Phil's Insurance

Affordable Care Act faces Antitrust challenges

2011-09-09T06:21:00.000-07:00

by Dan Diamond, California Healthline Contributing Editor

Wednesday, September 07, 2011

FTC Emerges as Another Obstacle to Health Reform Law
by Dan Diamond, California Healthline Contributing Editor

Many assessments of the Affordable Care Act's long-term viability have focused on Congress' ability to weaken or repeal the law, especially if Democrats lose both chambers in 2012. Others are looking ahead to the Supreme Court's potential impact on the individual mandate's constitutionality.

But another Washington, D.C. player -- the Federal Trade Commission -- is already creating problems for the Obama administration.

True to its name, the Affordable Care Act tries out a number of new ideas to make health care less expensive. As one tactic, the law provides incentives for the creation of accountable care organizations to care for dedicated populations of Medicare beneficiaries.

However, the White House and FTC don't see eye to eye on ACOs' antitrust implications. The White House -- and by extension, the Department of Justice -- has viewed ACOs through the lens of consumer benefit. Meanwhile, the FTC spots a risk that ACOs could help already strong health care providers further fix prices.

read more

Pre-Existing Condition Insurance Program (PCIP) to pay Brokers

2011-06-01T19:44:00.000-07:00

June 1, 2011

The U.S. Department of Health and Human Services is making several changes to the Pre-Existing Condition Insurance Plan (PCIP), and making it easier to qualify.

Beth Uselton is a patient advocate with the Tennessee Health Care Campaign and she said, "For many decades people with pre-existing conditions were often locked out of insurance or small group insurance market."

Uselton said these are important steps to get insurance to the people who need it the most. "The irony is that so many people who have high health needs, or already have a medical condition, are some of the people least likely to be covered by the private insurance market." Broker will be able to direct insureds to this program and earn a commission beginning in the fall More

Big changes in Medicare appear to be inevitable

2011-04-24T21:36:00.000-07:00

Obama calls for slowing growth of Medicaid, Medicare to reduce deficit Apr 13
By Jack Torry, Washington Bureau
12:53 AM Sunday, April 24, 2011
WASHINGTON — No matter which sides prevails in the intensely ideological and partisan debate in Washington over the mushrooming costs of Medicare, one thing is certain: The program as we know it is in for big changes.
“Everybody admits doing nothing is not an option,’’ said Michael Tanner, an analyst at the CATO Institute in Washington.

In particular, they contend that health costs continue to rise because of the increase of such diseases as diabetes, caused in large part by preventable conditions such as obesity. They say that until hospitals and physicians become more efficient in preventing and treating the chronically ill, U.S. health care costs will continue to soar. read more

Ryan, Obama both fail Medicare test

2011-04-17T21:57:00.000-07:00

Updated: April 16, 2011 - 9:01 PM
They offer contrasting approaches, but there are flaws in each.

Wisconsin Congressman Paul Ryan deserves credit for putting Medicare's soaring costs front-and-center in the raging debate over the nation's runaway spending.

But his prescription for fixing the federal health program for the elderly -- Ryan's plan would provide subsidies to buy private health insurance -- is too harsh and would shift unaffordable care costs onto seniors

The reality is that Medicare's current costs are an existential threat to the program. The total Medicare bill in 1999 was $212 billion: Ten years later, it had increased to $502 billion as the baby boomers prepared to retire.

Obama's speech offered reassuring but vague rhetoric about Medicare's future. He's right that there are alternatives to Ryan's plan, which paints in stark detail what it means to rein in entitlement programs without a tax increase.

But the president needs to provide details..

Now the president and his party need to do the same. The nation can't afford to wait until after the 2012 election..

ANOTHER CONCERN
"When Roosevelt invented Social Security, it was not designed to lift the old out of poverty. It was designed because the cost of caring for the old was crushing middle-aged families. One of the questions that needs to be asked here about the [Ryan] plan is not how does this affect the old, but rather what are the Gen-Xers and -Yers going to do when Grandpa's medical bills come due? Because they're going to come due.''read more

DR. STEVEN MILES, Minneapolis physician and bioethicist
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Agents Likely to be Part of Exchange System

2011-02-16T17:27:00.000-08:00

By ARTHUR D. POSTAL
Published 2/16/2011 Subscribe to Life & Health

WASHINGTON BUREAU -- The role that insurance agents play in the health insurance marketplace in 2014 and beyond will likely be left up to the states, according to Joel Ario, head of the insurance exchange bureau at the U.S. Department of Health and Human Services (HHS). more

And now the real work begins

2011-01-28T06:06:00.000-08:00

Some parts of the Affordable Care Act simply don’t work for small employers, a New Jersey business owner testified today at a House Ways and Means Committee hearing.
read more

House republicans Start spin to take credit for HealthCare Reform

2011-01-20T05:06:00.000-08:00

By ALLISON BELL
Published 1/19/2011

"House leaders scheduled a vote on H.R. 2, the Repealing the Job-Killing Health Care Law Act bill, to take place just as many civic-minded citizens were coming home from work and flipping on C-SPAN.

House members voted 245-189 to pass the bill at 5:53 p.m. today. All Republicans in the House voted for the bill; 189 of the 193 Democrats voted against it. "read more

Health Care Repeal Snag

2011-01-10T19:53:00.000-08:00

January 10,2011
Reporting from Washington — The Supreme Court may not be so anxious to rein in Congress' broad power to pass regulatory laws under the Constitution's commerce clause, the key point of dispute in the pending court battles over President Obama's health insurance law.

By a 7-2 vote, the justices turned down a constitutional challenge to a 2002 law that makes it a federal crime for a felon to have body armor or a bulletproof vest.

read more

New laws will allow Calif. to begin health reforms

2010-12-26T19:24:00.000-08:00

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

Test of "Accountable Care Organizations" going well

2010-12-24T05:39:00.000-08:00

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

A doctors take on universal heath insurance mandate

2010-12-21T20:29:00.000-08:00

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

No Social Security until age 65?

2010-11-11T04:31:00.000-08:00

November 11,2010
The author of the recently released report, Andrew Biggs, a scholar in residence at the American Enterprise Institute, a conservative think tank , outlines these advantages:

•Prolong the life of the Social Security trust fund by five years, a modest but significant increase.
•Raise median income of older Americans by $7,500 a year, including both increased Social Security benefits and savings and other pension income.
•Boost gross domestic product by about 5 percent through increased productivity, adding billions to the economy and tax revenues.
Biggs says keeping people working until 66 or 67 isn't a physical problem for most these days. Biggs would offer one big concession. He suggests reducing significantly or eliminating Social Security payroll taxes for people who work and contribute to Social Security longer than 35 years, Eliminating payroll taxes would "sweeten the pot" for those asked to work longer, he says.

for full textclick here

2010-10-25T17:43:00.000-07:00

New health law is a prescription for distortion
By: JO CIAVAGLIA
Bucks County Courier Times

The onslaught of misinformation and distortions about the Patient Protection and Affordable Care Act this political season isn't helping the many Americans who are confused about the law.

Who hasn't seen political ads claiming that under the health law, Medicare will be cut $500 billion.

But are any of these claims true?

Yes and no. Mostly it depends on what health coverage you have, who pays for it, how much you earn and how you earn it, according to health care policy and reform experts.

Next year employers will be required to list the value of employee health benefits on W2 forms. No, you won't be taxed on it.

But combine a take-no-prisoners political season with a law as voluminous and complex as the Patient Protection and Affordable Care Act, and confusion explodes. Experts who've studied the new reforms say the truth is out there, but it can be hard to find.

Four out of 10 surveyed believed the health care law would require Americans to provide a government ID card to get hospital care. (It doesn't.)

Almost as many believed that committees would review medical histories of some people and decide whether they can get medical care paid for by the government. (That's also untrue).

Six in 10 think the law increases the federal deficit. (The nonpartisan Congressional Budget Office projects the law will shrink the deficit.)

"The great irony is the law was designed to avoid a government takeover," said Timothy Jost, a law professor at Washington and Lee University who specializes in health care reform and policy. "It's a law that is intended to make private insurance work and it's troubling that it's being attacked as a (government) takeover of the markets

New Healtrh reform drives cost acutting

2010-10-24T05:33:00.000-07:00

SAN DIEGO 10/23/2010 — According to Van Gorder of Scripps Ihnstitute of San Diego.
"....the health reform plan, signed by Obama this year, was health insurance reform. It was not a reform that went to the heart of escalating health care costs.

But now Scripps Health, which runs 5 hospitals and 20 clinics in the San Diego area, is in the midst of a corporate restructuring they claim will make a big difference in cost. CEO Chris Van Gorder, in fact, believes their reorganization will eventually save $150 million a year.

Scripps Health was built from the union of several large hospitals. But the vertical corporate structure, in which each hospital had a chief operating officer who ran the place, remained intact. That meant every hospital within the system did things in a different way. They used different staffing levels and different materials. And that has required different levels of funding.

“We know, for example, that at one of our hospitals an open-heart case costs $3,000 more than it does to do the same kind of operation at another one of our hospitals,” said Van Gorder.

He said they’re trying to solve that problem by getting horizontal, in a corporate sense…. by getting rid of the silos and putting everything in one bin.

Van Gorder said the company has reassigned the top managers of its five hospitals to make them responsible for operations across the system. The goal is to standardize hospital operations and bring best practices to each site. This even applies to serving coffee.
“We’re spending $680,000 dollars a year for coffee and we’re using 15 different brands,” said Van Gorder. “If we standardize and buy at a larger scale we can get better buying power.”

Scripps claims it can save $200,000 dollars on coffee alone.

But if this is such a good idea, why didn’t Scripps do it five years ago? Van Gorder says strained relations between Scripps doctors and the company administration in the past have made it difficult to make dramatic changes.

Medicare revisited

2010-08-09T08:34:00.000-07:00

Medicare celebrated its 45th birthday on July 30.

In 1965, President Lyndon B. Johnson signed the Medicare bill into law, providing government-sponsored health insurance for Americans 65 and older and younger people with disabilities.

Although every senior in the United States grew up without Medicare, most Americans today accept this single-payer, government-created and government-administered system as one of their rights as citizens, much like the right to vote.

Yet before we reach the age of 65, most of us don't have a clue how Medicare works. We only know it's there.

Misunderstandings about the Medicare program surfaced during recent discussions over the administration's sweeping health reform bill that finally passed in March.

Unclear on the concept, elders in some states vented outrage against the Obama administration, whose bill included Medicare changes, for "meddling" in "their" Medicare.

Others, also unclear on the facts, protested a provision in the bill that would have reimbursed physicians for time-consuming conversations with patients and family regarding the patient's wishes at the end of life. Mistakenly condemning these as "death panels," they raised loud and confusing voices, and the provision was removed from the bill.

But the uninformed ranters remain. To help clarify confusion, here are a few basic facts.

The health reform bill proposed by President Obama and passed by the
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Congress in March is called the Affordable Care Act. You will often hear bureaucrats referring to ACA. They mean the new health care law.

Among the most immediate changes:

# The infamous "doughnut hole," in which Medicare recipients must pay full price for their medication, will close completely by 2020. This year, those in the hole will receive a $250 rebate. Starting in 2011, a 50 percent discount will be available for brand-name drugs.

# The open-enrollment period, during which a Medicare recipient may choose a prescription drug program, will be extended.

# Starting in 2011, co-payments or deductibles will be removed for annual checkups and mammograms, colonoscopies and some other preventive tests. There will be no charge for these tests.

Other provisions are designed to improve delivery of medical care, prevent frequent readmissions to hospitals and, in the process, cut health care costs.

According to the Kaiser Health Foundation, nearly 18 percent of hospital admissions among Medicare beneficiaries in 2005 occurred within 30 days of being discharged from the hospital. Critics of high costs say that readmission can be prevented by better care in the hospital and improved coordination between patients and doctors after release.

Until now, hospitals, paid separately for each hospital stay, have had no incentive to prevent readmission, experts say. Under the new law, payments to certain hospitals with high readmission rates will be reduced starting in 2013, a spokeswoman for the federal Centers for Medicare & Medicaid Services said in a phone interview.

Among health care providers, pilot projects to streamline health care delivery and coordinate care are already underway.

These are only a few of the changes and modifications included in the new law.

For more information, call the Health Insurance Counseling Advocacy Program (HICAP) at 650-627-9350 or 800-434-0222.

New Health Care Rules begin in June

2010-05-21T06:22:00.000-07:00

By Christopher Behnan • DAILY PRESS & ARGUS • May 16, 2010

Staring June 23, the law creates a health subsidy for retirees between the ages of 55 and 64. The program will subsidize 80 percent of approved claims totaling $15,000 to $90,000.

That program is planned to expire in 2014.

Also this year, employers with less than 25 employees that contribute at least 50 percent of premiums per employee may be eligible for a tax credit.

The credit wouldn't be filed until next year's tax return, but employers should start calculating employee hours required to determine full-time equivalency data, Porta said.

The government will count a 4.98 full-time equivalency as four full-time employees rather than rounding it up to five, for a greater credit.
read more

In that case, employers can bump up their staff's hours slightly to obtain the higher credit, Porta explained.

"It can make a difference. You want to maximize the tax credit," he said.

Health insurers end cancellations

2010-05-01T05:49:00.000-07:00

Rueter's
Susan Heavey and Lewis Krauskopf - Analysis
WASHINGTON/NEW YORK
Fri Apr 30, 2010 12:51pm EDT
WASHINGTON/NEW YORK (Reuters) - U.S. health insurers are avoiding the controversial but rare practice of canceling coverage when a customer gets sick, but it is unclear how regulators will enforce the ban, which could affect thousands of policyholders.
read more

Companies Drop Employer-Sponsored Health Insurance

2010-04-23T07:12:00.000-07:00

Clarifying Health
Thursday, April 22nd, 2010

The Health Care Reform bill signed into law on March 23, 2010 is the death knell for employer-sponsored group health insurance. And that’s a good thing.

read more

Agencies Seek Health Care Implementation Comments

2010-04-14T06:38:00.000-07:00

LIfe and Health Magazine

Article by ALLISON BELL
Published 4/12/2010

"Federal regulators are asking members of the public for comments on how the government should implement the Patient Protection and Affordable Care Act..."

"..... how states define 'unreasonable rate increases,' rules for public disclosure of rate increase information, ideas about how to go about excluding plans that impose 'unreasonable rate increases' from the new state health insurance exchange system, and ideas about how to minimize the rate review process paperwork burden."

And now the real work of health care reform begins.read more

Quick analysis of effect of new health care bill

2010-03-28T10:58:00.000-07:00

Washington Post article 3/28/2010

Now that all the rhetoric is behind us (you think?) what does the new law mean to each individual. Well there is a site with a situation calculator. Requires just 4 inputs. 1. How you are/not insured now 2. how many in your family 3. Your adjusted gross income. 4. Your marital status. The resultant statement is clear and concise.

Click here for site to analyze what the new bill means to you

Personal Commentary

2010-03-23T08:03:00.000-07:00

Posted 3/23/2010

President Obama has engineered a watered down semi-universal profit driven health care system. His accomplishment will go down in history as one of the major social legislation issues to have been undertaken in generations. To his credit he negotiated placated and modified his way into a victory for politcal accomodation that will (in spite of it's faults) stand the test of time as a Major step forward in American Health Care for all.

Machiavelli said 500 years ago "Change is hard. The losers know very well what they are losing and fight with passion to maintain the status quo. The winners have no experience to know what they are gaining, so are lukewarm in their pursuit" (quotation marks are mine and statements within approximate)

A huge portion of our great nation are currently involved in demonizing and denigrating what has been accomplished. How much better it would be if they stopped for a moment and reflected on their good fortune and proceeded in good faith to modify it to better reflect and adjust to what will become obvious with time needs to be modified.

More Commentary on New Health Ins Bill

2010-03-22T15:54:00.000-07:00

The New Health Insurance Law and Your Money

by Smithee on March 21, 2010.

Small group (50 or less employees) health insurance Employers get this years tax break!

complete details of article here

New Health Care Law Summary

2010-03-22T08:00:00.000-07:00

By CBS News Capitol Hill Producers Jill Jackson and John Nolen

March 22,2010

"Coverage:

* Would expand coverage to 32 million Americans who are currently uninsured.

Health Insurance Exchanges:

* The uninsured and self-employed would be able to purchase insurance through state-based exchanges with subsidies available to individuals and families with income between the 133 percent and 400 percent of poverty level.
* Separate exchanges would be created for small businesses to purchase coverage -- effective 2014.
* Funding available to states to establish exchanges within one year of enactment and until January 1, 2015.

Subsidies:

* Individuals and families who make between 100 percent - 400 percent of the Federal Poverty Level (FPL) and want to purchase their own health insurance on an exchange are eligible for subsidies. They cannot be eligible for Medicare, Medicaid and cannot be covered by an employer. Eligible buyers receive premium credits and there is a cap for how much they have to contribute to their premiums on a sliding scale.

Federal Poverty Level for family of four is $22,050

Paying for the Plan:

* Medicare Payroll tax on investment income -- Starting in 2012, the Medicare Payroll Tax will be expanded to include unearned income. That will be a 3.8 percent tax on investment income for families making more than $250,000 per year ($200,000 for individuals).

* Excise Tax -- Beginning in 2018, insurance companies will pay a 40 percent excise tax on so-called "Cadillac" high-end insurance plans worth over $27,500 for families ($10,200 for individuals). Dental and vision plans are exempt and will not be counted in the total cost of a family's plan.
* Tanning Tax -- 10 percent excise tax on indoor tanning services.

Medicare:

* Closes the Medicare prescription drug "donut hole" by 2020. Seniors who hit the donut hole by 2010 will receive a $250 rebate.
* Beginning in 2011, seniors in the gap will receive a 50 percent discount on brand name drugs. The bill also includes $500 billion in Medicare cuts over the next decade.

Medicaid:

* Expands Medicaid to include 133 percent of federal poverty level which is $29,327 for a family of four.
* Requires states to expand Medicaid to include childless adults starting in 2014.
* Federal Government pays 100 percent of costs for covering newly eligible individuals through 2016.
* Illegal immigrants are not eligible for Medicaid.

Insurance Reforms:

* Six months after enactment, insurance companies could no longer denying children coverage based on a preexisting condition.
* Starting in 2014, insurance companies cannot deny coverage to anyone with preexisting conditions.
* Insurance companies must allow children to stay on their parent's insurance plans through age 26.

Abortion:

* The bill segregates private insurance premium funds from taxpayer funds. Individuals would have t * abortion coverage by making two separate payments, private funds would have to be kept in a separate account from federal and taxpayer funds.
* No health care plan would be required to offer abortion coverage. States could pass legislation choosing to opt out of offering abortion coverage through the exchange.

**Separately, anti-abortion Democrats worked out language with the White House on an executive order that would state that no federal funds can be used to pay for abortions except in the case of rape, incest or health of the mother. (Read more here)

Individual Mandate:

* In 2014, everyone must purchase health insurance or face a $695 annual fine. There are some exceptions for low-income people.

Employer Mandate:

* Technically, there is no employer mandate. Employers with more than 50 employees must provide health insurance or pay a fine of $2000 per worker each year if any worker receives federal subsidies to purchase health insurance. Fines applied to entire number of employees minus some allowances.

Immigration:

* Illegal immigrants will not be allowed to buy health insurance in the exchanges -- even if they pay completely with their own money."
More info

Truth is we can improve healthcare and reduce deficit

2010-03-11T20:18:00.000-08:00

New England Journal of Health
March 11,2010
Article by Len N Nichols Phd

The Congressional Budget Office says current version of Health Care Reform bill will in fact offer Health Insurance to 30 million not now covered and will reduce healthcare costs over time and reduce our deficit. Conservative myth makers say otherwise. Dr.Nichols full statement here

Health Economists Urge Passage of Reform

2010-02-26T21:52:00.000-08:00

Friday, February 26, 2010
New York Times By DAVID LEONHARDTE
Excerpts

An impressive panel of 88 Professional Health Economist sends a letter to Obama urging him to use reconciliation to pass a merged version of already passed Senate and House Health reform bills.
read whole article here

Senate easily approves jobs bill; House passes health-insurance antitrust bill

2010-02-25T08:16:00.000-08:00

Washington Post Article
By Ben Pershing and Perry Bacon Jr.

Thursday, February 25, 2010

Comment: It would seem that our congress is having the same problem grasping the whole Health Care Reform bill all at once that we are. By breaking it down into understandable smaller units we seem to see them actually working on getting it done. Who Knew? read actual article here

Major Health Insurers raise rates after record profits

2010-02-21T10:48:00.000-08:00

Sunday Feb 21,2010
Excerpts from an Editorial in The Tennessean
Tennessean staff writer Getahn Ward contributed to this report.

After a year (2009) of record profits Major Health Insurers are raising premiums to record levels
read whole article

Economy Down, Health Insurance Industry posts largest Profits ever

2010-02-13T08:00:00.000-08:00

February 12, 2010 6:39 p.m. EST
Topics: business, economy, business and finance, health, United States
Linda Young - AHN(All Headline News - Digital news media) Editor

Washington, D.C., United States (AHN) - While businesses and individuals struggled to cope with ever-rising health insurance costs, health insurance companies lined their pockets with profits of $12.2 billion in 2009 - an increase of 56 percent from 2008.

Those staggering statistics were revealed in a report by a coalition of liberal advocacy groups and labor unions, Health Care for America Now.

"The five largest U.S. health insurance companies sailed through the worst economic downturn since the Great Depression to set new industry profit records in 2009, a feat accomplished by leaving behind 2.7 million Americans who had been in private health plans. For customers who kept their benefits, the insurers raised rates and cost-sharing, and cut the share of premiums spent on medical care. Executives and shareholders of the five biggest for-profit health insurers, UnitedHealthGroup Inc., WellPoint Inc., Aetna Inc., Humana Inc., and Cigna Corp., enjoyed combined profit of $12.2 billion in 2009, up 56 percent from the previous year. It was the best year ever for Big Insurance," Health Care for America Now wrote in a statement on its Website.

Part of the shocking profits were made by dropping the sickest policy holders, Health Care for America Now noted.

In addition, although many people view health care as a necessity, health insurance companies price it like it's a luxury.

Health Care for America on its Website quoted Andrew Kurz, former chief financial officer of Wisconsin Blue Cross-Blue Shield as saying, "Insurance company profit margins put the industry in the top 10% of all industries, up there with cigarette manufacturers. Insurers price their products like a discretionary luxury, not something essential for health and well-being

Read more:

Anthem BlueCross Increases Calif rates 39%

2010-02-11T12:03:00.000-08:00

Anthem Blue Cross a division of WellPoint Insurance Company has announced a March 1 rate hike of 39% for individual heath insurance plans in California. see SF Chronicle Article here

Demo contemplate piecemeal legislation

2010-01-31T20:14:00.000-08:00

CNN Politics January 31, 2010 5:16 p.m. EST

White House press secretary Robert Gibbs says passing a health care bill is "still inside the five-yard line."

* Instead of overall health care reform, health insurance reform gains traction among Dems
* White House press secretary says health care bill "still inside the five-yard line"
* House Speaker Pelosi says Congress "must take whatever time it takes" to pass bill

Washington (CNN) -- Democratic efforts to pass a health care bill have stalled a bit, and the immediate focus may be shifting toward health insurance reform instead of quickly trying to pass a comprehensive bill, White House officials signaled Sunday.read whole article

Demos working on side issue legislation

2010-01-23T18:28:00.000-08:00

January 23, 2010

FoxNews.com

House Speaker Nancy Pelosi and Senate Majority Leader Harry Reid reportedly are considering a new list of changes to the Senate health care reform bill that could be passed separately as a way to advance the suddenly stalled overhaul of the health care system. Read whole story here

Doctors drowning in insurance paperwork

2010-01-18T06:11:00.000-08:00

Posted on Sun, Jan. 17, 2010

By Jane M. Von Berge
Philadelphia Inquirer Staff Writer

Administrative expenses cost the U.S. health system hundreds of billions a year. The goal? A standardized, digital process.
read whole article

Possible effect of Proposed Insurance Exchange

2010-01-17T06:03:00.000-08:00

Los Angeles Times
By Kim Geiger

January 17, 2010

HEALTHCARE Q & A

"My family's current policy costs more than $400 per month, which is not affordable for us. Will we be able to afford insurance under the healthcare bills?"

Comment: The answer seems to be a qualified yes
read article here

Courts likely to uphold tax to pay for Health Care.

2010-01-13T05:57:00.000-08:00

excerpts from Wall Street Journal Jan 10,2010
By JESS BRAVIN

WASHINGTON -- As congressional Democrats try to iron out differences in the House and Senate health-care bills, Republicans are attacking the legal premise of the legislation, saying Congress has no power to make people carry health insurance or pay a penalty or tax. However, courts usually defer to lawmakers, and Democrats could smooth the way further by using language in the final version that clearly asserts Congress's power under the Constitution to levy taxes -- which the House bill already does.

Since the New Deal era, the Supreme Court has broadly interpreted congressional authority under the Commerce Clause.

The House version explicitly includes a "tax on individuals without acceptable health-care coverage."

Congress has broad power to tax -- and courts have been highly deferential to the way it is exercised.

"Given the precedent of Medicare, courts are likely to uphold Congress if it imposes an income tax to pay for a government health-care system,".
read whole article

Pelosi Has her work cut out for her

2010-01-10T06:05:00.000-08:00

From the Politico
PATRICK O'CONNOR & CARRIE BUDOFF BROWN 1/9/10 9:58 AM EST

Speaker Nancy Pelosi is telling her caucus not to believe stories that the House will simply roll over and accept the Senate’s hard-fought health care bill.

“That’s not true for one second,” Pelosi told her agitated rank-and-file in a call this week.

But she may not have a choice.

Any major changes to the Senate bill threaten to upset a delicate détente Majority Leader Harry Reid (D-Nev.) built over months of cautious negotiations to hold together 60 votes in his divergent caucus.

The public option is out. Employer mandates could prove too tough to change. And the president has already taken the Senate’s side in the fight over a tax on high-end health care plans.

“Each of the provisions at issue has already been negotiated ad nauseam in the Senate,” said a Senate Democratic aide. “The physics of this are unlikely to change much.”

Pelosi even seemed to concede one of her top priorities during the call – suggesting she could live with pushing the start date for reforms from 2013 to 2014, the date in the Senate bill. That alone would save $100 billion in the House bill, according
several congressional aides, money the speaker told her caucus could be plowed into making insurance more affordable.

So the ever-practical Pelosi is setting her sights on achievable goals: boosting insurance subsidies, strengthening oversight of insurers and setting up a national exchange to make sure the federal government sets minimum standards for coverage under the reforms.

Even those could prove to be a tall order.

Two key moderates – Sen. Ben Nelson (D-Neb.) and Sen. Joe Lieberman (I-Conn.) – have favored the state-based exchanges over national exchanges. The question now is whether it will prove make-or-break for either.

It’s not just the Senate. Pelosi, who relishes a good fight, finds herself locked a duel with President Barack Obama over the so-called Cadillac tax included in the Senate bill – a 40 percent levy on insurance plans that exceed $8,500 for individuals and $23,000 for families.

To win this skirmish – or any other – she needs to convince Obama her math is tougher than Harry Reid’s.
read whole article

Why we all must have health insurance

2010-01-09T05:21:00.000-08:00

Updated: 01/08/2010
Excerpts from article By Scott Schaefer

Scott Schaefer, associate dean for academic affairs and David Eccles Professor of Finance at the University of Utah's David Eccles School of Business.

Why an individual mandate to buy health insurance? We've heard a lot of debate on this question lately. But it seems a lot of the talk doesn't reflect much knowledge of why some think an individual mandate might be a good idea.

Reason 1 » It's because of uncompensated care. it's about 1.5 percent of our overall health care expenditures.

Reason 2 » Because you have to get auto insurance, right? Maybe. A mandate makes sense here because there's a general tendency to think too little about harm we might impose on others. But this reasoning doesn't apply for health insurance.

Reason 3 » It's a plot by the Democrats to take away our liberties. I guess I can't definitively disprove this one,

Reason 4 » To prevent unraveling of the insurance market. This one's kind of complicated, but it's also the right answer. And to understand it, one needs to understand the effect of "asymmetric information" on insurance markets. Asymmetric information is when I know something and you don't.

Let's think about how this applies to health insurance. Some people know they're relatively less likely to get sick, and, for them, insurance is a bad deal. They figure they'll pay in more than they get out, so they don't buy. And if healthy people don't buy, it's harder for insurers to make up the costs of those cancer drugs, which means the price for insurance goes up, to a level far higher than it would be in a market where people weren't asymmetrically informed about their health status.
It's this unraveling of the insurance market that makes it so expensive. A mandate may stop this unraveling, and help bring prices down.read whole article

Removing Public Option

2009-12-28T05:45:00.000-08:00

Calvin Woodward, Associated Press – Mon Dec 28, 2:50 am ET

Rep. James Clyburn of South Carolina added: "We want a public option to do basically three things: Create more choice for insurers, create more competition for insurance companies, and to contain costs. So if we can come up with a process by which these three things can be done, then I'm all for it. Whether or not we label it a public option or not is of no consequence." see whole article

Health Care Reform inches forward

2009-12-22T08:14:00.000-08:00

December 22,2009

After some 60+ years of effort and one year of intense debate we are finally within reach of a move in the right direction toward affordable health care in our divisive,multi-ethnic,wonderfully co-mingled nation.

In the end the one remaining sticking point seems to be how we deal with abortion. Whatever your personal thoughts on the subject. Even a cursory review of history reveals that no matter how hard we continue to try, we can never regulate morality. One culture's prohibition is another's religion.

If you list all the possible variations of all the various religions and non-religions of our current world and try to find one common thread I believe you will find some version of "Treat others as you would be treated" The golden rule. Maybe that could be a road we could all travel.

MERRY CHRISTMAS

Senate ready to Vote Health Care Reform

2009-12-21T08:52:00.000-08:00

LA Times Dec 21,2009

Reporting from Washington - The Senate took a giant step toward passing its sweeping healthcare bill early today, uniting fractious Democrats after months of debate over President Obama's promise to reduce the ranks of the uninsured.

Read whole story

Liebermun clogs the debate for political gain

2009-12-17T16:28:00.000-08:00

Thursday, December 17, 2009
By Howard Dean
former chairman of the Democratic National Committee and governor of Vermont from 1991 to 2002.

I'm not giving up on health-care reform. The legislation does have some good points, such as expanding Medicaid and permanently increasing the federal government's contribution to it. It invests critical dollars in public health, wellness and prevention programs; extends the life of the Medicare trust fund; and allows young Americans to stay on their parents' health-care plans until they turn 27. Small businesses struggling with rising health-care costs will receive a tax credit, and primary-care physicians will see increases in their Medicare and Medicaid reimbursement rates.

In Washington, when major bills near final passage, an inside-the-Beltway mentality takes hold. Any bill becomes a victory. Clear thinking is thrown out the window for political calculus. In the heat of battle, decisions are being made that set an irreversible course for how future health reform is done. The result is legislation that has been crafted to get votes, not to reform health care.

In my home state of Vermont, we have accomplished universal health care for children younger than 18 and real insurance reform I know health reform when I see it, and there isn't much left in the Senate bill. I reluctantly conclude that, as it stands, this bill would do more harm than good to the future of America.

read whole article here

Comment: Ex Governor Howard Dean pretty much has the current situation nailed. The few are holding the majority hostage for personal political gain. It is beginning to look as if it is our politicians are even more in need of reform than our health care system.

Rep. Stupak says his amendment unlikely to prevail

2009-12-08T06:05:00.000-08:00

Dec 7 2009
WASHINGTON – Michigan’s Bart Stupak, the Democratic congressman who set off a firestorm of controversy with an amendment restricting abortion coverage in the health care reform legislation, says he doesn’t believe his proposal will survive in the Senate.read free press interview here

Health care reform contains tax increases hidden in plain sight

2009-12-07T05:14:00.000-08:00

excerps from an article By MIKE DENNISON Missoulian State Bureau | Posted: Sunday, December 6, 2009 6:30 am

HELENA – To pay for health care reform, you’ll find billions of dollars in tax increases tucked inside the two major bills now before Congress – with each taking a vastly different approach to who ends up paying.

Here’s a quick look at the tax proposals in each of the major bills:

House bill: It would raise about $46 billion a year by levying an income tax surcharge on single people earning more than $500,000 a year and couples earning more than $1 million. Only 700 taxpaying households in Montana fall into those categories.

It also would tax medical devices and limit tax-free medical “flex” spending accounts to $2,500.

Senate bill: It has a controversial 40 percent tax on so-called “Cadillac” health plans; levies an annual fee on insurers, drug makers and medical device makers; and raises Medicare payroll taxes for singles earning more than $200,000 a year and couples earning more than $250,000.

It also limits flex spending accounts and medical-expense tax deductions.

The excise tax would be levied on the “aggregate value” of health care benefits that exceed $8,500 for single people and $23,000 for families, starting in 2013.

While no one is enthusiastic about paying higher taxes, two prominent supporters of the health reform bills – AARP and Montana Change That Works, a labor-funded organization – say they can live with the taxes in the Senate bill. read whole article

Comment: Flex Spending Account, a payroll deduction before payroll taxes to pay for medical and/or related expenses

Webb, Warner quiet on health care bill, for now

2009-12-04T08:17:00.000-08:00

By Bill Bartel
The Virginian-Pilot
© December 4, 2009

As the U.S. Senate completes its first week of debate on a massive health care overhaul bill, Virginia's two senators(Sens. Mark Warner and Jim Webb, both Democrats) have been silent. But that could change soon.

The goal would be a transparent system in which costs, treatments and outcomes for patients could be compared across the nation in real time.read whole article here

about COBRA

2009-12-02T21:43:00.000-08:00

Under the American Recovery and Reinvestment Act of 2009, eligible individuals receive a 65 percent reduction in their COBRA premiums. But that benefit ended Dec. 31, 2009.

Under current law, if individuals get laid off in January 2010, they will not be eligible for the 65 percent COBRA subsidy. However, that may change soon.

The Extended COBRA Continuation Act of 2009 has been introduced as legislation to extend the premium reduction into 2010

Reform Could Cut Medicare Advantage Provider Pay

2009-11-24T14:01:00.000-08:00

By ARTHUR D. POSTAL

Published 11/24/2009
Subscribe to Life & Health

WASHINGTON—Medicare Advantage payments to (insurance)providers under the Senate health care reform bill would be based on enrollment-weighted competitive bidding instead of the current system, a law firm says.

Under that bill, payments to providers would be reduced by $118 billion between 2010 and 2019, the traditional 10-year cost estimate period for federal budgets.

By comparison, the Budget Office estimates that the House bill would reduce Medicare Advantage plan payments by $170 billion in the same period.

The Senate bill is the Patient Protection and Affordable Care Act, and the House bill is H.R. 3962, the Affordable Health Care for America Act. read whole article

Comment: It appears that the health care initiative which was started during the campaign. Has been hammered to death by politicians leveraging people's natural suspicion of anything different. But now it has gained momentum and hopefully will rise above the recationary idiocy we have seen too much of. We all look forward to an improved,caring, approach to medical insurance that will take us out of our third world status and finally give our country the health care it has earned at a price it can afford.

Washington State Report Details Cost of Medically Uninsured

2009-11-21T06:46:00.000-08:00

Excerpts from November 19, 2009 Insurance Journal(paid newsletter) Report

The number of Washingtonians with no health insurance will soon reach 1 million, according to a report issued yesterday by the state's Insurance Commissioner Mike Kreidler.

According to the report, uncompensated care costs the average insured Washington family $917 a year.

Kreidler said we have a once in a generation opportunity to pass health care reform.

“Many people fear the costs of health care reform and I don’t blame them,” he added. “But I’ll tell you what keeps me up at night, it’s thinking about what happens if we fail. We’ll spend $33 trillion over the next decade, get the results approaching a third world country and outspend our economic competitors two to one. We simply cannot afford to fail.”read article

What About Medicare Advantage

2009-11-18T06:45:00.000-08:00

By Eric Johnson Published 11/1/2009
Medicare advatage is a plan offered by insurance comapanies through groups like kaiser etc that receives a rebate from government of 14% of average medicare costs. thus allowing medicare recipients to receive larger benefits for less money but more restrictions

read whole article

Who Knew?

2009-11-13T05:44:00.000-08:00

Excerpt from "Politco" Friday November13,2009

Federal Election Commission Records show the RNC purchases its insurance from Cigna, and two sales agents for the company said that the RNC’s policy covers elective
abortion.
read whole article

Health Reform Endanger Vision Care

2009-11-13T05:27:00.000-08:00

Written by Rob Lynch president and CEO of VSP Global, a nonprofit vision benefits plan.

"Whether you are for or against the current health care legislation, you can most likely agree that the current health care system needs to be fixed. What exactly to fix is where the debate lies. But what about the things that aren't broken?

Amazingly enough, there is a vital component of our national health care system that not only provides top-notch services, but actually has an incredible 90-plus percent approval rate by those who are covered. This is America's vision insurance system. Vision insurance and eye care not only deliver vital health care services but actually lower the cost for treating the chronic diseases that are bankrupting America's health care system. It is a shining example upon which Congress should base the reforms they are now examining. So why are they trying to change a part of the system that's not broken?

Today, most Americans who have some form of vision insurance are covered by standalone plans. They do not get their vision coverage through their medical insurer. In survey after survey, people covered by stand-alone vision plans report that they not only utilize the service, but actually love their coverage and the relationships they develop with their eye doctors. In fact, 61 percent of working Americans with vision care receive an annual eye exam, while only 21 percent of Americans receive physicals each year.

For the more than 100 million Americans with stand-alone vision insurance, legislation on the floor of the House and Senate will not only force them to change insurance companies, but also change their doctor. This directly contradicts what President Obama has repeatedly promised: "If you like your doctor, you can keep your doctor. If you like your health care plan, you can keep your health care plan." It's too bad that some members of Congress are not listening to the president.

Proposed legislation will kill stand-alone coverage by excluding it from what constitutes a federally qualified health plan. Americans would be required to buy bundled insurance — both vision and medical — through the same insurer.

That's like forcing individuals to buy homeowner's insurance through their auto insurer.

Many medical insurers have zero experience with providing vision coverage or benefits.

Furthermore, the legislation would also separate children's vision coverage from their parents', making vision care much more complicated for families.

Why get up in arms about vision care? It's simple. The current model works and serves millions. Vision care helps improve health and quality while lowering costs. For example, the Center for Health Transformation conducted a study of 2,000 uninsured patients in Columbus, Ga. which showed 100 percent of patients diagnosed by eye doctors as having diabetic retinopathy or retinopathic changes followed through to obtain the requisite additional care, as opposed to only 64 percent of patients who followed through on additional care after receiving a diagnosis of a chronic disease that did not threaten their ability to see.

Killing stand-alone vision plans will decrease competition, increase taxes, increase costs, and ultimately hinder Americans from receiving critical vision care. At a time when change may be imminent, it is incumbent upon our government to make changes that will reduce cost, increase efficiencies, and provide Americans with more choices. We have an opportunity to fix some of the foundational problems with our system. But vision care is not one of them. Instead, vision should be looked upon as a model for what works."

Comment: I thought the above important enough to reproduce in total. It was published in Agents Sales Journal, an industry newsletter.

Pro Choicers' Shoot themselves in the foot

2009-11-12T19:25:00.000-08:00

Nov 12 2009,
Excerpts from article "Politics in the Atlantic"
1:58 pm by Chris Good
Stupak On The Stupak Amendment

Rep. Bart Stupak's (D-MI) abortion amendment, which passed Saturday night has set off a firestorm of criticism from pro-choice lawmakers and interest groups, and it's being viewed as a coup for pro-lifers in Congress.

In an interview today, Stupak said his amendment does nothing more than apply current abortion law (the annually renewed Hyde amendment) to health care reform, and that pro-choice Democrats have only themselves to blame for its passage on the House floor Saturday night.

The amendment prohibits federal subsidies from being used to purchase insurance plans that cover elective abortions.

Speaker Pelosi went to present what she agreed to with us, that it would be part of a manager's amendment. There never should have been a vote on this. We had agreed to put it in a manager's amendment, which would have been less than what I actually got--Hyde-lite as I call it, Hyde language lite--and it was the pro-choice people that rejected it. read whole interview

Comment: The Hyde amendment has been federal law for 37 years and prohibits federal funds for abortion. Having said that...Will we never learn that you cannot legislate morality?

Calif Insurance Commissioner nixes rate increase

2009-11-10T06:16:00.001-08:00

Excerpts from Los Angeles Times article November 9,2009

Steve Poizner on Monday rejected a call from the California Workers' Compensation Insurance Rating Bureau to hike rates by 22.8% for policies that would be written or renewed after Jan. 1. Poizner also rejected a subsequent recommendation made by a hearing examiner from his department who had reviewed the 22.8% proposal and suggested 15.4% instead.

In rejecting the recommendations made to him, Poizner cited the weakness of California's economy and high unemployment.

Potential cost-cutting measures contained in a landmark legal overhaul of workers' compensation laws in 2003 and 2004 have not been fully exploited even though rates have fallen by more than half in the last six years, he said.

"It's hard for me to understand why there would be no rate increase," said Scott Hauge, president of Small Business California and a San Francisco insurance broker.
read whole article here

marc.lifsher@latimes.com

Copyright © 2009, The Los Angeles Times

Comment: As in most things relating to health, workers compensation insurance rates can be held down by serious consideration of maintaining a healthy safe working environment, handling small industrial mishaps internally and continue to educate employees in safe working environment policies.

Calif Insurance

2009-11-10T06:16:00.000-08:00

Steve Poizner on Monday rejected a call from the California Workers' Compensation Insurance Rating Bureau to hike rates by 22.8% for policies that would be written or renewed after Jan. 1. Poizner also rejected a subsequent recommendation made by a hearing examiner from his department who had reviewed the 22.8% proposal and suggested 15.4% instead.

By law the commissioner's decision is not binding, but it generally is followed by many leading insurance companies.

In rejecting the recommendations made to him, Poizner cited the weakness of California's economy and high unemployment.

"I'm very concerned about anything that would encourage or result in higher workers' compensation premiums," he said in a conference call. "This effectively is a tax on every employer in the state of California to cover the cost of workers' compensation insurance. As rates go up, it will definitely make our unemployment grow worse."

California's unemployment was 12.2% in September, the highest since World War II.

Insurers should be wringing more efficiencies out of their operations and cutting claims handling and medical costs rather than raising rates, Poizner said.

Potential cost-cutting measures contained in a landmark legal overhaul of workers' compensation laws in 2003 and 2004 have not been fully exploited even though rates have fallen by more than half in the last six years, he said.

The rating bureau based its suggested increase in premiums on a review of increased medical costs for treating workplace accident claims in the 12 months prior to June 30.

The bureau also said it factored in the potential effect of changes in statistical reporting and a pair of cases pending before the Workers' Compensation Appeals Board.

Representatives of insurance trade groups said they were puzzled by Poizner's decision to not recommend any rate increase in light of his department hearing officer's own finding that rates could climb 15.4% to cover increased medical costs and possible jumps in permanent disability awards.

"I really question the basis of the decision," said Sam Sorich, president of the Assn. of California Insurance Cos. "To reject the staff recommendation without any contrary quantitative evidence does not seem to be warranted."

Employers said they appreciated Poizner's attempt to keep rates down as long as they were not artificially suppressed.

"It's hard for me to understand why there would be no rate increase," said Scott Hauge, president of Small Business California and a San Francisco insurance broker.

marc.lifsher@latimes.com

Copyright © 2009, The Los Angeles Times
Related stories
From other L.A. sources

* Insurance commissioner Steve Poizner nixes 22.8% comp rate increase|bizjournals.com

House Democrats set vote on health reform bill.

2009-11-05T19:47:00.000-08:00

Excerpts from Nov 5,2009 NATIONAL ASSOCIATION OF HEALTH UNDERWRITERS newsletter(subscription)

House Democratic leaders have set the vote for their healthcare bill for Saturday evening. Media reports note a key stumbling block is the issue of whether the plan would permit the use of federal funds for abortion.

Bloomberg News (11/4, Rowley) reports, House Democratic leaders set a "vote as early as Saturday on the most sweeping overhaul of healthcare policy in four decades." Democratic leaders "were still locking down support Wednesday among a handful of holdouts, Many Democrats "said passing the measure has become even more crucial politically after Republicans won governor's races in Virginia and New Jersey this week."

Comment: The above is the short version of a longer and more detailed article in the NAHU subscription newsletter. I thought it would be informative to hear the Insurance industry take on the politics of Health Care reform.

GOP health bill shows challenge of health insurance reform

2009-11-04T05:52:00.000-08:00

Nov 4,2009 Excerpts from Kansas City Star Editorial

Republicans have offered an alternative of their own that they promise won't raise taxes, change the doctor-patient relationship, or cut Medicare.

But the GOP alternative also shows why health care reform is so tough: Each piece of health care reform interlocks with the others.

The Republican bill doesn't force insurance companies to provide coverage for those with pre-existing conditions

Why would the GOP not protect people with pre-existing conditions? That's one of the most popular part of health care reform

Here's why: Insurance companies have repeatedly said they can cover those with pre-existing conditions only if everyone has to buy insurance. Premiums from healthier workers, they say, will cover the costs of those with illnesses.

But if you require everyone to have insurance, you're deep in the muck. Do you fine people who don't get it?
And if you subsidize premiums for the poor, you have to find a way to pay for it. Raise taxes? Cut other spending ?

Instead, Democrats and Republicans are trying to glue some very different parts onto a model without an instruction sheet. No wonder it's so complicated.
read whole article

States May control final shape of new health insurance

2009-10-31T21:35:00.000-07:00

Excerpts from Washington Post Oct 30,2009

The debate over whether to let states opt out overlooks a key facet of the health-care measures : the shape of any new health-care system is likely to be finalized in Lansing and Boise and Baton Rouge.

"The fact is that state programs are going to look different," said Judith Solomon, a senior fellow at the Center on Budget and Policy Priorities in Washington. "Where some people might be expecting national health reform, we're facing the real possibility that what you get is going to depend heavily on where you live."

The health-care package unveiled by (the)House comes closer to national reform. It would create a national marketplace where those who lack insurance could shop for policies. States would play a supporting role, helping to design the largest expansion of Medicaid in 40 years and to develop high-risk insurance pools for people in immediate need of coverage. read whole article

Comment: It would seem that we are getting closer to some kind of different(hopefully better) health care system. We can only hope that whatever comes out of Congress can be handled by the states that it seems will be administrating the new system. It could take years to resolve all the new Federal rules.

Health Care: Behind the Debate

2009-10-27T06:17:00.000-07:00

Oct 27,2009 Excerpts from

Employers, individuals face tough choices on health coverage
By ARNOLD PLATOU
October 17, 2009
arnoldp@herald-mail.com

HAGERSTOWN — Two years ago, CareFirst BlueCross BlueShield told Peter P. Thomas his agency would have to pay 16.4 percent more to keep its workers’ health insurance the same.

This past year, CareFirst wanted the consortium to pay 22 percent more and, for the new insurance year it began this month, 19.5 percent.

“Since 1999, premiums have gone up a total of 131 percent, far more rapidly than workers’ wages (up 38 percent since 1999) or inflation (up 28 percent since 1999),”

“When health care costs continue to rise much faster than overall inflation in a bad recession, workers and employers really feel the pain. That’s why we’re having a health reform debate,” said Drew Altman, president and CEO of Kaiser.

Across the nation, many companies are reducing benefits,(to deal with increased premiums) according to the Kaiser-HRET survey.
read more

comment: It would seem that the problem is increased medical costs because of unrestricted use of newer, more expensive technology, (not necessarily a bad thing, just more expensive), increasing number of uninsured patients not paying, and our current economic situation. We blame the insurance companies who raise premiums, yet publish lower profits. It is a complex problem and is complicated by the publics' hesitance to embrace any change (change is always scary) What our legislatures are faced with is the attitude that a change is critical, just don't mess with my plan!

Canadian Message to US re: Public Option

2009-10-20T06:20:00.000-07:00

Oct 20,2009
Comment, Americans apparently spends more gets less and are less informed about their healthcare system than any other developed country. We should be listening to our neighbor to the North instead of to self serving politicians working to preserve their own special interests. Take time to view the Utube posting below

Medicare for everyone

Anti Trust Price Gouging Discussion

2009-10-16T05:56:00.000-07:00

Friday Oct 16,2009

Comment: The Tort reform we keep hearing about which is touted as a cure for exorbitant payouts for medical malpractice. A situation which can cause out of sight insurance premiums and evidence of defensive medical practices to avoid possible lawsuits. There are also those who say that insurance companies take advantage of this and raise premiums to ridiculous heights. Not so says the PIAA

Excerpts from Rueters Article

Physician Insurers Association of America (PIAA) Issues Statement Regarding Senate Judiciary Committee Hearing on Antitrust Exemption for Insurance Companies

"The Judiciary Committee`s hearing appeared to be an attempt to deflect
attention from much-needed federal medical liability reform, by blaming health
industry insurers for rising prices due to market conduct abuses. This simply
does not happen in the medical liability industry, which is highly regulated and
subject to continuous state-based oversight. While we agree with the overall
theme of the bill-to prohibit market abuses-the vagueness of the language of the
bill make interpretation of its effects impossible. Senator Leahy should
completely re-write the bill, garnering industry input, if he truly wants to
avoid unintended consequences, which would undermine competition and harm
consumers."

"Unlike other lines of insurance, medical liability coverage for doctors is
primarily provided by physician-owned and operated mutual and reciprocal
companies, which have no incentive to price gouge."
read more

The Social Security COLA and Medicare Part B Premium:

2009-10-15T06:41:00.000-07:00

Excerpts from Henry J Kaiser Foundations Research Oct 14,2009

Social Security recipients are not expected to receive a cost-of-living adjustment (COLA) for the first time in 2010, with no or low COLAs projected through 2012.

This issue brief, based on the most recent projections of the Medicare and Social Security Trustees, explains the relationship between the Social Security COLA and the Medicare Part B premium.

Not all Medicare beneficiaries will be affected. About three in four Medicare beneficiaries are protected by a “hold-harmless” provision in the law Thus, the higher premiums would fall on the remaining one quarter of beneficiaries ‍— ‍with monthly premiums expected to rise from $96.40 this year to $120.20 in 2011.

Medicaid would pay the cost of the monthly Part B premium, increasing Medicaid costs for states.

read complete brief

Tort Re-visited

2009-10-12T09:15:00.000-07:00

CBO Finds That Medicare Malpractice Reform Would Produce Substantial Savings

The CBO responded this week to a request from Senator Orrin Hatch (R-UT) with an updated analysis on the potential budgetary effects of tort reform proposals aimed at limiting the costs related to medical malpractice. The CBO found that by instituting prudent tort reform measures, federal spending would be reduced by $41 billion over 10 years and the federal deficit would decline by $54 billion.

TORT Definition: A tort is a civil wrong for which a remedy (usually money damages) can be obtained by law. It is a breach of the special duty that skilled professionals such as doctors have in excess of the ordinary person. Tort law and insurance regulation are traditionally under the purview of the states.

Senate Panel To Vote On Baucus Plan Next Tuesday

2009-10-09T06:12:00.000-07:00

A number of media reports see momentum now building behind the President's push to overhaul the nation's healthcare system. ABC World News reported, "A vote is now set for next Tuesday in the Senate Finance Committee on its $829 billion health care reform plan." The CBS Evening News noted that "according to a new report from the nonpartisan Congressional Budget Office, the plan costs less than expected and would actually reduce the deficit.

So why do Republicans still oppose it?" CBS showed House Minority Whip Eric Cantor saying, "The fact is the numbers arrived at by taxing businesses, by taxing people who have insurance, as well as cutting benefits for seniors. That's not an acceptable health care reform recipe."

The AP reports Democrats "have made significant strides since Labor Day, when they returned to the Capitol in near disarray after an August spent absorbing attacks from noisy conservative critics at home." The New York Times reports that "Republicans were not impressed by the new numbers" from CBO,

Comment: It seems we all agree that our healthcare system needs to be fixed. Some of our lawmakers seem to actually be working on a solution. While the majority of them spend endless hours plotting how they can take political advantage of the disorder they themselves have created.

Our political system provides us with the means to advance our human condition while at the same time allowing us to place roadblocks to its realization.

Baucus Bill meets Obama's requirements

2009-10-08T06:06:00.000-07:00

October 8,2009

Senate Budget Chairman Kent Conrad said on MSNBC's Ed Show, "I'm still not at all certain we can get the 60 votes necessary without some Republicans. At the end of the day, this is a good bill. It's a good beginning. It's paid for. It reduces the cost curve by $650 billion to $1.3 trillion over the second 10 years according to CBO in this latest report."

You think there might be a light at the end of the tunnel?

2009-10-07T20:19:00.000-07:00

Oct 7,2009

Preview of article from Dow Jones Subscription service

"WASHINGTON (Dow Jones)--A health overhaul proposal from Sen. Max Baucus, D-Mont., got a boost Wednesday from the Congressional Budget Office, which said the bill wouldn't add to the deficit through 2019 and probably would continue to raise more money for the government than it costs after that time.

The widely awaited preliminary estimate from CBO found that the bill would reduce the deficit by $81 billion through 2019.

The CBO said the gross cost of the bill comes to $829 billion ..."

Comment: Seems like the invective and mudslinging chaos is starting to dissolve into an overhaul of our broken Health care system that looks a lot like Obama promised in his campaign. I am sure there are plenty of critics who find this direction unpalatable but life goes on and good people of good intent do sometimes do good things, we can hope.

Will Insurers Balk At Weakening of Individual Insurance Mandate

2009-10-03T06:08:00.000-07:00

By Mary Agnes Carey, KHN Staff Writer
Oct 02, 2009

"Health insurers have held their fire as Congress debates payment cuts, new fees and taxes and more regulation for their industry. Now the question is: Will they balk – or walk – if lawmakers continue to weaken a requirement that people carry insurance?"
read whole article

Comment:

If you ignore all the politics and special interest bombardment and think about it what we are seeing here is a zeroing in on is one huge group insurance policy.

When everybody is in the pool, all of the majority of healthy people are paying for services they may not need often and the ones who really need the help are paying the same low rates.

Everybody gets the help they need and nobody gets to die young because they can't afford medical help.

Some of the side benefits are less workers off because they are sick and more productive workers because they are healthier and feel more like working.

Let's face it, a healthier nation is a more productive nation. Everybody wins.

Medicaid Fraud Uncovered in Survey

2009-10-02T05:44:00.000-07:00

NAHU Newswire 10/1/2009

GAO finds "thousands" of potentially fraudulent Medicaid purchases. CQ HealthBeat (10/1, Norman, subscription required) reports that a GAO "analysis has found thousands of Medicaid beneficiaries involved in potentially fraudulent purchases of controlled substances in five large states -- including prescriptions filled for some 1,800 people who had already died." The investigation "also found Medicaid in those states paid about $500,000 in claims based on controlled substance prescriptions 'written' by physicians after their deaths." The report was issued to the Senate Homeland Security and Governmental Affairs Committee on Wednesday. Committee member Sen. Thomas R. Carper (D-DE) said, "It is clear that the Centers for Medicare and Medicaid Services need to do a better job of providing guidance and regulatory enforcement for the states. .. At the same time, states need to take greater responsibility for preventing and rooting out fraud, waste and abuse from their own backyards."

State amendments could limit health overhaul

2009-09-30T05:55:00.000-07:00

Excerpts from article By Monica Davey
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

Rising Health Care Costs affect Retirees

2009-09-24T05:19:00.000-07:00

Excepts from The Dallas Morning News article

American Airlines to end health plan for non-union retirees

12:00 AM CDT on Wednesday, September 23, 2009

By TERRY MAXON tmaxon@dallasnews.com

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.
read more

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

We already have a healthcare bill in congress that both parties can agree on

2009-09-22T06:07:00.001-07:00

Sept 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

Young Doctors Speak out on Health Care Reform

2009-09-21T17:21:00.000-07:00

Monday Sept 21,2009 from Youth Radio[YR] (global public radio) one of their interviews with doctors on Health care reform

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

Gender Equity in Health Insurance?

2009-09-18T05:32:00.000-07:00

Excerts from the Huffington Post article by:

Morgan Carroll
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.

Read More

Rueters Reports US Health premiums double

2009-09-16T08:07:00.000-07:00

Sept 16,2009

Rueters publishes survey of Health Care Costs in US. Employees are paying more of share, Employers are rethinking employees participation.
read whole article here

Massachusetts Universal Healthcare Success

2009-09-14T14:58:00.000-07:00

Sept 14,2009 Excerpt from NAHU Daily Newsletter

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.

Frances Health Care System

2009-09-14T06:44:00.000-07:00

Health Care Abroad: France
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.

Q.

In 2000, the World Health Organization ranked the French health system as the best over all in the world. Do you agree?

A.

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.

Q.

That finding implies that the French have good access to health care. Do they?
A.

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.

Q.

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?

A.

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

Q.

So it’s not a single-payer system.
A.

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

Q.

If the French system resembles Medicare, does that mean that it also faces the problem of rising costs?

A.

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.

Q.

How do they control health care costs?

A.

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.

Q.

But you also said the French have no choice in their plan. Americans seem to want choice.

A.

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.

Q.

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?
A.

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.

Q.

What key lessons can the United States learn from France?
A.

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

Are our pre-conceptions influencing our thinking?

2009-09-11T06:02:00.000-07:00

Health Care Reform and ‘American Values’

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

The Debate Gets Serious

2009-09-08T21:18:00.000-07:00

The Wall Street Journal * SEPTEMBER 6, 2009

Excerpts from:
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

The Language of HealthCare Debate

2009-09-05T06:15:00.000-07:00

Chicago Tribune

September 4,2009

HEALTHCARE GLOSSARY

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 U.S.

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

exchange.

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

reimburse.

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. .

Hate mongers pay little attention to health care facts

2009-09-03T07:49:00.000-07:00

A Recent survey shows little difference in users opinion of healthcare private or public see full report here

Excerpt from
September 1, 2009, 8:40 pm

Rating Public and Private Health Insurance

By 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.

Brookings Institute Experts way in on Healthcare

2009-09-01T21:52:00.000-07:00

September 1, 2009, 2:21 pm

A Bipartisan Proposal on Health Care Costs

By 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.

America, the last holdout

2009-08-30T05:40:00.000-07:00

Health care abroad: the myths

Excerpts from an article in The Oregonian

by T.R. Reid, guest opinion
Saturday August 29, 2009, 5:45 PM

As Americans search for the cure to what ails our health care system, we've overlooked an invaluable source of ideas and solutions: the rest of the world. All the other industrialized democracies have faced problems like ours, yet they've found ways to cover everybody -- and still spend far less than we do.
I've traveled the world from Oslo to Osaka to see how other developed democracies provide health care. Instead of dismissing these models as "socialist," we could adapt their solutions to fix our problems. To do that, we first have to dispel a few myths about health care abroad:

1. It's all socialized medicine out there.

Not so. Some countries, such as Britain, New Zealand and Cuba, do provide health care in government hospitals, with the government paying the bills. Others -- for instance, Canada and Taiwan -- rely on private-sector providers, paid for by government-run insurance. But many wealthy countries -- including Germany, the Netherlands, Japan and Switzerland -- provide universal coverage using private doctors, private hospitals and private insurance plans.
2. Overseas, care is rationed through limited choices or long lines.

Generally, no. Germans can sign up for any of the nation's 200 private health insurance plans -- a broader choice than any American has. If a German doesn't like her insurance company, she can switch to another, with no increase in premium. The Swiss, too, can choose any insurance plan in the country.
3. Foreign health care systems are inefficient, bloated bureaucracies.

Much less so than here. It may seem to Americans that U.S.-style free enterprise -- private-sector, for-profit health insurance -- is naturally the most cost-effective way to pay for health care. But in fact, all the other payment systems are more efficient than ours.
4. Cost controls stifle innovation.

False. The United States is home to groundbreaking medical research, but so are other countries with much lower cost structures. Any American who's had a hip or knee replacement is standing on French innovation. Deep-brain stimulation to treat depression is a Canadian breakthrough. Many of the wonder drugs promoted endlessly on American television, including Viagra, come from British, Swiss or Japanese labs.
5. Health insurance has to be cruel.
Not really. American health insurance companies routinely reject applicants with a "pre-existing condition" -- precisely the people most likely to need the insurers' services. Foreign health insurance companies, in contrast, must accept all applicants, and they can't cancel as long as you pay your premiums. The plans are required to pay any claim submitted by a doctor or hospital (or health spa), usually within tight time limits.

The key difference is that foreign health insurance plans exist only to pay people's medical bills, not to make a profit. The United States is the only developed country that lets insurance companies profit from basic health coverage.
In terms of results, almost all advanced countries have better national health statistics than the United States does. In terms of finance, we force 700,000 Americans into bankruptcy each year because of medical bills. In France, the number of medical bankruptcies is zero. Britain: zero. Japan: zero. Germany: zero.

Given our remarkable medical assets -- the best-educated doctors and nurses, the most advanced hospitals, world-class research -- the United States could be, and should be, the best in the world. To get there, though, we have to be willing to learn some lessons about healthcare administration from the other industrialized democracies.

Copyright: 2009, The Washington Post

T.R. Reid, a former Washington Post reporter, is the author of "The Healing of America: A Global Quest for Better, Cheaper, and Fairer Health Care."

Cheap Insurance for expensive Classic Cars

2009-08-30T05:13:00.000-07:00

Excerpts from anLA Times article by KATHY KRISTOF

kathy.kristof@latimes.com

Got a classic car, like a 1960s-era Mustang or a gull-wing Mercedes? You could be paying too much to insure it.

Roughly half of classic car owners put their vehicles on a standard auto insurance policy without realizing that they could be paying too much for inadequate coverage.

"A lot of people who are into car collecting as a hobby might not be paying attention to things like insurance," he said. "They just call their agent and add the car to their policy."

Insuring a classic with a traditional auto policy is a mistake for various reasons, Heacock said.

For one, traditional insurance is based on the notion that a car’s value will decrease over time. But a classic car is likely to appreciate, especially if you’re restoring it. You don’t want to get a depreciated value if something happens to your pristine 1967 Jaguar XKE, he noted. But if you have a standard policy, that’s generally what you’ll get.

When buying a classic car insurance policy, which is offered by dozens of specialized companies nationwide, you and the insurer agree to the car’s replacement value. That price will be based on your assessment of the car’s value and the price the car has brought at auction and in collectors’ sales. If the car is destroyed, you’ll get that agreed-to value without having to dicker about depreciation.

It may seem counterintuitive that the premiums would be lower on a policy that provides a higher replacement cost. But the reason is simple: Classic and collectible cars are pampered (and driven infrequently and carefully).

How much cheaper is classic car insurance? The answer varies widely based on the insurer and vehicle.

A State Farm spokesman said it might cost $470 annually to cover a 1968 Camaro with a traditional policy — with a lot of caveats: the driver has 30 years of experience, multiple discounts and a perfect driving record.

Why? Because State Farm uses dozens of factors to price your policy, while Heacock has a simpler model. It looks mainly at the car’s value and how it is going to be used. If you’re driving it solely in parades and to and from auto shows, the chance of getting T-boned on the highway — or slamming into another driver — is pretty slim, Heacock said.

The low prices come with plenty of restrictions, however. Heacock doesn’t cover youthful drivers. (Don’t apply if you’re younger than 30.) The car can’t be driven more than 5,000 miles a year, and it had better have a home in the garage, not in the driveway or yard. State Farm specifies that it’s insuring you to drive in parades and to car shows — not to work or to the supermarket.

"We’re not looking to insure your second car," Heacock said. "We’re only interested in insuring cars that are getting some extra attention."

What isn’t necessarily required to secure classic car insurance is an expensive antique vehicle. If a car draws enthusiasts and is driven like a collectible, it can probably be insured like a collectible, said Candysse Miller, executive director of the Insurance Information Network of California and an avowed car buff.

But the right insurer and policy are going to vary based on the type of car you have and how (or whether) you drive it.

This is a highly specialized market, Miller noted. Some companies specialize in antique cars, some in muscle cars or race cars, others in elegant classics.

Moreover, the premium charged for a car that is on display is a fraction of what it is for a car that’s on the road, Heacock said. Heacock figures that a collectible car can typically be insured for a premium amounting to 1 percent of its value.

If you’re in a car club, ask your fellow Duesenberg or Corvair enthusiasts where they bought their insurance, she said.

California insurance commissioner to fight sale of part of workers' comp fund

2009-08-28T06:38:00.000-07:00

Excerpts from an August 28, 2009 Los Angeles Times article
By Marc Lifsher

California's regulator is expected today to file a lawsuit to try to stop the governor from selling $1 billion worth of business at state-run workers' compensation insurance company.

Last month, Gov. Arnold Schwarzenegger and the Legislature approved the proposed sale to raise money to partially plug a $24-billion hole in the state budget.

Insurance Commissioner Steve Poizner vowed to fight it. "This is bad politics; it's illegal, and I'm going to stop it," he said. And he warned that a sale could increase the price of workers' comp insurance for millions of workers.

Poizner said he would ask a Sacramento County Superior Court judge for an injunction preventing any sale of policies at the $21-billion company known as State Fund.

To net $1 billion, the state would have to sell a significant portion of State Fund's best, least risky business, officials estimate. But doing that, Poizner warned, could drive up rates for policyholders at both State Fund and private companies.

"They may have to raise rates by thousands of dollars a year per policy to make up for this $1 billion," he said. "It could ripple through the entire workers' compensation system."

Selling assets "can be accomplished in a manner that is legal and that maintains the integrity of the fund," said H.D. Palmer, a spokesman for Schwarzenegger's finance department.

But selling a big chunk of State Fund would violate a provision of the state Constitution approved by voters in 1918, Poizner said. That statewide vote set up a legal system for providing medical care and compensation to injured workers. State Fund's board of directors, nine of 11 of whom are appointed by the governor, has also gone on record opposing the proposed sale.

Money collected by selling State Fund assets legally belongs to policyholders, not California taxpayers, said Nicholas Roxborough, a Los Angeles attorney who specializes in employers' rights in workers' compensation disputes.

Trying to balance the budget by selling State Fund business is "pie in the sky, Fantasyland stuff," he said. "For the governor to propose this means he either truly does not understand what is State Fund or this is nothing more than a ruse."

What about a Voucher System for Health Care?

2009-08-26T19:59:00.000-07:00

August 25, 2009, 10:00 pm

A Reading List on Insurance Choice

By David Leonhardt

InIn my ColumnI talk about an idea that’s missing from the current versions of health reform: allowing people to choose an insurance plan other than the ones offered by their employer.

Ezekiel Emanuel, an oncologist now working in the Obama budget office, and Victor Fuchs, a Stanford economist, lay out their version of a plan here.

Comment by Phil

Get ready to suspend disbelief and spend some time reading a serious proposal that has real merit. Jump to page 10 of the adobe pdf file for a brief summary of the plan. It will be worth your time.

An Independant Study Group's conclusions

2009-08-24T22:40:00.000-07:00

Mon Aug 24 08:07:40 2009 Pacific Time

RAND Analysis Finds Certain Health Reform Policy Options Would Significantly Reduce Number of Uninsured Americans

SANTA MONICA, Calif., Aug. 24 (AScribe Newswire) -- New analysis from the RAND Corporation shows that a mandate requiring individuals to obtain health insurance -- an option in various current legislative proposals -- would increase the number of Americans with coverage by 9 million to 34 million, while a mandate requiring employers to offer insurance would boost the figure by 1.8 million to 3.4 million.

The findings are from a micro-simulation model created as a part of RAND COMPARE, an ongoing, independent effort to provide objective information about health care reform. The latest analysis, released today at www.randcompare.org, examines policy options designed to expand coverage to the uninsured.

In addition to individual policy options, the analysis examined a plan proposed in the lead-up to the current health care debate by U.S. Sen. Max Baucus. Researchers evaluated the likely effect of the proposal on coverage, spending, consumer financial risk and health. RAND's analysis of that plan, outlined in a white paper in November, concludes it would reduce the number of people without insurance by an estimated 60 percent to 85 percent, depending on specific design choices.

That proposal relates to draft legislation that is still being negotiated by the Senate Finance Committee, of which Sen. Baucus (D-Montana) is chairman. Not all of the elements examined by RAND will necessarily be part of the legislation that ultimately emerges from that committee, but many of the features are similar to those found in the House Tri-Committee bill and the Health, Education, Labor and Pensions (HELP) Committee bill.

Researchers from RAND, a nonprofit, nonpartisan research organization, found that under different design choices the Baucus proposal could significantly cut the number of uninsured Americans with almost no increase in overall spending on health care, although government costs would increase by an estimated 5 percent to 7 percent.

"What is clear is that the extent of subsidies to help people purchase insurance, as well as the size of the penalty for an individual who fails to purchase insurance or an employer who fails to offer it, can make a substantial difference," said Elizabeth McGlynn, co-director of COMPARE and associate director of RAND Health. "These are some of the key decisions that face Congress when it returns after the recess."

The plan as outlined in the white paper would be implemented over time and would include: a requirement that all employers above a certain size offer health insurance to their employees, an expansion in the eligibility for Medicaid and the State Children's Health Insurance Program and a requirement that all individuals have health insurance coverage.

The white paper did not specify which employers would be required to offer insurance or what the penalty would be for those who choose not to offer it. Researchers examined the effect of excluding companies with fewer than 5, 10 or 25 employees from the mandate, as well as the effect of penalties set at 5 percent, 10 percent and 20 percent of total payroll.

RAND estimates that before implementation of the individual mandate, the number of people who would become newly insured through employer-sponsored coverage could range from 2 million to 7.2 million, depending on assumptions.

Before the individual mandate is implemented, expanding eligibility for Medicaid and the State Children's Health Insurance Program results in about 5 million more people obtaining health insurance coverage than under the employer mandate alone.

All of the health reform bills introduced by chairs of committees with jurisdiction thus far include some type of new national health insurance exchange that would allow individuals to purchase health insurance in a national market, rather than only among those plans offered in the state where they live. Once this exchange is operational, the plan RAND analyzed would require everyone to have insurance through either a public program (Medicaid, State Children's Health Insurance Program, TRICARE) or through private sources (employer, individual policies, exchange).

"We found that the individual mandate has the largest effect on reducing the number of people without health insurance," said Christine Eibner, lead researcher on the analysis of the white paper and an economist at RAND. She noted that the Baucus proposal specifies that subsidies to help purchase insurance would be offered to people with incomes of up to 400 percent of the federal poverty level.

She said the individual mandate is the one policy option that addresses the different characteristics of the uninsured. It will affect both the 44 percent of people who already have an offer of health insurance through their employer or Medicaid, but have not taken it, as well as the remaining group that would have to seek out insurance.

The white paper did not specify the size of penalty that would be imposed on people who do not comply with the mandate to purchase insurance. Researchers examined the effect of penalties set at 25 percent, 50 percent and 75 percent of the premium an individual would have to pay for a policy from an insurance exchange. Assuming a moderate employer mandate, increasing the penalty from 25 percent to 75 percent of the premium an individual would pay on the national insurance exchange would reduce the number of uninsured by 32.5 million -- a 71 percent reduction. By contrast, a penalty of 25 percent would reduce the number of uninsured by 20.8 million, a 46 percent reduction.

Most of the major proposals in Congress include some new health insurance marketplace (such as the "exchange" in the white paper and the House Tri-Committee bill, and "gateways" in the HELP Committee bill). Subsidies to offset the costs of purchasing health insurance are generally only available to people who purchase via the exchange; and access to the exchange in many bills is limited to those who do not have any other source of coverage. The RAND team estimated that if this restriction were relaxed, 38.3 million people would be newly insured -- an 85 percent reduction in the rate of uninsurance.

RAND researchers also estimated the increase in national spending on health care, the increase in government spending, the effect for consumers in different types of households, and the change in the health of the population that might be caused by adopting provisions in the white paper.

Under all of the policy options, the increase in national spending on health care was negligible, meaning that increasing the number of people with insurance would not likely change the rate of growth in health spending. Government spending would increase by 5 percent to 7 percent under the most likely scenarios; however, if the insurance exchange were open to a much wider group of people, government spending could increase by as much as 9 percent, according to the RAND analysis.

Consumers who are currently uninsured would likely spend more on health care if the proposals in the white paper were implemented than they do today. RAND researchers estimate that people without insurance currently spend about 2 percent of their income on health care on average, compared with 6 percent among those with insurance. The analysis suggests the plan would prompt those who become newly insured to increase their spending on health care to about 5 percent, on average.

Researchers also evaluated whether any change would occur in the proportion of population likely to experience very high rates of spending on health care. They found that about one-quarter of the nation's population would spend more than 10 percent of their income on health care after the policy change, the same proportion that faces high levels of spending today.

A unique feature of the RAND analysis is the ability to estimate the impact of these policy changes on the health of the nation. Researchers estimate that under full implementation, the white paper's proposal would add 9.3 million life years to the U.S. population.

RAND developed COMPARE to provide objective facts and analysis to inform the dialogue about health policy options. Individuals, corporations, corporate foundations, philanthropic foundations, and health system stakeholders have funded COMPARE. The new analysis is presented on the Web site's "dashboard" (see http://randcompare.org/analysis/), which allows users to compare different policy options across a broad set of criteria.

RAND Health, a division of the RAND Corporation, is the nation's largest independent health policy research program, with a broad research portfolio that focuses on quality, costs and health services delivery, among other topics. RAND Health is the developer of COMPARE (Comprehensive Assessment of Reform Efforts), a one-of-a-kind online resource that provides objective analysis about national health care reform proposals.

The RAND Corporation is a nonprofit research organization providing objective analysis and effective solutions that address the challenges facing the public and private sectors around the world. To sign up for RAND e-mail alerts: http://www.rand.org/publications/email.html .

A Public Option that Works

2009-08-24T06:22:00.000-07:00

By WILLIAM H. DOW, ARINDRAJIT DUBE and CARRIE HOVERMAN COLLA

Published: August 21, 2009

TWO burning questions are at the center of America’s health care debate. First, should employers be required to pay for their employees’ health insurance? And second, should there be a “public option” that competes with private insurance?

Answers might be found in San Francisco, where ambitious health care legislation went into effect early last year. San Francisco and Massachusetts now offer the only near-universal health care programs in the United States.

The early results are in. Today, almost all residents in the city have affordable access to a comprehensive health care delivery system through the Healthy San Francisco program. Covered services include the use of a so-called “medical home” that coordinates care at approved clinics and hospitals within San Francisco, with both public and private facilities. Although not formally insurance, the program is tantamount to a public option of comprehensive health insurance, with the caveat that services are covered only in the city of San Francisco. Enrollees with incomes under 300 percent of the federal poverty level have heavily subsidized access, and those with higher incomes may buy into the public program at rates substantially lower than what they would pay for an individual policy in the private-insurance market.

To pay for this, San Francisco put into effect an employer-health-spending requirement, akin to the “pay or play” employer insurance mandates being considered in Congress. Businesses with 100 or more employees must spend $1.85 an hour toward health care for each employee. Businesses with 20 to 99 employees pay $1.23 an hour, and businesses with 19 or fewer employees are exempt. These are much higher spending levels than mandated in Massachusetts, and more stringent than any of the plans currently under consideration in Congress. Businesses can meet the requirement by paying for private insurance, by paying into medical-reimbursement accounts or by paying into the city’s Healthy San Francisco public option.

There has been great demand for this plan. Thus far, around 45,000 adults have enrolled, compared to an estimated 60,000 who were previously uninsured. Among covered businesses, roughly 20 percent have chosen to use the city’s public option for at least some of their employees. But interestingly, in a recent survey of the city’s businesses, very few (less than 5 percent) of the employers who chose the public option are thinking about dropping existing (private market) insurance coverage. The public option has been used largely to cover previously uninsured workers and to supplement private-coverage options.

Through our experience working on health-care-reform efforts in California and Washington (one of us worked for President George W. Bush’s Council of Economic Advisers), we have seen how concern over employer costs can be a sticking point in the health care debate, even in the absence of persuasive evidence that increased costs would seriously harm businesses. San Francisco’s example should put some of those fears to rest. Many businesses there had to raise their health spending substantially to meet the new requirements, but so far the plan has not hurt jobs.

As of December 2008, there was no indication that San Francisco’s employment grew more slowly after the enactment of the employer-spending requirement than did employment in surrounding areas in San Mateo and Alameda counties. If anything, employment trends were slightly better in San Francisco. This is true whether you consider overall employment or employment in sectors most affected by the employer mandate, like retail businesses and restaurants.

So how have employers adjusted to the higher costs, if not by cutting jobs? More than 25 percent of restaurants, for example, have instituted a “surcharge” — about 4 percent of the bill for most establishments — to pay for the additional costs. Local service businesses can add this surcharge (or raise prices) without risking their competitive position, since their competitors will be required to take similar measures. Furthermore, some of the costs may be passed on to employees in the form of smaller pay raises, which could help ward off the possibility of job losses. Over the longer term, if more widespread coverage allows people to choose jobs based on their skills and not out of fear of losing health insurance from one specific employer, increased productivity will help pay for some of the costs of the mandate.

The San Francisco experiment has demonstrated that requiring a shared-responsibility model — in which employers pay to help achieve universal coverage — has not led to the kind of job losses many fear. The public option has also passed the market test, while not crowding out private options. The positive changes in San Francisco provide a glimpse of what the future might look like if Washington passes substantial health reform this year.

William H. Dow, who was a senior economist for President George W. Bush’s Council of Economic Advisers, is a professor of health economics at the University of California, Berkeley, where Arindrajit Dube is an economist at the Institute for Research on Labor and Employment and Carrie Hoverman Colla is a doctoral student in health economics.

A thoughtful insight

2009-08-24T06:07:00.000-07:00

Excerpt from a middle America Professional news editor

August 24,2009

As you read this, unemployed people are wondering if the cancer treatments they endured five years ago will prevent them from getting an insurance policy.

Hardworking families are filing bankruptcy papers because of medical bills they can’t begin to pay.

The 24-hour news cycle spins and spins, the pundits talk and talk, and the Internet rumors fly. It’s all a great, captivating show but it is surreal. Reality is the stories playing out in our communities, and I fear we’re losing sight of them.

Editorial board member Barbara Shelly can be reached at bshelly@kcstar.com or 816-234-4594. She blogs at voices.kansascity.com

The crux of the problem

2009-08-23T05:51:00.000-07:00

Submitted by todaydata on August 22, 2009 - 11:05am.

It is not just Medicare not paying the full price. Those of us who buy private plans pay ridiculously high prices for poor coverage because the big employer based plans negotiate big discounts and the insurance companies shift the costs to those of us with no buying clout.

And people who pay out of pocket pay two or three times what big insurance companies pay for the same service.

Two Very Different Views of Health Care Reform

2009-08-22T05:57:00.000-07:00

It's difficult to sort out fact from emotion driven view point. Here are two views posted today August 22,2009

The Real Death Panels
Rep Tom Price on Patient Centered Care

CBS news asks Will Insurance Alone Cure What Ails Us?

2009-08-18T20:55:00.000-07:00

Insuring All Americans Won't Help if There Is a Shortage of Primary Care Doctors

By Sanjay Gupta

President Obama says everyone should be required to have health insurance, much like car insurance. Is Massachusetts' mandatory health insurance laws on the right track?

(CBS) Baystate Medical Center is the second busiest emergency room in Massachusetts. They treat over 100,000 patients a year, but here's the thing: according to Dr. Niels Rathlev, who runs the ER, a quarter of them don't need his services.

"Well I think the way I would phrase it is to say I think that there are alternate sites of care that would be more appropriate," Rathlev said.

He means a doctor's office - a primary care doctor's office, reports CBS News contributing medical correspondent Dr. Sanjay Gupta.

"The majority of patients who are frequent utilizers of the emergency department actually have insurance," Rathlev said. "They have a primary care physician, but they choose to come to the ER because they don't have access."

Like Kenneth Mills, who is in pain from a bowling injury.
"I went and called my doctor this morning," Mills said. "But I wouldn't be able to get in to see him."

Mills is bruised, not broken, and could have easily been treated outside the ER.
Well, I wish I had a primary I could just call and come in and I wouldn't have to wait as long," Mills said.

That's the issue: There aren't enough doctors.
the Department of Health and Human Services, we're more than 16,000 primary care doctors short in The United States.

I've been in practice for 10 years and I still owe $60,000 in student loans," said Dr. Kate Atkinson from Amherst, Mass.

The reality here is that Atkinson and her nurse practitioner treat 3,000 patients, but filling out hundreds of different forms takes a staff of 11- so she simply can't make ends meet.

Gupta thinks money plays a role. There has also been discussions of medical school loan forgiveness programs, which might help. But it's also the paperwork - it makes it hard for primary care physicians to get work done.

Historical bacground of a working Not-For-Profit Health Care Group

2009-08-16T16:42:00.000-07:00

Medicacare Advantage plans (private ins wrapped around personal medicare ) works and provides smaller premiums because the govt funds at 14% higher to private insurance .

Enter Kaiser Permanente
(a model for Not for Profit Co-Op Insurance groups)

Excerpts from "About" Kaiser Permanente website

Kaiser Permanente evolved from industrial health care programs for construction, shipyard, and steel mill workers for the Kaiser industrial companies during the late 1930s and 1940s. It was opened to public enrollment in October 1945.

The organization that is now Kaiser Permanente began at the height of the Great Depression with a single inventive young surgeon in the middle of the Mojave Desert. Sidney Garfield, MD, looked at the thousands of men involved in building the Los Angeles Aqueduct, . He borrowed money to build Contractors General Hospital; six miles from a tiny town called Desert Center, and began treating sick and injured workers. Dr. Garfield was having trouble getting the insurance companies to pay his bills in a timely fashion. To compound matters, not all of the men had insurance, so he often was left with no payment at all for his services. Soon, the hospital’s expenses were far exceeding its income.

Prepayment System is Born

Harold Hatch, an engineer-turned-insurance agent suggested that the insurance companies pay Dr. Garfield a fixed amount per day, per covered worker, up front. This would enable Dr. Garfield to emphasize maintaining health and safety rather than merely treating illness and injury. Thus, “prepayment” was born. Thousands of workers enrolled, and Dr. Garfield’s hospital became a financial success.

As the aqueduct project wound down, Dr. Garfield prepared to leave his desert hospital and start a solo practice in Los Angeles. But he got a call from another industrialist. This time, the problem was providing health care to 6,500 workers and their families at the largest construction site in history—the Grand Coulee Dam.

He recruited a team of doctors to work in a “prepaid group practice.” The method again was a smashing success and a big hit with the workers and their families. But as the dam neared completion in 1941, it seemed once again that the grand experiment was reaching an end.

America’s entry into World War II brought tens of thousands of workers—many of who were inexperienced and in poor health already—pouring into the Kaiser Shipyards in Richmond, Calif. Now, Henry J. Kaiser had the problem: How to provide health care for this teeming mass of 30,000? Kaiser convinced Dr. Garfield he could solve the problem, but it took some special wrangling—the surgeon was already scheduled to enter active duty with his U.S. Army Reserve unit .

At Kaiser’s request, President Franklin D. Roosevelt released Dr. Garfield from his military obligation so he could organize and run a prepaid group practice for the workers at the Richmond shipyards.
So, Dr. Garfield and his health care delivery system came to the San Francisco Bay Area, and formed the association with Kaiser that would imbed itself in the organization and continue until the present day.

Thus, the organization known in modern times as Kaiser Permanente was born. We are still a working partnership of two organizations: the not-for-profit Kaiser Foundation Health Plan and Hospitals, and the Permanente Medical Groups.
© 2009 Kaiser Permanente

A thoughtful alternative

2009-08-14T08:19:00.000-07:00

Excerpts from a Wall Street Journal article (August 13,2009)
By JOHN H. COCHRANE

Mr. Cochrane is professor of finance at the University of Chicago Booth School of Business, and author of "Health Status Insurance" (Cato, 2009)

Even if you don't like the massive health-care package being considered in Congress, you have to admit that health insurance and health care in this country are not working well. There are two basic problems:

First, if you get sick and then lose your job or get divorced, you lose your health insurance. With a pre-existing condition, new insurance will be ruinously expensive, if you can get it at all. This, the central defect of American health insurance, explains why most Americans are happy with their current coverage yet also support reform.

Second, health care costs too much. Yes, we get better treatment, but the cost-cutting revolution has not touched health care.

The problems are real, but the remedy— more government intervention—is counterproductive. A market-based, reform is possible, and it will work.

Health care and insurance are service-oriented, retail businesses. The only way to reduce costs in such a business is intense competition for every customer. The idea that the federal government can reduce costs is a triumph of hope over centuries of experience.

The cost-cutting revolutions didn't settle questions like these with acts of Congress, That approach has never spurred efficiency, and for good reasons. Cost-cutting is painful. Patients might have to get tests at inconvenient times and locations. They will do this when their money is at stake—what people will put up with from airlines for a few dollars is truly amazing—but they will never accept it from the government.

But what about pre-existing conditions?

A truly effective insurance policy would combine coverage for this year's expenses with the right to buy insurance in the future at a set price. UnitedHealth now lets you buy the right to future insurance—insurance against developing a pre-existing condition.

These market solutions can be refined. Insurance policies could separate current insurance and the right to buy future insurance. Then, if you are temporarily covered by an employer, you could keep the pre-existing-condition protection.

Some insurers avoid their guaranteed-renewable obligations by assigning people to pools and raising rates as healthy people leave the pools. Health insurers, like life insurers, could write contracts that treat all of their customers equally.

The right to future insurance could be transferrable to another company, for example, if you move. You could have the right that your company will pay a lump sum, so that a new insurer will take you, with no change in your premiums. Better, this sum could be occasionally placed in a custodial account. If you got sick but had something like a health-savings account to pay high premiums, you could always get new insurance. Insurers would then compete for sick people too.

Innovations like these would catch on quickly in a vibrant, deregulated individual insurance market.

How do we know insurers will honor such contracts? A car insurer that doesn't pay claims quickly loses customers and goes out of business. And courts do still enforce contracts.

More importantly, health care and insurance are overly protected and regulated businesses. We need to remove regulations such as the ban on cross-state insurance. Think about it. What else aren't we allowed to purchase in another state?

Private, competitive insurance markets are a superior way to solve the pre-existing-conditions problem, and the only hope to lower costs.

What about immigration?

2009-08-12T06:15:00.000-07:00

Hispanics watching health care debate closely
Excerpts from article
By JULIANA BARBASSA (AP) – 1 day ago (Aug 11,2009)

OAKLAND, Calif. — Perched at the edge of an exam table, Delmira
Maravilla is anxious for a check-up — and for a timeline on the
president's promise of health care for all Americans. (mother of 9
without health insurance)

Without immigration reform and a path to citizenship, millions could be
left out of the system. About 59 percent of the 11.9 million
undocumented immigrants living in the United States have no health
insurance, according to the Pew Hispanic Center.

".. we're so close to having health care reform. We'd be working
against ourselves to let immigration issues stall the process."

Jennifer Ng'andu, deputy director of the National Council of La Raza's
Health Policy Project, believes that any plan which doesn't include
undocumented immigrants won't last. They make up about 15 percent
of the nation's approximately 47 million uninsured.

"If we don't talk about integrating communities that have been
traditionally shut out, we're going to be talking about health care
reform again in 15 years," said Ng'andu, who has been talking to
legislators and to health care advocates on their behalf.

On the other hand...

To proponents of greater immigration controls, allowing illegal
immigrants to benefit from federally subsidized health care and
insurance would go against enforcement goals by legitimizing their
presence.

"They would have no incentives to leave," said Mark Krikorian, of the
Center for Immigration Studies.

Obama launches Website to offer Truth-in-HealthCare

2009-08-11T05:33:00.000-07:00

POLITICO 44
By MIKE ALLEN | 8/10/09 7:20 AM EDT

Facing an onslaught of opposition to health reform, the White House on Monday opened a “Reality Check” website
with a viral tool aimed at online combat on everything from “rationing” to euthanasia.

Click here for Euthanasia Myth video

Personal observation

2009-08-10T09:00:00.000-07:00

Auto insurance addresses repair of damage not regular maintenance. Perhaps we should consider that same approach to health care

Health Insurance companies View of Health Care Reform

2009-08-09T21:51:00.000-07:00

New York Times
Excerpts from
REED ABELSON
Published: August 4, 2009

A major shift in Insurance companies approach to Health Care Reform

There has been a striking change for the insurance industry, long an opponent of health care reform. Insurers have agreed to abandon some of their most controversial practices, like denying coverage to applicants with pre-existing medical conditions.

Karen M. Ignagni, the industry’s chief lobbyist, personally pledged to President Obama that insurers would not stand in the way of a sweeping overhaul this time.

For a while, it seemed to be working — then the insurance industry re-emerged as Washington’s favorite target. “Villains,” Nancy Pelosi, the House speaker, called them. And Mr. Obama derided the industry for pocketing “windfall profits.”

As the debate heats up, Ms. Ignagni is facing her toughest test. After winning concessions, and consensus, from many insurance companies with competing interests, she now has to keep them together as the assault on the industry picks up. Her strategy has been to push for changes her members can live with.

Despite her efforts to ally the industry with Washington, however, it risks being thrust in the same role it played 15 years ago when it helped derail reform.

When the president called on Ms. Ignagni at a White House meeting in March, she was quick to reassure him, “You have our commitment to pass health reform this year.”

But the talk has become increasingly unfriendly of late, as the president and Congress have latched onto the insurance industry’s failings.

Even as she fends off industry criticism, Ms. Ignagni must try to preserve the current consensus over what changes insurers are willing to make.

Ronald A. Williams, Aetna’s chief executive said that they came to their current position after significant discussion, in contrast to the early 1990s, and that despite the current tenor of the debate, they “intend to remain at the table,” .

Insurance Industry fighting hard to stop govt plan

2009-08-07T17:14:00.000-07:00

Associated Press Aug 7,2009

The AP reports the insurance industry "still has a fighting chance to fend off the part of health care overhaul it most despises - creation of a government-run plan to compete with private insurers. Industry lobbyists are using influential allies, a thick wallet and a strategy of avoiding blatant confrontation to block or weaken the proposal." Newsweek's Jonathan Alter said on MSNBC's Countdown that Democrats "can argue about the detail, but the idea of sustaining status quo is unacceptable, and Democrats all over the country have to just come out and say, we need a bill."

The Hill August 7,2009

Axelrod Gives Senate Democrats Recess Talking Points On Healthcare

(By Alexander Bolton and Jeffrey Young Posted: 08/06/09 05:52 PM [ET] )
The Hill reports Senate Democrats have been "armed with a new set of talking points from David Axelrod, the president's chief political strategist."He"told lawmakers to focus on reform of the health insurance industry when talking to constituents said Democrats who attended the meeting. Axelrod also instructed them to talk about Democratic healthcare reform plans compared to the status quo."

House HealthCare to be signed into law

2009-08-07T17:12:00.001-07:00

Martinez News-Gazette reports
August 4, 2009

Rep. George Miller (D-Martinez), one of the three principal authors of the health insurance reform bill in the House of Representatives, said today that significant progress is being made in Congress on the issue and that he expects a strong reform bill to be signed into law later this year.

Miller said the alternative to passing health insurance reform is “unacceptable, unaffordable, and unfair.” People with insurance will see their costs rise by an average of $1,800 per year, every year, without reform, Miller said. In addition, people are at risk every day of losing their insurance or having their claims denied because of a pre-existing condition.

In July, three committees in the House – the Education and Labor Committee, the Ways and Means Committee, and the Energy and Commerce Committee – each passed a version of the bill, and those three versions will be put together in one bill that the House will consider later this year. As one of the three committee chairs, Miller will be at the center of those discussions

“Our bill offers stability, security and quality,” Miller said, “and it will not increase the federal budget deficit.”

There is some Industry Support for Employer Mandated Health Ins

2009-07-21T06:04:00.000-07:00

Here are some recent quotes from a few industry leaders

July 14 (Bloomberg) -- Target Corp. and Kelly Services Inc. said they may support Wal-Mart Stores Inc.’s call for mandatory medical insurance by large(usually more than 50 employees) companies as part of a proposed overhaul of U.S. health care.

“Conceptually, we can accept an employer mandate,” said Kay Rubbelke, a spokeswoman for Minneapolis-based Target, the country’s second-biggest discount retailer after Wal-Mart.

"Kelly Services, the Troy, Michigan-based provider of temporary workers, could support a mandate that has effective cost-containment provisions", said Jim McIntire, vice president of public affairs.

the National Retail Federation, the industry’s largest trade group, told members to “come out swinging” against Wal-Mart’s call for federally mandated company health insurance.

“Employer mandates and costly changes to the taxation of employer-provided health care will have a negative impact on employer-sponsored coverage,” said Malcolm Berkley, a spokesman for UPS.

"Kelly is breaking ranks with other companies because of a commitment by Chief Executive Officer Carl Camden to health-care changes", "A health-care system that covers more uninsured also would cause more individuals to consider the part-time employment services Kelly provides", McIntire said.

Recent House Healthcare Bill

2009-07-20T14:02:00.000-07:00

July 14, 2009

WASHINGTON — House Democrats on Tuesday rolled out a far-reaching $1.5 trillion plan that for the first time would make health care a right and a responsibility for all Americans, with medical providers, employers and the wealthiest picking up most of the tab.

The federal government would be responsible for ensuring that every person, regardless of income or the state of their health, has access to an affordable insurance plan. Individuals and employers would have new obligations to get coverage, or face hefty penalties.

Health care overhaul is President Barack Obama's top domestic priority, and his goal is to slow rising costs and provide coverage to nearly 50 million uninsured Americans.

Democratic leaders said they would push the measure through committee and toward a vote in the full House by month's end, while the pace of activity quickened on the other side of the Capitol.