Health Insurance Cost – Page 6 – The Moral Healthcare Blog

Health Benefits Inspire Rush to Marry, or Divorce – NYTimes.com

Health Benefits Inspire Rush to Marry, or Divorce – NYTimes.com:

“More than romance, the couple readily acknowledge, it is Mr. Huggins’s Blue Cross/Blue Shield HMO policy that is driving their rush to the altar.”

These articles on the financial burdens of health insurance and health care are easy enough to find, and frankly, I don’t even think the most dyed-in-the-wool advocates for the status quo argue about this anymore.

So, I think I’ll sort of retire this category for a while and not post any further on it…

Need Some Botox With that Flu Shot? : NPR

Need Some Botox With that Flu Shot? : NPR:

“Primary care doctors say they’re having more and more trouble making ends meet. They’re drowning in required paperwork and getting paid less than specialists. So, a growing number of general practitioners are adding cosmetic procedures to their offerings as a way to bring in more money.”

No surprizes in this story, except at the end there is a bit of discussion of the reimbursement differential among procedure-based specialties and the rest of us.

And NPR really seems to be giving healthcare the full coverage blitz lately. Lots of stories about healthcare including this one on Morning Edition documenting the travails of two patients with MS. The first in the “new and improved” NHS in Britain and the other, a man in Philadelphia who thought he had good healthcare insurance.

And here is a link to their “Health Care for All” home page.

Falling Behind: Americans’ Access to Medical Care Deteriorates, 2003-2007 – RWJF

Falling Behind: Americans’ Access to Medical Care Deteriorates, 2003-2007 – RWJF:
(From the Robert Wood Johnson Foundation. Follow the link for the full report.)

“The number and proportion of Americans reporting going without or delaying needed medical care increased sharply between 2003 and 2007, according to findings from the Center for Studying Health System Change’s (HSC) nationally representative 2007 Health Tracking Household Survey. One in five Americans—59 million people—reported not getting or delaying needed medical care in 2007, up from one in seven—36 million people—in 2003. While access deteriorated for both insured and uninsured people, insured people experienced a larger relative increase in access problems compared with uninsured people. Moreover, access declined more for people in fair or poor health than for healthier people. In addition, unmet medical needs increased for low-income children, reversing earlier trends and widening the access gap with higher-income children. People reporting access problems increasingly cited cost as an obstacle to needed care, along with rising rates of health plan and health system barriers.”

Melani followed circuitous journey from Allegheny Valley to Highmark

Melani followed circuitous journey from Allegheny Valley to Highmark:

“Some peoples’ lives are framed by the gravity of their forebears’ legacy; others by a singular, undeniable talent. The life of Dr. Melani, now 54, was not so much framed as it was forged, by his own personality and skills as a diplomat.

Those skills have him on the cusp of becoming one of the most powerful business leaders in Pennsylvania, and one of the most important health insurance executives in the United States. Highmark is seeking a merger with Philadelphia’s Independence Blue Cross, and combined, the two nonprofits will have up to 26,000 employees, 7 million policyholders, a $24 billion organization — physicians’ practices, dental, vision, casualty and life, and of course health insurance.

If the merger is completed, he’d head the entire company as its CEO.

‘It’s a very serious responsibility,’ says Dr. Melani, who in his current job makes more than $3 million a year and occupies a radiant, 31st-floor office. ‘I step back and look at it and say, Oh my God, how did little me from Cheswick, a little kid from Arnold, end up in this position? I was just going to practice medicine, and that was overwhelming to me.'”

My point in posting this is not to pick on Dr. Melani nor Highmark, per se, just to point out the obvious: These things are huge, money making machines.

JAMA — From Waste to Value in Health Care, February 6, 2008, Boat et al. 299 (5): 568

JAMA — From Waste to Value in Health Care, February 6, 2008, Boat et al. 299 (5): 568:

“The United States ranks among the worst of industrialized countries for indicators of health such as infant mortality and life expectancy,1 despite spending $2 trillion annually on health care,2 more than any other nation per capita. However, higher health care spending does not correlate with higher quality of care or better patient outcomes.3-5 These sobering indicators suggest that an opportunity exists to close the value gap in the day-to-day delivery of health care by eliminating actions that impede optimal systematic performance, which result in less than perfect outcomes, extra work, or corrective work, otherwise described as waste.

Patient falls and decubitus ulcers represent waste in the form of ‘never events’ that create more costs and result in systemic dissatisfaction. Waste is illegible and incomplete prescriptions that consume technician, nurse, and pharmacist time and, at worst, risk the life of the patient. Waste is acute care hospitalization of patients with diabetes who received inadequate preventive care. Waste is failing to adopt evidence-based care. Waste accounts for 30% to 50% of health care spending.6-7

Over the last 20 years, quality has become a widely shared mantra in health care but with few efforts to systematically define the exact size and nature of the opportunity to improve value. This situation is somewhat analogous to when a physician determines that a patient is ill but does nothing more to diagnose or treat the patient. A better or more accurate approach to taking advantage of the opportunity would be to produce detailed problem statements that permit a locally driven but nationally connected set of interventions to close the value gap.”

More about QI than cost, but they do mostly go hand in hand…

NEJM — Market-Based Failure — A Second Opinion on U.S. Health Care Costs

NEJM — Market-Based Failure — A Second Opinion on U.S. Health Care Costs:

“Relentless medical inflation has been attributed to many factors — the aging population, the proliferation of new technologies, poor diet and lack of exercise, the tendency of supply (physicians, hospitals, tests, pharmaceuticals, medical devices, and novel treatments) to generate its own demand, excessive litigation and defensive medicine, and tax-favored insurance coverage.

Here is a second opinion. Changing demographics and medical technology pose a cost challenge for every nation’s system, but ours is the outlier. The extreme failure of the United States to contain medical costs results primarily from our unique, pervasive commercialization. The dominance of for-profit insurance and pharmaceutical companies, a new wave of investor-owned specialty hospitals, and profit-maximizing behavior even by nonprofit players raise costs and distort resource allocation. Profits, billing, marketing, and the gratuitous costs of private bureaucracies siphon off $400 billion to $500 billion of the $2.1 trillion spent, but the more serious and less appreciated syndrome is the set of perverse incentives produced by commercial dominance of the system.

Markets are said to optimize efficiencies. But despite widespread belief that competition is the key to cost containment, medicine — with its third-party payers and its partly social mission — does not lend itself to market discipline. Why not?”

Read on…

In Holland, Some See Model For U.S. Health-Care System – WSJ.com

In Holland, Some See Model For U.S. Health-Care System – WSJ.com:

“The Dutch system features two key rules: All adults must buy insurance, and all insurers must offer a policy to anyone who applies, no matter how old or how sick. Those who can’t afford to pay the premiums get help from the state, financed by taxes on the well-off.”

Sound familiar? Go to the link to see the accompanying graphic comparing the Netherlands, Massechusetts and (proposed) California plans. They are not too different. What is different is the minimum wage in the Netherlands-about 1.8 times ours.

So in order to avoid the pesky problem of deciding among insurance, food, and heating your home, we’d have to do a much better job against low wages and poverty in general. Thiis couldn’t happen in most states, but I wonder if California could double its minimum wage and get away with it? Not a lot of egress from california, almost no matter what. So maybe that could be the state to experimant with a mandated living wage and mandated health insurance.

Cheers,

The Pain of Health Coverage | Philadelphia Inquirer | 12/09/2007

The Pain of Health Coverage | Philadelphia Inquirer | 12/09/2007: “Frank Manzo keeps doing the math, trying to figure out how he can still offer health insurance to his employees.
His 28-employee tech-staffing company, Computer Methods Corp., charges clients $35 an hour for help desk workers. He pays them $25 an hour.
Health insurance premiums proposed for 2008 for a family run nearly $12 an hour – up 30 percent from last year.
Forget about profit. Forget about rent on the company’s Marlton offices, the electric bill, or even paper for the copy machine.
The middle-class, college-educated people at Manzo’s company were on the edge of joining America’s 47 million uninsured.
‘Where do I find the money?’ Manzo asked, his voice rising in frustration. ‘What am I supposed to pay them – $10 an hour? At this point, they may as well go work for McDonald’s.’
Health insurance makes everyone miserable. But among the most miserable are small-business owners.”

Sorry if this is an old article to you, just appeared in my Pittsburgh paper this Sunday…

REP. TODD TIAHRT: SCHIP IS POLITICAL TUG-OF-WAR

Kansas.com 09/26/2007

“Ensuring the welfare of America’s children should be top priority among congressional members. That’s why I supported SCHIP when it was created by the Republican Congress in 1997. I would continue to offer my support this year; however, Democrats have politicized this program and used it as a platform to take one giant step toward a national socialized health care system.”

It’s always disappointing when a member of Congress argues against the straw man of “socialized medicine” when nobody is advocating for a socialized system in which the government owns all parts of the health system. It can work: look at the VA, and imagine the VA if it weren’t underfunded and forced to outsource parts of its responsibilities to those wonderful “privateers” (remember the Walter Reed debacle – outsourcing).

But virtually nobody wants socialized medicine. Virtually everyone whom I’ve ever heard advocate for universal coverage advocates for a single payer system where we, the taxpayers, pay for our health insurance via taxes, and it is administered through a system like Medicare is right now. Medicare contracts with private companies that operate under Medicare rules (our rules, by the way, Congress sets the rules) and pay hospitals, doctors, etc. No socialized medicine, thank you; Medicare for all, please.