Thursday, August 31, 2006
Many physicians have cited payment and patient-care problems experienced when the managed care program started in metro Atlanta and central Georgia in June, and they fear they will surface as the program expands this week. Several doctors said many families still have not received their ID cards for the new program, confusing patients.
In an attempt to shore up a money losing operation, the state opted to allow tighter managed care for their Medicaid program. Based on what has occurred so far it does not appear to be working.
On Wednesday, the state said the total number of people joining HMOs statewide could be one-fourth fewer than expected, in part because the state began checking citizenship and income of beneficiaries on Jan. 1. The total number of people joining HMOs statewide will be 847,000, not 1.2 million as was originally projected, officials said
Note the operative phrase here . . .” began checking citizenship and income of beneficiaries”
Does this mean there were almost 400,000 people receiving free health care that were not eligible?
Kind of put’s a dent in the argument that the private health care system is wasteful. Having 400,000 more people than are truly QUALIFIED is almost a 50% overcharge.
Keep in mind this is TAXPAYER money, not the government.
The government doesn’t have any money.
MCG Health, an Augusta hospital system and leading Medicaid provider, told state officials Tuesday that it would not accept nonemergency Medicaid patients because it had not reached a contract with two HMOs serving that area. Staff members have started canceling patient appointments scheduled for Friday
Fewer Medicaid recipients AND fewer providers willing to see them.
I see a train wreck waiting to happen.
The HMO transition follows years of a traditional system of care in which Medicaid patients were allowed to go to whichever doctor would serve them. But after years of double-digit percentage increases in Medicaid costs, Perdue's administration opted to switch to HMOs, which have a reputation for tighter financial controls.
“Double-digit percentage increases”.
Even Medicaid, with it’s tight fisted tactics could not make a dent in controlling medical care inflation.
Since the start-up, though, physicians have complained that the state's three HMOs have delayed paying them millions of dollars for medical care. This month, a group of Georgia physicians filed suit against the private companies running the Medicaid HMOs, claiming these firms owe millions in outstanding claims to medical providers. The suit alleges the plaintiffs have had to lay off employees and cut back on providing services to low-income residents.
Some patients have also had trouble getting their regular medications and have experienced delays in receiving needed care, medical providers say.
When providers are scheduled to be reimbursed for care at a lower rate, and they are not paid at all, this is a disaster waiting to happen.
The state is counting on a projected $80 million in first-year savings from the initiative. In addition, experts say some doctors and other providers may end up dropping out of Medicaid because of problems, making access to care more difficult for poor patients, possibly pushing them into already overcrowded hospital emergency rooms for routine care.
Wonder how much of that $80M is due to kicking folks off the Medicaid role that never belonged there?
Dr. Adrienne Butler, a Waycross pediatrician, said she retired earlier this month. The upcoming Medicaid transition was "the last straw" for her.
Butler, 59, said she was already losing income, with Medicaid patients being about 80 percent of her practice. "There are families who don't know what [HMO] they're in," Butler said. "The frustration is really high."
This may not be another Tenncare but it could be a close second.
Wednesday, August 30, 2006
The British Fertility Society is recommending women with a body mass index of 36 and over should not be allowed access to fertility treatment.
Underweight women and those classed just as obese (BMI over 29) should be forced to address their weight before starting treatment, the society said.
Tuesday, August 29, 2006
The woman, who later called the doctor "a very unusual man," got her license renewed after appealing to the Norwegian Public Roads Administration and seeing another doctor, the newspaper Oppland Arbeiderblad reported.
The second doctor put her through a more conventional check-up of eyesight, blood pressure and some routine questions.
"First he asked me who the prime minister of Denmark was," the woman told Oppland Arbeiderblad about the first doctor. "Then I said that I wasn't interested in politics and I didn't know, so he asked me if I knew who the prime minister of Sweden was, and I gave him the same answer."
The woman said she worries that most of the people who hear her story find it funny because she has heard similar complaints about the doctor.
Come to think of it, I have no idea who the PM of Denmark is either . . . or Sweden.
But is there a downside?
It would be bad enough if national health care merely offered patients low-quality treatment. Even worse, Ridenour finds, it kills them.
• Breast cancer is fatal to 25 percent of its American victims. In Great Britain and New Zealand, both socialized-medicine havens, breast cancer kills 46 percent of women it strikes.
• Prostate cancer proves fatal to 19 percent of its American sufferers. In single-payer Canada, the National Center for Policy Analysis reports, this ailment kills 25 percent of such men and eradicates 57 percent of their British counterparts.
• After major surgery, a 2003 British study found, 2.5 percent of American patients died in the hospital versus nearly 10 percent of similar Britons. Seriously ill U.S. hospital patients die at one-seventh the pace of those in the U.K.
• "In usual circumstances, people over age 75 should not be accepted" for treatment of end-state renal failure, according to New Zealand's official guidelines. Unfortunately, for older Kiwis, government controls kidney dialysis.
• According to a Populus survey, 98 percent of Britons want to reduce the time between diagnosis and treatment.
Why don’t we ever hear about these stats?
OK, now you have . . .
Monday, August 28, 2006
Or how about Pet-icare?
Sunday, August 27, 2006
Lies, damn lies & statistics.
Choose your poison.
Of course in practical terms this report is useless. I’m a great example in that I applied for two identical policies from different carriers on eHealthinsurance—both quotes about $100 a month for a $2500 deductible plan. But when the underwriting was done, one was still $100 a month and the other wouldn’t take me at all and suggested I went in the guaranteed issue pool at $400 a month for a $4000 deductible. So quoting price without knowing what the individuals concerned need to go through to get the insurance and therefore knowing the actual price is useless.
This has been said before but it definitely bears repeating.
Rates mean nothing unless you know what the final offer will be.
Saturday, August 26, 2006
Farming is no longer a small business. With the amount of capital tied up in land & machinery, a wise farmer will purchase insurance to protect those assets.
The study found about 95 percent of Kansas farmers buy medical insurance -- but most of those get only minimal or catastrophic health coverage. That leaves them bearing the costs of most illnesses or accidents themselves
95% is much higher than the general population. They are to be commended. And cat cover is what everyone should buy. We don't have copay's for oil changes, tires or gasoline for our automobile. Why do we think we need copays for routine items like doctor visits?
Ninety percent reported owing money to their doctors, with nearly that percentage owing money to hospitals. About two-thirds had outstanding prescription costs, while slightly over half had bills with dentists.
Most people think hospital bills will wreck you financially. Fact is, about 40% of claim dollars paid by carriers is for hospital bills. That leaves another 60% for outpatient care such as doctors & Rx costs.
Total debts varied widely, with the median about $2,500.
When did $2500 become classified as a "heavy debt"??
Friday, August 25, 2006
Eric Peoples was the first of 30 former workers at the Gilster-Mary Lee Corp. plant in Jasper to have his suit heard against the two makers of the butter flavoring. Following a morning of closing arguments, the jury deliberated for a little more than three hours before returning the verdict.
People cried and hugged his wife, Cassandra, as the jury ruled against International Flavors and Fragrances Inc. and its subsidiary Bush Boake Allen Inc., the manufacturers of the flavoring. They were ordered to pay $18 million to Eric Peoples and $2 million to his wife for compensatory personal injury damages.
Thursday, August 24, 2006
The debate will involve financially powerful players such as insurers, health care providers and businesses, whose interests often are at odds. The issue surfaced after Massachusetts passed a law earlier this year requiring residents to have insurance.
The National Federation of Independent Businesses also offered an unenthusiastic view of the Massachusetts plan.
Such a plan could add $150 million to the cost of doing business for Pennsylvania companies and worsen an already bad business climate, said Mark Richards, assistant state director for the federation.
The new cards, which will carry the MasterCard logo, can be swiped like a credit card at a doctors' office or other certified health provider. But in addition to providing payment, the cards can be used to confirm eligibility for services and provide access to personal health information at the point of care. The cards should be broadly available early in 2007.
UnitedHealth is working on a feature that uses the cards to interface with its electronic systems and determine precisely how much the patient owes at the time of the doctor visit. Besides collecting copayments and other patient-billable expenses easily, doctors' offices can use the cards to submit and process insurance claims more quickly, says UnitedHealth.
Wednesday, August 23, 2006
Some two-thirds of those surveyed indicated that they had added some kind of financial incentive, such as increased pension matches, as well.
Called "pragmatic benefits," the emphasis is on offering things that are more lifestyle related, not just "show me the money."
Tuesday, August 22, 2006
“Are you smoking more and enjoying it less?”
That phrase can be re-worked and applied to health insurance as well.
Are you paying MORE for health insurance and getting less?
If you are like most people, the answer is yes.
Family of 4, mid 30’s in greater Atlanta. They want a plan with all the bells & whistles with low copays & low deductible.
OK, so how about $25 copays and a $500 deductible?
Outstanding! Just what they want.
Premium is $751 per month.
So what are they getting for their $751?
Unlimited doc visits at $25 each. Generic drugs covered with a $15 copay. Rx deductible of $100 for brand name only, then $30 or $60 copay. Other charges subject to a $500 deductible then 80% of the next $10,000. Out of pocket on a major claim is $2500 + copays.
All this for only $751 per month.
What happens when you eliminate the copays and discount the professional services? You raise the deductible to $2500 but pay 100% after the deductible. Your out of pocket on a major claim is now $2500. That’s it. Not $2500 PLUS copays, just $2500.
And the new premium is . . . $290 per month.
That is a savings of $461 per month. Over $5500 per year.
In most households that will pay for a lot of doctor visits & meds.
Nothing wrong with the copay plan as long as you understand you are paying more but getting less for your dollar.
Monday, August 21, 2006
Today I talked to a man who was looking for coverage to replace his current plan. He now has a $10,000 deductible with another $5,000 out of pocket on a major claim. His premium is increasing, unjustly in his mind, and he feels he can do better.
He also feels he does not need an agent to advise him.
He told me he found a plan that was about $40 per month less expensive than his current plan, and had a $2500 deductible.
For some reason, this did not seem odd.
He wanted to know if I could offer anything better.
Of course I can.
I can offer a policy that will cover more than is covered now, and considerably more than the plan he thinks he wants, for somewhere in between his current premium and the one he has found.
On a $680,000 claim his current plan will pay all but $15,000.
The plan he has found will stop after paying $100,000.
And he thinks he doesn't need an agent . . .
The bill provides nothing. The taxpayers provide the coverage. BS 840 will actually LOWER the standard of care for residents.
Incredibly, nearly 7 million Californians lack health insurance during all or part of the year. Roughly 70 percent of these people are employed but do not receive employer-based insurance.
Apparently there is no expectation of personal responsibilty in California. If your employer, or the taxpayer, does not provide it then you will have to do without.
In California, with the sixth-largest economy in the world, it is past time to offer our citizens what so many other nations offer, universal single payer coverage for all Californians.
If/when BS 840 passes, expect fewer providers to accept the universal insurance. Fewer providers means more rationing and higher prices for those who choose not to use the taxpayer funded plans.
Sunday, August 20, 2006
Saturday, August 19, 2006
One visited Terre Haute today looking for a remedy to the state`s health insurance crisis.
Jeanne Labrecque, a representative from the Indiana Family and Social Services Administration, came to Ivy Tech for a town hall meeting.
The administration is looking to find a solution to the complicated and growing problem of health insurance.
One way they might do that is by raising cigarette taxes.
Tax smokers to pay for health insurance for those who are without. Does one have to PROVE they are unable to buy health insurance before they will qualify (assuming this passes)? Will just anyone be able to drop coverage and pick up the free coverage courtesy of the smokers in the state?
So where does it go from here?
Taxing expensive foreign cars so poor people can have a nicer car too.
How about 4 star restaurants so the fast food crowd can have a nice meal too?
Tax the birth control products so old guys can have free Viagra.
Wednesday, August 16, 2006
The premium charged for health insurance, particularly individual health insurance, is not the only factor affecting affordability.
More often than not, the one factor that most fail to account for is their health.
Your health can change from one day to the next.
Here are a few examples.
Don was considering leaving his job and striking out on his own. He started looking at plans but figured he had time and could afford to wait.
Don left his job last month. He is still trying to decide. Last week he visited the doctor for a routine physical. Turns out his cholestorol reading was 350.
He was immediately put on cholesterol lowering meds.
Now when Don applies for health insurance his premium will be 20 - 45% higher or he may find that the carrier will refuse to cover any treatment for high cholesterol and any related illness.
The cost of waiting as it turns out is quite high.
Karen started looking in January. She was on COBRA which was due to run out in August. No rush. She could have made a change in January and saved about $100 per month over her COBRA coverage. She could even have a carrier that will cover her cholesterol treatment.
Karen chose to wait.
In April she had surgery to remove a kidney stone. All is fine now.
Except her search for coverage has changed dramatically.
The carrier who would accept her before without restriction on cholesterol treatment now refuses to offer a policy.
Every other carrier she will consider will not cover kidney stones for a minimum of 2 years.
She does have a conversion option. The premium for conversion is $900 per month.
The plan she wanted in January was $250 per month.
Her kidney stone operation was $15,000. Now when she takes a policy she will have to hope she doesn't have additional problems with kidney stones.
Karen's decision to wait could cost her plenty.
Tuesday, August 15, 2006
There is a movement going on in several state, most notably the states that lean to the left, to provider some form of universal health care. One of the plans at the forefront is California's SB 840.
Here are some excerpts . . .
Not just junk insurance, but full care for all.
Health Security with full benefits for LIFE
Now who wouldn't want that? FULL care (no out of pocket), for ALL residents (including illegals), for life (from cradle to grave).
Free choice of any primary care doctor
Wow! Any doc. No networks. Docs are allowed to charge whatever they want and 840 will pay for it.
Who says there is no free lunch?
All care needed including hospital, emergency, prescription drugs, dental, vision & more.
A Socialist's dream. Free everything.
No copays or deductibles for at least 2 years.
Then what happens after 2 years?
Efficient administration cuts costs 25%
No one says HOW they will cut admin costs by that much, but even if they do, what happens once the admin savings have been overtaken by medical inflation? About 2 years out any admin savings is a wash and you are back to the same issues you have now.
I thought the Massachusetts plan was silly. This puts them to shame.
Late addition . . .
It seems the Gentle Cricket has also been keeping an eye on this legislation. I invite you to read his take on SB 840 here.
Monday, August 14, 2006
The Emergency Medical Treatment and Active Labor Act is a statute which governs when and how a patient may be (1) refused treatment or (2) transferred from one hospital to another when he is in an unstable medical condition.
EMTALA applies only to "participating hospitals" -- i.e., to hospitals which have entered into "provider agreements" under which they will accept payment from the Department of Health and Human Services, Centers for Medicare and Medicaid Services (CMS) under the Medicare program for services provided to beneficiaries of that program. In practical terms, this means that it applies to virtually all hospitals in the U.S., with the exception of the Shriners' Hospital for Crippled Children and many military hospitals. Its provisions apply to all patients, and not just to Medicare patients.
The avowed purpose of the statute is to prevent hospitals from rejecting patients, refusing to treat them, or transferring them to "charity hospitals" or "county hospitals" because they are unable to pay or are covered under the Medicare or Medicaid programs.
EMTALA is primarily but not exclusively a non-discrimination statute. One would cover most of its purpose and effect by characterizing it as providing that no patient who presents with an emergency medical condition and who is unable to pay may be treated differently than patients who are covered by health insurance.
Any patient who "comes to the emergency department" requesting "examination or treatment for a medical condition" must be provided with "an appropriate medical screening examination" to determine if he is suffering from an "emergency medical condition". If he is, then the hospital is obligated to either provide him with treatment until he is stable or to transfer him to another hospital in conformance with the statute's directives.
Note the use of the words “emergency medical condition” and “treatment until he is stable”. If a true emergency situation does not exist, the provider is not obligated to provide treatment. Once the patient is stabilized there is no further obligation to treat the patient.
So when is the patient stabilized?
• (for emergency medical conditions) that no material deterioration of the patient's condition is likely to result from the transfer or is likely to occur during the transfer;
• (for patients in active labor) the infant and the placenta have been delivered.
And what if the patient lacks the ability to pay? Can the hospital (or doctor) ask if the patient has the ability to pay?
Yes, but timing is everything. The statute does not prohibit an inquiry into availability of medical insurance; it does provide that neither examination nor treatment may be delayed to make the inquiry.
Some knowledgeable commentators have suggested that no discussion of any payment issues should take place before the medical screening examination and any needed stabilizing treatment are provided. Others have found no reason for an outright prohibition on asking about insurance coverage while the patient is waiting for the examination so long as it is made clear that financial considerations will not affect decisions regarding examination and treatment. This is obviously an area with some dangers, and one benefit of absolute rules is that no one has to wonder where the line may be drawn. CMS has even recommended that hospital personnel not answer any questions initiated by the patient, apparently on the theory that some patients may be dissuaded from staying if they learn that they will be financially responsible for the treatment, even if they are assured that they will be seen without consideration of payment issues.
I find this disturbing. “Some patients may be dissuaded from staying if the learn they will be financially responsible for treatment”.
What kind of people feel that medical treatment is, or should be, free?
So what happens if a patient feels they have been discharged early, or have not been treated fairly?
A hospital which negligently violates the statute may be subject to a civil money penalty (i.e., a fine, but without criminal implications) of up to $50,000 per violation. If the hospital has fewer than 100 beds, the maximum penalty is $25,000 per violation.
A physician who is responsible for providing an examination or treatment, including but not limited to an on-call physician, may be liable for a civil money penalty for signing the medical certificate if he knew or should have known that the benefits of transfer did not in fact outweigh the risks of transfer, or if he misrepresents the patient's condition or the hospital's obligations under the statute.
A physician who is on call and who fails or refuses to appear after being called by an E.R. physician (or other physician) may be subject to a penalty under the statute, or may subject his hospital to a penalty. The wording of this section [1395dd(d)(1)(C)] is so garbled as to be virtually indecipherable
In other words, they can be sued.
So to summarize . . .
If you have a medical emergency, you have a right to treatment regardless of your ability to pay. Once your condition has been stabilized you can be discharged or transferred to another facility for care. If you feel the hospital or staff has acted inappropriately in discharging you, they may be sued.
What a country.
My favorite was this thoughtful item at Tore O's Money Matador. Ever wondered if beggars *can* be choosers?
Sunday, August 13, 2006
The problem was not the withdrawal of PROVIDERS, but rather CARRIERS from the program. Blue Cross of California did not find the program to be economically feasible and withdrew.
Created as the Health Insurance Plan of California by the state in 1992 and taken over in 1998 by Pacific Business Group on Health, PacAdvantage is an independent, non-profit purchasing pool for small businesses with between 2 and 50 employees. It was intended to make health insurance more available and affordable and to ensure a choice of health plans for employees of small businesses.
In other words, this was an association plan that has been hailed as a solution to rising health care costs. Association plans are also known as MEWA’s.
At its peak, in 2002, its membership stood at 9,000 employers and 147,000 employees. But participation from insurers was voluntary, and under the weight of increasing health care costs and other unfavorable market pressures, they bailed out one after the other, Grgurina said
Current enrollment now stands at 116,000 covered participants; more than a 20% drop from the high enrollment.
Several things were inherently wrong and doomed the plan almost from the first.
The plan targeted small employers with 2 – 50 employees.
The plan was guaranteed issue. ANYONE can be covered, regardless of prior health history.
These two items alone are not enough to sink the plan but the next item appears to be a major flaw that pulled down the plan.
Each employee was allowed to pick their own plan. This is a key component that led to adverse selection.
When claims continue to rise faster than premiums, more carriers pull out of the plan. The more premiums rise, the more adverse selection there is which puts even more pressure on loss ratio’s. When there are not enough bodies & premium to support the risk the plan implodes.
Saturday, August 12, 2006
Why is this a solution? No one has EVER proved a single payor system works long run. Savings generated, if any, are only temporary. One year maximum
And the state government can’t buy anyone anything. They don’t have their own money to pay for it.
The measure establishes a system that, in theory, would be funded by payroll taxes on businesses of 8 percent and individual income taxes of 3 percent. Those taxes would replace the premiums that individuals and businesses now pay to insurance companies
See? Taxes replace premiums. Taxes are not government money, just ours sent through a different food chain.
Schwarzenegger has said he will release his proposal for making health care more accessible to Californians in January, if he is re-elected in the November general election. He supports streamlining private insurance coverage through the use of new technology and other approaches that make private insurance coverage more affordable
Streamlining coverage through the use of technology. Sounds like a Star Trek approach. Beam me up Scottie.
Advocates of SB 840 say their plan will save consumers and businesses about $8 billion a year because the government will be able to negotiate lower prices with health care providers
Lower fees to providers mean fewer providers willing to accept the lower fees. Add to that increased demand created by “free” health insurance and the result is more rationing of health care.
Lower fees to providers is a one year fix. After that you are back to the same issues you have now.
"The governor just doesn't get it,"
Neither do you.
Personally, I fail to see why government should be allowed to force a business to provide ANY coverage. This is just another form of tax increase.
The rule's supporters said lawmakers who reached the deal in the spring shared a modest goal: ending an unfair system that allowed companies offering no insurance to get a free ride by relying on more generous employers to help foot the bill for uninsured medical expenses. The Democrat-led Legislature that adopted the nation's most ambitious healthcare restructuring didn't embrace the broader goal of requiring employers to meet minimum coverage levels, supporters said.
What is “unfair” about free enterprise? Employers who pay a generous wage, and provide health insurance & retirement benefits are able to attract a higher class of employee and will experience lower turnover. If a business owner CHOOSES to pay less than their competitors, and CHOOSES to bypass employee benefits, then who suffers?
The customers of the lower paying business usually get the lower price goods they want. The employees have a job they are willing to accept at a compensation level that is suitable to their needs & qualifications.
WHO is hurt in this situation?
Friday, August 11, 2006
Thursday, August 10, 2006
Wednesday, August 09, 2006
The phone rang. Your daughter has been in an accident. You need to come to the hospital.
The car was damaged beyond recognition. Kristin had to be removed by with the aid of the jaws of life. She was stabilized and transported to the hospital.
Mother arrived at the hospital and was told the news. Kristin had been severely injured. In addition to lacerations she had 2 fractured cervical vertebrae and would be admitted to surgery to allow for placement of a halo brace.
Until the swelling goes down, there is no way to know exactly how much paralysis, if any, is involved. Kristin had just turned 21. She was not what you would call a problem child, but she did lack direction and focus. She was even considering dropping out of school.
Over the next few weeks Kristin’s condition improved. Her cut’s and bruises healed and eventually she progressed to the point where she could sit up in bed. Eventually she would have to learn to walk again, feed & dress herself . . . daily routines most of us take for granted.
It has now been just over 2 months since Kristin’s accident. She still wears a brace but she is adjusting to a new normal.
The bills are still coming in, but not as frequently or as large as they were initially. As of now the total is $680,000 . . . most of which was paid by insurance.
Had this happened after Kristin dropped out of school the outcome might have been different, especially without health insurance.
She would still be 21. She would still be relearning a new routine for daily life. The difference would be the $680,000 debt hanging over her head.
Tuesday, August 08, 2006
Umbrella group, Health Funds Association's executive director, Claire Austin says there has been a 1% increase in membership of health insurance companies, or about 13,500 people joining up in the last quarter.
She says the private sector is now funding half of common elective surgeries, such as hip replacements and cataract operations.
Austin says those seeking information on health insurance through the association often blame the cuts to waiting lists.
Major New Zealand health insurance company, Southern Cross Healthcare, is reporting its biggest leap in membership in five years as a result of the waiting list cuts. The insurer says its membership has increased by 7,500 to a total of 808,000 in the last year.
Southern Cross group chief executive Ian McPherson says the waiting lists issue is a significant reason for the increase. He says the number of people without insurance paying cash for operations in private hospitals has also increased.
Free health care + private insurance. Who would have thought??
In some cases, a lot more.
Two years ago in Atlanta we had the same kind of showdown. Once again Blue was the carrier but Tenet hospitals were on the other side of the bargaining table. That dispute lasted about 2 months.
Thousands of Denver-area patients may need to find a new hospital because of a contracting quarrel between a giant insurer and a hospital system.
HealthOne, parent company of seven metro-area hospitals and 10 surgery centers, is warring with United Healthcare over reimbursement rates.
On Tuesday, the company sent a letter to its 3,500 affiliated doctors, warning that its contract with United may end on Aug. 31. From then on, HealthOne facilities would be "out of network" for United Healthcare's nearly 1 million Colorado members.
"We are far apart on many issues," the letter said, "and we will not continue as participating providers unless we agree on acceptable terms."
The HealthOne contract affects all of United's business: its HMOs, PPOs and PacifiCare Secure Horizon's business.
Likewise HealthOne, a joint venture between nonprofit HealthOne Alliance and for-profit HCA Inc., gets 9 percent of its inpatient volume from United. Some 3,200 of its own employees have health insurance through United Healthcare.
The pair have been negotiating for months
Every time this happens, patients get squeezed. If it hasn't happened to you yet, just wait.
Bipolar: I am looking for health insurance and I was given your name & number.
Me: Thanks for calling. I need to get some information such as date of birth, height & weight as well as any meds you take.
Bipolar: I take (2 psychotropic meds, 4 BP meds and one HRT).
Comment to self, this is going to be a short conversation . . .
Me: Do you have coverage now?
Bipolar: Yes, I have coverage through my employer but I can’t afford it.
Me: How much does it cost?
Bipolar: I don’t know, it comes out of my check.
Second comment to self; this is going to be even shorter than I thought.
Me: If you don’t know how much it costs, then how do you know it costs too much?
Bipolar: Because I can’t afford to go to the doctor. The copays are too high. I want something with better coverage but at a lower price.
Now I figure I might as well have some fun since I am already in to this.
Me: So how much can you afford to pay in monthly premium?
Bipolar: How can I know how much it costs? That is why I called you. Don’t you know?
OK, time to pull the plug on this one.
Me: You really need to keep your current plan.
Bipolar: But I can’t afford it.
Me: As I was saying, you need to keep your current plan. No carrier will take you as a bipolar.
Bipolar: I should have known better than to call you. Insurance companies are all alike.
She hangs up.
Two minutes later the phone rings.
Bipolar: I am looking for health insurance and I was given your name & number.
I guess being bipolar is not her only issue. Seems like a touch of short term memory lapse as well . . .
This is a true story. I can’t make this stuff up.
Monday, August 07, 2006
HCA Inc., which owns JFK and St. Lucie Medical, is enacting the policy at several of its hospitals nationwide. The punitive measure reflects the near-chronic clogging of emergency rooms, often with patients whose minor scrapes, coughs and aches could be treated - cheaper - at a doctor's office or clinic. The worst result of the pay-first policy would be a seriously ill patient being turned away because he did not appear sick enough and could not pay the $140 upfront fee. Some doctors are worried they might become targets for malpractice lawsuits. And apprehension about the policy could deter patients with genuine emergencies.
The ER crisis includes crowding, long waits and patients being turned away, especially during the winter tourist season, but it also reflects a shortage of nurses, hand surgeons, neurosurgeons and other specialists - a problem Palm Beach County hospital executives, doctors and health-care specialists have been working to solve for more than two years. Clinics such as Martin County's Volunteers in Medicine site help, as would federal attention to immigration, requiring employers to provide some level of health benefit for the workers they hire. But the crowding reflects a problem that pay-first policies will not solve: lack of insurance
No such thing.
The correct term is TAXPAYER funded.
Ideally, every person in America would have personal health care coverage from childhood, through school and a career, and into retirement. Coverage would no longer depend on employment or pre-existing conditions. Basic health care would be free, and additions to standard coverage would be available for a price
The operative word here is “ideally”.
It's going to be expensive to provide basic health care to everyone, but it makes sense, not just as a matter of social justice but because we can prevent more-expensive care later.
It IS true that many maladies are preventable but there is little to show that there is a SIGNIFICANT increase on the overall health of those who have ready access to routine care.
People who have insurance still are obese which can lead to heart disease, diabetes, increased risk of stroke and a host of medical problems.
Doctors, hospitals and pharmaceutical companies would have to give up their distorted system of payments in which economic incentives reward those who do the most testing, prescribe the most drugs and overtreat patients who are in fee-for-service plans now
Many times more testing is done as a defensive practice. Fail to order enough tests and the treatment may not be covered by insurance. Even worse, you may be subject to litigation for malpractice if your testing fails to rule out every conceivable illness.
Doc’s make nothing by prescribing two pills when one (or none) will work. However, with direct to consumer advertising if the doc fails to write a script, or fails to prescribe the medication the patient asked for, that patient may simply shop for a new doc that will give them what they want . . . whether they need it or not.
If doctors are ROUTINELY “over-treating” their patients, I have yet to see anything to support such an accusation. Perhaps the author of this article has access to information I have not seen.
Government should set a basic health care benefit required in every private health plan. It should also compel the health insurance industry to be accountable and reliable
More government intrusion.
Every time the government passes a new mandate the cost of health insurance goes up not down.
And government must finance the system
Here we go again.
The government doesn’t have their own money.
But let's be honest: There would probably need to be some increase in taxes.
Ahh, now we see the truth. Higher taxes.
How much higher?
No one knows.
Every health plan would be free to offer upgrades beyond the government-paid basic plan
OK, I jumped the gun a bit. Now he is back to referring to it as a government paid plan. Seems he forgot the part about increasing taxes.
Must be a short term memory lapse. Wonder if that is covered as a “basic” benefit or one of those additional benefits paid for by the folks who have the funds to “buy up” to the better plan.
Oops! This is sounding like a class system where the “rich” have access to better health care.
Maybe the author can remedy that as well.
Sunday, August 06, 2006
Saturday, August 05, 2006
Joe Kristan at Roth & Co makes sense of the whole Estate Tax controversy (now that's an accomplishment!).
Over at the Health Business Blog, Eric Zimmerman has a great piece on how health care "consumerism" and internet-based information come together.
Jon Coppelman, co-host of Workers Comp Insider (which, BTW, plays host to the current Cavalcade of Risk), shows us that Mom was right when she told us to "stop that before someone gets hurt!"
And Bob Coffield at the Health Care Law Blog fills us in on the new Health Information Technology Promotion Act (now there's a mouthful).
Premiums are expected to jump an average 23 percent - even more for older people buying lower-deductible coverage.
The plan is for people who do not have access to health insurance through employers and can't get coverage from private insurers, or would have higher premiums through private insurance
High risk pools, usually considered the answer to uninsurable conditions, are becoming more costly to run. Even with taxpayer subsidies the premiums paid by the insured is becoming cost prohibitive.
In 2004, more than 6,000 Nebraskans bought insurance through the state's Comprehensive Health Insurance Pool. By June, the number had dropped 10 percent, to 5,400
As the number of participants drop, the cost of providing cover for the rest of the pool increases as fewer dollars are available to pay claims. This results in even higher premium increases for those who remain in the pool.
State Insurance Director Tim Wagner said rising claims could exceed revenue in a couple years. The program is paid for by people's premiums and a subsidy from the state tax on insurance premiums.
With the increase, Nebraska will have some of the highest premiums for any state high-risk program in the nation, said Holly Whelan with the American Diabetes Association.
At least one state (Florida) closed their risk pool a few years ago to new entrants. Other states may follow and Nebraska may very well be the next.
The Aug. 1 editorial, "Do-it-yourself fixes for high health costs," neglected one significant step consumers can take to hold down costs: If you are relatively young and healthy, don't buy health insurance. Learn to distinguish between the cost of health insurance and the cost of treatment, and be aware that for the large majority insurance premiums are approximately five to 10 times the actual cost of medical care in any given year. For a family of four, the break-even point is about $4,000 to $5,000.
Only buy health insurance in the years where your expenses will exceed $5,000.
Even though the university expected Merino's office to lose $50,000 to $80,000 a year, in the past 12 months it was almost $250,000 in the red, said Jerry Broderick, assistant chairman of the university's department of medicine.
''The loss was far greater than what we'd planned for,'' Broderick said. ``Professional fees and patient revenues were never at the level we had hoped to achieve.''
The university will keep its concierge practice, which charges $1,500 a person for more personalized services and preventive care not covered by typical insurance plans.
“I love everything here,” said Laurie Wheeler, who came with sons Justin, 10, and David, 12. The boys couldn’t wait to play their favorite video game. Wheeler, if she wants, can check her e-mail in the patient library/computer room.
“This is really fancy. They deserve fancy,” Ronda Woods said of the Parkview Medical Group clinic she manages, and of the people who come through its doors at 10515 Illinois Road, just west of Scott Road. Her staff benefit from the lessons she’s learned from people running such places as Disney World, Ritz-Carlton hotels and M.D. Anderson Cancer Center in Houston.
Friday, August 04, 2006
Thursday, August 03, 2006
Wednesday, August 02, 2006
Tuesday, August 01, 2006
A lot has been said about HMO's over the years . . . much of it negative. Comic's have made jokes about HMO's. The general press has not looked on them favorably for their "hands on" manipulation of health care treatment.
My own experience, at least with Kaiser Permanente, has been positive. Now from someone who has posted comments on this site in the past comes this observation.
I may not agree with Marc's view on risk management as it applies to health insurance, but I do applaud his bravery in dealing with personal health challenges.
Here is a small portion of his story.
At this point I have to add a plug for all the doctors, nurses and staff at Kaiser Permanente. They have been exceptional. I experienced the same treatment, when I was diagnosed with mantle cell lymphoma 4 years ago, but now I realize it wasn't just my bubbly personality which resulted in that great care.
Within the past two weeks, since my wife's MRI revealed an anomaly in her T2 vertebrae, she has had lots of blood work, a CT scan, bone scan, appointment with an oncologist and a biopsy of her T2 vertebrae. Today she has a bone marrow biopsy scheduled, to check for any spread of the disease, and tomorrow she has an appointment with the radiation oncologist.
I can't imagine that anyone could possibly receive better service from any other health care provider. Thank you Kaiser Permanente!