Monday, December 31, 2007
The NHS in U.K. continues on its path toward an electronic data base for medical records. In theory, this endeavor (or, endeavour?) is expected to result in improved quality of care and lower costs. This theory is also widely touted by health care observers in the U.S.
The poll reported in this article measures disagreement among British doctors whether the theory can be implemented satisfactorily. The article reports that, among doctors polled, “more than two thirds (70 per cent) agree that such records will improve patient care”. [i.e., agree with the theory] but, at the same time, doctors polled are almost evenly split “whether the benefits of electronic patient records will outweigh the risks.” [i.e., have doubts about how it will work in real life].
As with all theory, the true test is whether it works in real life. No better way to tell than to try it out. And - maybe - the best place to try it out is somewhere else not here.
Meanwhile, the NHS has lost medical data on millions of families; nine separate NHS trusts have lost patient data. In addition, the system development is reportedly years behind schedule. Understandably confidence in the security of patients’ records is mixed at best among doctors – and low with the public.
I think we should all root for the system to work and at the same time not hold high hopes until or unless positive, real-life experience emerges. Definitely worth watching.
Sunday, December 30, 2007
This final rule protects group retiree health benefits by allowing group plan sponsors that provide retiree health benefits to continue their longstanding practice of coordinating benefits with Medicare. This rule was first proposed many years ago but was delayed due to a parade of litigation. That litigation has now been resolved, clearing the way for EEOC to issue the final rule.
What this means is that plan sponsors may continue to offer two distinct levels of retiree benefits (1) Medicare “pays first” for Medicare-eligible retirees and (2) no Medicare offset for pre-Medicare retirees.
Plaintiffs in the earlier litigation had claimed that coordination of health plan benefits with Medicare violated ADEA because it resulted in lesser group benefits for Medicare-eligible retirees - and less cost for those benefits - than for pre-Medicare retirees. They also argued that EEOC did not have authority to issue the proposed rule.
The plan sponsors argued that disallowing coordination with Medicare would significantly increase their cost for retiree benefits and would result in termination of many retiree health plans not only for Medicare retirees, but for pre-Medicare retirees as well.
The U.S. Court of Appeals agreed that EEOC could proceed to implement the proposed rule, which it is now doing. In effect, the rule creates a narrow exemption within ADEA regulation for the practice of “coordinating employer-sponsored retiree health benefits with eligibility for Medicare.”
There seems to be little media attention on this development. I think that's odd, because both the new rule and the settlement of the litigation that blocked it for years, are quite significant.
Saturday, December 29, 2007
Some time ago, The City by the Bay enacted a little provision that requires employers to provide health insurance to their employees or face fines (Sound familiar?). While that may have seemed like a good idea at the time, turns out that it faces a non-trivial challenge:
Says who, you ask?
Says US District Judge Jeffrey White, "who found that the city was intruding into federal regulation of employee benefits."
And that may become an even bigger oops: his "ruling Wednesday invalidating part of San Francisco's landmark attempt to extend health care coverage to all uninsured adult residents cast new doubt on the viability of a statewide program for covering the uninsured that is now pending in the Legislature."
Apparently, both the local and state laws have run into the mammoth buzz-saw that is ERISA (the Employee Retirement Income Security Act). Being a federal law, ERISA preempts such attempts by local and/or state governments. If this stands (and that may be a big "if"), look for the ripple effect to impact new efforts in Delaware, as well as current ones in The Bay State (how's that for irony?).
Shortly after the attack, Congress established the Victim's Compensation Fund and authorized a payout to the surviving family members of the 9/11 attack. Total payout is just shy of $16 billion.
On June 8, 1995 one of the most popular baseball players in the last 50 years received a liver transplant at Baylor University Hospital. Years of drinking had worn down the body of "The Mick" resulting in Hepatitis and cirrhosis damage to his liver.
Mickey Mantle died on August 13, 1995 taking with him his recently implanted liver.
More recently the case of Nataline Sarkisyan has made headlines because she was (some say improperly) denied a liver transplant following a failed bone marrow transplant. The insurance carrier (Cigna) originally denied payment for the liver transplant and then later reversed that decision.
How are these stories related, if at all?
In the case of 9/11, Congress authorized payout of taxpayer monies to the victim's families. There was no legal precedent for the payout, nor was there Constitutional authority to make the payout. Instead, they reacted to public sentiment.
At the time, many questioned why Mickey Mantle was moved to the head of the transplant waiting list. Sure, he was an American sports hero and a wildly popular public figure even long after his playing days. But was someone who willfully abused their body and destroyed their liver deserving of a new liver? Should they be placed ahead of someone younger, who also needed a liver, but had developed liver disease through no fault of their own?
It appears that public sentiment may have played a part in efforts to keep alive a popular sports figure.
Then we have the case of Nataline. After years of battling Leukemia she received a bone marrow transplant the day before Thanksgiving. Her body reacted negatively to the transplant and her organs started to deteriorate, including her liver.
Her insurance carrier was asked to authorize a liver transplant, which was initially denied after consulting with outside medical authorities. They later reversed that decision, perhaps in response to a public outcry.
Congress had no authority to establish the Victim's Compensation Fund but bowed to public sentiment.
Those attending to the needs of Mickey Mantle moved him to the top of the waiting list, perhaps not because his situation was more needy than others, but because of who he was.
Cigna authorized an extra-contractual medical procedure because of media publicity and public reaction.
We are a nation of laws, but we are also a nation that strives to do what is right in the wake of public sympathy. The cold facts of these situations say the victim's of 9/11 were not legally entitled to any monies, the "Mick" was not entitled to special treatment, and Nataline was not entitled to coverage for a second transplant. Yet in each case, the powers that be made decisions that went beyond the bounds of their authority.
There are no clear winners in these situations. Someone will feel short-changed while others will feel justified in their position.
All of these situations and many others will continue to be played out in the court of public opinion as long as there is human suffering and limited resources.
Friday, December 28, 2007
■ Your post's url
■ The post's trackback URL (if available)
■ A (brief) summary of the post
Thursday, December 27, 2007
Once again, Dr John Ford proves his indispensibility in bringing order out of chaos. This time, he brings his experience and insight to bear on the Nataline Sarkisyan story, offering some much needed calm and perspective.
Wednesday, December 26, 2007
This is an anecdote about the Japanese health care system. It is only an anecdote. It could never happen here.
You can read background here, here and here. In Japan about 10,000 citizens have contracted hepatitis C from blood plasma products containing fibrinogen. Fibrinogen is a blood coagulation agent produced by the liver. At one time, blood plasma products containing added fibrinogen were used by obstetricians, gynecologists and surgeons as a means to control hemorrhaging. The U.S. government canceled its approval for such blood products in 1977 because of concern for the risk that fibrinogen obtained from donated blood could be infected by hepatitis C. Japan banned use of fibrinogen for similar reasons in 1988.
OK, back to present day. Many Japanese are infected with Hepatitis C from blood plasma containing fibrinogen. It turns out the government, specifically the ministry of health, was aware of the problem but failed to take any steps to warn those most at risk for infection:
In October , the government was embarrassed when Health Ministry officials admitted to having data that would have helped identify or warn hundreds of hepatitis patients before their illnesses worsened.
But - - please, not to worry. As I said, this is just an anecdote about another nation’s government-run health care system and an unfortunate lapse in the health ministry. This could never happen here.
If you're just tuning in, a teenager in California died recently, and there is quite a controversy surrounding the circumstances. The biggest problem so far is the lack of adequate information; while the parents are free to cast whatever accusations they want, the insurer (Cigna) is constrained by HIPAA (as well as the pending litigation).
Tuesday, December 25, 2007
One of the best parts of blogging is the comments: who's reading, what do they think of your post, that kind of thing. At Running a Hospital, Paul Levy (who, not coincidentally, runs a hospital) takes to task a U S News and World Report article on hospital rankings. The really cool part? The editor of USNWR responds in the comments, and it's off to the races from there.
Monday, December 24, 2007
Sunday, December 23, 2007
No matter what your religious beliefs, miracles are something positive that happens during times of stress, emotional turmoil, financial worries or ill health. Even those who do not hold to a belief in a higher power still will marvel at positive happenings even though they may stop short of terming them as miracles.
For Christians everywhere, the true meaning of this season has nothing to do with gifts, reindeer or Santa Claus. Rather, the focus is on a baby, born to a virgin, in a stable in the town of Bethlehem.
Baby's are miracles in their own right. They grow inside their mothers womb, starting out as two small cells and in a few months enter the world as part of the process we call the miracle of birth. Anyone who has witnessed the birth of a child, particularly their own child, will confess it is a humbling, and sometimes frightening occurrence.
Most of us have been blessed with healthy children, but some have experienced the birth of a child who is forced to deal with the complexities of life early on.
Such is the case of baby Wilson (Wil) as related at InsureBlog a few weeks ago.
You will be glad to know that baby Wil is progressing and thanks to the work of the doctors in attendance, and the prayers of many, is showing improvement.
If you would like to track the progress of baby Wil, you can do so by clicking this link and registering. You may also post a message of hope if you wish.
For the parents of baby Wil, the miracle of Christmas is an ongoing event. And that is the way it should be.
God bless. Peace to all.
Saturday, December 22, 2007
UPDATE (12/23): At the risk of jinxing it, it appears that HaloScan is back up and running.
Friday, December 21, 2007
Perhaps you've heard this:
I had a brief conversation with another agent earlier. We were trading war stories about some of the frustrations we face in our business. Here is one of his.
He had been working with a family for 3 months. Husband, wife, 2 kids. Good income. Nice neighborhood.
No health insurance.
Yesterday he made another follow up phone call to see if they wanted to put in an application before rates go up in January.
No, he was told. They can't afford health insurance now. They just purchased a 2008 Suburban so it will be a while before they can fit health insurance in their budget.
Thursday, December 20, 2007
The fastest eco boat on the planet will attempt to break the round the world speed record using fuel made from human fat.
Fastest boat powered by fat? Must mean there are slow boats powered by fat.
Bethune underwent liposuction and donated enough to produce 100ml of biofuel, while two other, larger volunteers also had the procedure, making a total of 10 litres of human fat.
For the rest of us, 10 litres (British spelling) equals a little over 2 gallons of fat.
That converts into a little over 1.5 gallons of fuel.
Enough to travel 15km or 9 miles . . give or take.
Earthrace is fuelled on 100 per cent biodiesel and has a net zero carbon footprint.
See? I told you Al would love it.
But there is a problem.
Circumnavigating the globe represents the pinnacle of powerboat challenges, and more than 24,000 nautical miles is the world's longest speed challenge.
If they have a 24,000 mile journey and they start with enough fuel to travel 9 miles with "fat donations" from 3 volunteers, how many more fat people will it take to complete the journey?
Don't you just love these kind of math problems?
Happy eating over the holidays!
[New York Insurance] Superintendent Eric Dinallo said that to fill a $500 million deficit . . . the 30,000 physicians in the state who get malpractice insurance through two large nonprofit companies could owe $50,000 each.
Well, THAT’s one way to get your doctors’ attention!
This latest insurance crisis shows once again that it does not much matter whether an insurance company is for-profit or “nonprofit”. What matters most is that both types of companies get their premiums right. This requires correctly assessing the cost of the malpractice liabilities that they insure. After all, the cost of premiums is mostly driven by the cost of the liabilities. [Sound familiar? Anyone? Anyone?]
Even a not-for-profit insurance company that underprices its liabilities will sooner or later have to charge higher premiums, reduce benefits, or go out of business. Predictably, the doctors and the trial lawyers and the insurance companies and the state regulators disagree about what the real problem is. Of course that means they disagree how to solve this crisis they can't quite define. And, predictably, our governor has ordered another “study”. [Sound familiar? Anyone? Anyone?]
Is there a call to establish a state-run, single-payer med mal insurance mechanism so this crisis could be fixed without curtailing our right to sue and without requiring anyone to pay more? I haven't seen such a call but that's probably just due to inattention on my part.
In this thoughtful post, he offers his well-researched opinion about the "why," and offers an intriguing suggestion about changing that situation.
Wednesday, December 19, 2007
Tuesday, December 18, 2007
As we've discussed before, DTC (Direct To Consumer) advertising is a big deal for big pharma. To some extent, it exacerbates the ever-increasing cost of health care, and thus health insurance.
Monday, December 17, 2007
Under the Indiana program, eligible residents can pay up to 5 percent of their incomes into state-subsidized "Personal Wellness and Responsibility Accounts" that cover their initial medical expenses up to $1,100. Once that deductible is reached, private insurance purchased by the state kicks in.
Personal Wellness and RESPONSIBILITY Accounts.
Personal responsibility. I like that concept.
How could anyone object to requiring adults to act like adults?
Well, apparently some can . . .
Judith Solomon, senior fellow at the Center on Budget and Policy Priorities, said she doubts that many people making $10,000 a year can afford to pay $500 for health insurance. She said that about 50,000 people lost Medicaid coverage in Oregon after that state got permission to raise insurance premiums to $20 a month.
The state increases the premium from $0 to $20 per month and 50,000 LOST their coverage?
Lost their coverage?
They chose not to pay $20 for something that was previously free.
They didn't lose anything.
Sunday, December 16, 2007
■ This is but another in a (very) long string of "gotcha's" perpetrated by the MVNHS©.
■ It's been said that our system has inequalities, and that it is therefore "broken." Indeed, one of our "regulars" is on record as stating that such things happen "only in America." And yet we see the British "system" failing its patients time, after time, after time. And because it is nationalized, there are few alternatives left when such egregious failures (such as the plight of Ms Mills) come about.
Saturday, December 15, 2007
"unless the physicians are vigilant in correcting [policy wonks’] fantasies, the absurdities will press on unabated."
This is the beginning of an important insight. But it’s left unfinished.
Meanwhile, and in reality, such absurdities have grown for 40 years and IMO are likely to become even worse.
Let's keep in mind that health care policy wonks do not fall out of the sky. It's trite, but true: nature abhors a vacuum. The policy vacuum in health care sucks in people who become health policy wonks, when otherwise most of them would pursue more useful vocations.
And how have these wonkish folk gained significant control within our "system?" IMO, because physicians have increasingly failed to assert control.
The resulting vacuum of physician leadership has become especially harmful during the past 40 years.
Moses found a way out of the wilderness in 40 years. OK, health care is a more difficult problem. But still . . .
Regrettably physicians by their inaction cede leadership on far too many fundamentals of health care management. If physicians want health care to be managed differently, they must find ways to exert more significant and direct leadership.
Physicians’ attempts to correct others' fantasies won’t work. Physicians' attempts to persuade policy wonks to lead, but in a manner agreeable to physicians rather than to policy wonks, won’t succeed. Physicians’ complaints about others’ poor leadership is not leadership. In fact, none of these behaviors is leadership. What to do? Well, I’m no wonk. I don't know for a fact what will work. If I knew I’d be very rich. But my opinion is that physicians must assert much more direct influence on health care policy and management in this country.
“First, do no harm” is sometimes a call to take action, rather than to refrain from taking action. If now is not one of those times to act – then when?
Friday, December 14, 2007
Thursday, December 13, 2007
"S corporation shareholders need to make sure that their premiums are included on their 2007 W-2s."
What's the point, you ask?
Simply this: if you own a business, and you want to (legally) deduct your health insurance premiums (usually a non-trivial amount), there are some new rules, and you need to know about them.
Fortunately, Joe has all the sordid details, which he generously shares with those of us who don't count (or even necessarily know) beans.
Check it out.
Wednesday, December 12, 2007
Close, but no cigar.
All have called for a more robust individual health insurance market. But that market today relies upon medical underwriting--people who have had cancer will have great difficulty finding an insurance company to underwrite them. As the Times reports, "Cancer survivors -- even if they have been free of disease for several years -- are routinely denied health insurance when they try to purchase it as individuals."
True, at least to an extent. Some cancers with good remission/cure rates are given a free pass.
If coverage is offered, it often comes with restrictions on the disease the person suffered with or high premiums.
If coverage is offered.
Tempering the headline?
First they cannot get coverage. Now the author opts to qualify his contention.
But when individual coverage costs thousands of dollars a year, many can't afford to get it.
And many cannot afford COBRA either.
Or, for that matter, risk pool premiums.
So the issue is not one of AVAILABILITY as it is AFFORDABILITY.
Several dynamics come in to play here. One is a reliance and expectation that the carrier should cover items that are routine, such as primary care. Stripping out primary care as part of a health plan goes a long way toward reducing premiums, often by 30% or more.
The other issue that no one wants to address is that Americans as a whole are not savers. Most live paycheck to paycheck. When the check stops they go into a crisis mode.
If the taxpayer wants forced health care for everyone (regardless of the funding) then they should also require forced saving accounts. If you cannot support yourself and your family for 6 months without a paycheck then perhaps you should not be eligible for subsidized health insurance.
At some point the taxpayer needs to accept the responsibility of adulthood.
Dillinger was wrong.
Dillinger never heard of Medicare.
A recent report by NBC News reveals an estimated $60B in fraud committed on the taxpayers by virtue of Medicare fraud.
A recent report by the inspector general for the Department of Health and Human Services noted that 72 percent of the Medicare claims submitted nationwide for HIV/AIDS treatment in 2005 came from South Florida alone. That percentage is of great concern to authorities, since only eight percent of the country's HIV/AIDS Medicare beneficiaries actually live in South Florida,
And no one noticed?
Who's minding the store?
"For every one owner we arrest, another one pops up, maybe even two, tomorrow. It's so lucrative that we have yet to turn the tide."
Stealing from taxpayers. Lucrative.
Interesting choice of words.
One of the most common schemes is the illicit billing for DME, or durable medical equipment, such as oxygen generators, breathing machines, air mattresses, walkers, orthopedic braces and wheelchairs. This scheme involves billions of dollars a year in illegal claims.
And let's not forget the Medicare scooters heavily advertised on TV.
federal officials in Miami pointed to a red electric wheelchair they seized from an illicit company. Normally it would cost about $5,000. But by billing Medicare over and over, nor ever delivering the wheelchair to an actual patient, criminals charged a total of $5 million for that one item alone.
That's some wheelchair.
Here's a bit of trivia. Most folks know that Lyndon Johnson instituted Medicare with a stroke of a pen. But who was the first Medicare beneficiary?
In honor of (Harry) Truman's leadership foresight, Johnson enrolled him as the program's first beneficiary and presented him with the nation's first Medicare card.
So how much does Medicare fraud cost the taxpayer?
thieves now steal an estimated $60 billion a year in taxpayer money that is supposed to finance health care for 43 million American seniors and the disabled.
$60B out of a total $408B spent on Medicare.
That's 15% of the budget lost to fraud.
So who wants "Medicare for all"?
If John Dillinger were alive, he probably would be in the thick of it. He might even be willing to make a go of it with just a smile . . .