Thursday, April 27, 2006

WI to attempt 100% healthcare coverage

The Wisconsin state legislature is beginning to talk about a health program that covers every employee in the state, and will allow self-employed people to buy in at cost.

This program:
  • Covers every employee in the state.
  • Standardizes benefits and administration (lowering administration cost substantially.)
  • will lower prescription drug prices by bargaining with pharmaceutical companies
  • establish common quality standards for hospitals and health care providers to control costs.
Since this plan covers ALL employers and reduces costs, employers are not opposing it.

From the Madison, Wisconsin Capital Times:
Employers would be required to pay a monthly premium and employees would be responsible for deductibles and co-pay costs. Self-employed people, early retirees and others not covered could buy into the plan at cost.[Snip]

The proposal was developed in consultation with employers, medical experts and community representatives as a way of providing affordable, comprehensive, quality health care, Newby said.

"We will have a product that people can look at, so we have something concrete that can be discussed during the coming election campaigns," Newby added. "We knew we would not get consideration during this legislative session because it is almost over."[Snip]

Benefits would be comprehensive and cover "all medically necessary care," he said, including inpatient and outpatient hospital costs, physician services, routine physical exams, diagnostic testing, maternity care, emergency care and prescription drugs.

An actuarial study done in 2003 by the Lewin Group at the request of the Wisconsin State AFL-CIO found that if the plan been in effect during that year, employers would have paid a flat fee per employee of less than $300. A projection for current costs comes to $340.

Employees and dependents would pay a yearly deductible of $300 for a single person or $600 for a family. Co-pays would be $15 for office visits, $10 for generic drugs and $20 for brand-name drugs.

Those speaking in favor of the bill included the mayors of Menasha and Lodi, who said their cities and taxpayers could save substantial amounts on insurance coverage under the plan. Fond du Lac County Executive Allen Buechel said the county could save $3.5 million per year. [Snip]

Details of the plan are available on The bill -- S.B. 698 -- will soon be available on the Legislature's Web site,
This plan should be compared to the one being discussed in the Massachusetts legislature.

Universal healthcare is an idea whose time has come in America. This one in Wisconsin will be single payer. The one in Massachusets does not seem to be single payer, so it will be (in my opinion) more expensive. The difference is that the Wisconsin plan will Standardize benefits and administration. The cost of a variety of types of benefits and forms of administration are substantial.

That's two states discussing, 48 left to go.

Wednesday, April 26, 2006

Availability, cost of healthcare getting worse

Healthcare problems that result from the lack of an adequate structure of healthcare financing are getting worse. The following is from the Commonwealth Digest.
Findings from the Commonwealth Fund Biennial Health Insurance Survey show that, while lack of insurance continues to be highest among families with incomes under $20,000, uninsured rates for moderate- and middle-income earners and their families are rising, putting their health and financial security at risk. The survey finds that most of these individuals reside in working families: Of the estimated 48 million American adults who spent any time uninsured in the past year, 67 percent were in families where at least one person was working full time. In addition, survey respondents were asked about problems with medical bills and accrued medical debt; difficulties in accessing needed health care; problems managing chronic conditions; utilization of routine preventive care, like mammograms and colonoscopies; and coordination and efficiency of care.

Executive Summary
National health care spending is climbing by more than 7 percent per year, outpacing economic growth by a substantial margin. As health care costs have climbed, so has the number of people without health insurance in the United States, even during a period of overall economic growth. In 2004, according to U.S. Census data, nearly 46 million people of all ages were uninsured, an increase of 6 million over 2000. This combination of eroding health insurance coverage and rapidly rising health care costs raises concerns about the ability of U.S. families to obtain timely medical care, protect their finances from catastrophic health care costs, and save for retirement.
Single payer will not solve all the problems in the Healthy care system, and will also run into the normal problems of a government program, but it will be head-and-shoulders above the current lack of system. Just ask the automotive companies what will happen if they no longer have to pay $1500 from each car sold for health care for employees and retirees.

CA Blue Cross canceling policies if holder gets sick

You were farsighted and fortunate. You bought an individual health insurance policy from the best company out there, Blue Cross Blue Shield, when you could get it. Now you find you are ill, and you want to use the policy you were careful enough to get before getting sick.

Your diagnosis was hypertension or diabetes. That triggered a review of your policy, and Blue Cross cancels your policy instead of providing the coverage they promised.

Welcome to the world of "for Profit" health insurance. The LA Times (Registration required) published the story today. They haven't published the full list of conditions that trigger the review of your policy, because the company convinced the Judge to seal that part of the testimony. Wouldn't want competitors to learn proprietary business information and methods, after all.
A California Blue Cross employee testified in secret last year that the state's largest health-plan company routinely canceled policies of sick members after looking for inconsistencies — not fraud — in their applications.

Experts say, however, that state law allows only deliberate omissions or misstatements as grounds for canceling health coverage.[Snip]

Sheila Millan, testified that the reviews were triggered by claims made for treatment for certain illnesses, such as hypertension, diabetes and cardiovascular disease.

"When a claim comes in and there is a certain diagnosis, that would pretty much [consign] them to be reviewed for a possible preexisting condition," Millan testified. "There is a list." [Snip]

Plaintiffs' attorney Shernoff has filed policyholder suits for years. But he said he had no proof that the cancellations were anything more than isolated problems until the employees deposed last summer described how the reviews worked and revealed that the company kept monthly reports of its cancellation activity.

"That's when it became clear that this was systematic and widespread," Shernoff said
Of course, once Blue Cross has canceled your policy you cannot get another company to cover you. You have just become one of the 45,000,000 American uninsured, in spite of all your foresight, planning and careful payments.

But there is an up side. Blue Cross becomes more profitable.

(via nyceve at Daily Kos)

Monday, April 24, 2006

More on Cancer and Insurance Companies

One Oncologist is of the opinion that health insurance companies just want to collect their premiums, then let his cancer paitients die. Here is a dKos diary on the subject.

Sunday, April 23, 2006

"Just let the market provide health care"

Markets do a fine job of allocating investment resources in those areas with the greatest possible profit, but when someone get really sick - cancer for example - where's the profit?

Ask any insurance underwriter. The profit is in denying care, not in providing it. As Kevin Drum point out today:
One of the reasons America spends so much more than any other country on healthcare is because upwards of 30% of our expenditures are for paper shuffling by insurance companies doing their best to deny treatment whenever possible. By contrast, administrative costs in countries where there's only one paper shuffler — and it's not trying to make a profit from its shuffling — are closer to 10%.
So how does an insurance company which is required by law to not adjust your premiums upward when you get sick able to avoid paying the expenses of your illness?

Cathy Siepp writes a weekly column for National Review Online. Cathy also has cancer. Let's let her tell us:
By law, insurance companies aren't allowed to adjust your monthly premiums just because you get sick. But they can raise the out-of-pocket cap for all of their members anytime they like, which amounts to the same thing because it affects only the unvalued sick members.[Snip]

Policy wonks keep arguing about market competition and consumer choice. But healthcare for the sick isn't a market because choice disappears. You can't shop around for generic drugs when you have cancer. Whatever chemical treatment the doctor suggests, it almost certainly will be a brand name costing several thousand dollars a month.

My out-of-pocket cap is $7,500, which means that after I reach $7,500 in co-payments, Blue Cross pays 100% of my medical expenses for the rest of that year — except for the $30-per-brand-name prescription I have to pay the pharmacy after I reach my $500 annual deductible for drug coverage. According to the policy, it's supposed to be a $30 co-payment for a month's supply, but a new anti-nausea drug I was taking for weekly chemo costs $285 for just three pills, so Blue Cross made me go to the drugstore and fork over $30 every seven days. [Snip]

I began getting letters from Blue Cross in February announcing that it was retroactively disallowing the anti-cancer drug Avastin treatments it had been paying for since October, at $5,000 a pop every other week. It seems Blue Cross decided this new and expensive targeted therapy is experimental.
One thing that single payer would change is that the therapies that are covered would be predictable to the physician and the customer. As it is, each insurance company makes different decisions, and except in unusual cases, no one gathers the date across multiple insurance companies to see what works and what doesn't. Each physician and patient is left alone to battle with the insurance company as it denies care.

With single payer, everyone goes under the same rules. If a treatment is denied as experimental, then a number of patients and their physicians can join together to contest the decisions. The physician will also be able to generally determine in advance what treatments will be paid for and what treatments will not. For those known to be not covered, the physicians and patients can begin making alternative choices early in the treatment.

Single payer is not perfect, by a long shot. But it is a lot better for a lot more people than the current system is, and it can cut health costs by the 20% of paper shuffling that is eliminated by underwriters attempting to avoid payment for expensive treatments. That's more than enough to provide universal health care.

Tuesday, April 18, 2006

Social Security Annual Report is late

Regarding the late Social Security Annual Report, I emailed a request to the Social Security Administration and received a reply from the Office of the Actuary that they will publish it in May and send me a copy.

I was given no reason for it being late.

I have also written my Congressman and both Senators asking why it is late. No reply yet. I don't expect one from John Cornyn.

Prior post on this subject Social Security annual report is late dated April 4, 2006.

Why we need single-payer health insurance

This is the position of Benjamin Brewer, M.D.:
Doctors in private practice fear a loss of autonomy with a single-payer system. After being in the private practice of family medicine for 8 1/2 years, I see that autonomy is largely an illusion. Through Medicare and Medicaid, the government is already writing its own rules for 45% of the patients I see.

The rest are privately insured under 301 different insurance products (my staff and I counted). The companies set the fees and the contracts are largely non-negotiable by individual doctors.

The amount of time, staff costs and IT overhead associated with keeping track of all those plans eats up most of the money we make above Medicare rates. As it is now, I see patients and wait between 30 and 90 days to get paid. My practice requires two full-time staff members for billing. My two secretaries spend about half their time collecting insurance information. Plus, there's $9,000 in computer expenses yearly to handle the insurance information and billing follow up. I suspect I could go from four people in the paper chase to one with a single-payer system.

It would be simpler and better for the patient, and for me, if the patient could choose a doctor, bring their ID card with them, swipe it in a card reader at the time of service and have the doctor get paid on the spot with electronic funds transfer.

Instead, patients have to negotiate a maze of deductibles, provider networks, out-of-network costs, exclusions, policy riders, ER surcharges, etc. Wouldn't a card swipe be simpler? No preexisting conditions to worry about. No indecipherable hospital bills. One formulary to deal with and one set of administrative rules to learn instead of 300.

With a single-payer system, there are concerns about waiting times for procedures and not getting access to the "best doctors." These are real issues, but not unsolvable ones. We have these disparities now. Fact is, they are mostly a matter of geography, insurance status and personal wealth.

A single-payer system would increase access to care for the uninsured and the underinsured, including the working poor. It would lower total health costs, in part by replacing 50 different state Medicaid programs and umpteen insurers with one system. This approach has the potential to improve quality and lower costs by improving care for chronic illnesses such as diabetes, high blood pressure and heart disease.

Such a system of care would rely on evidenced-based interventions, that is, providing the right care at the right time to the right patients, according to generally accepted best practices, and it would reduce the disparities in access to and quality of care among ethnic groups. Better tracking of chronic diseases, outbreaks and identification of bioterrorism would also be benefits.
Such a system would cut out the estimated one quarter of all medical expenses that go towards determining whose care is paid for and how much, and who is excluded.

It would not lower the expenses of actual medical care, but it would stop the money wasted on administration and permit all Americans to have equal and easy access to health care regardless of their income. The Average American life span would increase, while the infant mortality rate in America might reach the excellent levels seen in Cuba. Health care would become portable, so that no one would be trapped in a job by need for health care and a pre-existing condition.

The average American could get care as good as provided to Veterans in the VA System (which is the best overall system in America today.) It's far from perfect, but it is a lot better than what we have today.

America badly needs single-payer health insurance.

Thursday, April 06, 2006

Massachusets offers universal healthcare.

The Massachusets legislature passed a bill designed to provide health care coverage to all citizens of the state. The House passed it 154 to 2 and the Senate passed it 37 to 0. Governor Mitt Romney is expected to sign it.

I am not sure yet what to think of the bill, except that it seems to be going the correct direction. Here is the article in the Washington Post. Naturally the Boston Globe has an article.

Kevin Drum does have some more information and opinion on the bill.

Medicare Part D was designed to fail

First you are asked to choose which, from about 40 plans with "...different premiums, co-payments, deductibles and formularies", is the plan that will meet your needs for the next twelve months. This is a decision which it almost impossible for healthy and well educated people to make. Someone who is elderly, ill and/or not very educated or not a native English speaker will find this part of the process impossible to deal with.

But you make the decision, and adapt to the many restrictions and poorly implemented unique administration procedures demanded by the company you did finally choose. You are locked in to that plan until next January first. Then comes the kicker.

The company you chose changes the formulary they offer, effective June 1, 2006. Half the medications you take for your chronic high-blood pressure or other illness are no longer offered. Nor is it just half the medications you take. It's the most expensive and most effective half of the medications you take.

Jeff Cruz at TPM Cafe points out that
"The Philadelphia region's largest insurer, Independence Blue Cross, has demonstrated this ability by announcing it will make 22 changes in drugs covered starting June 1st."
OK. So you had been getting medications 60% cheaper by getting them from Canada. You can go back to that, right?

Nope. The federal government has cracked down on medications being shipped in from Canada. Instead of the medications you have already paid for you get a letter from the Department of Homeland Security. They are "protecting you" by not leting you get the medications you need to survive at a price that, while difficult to pay, is not ridiculously high.

The prices you pay here in the states are too high because as an individual, you do not have the power to negotiate prices with the Pharmaceutical Companies. But with so many seniors banded together and getting medications through Medicare, Part D, it is possible for Medicare to do what the Veteran's Administration does and negotiate to get the best price the pharmaceutical companies give to any other customer, right?

Nope. The law establishing Part D forbids Medicare from negotiating prices with the pharmaceutical companies.

Hey! You wouldn't want the Pharmaceutical Companies to get lower prices so that they can't afford all those very expensive advertisements we all see on television, would you? Your health depnds on those advertisements. Doesn't it? No? Well, the extremely high salary and bonuses received by the CEO might suffer, and we wouldn't want that, would we? I mean, should we really expect him to take a pay cut just so we can live longer with a better quality of life? How selfish are you anyway?

Really! Do you think that Medicare Part D was designed to help seniors to actually get the medications they need at reasonable prices? Of course not. It was written by Pharmaceutical Company Lobbyists to increase Pharmaceutical Company revenues. That's what free enterprise does!

This was a plan designed by Congress to fail.

See also

Wednesday, April 05, 2006

Did you know Bush is again pushing HSA's?

Dan Froomkin asks "Is anyone paying attention to the president anymore?"

It seems that Bush is pushing Health Savings Accounts especially hard yesterday and today. Anyone heard that?

Except for Froomkin, I sure hadn't.

Froomkin goes on to point out that supposedly HSA's will squeeze health care prices lower because individuals will be more price conscious.

Yeah, right. More price conscious than the HMO's who tried for two decades to squeeze health care prices by squeezing doctors and restricting patient care? I don't think so.

Part D of Medicare has been incompetently implemented

Part D of Medicare added critically needed pharmaceutical coverage to Medicare, but it was poorly designed and has been implemented incompetently. Go read this post at Easter Lemming Liberal News.

Tuesday, April 04, 2006

Social Security annual report is late

The Social Security Administration is required to publish its annual report each year not later than April 1. It is now April 4th, no report and there is no idea when one will be published. (Matt Yglesias at TPM Cafe.) This is extremely suspicious.

The Social Security Act requires the publication of the Social Security Trustees Report to Congress by April 1 of each year. (The relevant provision can be found here.) Here is what it says:
SEC. 201. [42 U.S.C. 401] (c)(2)
(2)[11] Report to the Congress not later than the first day of April of each year on the operation and status of the Trust Funds during the preceding fiscal year and on their expected operation and status during the next ensuing five fiscal years;

(Atrios reported the legal deadline here and provided the link I reported above.)