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HealthBiz: Debate Continues on Uninsured

Posted - Jun. 15, 2004 at 9:20 a.m.



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WASHINGTON, Jun 15, 2004 (United Press International via COMTEX) -- The Alliance for Health Reform gathered experts from the various political and policy perspectives Monday to talk about the nation's almost 44 million uninsured. Ideas on the subject ranged from a national, single-payer healthcare system to private, tax-based policies such as the credits proposed by the Bush administration.

Following last year's passage of Medicare reform legislation, there is a sense Congress should begin debating long-term solutions to the problem of the uninsured, but just how soon any serious discussion gets underway is anyone's guess. Policy experts and groups hope to keep the issue on the table for discussion.

Stuart M. Butler, vice president and director of domestic and economic policy studies at The Heritage Foundation in Washington, D.C., has talked about problems with the current approach for some time. For example, most people now obtain health coverage through the employer-based group insurance market. Coverage is dependent upon employment.

Only about 7 percent of people who carry health insurance have purchased their coverage individually.

"The erosion of the employer-based system, in some respects, may be a good thing," Butler told the gathering as he talked about the need for America to decide its priorities for coverage.

Jack Meyer, founder and president of the Economic and Social Research Institute, said rigid ideologies should not get in the way of practical solutions, but there are no "magic bullets" to solving the uninsurance problem. He talked about having a variety of plans to accommodate people's differing needs and said universal coverage might not be as expensive as some people might expect. He added there are trade-offs and benefits in any plan, but called himself one of the few advocates of employer-based insurance.

"If it ain't broke, don't fix it," he said, "and a corollary of that is don't try to fix something that isn't broken unless you have something ready to replace it."

Gail Wilensky, a John M. Olin senior fellow at Project HOPE in Washington, said the areas of agreement between the political left and right include the idea it is important to "mix and match" the solution to the needs of various people.

(Thanks to UPI's Elizabeth Suh in Washington)

MASSPRIG MOVING CLOSER TO PASSAGE

More states are looking to establish buying pools to gain leverage in negotiating with drugmakers to hold down prescription drug costs. A buying pool would include a state's Medicaid drug purchases and prescription drug programs offered as benefits for state employees. A key component would be a uniform drug formulary, allowing the state to take advantages of bulk buying on specific, high-use drugs.

The state of Maine went through legal battles to set up its program, called Maine Rx Plus. Now in effect, it includes people with incomes under 350 percent of poverty -- which covers a family of three with an income of $68,000 -- as well as 96 percent of the state's uninsured population. Early reports on the program show more than 100,000 people were enrolled in the first month and savings already are ranging from 15 percent to 60 percent.

Deirdre Cummings, consumer program director for MASSPRIG, the Massachusetts buying pool, said the bill to create the pool now is in a conference committee in the state Legislature. Still, Cummings told UPI's HealthBiz, bulk purchasing bills have passed before but never were implemented so this bill still faces a battle.

"It absolutely does," she said. "The biotech industry is very strong in this state and it is one that the Speaker of the House has said, over and over again, 'I don't want to do anything to interfere with the biotech industry'," she said.

Cummings said the bill has "tremendous rank and file" and bipartisan support, but there are worries about how it will fare with the legislative leadership and the governor's office, "where we see the strength of the biotech industry."

Those involved with such buying pools stay connected through the National Legislative Association on Prescription Drugs, where they meet their counterparts in other states. Eighteen states have some type of bulk purchasing law on the books. California has a pool to purchase drugs for its agencies, and other states, including Maryland, have discussions underway.

Cummings does not see the programs as an alternative to reimportation.

"We want to go to our local pharmacy," she said, and added the pharmaceutical companies need to come to the table to "negotiate a better solution" overall to the prescription drug cost problem.

TRICARE/EXPRESS SCRIPTS PROGRAM HITS SNAG

Tricare's Retail Pharmacy Program with Express Scripts Inc. began June 1 and within hours hit a major technological glitch -- causing a system claims processing slowdown for Tricare beneficiaries. The system was restored and improvements and refinements continue to iron out all the problems.

The new program allows Tricare members to fill prescriptions using Express Scripts network retail pharmacies, paying $3 for generic drugs and $9 for brand-name drugs.

Dr. William Winkenwerder Jr., assistant secretary of defense for health affairs, issued a statement that apologized to military beneficiaries and "the 53,000 pharmacies across the United States who have experienced the difficulties associated with these processing problems."

Last week, on June 7 and 8, more than 180,000 claims were processed and paid each day, far more than the 125,000 Tricare claims usually processed on Mondays and Tuesdays.

"Nevertheless, higher than normal rates of claims rejection continue and problems exist in some areas," the company said in a statement. "The ESI provider-relations team is working with individual pharmacies and pharmacy chains alike to resolve both systems problems and the particular problems experienced by those pharmacies."

EXERCISING TO REDUCE THE BOTTOM LINE

Employees who are moderately active or very active can cost about $250 per year less in healthcare than their sedentary co-workers. A study by the University of Michigan Health Management Research Center in Ann Arbor said obese employees cost a company about $450 more each year in healthcare costs.

The study, published in the Journal of Occupational and Environmental Medicine, is based on a sample population of 23,490 active employees of a large manufacturing corporation. The average age was 47 and nearly 79 percent of the group was male. Employees with known chronic conditions such as heart disease, stroke, diabetes, cancer and bronchitis were removed from the study.

MANY DOCTORS UNAWARE OF CLINICAL TRIALS

Harris Interactive polling has looked at patient participation in clinical trials for the past couple of years but this year's survey also includes a section on physician responses.

The results show only about 13 percent of physicians are clinical investigators. About 34 percent said they had done trials in the past but currently were not involved in one, and 53 percent said they never had participated in a clinical trial.

The reasons the doctors gave for not participating included a lack of time to commit to the project, a lack of personal support and not having enough resources to conduct a successful trial. The biggest factor, however, was physicians were unaware of what trials are available to them.

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E-mail ebeck@upi.com

Copyright 2004 by United Press International.

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