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'No more banging heads,' says Blue Cross boss

"People in America think you should get everything for free, and nobody should be in control," complains PA's insurance commissioner

Newly-retired Cigna boss  Edward Hanway, Independence Blue Cross executive Daniel J. Hilferty, and Pennsylvania state insurance commissioner Joel Ario, who's been spending time in Washington talking to federal officials about the modest insurance office they would set up under the bank reform law, cleared the air a bit about the new federal health insurance reform, in Philadelphia, on Tuesday, at a forum sponsored by law firm Stradley Ronon and accounting-advisory firm LECG Smart. Highlights:

Ario: Why health insurance has to be mandatory: "Or else sick people will come into the market, and healthy people will leave... (But) you'll need subsidies on people who make up to (four times as much as) the poverty line."

The end of pay-per-visit: "You have to end fee-for-service medicine. If you pay for volume, you'll get volume. You need wellness incentives.  Paying premiums, you're punished for inherited diseases, and you're not rewarded for quitting smoking."

What America lacks: "We have to make these cost controls work. Look at every other industrialized country, you find effective cost control. People in America think you should get everything for free, and nobody should be in control... You become like Greece."

Hilferty: Insurers as villains: "We were the demons in this discussion... The days are over, of banging heads. That ended the day the bill passed...We all have to come together to improve acess and quality."

Government hypocrisy: "We're all familiar with the (new federal) mandate that allows coverage of dependent children til they're 26... Cigna agreed to do it, Aetna agreed, the Blues agreed," even though "there's a cost to the employer. There's pushback we're getting from the (corporate and union) groups we insure... And then the federal government says 'We're not gonna do it'" for federal employees.

Paying to stay well: "Our customers can no longer take these double-digit increases that we're throwing at them. Do we put a pay-for-performance program in place that drives down costs? That's where our focus needs to be."

Hanway: What Obama care lacks: "The objectives of the law are access, cost and quality. I would disagree that it's dealt with cost. The elements that deal with cost are trivial, at best."

Know your prices: "How many of you have had to get a CAT scan or some kind of radiation recently? How many of you even know the cost of the options? Within five miles of where you live there are probably 10 places (where) the variance of costs are 400 to 500 percent. (By contrast) you are knowledgable about the (price of) the car you'll buy... The only way we'll truly reduce the cost of health care is to engage all of us in the cost of healthcare."

Medicare market forces: "50 percent of the cost of healthcare is controlled by the federal government. Our industry can only do so much. (Costs) have to be addressed by Medicare and Medicaid.... I am not in favor of command and control. I am in favor of having the market do as much as possible."

More customers, less profit: "The influx of 30 to 50 million individuals" covered under the Obama law "obviously creates significant demand." Big companies like Cigna didn't used to offer individual plans. They do now -- at high prices. Hanway predicts prices will flatten, and profits go down, as more insurers add new plan choices.