Wednesday, September 30, 2009
New York Times / September 29, 2009
ST. PAUL - In more than a dozen statehouses across America, a small but growing group of lawmakers has been pressing for state constitutional amendments that would outlaw a crucial element of the health care plans under discussion in Washington: the requirement that nearly everyone buy insurance or pay a penalty.
Approval of the measures, the lawmakers suggest, would set off a legal battle over the rights of states versus the reach of federal power, an issue that is, for some, central to the current health care debate but also one that has tentacles stretching into a broad range of other matters, including education and drug policy.
Opponents of the measures and some constitutional scholars say the proposals are mostly symbolic, intended to send a message of political protest, and have little chance of succeeding in court over the long run. But they acknowledge the measures could create legal collisions that would be costly and cause delays to health care changes and could be a rallying point for opponents in the increasingly tense debate.
The groundbreaking 2006 law in Massachusetts requires nearly everyone to have health insurance or pay a tax penalty of as much as $912 a year, though there are exemptions for financial hardship.
In Arizona - with help from Dr. Eric Novack, an orthopedic surgeon who says his intent was not “some grand secessionist plot’’ but a health care overhaul with protections for individuals’ rights - an amendment first went before voters in 2008. The idea lost, but by fewer than 9,000 votes among more than two million cast. This year, Arizona’s Legislature, dominated by Republicans, voted to send the question back to the ballot in 2010.
read whole article here
Thursday, September 24, 2009
American Airlines to end health plan for non-union retirees
12:00 AM CDT on Wednesday, September 23, 2009
By TERRY MAXON firstname.lastname@example.org
American Airlines Inc. has notified its non-union retirees that the carrier will no longer pay for health insurance coverage for retirees past age 65.
The health plan, which ends Dec. 31, covers retired company officers, managers, specialists and support staff as a supplement to the Medicare program.
Unions representing pilots, flight attendants and other American employees have contracts that provide for company-funded retiree medical insurance.
The airline established the program for non-union employees in 1990 to shift some costs away from the carrier and onto employees.
Latham said that under its benefit programs, American had the right to make changes at its discretion.
Phil's comment: Even though American retirees are losing "their insurance" they still have their primary Medicare coverage which is A PUBLIC OPTION. By adding a medicare supplement plan such as Supplement F they will still have 100% no deduction coverage
Tuesday, September 22, 2009
Phil's comment. There has been so much misinformation and emotionally charged rhetoric surrounding this countries health care system and our effort to improve it that it seems an impossible task. Yet there has been a bill simmering in congress since 2007 that has large bipartisan support it is called the "Healthy Americans Act" . Click on the link below for a full coverage of the act described on Wikipedia.
Healthy Americans Act
Monday, September 21, 2009
Ramnik Dhaliwal, third-year medical student pursuing JD/MD at the University of Colorado Denver Medical School and CU Law School
YR: How would you like to see health care coverage run in this country--do you fear the 'socialized medicine' scenario?"
Dhaliwal: If you look at the statistics right now, the government, whether federal or state, and taxpayers are already one of the largest providers of health care in this country. Programs like Medicare, Medicaid, and CHIP [Children's Health Insurance Program] are all government run and funded. I believe that creating a scenario where the government drives the competition will not only allow more to be covered, but also will help drive prices down as private insurance companies will be forced to decrease costs through streamlining and becoming more innovative to be able to compete with the government programs.
Currently, insurance companies have no incentive to change. They are making billions of dollars in profit with a system that is so inefficient. Health care does not follow the normal economic model of supply and demand where increased demand brings in more players. Because the initial cost of starting an insurance company is so high the big players that have always been there pretty much have a monopoly.
Doctors are unable to really negotiate a great deal because any way they look at it, they must accept the insurance companies' demands since they are the only ones offering the product, which in this case is payment for [medical] services.
Everyone fears such large changes, but without change we will just run further into debt and more Americans will be unable to obtain needed medical care without incurring devastating debt.
read whole article here
Friday, September 18, 2009
State Senator for SD 29 in Aurora, Colorado
Posted: September 15, 2009 12:38 AM
Nope. Not according to the Colorado Association of Health Plans and the Colorado Association of Insurance Underwriters.
Here's what we know:
* Gender rating has been a prohibited practice of gender discrimination in the small and large group employer-provided insurance markets since the Civil Rights Act of 1964 as confirmed by the United States Supreme Court.
* Women are charged as much as 30 - 40% more than men for the same coverage in individual health insurance plans.
If a person does not have access to health insurance through their employer and they are not otherwise legally indigent, the only place he or she can get coverage is in the individual health insurance market where:
* They can refuse to underwrite people (for any price) for pre-existing conditions (and some carriers count pregnancy as a "pre-existing condition").
* The rates are already significantly higher than in the small or large group market.
* The more the individual health market fails women the more uninsured women and children we have at a greater cost to the system.
Wednesday, September 16, 2009
Monday, September 14, 2009
Only four percent remain uninsured since Massachusetts' 2006 health reform initiative began.
Modern Healthcare (9/14, Rhea, subscription required) reports, "Massachusetts' three-year-old healthcare reform effort has helped the state achieve near universal coverage with just 4 percent of state residents 18 to 64 years old remaining uninsured," compared to a national average of "20-percent uninsured," according to a study sponsored by BlueCross BlueShield of Massachusetts Foundation, the Commonwealth Fund and the Robert Wood Johnson Foundation. "Adults with incomes less than 300 percent of the federal poverty level -- $10,991 for a single person -- experienced the greatest gain in coverage" and saw its "uninsured rate drop to 8 percent from 24 percent." At the same time, "employer-sponsored insurance coverage also continued to grow with more than 70 percent of nonelderly" covered through employers. Notably, the study also found that "72 percent of state residents" were satisfied with the progress made under the Massachusetts' plan.
By Anne Underwood AND Sarah Arnquist
Excerpts from an interview with Victor Rodwin Highlighting Europes best liked HealthCare system
Victor G. Rodwin is a professor of health policy and management at the Wagner School of Public Service at New York University and co-director of the World Cities Project.
In 2000, the World Health Organization ranked the French health system as the best over all in the world. Do you agree?
I question the W.H.O. methodology, which has serious problems with data reliability and the standards of comparison. A study I would take more seriously is one published last year by Ellen Nolte and Martin McKee in the journal Health Affairs.
That finding implies that the French have good access to health care. Do they?
On most measures, they do. They don’t do a better job of cancer screening than we do. But when it comes to timely access to primary care, the French are superb.
As I understand the French health care system, doctors are private, but patients are enrolled in national health insurance. Is it sort of like Medicare for all?
Very much so. It’s not government run but government financed. Like Medicare and Social Security, it is funded by compulsory payroll taxes with some income tax contributions. But doctors work predominantly in private, office-based, fee-for-service practices, and there is a mix of public
Almost the entire population has some degree of private supplementary insurance, too, much like Medigap policies
So it’s not a single-payer system.
That’s correct, but it operates much like one. In France, nobody has a choice of insurer for basic coverage. There are three major plans — one for most people who are employed (77 to 78 percent of the population), a smaller one for agricultural workers (4 to 5 percent), and another small one
If the French system resembles Medicare, does that mean that it also faces the problem of rising costs?
Yes, all health care systems face the pressures caused by expensive new medical technologies and prescription drugs. Since there are no enforceable budget ceilings on French national health care expenditures, annual increases tend to exceed spending targets.
How do they control health care costs?
Three ways. First, the government negotiates prices for doctors, hospitals and prescription drugs. Second, France has far fewer private health insurers, so the system requires less expenditure on administrative costs for marketing, underwriting and managing complex reimbursement rules. Third, France’s investor-owned insurance sector is far smaller than in the United States, and its medical-industrial complex is far less powerful, so the government can negotiate stronger cost controls.
But you also said the French have no choice in their plan. Americans seem to want choice.
The French have no choice among insurers for the basic plan. But French National Health Insurance gives them more choice of doctors and hospitals than the average American has.
Medical malpractice has become an issue now in the debate over health care reform in this country. How much of every health care Euro in France goes to pay for malpractice costs?
I’ve never seen such an estimate, but even in the U.S. this figure is much smaller than people generally believe — less than 1 percent of health care expenditures.
What key lessons can the United States learn from France?
The French health system demonstrates that it is possible to achieve universal coverage without a government-run system that regulates how doctors practice medicine.
read the whole article here
Friday, September 11, 2009
Excerpts from a New York Times Health article
By PAULINE W. CHEN, M.D.
Published: September 10, 2009
I was born, raised and live in the United States, but recently a neighbor asked me, “What are you?”
As the daughter of Taiwanese immigrants, [I]was not, at least in his eyes, entirely American.
“Well,” I said, “tell me first, what are you?”
“I’m an American!” he replied without a moment’s thought. But then he asked once again, “So what are you?”
According to Dr. Allan S. Brett, a professor of medicine and bioethicist at the University of South Carolina, politicians and pundits from both sides of the aisle are now doing the same, using incorrect beliefs about “American values” as a smokescreen in the health care reform debate.
Dr. Brett writes, “[T]he underlying premise is that an identifiable set of American values point incontrovertibly to a health care system anchored by the private insurance industry"
I spoke to Dr. Brett recently ...
Q. What assumptions do public figures have when they use the term “American values”?
A. They assume several things. [pick any american and you can]make an inference about what their views will be and what they deem important . But anyone with his or her eyes open knows just how heterogeneous we’ve become in this country.
The concept of American values is used to tell people what they should be wanting rather than objectively trying to understand what Americans are all about.
Q. What about freedom of choice in health care? Isn’t that uniquely American?
A. There are three types of choice in health care.
First your choice of your preferred physician. But a single-payer system, for example, does not necessarily change that, since all the facilities and practices as we know them today are left in place. In fact, if you take away all the insurance restrictions we have today on whom you can see, your choice is increased.
second is the freedom to choose a health care plan. What people really want is a user-friendly system to get what they need.
Finally, third choice has to do with deciding on whatever tests and treatments you might want as a patient. [T]hose choices affect cost. [The]pendulum has swung toward patient autonomy — which is a good thing — doctors sometimes feel they must give patients whatever they want. That has led to a huge proportion of money being spent on care that is not only marginally beneficial but is also of no benefit at all. I think that if we had a way to eliminate that — which means using our clinical decision-making skills and saying no when appropriate — we would have more money to spend on care that does matter and that makes a difference.
No matter what system we ultimately decide upon, there will have to be mechanisms in place to insure that we spend money wisely.
Q. So is there anything that is uniquely “American” about our way of approaching health care?
A. Yes. We are unique almost worldwide in that we deny health care coverage to a proportion of our population. [T]he important thing is to get health care right and not to harp on the uniqueness of the system we come up with.
Q. How would you envision a health care system that is imbued with “American values”?
A. In virtually every opinion poll conducted in recent years, a majority of Americans favor government guaranteed health insurance. [T]hink of such a system as “Medicare for all.”
[T]here would be hard choices, and not everyone would be happy. But we might come closer than we are to representing the interests of most Americans.
Read the whole article here
Tuesday, September 8, 2009
Health Care: What's on the Table, What's Ahead
By JILIAN MINCER
It's been a summer of discontent . And when Congress reconvenes this week it has its work cut out.
A possible overhaul has been hotly debated in town-hall meetings and bogged down in committees. So President Barack Obama is expected to lay out new details of the administration's proposal.
Four of the congressional committees responsible for health-care legislation approved proposals. The three House committees still have to merge those bills for a House vote. The Senate has one committee bill proposed.
Much of the debate is over how to pay the estimated $1 trillion price tag. There also is disagreement over a public option for coverage.
Despite the confusion and contentious atmosphere, there are some issues that most sides appear to agree on.
Lawmakers agree there need to be subsidies to help families pay for health coverage if it's not available at work.
Mr. Altman says there is consensus that the legislation should include provisions ensuring that insurers don't deny anyone coverage or charge significantly higher rates because of pre-existing medical conditions.
Insurers already have agreed to many of these changes, as long as the legislation requires that all people have coverage.
"If you're in the employer system, there wouldn't be much change" to your insurance, says Kathryn Bakich, a senior vice president at consulting firm Segal. "But in the individual market or [small-business] market would see significant changes in their ability to get insurance, how much it would cost"
Mike Langan, a principal at consulting firm Towers Perrin, says, "I don't see the legislation having a negative impact on the quality of care." That's because the majority of Americans still get their health insurance from their employers.
Who Gets the Bill?
A big area of disagreement is how to foot the bill. President Obama and congressional leaders don't want the health-reform plan to add to the deficit over a 10-year period. The largest potential cost would be the subsidies to the uninsured, according to the Kaiser Family Foundation.
The House has proposed that the additional revenue come from cuts to certain Medicare services and additional taxes on affluent families.
There also is a lot of disagreement over whether to include a public plan as an insurance option for those who need to get coverage. Some groups oppose the idea because they say it would destabilize employer coverage.
Mr. Langan of Towers Perrin thinks that in the end there will be a law this year. But he warns that "it will take several years to implement."
See whole article here
Copyright 2009 Dow Jones & Company, Inc. All Rights Reserved
Saturday, September 5, 2009
Republicans and Democrats have been trying to pass health care
Legislation for many years, as a result, politicians and media
often assume citizens are familiar with the ongoing legislative
buzzwords associated with it. Below is a glossary that will help
you become fluent in the language of health care:
The Exchange A "marketplace" created by the legislation in which
individuals could comparison-shop for insurance plans overseen by the
government . Plans offered within this exchange must meet certain
basic standards, to be determined by an "expert panel" (see below) It's
still unclear on which level these exchanges would be offered e.g.
national, regional, statewide, etc.
Single-payer System Sometimes called "Medicare for all" a system
in which one entity (typically the government) arranges payment for
everybody's medical care. This is in contrast to the multiple health
insurance companies that now assume this task. Advocates of a
single-payer system say it would simplify paperwork, eliminate
administrative costs and more easily achieve universal coverage;
opponents call it "socialized medicine.
Public Option Also called a "government-run plan," this
government-sponsored insurance policy would be offered alongside
private plans within the "exchange" (see above). The goal would be to
insure a greater number of Americans by offering more choices and by
setting reimbursement rates for doctors and hospitals – which could
also prompt insurance companies to compete more fairly and cut
premium costs, proponents say.
Co-ops Senate Budget Committee Chairman Kent Conrad (D-ND) has
proposed "health cooperatives" as a compromise/alternative to the
public option. Like the public option, these co-ops would be nonprofits
and would compete with private plans within the exchange. But the key
distinction is that they'd be "owned" by members, not the government
(although the government would likely provide initial start-up help).
Universal Health Care A situation in which everyone has medical
insurance. This is difficult to achieve without a single-payer system in
which every citizen is automatically covered, even if Americans were
required to purchase insurance. In August, Obama estimated that the
various health care legislation would likely cover only about 38 million
of the estimated 46 million Americans without insurance.
Gang of Six Three Democrats and three Republicans on the Senate
Finance Committee. The "centrist" Gang of Six is reportedly working
toward a bipartisan Senate bill by Sept. 15.
Underinsured Those who have an insurance plan that provides poor
coverage against illness. Some researchers define it as spending more
than 10 percent of income on out-of-pocket medical costs (excluding
premiums). By some estimates, more than 60 percent of
bankruptcies are linked to medical expenses; and in about 75% of these
cases, the individuals filing for bankruptcy had health insurance.
Expert Panel Both House and Senate bills establish an "expert panel"
from various health and medical disciplines to determine which benefits
meet minimum requirements for inclusion in the health insurance
Medicare A taxpayer-supported government insurance program for
persons who meet specific medical criteria and/or are age 65 and older.
It was first signed into law in 1965 and now comprises four-parts: A, B,
C and D.
Medicare Part A covers hospital services, Part B covers
physician services, and Part C, also called Medicare Advantage, allows
people to enroll in a private plan, which the government helps
Medicare Part D, the most recent add-on, took effect in 2006 and offers
a voluntary prescription drug benefit.
Medicaid Enacted in 1965, a taxpayer-supported government health
insurance program for the poor, funded by a combination of federal and
state money. Medicaid is administered by the states. The current health
care bills seek to expand Medicaid eligibility to cover more Americans.
CHIP (Children's Health Insurance Program) A taxpayer-supported
government health insurance program for children whose parents
aren't poor enough to qualify for Medicaid. In February 2009, President
Obama signed into law a reauthorization of CHIP ("CHIPRA") that
extended coverage eligibility to about 4 million children who would've
otherwise been uninsured. Currently the program is set to expire in
2013, after which it's unclear what would happen to CHIP-eligible children.
Donut Hole Also called "the gap" or the "coverage gap" in Medicare
Part D. Part D enrollees' drug costs are partly covered up to a certain
amount each year ($2,700 in 2009), after which enrollees must spend a
certain amount of their own money (about $4,350 in 2009) before
"catastrophic" drug coverage kicks in.
Mandate A requirement that an individual or business purchase
health insurance or risk paying fines or payroll taxes.. In the House bill,
individuals who neglect to purchase insurance for themselves or
families would pay a 2.5 percent tax on their adjusted gross income.
Cadillac Plans Also called "gold-plated" health insurance plans. The term typically refers to those whose overall premiums total between $19,000 and
$25,000 per year There has been some discussion of taxing these
high-end plans. But some argue that the premiums might be high
because of preexisting conditions. .
Copyright © 2009, Tribune
Thursday, September 3, 2009
September 1, 2009, 8:40 pm
Rating Public and Private Health InsuranceBy Catherine Rampell
Despite concerns over what happens when government gets involved in health care, there is little difference between Americans on private health insurance plans and those on Medicaid or Medicare in rating the care they receive, according to Gallup Poll data.
The fact that Americans’ ratings of their health care differ little, whether they have a private or a government plan, suggests that a properly constructed government health plan may not necessarily lead to perceptions of reduced quality or poor coverage from its beneficiaries. However, the fact that a public-private gap in quality ratings appears to exist for non-seniors (who presumably would be most likely to use a new public option) suggests that views about government-sponsored health care may differ by demographic group, possibly depending on one’s likelihood of being affected.
Tuesday, September 1, 2009
A Bipartisan Proposal on Health Care CostsBy Reed Abelson
How many economists does it take to fix the United States health care system?
Dr. Mark McClellan, a former Medicare administrator under President George W. Bush, who is now a health policy expert at the Brookings Institution, convened 10 experts of varying political persuasions to propose the best ways of bringing the nation’s high medical costs under control, while also raising the quality of care. The group ranged from free-market thinkers like Joseph R. Antos of the American Enterprise Institute to the Democratic policy adviser David M. Cutler from Harvard.
Dr. McClellan said the group, which released its report Tuesday, tried to reach a bipartisan consensus about the gradual steps that could be taken to move the country in the right direction. They say that any legislation should support long-term changes, rather than short-term fixes like slashing Medicare payments.
The ideas include taxing sugary beverages as a way to promote personal health, establishing health insurance exchanges to make it easier for individuals to buy insurance and reducing the current tax subsidies for employer-provided health insurance. Dr. McClellan said the proposals were intended as part of a comprehensive overhaul rather than a set of discrete suggestions.“These steps are about accountability and support for what we really want — better care at a lower cost,” Dr. McClellan said.