Here is Senator Lieberman's response to my letter to him regarding health care reform. I personally interpret "ecreasing the costs of insurance" as eliminating the exemption from the Anti-trust laws. Let's hope we can create a true free market system for health care.




June 4, 2009

Dear Mr. Coman:

Thank you for contacting me to express your desire to improve our nation's health care system. I share your concern that this must be a top national priority, and I am committed to addressing this critical issue. I understand that Americans today are faced with greater uncertainty than ever before when it comes to their health needs. These concerns often focus around rising medical costs, aging, the risk of disease, and the multitude of treatments. In Connecticut, 325,000 residents - 50,000 of whom are children - are uninsured.

Throughout my career in public service, I have fought to make the nation's health care system work better for all Americans. I have concentrated on decreasing the costs of insurance, expanding access to treatment, assuring the best health care workforce has the newest medical technology, and protecting the rights of patients and consumers through their interactions with our cumbersome system.

It is especially important that we work to strengthen health care delivery systems for the uninsured, while also providing affordable, quality health care coverage for everyone.

Unfortunately, individuals and families without health coverage are more likely than those with coverage to forego needed health care, which often leads to worse health outcomes and the need for expensive medical treatment. Lack of insurance can lead to health care access problems affecting whole communities, such as overcrowding in emergency rooms. The nation as a whole is burdened through increased taxes to pay for the uncompensated care of uninsured persons.

On November 21, 2008, I sent a letter, along with several of my colleagues, to President-Elect Obama, in which we indicated our commitment to working with him in a bipartisan fashion to reform our health care system. Given our current economic challenges, and the fact that a growing number of Americans have lost their jobs and subsequently their health care benefits, we urged that the Congress and the White House immediately work together to tackle the challenges of health care costs and coverage. In the letter we outlined principles for reforming our nation's health care system. These include: ensuring that all Americans have health care coverage; making health care coverage both affordable and portable; implementing strong private insurance market reforms so that insurers can compete on price, benefits, and quality; modernizing federal tax rules for health coverage; promoting improved disease prevention and wellness activities, as well as better management of chronic illnesses; making health care prices and choices more transparent so that consumers and providers can make the best choices for their health needs and health care dollars; and improving the quality and value of health care services. I look forward to working with the new Administration to enact legislation that accomplishes these principles. I am pleased that President Obama conducted the first White House Forum on Health Reform on March 5, 2009, in which a broad group of doctors, patients, business owners, insurers, and lawmakers, among other interested stakeholders, met to discuss and advance ways to reduce costs, expand coverage, and improve quality.

On February 5, 2009, along with 12 cosponsors, I reintroduced sweeping bipartisan legislation that would guarantee every citizen affordable health insurance, regardless of income, and significantly improve access to quality medical treatments. The Healthy Americans Act (S. 391) would comprehensively reform the health care system by providing universal coverage through a centrally financed system of private health insurance. This fiscally responsible legislation reverses the current trend in health care costs and provides much-needed relief for families and businesses. Under the plan, comprehensive coverage policies would be available through regional markets, harnessing the power of competition and providing individuals with greater choice and better value. Insurance companies would be required to offer a generous benefits package, similar to what federal employees receive. Coverage could not be denied; and insurance companies could not charge higher premiums because of a person's health status, occupation, gender, genetic information, or age. It would also implement a standard health care tax deduction and a system of subsidies in order to guarantee that all Americans can afford quality health coverage.

Last Congress, I took a first step to expanding coverage by cosponsoring legislation to provide more affordable health care to the millions of Americans working for small businesses. Over 45 million people in the United States had no health insurance in 2007. Among the non-elderly uninsured, more than half of these individuals were in families with a full-time worker and employed by, or with family members employed by, a small business with fewer than 100 employees.

On September 24, 2008, I became the lead cosponsor of the Affordable Coverage for Small Employers Act. This bipartisan bill would increase access to high-quality and affordable health care for our nation's small business owners, their employees, and their families by removing barriers to health care coverage faced by small business owners. This legislation would partner the federal government with states and small businesses to create regional health care pools that would allow for more competition in the small group market. It would offer more health insurance options to small business owners so they can pick the health care coverage that best fits their needs. It would also provide a framework for extending coverage to all Americans. The benefit packages available through this plan mirror the health care benefits available to Members of Congress and other federal employees. In addition, the bill provides advanceable, refundable tax credits to working families to help offset the cost of health coverage, as well as tax credits to small employers who contribute to their employees' health insurance premiums.

Over my career, I have focused on making sure high-quality health care was available to those in the greatest need. In both the 108th and 109th Congresses, I introduced the FairCare Act to ensure that all Americans receive the same quality of medical care regardless of gender, race, or ethnicity. That measure would have set medical standards of care for diseases that doctors should follow for each and every patient, rewarding health professionals for practicing these standards, and increasing transparency of health care practices by creating the conditions for an electronic health record that can be analyzed for the quality of care received. By improving the quality of care in this country, we can save approximately $30 billion a year. More importantly, we can reduce suffering and save lives.

I support legislative initiatives to protect the rights and benefits of patients who are enrolled in managed care and other types of health care plans; and I have been involved in efforts to craft a bipartisan managed care reform bill that can be enacted by the Congress. We must ensure that all Americans have decent health care plans with essential patient protections, such as guaranteed access to needed health care specialists; access to emergency room services when and where the need arises; continuity of care protections to assure patient care if a patient's health care provider is dropped; access to a timely internal and independent external appeals process with a medical necessity standard; assurance that doctors and patients can openly discuss treatment options; and an enforcement mechanism that ensures appropriate recourse for patients who have been harmed as a result of health plan actions and that holds health plans accountable for decisions that result in patient injury or death.

We must also update our health care system's infrastructure by expanding the use of health information technology (IT) in our country. Widespread adoption of health IT would save the system money and increase the quality of care delivered. Improving the quality of care delivered to Americans is dependent on decreasing medical errors and limiting wasteful spending on clinical procedures that fail to improve health outcomes. I am paying close attention to legislative initiatives to expand pay-for-performance to Medicare, which would result in payments to physicians based on delivering high-quality care to their patients. These efforts must be comprehensive, well funded, and thoughtful to ensure that positive impacts are experienced by every American.

Expanding access to health care for Americans will involve safeguarding the successful Medicare and Medicaid programs and improving the quality of medical care in our country which can make our health care systems more effective and efficient. I will continue to fight against cuts to clinically proven programs and reimbursement reductions for our high-quality hospitals and providers serving those on Medicare and Medicaid.

Finally, in addition to providing greater access to life-saving treatments, we need to invest in the development of new treatments. During the 110th Congress, I reintroduced my Accelerating Cures Act legislation, which would accelerate the pace of biomedical research so that we can advance the study and development of therapies that can more effectively treat and even solve diseases, such as cancer, Parkinson's disease, heart failure, and diabetes. The sole mission of this legislation is to translate basic science discovery, such as that produced by the National Cancer Institute (NCI), into novel diagnostics, therapies, and life-altering cures. Some examples of what this proposal would do are to create new opportunities for: increasing collaboration between traditionally separate disciplines and between the public and private sectors; funding high-risk, high reward research that could result in new treatments for diseases quickly; and making funding available to small companies that are doing breakthrough medical work but often do not have the resources to bring their products to market. Many life-threatening and chronic diseases would undoubtedly benefit from passage of such legislation. I also support expanding stem cell research in the hope of realizing lifesaving treatments for many diseases, along with increased funding for more coordinated efforts to combat autism and other developmental disorders.

As the Senate focuses renewed attention on health care quality, affordability, accessibility, and related matters in this 111th Congress and beyond, you can be assured that I will keep in mind your specific thoughts and suggestions; and I will continue to be an advocate for strong patient protections, health care plan accountability, and affordability to benefit all of our nation's citizens.
Thank you again for sharing your views and concerns with me. I hope you will continue to visit my website at http://lieberman.senate.gov for updated news about my work on behalf of Connecticut and the nation. Please contact me if you have any additional questions or comments about our work in Congress.

Sincerely,

Joseph I. Lieberman
UNITED STATES SENATOR

JIL:vdh

In my previous post I shared with you that rational concern that I have for the future of our country based on the unwise financial decisions we are making. Today I wish to share one of the reasons why the government has a legitimate concern in health care costs and some things that can be done to address those concerns.

Health Care cost reform is essential to true advancements in health care for the American people. We have been taught to believe that we have a fair market system and that the one being proposed is a socialist alternative.

Perhaps the issue most overlooked, and quite possibly the most consequential, is the insurance industry's exemption from Federal Anti-Trust laws and how that plays into the rise in health care costs. We have been led to believe that our current system is free market. In reality, it isn't entirely. We are living the third alternative that none of us like. It isn't free market. It isn't socialist. It is essentially monopolistic. The insurance industry is one of only two industries that are exempted from Federal Anti-Trust laws. This exemption provides them with a non-free market control over health care (FYI, the other industry is Major League Baseball) (see footnote 2).

This exemption gives insurance agencies the opportunity to do things that, for every other company in America (besides the NY Yankees), is illegal. For example, they can set policies together, set prices together and gather information together. How is that helpful for us? It isn't (see footnote 4).

Health Care cost reform must tackle this huge issue. If it doesn't, then it has failed. Health Care cost reform should focus on the following areas:

1. As mentioned, bring fair market principles to the insurance industry by repealing the anti-trust exemption and responsibly regulating that industry to ensure that price fixing is ended & monopolies are broken up. Imagine what that alone would do.

2. Introduce true incentives to reduce costs in the industry. Those incentives could take the form of tax breaks, grants, fines, etc.

3. Eliminate the huge divide between what someone without insurance pays versus what the insurance company pays for the exact same services. For example, your insurance company may have paid $3,000 for certain services; but you, however, would have to pay perhaps $5,000 for the same treatment if you didn't have insurance. That divide needs to end, or be brought more closely in line, to give consumers a true choice between self insurance and no insurance. People are FORCED onto insurance because of the monopoly on the payer system. It works to their advantage by reducing the amount that they pay to doctors, clinics, etc. to such a degree that the doctors & clinics, to make up that money, have to charge more to the uninsured in order to recoup some of that lost money. This incentivizes people to buy insurance. Who wins? Not the health care industry - the insurance industry.

4. More closely regulate malpractice lawsuits. Malpractice insurance is a large part of the increased costs.

Notice how #1 & #4 are both related to insurance. There is real work to be done with that industry. I believe it would have a sudden & immediate impact on health care costs nationwide. Insurance & health care cost reform should be the cry. Is this list of mine all inclusive? Not by any stretch of the imagination. This is a huge topic. But I do believe that insurance reform would supply a huge benefit to the public whereas pushing forward with universal care would actually increase costs, increase taxes, decrease individual incomes, lead to a rationing of care, reduce personal liberties and contribute toward the ruin of the country.

Creating a one-payer system only further entrenches the monopoly held by the insurance companies on health care and ensures that there will never, ever be a free market system to help the consumer & tax payer. Sadly, as the AFL-CIO reports, the insurance industry is a huge partner in the current "Health Care Reform" process (see footnote 5).

Health Care Cost reform will only happen with Insurance Industry Reform. Although it is 65 years in the making, it is never too late to start and it is long overdue.

___________________________________________

I have written before about Health care expenses and that one way to encourage more free market forces in the health care industry would be to eliminate the anti-trust protection afforded to the insurance industry. This was not very well accepted by our own Senator Orrin Hatch - you can read his letter to me below.

Another thought provoking idea is one created by Michael Cannon of the CATO Institute. In his paper, "Large Health Savings Accounts: A Step toward Tax Neutrality for Health Care," Cannon proposes making some changes to HSA's which would encourage more competition and therefore drive prices down to a competitive level. His proposals are as follows:

1. Increase HSA contribution limits dramatically. For illustrative purposes, assume the maximum annual contribution limits would be roughly tripled, from $2,850 to $8,000 for individuals and from $5,500 to $16,000 for families.
2. Remove the requirement that HSA holders be covered by a qualified high-deductible health plan. HSAs would be open to those covered by any type of insurance, as well as the uninsured.
3. Allow HSA holders to purchase health insurance, of any type and from any source, tax-free with HSA funds.

Cannon writes, "Restructuring the exclusion for employer-sponsored health benefits in this way would enable more individuals to obtain health insurance that matches their preferences, would increase efficiency in the health care sector, and could reduce inequities created by the exclusion. These changes also offer a means of limiting the currently unlimited tax exclusion for employer-sponsored health benefits that may be more politically feasible than past proposals. " He concludes: "Large HSAs could serve as a step toward a tax system that offers no preferred treatment to health expenditures, and thereby forces the health care sector to accomplish more with the resources devoted to it."

I personally liked his ideas and recommend that we look closer at them and invite our elected officials to look closer as well. What we need is not more government health care programs or forcing employers to purchase group insurance (which would just perpetuate and deepen the divide between the consumer and the prices) such as those being proposed by certain presidential contenders.

To read his full report, please click on the link below.

http://www.bepress.com/fhep/11/2/3/

One of the most important political issues besides the economy is health care. The rate of soaring health care costs is alarming to me and to most Americans. It is my belief that competitive forces should push prices lower - not higher. Solutions are being proposed in congress as well as by most of the presidential candidates. It worries me that most of the solutions being proposed involve more government. Not only do I not see the power over health care within the bounds of the constitution, but I also disagree with government involvement and regulation in private industry. Socialism is by definition the control of private property by the community or the government. At our nations founding, we, as Americans, ascribed to the free market system rather than a socialist system. However, when the free market system is perceived to have failed us, we move towards socialism to find a solution.

It is my opinion that we the people are being told that the free market system has failed us in the health care industry. By looking at health care premiums, out of pocket maximums, deductibles, co-pays and the like, I would agree with them. However, it just doesn't seem right to me - there has to be something missing.

What if our current health care system isn't really free market? That is what I proposed to Congressman Rob Bishop and Senator Orrin Hatch. In our current US Anti-trust laws there are two industries exempted: Major League Baseball and Insurance. I believe that the protection afforded to the insurance industry could be a likely cause of our rising health care costs - simply because they are not required to compete in a fair, open market system. This protection keeps them from competing against each other and allows prices to soar - and the consumer can do nothing about it.

My letters received two entirely different responses. I got a personal phone call from my congressman who said he was in favor of creating an environment of more competition but was unaware of the protection the insurance industry enjoyed and promised to look into it. Senator Hatch on the other hand sent me the following:

"Dear Mr. Coman:

Thank you for your letter... I certainly understand your concern regarding this issue. I have heard similar concerns from Utahns regarding these matters. In addition, over the past few years, legislation has been introduced in Congress that would repeal all or part of the insurance industry's anti trust exemption.

In general, I approach antitrust issues with the priority of doing what is best for the consumers... there are (however) many arguments in favor of maintaining the insurance industry's current exemption.

Rest assured that, as the Senate continues to debate this issue, I will work to ensure that we properly balance the needs of the consumers with the needs of various businesses. While I recognize that repealing or even imposing certain limits on the current exemption might have some market benefits, I would be hesitant to support legislation that would unduly harm small insurance companies and agents, especially those in Utah...

Sincerely,

Orrin G. Hatch"

I am inclined to disagree with my Senator. I am worried that this is a short sighted approach - if we don't do the right thing, it will hurt the consumer as well as all of the insurance companies as we move to more socialized medicine due to the failure of the current system to bring us the care needed, for those who need it, at a price they can afford. It is my opinion that the free market hasn't done this to us - it is everything but the free market. Plastic surgery is a great example - it's not covered by insurance but the prices have been falling year after year while care and quality has gone up and up. The free market could get us out - we need to send in our voices and ask the government to repeal the exemption afforded the insurance industry.

Freedom is the answer.