Recently UPS was criticized for dropping employee health insurance coverage for spouses who are eligible for health insurance through their employers. But that's only 15,000 people. The majority of their drivers and other employees are covered through Teamster's Union benefits so they will not be affected by the change.
A recent article called Employers Play Obamacare Blame Game discusses reactions to the shared costs complaints and how other companies are reacting to the upcoming changes.
The whole point of mandatory health care is to have a healthier population. This requires change. So of course employers are going to start shifting burdens around as much as they can. Companies which have provided the most benefits I am sure will be some of the first to start making changes.
There is a separate requirement, starting in 2018, where employees who offer richer policies will be required to start shifting more of the costs to employees or start paying a penalty.
People are dying or going bankrupt due to lack of medical care or the high costs associated with it. We need to share the burden and can't assume our employers or the government will hand us everything we need. Its part of taking our place in society and being a contributing human being.
There are those, including me, who face health or other issues, who can't contribute as much as others. But that doesn't make them any less of human beings.
If you do not like the current and upcoming changes for whatever reason, then you can do your part by cooperating with the existing legislation and work to find ways to change it.
What this is all called is change. Get over it. Change is needed to make health insurance more affordable and health care more available. Our current system does not work. Insurance companies, not doctors, are making decisions about the health of people.
Showing posts with label health insurance. Show all posts
Showing posts with label health insurance. Show all posts
So are you an inpatient or an outpatient?
The hospital and Medicare get to decide. Not your doctor who is actually treating you.
I found this pretty appalling. Medicare patients can be in the hospital for DAYS and be called and an outpatient because they are only being 'observed'. They get the same care as everyone else. But then they get a big fat bill if they were an outpatient.
Their doctor can even admit them and make them an inpatient but then the hospital can change it back to outpatient. Hospitals like this because they get reimbursed more that way.
"Medicare originally intended observation care as a way to give doctors time to evaluate whether a patient should be admitted to the hospital or is stable enough to go home, usually within 24 to 48 hours. But hospitals are increasingly keeping patients in observation status longer: 8 percent of Medicare recipients had observation stays longer than 48 hours in 2011, up from 3 percent in 2006.
Apparently the government can tell by looking at a rule book to figure out how sick you are, not but diagnosing you and reading your chart. Or, God forbid, even talking to you.
That increase may partly be a response to aggressive reviews of hospital billing practices in recent years. Medicare contractors have demanded refunds from hospitals that admit patients the government believes should have been treated as observation patients or outpatients. Medicare pays hospitals less for those patients."
And also hospitals are now rated on their readmission rates. If you aren't admitted the first time, you are not readmitted later on.
"Toby Edelman, senior policy attorney at the Center for Medicare Advocacy in Washington, D.C., said she believes hospitals also could be trying to avoid readmission penalties, which are assessed if too many patients are readmitted within 30 days. Harold Engler, for example, went home after five days, grew sicker, and then returned for another five-day observation stay. If he had been an inpatient, he would have counted as a readmission within 30 days."
Hospitals claim they are working on it because they computer tells them what to do. The computer even knows more than the government:
"Dr. James Hart, who heads a Beth Israel Deaconess committee that makes sure the hospital follows Medicare rules, said he could not comment on Engler’s case. But he said the hospital uses a sophisticated computer program that tries to match patients with the correct Medicare designation based on their illness and the intensity of hospital services required. “We are very focused on getting the level of care accurate,’’ he said."
Medicare knows this is a problem and even has created a brochure on this telling patients the difference. But if you are sick in bed, do you really care about semantics? No.
"Case managers generally inform patients of their status, especially if they require skilled nursing care, he said. But that doesn’t mean patients digest the information, at a time when they have so much to focus on. “Part of the challenge from a patient perspective is there really is an information overload,’’ Hart said."
You just want to feel better and go home where you can be in your own bed eating real food instead of the crappy hospital food they serve.
I knew Medicare had its issues but I didn't think it was out to impoverish seniors. I thought it was supposed to be the other way around. Clearly some changes need to be made here.
Update: 8/30/13 - One of the former heads of Medicare wants the rule on observation to be abolished.
I found this pretty appalling. Medicare patients can be in the hospital for DAYS and be called and an outpatient because they are only being 'observed'. They get the same care as everyone else. But then they get a big fat bill if they were an outpatient.
Their doctor can even admit them and make them an inpatient but then the hospital can change it back to outpatient. Hospitals like this because they get reimbursed more that way.
"Medicare originally intended observation care as a way to give doctors time to evaluate whether a patient should be admitted to the hospital or is stable enough to go home, usually within 24 to 48 hours. But hospitals are increasingly keeping patients in observation status longer: 8 percent of Medicare recipients had observation stays longer than 48 hours in 2011, up from 3 percent in 2006.
Apparently the government can tell by looking at a rule book to figure out how sick you are, not but diagnosing you and reading your chart. Or, God forbid, even talking to you.
That increase may partly be a response to aggressive reviews of hospital billing practices in recent years. Medicare contractors have demanded refunds from hospitals that admit patients the government believes should have been treated as observation patients or outpatients. Medicare pays hospitals less for those patients."
And also hospitals are now rated on their readmission rates. If you aren't admitted the first time, you are not readmitted later on.
"Toby Edelman, senior policy attorney at the Center for Medicare Advocacy in Washington, D.C., said she believes hospitals also could be trying to avoid readmission penalties, which are assessed if too many patients are readmitted within 30 days. Harold Engler, for example, went home after five days, grew sicker, and then returned for another five-day observation stay. If he had been an inpatient, he would have counted as a readmission within 30 days."
Hospitals claim they are working on it because they computer tells them what to do. The computer even knows more than the government:
"Dr. James Hart, who heads a Beth Israel Deaconess committee that makes sure the hospital follows Medicare rules, said he could not comment on Engler’s case. But he said the hospital uses a sophisticated computer program that tries to match patients with the correct Medicare designation based on their illness and the intensity of hospital services required. “We are very focused on getting the level of care accurate,’’ he said."
Medicare knows this is a problem and even has created a brochure on this telling patients the difference. But if you are sick in bed, do you really care about semantics? No.
"Case managers generally inform patients of their status, especially if they require skilled nursing care, he said. But that doesn’t mean patients digest the information, at a time when they have so much to focus on. “Part of the challenge from a patient perspective is there really is an information overload,’’ Hart said."
You just want to feel better and go home where you can be in your own bed eating real food instead of the crappy hospital food they serve.
I knew Medicare had its issues but I didn't think it was out to impoverish seniors. I thought it was supposed to be the other way around. Clearly some changes need to be made here.
Update: 8/30/13 - One of the former heads of Medicare wants the rule on observation to be abolished.
Let the patients make the decisions
I'm not sure why we continue to let insurers make decisions for us on our care. I completely understand that an insurer wants to keep an eye on expenses and want preapproval so they can count their beans. But they should not be telling us what care we can get - with in reason.
I agree insurers should not need to pay for cosmetic procedures for example. If someone wants to fix their nose, they can pay for it (through the nose). But decisions which relate to life and death care should not be theirs to make.
A new study showed that women on Medicaid are much more likely to have a mastectomy instead of a lumpectomy - 60% of those on Medicaid had a mastectomy vs. 39% of those with other insurance.
Or are the surgeons making the decision for the patient? The study also points out that surgeons are reimbursed 40% less for a lumpectomy than for a mastectomy from Medicaid. The surgeon should provide the information and the advice to the patient to make the decision but they should let the patients think for themselves, not the doctor's wallet.
The patient should make the decision - no one else.
I agree insurers should not need to pay for cosmetic procedures for example. If someone wants to fix their nose, they can pay for it (through the nose). But decisions which relate to life and death care should not be theirs to make.
A new study showed that women on Medicaid are much more likely to have a mastectomy instead of a lumpectomy - 60% of those on Medicaid had a mastectomy vs. 39% of those with other insurance.
Or are the surgeons making the decision for the patient? The study also points out that surgeons are reimbursed 40% less for a lumpectomy than for a mastectomy from Medicaid. The surgeon should provide the information and the advice to the patient to make the decision but they should let the patients think for themselves, not the doctor's wallet.
The patient should make the decision - no one else.
Price shopping for surgery
We all price shop for things. If the gas station across the street is five cents cheaper per gallon, we might go there. If one brand of milk is cheaper than the other, we will probably grab the cheaper one. Some of us coupon clip and research prices online.
We also all have some splurges. Maybe its hand bags, maybe its shoes, maybe its chocolate. These are the items that we purchase regardless of the price. Maybe its that Coach bag or the Manolo Blahnik shoes that we want no matter what. We just blindly get what we want.
So where should our surgery shopping go? If you think about it, most of us have been treating surgery in the second category as a purchase without looking at the cost. Should we be doing this? Or should we shop around and look at price first?
Two recent studies showed the range of appendectomies (done at Washington University) and hip surgery (done at University of California San Francisco). The first ranges from $1529 to 186,955 and the second $10,000 to $125,000. I'm not kidding. My first thought is that there surely must be some sort of quality variance here but if we leave that out for a moment, aren't these ranges amazing?
In any other circumstance if someone said you could get the same car for either $10,000 or $125,000 - which would you take? The $10,000 of course.
But most of us don't seem to apply this same price consciousness when it comes to medical procedures. Maybe we think insurance will cover it so it doesn't matter to me. Yes your insurance covers it but high priced procedures are on of the many things causing continual premium increases. Or if I go to another hospital will I have to get a new doctor? Maybe a new doctor will be even nicer. You don't know until you try. Sometimes we get stuck in a rut of going for treatment to the same place.
Wouldn't it make sense to pay a little attention to the price? As part of the health care changes still coming into play medical providers will need to offer some price transparency to patients. But that is still a long way off.
We also all have some splurges. Maybe its hand bags, maybe its shoes, maybe its chocolate. These are the items that we purchase regardless of the price. Maybe its that Coach bag or the Manolo Blahnik shoes that we want no matter what. We just blindly get what we want.
So where should our surgery shopping go? If you think about it, most of us have been treating surgery in the second category as a purchase without looking at the cost. Should we be doing this? Or should we shop around and look at price first?
Two recent studies showed the range of appendectomies (done at Washington University) and hip surgery (done at University of California San Francisco). The first ranges from $1529 to 186,955 and the second $10,000 to $125,000. I'm not kidding. My first thought is that there surely must be some sort of quality variance here but if we leave that out for a moment, aren't these ranges amazing?
In any other circumstance if someone said you could get the same car for either $10,000 or $125,000 - which would you take? The $10,000 of course.
But most of us don't seem to apply this same price consciousness when it comes to medical procedures. Maybe we think insurance will cover it so it doesn't matter to me. Yes your insurance covers it but high priced procedures are on of the many things causing continual premium increases. Or if I go to another hospital will I have to get a new doctor? Maybe a new doctor will be even nicer. You don't know until you try. Sometimes we get stuck in a rut of going for treatment to the same place.
Wouldn't it make sense to pay a little attention to the price? As part of the health care changes still coming into play medical providers will need to offer some price transparency to patients. But that is still a long way off.
Show me the data but don't charge me an arm and a leg
In the past the biotechnology industry enjoyed a cost and procurement system where drugs were provided at the cost set by the provider. Now there is change coming in the industry where the value of the drugs must be proven before being accepted. They now will be forced to sell good outcomes and at a lower cost.
While the industry stock levels are running at a long term high and the FDA has approved a record number of drugs, the winds of change are shifting on through. On Monday, there was an executive meeting at the Biotechnology Industry Organization convention in Chicago where this issue was discussed in detail.
"The national health care overhaul, the shift toward personalized medicines targeting smaller patient populations, and tougher reimbursement standards by commercial health insurers in the United States and government payers in Europe are changing the game for biotechnology start-ups and pharmaceutical giants alike, Burrill said.
“We as a health care system are at a pivotal moment,” said David Meeker, chief executive of the Genzyme division of Sanofi SA in Cambridge. “Economic growth in the Western world is negligible to negative. Everyone’s taking a hit. That’s translating into increased pressure on health care spending. The trend is to spend less.”
Drug makers once could count on a straightforward regulatory process and automatic reimbursement for approved medicines. But the process for getting experimental drugs to market has grown longer and costlier as regulators demand more patient-specific data before granting approval. At the same time, payment regulations have become more variable and less certain.
“The payers used to just pay,” Burrill said. “Now they want proof that drugs can improve outcomes and lower costs. And the way you do that for the French versus the way you to it for the Chinese versus the way you do it for Aetna or Kaiser Permanente is all different.”
Industry executives discussed the new dynamic at a Monday session on “pay for value” in the drug business, but there was little agreement on how to define the value of new medicines."
Payers are demanding more data showing benefits before covering them. Manufacturers are creating more and more drugs for smaller populations - for the rarer ailments. Insurers are also reluctant to pay for new expensive drugs to treat common conditions such as diabetes or heart disease.
These changes are causing pharma companies to look at how they do business and partner with other companies, particularly smaller ones, to reduce their risks. I hope to see this continued change s that medications become more affordable and insurance companies are not denying new drugs because the costs are too high. The doctors should be the one making the decisions on which medications are appropriate for their patients, not the pharmaceutical companies nor the insurance companies.
While the industry stock levels are running at a long term high and the FDA has approved a record number of drugs, the winds of change are shifting on through. On Monday, there was an executive meeting at the Biotechnology Industry Organization convention in Chicago where this issue was discussed in detail.
"The national health care overhaul, the shift toward personalized medicines targeting smaller patient populations, and tougher reimbursement standards by commercial health insurers in the United States and government payers in Europe are changing the game for biotechnology start-ups and pharmaceutical giants alike, Burrill said.
“We as a health care system are at a pivotal moment,” said David Meeker, chief executive of the Genzyme division of Sanofi SA in Cambridge. “Economic growth in the Western world is negligible to negative. Everyone’s taking a hit. That’s translating into increased pressure on health care spending. The trend is to spend less.”
Drug makers once could count on a straightforward regulatory process and automatic reimbursement for approved medicines. But the process for getting experimental drugs to market has grown longer and costlier as regulators demand more patient-specific data before granting approval. At the same time, payment regulations have become more variable and less certain.
“The payers used to just pay,” Burrill said. “Now they want proof that drugs can improve outcomes and lower costs. And the way you do that for the French versus the way you to it for the Chinese versus the way you do it for Aetna or Kaiser Permanente is all different.”
Industry executives discussed the new dynamic at a Monday session on “pay for value” in the drug business, but there was little agreement on how to define the value of new medicines."
Payers are demanding more data showing benefits before covering them. Manufacturers are creating more and more drugs for smaller populations - for the rarer ailments. Insurers are also reluctant to pay for new expensive drugs to treat common conditions such as diabetes or heart disease.
These changes are causing pharma companies to look at how they do business and partner with other companies, particularly smaller ones, to reduce their risks. I hope to see this continued change s that medications become more affordable and insurance companies are not denying new drugs because the costs are too high. The doctors should be the one making the decisions on which medications are appropriate for their patients, not the pharmaceutical companies nor the insurance companies.
Share personal information or pay up
The claim is that it helps the company save money in insurance costs because its a preventive measure and helping people get and stay healthy. I have a real problem with this on several levels.
Its none of your insurance company's business as to what is wrong with you. This leads to bias and to loss of or lack of coverage.
Body fat percentage is not a good value to represent overall health. While my body fat percentage is probably higher than it should be, I go to the gym three times a week and get the recommended amount of exercise each week and not everyone can saying that..
Finally knowing someone's weight and body fat percentage does not get them to the doctor's office for a check up which is more important. Even skinny people need check ups.
Its no one's business what I weigh. That's between me and my scale and the doctor's office. During all my medical treatments, my husband is allowed to know everything but my weight. I am working on my personal deflabbification project. I will share I wear size 12 pants and wish I wore size 10 - that's all you need to know.
I understand the point is that insurers want healthier people but this is not the right way to do this. Find a different way. Work with the patients. Do not invade their privacy or financially penalize them. My insurance company gives us a freebie if we get an annual physical.
Good bye 2012, Hello 2013 health care-wise
So if you read CNN, which I do. I find it much easier than watching CNN - either HLN screaming about new 'factoids' and miracles, or regular CNN going on and on and on about something boring and political that will put me to sleep before I learn anything. I prefer my news in the low brow way - tell it like it is and keep it short. This is why I like CNN online - because I can skip through articles instead of listening to people S L O W L Y reading them. I don't have a lot of time in my life to waste on the news. I have better things to do - like have fun.
I have digressed. CNN put out their list of the top health news stories of 2012 - which I found to be exceptionally lame as several of them focus on individual people. Here's the list:
But here is the list for 2013 of things to look out for:
I have digressed. CNN put out their list of the top health news stories of 2012 - which I found to be exceptionally lame as several of them focus on individual people. Here's the list:
- Supreme Court upheld the Affordable Care Act.
- Woman from Georgia and her case of flesh eating bacteria
- Meningitis from steroid injections that killed 39
- The Record West Nile Virus outbreak
- Robin Roberts bone marrow transplant
- Hantavirus at Yosemite
- Jesse Jackson and bi-polar disorders
- Spike in autism cases
- Kathy Bates double mastectomy
- Hepatitis C from the traveling hospital worker
But here is the list for 2013 of things to look out for:
- Medicaid expansion
- Medicaid provider payments will go up so more providers will take medicaid patients
- Health insurance exchanges
- Medicaid taxes are going up for those making over $250,000
- Medicare reform
- Insurance transparency - health insurance policies will need to be understandable
- Health care spending will be a big issue
The Cost of Cancer Care, Part 2
Cost is now becoming a significant factor in people's cancer treatment decisions - something that should not be happening.
In the past decades, and more significantly in recent years, there have been many developments in cancer treatment. We hear talk about individualized medicine, new treatments which add months to stage IV cancer patients' lives, and more. But we rarely or never hear about the costs. I think of it as the silent side of treatment.
Often these new treatments costs tens of thousands of dollars or more for a single year of treatment with a single dose coming in at the multi-thousand level. What is wrong with this picture? Lots. Why should a patient make a decision on their life because their cancer treatment which could extend their life is out of their price range? Please do not suggest the patients ask for assistance from the pharmaceutical companies because that is not always available.
See this example from an article on CancerNetwork.com, titled "The Cost of Cancer Care, Part I":
"Three years ago, I counseled a patient after a gastrointestinal stromal tumor had been resected from his stomach. I was pleased to be able to tell him that imatinib (Drug information on imatinib) (Gleevec), a drug very well tolerated by most patients, would meaningfully reduce his risk of recurrence. Later, we learned that his out-of-pocket expense under his Medicare Part D plan would be several thousands of dollars for a year of treatment. The patient decided the expense was too onerous and that he would forgo treatment. Patient assistance programs are often limited for Medicare beneficiaries, and none could be secured. I pressed to ascertain whether cost was his sole concern, or if there was another unspoken reason for his resistance to proceed with treatment. There was not; his decision was purely due to cost."
There have been many significant advances in cancer research in recent years including a greater understanding of the biologic side of the disease. The research and FDA approvals can take over a decade to complete. Companies are then offered patent protection for 17 years (or something close to that as my chemo brain fails to recall the exact number) to protect their pricing from competition. Costs in research have escalated creating high drug costs. Other contributing factors are:
The ensuing problem is that costs are high for the patients, insurance companies have high copayments for new non-generic/non-preferred medications. There is a switch to oral treatments which are covered by pharmacy benefits. A chemotherapy infusion may be covered by a $50 copay but an oral chemo in pill form might have a several thousand dollar copay. Its easier on the patient than going to the hospital but much tougher on their wallet. But research has helped saved many lives. There are more gains visible in the coming years as well but at what price?
"These gains have not come without a price. Research and development is expensive. Patients who survive longer under active therapy generally receive more intense overall treatment; this includes not just the therapy itself but also the radiographic and laboratory surveillance necessary to monitor ongoing treatment response and toxicity. While we strive for the development of more effective, less toxic therapies, this progress may be transforming into a painful paradox: the more we advance scientifically, the more constrained we become economically."
So how do we progress and allow advanced treatments, longer lives, and containable costs? That will be part of my next post.
[This is something new for me to have a series looking at a particular issue. As my personal cancer story becomes more of a maintenance factor and a new lifestyle with my other newer ailments, you may see more of these posts in series on differing topics but always ailment related.]
In the past decades, and more significantly in recent years, there have been many developments in cancer treatment. We hear talk about individualized medicine, new treatments which add months to stage IV cancer patients' lives, and more. But we rarely or never hear about the costs. I think of it as the silent side of treatment.
Often these new treatments costs tens of thousands of dollars or more for a single year of treatment with a single dose coming in at the multi-thousand level. What is wrong with this picture? Lots. Why should a patient make a decision on their life because their cancer treatment which could extend their life is out of their price range? Please do not suggest the patients ask for assistance from the pharmaceutical companies because that is not always available.
See this example from an article on CancerNetwork.com, titled "The Cost of Cancer Care, Part I":
"Three years ago, I counseled a patient after a gastrointestinal stromal tumor had been resected from his stomach. I was pleased to be able to tell him that imatinib (Drug information on imatinib) (Gleevec), a drug very well tolerated by most patients, would meaningfully reduce his risk of recurrence. Later, we learned that his out-of-pocket expense under his Medicare Part D plan would be several thousands of dollars for a year of treatment. The patient decided the expense was too onerous and that he would forgo treatment. Patient assistance programs are often limited for Medicare beneficiaries, and none could be secured. I pressed to ascertain whether cost was his sole concern, or if there was another unspoken reason for his resistance to proceed with treatment. There was not; his decision was purely due to cost."
There have been many significant advances in cancer research in recent years including a greater understanding of the biologic side of the disease. The research and FDA approvals can take over a decade to complete. Companies are then offered patent protection for 17 years (or something close to that as my chemo brain fails to recall the exact number) to protect their pricing from competition. Costs in research have escalated creating high drug costs. Other contributing factors are:
The ensuing problem is that costs are high for the patients, insurance companies have high copayments for new non-generic/non-preferred medications. There is a switch to oral treatments which are covered by pharmacy benefits. A chemotherapy infusion may be covered by a $50 copay but an oral chemo in pill form might have a several thousand dollar copay. Its easier on the patient than going to the hospital but much tougher on their wallet. But research has helped saved many lives. There are more gains visible in the coming years as well but at what price?
"These gains have not come without a price. Research and development is expensive. Patients who survive longer under active therapy generally receive more intense overall treatment; this includes not just the therapy itself but also the radiographic and laboratory surveillance necessary to monitor ongoing treatment response and toxicity. While we strive for the development of more effective, less toxic therapies, this progress may be transforming into a painful paradox: the more we advance scientifically, the more constrained we become economically."
So how do we progress and allow advanced treatments, longer lives, and containable costs? That will be part of my next post.
[This is something new for me to have a series looking at a particular issue. As my personal cancer story becomes more of a maintenance factor and a new lifestyle with my other newer ailments, you may see more of these posts in series on differing topics but always ailment related.]
Costs of Cancer Care
I have decided to do a series on health care costs. A friend sent me a link to an article on the cost of cancer care which is in two parts. And then it had links to more articles so now I am on a roll.
The first article is on healthcare financing and how we pay for our care and insurance. These articles are published on CancerNetwork.com which you will have to join to free of charge to read.
"Fundamental to questions centering on the expense of cancer care in particular and of healthcare in general, is the way in which Americans pay for the healthcare they consume. Most Americans are covered by some type of insurance, and consequently, when they consume healthcare they do not bear the full cost of the care they receive. That is the point of having insurance. We insure against healthcare losses just as we insure our cars and homes against loss.
However, because most private health insurance is an untaxed form of compensation, we spend more on it than we would if it were taxed like other goods and services. This year the tax expenditure, or foregone tax revenues, on employer-provided health insurance is $128 billion. Further, public programs like Medicare and Medicaid are also taxpayer-financed. Altogether, public health insurance and tax-preferred private insurance increase the demand for healthcare relative to the demand that would exist if the programs and more favorable tax treatment had not grown to their current levels.
The point here is that the healthcare advances, the types of technological improvements, and the total spending are all related to the particular financing arrangements that now exist. Though often onerous for patients, out-of-pocket cost-sharing accounts for less than 14% of total personal healthcare spending, while third-party payers account for more than 86%. The out-of-pocket shares for the components of spending on prescription drugs and on physicians are about 19% and 10%, respectively."
So if the true costs of our health care are hidden from us in tax exemptions, tax payer burden, and out of pocket payments, how do we really know what our costs are? I think we all feel our health care costs and national health care spending is too high and out of control. But if we do not even know what our real costs are, how do we cope with it? That is before the collection agencies and bankruptcy courts take away the rest of our money because of the mounting bills.
My feeling is that we need to take a close look at all of the healthcare system and how we pay for treatment, insurance, and absorb the costs of medical advances. This needs to be done systematically and individually. It can no longer be a piecemeal situation where the haves and the have-nots receive different levels of care simply because of what they can or cannot afford.
The first article is on healthcare financing and how we pay for our care and insurance. These articles are published on CancerNetwork.com which you will have to join to free of charge to read.
"Fundamental to questions centering on the expense of cancer care in particular and of healthcare in general, is the way in which Americans pay for the healthcare they consume. Most Americans are covered by some type of insurance, and consequently, when they consume healthcare they do not bear the full cost of the care they receive. That is the point of having insurance. We insure against healthcare losses just as we insure our cars and homes against loss.
However, because most private health insurance is an untaxed form of compensation, we spend more on it than we would if it were taxed like other goods and services. This year the tax expenditure, or foregone tax revenues, on employer-provided health insurance is $128 billion. Further, public programs like Medicare and Medicaid are also taxpayer-financed. Altogether, public health insurance and tax-preferred private insurance increase the demand for healthcare relative to the demand that would exist if the programs and more favorable tax treatment had not grown to their current levels.
The point here is that the healthcare advances, the types of technological improvements, and the total spending are all related to the particular financing arrangements that now exist. Though often onerous for patients, out-of-pocket cost-sharing accounts for less than 14% of total personal healthcare spending, while third-party payers account for more than 86%. The out-of-pocket shares for the components of spending on prescription drugs and on physicians are about 19% and 10%, respectively."
So if the true costs of our health care are hidden from us in tax exemptions, tax payer burden, and out of pocket payments, how do we really know what our costs are? I think we all feel our health care costs and national health care spending is too high and out of control. But if we do not even know what our real costs are, how do we cope with it? That is before the collection agencies and bankruptcy courts take away the rest of our money because of the mounting bills.
My feeling is that we need to take a close look at all of the healthcare system and how we pay for treatment, insurance, and absorb the costs of medical advances. This needs to be done systematically and individually. It can no longer be a piecemeal situation where the haves and the have-nots receive different levels of care simply because of what they can or cannot afford.
Protection from financial ruin
Why do we have any kind of insurance? For protection from financial ruin.
But the health insurance world doesn't quite work that way.
If a tree falls on your house, you assume your home owner's insurance would cover it. And it probably will except a relatively small deductible. If you get in a car accident, you assume your car insurance would cover it. And it probably will except for a relatively small deductible. If you get sick, you can assume you will end up paying a lot somehow because of what your health insurance won't cover.
That's the key difference. With any other kind of insurance, we assume we will be covered except for a relatively small proportion of the total amount which is why we carry the insurance. But we know our health insurance won't cover everything - they only cover the parts they want to unless you can get a special approval. What is wrong with this system? Everything. It is not designed to protect the patient from financial ruin.
I do not have a solution for this. It is a systemic problem which will require systemic change throughout the health care system.
But the health insurance world doesn't quite work that way.
If a tree falls on your house, you assume your home owner's insurance would cover it. And it probably will except a relatively small deductible. If you get in a car accident, you assume your car insurance would cover it. And it probably will except for a relatively small deductible. If you get sick, you can assume you will end up paying a lot somehow because of what your health insurance won't cover.
That's the key difference. With any other kind of insurance, we assume we will be covered except for a relatively small proportion of the total amount which is why we carry the insurance. But we know our health insurance won't cover everything - they only cover the parts they want to unless you can get a special approval. What is wrong with this system? Everything. It is not designed to protect the patient from financial ruin.
I do not have a solution for this. It is a systemic problem which will require systemic change throughout the health care system.
Health care reform and employee benefits
Here in the precocious state of Massachusetts which adopted health care reform in 2006, we already have six years of change. Are we better off? On some levels yes. The rate of insured here is around 96% if I can recall the latest statistic with my tiny chemo brain. But the problem of medical debt still exists at comparable rates to before 2006. But the good news in that is that the rates did not increase as I believe they have in the rest of the country.
So while we have progress here, we still need more. It would also be nice for the rest of the country to experience the key benefit we have had for decades - the pre-existing condition clause. That is been on the books here for a couple of decades. I would be interested to see the rates of medical debt nationally after a few years with the pre-existing condition clause in effect.
On the other side of the coin is that employers nationally are asking employees to pick up more and more of the cost of benefits that were once free to employees. On this I am a bit torn. While it is nice that employers provide benefits I do not believe that they are required to offer them all free. Free is a great price but its all part of package deal if you think about it.
Your salary plus benefits is your compensation package and employers are feeling the pinch. They want to keep employees happy and offer benefits and salary increases and then the insurance companies raise their rates by 10% each year, how are they supposed to afford all that?
There is always a hidden price. Somewhere that 'free' is being paid for. And if you want your health insurance to cover EVERYTHING think again. My health insurance does not cover chemotherapy wigs, which I found out to my dismay. But a way of reducing costs for insurance companies is to cut coverage for rarely needed benefits. I would prefer to pay for a wig and not pay $20,000 for each chemo round. Its a carefully balanced system and we can't always get what we want. Sometimes we just get what we need.
PCIP.gov
Remember that website. It stands for Pre-Existing Condition Insurance Plans. It is a US government plan for those without healthinsurance. Here are the eligibility requirements:
All other states offer their own PCIP programs and you can find a link to them here.
The reason I am writing this post is because of this woman, Leslie Elder with four cancer diagnoses and no insurance, who died of cancer because she did not know she was eligible for insurance with these new plans. This is so wrong.
The new Affordable Care Act provides insurance to more people but I cannot say by any stretch of imagination that it is a 'simple plan'. Didn't Congress end up with a many thousand page document? Its a lot of information to get out there.
To qualify for PCIP, you must:
- Have a pre-existing condition
- Be a U.S. citizen, or live in the U.S. legally
- Have been without health coverage for the last 6 months
You are NOT eligible for PCIP coverage if:
- You have other insurance coverage, even if it doesn't cover your medical condition
- You're enrolled in a state high risk pool
- You have Medicare, Medicaid, CHIP, VA or TRICARE coverage
- You have job-based coverage, including COBRA, or continuation of coverage, even if it’s about to end
- You have a limited benefit plan
It is available for residents of Alabama, Arizona, Delaware, District of Columbia, Florida, Georgia, Hawaii, Idaho, Indiana, Kentucky, Louisiana, Massachusetts, Minnesota, Mississippi, Nebraska, Nevada, North Dakota, South Carolina, Tennessee, Texas, Vermont, Virginia, West Virginia, and Wyoming.
The reason I am writing this post is because of this woman, Leslie Elder with four cancer diagnoses and no insurance, who died of cancer because she did not know she was eligible for insurance with these new plans. This is so wrong.
The new Affordable Care Act provides insurance to more people but I cannot say by any stretch of imagination that it is a 'simple plan'. Didn't Congress end up with a many thousand page document? Its a lot of information to get out there.
Pre-existing condition exclusions
Here is someone who has never had a preexisting condition:
"And I believe my state of California has a structure in place to deal with pre-existing conditions. It’s a pooling process, which I think is one worthy of consideration, because while I don’t that think someone who is diagnosed with a massive tumor should the next day be able to have millions and millions and millions of dollars in health care provided, I do believe that there can be a structure to deal with the issue of pre-existing conditions."
He is State Representative Dreier (R) of California. I'm glad I don't live there. Apparently if you have a tumor, you become a non-person because you aren't worth treating. Would that be the fate of these two people? First a little 2 year old boy had a 33 lb tumor remove and then a 65 year old woman has a 51 lb tumor removed.
I hope this leads to his political down fall. First of all to make such a blanket statement is ridiculous. Not all tumors are cancerous that will require expensive and long term treatment. Second each person's life is valued equally. All have their rights to choose their medical treatment. Third I can't think of a third because I am too flabbergasted by the whole thing.
"And I believe my state of California has a structure in place to deal with pre-existing conditions. It’s a pooling process, which I think is one worthy of consideration, because while I don’t that think someone who is diagnosed with a massive tumor should the next day be able to have millions and millions and millions of dollars in health care provided, I do believe that there can be a structure to deal with the issue of pre-existing conditions."
He is State Representative Dreier (R) of California. I'm glad I don't live there. Apparently if you have a tumor, you become a non-person because you aren't worth treating. Would that be the fate of these two people? First a little 2 year old boy had a 33 lb tumor remove and then a 65 year old woman has a 51 lb tumor removed.
I hope this leads to his political down fall. First of all to make such a blanket statement is ridiculous. Not all tumors are cancerous that will require expensive and long term treatment. Second each person's life is valued equally. All have their rights to choose their medical treatment. Third I can't think of a third because I am too flabbergasted by the whole thing.
What if they were right?
What if health care costs can be controlled? Blue Cross in MA set up a global payment system where doctors are compensated through a budget system. A doctor or medical center is given a budget to meet for the care of their patients, regardless of what tests, number of visits and everything else. If they go over budget, they need to reimburse the insurance company, if they are under budget, they are rewarded. They can save money on patients by ordering tests at cheaper facilities or reducing the number of tests ordered.
In addition:
"Physicians also earn bonuses of 2 percent to 10 percent of their budget for providing good care. Blue Cross monitors quality indicators, such as whether doctors control patients’ blood pressure, provide regular check-ups to children, and prescribe appropriate and timely medications for depression. Compared to the control group, doctors with the alternative contract improved care for chronically ill adults and preventive care for both adults and children more quickly, the researchers found."
I am glad to see this kind of system. It proves that costs can be controlled.
But it also makes me wonder - what kind of care were these doctors providing before? Were they just ordering too many tests? Not looking at costs? I do not assume they were doing anything intentionally wrong but if costs can be controlled so easily with out any drastic cuts in services and with healthier patients overall, something must have been wrong.
Hmmm... something to think about.
In addition:
"Physicians also earn bonuses of 2 percent to 10 percent of their budget for providing good care. Blue Cross monitors quality indicators, such as whether doctors control patients’ blood pressure, provide regular check-ups to children, and prescribe appropriate and timely medications for depression. Compared to the control group, doctors with the alternative contract improved care for chronically ill adults and preventive care for both adults and children more quickly, the researchers found."
I am glad to see this kind of system. It proves that costs can be controlled.
But it also makes me wonder - what kind of care were these doctors providing before? Were they just ordering too many tests? Not looking at costs? I do not assume they were doing anything intentionally wrong but if costs can be controlled so easily with out any drastic cuts in services and with healthier patients overall, something must have been wrong.
Hmmm... something to think about.
Lack of health insurance kills
On July 3, a 30 year old woman died from breast cancer, just over a year from when she was diagnosed. She had found a lump and didn't go to the doctor because she had no insurance. When she finally went she was diagnosed at stage III. The she became stage IV in December even though she had treatment. Her colleagues rallied around her and helped raise money for her medical costs.
This young woman was actually a clown porn star and relatively famous. While her profession is certainly one which I would not have chosen, she should not be judged on that. It only matters that we need to prevent these stories from occurring.
This young woman was actually a clown porn star and relatively famous. While her profession is certainly one which I would not have chosen, she should not be judged on that. It only matters that we need to prevent these stories from occurring.
And the world didn't come to the end
So when the Supreme Court upheld the health care reform law (whether its a tax or not is still up for debate) and the world did not come to an end. I know there has been a lot of hate mongering on the topic which is supposedly somehow related to the president's citizenship to some people.
But now more people will be able to get health insurance. Recently there was of those stupid slide show news stories (because evidently the media thinks we need our news in slide shows and can't read articles) that listed the percent of residents of each state without health insurance. Massachusetts, with its state law, has the lowest rate of 5%. Texas has the highest rate of 25% which I found to be amazing. According to our friend Google, there are 26,403,743 residents of Texas. That means in Texas alone there are 6,600,936 people without insurance. I find that amazing.
I realize some people go with out insurance by choice. While I do not agree with it, I respect their decision. But I am sure that the vast majority of those 6.6 million would like to have insurance and either could not afford it or the insurance companies rejected them for pre-existing conditions or whatever.
Anyway since the world didn't come to an end, I am happy to wait and see what the changes really mean. I also hopes it has a chain reaction effect on the rest of the health care industry. And how the 'poor' insurance companies will have to adapt.
But now more people will be able to get health insurance. Recently there was of those stupid slide show news stories (because evidently the media thinks we need our news in slide shows and can't read articles) that listed the percent of residents of each state without health insurance. Massachusetts, with its state law, has the lowest rate of 5%. Texas has the highest rate of 25% which I found to be amazing. According to our friend Google, there are 26,403,743 residents of Texas. That means in Texas alone there are 6,600,936 people without insurance. I find that amazing.
I realize some people go with out insurance by choice. While I do not agree with it, I respect their decision. But I am sure that the vast majority of those 6.6 million would like to have insurance and either could not afford it or the insurance companies rejected them for pre-existing conditions or whatever.
Anyway since the world didn't come to an end, I am happy to wait and see what the changes really mean. I also hopes it has a chain reaction effect on the rest of the health care industry. And how the 'poor' insurance companies will have to adapt.
Health care reform
Of course I need to offer my opinion on the health care reform act. Now that we can stop arguing about whether its legal or not - or you can feel free to disagree with the Supreme Court but I just want the arguments to stop that I can hear. Whatever your opinion about the law, its a law and we have to live with it until someone comes along who wants to have it retracted or changed.
I'm not calling it perfect by any stretch but I do like it because it represents change to the health care system. The health care system is broken. We all know horror stories about people who couldn't get care, or went bankrupt trying to get care, or lost their insurance for some reason and then got very ill.
Insurance companies are making health care decisions based on their statistics instead of letting doctors make decisions based on what is needed for the patient. People use emergency rooms instead of primary care doctors and often wait until they are very sick to get treatment. If they had insurance they might have gotten wellness care where the ailment could be prevented or caught early so medical bills will be less.
People may not realize the importance of health insurance until they get a nasty ailment, have a car accident, or need surgery. Then they find out they really need it.
So unless someone else has a bright idea on how to fix the health care system now that we will all have insurance we are stuck with this plan for now.
I'm not calling it perfect by any stretch but I do like it because it represents change to the health care system. The health care system is broken. We all know horror stories about people who couldn't get care, or went bankrupt trying to get care, or lost their insurance for some reason and then got very ill.
Insurance companies are making health care decisions based on their statistics instead of letting doctors make decisions based on what is needed for the patient. People use emergency rooms instead of primary care doctors and often wait until they are very sick to get treatment. If they had insurance they might have gotten wellness care where the ailment could be prevented or caught early so medical bills will be less.
People may not realize the importance of health insurance until they get a nasty ailment, have a car accident, or need surgery. Then they find out they really need it.
So unless someone else has a bright idea on how to fix the health care system now that we will all have insurance we are stuck with this plan for now.
The power of health insurance
If you wondered what life was like without health insurance? Here's a little statistic: 26,000 Americans die prematurely each year due to lack of health insurance. They didn't get preventive care or they didn't get needed care. Many of these are caused by high premiums or denial of coverage.
As we await the Supreme Court's decision on healthcare reform, what do we do for those people who die prematurely if the act is struck down, all or in part? I am not saying the healthcare act as proposed is right or wrong, I just think the current system is broken.
I know you can blame people like me with a million little bitty ailments who are driving up health care costs with all my medical adventures. But I do feel everyone should be able to get health insurance if they want it. Call me optimistic but it would be nice.
As we await the Supreme Court's decision on healthcare reform, what do we do for those people who die prematurely if the act is struck down, all or in part? I am not saying the healthcare act as proposed is right or wrong, I just think the current system is broken.
I know you can blame people like me with a million little bitty ailments who are driving up health care costs with all my medical adventures. But I do feel everyone should be able to get health insurance if they want it. Call me optimistic but it would be nice.
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