Wednesday, December 31, 2008
“[The patient’s] daughter-in-law Amanda . . . added: ‘All that he had at the end of his 101 years was his dignity and they took that away from him.”
Also take a few moments to scroll thru the comments left by Daily Mail readers.
No one should conclude that NHS works like this, routinely. But just as clearly this episode happened, none of the hospital staff seeemed particularly concerned about it, and many of the commenters don’t seem surprised either.
Is this, after all, the future we may look forward to in the US as we sail along toward single-payer, government-controlled health care system?
What evidence is there that the answer is anything but “yes”??
It is also eye-opening to read the cold, bloodless, and lawyerly form-letter “apology” from the Hospital. It’s almost as though the hospital is responding to a complaint about late meal delivery or some other trivial service glitch:
‘Some aspects of Brig Platt’s discharge from hospital in 2006 were unacceptable and the trust apologises for any distress that this has caused.’
Some aspects, huh? Of the discharge (and not of Mr Pratt’s mistreatment prior to his discharge?) And the “trust apologises” – well, that’s about as impersonal as one can get. Gahhhh.
Tuesday, December 30, 2008
Sabrina is a 39 year old mother of 8 covered by Medicaid. But "covered" isn't exactly true.
Therein lies the story.
Holloway is covered by Medicaid, the insurance program for the poor and disabled. But unlike other states’ Medicaid programs, Georgia’s does not cover an intestinal transplant for patients 21 years old and older.
Such transplants are covered for younger patients, but not someone older. Wonder why?
Without the surgery, Holloway likely would have died within two to three years, Katz had said.
Is the Medicaid system heartless?
The federal government gives state Medicaid programs leeway on which transplants to approve. Other states’ Medicaid programs —- which have their own coverage rules —- approve intestinal transplants for people Holloway’s age.
So federal health care programs allow each state to decide the level of treatment. So much for "universal" coverage.
Without the surgery, Holloway was fed intravenously at an estimated annual cost of $150,000.
So how much does the surgery cost?
The operation generally costs $200,000 to $400,000, doctors said recently. But Dr. Douglas Farmer, head of the intestinal transplant program at UCLA, said in June that a transplant could be less expensive for the state in the long run. He added that intestinal transplants can cost less than $200,000.
So how was it that she received the transplant?
It seems she relied on the charity of others at the Cleveland Clinic.
The Cleveland Clinic last week declined to disclose the cost of Holloway’s surgery and postoperative care. Officials there said they “made every attempt to obtain coverage from Georgia Medicaid.”
It begs the question.
If government run health care is so great, why do patients have to rely on charity?
Sunday, December 28, 2008
Well then, now read this:
NHS chiefs are planning to order a massive 40 per cent increase in weight loss surgery for dangerously obese patients from Yorkshire.
After getting our attention with this lead paragraph the article goes on and on, but curiously never gets around to these two questions:
1. How exactly will NHS chiefs decide who will be ordered to undergo surgery?
2. What is the penalty if one should refuse the order?
Oh well, maybe these questions aren't so important. After all, Brits have every reason to trust that Her Majesty's government will always do the right thing.
Saturday, December 27, 2008
Timely Medical Alternatives is a firm that arranges private medical care for Canadians.
Why does TMA exist?
Timely Medical Alternatives is able to expedite most types of private medical services from diagnostics to virtually all types of surgery, including procedures not available within the Canadian healthcare system. Wait times for our clients are measured in days rather than in months or years.
How long will I have to wait for services under the Canadian system?
Private Health Care is increasing in demand across Canada more than ever before. The public health care system in Canada has a waitlist in every province and surgery dates are often cancelled or bumped due to a more urgent case arising or a shortage of beds being available.
Click on a Province to view waitlist numbers and options for private medical care in that area.
Will I get in trouble for using a private system?
Inmates in Federal prisons and politicians (among others) routinely jump the queue and we agree that this practice is outrageous. Jumping the queue occurs when convicted criminals and politicians are given preference over the rest of us.
So there is preferential treatment for inmates & politicians.
I suppose if you can't get elected the next best thing is to get arrested.
Friday, December 26, 2008
Thursday, December 25, 2008
The surprise comes when she discovers he has sold his watch to buy silver combs to place in her hair.
Each has made a sacrifice, with good intention, as a way of expressing their love for the other.
The Magi were rumored to have traveled from afar bearing gifts for a new born king. Their gifts of gold, frankincense and myrrh were just as appropriate for the recipient as the watch fob and combs were in O Henry's story.
Gold was a traditional gift for royalty.
Frankincense had many uses including medicinal properties for calming and restoring peace. It was also burned by priests as a way of carrying the prayers of the faithful to heaven.
Myrrh was used to treat wounds due to its' antiseptic qualities. It was also used by Egyptians as an embalming ointment. The significance of myrrh is probably lost on many who read the story of the wise men. This tiny baby was born to be a king but would only do so through death 33 years after his birth.
Gifts exchanged at this time of year are only one way of expressing love. The true gift is not the physical item but the thought that goes with it.
Della put a lot of thought into the gift of a chain for her husband's watch. She purchased it by putting her husband ahead of vanity. In turn, Jim expressed his love for Della by sacrificing something dear to him to in order have the money to purchase his gift for her.
Christmas is a time to think of others and putting their needs and wishes ahead of our own. Blessings on you and yours during this season of love.
Wednesday, December 24, 2008
This season, give thanks to those you love, and who love you.
This season, give thanks to those who protect us, risking their lives in the process.
This season, be sure to give thanks to the One who made it all possible.
We wish you and yours enjoy a wonderful (and safe) Christmas.
In other words, there are problems in health care so let's do something about insurance.
Real logical, Congressman.
Health care? Health insurance? The same things, right? No, they are not and unfortunately Stark is not the only one who ignores the difference between health care and health insurance.
Besides, what exactly is Stark's idea for insurance reform? Enroll more people in something “like” Medicare! How . . . creative! But practical?
Medicare’s financial problems are exceedingly well-documented. Its yearly expenditures are projected to exceed its income within the next few years. Medicare is financed on the notorious pay-as-you-go basis, and its unfunded liability is estimated to be $60 trillion (20X's the current U.S. annual budget). I understand that there are some like Stark who apparently believe that any program so hopelessly in debt as Medicare is a successful program because it is a government program. I differ.
What evidence is there that this Medicare financial train wreck will miraculously jump back on the rails if only EVERYONE were enrolled in it? The answer is, none.
And there ain’t gonna be such evidence unless something is done to improve the effectiveness and reduce the cost of the health care delivery system we have now. And that won’t happen until the cost of insurance is understood as a symptom of the underlying cost of health care delivery, not misunderstood as a disease itself. That is, not until the health care system becomes the primary emphasis for reform. Until then, expanding Medicare will just throw more of our tax money into a system that has shown neither the ability nor the inclination to control its costs.
Tuesday, December 23, 2008
Monday, December 22, 2008
Sunday, December 21, 2008
Thursday, December 18, 2008
Wednesday, December 17, 2008
JoBeth Williams, Glenn Close, Mary Kay Place . . . just to name a few.
But the story line was entertaining (at least to me) and the music was the best. The Rolling Stones have provided us (some of us at least) with some incredible songs over the years. One of those, "You can't always get what you want" plays a role in the Big Chill.
There are those who want lower insurance premiums but don't want lesser coverage, or at least what they perceive as lesser coverage. Doc copay's are not insurance but prepaid medical coverage. No one needs a doc copay but everyone wants a copay.
So to accommodate those who think insurance isn't insurance if it lacks a copay, carriers have been introducing lower premium plans that give more prepaid medical on the front end but strip away needed (catastrophic) benefits on the back end.
This is a move in the wrong direction.
Apparently the folks at the Philadelphia Enquirer feel the same.
They published a story about Karlin Brockington who used up all the money in her plan. Only one problem.
She has acute myeloid leukemia and she needs further treatment.
Brockington had been paying $19 a week from her paycheck for health insurance.
For 16 months, insurance covered chemotherapy, a bone marrow transplant, five months in hospitals.
But on Aug. 28, 2008, a letter came from her plan administrator. Brockington had reached her "lifetime maximum coverage of $2 million."
In five days, she would be uninsured.
In most cases $2M is adequate, but eventually that well can run dry in some situations.
This is one of them.
"The primary reason for . . . caps is to lower the cost of insurance so employers can cover as many people as possible," said Mary McElrath-Jones, spokeswoman for UnitedHealthcare, parent company of UMR, administrator of Brockington's health plan.
That is true, but, in this case at least, it is a weak argument.
The difference in a plan max of $5M vs. $2M is almost nill. For literally a few dollars extra per week the plan max could have been higher.
Had the plan "skimped" a bit on the front end, with say a higher copay for docs they most likely could have shifted the premium savings to the back end and provided a much better plan.
"What insurance is supposed to do best is handle the extraordinary thing that is rare," said Gary Claxton, health policy expert at the Kaiser Family Foundation. "So to some extent, these policies are not protecting the people who most need insurance. These people did everything they were supposed to do. They were paying their premiums. Insurance companies are finding ways to limit exposure of these policies to really sick people."
I coach all my clients in ways to keep their premiums affordable while protecting them on the back end. My traditional line goes something like this.
"You don't have copay's for tires, brakes and oil changes on your auto insurance. Why do you need them for health insurance?"
For most folks, it makes sense.
I also caution them about internal limits on potentially catastrophic claims, especially Rx which can run $5k or more per month for one drug.
The problem of benefit caps and trying to deliver a viable product while containing costs isn't just limited to the private sector. Medicare has their issues as well.
In November 2007, Brockington was approved for Social Security disability, and began receiving $944 a month.
But that disability income is eaten by co-pays, living expenses, car insurance.
She will be eligible for Medicare - but not until next November. When Congress extended Medicare to include the disabled in 1972, it imposed a two-year wait, which still exists today.
Why isn't anyone calling for Medicare reform?
If not Medicare, then what about Medicaid?
Brockington then tried to get Medicaid, medical coverage for the poor. She applied in New Jersey, but because she owns a mobile home in Delaware, and is licensed to drive there, New Jersey told her to apply there, she said.
Delaware officials, she said, told her that with a $944 disability income, she earns too much to qualify for Medicaid. She plans to apply again soon in New Jersey under a program called Ticket to Work. She has been living in Lawnside for years with her mother and sister - commuting to work in Deptford long before she got sick.
Seems the government safety net plan doesn't want her either.
Seems a lot of people want to cover everyone for everything. It just isn't fiscally possible.
But it is possible to cover almost everyone when they truly need it most. And that can be done for a lot less than most people think.
Tuesday, December 16, 2008
Monday, December 15, 2008
Sunday, December 14, 2008
Performing CPR on a heart attack victim is a medical necessity.
Having a plastic surgeon enhance your breasts is not.
Suturing a bleeding wound is a medical necessity.
Removing a tattoo is not.
But what happens when you ask your doc to induce labor so you can deliver before your insurance runs out?
Starla Darling was just days away from giving birth to her second child. The 27-year-old mother from Polk, Ohio, had a well-paying job with good health insurance at the Archway Cookie plant in nearby Ashland.
But during a visit to her parents' house, Darling received news that sent her into a panic. A neighbor, who also worked at Archway, told them the plant was closing and their health insurance was ending two days later.
Under normal situations COBRA would be an option. But the plant was filing bankruptcy and the group plan terminating. This eliminates the COBRA option.
But there could have been other HIPAA options. Perhaps Hank will enlighten us on options in Ohio.
"I flipped out," Darling said. "It was five minutes after she told me, I was on the phone with the doctor," Darling said. "I told her, 'I need to be induced.'"
A few hours later, Darling was in the hospital. The next day, she had to have an emergency C-section.
Inducing labor is sometimes done when the baby is overdue, or if the babies life, or the mothers life is in jeopardy.
Based on the information in the news article, none of these situations seem to have existed.
After the mad rush to give birth to baby Kathryn, Darling got some more bad news. A bill for nearly $18,000 arrived from the hospital. Even though Darling gave birth before she says she was told her insurance was supposed to run out, the company denied the claim.
The EOB would explain why the claim was denied. Of course it would be too easy for the reporter to do their job and enlighten us.
Instead it would appear that the claim was denied due to lack of medical necessity.
Darling applied for Medicaid while in the hospital. In many states, including Ohio, Medicaid covers medical expenses in special circumstances, such as pregnancy, if the expenses were incurred up to 90 days before the date of application and if eligibility requirements are met.
So you can apply for Medicaid and, if approved, include charges incurred up to 90 days prior. Why would anyone want to act responsibly if they can get the taxpayer to pony up and pay their bills?
Well, in part yes, it does. Let's look at it.
Here is a link to a transcript of the hearing Friday December 12 in which Illinois Attorney General Lisa Madigan argued that the Illinois Supreme Court can, and should, declare the Governor “disabled” and therefore no longer “legitimately” able to carry out his official duties. Ignore her continual abuse of the terms “disabled” and “legitimately”. That is part of a political argument and has no place here.
But read the whole transcript and then consider these two little excerpts:
MS. MADIGAN: “. . . as you are aware, the state of Illinois is behind in paying its bills, in particular to Medicaid providers.”
MS. MADIGAN: “What we have delineated are all of the activities that were contained in the criminal complaint filed by the U.S. attorney . . . based on the apparent refusal to provide Medicaid reimbursement to Children's Memorial Hospital unless he received a campaign contribution from its CEO . . .”
These excerpts provide a revealing glimpse behind the curtains – they show how governmental control of the health care system is turned into political control of graft. It’s not a pretty picture: First step, withhold government funds. Then, extract political favors as a condition for freeing up the flow of government funds. Patients suffer – but hey who cares? You say, this is exceptional? Not representative of politics in general, you say? To which I say, yeah, right. And I also say, if more government control of health care is what you want, more situations like Illinois is what you will likely get. You, and the rest of us along with you.
Friday, December 12, 2008
Thursday, December 11, 2008
They are no longer willing to pay more for first dollar benefits. They are willing to abandon copay's and lower deductibles in exchange for no frills "bare bones" plans. (Shameless plug).
Only 19 percent of employees surveyed this year were willing to opt for higher premiums, compared with 38 percent last year.
That is a seismic shift.
But with this change to more personal responsibility comes good and bad.
The study also found that 66 percent of workers took steps to improve their personal care, up from 61 percent in 2007. However, 17 percent skipped a doctor's visit this year to save costs, and an equal percentage failed to fill a prescription or passed on medicine for the same reason.
I don't survey my clients to see who is "skimping" on care and who isn't. I do know that all of them are pleased with saving as much as 50% on premiums with no noticeable loss of coverage.
Wednesday, December 10, 2008
Worried about your job or how you will pay the bills?
How about a few laughs?
Patton Hyman of Barnet, VT should do stand up comedy.
In reference to Sen. Baucus' proposal for health care reform, Mr. Hyman notes the following.
His reform "will simply [love that word!] preclude insurers from discriminating against those who are sick." This is analogous to saying that property and casualty insurers should be precluded from charging higher rates or denying coverage to (i.e., discriminating against) people who store gasoline in the basement.
Mr. Hyman fails to indicate if the gas hoarder is also a smoker. That info is probably PHI (protected health information).
But he did offer this additional argument.
Properly conceived, "insurance" is a plan for spreading the cost of a known but specifically unpredictable risk. Take fire insurance as an example. I make monthly payments for fire insurance that are a small fraction of the cost of rebuilding my house. That is possible only because a pool of homeowners does likewise, and the insurer can calculate the risk of the occurrence of the casualty and spread the cost over the pool of insureds. However, if I can buy insurance for the same rate after my house has burned, then it's impossible for the premium to be spread, because everybody else can do likewise; in which case, the premiums would have to approach or equal 100% of the loss. Allowing those who are already ill to purchase health "insurance" on the same basis as the healthy is like letting someone buy fire insurance after the house has burned.
So what are you saying Mr. Hyman?
That someone diagnosed with cancer would be unwilling to pay a cost plus premium for their care?
With Sen. Baucus's system, once everybody finds out they can wait to buy insurance until they are sick, watch what happens to the premiums
You mean, like, they might go up?
You are kidding, right?
Well other than the fact the Medicare is broke, I can't think of any reason why they shouldn't expand Medicare.
Except maybe this reason . . .
Glenda Fried had no problem getting her PCP to accept Medicare. Others are not so lucky.
They talked of having to make at least 15 calls before finding a new primary care physician who participated in the taxpayer-funded medical insurance program largely for those 65 and older
Seems docs are willing to take cash, but not Medicare, and sometimes not willing to take ANY insurance.
Phone call after phone call was met with apologetic office mangers saying that Dr. X wasn't taking any new Medicare patients or Dr. Y wasn't taking any type of insurance at all.
Some offices we know say it takes 3 - 4 months to get paid by Medicare. When they do get paid it is not enough to cover the actual cost of the visit. In other words, the docs lose money when they treat Medicare patients.
Health-care experts and advocates for the region's elderly say the problem is partly a reflection of how worried physicians are about changes in reimbursement rates from the federal government. Some physicians say they are afraid of accepting new Medicare patients and discovering later that the amount they receive for treating them will be decreased. Exacerbating those worries are concerns about the slow pace of reimbursement and the layers of paperwork it requires.
And this is a system that Washington wants to expand?
Seems the Emperor has no clothes.
Sometimes the noise is deafening. Of course most of the time the complaints are without merit.
Here is one of those. The New York Times published a report on overcrowding in ER's due to (at least in part) the number of uninsured.
One emergency room doctor in Iowa, Dr. Thomas E. Benzoni, said he recently saw a mother come in with her two children for what he thought was routine care. When he asked her why she had not gone to her family doctor, she said she did not have health insurance.
You don't need health insurance to go to a doc for routine care. This is tantamount to saying you can't get your oil changed in your car because you don't have auto insurance.
“I don’t know what else she was supposed to do,” Dr. Benzoni said.
Here's a thought. Why not pay for the office visit out of pocket?
Certainly much less expensive than paying ER charges for a routine visit. That can turn a $100 office visit into a $500 trip.
Until hospital ER's do a better job of triage, and turning away those who do not truly need emergency care, this problem will only get worse.
It is like the folks who call 911 to get the phone number for Domino's Pizza.
Time to stop coddling these folks and force them to grow up.
Tuesday, December 09, 2008
Or they say they just need something for doctor visits since the don't plan on getting sick.
My response is always, "Go through an emergency room and ask for a show of hands on how many had PLANNED on being there 24 hours ago."
I figure if they can be flip so can I.
The problem is, none of us ever PLAN on having an accident. Otherwise, it wouldn't be called an accident, would it?
And no one PLANS on getting sick . . . especially something like cancer.
Heart disease is still the number one killer, but not for long.
Cancer is closing in.
Globally, an estimated 12.4 million people will be diagnosed with some form of cancer this year and 7.6 million people will die, the U.N. World Health Organization's International Agency for Research on Cancer said in a report.
It is worth noting that is a GLOBAL estimate, not U.S.
U.S. stats may be different, especially the death ratio.
Trends that will contribute to rising cancer cases and deaths include the aging of populations in many countries -- cancer is more common in the elderly -- and increasing rates of cigarette smoking in poor countries.
Apparently those Surgeon General warnings don't appear on cigs sold in poor countries . . .
However, cigarette companies are finding new customers in developing countries. Seffrin noted that 40 percent of the world's smokers live in just two nations -- China and India.
So the Marlboro man is now speaking Mandarin, I suppose.
Decades ago, cancer was considered largely a problem of Westernized, rich, industrialized countries. But much of the global burden now rests in poor and medium-income countries.
Many of these countries have limited health budgets and high rates of communicable diseases, while cancer treatment facilities are out of reach for many people and life-saving treatments are seldom available, Boyle said.
So other countries, like maybe places with universal health care, might not have as many options for cancer patients.
68 percent of the respondents said AIDS was the nation's biggest health woe while 1 percent cited the cost.
Today the worry is about the overall cost of health care.
Concerns about the access and cost of health care far outweigh the worrisome challenges posed by obesity, cancer, heart disease, AIDS and diabetes,
55 percent - said the availability and financial challenges of the entire system
One positive about this survey . . . those polled indicated a worry about the cost of health care, vs. the cost of health insurance.
The two are related, as the cost of health care drives the cost of health insurance.
But this observation caught my eye.
"Health care has never saved a single life. That's more of a theological question. What health care is supposed to do is delay death, overcome disability and pain, and provide medical security
I'm not sure I buy that initial statement . . . health care has never saved a life.
I suppose you can argue the back part of the statement supports the first part. If you save a life it does not mean the individual will never die, so it is true that health care just delays death.
Still, it is a convoluted statement.
In 2007, total national health care expenditures topped $2.3 trillion, or 16 percent of the gross domestic product
But don't overlook this.
providers also suffer; some $60 billion a year in medical bills goes unpaid,
That figure is understated.
The unpaid bills don't include cost shifting. Most bills that are not paid by the patient or a third party are simply added on to the bills of those who DO pay for their care. The rest result in a loss to the provider.
Sunday, December 07, 2008
Health care providers are feeling the squeeze like many others.
Georgia hospitals, doctors and other medical providers are reporting financial pain from an increase in patients who can’t pay bills —- or who postpone care.
That trend stems, in part, from the rise in Georgia’s unemployment rate, which has swelled the ranks of those without health insurance. In addition, many Americans who have insurance face higher deductibles and other out-of-pocket costs, making a medical bill harder to pay.
I understand, but I also have a problem when health insurance is tied to your job.
If money is tight, I understand raising deductibles (which is something that should be done even if money isn't tight). I have difficulty with those who can afford health insurance but simply refuse to buy it. There are people who believe it is the responsibility of their employer to provide health insurance. If they don't have a job with insurance, they don't feel a compulsion to pay for it themselves.
That makes no sense to me.
The recession also has caused more people to cut back on elective surgeries, scheduled procedures and appointments, and prescription drugs, according to surveys and medical professionals.
Again, some of this makes sense, some not.
I can understand postponing elective procedures.
What I don't understand is cutting back on necessary meds.
People will sometimes cut back or eliminate BP or cholesterol meds. They claim they don't feel any different when they skip the meds so they feel there is nothing wrong with skipping the med.
Why not look for a lower price med rather than stopping meds altogether?
Dr. Harry Strothers, a family physician in East Point, said many patients with chronic diseases are canceling appointments or not showing up. He cited a woman who had an abnormal mammogram.
“She has put off seeing a surgeon because she has a 20 percent co-pay to pay,” Strothers said. “She doesn’t have the money.”
Delaying necessary services can cause more problems later, Strothers said, adding that patients are also not filling prescriptions.
“Going without a medication for hypertension, diabetes or high cholesterol will take its toll later,” Strothers said.
Some things are not worth scrimping on.