AMERICAN CONSERVATISM IN 2008 AND BEYOND

Parados -- In your opinion, would there be a problem with cross border competition as long as states can still enforce their minimum standards on "imports"? I'm thinking of something analogous to driving: The UK will let you drive on its streets with your US driver's license, but you still have to drive on the left there. Why couldn't the same deal be worked out for health insurance?

With the national spotlight on health care reform and this week's apparent criticism of some screenings by the head of the American Cancer Society, Lunsford said he is considering submitting a bill to allow for insurers to provide coverage with potentially fewer mandates..

Georgia law provides that many health insurance policies cover certain tests and procedures, including mammograms, pap smears, colorectal screening, ovarian cancer screening and prostate cancer screenings.

Lunsford said he is considering introducing legislation that would allow employers to offer workers the option of health policies that don't include all the now-mandated procedures and tests.

He stressed that such legislation would not try to limit cancer screenings or major tests and procedures, but rather those he believes are not necessary to save lives. He said more review would be necessary to determine the choices.

Such a measure would provide for more affordability and flexibility in health insurance plans, Lunsford said. For example, young healthy people may not need all the coverage of an older person, he said.

But some state legislators worry that efforts to change the law will chip away the number of state mandates in policies, as well as tests and procedures covered under state Medicaid.

Rep. Mary Margaret Oliver (D-Decatur) said statements such as those of the American Cancer Society can make protecting state mandates "more difficult in the political world."

The controversy broke out after Dr. Otis Brawley, the chief medical officer of the American Cancer Society was quoted in a New York Times article Wednesday, saying that the benefits of some cancer screenings have been exaggerated. The article also indicated that the cancer society was preparing to alter its message on screenings for breast and prostate cancer, to emphasize the risk of over-treating small cancers and missing cancers that are deadly.

Brawley issued a subsequent statement Wednesday stressing that the American Cancer Society stands by its current screening guidelines.

"While the advantages for screening for some cancers have been overstated, there are advantages, especially in the case of breast, colon and cervical cancers," Brawley said in his statement.

He said that the American Cancer Society stands by its recommendation that women age 40 and over should receive annual mammograms to screen for breast cancer.

But some advocates worry that people at risk will take Brawley's criticism of some screenings as a reason not to get tested.

The criticism comes at a time when health issues -- including unnecessary tests and spiraling costs -- are under a microscope in the national discussion on health care reform.

Lunsford, the Georgia lawmaker, said many doctors order tests just to protect themselves.

"I think many tests are ordered when there are no precursors for it," he said.

Georgia has addressed the issue before. In 2005, legislators passed a law allowing insurers to offer employees and consumers alternative health benefit plans that do not contain all the state mandates.

A State-by-State Breakdown of
Health Insurance Mandates and Their Costs
A health insurance “mandate” is a requirement that an insurance company or health plan cover (or offer coverage for) common
" but sometimes not so common " health care providers, benefits and patient populations. They include:
• Providers such as chiropractors and podiatrists, but also social workers and massage therapists;
• Benefits such as mammograms, well-child care and even drug and alcohol abuse treatment, but also acupuncture
and hair prostheses (wigs); and,
• Populations such as adopted and non-custodial children.
For almost every health care product or service, there is someone who wants insurance to cover it so that those who sell the
products and services get more business and those who use the products and services don’t have to pay out of pocket for them.

The Impact of Mandates. While mandates make health insurance more comprehensive, they also make it more expensive because mandates require insurers to pay for care consumers previously funded out of their own pockets. We estimate that mandated benefits currently increase the cost of basic health coverage from a little less than 20% to perhaps 50%, depending on the number of mandates, the benefit design and the cost of the initial premium. Mandating benefits is like saying to someone
in the market for a new car, if you can’t afford a Cadillac loaded with options, you have to walk. Having that Cadillac would be nice, as would having a health insurance policy that covers everything one might want. But drivers with less money can find many other affordable car options; whereas when the price of health insurance soars, few other options exist.

Why Is the Number of Mandates Growing? Elected representatives find it difficult to oppose any legislation that promises enhanced care to potentially motivated voters. The sponsors of mandates know this fact of political life. As a result, government interference in and control of the health care system is steadily increasing. So too is the cost of health insurance.

By the late 1960s, state legislatures had passed only a handful of mandated benefits; today, the Council for Affordable Health Insurance (CAHI) has identified 2,133 mandated benefits and providers. And more are on their way.

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they also make it more expensive because mandates require insurers to pay for care consumers previously funded out of their own pockets.

We estimate that mandated benefits currently increase the cost of basic health coverage from a little less than 20% to perhaps 50%, depending on the number of mandates, the benefit design and the cost of the initial premium. Mandating benefits is like saying to someone
in the market for a new car, if you can’t afford a Cadillac loaded with options, you have to walk. Having that Cadillac would be nice, as would having a health insurance policy that covers everything one might want. But drivers with less money can find many other affordable car options; whereas when the price of health insurance soars, few other options exist.

Parados -- In your opinion, would there be a problem with cross border competition as long as states can still enforce their minimum standards on "imports"? I'm thinking of something analogous to driving: The UK will let you drive on its streets with your US driver's license, but you still have to drive on the left there. Why couldn't the same deal be worked out for health insurance?

It ends in a world where the law takes our freedom to drive on the left side of the road. Oh wait, we're already in that world -- and there's nothing wrong with it!

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interesting word, I don't see any "debate." Actually I would be delighted to see some "debate."

The only way for it to work Thomas is for the Federal government to set standards that apply to all states. I can't wait to see the political argument about that one.