...Now, what would have happened if the Medicaid program hadn't cut her off -- because she earns $100/month too much? In that case, she wouldn't have had to worry about the bill.

But -- the receptionist would have had to say: "You'll need to fax over a referral."

A Medicaid patient can't be billed, except for a nominal copayment. Without a referral, Medicaid can’'t be billed. So if the specialist, or in this case subspecialist, sees the patient, he cannot be paid. Moreover, he is probably violating a rule and conceivably might be prosecuted for soliciting business (that's called "fraud"). Discounts and freebies are marketing strategies, after all, and the poor and vulnerable have to be protected.

Not just any doctor can give the patient a referral. This doctor couldn't. It has to be the patient's primary care provider, who is contracted with the patient's plan. And the specialist has to be in the plan too.

Say that a seizure patient needs to see a neurologist promptly to have his medications adjusted. Sorry, the emergency room doctor can't write the referral. Neither can the hospitalist who is discharging the patient from the hospital. It has to be the "primary." If the primary happens to know the patient, he might just send the referral. But most of the time, the patient will have to come in. The primary won’t want to risk getting an unnecessary referral or an incident of "inadequate documentation" on his report card.

For a retinal problem, there are probably three hurdles: the primary gatekeeper (who might not even think of the diagnosis), then the general ophthalmologist (who will make the diagnosis but can't treat it), and finally the subspecialist. All probably have waiting times for appointments, especially for Medicaid patients. Most doctors can’t afford to see very many of those.

Not just Medicaid, but all managed-care plans have a structure like that. It's part of the cost-containment strategy. I know of three insured patients who had retinal detachments. They all had premonitory symptoms, and they all -- eventually -- had elaborate and costly operations, as many as six procedures. They were "covered," and they didn't get a bill for $900, but they had a poor visual outcome that might have been prevented by prompt treatment.

Insurance is supposed to help you pay bills in the rare event of a catastrophe. If it morphs into a scheme for emptying your wallet in advance, and then prevents bills by preventing treatment, we just might be better off without it.

Labels: Analysis, Insurance, Medicaid

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Why is private health insurance so expensive? Blame Albany. First, state lawmakers have mandated that all health plans cover a host of procedures and "alternative-medicine" services, far more than companies in most states offer. Even the most stripped-down plan must include coverage of off-label drugs, surgical second opinions, and midwife and podiatrist services. Each mandated benefit makes the policy more expensive. Two state insurance regulations -- "guaranteed issue," which forces insurers to sell to any applicant, and "community rating," which requires them to offer the same price to everyone, regardless of age and health -- inflate prices further. Finally, the state has added billions of dollars in taxes and fees to private insurance policies, making them even pricier.

The perverse result: the young, healthy, and self-employed -- facing higher premiums for insurance that they seldom use, and realizing that they can always wait until they become ill to buy insurance -- tend to drop their coverage. (If New York regulated home insurance like this, you could buy a policy after your house had caught fire.) What's left is an insurance pool of older, sicker people, which drives private premiums higher still. Worse, the large number of uninsured people -- a consequence of Albany's bad policies—then becomes a justification for expanding the Medicaid rolls.

Labels: Insurance, Medicaid, NY, States

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In a private fee-for-service medical system, a dead patient is a revenue loss. In the National Health Service (UK), a dead patient was a cost savings.

...The fundamental distinction Dad was making is how differently the two systems view the patient and the incentives that view creates in each. The private fee for service system has more incentives to keep its patient alive and help them get better. Under socialized systems, and Medicare/Medicaid is a socialized-lite system, the overriding incentive is to control costs because the funds are finite and the needs are not.

I don't think I need to tell you which system Dad thought was better.

Of course he thought the private system vastly superior, even though he had his issues with that too. However, most of the issues he did have with it were created by government interference in the period after Medicare was enacted. Medicare doesn’t control costs, it controls prices. The costs just get shifted to someone else. The decisions on what to pay for exams were more or less completely arbitrary. Any time Medicare was looking for "cost" savings it simply dictated them by reducing reimbursement rates or, in other words, price fixing. The costs didn't actually disappear though. They just had to be shifted to the private patients who ended up subsidizing the Medicare patients. It is in this way that healthcare has become so expensive in the private sector. We pay for our own healthcare, subsidize the Medicare/Medicaid patients and carry the full freight on the people with no insurance who show up in the ER and must, by law, be treated.

Rationing is what we will get if we go down the socialized healthcare delivery path, the dead patient as cost savings view is likely to become dominant because the government, as single payer, is going to be forced to ration. The funding available to pay for medical care will be finite yet demand for "free" services will be infinite. The government will tell us if and when we may see a doctor. It will tell us what care and what procedures we will receive. That is the only possible outcome of a complete nationalization of our medical care delivery system. True healthcare reform will only come about by reducing government involvement in delivery, not further encroachment or a complete takeover.

Labels: Analysis, Medicaid, Medicare

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In a recent editorial published by Investor's Business Daily, associate editor (and PJTV.com regular) Terry Jones revealed stunning poll data showing that 45 percent of American physicians "would consider leaving their practice or taking an early retirement" if Congress passed the proposed ObamaCare health legislation.

As a practicing physician, I'm not surprised. These numbers mirror the sentiments I’ve heard expressed by my professional colleagues. I've been in practice for over 15 years and I've never seen physician morale as low as it is today.

Older physicians have told me that they're glad to be "getting out" and retiring soon. Medical students have asked me whether they should switch to engineering or pharmacology before it's too late. Physicians in the middle of their careers are just hoping to survive any "reform."

The same IBD poll also showed that an overwhelming majority (65 percent) of physicians were opposed to the proposed expansion of government in medicine. And they have every reason to be concerned, based on past experience...

Labels: Medicaid, Medicare, OpEd

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Bernie Madoff for Health Czar

...As I mentioned in my first healthcare letter, we do not have the money to pay for our current nationalized healthcare experiments, which we call Medicare and Medicaid. To open yet another financial wound, we do not have the money to fund Social Security over the next 30 years. So before you buy something expensive, it would seem wise to ask if you can afford to maintain it. The unfunded liabilities for Medicare and Medicaid alone have been estimated at $47-trillion dollars. This is the cost of insuring 30-million Americans. We do not have enough money for these existing programs, much less to expand these services to cover the lives of 304 million Americans.

What I am telling you is that Medicare and Medicaid will run out of money. The system will go bankrupt. It will be like AIG, which was "too big to fail", but which has failed despite pouring billions into it. People in my generation, and those younger, are "investing" in a Medicare system which promises to pay big dividends in healthcare dollars during our retirement. However, the politicians running the plan understand that this is a fiscal impossibility. It is dishonest. That money will not be there for us. It will be all used up by the time we reach age 65. The reason is that there will not be enough young workers to fund the Medicare system and keep it going for the aging baby boomers. Does this scenario sound familiar to you? Have you recently read about other people who have set up scams like this? You guessed it. Medicare is a Ponzi scheme.

...So why is a doctor like me engaging in "politics" or going on a rant about the healthcare dollar? Because money is a necessary part of the discussion! When you try to buy something on a credit plan that you can't afford, it is only a matter of time before that something is repossessed. Before we scrap private healthcare and open another credit card for nationalized healthcare, we should think about what we will do when we can't afford the payments. The answer is that people won't get the medical care they need, which is what happens in Canada. In all seriousness, I'd start putting away some extra cash in the bank for the day when Bernie Madoff or his sons reject your request for an MRI of the brain. You'll need that extra money to travel to Dubai for your MRI or your knee replacement - to purchase quality healthcare in a free-market system that is not dominated by a government rationing panel.

Labels: Analysis, Medicaid, Medicare

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Health program for kids assailed

...A report on the Children's Basic Health Plan found that 10 percent of patients were classified incorrectly - either as eligible when they weren't or as ineligible when they were entitled to services.

Hundreds of people were kept on the program after their eligibility expired - for up to two years in some cases.

...The report stunned lawmakers. "That's huge," House Minority Leader Mike May, R-Parker, said of the 10 percent error rate in qualifying participants.

If the wrong people are being enrolled, "then the whole program doesn't work," said May, who was appointed as a temporary member of the audit committee.

...The Children's Basic Health Plan is the Colorado agency that carries out the federal program called State Children's Health Insurance Program, or SCHIP.

...The auditors found 831 women who remained in the program after their eligibility should have expired. The cost associated with them is $104,000, the auditors said.

Labels: CO, Medicaid

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The swindle works like this: A state overpays state-run health-care providers, such as county hospitals or nursing homes, for Medicaid benefits far in excess of its typical rates. Then the federal government reimburses the state for "half" of the inflated bills. Once the state bags the extra matching funds, the hospital is required to rebate the extra money it received at the scam's outset. Cash thus makes a round trip from states to providers and back to the states – all to dupe Washington.

...The right word for this is fraud. A corporation caught in this kind of self-dealing – faking payments to extract billions, then laundering the money – would be indicted. In fact, a new industry of contingency-fee consultants has sprung up to help states find and exploit the "ambiguities" in Medicaid's regulatory wasteland. All the feds can do is notice loopholes when they get too expensive and close them, whereupon the cycle starts over.

Labels: Medicaid

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The practice of medicine is a calling and as such, my colleagues and I have endured more unfair revenue cuts than most businesses would have endured. Yet, a medical practice is also a small business, and there are limits to how much we can endure. We are now at the point where further cuts are not survivable. Just like any small business, our revenue has to exceed costs in order to survive. Despite everything that I have been able to do to cut costs, the margin of profit is now thin, and the proposed greater than 10 percent cut will put us out of business. The only option will be to downsize the practice and stop seeing all Medicare patients. I would hate this, but it will be the only option I have if Congress does not reverse the proposed cuts.

Dr. Atkinson, 45, said she paid herself a salary of $110,000 last year. Her insurance reimbursements often do not cover her costs, she said.

"I calculated that every time I have a Medicaid patient, it's like handing them a $20 bill when they leave," she said. "I never went into medicine to get rich, but I never expected to feel as disrespected as I feel. Where is the incentive for a practice like ours?"

Labels: Medicaid, Medicare

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Yet another bogus Families USA story
Linda Gorman, Director, Health Care Policy Center, Independence Institute, Golden

On April 22, Rocky Mountain News.com carried "Report ties Medicaid cuts to job losses". The story simply repeated the substance of a press release from Families USA.

In fact, the Bush administration has not proposed Medicaid budget cuts. Its FY 2009 budget proposal increases Medicaid spending by $12 billion to $13 billion over expected spending in FY 2008. This is in addition to FY 2005-2007 spending increases of about 10 percent. What the Bush administration is proposing is a slightly smaller budget increase, about 7.1 percent rather than 7.4 percent. The 2009 budget numbers are available on Page 61 at http://www.hhs.gov/budget/ 09budget/2009BudgetInBrief.pdf.

If Families USA were a real family making $50,000 a year, these budget numbers would be the equivalent of having an expected windfall of $53,700 reduced to $53,550.

Families USA is known for approaching health care with a well-defined ideological slant and for producing lousy numbers on all manner of health-care issues. One hopes that, next time, the Rocky will take the Families USA reputation for inaccuracy into account, and that it will check before it unquestioningly reproduces their press releases as news.

Legislature has made health insurance so high
Terry W. Donze, Wheat Ridge

RE: Fair Act, HB-1389, RMN, 04-24 and 25-08 Regarding Colorado’s health insurance, Representative Morgan Carroll asks, "Why are our premiums higher?" All she needs to do is get the plank out of her eye and look in the mirror.

The legislature has mandated so many items (40+ and counting) for the health insurance industry to cover, what does she expect? They have run several health insurance providers out of Colorado over the past several years, such that it is extremely difficult to find affordable individual coverage because of limited competition.

Yet more regulation as proposed by her will only add to the costs, not only in higher premiums but also in higher taxes to pay for yet more government.

If she is really interested in bringing costs down, instead of more regulation Carroll should be demanding rescission of the mandates already on the books.

Labels: Insurance, LTE, Medicaid

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Making Up Medicaid Cuts
Families USA Is At It Again

By Linda Gorman

If Families USA were a newspaper, it would be a supermarket tabloid carrying articles about alien abductions. Its latest campaign is a series of press releases screaming that states will lose thousands of jobs and zillions of dollars due to the Bush Administration Medicaid cuts.

Local newspapers in Colorado are repeating the Families USA press release almost verbatim.

If you are in a tax and spend health care reform haven, you may soon be seeing quotes from the Families USA director, Ron Pollack, saying things like "These cuts in federal Medicaid payments will have a ripple effect through state economies that are already struggling during this economic downturn."

In fact, as the Heritage Foundation's Nina Owcharenko explains, the Bush Administration has not proposed Medicaid budget cuts. Its FY 2009 budget proposal increases Medicaid spending by $12 to $13 billion over expected spending in FY 2008. This is in addition to FY 2005-2007 spending increases of about 10 percent. What the Bush Administration is proposing is a slightly smaller budget increase, about 7.1 percent rather than 7.4 percent. The 2009 budget numbers are available from the federal government here on page 61.

If Families USA and its fellow travelers were a real family making $50,000 a year, these budget numbers would be the equivalent of having an expected windfall of $53,700 reduced to $53,550. This small reduction in the rate of federal spending will, the people of Colorado are being told, cost Colorado "more than 3,500 jobs and an accompanying $135 million in wages," a neat trick given that Colorado is not an entity and does not earn wages.

If a newspaper in your area reproduces this nonsense, perhaps it should be politely reminded Families USA is known for approaching health care with a well defined ideological slant and for producing lousy numbers on all manner of health care issues. It might also be asked to check before reproducing Families USA press releases as news.

Labels: Medicaid, OpEd

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Universal health care is the wrong prescription

By BRIAN SCHWARTZ
INDEPENDENCE INSTITUTE

What good is having medical insurance if you cannot get medical care? Peddlers of "universal health care" - from Hillary, Obama, to 2nd Congressional Democratic candidate Jared Polis - don't get this.

"Universal health care" is false advertising for politically controlled medicine, with government as the "single payer" monopolistic insurer. But having coverage does not guarantee getting medical care.

Since patients prepay through taxes, medical care appears "free." Hence, they have strong incentive to over-consume and providers need not compete on price.

To contain costs, governments restrict your access to life-saving treatment. In countries with such "universal coverage," patients die waiting for treatment.

The Canadian Medical Association Journal reports that in one year, 71 Ontario patients died while waiting for coronary bypass surgery and over one hundred more became "medically unfit for surgery." The Canadian Broadcasting Corporation reports that "109 people had a heart attack or suffered heart failure while on the waiting list. Fifty of those patients died."

"Physicians across Canada are in an advanced stage of burnout due to work conditions" which "causes them to retire early . . . or simply leave," a former Canadian Medical Association president told the New York Times. He "attributed much of the problem to technological shortages and the powerlessness doctors feel when patients complain about long waits for treatment."

"Access to a waiting list is not access to health care," wrote Canadian Chief Justice McLachlin when striking down legislation banning private insurance in 2005. Last year, a New York Times headline read: "As Canada's Slow-Motion Public Health System Falters, Private Medical Care Is Surging."

And England? The BBC reports that "up to 500 heart patients die each year while they wait for potentially life-saving surgery." The Times claims that a British woman "will be denied free National Health Service treatment for breast cancer if she seeks to improve her chances by paying privately for an additional drug."

A Daily Telegraph headline reads: "Sufferers pull out teeth due to lack of dentists." Another article says that "doctors are calling for NHS treatment to be withheld from patients who are too old or who lead unhealthy lives."

Consider politically controlled health care in America: Medicaid and Medicare.

Doctors are five times more likely to refuse seeing new Medicaid patients than privately insured patients. Increasing reimbursement rates won’t help much; more than two-thirds of doctors reported being overwhelmed by Medicaid's billing requirements, paperwork, and delays in payment.

ABC News says that "Medicare rules bar cancer drugs for patients," including the privately insured.

"Single payer" advocates cite international comparisons of life expectancy to support their cause. But life expectancy depends on factors unrelated to health care, such as unintentional injury and homicide. Health economist Robert Ohsfeldt found that when accounting for these two factors, life expectancy in America is comparable to that of Canada and England.

What really matters is your chance of surviving a serious illness. The American Cancer Society claims that "U.S. patients have better survival rates than European patients for most types of cancer."

So if politically controlled medicine isn’t the solution, what is? Not a Massachusetts-style "individual mandate," which forces everyone to buy insurance. This is essentially single-payer in disguise. Insurance regulations severely limit competition, so insurance companies are effectively government contractors for politically defined insurance.

The Boston Globe reports that to contain costs, Massachusetts authorities will "probably cut payments to doctors and hospitals" and "reduce choices for patients." Sound familiar?

Instead, we must recognize how government policies have crippled free markets.

Because the tax code deeply discounts employer-provided insurance, you're essentially stuck with your employer's non-portable plans. Hence, insurance companies can afford to be stingy and deny you care; they know that losing you as a customer requires that you change jobs. With government as "single payer" it's even worse: To change insurance providers you must move to a different state or country.

Our current system also encourages thoughtless over-consumption and skyrocketing costs.

The tax code punishes paying for medical care out-of-pocket and rewards buying insurance. So "insurance" has become prepaid medicine, and patients over-consume like business travelers dining on their company's expense account.

Further, legislation mandating minimum benefits makes insurance unaffordable for many. Consider: Colorado law compels widowed wives to pay higher premiums for prostate screening, maternity, and marital therapy.

Some Colorado legislators recognize this injustice. Just as businesses incorporated in other states can operate in Colorado, Coloradans should be able to buy affordable policies from insurance companies that meet less damaging regulations of another state.

While "universal health care" may provide health insurance, it doesn't guarantee health care. The uninsured are not the problem, but the symptom of the real problem - government meddling in personal choices of how we care for ourselves and our families.

Brian Schwartz, an optical engineer in Boulder, is a guest author for the Independence Institute. His free-market proposal to the Blue Ribbon Commission is at WhoOwns You.org.

Labels: Canada, CO, Insurance, MA, Medicaid, Medicare, OpEd, UK

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The budget: An "immoral document"

A "moral document." This is what Colorado House Democrats called their budget ("State budget clears House,: March 27), which expands government-run children's health insurance. This moral grandstanding is typical of the anointed, who support expanding Medicaid and the State Children's Health Insurance Program (SCHIP) — and it’s nonsense. There's no compassion or virtue in spending other people's money taken by force.

If a thug forces you to donate to charity, does that make either you or the thug virtuous or compassionate? What if this charity unfairly competes with voluntary charities, fosters dependency of recipients, encourages people to stop buying private insurance, and is run by a government that makes insurance expensive in the first place? All of these apply to Medicaid and SCHIP, which are government-run charities.

Advocating for government-run charities doesn't make one compassionate, as there's no compassion in forcing others to comply with another's notion of virtue. Unlike voluntary charities, not "donating" to a government charity through taxes lands you in prison.

Compulsory donations to government charities are unfair to voluntary charities. Every dollar the state extorts from taxpayers for SCHIP or Medicaid is one less dollar for a voluntary charity.

Forced giving is also disrespectful and intolerant. By forcing us to fund causes others think are important, it thwarts our freedom of expression and ability to support causes we judge to be worthwhile.

Unlike government charities, voluntary charities have strong incentives to be effective. Since they compete with other charities for donations, they must convince potential donors that their cause is worthwhile. Government charities need not persuade.

We know the cost of not "donating": prison.

If each Colorado adult funded Medicaid and SCHIP equally, we’d each pay almost $1000 per year. If you had $1000 to donate to a medical charity, which would you choose? Would you choose SCHIP, or a voluntary charity like Rocky Mountain Youth Clinics, which provides primary care to infants, kids, and teens?

Might SCHIP or Medicaid deserve your donations? Downloading Cato Institute studies "Sinking SCHIP" and "Medicaid's Unseen Costs" could provide guidance. SCHIP covers non-needy families: more than half of eligible children already have private insurance. The National Bureau of Economic Research reports that "For every 100 children who are enrolled in public insurance, 60 children lose private insurance."

Both Medicaid and SCHIP ensnare recipients in a low-wage trap: aversion to seeking higher-paying jobs for fear of losing "benefits." This keeps people on their backs and dependent on government, instead of being independent and self-sufficient. As "entitlement" programs, they send adults the message that they are entitled to have children — even if they cannot afford to raise them.

Too bad you have no choice; it's your hard-earned income after all. But government could provide such choice — by allowing its programs to compete more fairly with voluntary charities. One method is a dollar-for-dollar tax credit for donations to non-government charities that assist families with the medical and insurance expenses.

Taxpayers who prefer Medicaid and SCHIP to non-government charities can continue to fund them. The threat of lost tax revenue would give Medicaid and SCHIP strong incentive to effectively and efficiently assist families in need and foster their independence.

Empowering taxpayers to choose allows for true compassion, which is absent when we are forced to give. Taxpayers could compare non-profits with tools like Charity Navigator and GuideStar.org. GuideStar envisions "an increasingly efficient nonprofit marketplace where donors seek out and compare charities, monitor their performances, and give with greater confidence; nonprofit organizations pursue more effective operating practices, embrace greater accountability, and enjoy lower fund-raising costs; and society benefits from a more efficient, generous and well-targeted allocation of resources to the nonprofit sector."

So drop the "you're a bad person for opposing government charity" rhetoric and rise to this challenge: If Medicaid and SCHIP are so good, why not let them compete fairly with other charities, and let individual taxpayers decide for themselves?

Brian T. Schwartz, Ph.D., submitted the free-market proposal to the Blue Ribbon Commission on Healthcare Reform.

Labels: CO, Medicaid, OpEd

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The Wave of the Future

The wave of the future is the free-standing Emergency Department.

By requiring insurance coverage or full payment at time of presentation, these facilities are able to offer reduced waiting times, concierge-style amenities, and a full array of emergency diagnostic and therapeutic services. And if they refuse to accept Medicare or Medicaid, then they are not forced to follow the restrictive rules of EMTALA.

EMTALA applies only to "participating hospitals" -- i.e., to hospitals which have entered into "provider agreements" under which they will accept payment from the Department of Health and Human Services, Centers for Medicare and Medicaid Services (CMS) under the Medicare program for services provided to beneficiaries of that program.

So these "free-market" emergency facilities can not only refuse treatment of patients who are unwilling or unable to pay, but they can also transfer patients at will without negotiating with a receiving hospital or jumping through a lot of regulatory hoops. Realistically, however, hospitals love receiving transfers from these types of facilities because they know they are getting fully-paying patients. Do you think that a hospital might accept an otherwise healthy well-insured young woman with a gallstone attack in transfer, perhaps causing the cirrhotic Medicaid patient to wait a few more hours in their own ER? I think they just might. The bottom line is a powerful incentive.

As this business model becomes more widespread, hospital-based emergency departments will be faced with an increasingly problematic payer mix, because the higher-paying patients will be siphoned off the top, leaving only the most undesirable trauma and Medicare/Medicaid populations to fill their overcrowded waiting rooms. And when emergency physicians have a broader selection of practice environments to choose from, I suspect the hospital-based ERs will soon have some difficulty filling their schedules as well, thereby compounding their problems even further.

Guess what?

Healthcare isn't a right after all.

Labels: Analysis, Insurance, Medicaid, Medicare

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Who's responsible?

As documented in the Cato Institute study, "Medicaid's Unseen Costs," (available on-line) Medicaid delivers sub-par medical care and unfairly competes with private insurance companies and voluntarily charities.

Medicaid also erodes personal responsibility. Many recipients avoid higher-paying jobs and saving money because such admirable behavior disqualifies them from benefits. Hence, Medicaid keeps those it "aids" helpless, on their backs, and dependent on government.

Medicaid's defenders want government in the insurance business and assert that their reforms can fix the above problems. If so, then why not let individual taxpayers decide for themselves? For every dollar expropriated from taxpayers to fund Medicaid, private charities lose a potential donation. That's unfair to private charities and condescending to taxpayers -- as if they were too callous or stupid to recognize if Medicaid were worthwhile.

A tax credit for donations to health care charities would partially level the playing field. The threat of lost revenue would motivate Medicaid administrators to be effective, and taxpayers would have more freedom to fund charities they deem most worthy.

Brian Schwartz

Bankruptcy looms

Medicaid is/was the fastest growing component of the state budget.

If left unchecked, it will bankrupt the state of Colorado.

The idea that, somehow, the government can magically create additional medical services out of thin air is an example of the kind of Santa Clause thinking that the government wants people to believe in.

I assert without proof (because no one believes the proof or the truth) that the economy, the delivery of health services to the indigent, and the health of the budget of the government of Colorado would be far better off it the state jettisoned Medicaid and went back to private insurance.

But, of course, actually delivering better services to everyone by privatizing the system is something that those who believe in government-as-Santa-Clause will never accept.

Ralph Shnelvar

Labels: CO, LTE, Medicaid

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Government, regulations drive up health costs
Linda Gorman, Independence Institute

I've got to say that the Feb. 25 editorial, "The surging tide of health-care costs," broke new ground for me in health-care policy. "The popular Medicare program... ." First time I knew that we had data letting us assess whether something that was virtually mandatory and without any substitutes, unless one is very rich, is "popular."

Then there were the factors cited by the editorial as driving health-care cost increases: "an aging population, boomer retirees, advances in drugs and medical technology." Never mind that the boomers are the aging population and so shouldn't count twice; advances in drugs generally save costs. So does a lot of new technology: MRIs are a whole lot cheaper than exploratory surgery, for example.

I guess the implication here is that to cut costs we should go back to the 1930s: put people in beds and provide lots of nurses to take pulses and temperatures without any medical devices or new drugs. Costs would go down.

The literature actually suggests a bunch of other major cost drivers — excess regulation is estimated to account for about 10 percent of U.S. national health spending each year. The spread of public insurance programs including the expansion of Medicaid/SCHIP also likely increases costs. Rising incomes are a huge factor. Wealthy people consume more health care just like they do more transportation, housing and education.

The spread of third-party payment, which has reduced consumer out-of-pocket expenses to all-time lows, is likely a big factor in the cost increase.

Finally, there's the line that "And if private Medicare plans become more popular, that too may increase costs." The embedded assumption here seems to be that private equals higher cost. This often is not the case in the real world.

Linda Gorman is director of the Health Care Center at the Independence Institute in Golden.

Labels: Insurance, Medicaid, Medicare, OpEd

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The value of health care

James K. Schroeder, MD
Grand Junction, CO, Colorado

Value is a word we don't hear often enough in the health care debate. Proponents of universal health care rarely acknowledge the value of health care as a professional service. Stop to consider the time and effort that comprise a medical education. Years of study and long hours are devoted to attaining the basic physician's toolset. Many more years are needed to hone those skills and develop the judgment to use them wisely. This process builds substantial value. When proposing expansion of governmental control, advocates of universal health care blithely discount that value and belittle the quality you desire for yourself and your family. This country already faces massive shortages of primary care physicians in many locations.

Expansion of low-paying programs such as Medicaid and CHP+ will not improve that. In Colorado, expanding Medicaid with its low reimbursements has previously been shown to decrease the number of pediatricians accepting new Medicaid patients. Universal health care advocates are fond of saying that nurse practitioners and physician's assistants will fill that gap. In other words they are admitting from the outset that consumer's access to physicians will be effectively rationed. At the same time they try to equate the "value" of that care as if the consumer is not bright enough to recognize the difference. As it stands, prices for most medical services are determined by the federal government (most insurance companies tie their reimbursement rates to the Medicare-determined value scale). The talent, training and experience of the provider are not even considered.

A better solution would be to return to a competitive market environment. Let the system operate openly so that the value of the service (as provided by any given provider) and the perception of that value (in the view of any given consumer) will determine the monetary cost of that service. Don't expect college-age students to embark on a career in medicine or seasoned physicians to remain in the field if the value of their hard work is not acknowledged.

Labels: Free Market, Insurance, LTE, Medicaid

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The Right Vision Of Health Care
Yaron Brook 1.08.2008

With the primary season in full swing, the presidential candidates are fighting over what to do about the spiraling cost of health care--especially the cost of health insurance, which is becoming prohibitively expensive for millions of Americans.

The Democrats, not surprisingly, are proposing a massive increase in government control, with some even calling for the outright socialism of a single-payer system. Republicans are attacking this "solution." But although they claim to oppose the expansion of government interference in medicine, Republicans don't, in fact, have a good track record of fighting it.

Indeed, Republicans have been responsible for major expansions of government health care programs: As governor of Massachusetts, Mitt Romney oversaw the enactment of the nation's first "universal coverage" plan, initially estimated at $1.5 billion per year but already overrunning cost projections. Arnold Schwarzenegger, who pledged not to raise any new taxes, has just pushed through his own "universal coverage" measure, projected to cost Californians more than $14 billion. And President Bush's colossal prescription drug entitlement--expected to cost taxpayers more than $1.2 trillion over the next decade--was the largest expansion of government control over health care in 40 years.

Today, nearly half of all spending on health care in America is government spending. Why, despite their lip service to free markets, have Republicans actually helped fuel the growth of socialized medicine and erode what remains of free-market medicine in this country?

Consider the basic factor that has driven the expansion of government medicine in America.

Prior to the government's entrance into the medical field, health care was regarded as a product to be traded voluntarily on a free market--no different from food, clothing, or any other important good or service. Medical providers competed to provide the best quality services at the lowest possible prices. Virtually all Americans could afford basic health care, while those few who could not were able to rely on abundant private charity.

Had this freedom been allowed to endure, Americans' rising productivity would have allowed them to buy better and better health care, just as, today, we buy better and more varied food and clothing than people did a century ago. There would be no crisis of affordability, as there isn't for food or clothing.

But by the time Medicare and Medicaid were enacted in 1965, this view of health care as an economic product--for which each individual must assume responsibility--had given way to a view of health care as a "right," an unearned "entitlement," to be provided at others' expense.

This entitlement mentality fueled the rise of our current third-party-payer system, a blend of government programs, such as Medicare and Medicaid, together with government-controlled employer-based health insurance (itself spawned by perverse tax incentives during the wage and price controls of World War II).

Today, what we have is not a system grounded in American individualism, but a collectivist system that aims to relieve the individual of the "burden" of paying for his own health care by coercively imposing its costs on his neighbors. For every dollar's worth of hospital care a patient consumes, that patient pays only about 3 cents out-of-pocket; the rest is paid by third-party coverage. And for the health care system as a whole, patients pay only about 14%.

The result of shifting the responsibility for health care costs away from the individuals who accrue them was an explosion in spending.

In a system in which someone else is footing the bill, consumers, encouraged to regard health care as a "right," demand medical services without having to consider their real price. When, through the 1970s and 1980s, this artificially inflated consumer demand sent expenditures soaring out of control, the government cracked down by enacting further coercive measures: price controls on medical services, cuts to medical benefits, and a crushing burden of regulations on every aspect of the health care system.

As each new intervention further distorted the health care market, driving up costs and lowering quality, belligerent voices demanded still further interventions to preserve the "right" to health care. And Republican politicians--not daring to challenge the notion of such a "right"--have, like Romney, Schwarzenegger and Bush, outdone even the Democrats in expanding government health care.

The solution to this ongoing crisis is to recognize that the very idea of a "right" to health care is a perversion. There can be no such thing as a "right" to products or services created by the effort of others, and this most definitely includes medical products and services. Rights, as our founding fathers conceived them, are not claims to economic goods, but freedoms of action.

You are free to see a doctor and pay him for his services--no one may forcibly prevent you from doing so. But you do not have a "right" to force the doctor to treat you without charge or to force others to pay for your treatment. The rights of some cannot require the coercion and sacrifice of others.

So long as Republicans fail to challenge the concept of a "right" to health care, their appeals to "market-based" solutions are worse than empty words. They will continue to abet the Democrats' expansion of government interference in medicine, right up to the dead end of a completely socialized system.

By contrast, the rejection of the entitlement mentality in favor of a proper conception of rights would provide the moral basis for real and lasting solutions to our health care problems--for breaking the regulatory chains stifling the medical industry; for lifting the government incentives that created our dysfunctional, employer-based insurance system; for inaugurating a gradual phase-out of all government health care programs, especially Medicare and Medicaid; and for restoring a true free market in medical care.

Such sweeping reforms would unleash the power of capitalism in the medical industry. They would provide the freedom for entrepreneurs motivated by profit to compete with each other to offer the best quality medical services at the lowest prices, driving innovation and bringing affordable medical care, once again, into the reach of all Americans.

Yaron Brook is managing director of BH Equity Research and executive director of the Ayn Rand Institute.

Labels: Analysis, CA, Free Market, MA, Medicaid, Medicare, OpEd

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Expanding Medicaid eligibility will mean fewer docs accept it

The dilemma faced by Dr. Glen Dean and his patients as outlined in the Nov. 11 article, “Tied up in red tape,” is nearly universal for those of us who provide medical care for children. Unfortunately, too many policymakers seem unwilling to accept some simple facts.

Rep. Buescher is quoted as saying, “If we expand eligibility without working on the reimbursement rates, any proposal is ineffective.” At the same time, he and his colleagues in the Legislature are considering several proposals that call for expanding Medicaid or the state Child Health Plan Plus, known as CHP+.

Apply some simple math. If you think the price tag for health-care reform is steep as currently projected, consider how much it costs when lawmakers think they can promise expanded coverage and increased physician reimbursement.

The truth of the matter is that expanding coverage will not ensure improved access. Rest assured that expanding Medicaid will result in a decrease in doctors who accept Medicaid.

Rather than expanding the current Medicaid and CHP+ system in Colorado, we should seriously look at fundamentally restructuring the nature of charity health care.

Instead of perpetuating Medicaid as a state-run charity with an iron-fisted lock on the charity market, we should encourage doctors to provide charity care outside of the Medicaid framework, allowing them to openly compete with Medicaid.

Eligibility for these private charity services could be determined on a need basis and incentives could be provided in the form of tax credits for providers who philosophically choose to provide specified services. In addition, individual donors who prefer to give money to a tangible local entity by choice rather than by coercion to an inefficient governmental bureaucracy could receive tax credits.

How many times must we hear that “the current system is broken,” so “let’s expand it”? That is purely nonsensical. I urge citizens to contact their state representatives today and tell them they oppose expanded government mismanagement of your health care.

JAMES SCHROEDER
Grand Junction

Labels: Medicaid, OpEd

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...But back to the original discussion. Should she go on the ranks of Medicaid while in school? I warned her that in this area, most docs will never see you. You will be bound to the ER for primary care services. I explained the economics of the situation. She offered to pay her doc more.

Ah, there in lies the problem. I explained quite clearly that Medicare/Medicaid does not allow "balanced billing". Even if the patient chooses to pay more, it is illegal for her to charge more. It is also illegal to charge a cash paying customer a fee less than Medicare pays, if that docs accepts Medicare. In other words, Medicare would want that smaller fee. So, they won't pay more and you can't charge less. How absurd.

She was surprised that it is illegal to pay the difference between what we charge and what insurance collects. Here is a potential Medicaid patient willing to pay her fair share, and the system won't allow it. Why? I have no idea why. Both patient and doctor win. Patient gets access, Doctor gets their fair fee.

She talked about using chiropractor services, about how they offered to "work with her" as an uninsured client. This is capitalism. This is how it should be. Right now, we can't "work with her". It's either in or out. If she's in the Medicaid system, nobody will see her. If she's out, we can't charge her less than the Medicare fee schedule or it's considered fraud. Even though the cash only model allows for lower costs because billing/collections/ resource utilization is lower.

This socialistic model is killing primary care.

Labels: Analysis, Medicaid

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Currently, Medicaid expenditure per enrollee is nearly $7,000 per year. This high cost “health plan” gives recipients access to long wait times for fewer doctors, guaranteeing little ability to make healthcare decisions for themselves and their families. Arbitrary decisions made by government employees—nearly 6,000 in California alone—overrule recommendations made by doctors and nurses sitting beside their patients in exam rooms across the state.

Medicaid’s astonishing administrative costs compound the problem. According to 2005 data from the Center for Medicare and Medicaid Services, over 31% of every dollar spent by Medicaid did nothing to provide medical treatment.

...I sustained a personal and professional loss when I was forced to stop providing services as the only breast cancer surgery specialist in a 70-mile radius in central California who still accepted Medi-Cal. I could no longer afford the $10,000-$15,000 monthly hemorrhage related to reimbursement so low it would be cheaper to close my office doors.

My own loss is nothing compared with what the women who will be diagnosed with breast cancer in my community will face. “Coverage” with a government-funded “insurance plan” for them offers no coverage, after all.

Labels: Analysis, Medicaid

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It's Official: Medicaid Managed Care Does Not Save Money

The reform plan drawn up by Colorado's Blue Ribbon Commission on Health Care Reform plans to enroll 50 percent of Medicaid recipients in managed care. Given the history of Medicaid managed care in Colorado, this is an odd recommendation.

Back in the dark ages of Clinton Care 1.0, heath care policy gurus asserted that managed care would save enormous sums. State governments salivated. To sweeten the pot for switchers, the Robert Wood Johnson Foundation and other acolytes of managed care encouraged the notion that Medicaid HMOs could provide better, more coordinated care, at rates that were 95 percent of fee-for-service costs. The usual economic models predicted big savings. Projects were funded. Federal waivers were pursued. Medicaid clients were herded into capitated health plans, and all parties proclaimed the dawning of a new era in health care.

In the heady days of 2002 and 2003 Colorado Medicaid enrolled 50 percent of Medicaid clients in one of five Medicaid HMO plans. Kaiser and United Health pulled out in November 2002. In 2003, two others left. Four of the five original plans sued the state for inadequate payments. They won $77,810,395 in additional payments, along with legislation requiring actuarially sound calculations of capitation rates.

Enrollment in Medicaid HMOs fell. Even though clients in the Denver metro area were automatically enrolled in managed care unless they actively chose fee-for-service, by September 2006 fewer than 10 percent of Medicaid clients were enrolled in risk-based managed care.

In June 2007, Denver Health Medicaid Choice, the remaining Medicaid HMO, informed the state that it would withdraw unless capitation rates were increased to 100 percent of the fee-for-service rates. The state applied for the emergency supplemental appropriation required to fund the increase.

After years of testing, the state has found that Medicaid HMO plans are at least as costly as traditional fee-for-service. They may even cost more. In its December 2006 Joint Budget Committee hearings, the Colorado Department of Health Care Policy and Financing wrote that "Although managed care organizations should experience savings over fee-for-service due to their improved ability to reduce unnecessary hospitalizations, emergency room visits, and other overutilization, there are also extensive administrative costs for care management, utilization management, providing networking to ensure access, and other processes such as bill paying and risk management."

The state could elect to give taxpayers a break and simply make the same payment for the same care regardless of delivery method. People who use the care would simply pick the kind of care they like. They might prefer a private physician to an HMO. In Medicare, where people do have a choice between HMOs and fee-for-service, the data show that healthier people tend to enroll in HMOs. Those most likely to leave HMOs are those in poorer health.

The fact that managed care should cost less but doesn't poses a problem for influential people who have spent their entire professional lives being trained in the managed care creed. Many of them prefer to believe that failure results from too little money and not enough regulation. Undeterred by failure, they want to repeat the Medicaid managed care experiment with more regulation and more tax money.

To attract managed care providers, the Department proposes increasing Medicaid HMO payment rates to 100 percent of fee-for-service payments and adding a 5 percent payment for administrative costs. If these measure fail, it is even investigating the possibility of setting up and running its own Medicaid HMO. The idea is that if it runs its own HMO, it will enjoy lower costs for purchasing and administration. In some particularly florid prose, the Department says that a state run HMO would allow the state to achieve "the efficiency of centralization," a transcendental state that has eluded every other government-run, centralized health care system in the English speaking world.

Meanwhile, the Consumer Directed Attendant Support program, Colorado's innovative experiment with consumer directed care, frees clients from Medicaid centralization, giving them a budget and letting them keep 50 percent of any money they save. In turn, their ingenuity saves the state about 20 percent a year. In the private sector, innovative companies are having similar results when they reduce centralized management by marrying tax free health savings accounts with high deductible health insurance.

Unfortunately, real savings by real people cut little ice with those who think that 50 percent of all Medicaid clients should, for some unknown reason, be in Medicaid HMOs. That the state is demonstrably unfit to run an HMO doesn't matter.

The goal has been set, "the efficiency of centralization" awaits, and real costs are of little real importance when true believers spend other people's money. Look for a massive rollout of results from esoteric theoretical models. These results will prove that state run health facilities will produce big theoretical savings. In practice, the real world is unlikely to oblige.

Labels: 208, Medicaid, OpEd

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Where are the doctors who accept Medicaid?

Sergey Sargsyan has lost 80 pounds since his symptoms began more than three months ago. He's in pain and getting weaker. Emergency room visits and surgery to remove gallstones have done little to help. Doctors say he needs a specialist.

...But finding one willing to accept Medicaid as payment has been an exercise in futility, said Susanna McPhilomy, the 77-year-old's daughter. "The first question isn't, 'How can we help you?' " she said, "but, 'What type of insurance do you have?'"

Sargsyan is not alone. Health care experts are seeing the first of what they say could become widespread lack of access to care for Medicaid patients.

...Specialists are in even shorter supply. In 2007, eight specialty groups had zero Medicaid billings: abdominal surgeon, cardiovascular surgeon, geriatrician, hand surgeon, head and neck surgeon, neuroradiologist, pediatric radiologist and therapeutic radiologist. That means patients are going to the emergency room for specialty care, said Fotheringham.

"You hope, at that point, the guy you need is on-call," he said. "And there are some doctors, such as orthopedic specialists, who won't work on-call for the simple reason they don't get paid."

Lincoln Nehring, an analyst at the Utah Health Policy Project, said he has also started to hear of Medicaid patients being pushed to emergency rooms for primary care.

Another common practice is for doctors to space their Medicaid patients, which can mean monthlong waits, said Nehring.

Labels: Medicaid, States, UT

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Single-payer health plan would be costly and unfair

Imagine every time a shopper goes to the store he encounters an armed bandit. This bandit takes $5 from the shopper and pockets $4. He then gives the remaining dollar to a hungry man nearby. Imagine then that the bandit goes inside the store and forces the grocery store owner to sell a $3 loaf of bread to the hungry man for that $1. The shopper would be outraged. The store would soon go out of business. Understandably, the hungry man would love this arrangement.

Sad to say, this is precisely the Medicaid system that would be expanded under one of the options being considered by the governor’s 208 Commission on health care. If you have not deduced already, the shopper is the taxpayer, the bandit is the government, the hungry man is the Medicaid recipient and the storeowner is the physician. While perhaps admirable to want to feed the hungry man, allowing the government to do it inefficiently and by coercion is economically nonsensical. It also is contrary to notions of individual freedom and responsibility.

I, as a physician, small business owner and taxpayer, feel the brunt of this on multiple levels. I am astounded that while tasked to consider meaningful reform, the commission is considering an expanded version of the current failed system.

The Legislature should debate a variety of reform proposals. One alternative would be the FAIR proposal submitted to the 208 Commission by Brian Schwartz. I urge the taxpayers of Colorado to learn about these issues. Beware the incremental expansion of government-run health care because we as a society will not be able to afford "free" health care.

I am a pediatric cardiologist and have been in private practice in Grand Junction since 2004. I am a former chief of the medical staff of Methodist Children’s Hospital in San Antonio, Texas, and a former army pediatrician. I have experienced many different aspects of health care in America. I am also a native of the Grand Valley.

JAMES K. SCHROEDER

Labels: 208, LTE, Medicaid

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Labels: CO, Medicaid, OpEd

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Don't model state reforms on Medicaid
How should Colorado lawmakers fix a broken system?
By Brian T. Schwartz

Colorado's Blue Ribbon Commission for Healthcare Reform recently selected four proposals for further analysis and eventual legislative review. The so-called 208 Commission's goals include improving access, encouraging personal responsibility, and supporting a "financially viable, sustainable and fair" system. Yet, these proposals preserve or expand Medicaid, which fails to meet these goals.

Colorado's Medicaid spending has almost doubled since 1997, eats up 20 percent of your state taxes, and increases prescription drug prices. The National Association of State Budget Officers reports that "increases in Medicaid costs will far outstrip the growth in state revenues into the future." But why should state-level administrators be frugal? For each dollar state taxes compel you to donate, the feds pitch in another by taxing someone else.

One of the four proposals being considered recommends that Medicaid switch from its current "fee-for-service" model - where taxpayers pay doctors at government-set rates - to HMO-style managed care. However, a National Bureau of Economic Research study concluded that switching from "fee-for-service to managed care was associated with a substantial increase in government spending but no observable improvement in health outcomes."

Medicaid and managed care are not insurance, but prepaid health care. Tiny or non-existent copayments and deductibles discourage prudent spending. Medicaid patients spend someone else's money, so providers need not reduce costs. Because the federal tax exemption for employer-paid premiums has transformed insurance into prepaid health care, the privately insured do the same. This tax policy makes medical costs skyrocket.

Medicaid recipients also have poor access to medical care. Doctors are five times more likely to refuse seeing new Medicaid patients than privately insured patients, who also have greater access to physicians after ER visits. Increasing reimbursement rates won't induce many doctors to see Medicaid patients; more than two-thirds of doctors reported being overwhelmed by Medicaid's billing requirements, paperwork, and delays in payment.

Medicaid erodes personal responsibility. Many recipients avoid higher-paying jobs and saving money because such admirable behavior disqualifies them from benefits. Hence, Medicaid keeps those it "aids" helpless, on their backs and dependent on government.

Medicaid is a bully. It unfairly competes with private insurers and private charities, crowds them out of the market, and hence forces some to depend on government for inferior health care. Harvard's George Borjas found that Medicaid cutbacks have significantly increased immigrant enrollment in employer-sponsored insurance. And USA Today reports that "many workers choose Medicaid over insurance offered by their employers."

One state proposal advocates significantly expanding Medicaid eligibility. This would further crowd out insurers and subject yet more Coloradans to Medicaid. The "single-payer" proposal advocates squashing private insurance entirely - forcing us all to depend on government for health care. A scary thought, given Medicaid's track record. If Medicaid is as good as its defenders claim, why not let it compete fairly with insurance companies and voluntary charities for customers and donations?

An alternative to Medicaid is consumer-directed health care, which combines low-premium, high-deductible policies with tax-deductible Health Savings Accounts (HSAs). Patients spend their own HSA funds until reaching their deductible, after which the policy's coverage applies. With savings from lower premiums, employers often contribute to employee HSAs, which employees own even after changing jobs. Further promoting consumer choice and affordable insurance entails eliminating laws mandating minimum benefits; these laws criminalize the sale of economical insurance policies. Empowering consumers provides quality, affordability and portability.

Patients spending their own money on medical care empowers them to consume wisely, take personal responsibility for their health, and gives doctors incentives to satisfy patients instead of bureaucracies. The RAND Health Insurance Experiment found that patients with the equivalent of consumer-directed plans spent 30 percent less than those with prepaid plans - with negligible effect on their health.

Consumer-driven health care is not foreign to Medicaid. Cash & Counseling programs have high participant satisfaction and Colorado's Consumer-Directed Attendant Support operated 21 percent under budget in its first two years.

Medicaid fails to meet the 208 Commission's criteria for cost, quality, access, personal responsibility, and fairness. The Colorado legislature should choose consumer-directed over authority-directed health care. Health care is too important to be left to government.

Brian Schwartz is an optical engineer in Boulder. This article was adapted from his proposal to Colorado's Blue Ribbon Commission on Healthcare Reform, called FAIR: Free-Markets, Affordability, and Individual Rights. The proposal is available at WhoOwnsYou.org.

Labels: Insurance, Medicaid, OpEd

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Promoting socialized medicine

I am increasingly concerned that the Denver dailies are assisting in a not too subtle attempt to shape public opinion to be receptive to schemes being concocted by Colorado's 208 Blue Ribbon Commission on Health Care. Initiated by a governor and a legislature that are both clueless as to how to solve the health care problem, this commission has deftly created a situation whereby two obviously unacceptable proposals are being put up against two proposals which would essentially mandate the uninsured buy health care insurance. This is classic railroading when you are forced to pick from options that have been selected to lead to a preordained outcome. Is there any question in your mind that this Commission is going to call for some kind of mandated insurance similiar to Massachusetts and California?

As an aside, an article on July 1, 2007 in the NY Times by Pam Belluck, noted that Massachusetts, (with a population of nearly 6.5 million people) has, since 2006, been able to get only 130,000 people into their new scheme, and that required the insurance be free or subsidized. The rest of the uninsured in the state have said, thanks, but no thanks.

This whole endeavor is a not so veiled attempt to solve the State's rising Medicaid cost crisis and the hospital's and doctor's collections problems by putting as many people as they can herd into a corral and force them to buy insurance. The problem is that federal ERISA plans in the state are not going to participate and you can bet that PERA and other governmental employee organizations are not going to touch this skunk with a ten foot pole. If the State unwittingly destroys the individual and small group health insurance market they will create a highly regressive system with many unintended consequences.

Recent editorials by members of the Commission are little-by-little revealing their socialistic philosophical core and their nearly complete lack of understanding of market-based economics. To say that the market has failed is to ignore the role government has played over the past 30 years in meddling in the health care market. You would have to go way back to before the 1970s to find any semblance of a functioning health care market. This is tantamount to the federal government polluting Rocky Flats and then proclaiming that nature doesn't work any more. We are on a path to socialize the remainder of 16%, soon to be 20%, of the US economy. If the hospitals and doctors think that forcing the uninsured to buy health insurance is not one more step toward having their fees and practices regulated by a government bureaucracy they are mistaken. Global warming has less of a chance of melting the glaciers than the creeping vine of liberal Democratic socialism has of turning the medical profession into proxy employees of the government. You reap what you sow guys!!!

Fran Miller has been a management consultant for 25 years and he has a graduate degree in health policy from the University of Colorado’s Graduate School of Public Affairs. Miller is the past president of the Colorado Business Coalition for Health, a two term member of the Colorado Legislature’s Interim Committee on Health Care. He was appointed by governors Richard Lamm and Roy Romer to two terms as vice chairman of the Colorado Health Data Commission. He is presently writing a book on health care in the 21st century.

Labels: 208, Analysis, Medicaid

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Labels: CO, Medicaid

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