Less Spending Can Mean Better Care

In calling for reform, President Obama emphasized the critical importance of bringing the soaring cost of health care. To do that, we need to address the underlying causes: a fragmented care system; lack of accountability for the overall costs and quality of care; a payment system that rewards growth and unnecessary care.

Our research, documented in the Dartmouth Atlas of Health Care, shows there are remarkable regional variations in spending. Those differences suggest there are substantial opportunities to improve the efficiency of our health care delivery system while reducing costs.

For example, in 2005, per-capita Medicare spending was $10,988 in Los Angeles but $6,838 in Sacramento; $14,360 in Miami, but $7,008 in Tallahassee, Fla.; $12,119 in Manhattan, but $6,556 in Rochester, N.Y.

If higher spending resulted in better care, this data would suggest that we need to spend more. But higher spending regions don’t provide better care. Ten years of research has shown that lower spending regions of the U.S. achieve equal or better health outcomes and quality

The higher spending — and much of the growth in spending — is due to the provision of unneeded and sometimes harmful care: hospitalizations that could have been avoided with better primary care; frivolous specialist consults; overuse of diagnostic tests. Unnecessary care can be harmful because hospitals are dangerous places to be, especially if you don’t need to be there. And having more physicians involved in your care makes it harder to know who is responsible: too many cooks can spoil the soup.

Aligning those varying costs with better health results will take time. The stimulus package, which includes nearly $20 billion to invest in electronic health records, new research programs, and preventive care, will help — especially if the standards for electronic health records are linked to a requirement that all providers within a region adopt them.

President Obama, at least in the speech, was silent on some central issues: whether he would foster the development of a more integrated and organized delivery system, whether he would modify the payment system to encourage improved quality and lower costs, and whether reform will contain performance measures to reassure the public that lower costs are compatible with high quality care. He will have to answer those questions soon

Source: www.nytimes.com

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Health-Care Spending Slows in U.S. as Recession Curbs Coverage

By Aliza Marcus

Feb. 24 (Bloomberg) — Health-care spending in the U.S. this year will grow 5.5 percent, the least since 1997, as the recession erodes incomes and leaves fewer people with private health insurance, government economists said.

The projected increase, to $2.5 trillion, compares with annual gains of 6.1 percent in 2008 and 2007, the economists reported online today in the journal Health Affairs. The calculations include stepped-up government spending to cover more elderly and poor through programs such as Medicare and Medicaid, efforts that are likely to keep expanding, the authors said.

The U.S. sank into a recession in December 2007, and payrolls have continued to decline. With slower growth in personal incomes, people cut back on filling prescriptions, going to the doctor and having surgery, according to the report.

“The recession has wide-reaching implications for the health-care sector,” Andrea Sisko, an economist at the Centers for Medicare and Medicaid Services, the agency that compiled the data, said in an e-mailed statement yesterday. “Policy makers and the public will be faced with tough decisions regarding the future of the health-care system.”

The slump has pummeled shares of Zimmer Holdings Inc., the world’s biggest maker of artificial hip and knee joints, which forecast Jan. 29 that sales would drop this year. Allergan Inc., maker of the wrinkle-smoother Botox, said this month it was firing 460 sales and marketing workers.

More Coverage

A stimulus measure signed last week by President Barack Obama provides more than $111 billion to bolster private and public health insurance. Obama this week will propose ways to broaden coverage to bring in the 46 million Americans who lack insurance.

Health-care spending will still grow faster than the U.S. economy over the decade, increasing to more than 20 percent of gross domestic product in 2018 from 16 percent in 2007, according to the economists. Government health-care spending will probably more than double to $2.23 trillion in 2018, swelling to more than half of all health spending in that final year of the survey period, the economists wrote.

Obama has warned that the U.S. faces continuing strain on the budget because the costs for programs such as Social Security, Medicare and Medicaid will keep rising as the U.S. population ages. Those programs now consume about 40 percent of federal spending, and White House budget director Peter Orszag said yesterday that the “the path to fiscal responsibility must run directly through health care.”

Medicare, Medicaid

Dealing with Medicare and Medicaid will succeed only by “slowing the overall growth rate of health-care costs,” Orszag said at a White House gathering focused on the strains on the budget.

Generic drugs will probably provide less of a brake on health-care spending costs. Drug spending is expected to accelerate in 2014, growing 8.6 percent by 2018, as new, costlier specialty medicines reach the market, the authors wrote. That compares with an increase of 3.5 percent in 2008.

Source: www.bloomberg.com

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Medical Marijuana, Hospital Laborists and Americans Without Insurance

February 24, 2009

Morning Rounds

 

By RONI CARYN RABIN

 

Expectant Mothers Find a New Face in the Delivery Room

Laborists — hospital-based specialists — are filling in the gaps as a growing number of obstetricians stop delivering babies because of malpractice insurance costs and long hours, the Boston Globe reports. Pregnant women don’t even meet a laborist until they arrive at the hospital to deliver, but some experts say the change will improve safety. Laborists start caring for women on arrival and have defined shifts, so they’re not overworked and fatigued.

Leeches Used to Help Reattach Severed Arm

Surgeons in Australia used leeches to reattach the severed arm of a surfer who was mauled by a great white shark. Agence France-Presse reports that doctors used the leeches to restore blood flow to the injured hand after 33-year-old Glenn Orgias almost lost it; surgeons said they are hopeful Mr. Orgias will regain some of the use of his hand. He was attacked by an eight-foot great white shark on Sydney’s Bondi Beach on Feb. 12.

New Jersey Contemplates Medical Marijuana Law

New Jersey may soon allow patients with cancer, AIDS or other chronic illness to use marijuana for medicinal purposes, becoming the 14th state with a medical marijuana law, NewJersey.com reports. A bill passed by the state senate would allow patients to keep six marijuana plants and one ounce for personal use if diagnosed by physicians as having a debilitating medical condition. Patients would also need to register with the state.

Report: Millions May Lose Health Insurance Next Year

Six million Americans may lose their private health insurance by the end of 2010, and Medicaid spending will jump almost 10 percent to accommodate many of them, government health analysts say. A McClatchy Newspapers report says working-age adults are not the only ones who will be hit; Medicare beneficiaries will also be affected, because they won’t be able to afford to go on purchasing supplemental private policies.

U.A.W. and Ford Agree on Health Benefits for Retirees

The United Auto Workers and Ford have come to agreement on funding health benefits for retirees, creating what could be a model for the other two big U.S. carmakers as they try to fend off bankruptcy, The Washington Post reports. The deal would let Ford pay up to half of its $13.2 billion obligation to retirees with stock instead of cash; union members still must ratify the proposal.

Source: www.nytimes.com

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Institute sees more Americans losing insurance

By Will Dunham

 

WASHINGTON (Reuters) – More Americans will lose their health insurance as the economy weakens, health care becomes more expensive and fewer employers offer coverage, the U.S. Institute of Medicine said in a report on Tuesday.

 

The institute, an independent research organization that advises U.S. policymakers, said safety-net services such as charity care and hospital emergency rooms cannot be relied upon to meet the needs of people without insurance.

 

An institute panel urged the White House and Congress to take urgent steps to ensure all Americans have coverage. The government says 45.7 million Americans, or 15 percent, had no public or private health insurance in 2007.

 

President Barack Obama on Monday announced a summit on health care next week and his budget director said reducing health-care costs was critical to the economy. Obama also was expected to discuss his health-care goals during his address to a joint session of Congress later on Tuesday.

 

“The evidence clearly shows that lack of health insurance is hazardous to one’s health, and the situation is getting worse because of the erosion of employment-based health coverage due to the current economic crisis,” said Lawrence Lewin, a health care consultant who led the institute panel.

 

The government projects the nation will spend $2.5 trillion on health care this year, compared to $912 billion in 1993.

 

Employer-provided insurance has been the cornerstone of private health coverage in the United States, with an estimated 160 million Americans getting their insurance this way.

 

SURGING COSTS

 

But surging health care costs are making it increasingly tough for employers to offer health insurance coverage to their workers, according to the report. And many employers have replaced permanent, full-time jobs with contract, part-time and temporary jobs without health benefits, the panel said.

 

Even when employers do offer health insurance, more employees are declining it because they cannot afford the premiums, the panel said. Between 1999 and 2008, the average annual employee premium contribution for family coverage rose from $1,543 to $3,354, the panel said.

 

“The lack of health insurance coverage for tens of millions of Americans cannot be ignored and should not be a chronic underpinning of American health care — it is in fact treatable and indeed preventable,” the panel wrote.

 

The fiscal crunch threatens to undermine public health care programs, the panel said. With the recession and rising health costs, some states will be unable to sustain recent expansions of programs for low-income children and adults, it added.

 

And increases in unemployment will further fuel the decline in the number of people with employer-sponsored coverage and put additional stress on state Medicaid and children’s health insurance programs, the panel of experts in health economics and policy said.

 

Studies show that people without health insurance wait longer to get important medical care, running up larger bills in the end.

Source: www.reuters.com

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HICAP helps seniors find primary care doctor

By SHANNA MCCORD

SANTA CRUZ — Carol Fuller was approaching 65 and in fine health.

The longtime Santa Cruz resident and former business owner had little reason to visit the doctor in previous years and relied mostly on annual visits to the gynecologist to catch anything wrong.

Just before her 65th birthday, Fuller was surprised to discover that in leaving her private medical insurance provider and becoming a Medicare recipient, she would need to find a primary care physician to coordinate her health coverage from here on out.

Such an endeavor isn’t easy in Santa Cruz County, where many doctors have closed their practices to new Medicare patients because of significantly lower reimbursement rates than other areas.

“It would be really damned impossible,” Fuller, now 66, said about finding a primary care physician. “Because we’re this rural designation reimbursement rate, no physician seems to want to add new Medicare patients.”

Fuller was guided through the complex world of Medicare and landed a primary care physician with the help of the Health Insurance Counseling and Advocacy Program, known as HICAP, a free service operated by Senior Network Services on Capitola Road in Live Oak.

The one-on-one counseling service has offices statewide geared to educate Medicare beneficiaries about their options. The program is funded by the California Department of Aging.

Locally, HICAP helps about 1,000 clients each year navigate the confusing world of Medicare — from simply signing up for the program to specifics like solving bill problems, picking a prescription plan and explaining the various options available.

 

The counselors can also point seniors like Fuller toward local doctors who accept new Medicare patients, though they are difficult to find, HICAP program manager Sally NeSmith said.

It’s particularly tough for seniors who are new to Santa Cruz County to get a doctor’s appointment, NeSmith said. HICAP receives a couple of phone calls each week from seniors new to the area and looking for a doctor.

“We have a very short list of doctors we can give them,” NeSmith said.

But if someone has an established relationship with a primary doctor and doesn’t move, rarely will doctors drop an existing patient after they turn 65 and switch to Medicare insurance.

“It is easier if you already have a primary care doctor,” Fuller said. “But I didn’t have one. I didn’t know.”

Fuller was forced to go with the Medicare Advantage plan to get access to a new doctor.

Medicare Advantage operates like a health maintenance organization in which the doctors are paid a monthly sum for each Medicare patient regardless of how many visits the patient might need. All of the patient’s central medical needs are funneled through the doctor assigned by the plan.

The drawback is that the plan does not cover treatment or doctor visits if you travel or leave the geographical area, NeSmith said.

Patrick Peer, executive director of the Dominican Medical Foundation, said the low Medicare reimbursement rate in Santa Cruz County makes it difficult for many doctors to see Medicare patients and still support their practices.

His foundation, which has about 38 primary care physicians serving patients at seven clinics from Boulder Creek to Capitola, is one of the few places Medicare recipients can find a doctor willing to take them.

“Our foundation wants people with Medicare insurance to have access to good doctors,” Peer said. “We’ve opened access and extended our hours. We hope it’s going to be easier than it has been for seniors to get access.”

Source: www.mercurynews.com

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Sebelius: No talks with Obama about health post

By BETH FOUHY – 1 day ago

WASHINGTON (AP) — Kansas Gov. Kathleen Sebelius, mentioned as a top candidate for health secretary, said Sunday she has not talked with President Barack Obama about joining his Cabinet.

“There really isn’t anything to tell. I haven’t had any meetings about the position,” Sebelius, 60, said in an interview with The Associated Press during the winter meeting of the National Governors Association.

Pressed on whether she had spoken to Obama about heading the Health and Human Services Department, Sebelius said, “I have not.”

Sebelius’s name surfaced when former Senate Majority Leader Tom Daschle, Obama’s first choice for health secretary, withdrew after disclosing he had failed to pay $140,000 in taxes and interest.

Sebelius was an early Obama backer during the Democratic primary contest and a frequent surrogate to women’s groups. She was a finalist for Obama’s running mate and was mentioned as a Cabinet possibility after the election but withdrew from consideration in December, citing Kansas’ budget problems.

Administration aides say no decision has been made about filling the health post and they continue to review candidates. Sebelius remains near the top of the administration’s list, but aides are using extreme caution to avoid yet another embarrassing mistake.

Sebelius served as state insurance commissioner before being elected governor in 2002. Under her leadership the state has expanded cancer screenings, allowed more residents to keep their health insurance up to 18 months after leaving their jobs and granted income tax deductions to help some lower their insurance costs.

Still, many of her health care reform efforts have been thwarted by the Republican-controlled Kansas Legislature. In the interview, the Democratic governor defended her record and said that despite some setbacks, she had been able to make several improvements to the state’s health care system.

“I think we’ve made a lot of heath care progress across the board,” she said, citing advances in health information technology, childhood obesity reduction and care for older people.

But, she acknowledged, “We haven’t gone as far as I would like in expanded coverage. I’d like to move farther to cover more Kansans.”

Sebelius has been mentioned as a top Senate prospect in 2010, when Republican Sam Brownback steps down. She deflected a question about the Senate race, saying she loves being governor.

“You know, everybody has lots of plans for me,” Sebelius said, laughing.

Source: http://www.google.com/hostednews/ap/article/ALeqM5h702UpSGq2AIfQKoN_karkJtZ5hQD96GPLOG0

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Obama wants to overhaul health care; can he do it?

By RICARDO ALONSO-ZALDIVAR – 2 days ago

WASHINGTON (AP) — Now for the hard part.

Even if the national credit card is maxed out and partisanship remains the rule for Washington’s political tribes, President Barack Obama and Congress are plunging ahead with a health care overhaul.

This week, Obama will start the dialogue on how to increase coverage, restrain costs and improve quality.

Whether a bill can get through Congress and to Obama this year is uncertain. For half a century, the track record on health care has been one of missed opportunities, spectacular failures and hard-won incremental gains.

Obama plans to stress the need for major changes in his address to Congress on Tuesday, administration officials say. He quickly will follow up with a budget that includes a commitment to expand coverage for the uninsured. A White House summit on health care is being planned in coming weeks.

“They don’t intend to blink. They intend to plow ahead,” said health economist Len Nichols of the nonpartisan New America Foundation. “Health reform is seen as essential to balancing the federal budget and economic recovery in the long run.”

People in the U.S. spend $2.4 trillion a year on health care, or about $7,900 per person. That’s more than twice as much per capita as in other advanced countries. But few would claim those dollars are buying good value. The costs are a staggering burden for taxpayers, employers and families, and the recession is leaving more people without insurance.

Yet even a self-described optimist such as Sen. Mike Enzi, R-Wyo., says he has doubts about prospects for overhauling health care. “It needs to be done up front and quickly,” said Enzi, the senior Republican on the Senate Health, Education, Labor and Pensions Committee. “I’m not so sure that we haven’t already lost that, with so many other things coming in and weighing us down.”

In the 1990s, President Bill Clinton took the better part of a year to deliver a 1,300-page health care bill to Congress and later waved his veto pen at lawmakers who might have given him half a loaf. He got nothing. Obama has shown a tendency to be more pragmatic.

Administration and congressional officials say Obama will lay out a vision and see if Congress can make the details work. The Senate has gotten an early start and is shaping up as the proving ground for legislation.

“The Obama administration has said they are going to give the Senate a very wide berth,” said Sen. Ron Wyden, D-Ore., who for years has tried to get Democrats and Republicans working together. “There are areas in which there is going to be spirited debate. But there are four or five major areas where there’s a lot of common ground.”

Polls show most people support coverage for all and believe government should help guarantee it. But what looks like consensus starts to break down once thorny details such as costs and the government’s influence on the doctor-patient relationship come into the picture.

Administration officials say Obama has made a down payment by expanding coverage for children of low-income working families and by providing subsidies to help people who lose their jobs keep health benefits.

As he moves forward, Obama will follow the plan laid out in his campaign.

It calls for government, employers, families and individuals to keep sharing financial responsibility for health care. The approach would overhaul the health insurance market, particularly for self-employed people and small businesses. It would set up a national insurance purchasing “exchange” through which people would be guaranteed access to private health insurance or the choice of a new public plan.

Obama sees coverage for all as a goal to be reached in steps. His plan would not require every individual to purchase insurance. The estimated cost is about $90 billion a year, to start with.

The plan might sound simple in a brief summary, but it’s not. Potential dealbreakers lurk at every turn.

Many liberals can’t get excited about doing battle for just a promise — not an immediate guarantee — of coverage for all.

Conservatives and insurance companies fear that a public plan offered to workers and their families could become the gateway for Canada-style government health care for all.

Employers, hospitals, doctors, and drug companies worry that the government’s already pervasive influence in health care will become stifling.

The initial work has fallen to the Senate, where Democratic Sens. Max Baucus of Montana and Edward Kennedy of Massachusetts want to present a bill by the summer.

Baucus is chairman of the Senate Finance Committee, which oversees Medicare and taxes. Kennedy, who is under treatment for brain cancer, leads the Senate health committee. He has pursued the goal of coverage for all his entire career and doesn’t want this opportunity to slip away.

Baucus has already outlined a plan that differs in some key details from Obama’s. For example, it contemplates taxing some health insurance benefits to raise money for expanded coverage. That’s an idea Obama has rejected but one that certain Republicans favor.

It takes 60 votes to get a bill through the Senate, and Democrats don’t have them.

In the House, the effort seems to be moving more slowly. Senior aides from leadership offices and committees are talking. Rep. Henry Waxman, D-Calif., chairman of the House Energy and Commerce Committee, is expected to take a leading role.

Some experts believe the issue is too complicated to try to accomplish in one year and one bill.

Watching and waiting are people such as Robyn Perry, 56, of Lake Worth, Fla., who recently lost a job with health benefits. She has struggled to find coverage now that she is self-employed. Private plans are either too expensive or won’t take her because she had a ministroke several years ago. A plan sponsored by local government accepted her, but won’t cover her outside her county.

“Something has to be done,” said Perry. “I work. I make decent money. But I still can’t get coverage. I would really like to find a normal health insurance plan that would cover me wherever I get sick, not just in Palm Beach county.”

Source: http://www.google.com/hostednews/ap/article/ALeqM5ivh-kZpIdQGiIEHc1LIAu4q9ecXAD96G0BH00

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Economic Stimulus Package Increases Affordability, Accessibility of Health Insurance Under COBRA

Economic Stimulus Package Increases Affordability, Accessibility of Health Insurance Under COBRA

      A provision in the recently enacted economic stimulus package that would provide federal subsidies to help cover the cost of health insurance premiums under COBRA will make the program more affordable and accessible, the Wall Street Journal reports. Under the provision, workers involuntarily terminated between Sept. 1, 2008, and Dec. 31, 2009, and whose annual incomes do not exceed $125,000 for individuals or $250,000 for families qualify for subsidies to cover 65% of the cost of health insurance premiums under COBRA for as long as nine months. According to the Journal, the subsidies “should make it easier for people to protect themselves not only from ruinous medical bills, but also from the inability to get new insurance due to a pre-existing medical condition.”

The stimulus package also includes a provision that allows recently unemployed workers who participate in COBRA to switch to less-expensive health plans, provided that their former employers offer them, before the open enrollment period begins. The provision could “help some people who chose the more-expensive health care plans offered by their employers when they had their jobs,” the Journal reports.

However, some employers raised concerns that the provisions will increase administrative and other costs. John Goodman, president of the National Center for Policy Analysis, said, “The new law will impose very large costs on employers” and “make it more expensive for employers to provide health insurance.” He added, “And for those who do, it will make it more expensive to hire new workers” (McQueen, Wall Street Journal, 2/19).

Stimulus Package Unlikely To Prevent State Spending Reductions
The $150 billion included in the economic stimulus package for states over the next two-and-a-half years likely will not prevent tax increases or spending reductions for health care and other programs, as states likely will continue to face large budget deficits after they use the funds, according to a report released on Thursday by the Nelson A. Rockefeller Institute of Government, the New York Times reports.

According to the Times, at least 46 states face budget deficits, and many “governors are being pressured to put off unpopular spending cuts or tax increases by interest groups who cite the large sums of federal aid that are on the way.” In New York, for example, advocates have asked Gov. David Paterson (D) to use funds from the stimulus package to prevent proposed spending reductions for health care programs.

However, according to the report, states “should use the breathing room provided by the stimulus package to mute and spread out spending cuts and/or tax increase they will need to make, to restructure programs and to allow for orderly decision making” (Cooper, New York Times, 2/19).

Opinion Piece
“The best thing that can be said for” the economic stimulus package “is that it will help state and local governments avert financial disaster,” Washington Post columnist David Ignatius writes. The effects of the current economic downturn on state and local governments are “severe and immediate,” as states, which face large budget deficits, likely will have to “raise taxes or cut spending — both of which could make the downturn even worse,” Ignatius writes. According to Ignatius, at least 28 states have considered spending reductions for health care programs, and 22 have considered reductions in services for elderly or disabled residents (Ignatius, Washington Post, 2/19).

Source: www.kp.org

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Will Americans Ever Get Their Health Care Reform — And Why I Suddenly Feel Very Lucky to have AIDS

Who would have ever guessed that anyone would say they felt lucky to have AIDS? As many Americans leave the land of financial over-hype and find themselves back on the ground trying to deal with the their new fiscal reality, it makes me realize that I got my proverbial shot in the arm years ago with my AIDS diagnosis. Once you enter that room, you immediately know that life as you once knew it will never be the same again. And I can tell you that is not necessarily a bad thing.

I learned years ago how to juggle my finances in order to make sure I always had enough money to pay for my health insurance. In 1999, when I was 36, I purchased an individual health insurance policy through Blue Shield of California. The policy offered a $1,000 deductible, a rather reasonable co-payment maximum and high life time maximum. It also included a $50,000 life insurance policy. For this, I paid just under $90 per month. Now, ten years later, and at age 46, I pay nearly $500 per month. Blue Shield also doubled the deductible along the way, offering to allow me to go back to my original one, but that would mean reapplying for insurance- and you could guess the answer I was going to get.

Please let me explain – I am not here to knock Blue Shield of California. They have been, in spite of the price increases, rather wonderful to me. When I arrived home from the hospital, after a twelve-day stay that cost just under $100,000 to them, I received a call from Blue Shield. I was scared to return it, thinking that they were calling to say that my policy was canceled. Instead, the nurse was calling to see if I was okay and if I needed home health care assistance. I said, no, but thanked her for the offer. I instantly told my friends about this – thinking that it was great that they had my best interest at heart. And I have to say, they usually do.

There was another time Blue Shield came through for me. After my hospital stay, I thought I had gotten through the worst part , but could not have been more wrong. Three weeks after leaving the hospital, I was diagnosed with KS – Kaposi’s Sarcoma – an AIDS related cancer. My oncologist suggested three possible treatment protocols – radiation, chemo, and this very, very new drug – Panretin Gel. She said that the Gel was her preferred choice, but that it was so new most insurance companies did not cover it. I contacted Blue Shield – not only did they cover it, but the co-payment was only $25. The Gel’s full price was $2800 per tube. It was worth every single penny, for what was left of the cancer literally melted away nightly.

I read these stories in the media of people not being able to afford their COBRA payments and their mortgages. The upside to having AIDS was that I was never able to afford that sub prime mortgage, I didn’t have a home to get a line of credit on, didn’t take multiple vacations a year which maxed out my credit cards, for I was too busy trying to stay alive and figure out how to pay for my medical bills. I learned this entire set of skills that most Americans now have to acquire very quickly. I knew years ago that keeping up with the Joneses was not just no longer on the table, but not good for my health. I also learned that in order to stay alive and be healthy, I had some choices to make, and that included not going on vacations, and not buying that condo that seemed like such a good idea at the time, and always making sure that I had money for my health insurance and other related medical expenses.

I learned what mattered most to me what how I felt about myself and what I did, and that the part of my life that meant the most to me was and remains my family and friends. I learned that having someone say your name during a thank you speech at an televised awards ceremony is nothing compared to hearing your nephew say your name for the first time. I learned that being considered the “fun” adult by my nephews is way better than a week on a beach in Hawaii at a five star resort. I learned that taking my nephews to museums in New York beats going out to the clubs with friends any day of the week. I learned that just being able to get out of bed on my own means it is going to be a good day, no matter what else happens.

So I understand when working America finally has to deal with these choices. I get when people are concerned that they are not going to be able to afford their home and their health care at the same time. What I don’t get it why we cover seniors and children but not the people that take care of them? How are we supposed to make sure that our oldest and our youngest get the best care possible, when the people who will have to take them to these medical appointments do not get even halfway decent coverage – if any at all.

What I also don’t get is why are we increasing the taxes on cigarettes to pay for this new children’s health program? The Federal taxes on cigarettes went up to $1.00 per pack to pay for the SCHIP. Is that an homage to President Obama’s tobacco habit? Are people being encouraged to smoke in order to pay for their children’s health care? In the famous words of Andy Rooney, “I just don’t get it.”

What I really don’t get is that in a blink of an eye we can save a bank but we cannot save the human capital that is deep inside the bank. We do not even have on the table a conversation about the workers at the bank — we only keep discussing toxic assets and their devastation upon America. What about the toxic asset that a HMO is and its effects on America? What about the effect we have on human potential when Americas are considered nothing more than loss centers for their health insurance, and are constantly denied access to treatments that could easily save them and put them back in the workplace, contributing to our society once again.

Unfortunately, I believe that after this Stimulus package goes through, there will be little left for health care reform. As Maslow clearly stated, man’s basic needs are food, shelter, and clothing. Having good health was not on the bottom of his pyramid. Apparently having a working digestive system in order to take full advantage of the food was not going through his mind.

I also think that Washington politics will continue as usual with health care reform turning into an Agatha Christie novel – Ten Little Health Care Plans. Right now, Senator Baucus is the one seemingly left standing, but that could easily change. Senator Clinton was taken out of his way with her appointment as Secretary of State. Senator Kennedy is also about to be taken off the game due to his own health issues. Senator Daschle was conveniently removed for being seduced by perks. Senator Daschle got caught up in this before and lost his Senate seat due to some rather strong commercials that showed him driving around Georgetown in his Jaguar, leaving the values of South Dakota behind. Once again, it is a car that tripped up the Senator.

Last year, Senator Baucus released a plan entitled “Health Care Reform 2009″, outlining his ideas for policy change. It is nothing new – and actually very similar to the previous plans outlined by other Democrats, so getting it through Congress should be an easy thing. There is just that one detail left – paying for it. However, given what we know about Senators, Baucus is going to fight hard to make sure his name is leading the way on the health care reform act, whatever year it may actually happen.

America, let me welcome you to what those of us with chronic diseases have known all along. Each day is a precious gift. Tell the people you love that you love them every chance you get. And health care is America is an oxymoron.

Source: http://www.huffingtonpost.com/thomas-delorenzo/will-americans-ever-get-t_b_167950.html

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Ten ways to cut your medical bills

KHQ-TV updated 7:43 p.m. PT, Tues., Feb. 17, 2009 Twyla and Robert House have excellent health-insurance coverage but after Robert was hospitalized twice within eight months, they ended up owing more than $6,500 in out-of-pocket medical expenses. The Little River, S.C., couple dutifully paid a portion of the balance each month until they whittled it to about $2,000. At that point, they decided to try a new tactic. Robert offered to pay off his bill in a lump sum if the hospitals would give him a discount. “We had an extra $1,300 in savings,” says Twyla. “Robert told them, ‘This is how much I have, and if you want your money, or at least a big chunk of it, you’ll cut me a deal.’” The gambit worked. The hospitals agreed to deduct more than $650. The Houses used the same strategy last year when their daughter, Elena, had gallbladder surgery. As soon as they received a bill, Robert asked for a deal. He rejected the initial offer to knock off 15% and held out for the same 25% break he had received before, shaving about $400 off the bill. Your out-of-pocket share of a hospital bill can be a budget buster, and now health insurers are passing along even more of the costs. For example, many are raising deductibles, and some are switching from co-payments (such as $20 per doctor’s visit or per prescription) to a co-insurance system that makes policyholders liable for a percentage of the total bill. Over the past five years, for instance, 70% of Cigna insurance policies have shifted from co-payments to co-insurance.

By comparison-shopping and negotiating the best price — the same tactics you would use for any other major purchase — you can trim your bills. “You have to wonder why some people don’t give the same time, effort and attention to their health-care costs as they do to other major financial decisions,” says Tom Bridenstine, the managed-care ombudsman with the Virginia Bureau of Insurance, who helps consumers with health-insurance issues.

Evaluating health-care services based on price doesn’t mean you’ll sacrifice quality. And you’ll find plenty of help from employers and insurers, who also benefit from lower costs. The following tactics will help you save hundreds, if not thousands, of dollars on your medical expenses.

1. Ask for a price break. Follow the strategy the Houses used. Each hospital has its own rules about negotiating bills, but it doesn’t hurt to ask. The same goes for doctors and other health providers. (For more on how to cut a deal, see Save Thousands on Your Medical Bills.)

2. Pick the appropriate facility. Where you go to receive care can make a huge difference in your costs. Emergency-room visits tend to cost $300 to $1,000, compared with $150 at an urgent-care center, $65 to $75 at a doctor’s office, and $35 to $45 at a convenience-care clinic. With a 20% co-insurance charge, that trip to the emergency room could cost you $200 versus just $7 for a visit to a convenience-care clinic. For non-emergencies, it pays to call your insurer’s 24-hour advice hotline for guidance on where to go for care. Make sure the facility and provider are in your health plan’s network.

3. Use online tools to compare costs. Insurers are making it easier to compare hospitals and providers based on quality and cost. And pricier doesn’t always mean better. “Hospitals with low complication rates and high survival rates tend to have lower costs,” says Jeffrey Kang, Cigna’s chief medical officer. Companies such as Cigna and Aetna have integrated Web tools that let customers search by ailment (such as diabetes or wrist pain), then find appropriate local doctors, including an assessment of their fees and quality of service. In certain areas, Aetna includes specific fees for up to 600 procedures.

4. Compare prices for tests at hospitals as well as free-standing imaging centers, which tend to charge a lot less. “One MRI facility may charge $500 for a scan, and a block away, another charges $1,500 for the same service,” says Kang. “But the quality of care is pretty much the same.” And it’s easy to calculate the cost of routine care. For example, MinuteClinic, located in CVS Pharmacy stores, charges $69 for treating strep throat and $59 for a child’s summer-camp physical (see the rate list for common treatments at www.minuteclinic.com).

5. Save on prescription drugs. You can save big money by switching to generic drugs, which tend to cost 30% to 60% less than brand-name equivalents, according to UnitedHealthcare. If a generic isn’t available, you may be able to switch to a “therapeutic alternative,” a similar drug that costs less. Most insurers now have Web tools showing the cost of all drugs — brand names and generics — that provide similar results, including the total price, as well as the amount you’ll pay under your health plan.

If your insurer’s site doesn’t have those tools, visit DestinationRx’s Web site (www.drx.com) and use the Medicine Cabinet feature to compare prices for similar drugs and specific pharmacies in your area, as well as online and mail-order pharmacies that tend to be cheaper. (For more on paying less for drugs, see Save Big on Prescriptions.)

6. Take advantage of free services. Insurers save money when you stay healthy, and many now provide free preventive care, such as annual mammograms and Pap tests for women in certain age groups, plus regular screenings for colorectal and prostate cancer.

7. Make the most of discounts. Many insurers offer discounts on services to promote healthy lifestyles, such as gym memberships, smoking-cessation and weight-loss programs, chiropractic service and acupuncture.

8. Sign up for employer incentives. To save money on medical costs, many employers are offering premium discounts, contributions to health savings accounts and outright cash incentives to employees who sign up for a wellness program or health assessment. Some also offer perks to people with, say, asthma, lower-back pain or diabetes for enrolling in a disease-management program, says Steve Kaczmarek, an actuary with Milliman, a consulting firm with expertise in health-care and employee benefits.

9. Review your bill. First, make sure you are charged the proper rate. Bridenstine says people with high-deductible policies who pay the full amount for many health-care services out-of-pocket (until they satisfy their deductible) are often mistakenly charged the more-expensive, uninsured rate rather than the rate that the insurer negotiates with health-care providers. Then, verify that all of your eligible out-of-pocket payments are credited toward your deductible. Finally, check whether you must meet separate deductibles for in-network and out-of-network services.

10. Play by the rules. As soon as you get your health-plan documents, review the procedures for receiving emergency care. Ask whether you need to call for approval or notify the insurer within a certain time period. If your emergency-room claim is denied, you may be able to win on appeal if you can show that you called your insurer’s 24-hour advice hotline first, says Bridenstine. Keep records of your discussions, get an itemized copy of your bill and submit your appeal in writing. If you need help, contact your state insurance regulator, which you can find from the tool column on our insurance center.

Source: www.msnbc.msn.com

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