A NEW CONCEPT FOR CALIFORNIA: HEALTH INSURANCE MANDATES COST MONEY!

A task force established by Gov. Arnold Schwarzenegger to draft a plan for dealing with skyrocketing health costs in California is considering calling for repeal of some treatment mandates on health maintenance organizations. Administration aides said the proposal -- which would require approval by the Legislature -- is one of many under consideration as part of the long-awaited plan the Republican governor says he will unveil in his State of the State speech in January. "Right now, the administration is combing through hundreds of ideas and concepts," said Adam Mendelsohn, the governor's communications director. "No idea is in, no idea is out, and there is no specific plan developed."

Michael Shaw, assistant director for the National Federation of Independent Business, said relaxation of some mandates would lower premium costs for small-business owners and allow them to provide coverage for more employees. "The No. 1 reason that small businesses do not provide health care in many cases is that they simply can't afford it," said Shaw, whose organization has met with members of the governor's task force to urge them to repeal mandates. Employers have complained about the more than 50 mandates since 1999, when Gov. Gray Davis signed health care legislation requiring HMOs to offer a host of treatment and preventive care services. Included are coverage for a variety of mental illnesses, including anorexia and bulimia, cancer screenings and contraception. Employers blame the mandates for contributing to the 55 percent rise in insurance premiums in the last five years alone.

Schwarzenegger has said that reducing the ranks of the more than 6 million uninsured people in California will be one of his top priorities in the coming year. "We feel we shouldn't have 6 million people uninsured," the governor said last week. "We maybe cannot solve the whole problem, but we definitely can cut it in half and do something that really is impressive and shows the rest of the nation that it can be done."

But Beth Capell, a spokeswoman for Health Access, a coalition of more than 200 consumer and community groups that lobby for increased health care coverage for Californians, said she hoped the administration would come up with better proposals. "The idea that eliminating such basic care as Pap smears, mammograms and childhood immunizations saves money has been disproved by study after study," Capell said. "What's the point of having health insurance if it doesn't get you any health care?" Schwarzenegger aides did not specify which mandates would be under consideration for repeal.

Shaw, whose organization represents 35,000 employers in the state, said that because group insurance plans are required to provide more benefits than individual plans, many small business have been priced out of the market. "So we want to create a set of rules for all plans that treat individuals equally but do not cost people the ability to afford health care," he said. Shaw said single men, for example, should not be forced to pay for maternity care "simply because the state determined that it should be part of health coverage."

But state Sen. Sheila Kuehl, who as a member of the Assembly was involved in the crafting of the HMO mandates, said repealing some of the requirements would not improve health care in California. Kuehl, D-Santa Monica, this year wrote a bill that would have insured all Californians and abolished the role of private insurance companies in California, instead setting up a single-payer system in which the state would take over the role of insurers. Schwarzenegger vetoed the measure, Senate Bill 840, saying he opposes "government-run" health care.

"I think (eliminating mandates) is the least desirable way to lower the cost of health care for people in California because it does nothing to address the record profits of the for-profit insurance companies," Kuehl said.

The administration has said the governor's plan will include several measures designed to squeeze cost savings out of the health care system, including reining in overuse of services. A possible model is a program in Illinois that would require doctors to file prescriptions electronically rather than filling them out by hand.

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Pennypinching Australian State government tries to cut back on medical training

And Leftists say that private business is characterized by short-term thinking!

A group of the state's most senior emergency doctors has resigned en masse from a high-level government committee, signalling worsening relations between the Iemma Government and its frontline physicians. The doctors say the Government is forcing them to halve the time they spend teaching registrars, which would result in hospitals losing their accreditation to train doctors in emergency medicine. The end result, they warned, was an exodus of young doctors from the NSW health system and dangerously understaffed emergency departments.

In an open letter to the Premier, Morris Iemma, the doctors say NSW Health's plans would result in an unsafe level of care for patients and, as emergency medicine was a compulsory rotation, it would prevent interns from becoming registered. They note that even at current staffing levels not one NSW public hospital met the minimum specialist staffing requirements endorsed by state and territory health ministers.

The dispute began, the doctors say, when they learnt that NSW Health was reneging on a pay deal struck in April that gave a 25 per cent allowance for city-based emergency specialists filling shifts in rural and regional hospitals. The department said it would pay the allowance only if the doctors reduced their clinical support duties such as registrar training, further education and taking part in quality improvement programs. Any reduction in these duties would breach guidelines set by the Australasian College of Emergency Medicine - 75 per cent clinical work and 25 per cent clinical support work - the doctors say.

The executive director of the Australian Salaried Medical Officers Federation, Sim Mead, said NSW Health was pushing for clinical support work to be limited to 10 per cent of doctors' time. "If they move to 10 per cent, the accreditation for all emergency departments for registrar training in NSW will be withdrawn and the registrar workforce would be completely destroyed. "Why would a registrar want to work in a hospital without a training program, if their aim was to become a qualified specialist?"

After months of talks, the specialists have resigned from the Government's emergency advisory committee, the Emergency Care Taskforce. Rod Bishop is a senior emergency physician and was, until he resigned, co-chair of the taskforce. Dedicated to the specialty for 17 years, he is deeply frustrated and disappointed at the attitude of NSW Health. "There is a terrible workforce issue - no emergency department in the state meets the minimum staff specialist requirements . nor do we have the supply of registrars . to meet predicted future needs." If NSW Health did not offer emergency specialists a reasonable employment package, doctors would leave and the losers would be the patients, he said.

A letter to the director-general of NSW Health, Robyn Kruk, sent 18 days ago, has gone unanswered, and the NSW Industrial Relations Commission is trying to resolve the matter through conciliation. The chairman of the NSW Faculty of the Australasian College of Emergency Medicine, Tony Joseph, also a senior emergency specialist in one of the state's largest public hospitals, said NSW Health did not appear to care that hospitals would lose their training accreditation if its plan was implemented. It preferred to rely on locums paid up to $200 an hour to staff emergency departments, rather than increasing its workforce of emergency specialists, who were paid half that amount. A spokeswoman for NSW Health said the department would conduct a work study and liaise with the college and the union on the matter.

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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?

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