A Couple More Questions for John Torinus

John Torinus wrote his third column on the Healthy Wisconsin plan yesterday, and it raised about as many questions as the rest.

Here's the opening line from the latest: "When I challenged David Riemer, the architect of the pending bill for a Wisconsin single-payer system for health care, that his concept was Swiss cheese, more holes than solutions, he challenged me for my plan."

Feel free to check out the transcript of the debate here. I don't see a single place where Torinus points out "holes" in the Healthy Wisconsin plan that Riemer doesn't immediately address; in fact, the "swiss cheese" line doesn't even appear until the final comments.

And when Torinus pulled out his patented line about public health costs vs. private health costs, Riemer addressed it, and Torinus never broached the topic again during the debate. Although that didn't stop him from using it again in yesterday's column.

In fact, to better answer the public vs. private health costs question, I asked Torinus a couple of weeks ago for the total cost of a family policy at Serigraph, including all cost sharing. Even though I still don't have a response for that question, I have a couple more questions that I just sent to Torinus.

In his column from yesterday, Torinus writes:

Health maintenance organizations, another grand scheme that is a form of what the Riemer plan proposes, has been roundly rejected by patients and doctors alike. Why? Because it limits choice, narrows competition and often defaults to rationing.

In sharp contrast, employees in consumer-empowered plans generally rate their health benefits as excellent. Why? They are in control. They are given health accounts. It's their money to spend or not spend. They make the choices. They collaborate with their doctors on decisions about treatments. Some large system isn't managing them.

Since the Healthy Wisconsin plan is based upon the coordinated system of managed care plans used for the state health plan, does Torinus have any examples of situations where state employees have experienced limited choice or rationing?

Secondly, I'm hoping Torinus can share some evidence for his claim that "employees in consumer-empowered plans generally rate their health benefits as excellent." In fact, multiple studies have shown the consumer satisfaction is significantly lower under HDHPs than traditional comprehensive coverage.

According to a June article in the Wall Street Journal (which I imagine Torinus reads):

[T]hose who are in consumer-directed health plans often report lower satisfaction and confusion about how the plans are supposed to work. The general idea is for patients to conserve money in their savings accounts, which are meant to pay for care until they reach their high insurance deductible. In theory, patients who shop carefully could have money left over, which they can keep and let build into savings for bigger health-care costs down the line.

In a survey published last month by Towers Perrin, an employee-benefits firm, employees enrolled in them said they felt less capable of finding a quality doctor or hospital, though they often were in the same network as colleagues in other plans. Only 29% said they tried to save money in their accounts for future medical expenses.

The WSJ also cited a Kaiser Family Foundation survey that similarly found low satisfaction rates and high confusion for consumers enrolled in HDHPs. According to that survey, when given a choice between a HDHP and comprehensive coverage, only 19 percent of employees opt for the HDHP.

And yet another survey conducted by the Commonwealth Fund and the Employee Benefits Research Institute found that 63 percent of individuals with comprehensive coverage were extremely satisfied or very satisfied with their coverage, while only 42 percent of individuals in consumer-driven health plans felt the same.

As with my last question for Torinus -- which I'm still waiting on -- I'll post an update when I hear back.

UPDATE: See a rundown of Torinus' responses here.