Hospital balance sheets hit historic lows last year, but a financial analysis shows a rebound. Hospitals have recovered substantially in the first quarter, reflecting modest improvements and stabilization in the financial markets, according to the Thomson Reuters' study examining 522 hospitals' financial data from second quarter 2005 through the first quarter of this year.
A collection of little-known insurance cooperatives around the country is winning attention as being key to a possible health reform compromise in Washington. But while some of their practices have cut costs and serve as models for change, questions remain about their ability to transform American healthcare. Specialists said that their patient-controlled structure and nonprofit status are not what will ultimately prove most useful, but instead it is the way they pay doctors and care for patients that holds the most potential for savings.
Democratic Sen. Kent Conrad defended his proposal for government-chartered insurance cooperatives, estimating they would start with 12 million members and be the third-largest player in the U.S. health-insurance market. Critics say the co-ops are unlikely to present real competition, while some observers say starting an insurer of the size Sen. Conrad envisions would present enormous practical difficulties.
For the most part, doctor fees are a mystery: If people see a doctor who is part of their insurance network, they are responsible only for deductibles and co-payments, and the price the health insurer pays is often a secret. But healthcare legislation under discussion does not directly address the out-of-network fee issue. And that is intentional, says Mark McClellan, MD, of the Brookings Institution. McClellan, a former head of Medicare, told the New York Times the goal of the House and Senate bills is to encourage people to stay in their networks. He added that the result should be networks that provide better care "so that people don’t have so much need to go outside of them."
Several leading Democrats objected to signals from senior Obama administration officials that they would abandon the idea of a government-run insurance plan if it lacked the backing to pass Congress. President Obama had pushed a nonprofit, government-sponsored insurance plan as an alternative to existing insurance companies. Over the weekend, he minimized the importance of a public option, saying at an event in Colorado that it was "just one sliver" of his overall effort to reduce healthcare costs and expand coverage. One Democrat predicted that without the provision, the bill could lose as many as 100 votes in the chamber.
As prospects fade for a public option as part of healthcare reform, key senators are considering member-owned, nonprofit health cooperatives to create competition for private insurers. Cooperatives, however, would face potentially greater difficulty getting off the ground and obtaining discounted rates from doctors and hospitals, some observers say.