Sunday, December 26, 2010

New laws will allow Calif. to begin health reforms

By DON THOMPSON Associated Press
Posted: 12/26/2010 11:03:05 AM PST
Updated: 12/26/2010 11:07:05 AM PST

SACRAMENTO, Calif.—California will create an Internet-based insurance exchange to let consumers comparison-shop for affordable health insurance coverage under two of the many laws taking effect with the new year. read more

Friday, December 24, 2010

Test of "Accountable Care Organizations" going well

Excerpt of an article By ALLISON BELL
Published 12/20/2010 Subscribe to Life & Health

The coming year could be the year when “accountable care organizations” (ACOs) get a chance to show whether they will be a fad or a classic.

An ACO is a vehicle for paying teams of health care providers to care for whole patients, instead of paying for care one service at a time.

The Affordable Care Act, the legislative package that includes the Patient Protection and Affordable Care Act (PPACA), is requiring Medicare to use ACOs starting in 2012, and many private health carriers are now testing ACOs.

Elizabeth Mills, a senior counsel in the Chicago officer of Proskauer Rose L.L.P., a law firm, ACO organizers still face regulatory challenges.

The coming year could be the year when “accountable care organizations” (ACOs) get a chance to show whether they will be a fad or a classic.

Aetna Inc., Hartford (NYSE:AET), says an ACO it has been testing on 20,000 Medicare Advantage enrollees since 2007 seems to be working well.

This year, the ACO enrollees have been using 43% less acute hospital care than comparable enrollees in unmanaged Medicare have been using, Aetna says.
read more

Tuesday, December 21, 2010

A doctors take on universal heath insurance mandate

The Insurance Mandate: Is It Legal?
Published: December 21, 2010

Re “Can Congress Force You to Be Healthy?,” by Jason Mazzone (Op-Ed, Dec. 17), defending a federal judge’s ruling that the health insurance mandate is unconstitutional:

We need to look at the consequences to patients, interstate commerce and the economics of health care if the mandate provision of the Affordable Care Act is overturned. When an individual with limited income chooses to forgo health insurance and comes down with appendicitis, how should the health system respond?

Mr. Mazzone uses the analogy of someone forgoing auto insurance alternatively taking the bus. What is the alternative to an appendectomy?

The care providers must either (1) explain to the patient that he did not choose wisely, provide him with some pain tablets and push him to the parking lot or (2) treat him appropriately. The former is both illegal and unethical; the latter (current practice) is where the commerce issues arise.

The costs of care for illness must be borne by someone. Currently these costs are paid by the state (taxpayers) and, through cost-shifting, the insurance carriers, many of whom are national companies.

The bus analogy, while clever, is inappropriate and trivializes the dire status of our current system and our public’s health.

Tim Carey
Chapel Hill, N.C., Dec. 17, 2010