employers to promote the use of a single, open, private, portable system among their workforces and communities. The infrastructure we are building with these employers will allow millions of consumers to create, get, store, edit, amend and transport all of their own medical data using a common networked system. This is a significant departure from the paternalism and proprietary lock-in inherent in the institutional relationships and IT vendor models that dominate the U.S. health care system. And our status as an independent non-profit reduces the mistrust inherent in other employer-sponsored approaches to PHR deployment.”
As Vice Chairman of Health Grades, a publicly traded health-care ratings company, Kleinke has watched the business slowly transform over the past few years from one that developed and marketed its information exclusively to hospitals, health plans and other institutions, to one that sees its biggest growth opportunity coming from selling the exact same information to consumers. “A decade ago, when we were creating the commercial health-care informatics business at HCIA [now Solucient, where Kleinke worked as vp of corporate development], there was no consumer business,” he says. “There was no Internet to distribute the small bits of industrial-strength information that an individual patient needed. There was no IOM report,” Kleinke says, referring to the 1998 report by the Institute of Medicine that quantified the nearly 100,000 deaths each year attributable to medical errors in hospitals. “And most importantly, until recently, patients had nevnever confronted high deductibles, large co-payments and other new economic mechanisms that have jarred them from complacency born of paternalism."
Health Care Premiums For An Individual Under Reform
Image by Speaker Pelosi
An analysis of the House bill by noted MIT health care economist Jonathan Gruber concludes that the bill would result in lower premiums than under current law for the millions of Americans using the newly-established Health Insurance Exchange – including those who are not receiving affordability credits to help them purchase coverage. (The Health Insurance Exchange is for those without access to affordable employer-sponsored coverage.) As Gruber states: “the premiums that individuals will face in the new exchanges established by this legislation are … considerably lower than what they would face in the non-group insurance market [under current law], due to the market reforms put in place by the House plan, the mandate on individuals to participate regardless of health, and the market economies of new exchanges.” Read the report at energycommerce.house.gov/Press_111/health_care/hr3962_gru….
