Health Insurance Cost – Page 5 – The Moral Healthcare Blog

Helping the Bottom Line – an Online Report

From HHS, the email summary is as follows:

Today, the Department of Health and Human Services released The Bottom Line: Health Reform and Small Business. The new report highlights key facts about the impact of high health care costs on small businesses including:

Nearly one-third of the uninsured – 13 million people – are employees of firms with less than 100 workers.

In the past two years, more than half of small businesses that offered coverage reported switching to plans with higher out-of-pocket costs in response to rising premiums. Another third switched to a plan that covered fewer services, and 12% dropped coverage entirely.

Among small businesses that offer coverage, 40% report spending more than 10% of their payroll on health care costs.

With Son in Remission, a Family Struggles to Find Coverage – NYTimes.com

With Son in Remission, a Family Struggles to Find Coverage – NYTimes.com:

“Now the Walkers face the possibility that Jake will no longer be seen at Houston’s renowned M.D. Anderson Cancer Center, which they credit for his remission.

“You realize how vulnerable you really are,” said Ms. Walker, who exhibits the maternal ferocity of a black bear. “You just — not give up — but you just feel that you’re at a loss, that you’re at your wits’ end. I ask myself, ‘Do I really have to lose my home to save my son’s life?’ ”

Neither of the Walkers has been able to land a job with the kind of large group coverage that would disregard Jake’s health status. His cancer history effectively makes him uninsurable on the individual market. He is too old to qualify for Medicaid as a child, and it is virtually impossible in Texas to qualify as an able-bodied adult.

Because the Walkers own their modest house, they have been told they do not merit other government assistance. With little predictable income beyond Ms. Walker’s $688 unemployment check every two weeks, the family cannot afford the state’s high-risk insurance pool or continuation coverage through the federal Cobra law.

To date, Jake’s treatment has cost nearly $2 million. Almost all of it has been paid by Cigna under a preferred-provider family policy that Ms. Walker paid $426.28 a month for through DHL, the troubled shipping company where she worked as a billing agent.

Until last fall, Mr. Walker was the co-owner of a business that supplied DHL with trucks and drivers, but it too fell victim to downsizing. The feed store, the last in an area where suburbs are swallowing ranchland, has been losing money.

What has made the Walkers feel most helpless, though, is that their son has been left so exposed, after all he has endured.

“Your job as a parent is to protect your children at any cost,” Ms. Walker said. “I really felt like I had let him down.””

At the beginning of the article, Mrs. Walker’s salary was noted to be $37,000. She paid, out of that, $426 a month for her health insurance (admittedly, pretty darn good insurance given the expense of Jake’s treatment). $426 x 12 = $5112 per year bringing her salary down almost 14%, not counting the subsidy on the employer side, probably close to another $5K.

The economic costs are brutal enough, but the fear, uncertainty, and skimping on care (prescriptions, skipping office visits, etc.) are just not acceptable in the richest country in the world.

How health care costs contribute to income disparity in US – The McKinsey Quarterly – health care costs income disparity US – Economic Studies – Country Reports

The top-income category (earning on average $210,100 annually1) has enjoyed rising incomes and growing employer-paid health care benefits, which have made their out-of-pocket spending on health care a relatively small and affordable portion of total spending. The higher-middle-income category (earning an average of $84,800 annually) and the lower-middle-income group (earning on average $41,500), have also seen increasing benefits and incomes—but at a much slower rate, making the uncovered portion of their health care costs ever-more expensive. In the bottom-income category (earning an average of $14,800 a year), incomes have been stagnant, and their employers are less likely to pay for their health insurance. This group is finding any health care difficult, if not impossible, to afford.

As part of a study of widening income gaps between US households, we found that rising employer-paid health insurance premiums constitute a growing share of the
combined income of lower-paid employees—a much larger share than for those who
are higher paid. For those workers within the bottom-income group who are insured (22 percent), the ratio of employer-paid premiums to household income is 20 percent. That compares with 3.3 percent for the top-income group, in which nine out of ten workers are insured.

This is in line with New America’s estimate of 17% of household compensation now going to health care, which, really, is a prohibitive amount for lower and middle income families.

A Public Health Insurance Plan | OurFuture.org

A Public Health Insurance Plan OurFuture.org:

As the ball rolls along in our debate, one thing that keeps coming up is the idea that everyone must have insurance. Being forced to buy insurance from a private insurer ($15K a year at our house – from a “not-for-profit” !) is obviously not an option for most, especially considering the median family income is only about $60K. Medicare spends anywhere from $6K to $14K per enrollee (65 and over, mind you). So can a public option be the solution?

Here are the key findings of the report, but you can click the link above to get the full report, an executive summary and a PowerPoint show.

The report contains these findings:
• Medicare has controlled health care costs much better than have private health insurers over the last 25 years.
• The private insurance market is highly consolidated and needs competition from a public health insurance plan to lower skyrocketing premiums.
• Administrative costs are dramatically lower under public health insurance plans,
resulting in enormous savings to the system.
• The bargaining power of public health insurance plans significantly reduces provider costs.
• In a head-to-head competition, the public Medicare plan is much better at containing costs than private Medicare Advantage plans.
• Independent analyses show substantial savings can be achieved from a public health insurance plan that competes with private insurance plans.
• Quality and effectiveness innovations occurring under the public Medicare plan show that public health insurance plans have greater potential to drive the quality revolution than do private plans.
• Public health insurance plans increase choice, competition and accountability.

Dartmouth Atlas of Health Care: Regional Disparity in Medicare Spending – Interactives – Quality/Equality newsroom – Quality/Equality – RWJF

The above link takes youto the interactive map that is kind of cool to look at and comare a few regions to see where yours falls.

The actual NEJM article is here. And here is the substantive part of the article (for me, anyway):

What’s going on? It is highly unlikely that these differences in growth could be explained by differences in health. Marked regional differences in spending remain after careful adjustment for health, and there is no evidence that health is decaying more rapidly in Miami than in Salem.

The variations allow us to rule out two overly simplistic explanations for spending growth. First, “technology” is clearly an insufficient explanation: residents of all U.S. regions have access to the same technology, and it is implausible that physicians in the regions with slower spending growth are consciously denying their patients needed care. Indeed, evidence suggests that the quality of care and health outcomes are better in lower-spending regions and that there have been no greater gains in survival in regions with greater spending growth.1 Second, it is difficult to blame regional differences entirely on the current payment system, since all our evidence on regional growth comes from populations in the fee-for-service system. Other research has emphasized the role of managed care in moderating the growth of costs,2 but this story cannot explain the rapid growth in Miami, where roughly half of Medicare enrollees are covered by Medicare Advantage plans.

The causes must therefore lie in how physicians and others respond to the vailability of technology, capital, and other resources in the context of the fee-for-service payment system. A recent study by researchers in our group provides further insight.3 Using clinical vignettes to present standardized patient care scenarios to physicians throughout the country, the researchers found that physicians in high- and low-spending regions were about equally likely to recommend specific clinical
interventions when the supporting evidence was strong. Those in higher-spending
regions, however, were much more likely than those in lower-spending regions to
recommend discretionary services, such as referral to a subspecialist for typical gastroesophageal reflux or stable angina or, in another vignette, hospital admission for an 85-year-old patient with an exacerbation of end-stage congestive heart failure. And they were three times as likely to admit the latter patient directly to an intensive care unit and 30% less likely to discuss palliative care with the patient and family. Differences in the propensity to intervene in such gray areas of decision making were highly correlated with regional differences in per capita spending.

Interview with Uwe Reinhardt on Inauguration Day | Worldfocus

How the U.S. measures up to Canada’s health care system Worldfocus:

“The Worldfocus signature story Canada’s hospitals cut the paperwork, emphasize care explores Canada’s health care system.

“In this extended interview, Uwe Reinhardt, a leading adviser on health care economics and professor of political economy at Princeton University, compares the Canadian and American health care systems. Reinhardt criticizes the U.S. health care culture and expresses his optimism about the Obama administration.

“As part of Worldfocus’ Health of Nations signature series, correspondent Edie Magnus conducted this half-hour interview with Uwe Reinhardt on January 20, 2008, the day of President Barack Obama’s inauguration.”

Terrific interview! Highly recommended!

Dodd Hears Anger, Frustration At Meeting On Health Care — Courant.com

Dodd Hears Anger, Frustration At Meeting On Health Care — Courant.com:

“On the first day of a listening tour on health care, an issue pivotal to the new Congress and his own re-election, U.S. Sen. Christopher J. Dodd got an earful Friday.

The first comment came from a furious homeless shelter manager: He and his clients have no coverage, yet insurance giant American International Group got an $85 billion federal loan.

Over 90 minutes, the Democratic senator heard from a string of constituents, who waved their hands, hoping for a chance to describe a struggle to hang onto middle-class lives after losing jobs and affordable health care. A few were angry, others just scared.

On the way out, Dodd embraced one woman who burst into tears as she described losing health coverage for her disabled 2-year-old. Dodd held her until she stopped sobbing.”
…
“Dodd said during his introduction that he was seeking reforms that provided universal coverage, cut costs and prevented disease. In an interview later, he made clear another condition:

“Not putting the insurance industry out of business.

” ‘I hear people talking about a single-payer plan and the like,” Dodd said. “That isn’t going to happen. It’s going to be a combination of public, private.’ “

Unless, as MLK did for LBJ, we make it impossible for them NOT to do it!

Medical Debt Is a Growing Worry, for Those With Insurance and Without – washingtonpost.com

Medical Debt Is a Growing Worry, for Those With Insurance and Without – washingtonpost.com:

“‘People who are underinsured end up facing almost identical problems as the uninsured,’ said Karen L. Pollitz, director of the Health Policy Institute at Georgetown University. ‘The difference is, they paid for the privilege.’

“Medical debt is likely to figure prominently in the looming national debate over reforming health care.

“Jim Eyler, 57, of Westminster, Md., says he needs help. The cement company manager said he spends about 33 percent of his take-home pay on unreimbursed medical bills, many connected with the advanced breast cancer his wife has been battling since 2005. ‘I keep wondering, where’s the money going to come from?’ he asked.”

More anecdotes here, of course, but the larger point is that our current cost structure is unsustainable.

U.S. Health Care Costs, Part V: Can Americans Afford Medicare? – Economix Blog – NYTimes.com

U.S. Health Care Costs, Part V: Can Americans Afford Medicare? – Economix Blog – NYTimes.com:

“Uwe E. Reinhardt is an economist at Princeton. For previous posts in his series on why America pays so much for health care, click here, here, here and here.”

I was taken to task on Sermo for quoting Uwe Reinhardt, so I felt obligated to post some new Uwe!

And to give him his own topic, too!

NEJM — Primum Non Nocere — The McCain Plan for Health Insecurity

NEJM — Primum Non Nocere — The McCain Plan for Health Insecurity:

“By this standard, John McCain emerges not as a maverick or centrist but as a radical social conservative firmly in the grip of the ideology that animates the domestic policies of President George W. Bush. The central purpose of President Bush’s health policy, and John McCain’s, is to reduce the role of insurance and make Americans pay a larger part of their health care bills out of pocket. Their embrace of market forces, fierce antagonism toward government, and determination to force individuals to have more ‘skin in the game’ are overriding — all other goals are subsidiary. Indeed, the Republican commitment to market-oriented reforms is so strong that, to attain their vision, Bush and McCain seem willing to take huge risks with the efficiency, equity, and stability of our health care system. Specifically, the McCain plan would profoundly threaten the current system of employer-sponsored insurance on which more than three fifths of Americans depend, increase reliance on unregulated individual insurance markets (which are notoriously inefficient), and leave the number of uninsured Americans virtually unchanged. A side effect of the McCain plan would be to threaten access to adequate insurance for millions of America’s sickest citizens.”

As I’ve said elsewhere, I believe McCain’s plan would blow up the current system fairly quickly and lead us to our much needed national debate on how we really want to do this, but the cost in every other way is too high to risk.