Cold grip of logic: Single payor health care

[RandomGuy]

the following is thanks to my buddy Dave who works in the Health Care Industry, I will elaborate on each of the points for the uninitiated shortly)

If you want to argue against the logic of a single payor health care system, you have to find some flaw in these points. Have fun with that.--RG

Does anyone disagree with any of the following premises?

1: Risk diffusion

The purpose of insurance is to apportion risk.

Insurance spreads the risk across individuals and for individuals across time.

There is an acknowledgment here that total lifetime health care costs will vary for individuals, and cannot be known until death. At the very least, insurance can be viewed in these cases as a budgeting plan.

2: Rationing

There will be rationing of health care, regardless of the system in place.

3: Guaranteed care

Guaranteed tertiary care is a pre-requisite to any viable emergency response system.

4: Cost shifting

Guaranteeing tertiary care will result in the shifting of uncompensated costs.

5: Timely access

Primary and preventive care reduce extended and emergency care needs.

6: Cost differentials

Extended and emergency care costs more than primary and preventative care.

7: Administrative overhead

Greater range of coverage options increases administrative cost while shifting medical decision making from the physician to the fee provider.

8: Adverse risk selection

Insurance providers have financial incentives to identify and remove adverse risks from their pool of insured.

9: Epidemiological data

Treatment response data is very valuable.

10: Market economies

A distinguishment can be made between nationalizing health care and nationalizing insurance.



Why would it matter if >$7000 per person year is being bled off by taxes or health care costs, if health outcomes are the same?


If you accept the premise that the purpose of insurance is to spread risk, does it seem reasonable to assert that after choosing to share risk through insurance, the best case outcomes are:

A. Buying in and experiencing no other loss. (in effect, having "wasted" your money")
B. Buying in, experiencing otherwise massive loss and being fully compensated.

[RandomGuy]

The risks generally covered by social insurance usually do not lend themselves to market-based approaches. The most important departure from compe ive market assumptions is that coverage for these risks may be perceived as a public good (i.e. benefits to society are external to the individual). For example, the provision of health care benefits may lower the overall incidence of disease in a country through preventative care. It may also increase the productivity of workers directly though better health and indirectly by reducing the need for family members to forgo participation in the work force.

Because the total benefits to society can exceed those insuring exclusively to the individual, economic theory suggests that individuals making up society will consume too little insurance (in society’s view) if they face the true cost of that insurance. Subsidizing the costs of these risks effectively lowers its price encouraging more consumption.

--Life and Health Insurance, 13th Edition, Black and Skipper

Translation:

If you subsidize health insurance for everybody, economy theory suggests that the economy gains overall, i.e. it is synergistic.

[RandomGuy]

Health care spending is roughly 25% on administrative costs.

What drives those administrative costs?

The huge number of insurance companies each with their own standards and plans as to what they will pay or not pay for.

I used my health insurance to see the doctor the other day (minor injury) and had to sign a statement saying that because there are so many plans/standards/companies, it was MY responsibility to know what my plan pays for and what it doesn't.

Ask any doctor about the administrative costs involved in billing and so forth.

People blather on about tort reform and spend a lot of energy on this, but then forget all the other components of health care overhead...

[boutons_]

"If you subsidize health insurance for everybody"

Universal coverage and universal (mandated, payroll) contributions.

Where's the subsidy?

[RandomGuy]

sounds like arguments for the free market

doctors/nonprofs will provide primary healthcare for free or at a reduced price because they're, um, compassionate human beings

of course, nationalized healthcare would probably be more efficient than our abortion of a system now. (since docs in both cases have the same incentives to overbill for everything and charge for unnecessary procedures to rip the govt off)

(oh, and rich people will Always get better healthcare than poor people. because they're rich.)

and where does one draw the line on what is a necessary procedure and what isn't?

Very good questions all.

I think we can find things we can agree on first.

1) There will be abuse in any system.

Is there ANYBODY who will disagree with this statement?

[RandomGuy]

"If you subsidize health insurance for everybody"

Universal coverage and universal (mandated, payroll) contributions.

Where's the subsidy?

Even with mandated coverage, you still must decide what that coverage will pay for.

The Japanese have an interesting bit on this:

Everything.

The Japanese health care system is pretty much the model I would use with some modification.

In Japan, the cost to a family for health insurance that literally pays for everything, no-copays, no "we won't cover this procedure", no "you have to have a referral to see that specialist":

$280.

Yes, health insurance for a family costs a TOTAL of less than $300. This cost is often completely picked up by employers.

Everybody in Japan is covered, either through what they pay, or through community based small non-profit insurers.

The kicker: The government sets the prices for procedures, often the rates for reimbursement is not enough for the community hospitals (some "hospitals" have fewer than 20 beds total) and doctors to be able to stay afloat.

That is where you get some system inefficiencies in terms of allocating costs.

For all of this, though the Japanese have some outstanding health care results compared to the US. Even controlling for a lot of other factors, they still spend far less and get far more than we do.

I will post below the recent NPR story on this.

[RandomGuy]

Link to written source article, but if you follow the link, there is a link on the page that lets you listen to the original piece through streaming audio.

Japanese Pay Less for More Health Care

Japan produces cars, color TVs and computers, but it also produces the world's healthiest people. It has the longest healthy life expectancy on Earth and spends half as much on health care as the United States.

That long life expectancy is partly due to diet and lifestyle, but the country's universal health care system plays a key role, too.

Everyone in Japan is required to get a health insurance policy, either at work or through a community-based insurer. The government picks up the tab for those who are too poor.

It's a model of social insurance that is used in many wealthy countries. But it's definitely not "socialized medicine." Eighty percent of Japan's hospitals are privately owned — more than in the United States — and almost every doctor's office is a private business.

Health Care for Anyone at Anytime

Dr. Kono Hitoshi is a typical doctor. He runs a private, 19-bed hospital in the Tokyo neighborhood of Soshigaya.

"The best thing about the Japanese medical system is that all citizens are covered," Kono says. "Anyone, anywhere, anytime — and it's cheap."

Patients don't have to make appointments at his hospital, either.

The Japanese go to the doctor about three times as often as Americans. Because there are no gatekeepers, they can see any specialist they want.

Keeping Costs Low

Japanese patients also stay in the hospital much longer than Americans, on average. They love technology such as magnetic resonance imaging; they have nearly twice as many scans per capita as Americans do. A neck scan can cost $1,200 in the United States.

Professor Ikegami Naoki, Japan's top health economist, explains how Japan keeps MRIs affordable.

"Well, in 2002, the government says that the MRIs, we are paying too much. So in order to be within the total budget, we will cut them by 35 percent," Ikegami says.

This is how Japan keeps cost so low. The Japanese Health Ministry tightly controls the price of health care down to the smallest detail. Every two years, the health care industry and the health ministry negotiate a fixed price for every procedure and every drug.

That helps keep premiums to around $280 a month for the average Japanese family, a lot less than Americans pay. And Japan's employers pick up at least half of that. If you lose your job, you keep your health insurance.

An Accommodating Insurance System

Japanese insurers are a lot more accommodating than their American counterparts. For one thing, they can't deny a claim. And they have to cover everybody.

Even an applicant with heart disease can't be turned down, says Ikegami, the professor. "That is forbidden."

Nor do health care plans covering basic health care for workers and their families make a profit.

"Anything left over is carried over to the next year," Ikegami says. If the carryover was big, "then the premium rate would go down."

Perhaps Too Cheap?

So here's a country with the longest life expectancy, excellent health results, no waiting lists and rock-bottom costs. Is anyone complaining?

Well, the doctors are. Kono says he's getting paid peanuts for all his hard work.

If somebody comes in with a cut less than 6 square inches, Kono gets 450 yen, or about $4.30, to sew it up.

"It's extremely cheap," he says.

Kono is forced to look for other ways to make a yen. He has four vending machines in the waiting room. In a part of Tokyo with free street parking, he charges $4 an hour to park at his clinic.

The upside is that virtually no one in Japan goes broke because of medical expenses.

Personal bankruptcy due to medical expenses is unheard of in Japan, says Professor Saito Hidero, president of the Nagoya Central Hospital.

Hospitals Hit Hard

But while the patients may be healthy, the hospitals are in even worse financial shape than the doctors.

"I think our system is pretty good, pretty good, but no system is perfect," he says. "But 50 percent of hospitals are in financial deficit now."

So here's the weakness: While the United States probably spends too much on health care, Japan may be spending too little. In a country with $10-a-night hospital stays, prices just aren't high enough to balance the books.

Hospital prices too low? That's a problem a lot of countries would like.
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I doubt such a balanced, complete look would ever be given to this on Fox "News" or, for that matter, PrisonPlanet.com. This is why I consider people who get the majority of their information at such places to be horribly ill-informed.

[101A]

Anybody watch Front Line last night?

They studied healthcare solutions from other wealthy democracies:

England (single payor - govt. owned hospitals in "compe ion" with each other)

Japan (Mandatory Insurance Coverage - subsidies for low income to get it; Extreme price controls, no profit for insurance companies)

Germany (Mandatory Insurance - Subsidies - Moderate Price Controls, profit for insurers ONLY for suplemental coverages)

Switzerland (They started bleeding together in my mind; but similar to Germany)

Taiwan (VERY technologically integrated; they built the system from the ground up in 1995; works very smooth - they admitted almost impossible to implement in an existing system) Interesting thing about their system? If you use it too much, you get "a visit" from a government representative to discuss that.


Now, what I garnered from this is that countries that have adopted a universal coverage policy relatively recently (Switzerland, Taiwan), have done their homework, studied other countries, and rejected single payor. They have chosen a system that controls cost by eliminating, or limiting the profit from insurers, and setting prices on Doctors, Hospitals and Drug Companies (German Doctors have been protesting in the streets).

What I suspect is that one of the reason THEIR systems work, is because, ultimately, the richest, most vibrant economy in the world is subsidizing them. Big Pharma, equipment manufacturers, etc. are cost shifting. When Japan sets a price of $10 for a month supply of some drug; and the manufacturers goal or need is higher than that; they manufacturer gives to several Congressmen's campaigns, and raises the price in this country - runs some adds, sells a ton of the stuff. It kind of pisses me off, frankly. If we were to implement price controls, the effect would ROCK all of these "successful" health plans around the world, IMO.

Trying to limit Doctor's salaries to the extent they are limited in those other countries, which is an ABSOLUTE necessity, will be VERY difficult. Over time it could also tend to NOT attract the best and brightest into the field, as it does now. (On the flip side, there might be more "science" types who would pursue research instead of medicine because the wage gap wouldn't be so incredible) We'll probably end up with more lawyers.

[101A]

Deleted because I read the entire post, and mine was redundant.

[101A]

BTW.

The company I own processes medical claims for medium to large businesses. They pay the claims themselves; don't buy coverage from traditional insurers.

Any of these other Universal Coverage systems would be GREAT for me. The biggest obstacle I have is competing with the insurers on the cost they pay for services. Because of their size, they can demand steeper discounts from providers. I make up the differenc by being more efficient, and offering superior customization and control. If the govt. MANDATED that we all paid the same? Be great for me.

What I think would help; short of price controls, would be for the hospitals to be made to PUBLISH their price for whatever they do - and charge the same for everybody. Then people could make decisions on where they get the most bang for their buck. As it is, you choose hospitals in this "market" system; without ever knowing the charges for a couple of months after you're released!

No "market" model I ever saw worked like that.

BTW; I agree that Health Coverage should be universal. I absolutely DO NOT agree with a single payor system.

[RandomGuy]

Holy crap!!

An informed, halfway respectful conversation has broken out in the politics forum.

Surely one sign that the apocolypse is upon us.

Actually, I have had a fair amount of time to spend on this with an odd alignment of cir stances in the last couple of days, but today I have to get back to my normal work schedule, so my time must be limited here.

I will try to give this some attention on my lunch break, but must get to work now.

[RandomGuy]

BTW.

The company I own processes medical claims for medium to large businesses. They pay the claims themselves; don't buy coverage from traditional insurers.

Also known as a licensed Third Party Administrator. RG knows a *bit* about such things.

Some of the codes sections governing TPAs changed a bit during the last legislative session. You might want to get someone to go through it just to make sure that nothing important changed that might affect you.

Give your legal beagle the following link and let them read up a bit:

http://tlo2.tlc.state.tx.us/statutes...tm#4151.101.00

Here is the quick hotlink

(just hit the quoted reply button to get the entire URL, or PM me and I can send it to you)

[101A]

Also known as a licensed Third Party Administrator. RG knows a *bit* about such things.

Some of the codes sections governing TPAs changed a bit during the last legislative session. You might want to get someone to go through it just to make sure that nothing important changed that might affect you.

Give your legal beagle the following link and let them read up a bit:

http://tlo2.tlc.state.tx.us/statutes...tm#4151.101.00

Here is the quick hotlink

(just hit the quoted reply button to get the entire URL, or PM me and I can send it to you)

Thanks; most of that has to do with Worker's Comp TPA's - we exclusively administer group medical plans; which are, by ERISA, exempt from State regs.

[RandomGuy]

Thanks; most of that has to do with Worker's Comp TPA's - we exclusively administer group medical plans; which are, by ERISA, exempt from State regs.

Oh, so you don't handle the money, you just process claims. This is a much more limited function than most TPAs then. RG looked up some stuff on it.

By the by, here is an excellent website for ERISA:

http://healthplanlaw.com/?page_id=2

Heh, I learned something new on my coffee break. Learning new things is my favorite use for any 15 minute period, tied only with playing with my kids.

Back to work.

[101A]

Oh, so you don't handle the money, you just process claims. This is a much more limited function than most TPAs then. RG looked up some stuff on it.

By the by, here is an excellent website for ERISA:

http://healthplanlaw.com/?page_id=2

Heh, I learned something new on my coffee break. Learning new things is my favorite use for any 15 minute period, tied only with playing with my kids.

Back to work.

Yes, we handle the money. The money flows through us for Medical Plans; which are handled differently than Worker's Compensation plans.

WC is regulated by the State of Texas; Self-Insured Medical plans, however, are regulated by the Federal Government; specifically the DOL.

The link you originally provided was new regs passed by Texas; although our company is licensed, it is not subject to (most) of those relating to the insurance plans themselves. We compete directly with the Big Insurance Companies; Blue Cross/Humana/Aetna/United HC, etc...

[RandomGuy]

Yes, we handle the money. The money flows through us for Medical Plans; which are handled differently than Worker's Compensation plans.

WC is regulated by the State of Texas; Self-Insured Medical plans, however, are regulated by the Federal Government; specifically the DOL.

The link you originally provided was new regs passed by Texas; although our company is licensed, it is not subject to (most) of those relating to the insurance plans themselves. We compete directly with the Big Insurance Companies; Blue Cross/Humana/Aetna/United HC, etc...

The regs I gave were indeed for the Texas Department of Insurance specifically, and did mention Workers Comp codes as well. The Division of Worker's Comp was recently merged with TDI and the Comissioner still seems to be hammering out how that works.

Self-Insured Medical plans and TPAs are still subject to some limited state regulation by insurance departments, even so.

Based on my reading, I would tend to think you do need to be licensed by TDI as a TPA, as most standing legal decisions/interpretations/laws about insurance regulations tend to have the Feds deferring to the states for insurance regulation. Although if you know the specific ERISA bit that exempts you from licensing, I would find it interesting reading, but then I am a nerd that way.

Exactly where the boundary between Federal regs and State regs regarding TPAs, seems to be somewhat murky, although one can read a lot about it in the Healhplanlaw.com website.

I don't envy you in the job of navigating your company through the patchwork of laws. No wonder you dislike government interference so much...

[101A]

The regs I gave were indeed for the Texas Department of Insurance specifically, and did mention Workers Comp codes as well. The Division of Worker's Comp was recently merged with TDI and the Comissioner still seems to be hammering out how that works.

Self-Insured Medical plans and TPAs are still subject to some limited state regulation by insurance departments, even so.

Based on my reading, I would tend to think you do need to be licensed by TDI as a TPA, as most standing legal decisions/interpretations/laws about insurance regulations tend to have the Feds deferring to the states for insurance regulation. Although if you know the specific ERISA bit that exempts you from licensing, I would find it interesting reading, but then I am a nerd that way.

Exactly where the boundary between Federal regs and State regs regarding TPAs, seems to be somewhat murky, although one can read a lot about it in the Healhplanlaw.com website.

I don't envy you in the job of navigating your company through the patchwork of laws. No wonder you dislike government interference so much...

I think I said we ARE in fact licensed - there are some things we do beyond administering medical plans, as a fiduciary that require thta license. The question as to whether we need to be licensed to administer is ERISA plans is academic.

As far as winding our way through it all; professional organizations help in such regards (people who have done it already), and of course competent help, an ERISA attorney, etc...it's actually not so much more than any employer has to deal with. Whenever you have employees, big brother COULD be watching.

[RandomGuy]

I think I said we ARE in fact licensed - there are some things we do beyond administering medical plans, as a fiduciary that require thta license. The question as to whether we need to be licensed to administer is ERISA plans is academic.

As far as winding our way through it all; professional organizations help in such regards (people who have done it already), and of course competent help, an ERISA attorney, etc...it's actually not so much more than any employer has to deal with. Whenever you have employees, big brother COULD be watching.

(nods)
"competant help"

Often, one of the biggest challenges of leadership is finding just that, IMHO.

They say as civilizations develop they benefit from increasing degrees of specialization, and when you said (ok, typed), "ERISA attorney" I couldn't help but think about that in terms of a specialization. An attorney who specializes in that kind of niche would never be out of a job as long as the program is out there.

Something like an accountant who happens to know a lot about insurance companies... I gave you and your CFO a bit of grief, but I do have respect for anybody who can run a company, and yes, I do know the value of practical experience.

Ok, lunch is over. I wasted it all on idle chit chat, and none on policy debate. Ah well. Always good to get to know other people as humans though, and time well spent.

Back to work.

[boutons_]

"Trying to limit Doctor's salaries"

Overheads for a small office of a doctor or two can run to $250K, which is the kind of headache driving doctors into bigger and bigger groupings.

What if that overhead could be reduced so a self-employed doctor would accept revenues of $200K less?

A lot of doctors are fed up being self-employed so they are becoming employees.

A lot of the overheads now are pushing paper, 3rd party parasites, etc. As in the MIC, the HIC has plenty of crooks, frauds, parasites that we all pay for.

[101A]

"Trying to limit Doctor's salaries"

Overheads for a small office of a doctor or two can run to $250K, which is the kind of headache driving doctors into bigger and bigger groupings.

What if that overhead could be reduced so a self-employed doctor would accept revenues of $200K less?

A lot of doctors are fed up being self-employed so they are becoming employees.

A lot of the overheads now are pushing paper, 3rd party parasites, etc. As in the MIC, the HIC has plenty of crooks, frauds, parasites that we all pay for.

Yes, it does; but it also has people trying to do a good job - with good ideas who get lumped in with the leaches - you can't imagine the number of auditors on BOTH sides of the equation (provider and payor) who spend all day every day going over records in hospitals, or through those at the payor, trying to find dollars lost/overpaid/underpaid, etc....

Add to that the $$$$$ spent on negotiators, again on both sides, JUST trying to come up with contractual prices for all of the procedures - then you have people ON BOTH SIDES, trying to figure out, after those contracts are signed how to squeeze the MOST money for their side out of the system.

In other words, VAST sums of money are consumed JUST ESTABLISHING prices, and keeping the other side "honest".

Simplifying, and shining a light on it (think "truth in lending" that was done with lenders/banks in the early 90's) would eliminate much of this, and bring some level of consumerism (which is just impossible right now) into the system. It would also promote compe ion among providers (hospitals) based on price/quality as opposed to simply perceived quality right now. (The best hospital in San Antonio, btw, is University at the Health Science Center) - if you can't get into Wilford Hall.

Right now, what control there is on Insurance premiums are there because of compe ion. If a carrier tries to raise rates too much, it is very easy for another one to come in and collect those premium dollars - at least with group plans, which cover the vast majority of the people with insurance. This keeps the carriers in check.

If the hospitals were made to "publish" their rates; and then compelled to charge the same rate for the same procedure for every patient - it would eliminate the carrier/provider annual negotion (think teams of lawyers and accountants on each side). The carrier could then offer the employer choices - and be able to demonstrate WHY one hospital is covered at a higher % than another (steerage). As patients were steered here for heart bypass surgeries, or there for kidney transplants, the OTHER hospitals would feel it in there pocketbooks, be able to see what the other hosipital is charging, and, well, you get the picture. I think the Japanese model of price controls will be met with, ultimately, shortages in Doctor's services. I might be wrong, and Docs might be more altruistic than I imagine.

This, obviously, doesn't address the problem of the uninsured; but that is a separate issue, really. I think the only real solution to that is direct government subsidy for premiums.

BTW, I readily admit, based on what I do, that I probably have a bias to this whole situation from the payor side; but I try to be as open-minded as possible. Also, I have no great love for insurance carriers - they are my compe ion.

[spurster]

How did this civilized discussion sneak into this forum?

I would edit "Primary and preventive care reduce extended and emergency care needs." by replacing "reduce" with "can reduce". Judging by the news and multi-fullpage ads on competing cholesterol reducing drugs recently, I suspect there's a lot of preventive care that is not doing much good at a substantial cost. Also, I have read that many doctors overuse their high-priced imaging machines for marginally preventive care because they need to pay for them.

I agree that prices should be public. Even more, I think patients should get comprehensible estimates before treatment, not multiple unreadable claims from multiple en ies afterwards. Even more, I think we should have publicly available comments and reviews on physicians, hospitals, insurance, etc.

If only we had "truth in lending", we would not be in as much of a financial crunch now.

[101A]

How did this civilized discussion sneak into this forum?

I would edit "Primary and preventive care reduce extended and emergency care needs." by replacing "reduce" with "can reduce". Judging by the news and multi-fullpage ads on competing cholesterol reducing drugs recently, I suspect there's a lot of preventive care that is not doing much good at a substantial cost. Also, I have read that many doctors overuse their high-priced imaging machines for marginally preventive care because they need to pay for them.

I agree that prices should be public. Even more, I think patients should get comprehensible estimates before treatment, not multiple unreadable claims from multiple en ies afterwards. Even more, I think we should have publicly available comments and reviews on physicians, hospitals, insurance, etc.

If only we had "truth in lending", we would not be in as much of a financial crunch now.

Took about a decade for the banks to come up with enough gimics/loopholes to make the law obsolete.

You're right about the docs and their toys - cholesterol drugs absolutely.

What about no advertising of Rx drugs?

[RandomGuy]

NEW YORK - Employer health care costs are poised to rise almost 10 percent in 2008 — more than double the annual inflation rate — and nearly that much again in 2009, according to an industry report released Tuesday.

ADVERTISEMENT

The study by PriceWaterhouseCoopers predicts that medical costs will increase 9.9 percent in 2008 and an additional 9.6 percent in 2009.

"Health care providers, insurers and employers will have to monitor medical costs carefully if we are to avoid a resurgence of the double-digit annual increases seen in the past," said Dr. David Chin, leader of the Health Research Ins ute at PriceWaterhouseCoopers.

The report identified two factors driving the increase:

_A hospital building boom, as hospitals replace facilities and add private rooms and centers for outpatient treatment.

_An increase in the expenses those with insurance are paying for those without. Cost-shifting from the uninsured, Medicare and Medicaid will account for nearly one in every five dollars spent by private insurers in 2009, according to the study, as the federal government underfunds public insurance programs and the number of people with private insurance continues to decrease.

One of the things employers are doing in response is increasing wellness, prevention and disease management programs, which they say not only keeps employees healthy but also raises productivity.

PriceWaterhouseCoopers surveyed more than 500 employers and health plans, with total coverage of more than 11 million people, for the report.

[101A]

NEW YORK - Employer health care costs are poised to rise almost 10 percent in 2008 — more than double the annual inflation rate — and nearly that much again in 2009, according to an industry report released Tuesday.

ADVERTISEMENT

The study by PriceWaterhouseCoopers predicts that medical costs will increase 9.9 percent in 2008 and an additional 9.6 percent in 2009.

"Health care providers, insurers and employers will have to monitor medical costs carefully if we are to avoid a resurgence of the double-digit annual increases seen in the past," said Dr. David Chin, leader of the Health Research Ins ute at PriceWaterhouseCoopers.

The report identified two factors driving the increase:

_A hospital building boom, as hospitals replace facilities and add private rooms and centers for outpatient treatment.

_An increase in the expenses those with insurance are paying for those without. Cost-shifting from the uninsured, Medicare and Medicaid will account for nearly one in every five dollars spent by private insurers in 2009, according to the study, as the federal government underfunds public insurance programs and the number of people with private insurance continues to decrease.

One of the things employers are doing in response is increasing wellness, prevention and disease management programs, which they say not only keeps employees healthy but also raises productivity.
PriceWaterhouseCoopers surveyed more than 500 employers and health plans, with total coverage of more than 11 million people, for the report.

That can actually help matters; but compliance can not be voluntary. Well care SOUNDS good; but evidence is it doesn't actually reduce costs, or make people healthier.

[RandomGuy]

[disease management programs] can actually help matters; but compliance can not be voluntary. Well care SOUNDS good; but evidence is it doesn't actually reduce costs, or make people healthier.

Then I imagine well-care will be abandoned.

I have little doubt that our national at ude towards diet and exercise will start changing once the true costs of being fat are really forced on us in a visable way.

Heh, your fat is my cost and vice versa.