Resources…

Definitions:

Cherry-picking: Selecting only young and well patients for coverage. This is done by “actuarial” departments in insurance companies.

Lemon drops: As people get old or sick, insurance companies find ways to move them out of the system, usually by increasing the individual rates.

Rescission: Private insurers can cancel a policy retroactively if they find any minor flaw in the application, such as the failure to report acne when you were a teenager. Even if you have major surgery scheduled.

Gatekeepers: The process of having a nurse employed by the insurance company, overrule the physician’s orders in an effort to reduce care and increase profits.

Trigger: If the insurance industry doesn’t introduce competition within three years, we will switch to a different system. A kookie plan introduced by the industry, it gives them another three years of ripping off the public. And even then, this whole debate starts over. (We need a trigger, but it needs to be applied to our politicians.)

Mandates: Those who are uninsured will be legally required to buy insurance, which locks the insurance industry in the loop (when they instead should be eliminated). If you can’t afford insurance the taxpayers will provide a subsidy, thus a new bailout for an already wealthy industry. Politicians already get a piece of the health care dollar, through campaign contributions, and this ensures their contributions going forward.

Lasering: When an insurance company increases the rates on one particular employee with a history of high claims.

No, a single payer system would have none of these.

HSAs

Health Savings Accounts and High-Deductible Health Plans: “HSAs coupled with high-deductible health plans increase cost-consciousness among enrollees, but have little effect on overall health care costs.” The Bell Policy Center

No ‘health savings’ scams; time for single-payer is now: “A RAND Corp. study demonstrated that when hypertensive patients had to pay part of the bill, they had a 10% higher death rate. Certainly if people die earlier we will reduce our health care costs, but that sounds too much like a Philip Morris study I once read. We can do better.”

“Even partial payment by the patient can be counter-productive, like co-pays, which usually cost more than they save. It was shown in a Kaiser Family Foundation study that mothers in low-income families will too often forego their blood pressure medicine to put food on the table, and then they have a stroke or heart attack or, worse, die. This sounds neither compassionate nor conservative.”
Jack E. Lohman

….. HSAs? Delaying the inevitable

….. Consumer-Directed Health Plans

….. Implications of High-Deductible Health Plans

….. Health Savings Plans Start to Falter

….. Some hospitals seeking fees before surgery

….. One HSA user’s experience.

….. The Trouble with Medicare Advantage

Health Care Waste

From Maggie Mahar: “With its decades of data, Dartmouth [Medical School] has exposed the incredible waste in the U.S. health-care system. Sizing up the evidence, Wennberg estimates that up to one-third of the over $2 trillion that we now spend annually on health care is squandered on unnecessary hospitalizations; unneeded and often redundant tests; unproven treatments; over-priced, cutting-edge drugs; devices no better than the less expensive products they replaced; and end-of-life care that brings neither comfort nor cure.”

See “The State of the Nation’s Health” in either html or pdf form.

So, eliminating the 31% of insurance bureaucracy systemic waste drops the legitimate costs from $2.2 trillion to $1.38 trillion, and cutting 33% of physician and hospital waste out of that drops to $910 billion what our total health care costs should really be, a total 55% savings. Over halfof our health care costs are wasted and dispensable! Is it any wonder that our healthcare costs are double everybody else’s?

Costs of Health Care Administration in the United States and Canada(Steffie Woolhandler, M.D., M.P.H., Terry Campbell, M.H.A., and David U. Himmelstein, M.D.) (by New England Journal of Medicine and www.pnhp.org)

“In 1999, health administration costs totaled at least $294.3 billion in the United States, or $1,059 per capita, as compared with $307 per capita in Canada. After exclusions, administration accounted for 31.0 percent of health care expenditures in the United States and 16.7 percent of health care expenditures in Canada. Canada’s national health insurance program had overhead of 1.3 percent; the overhead among Canada’s private insurers was higher than that in the United States (13.2 percent vs. 11.7 percent). Providers’ administrative costs were far lower in Canada. Between 1969 and 1999, the share of the U.S. health care labor force accounted for by administrative workers grew from 18.2 percent to 27.3 percent. In Canada, it grew from 16.0 percent in 1971 to 19.1 percent in 1996. (Both nations’ figures exclude insurance-industry personnel.)”

RAC-king Up Medicare Savings: The Centers for Medicare and Medicaid Services (CMS) released its most recent analysis of improper payments in the Medicare program on November 17, 2008.  The good news is that vigorous cost recovery programs have helped whittle the percentage of improper payments in the Medicare fee-for-service program from 3.9 percent in FY 2007 to 3.6 percent this year.  But that still means that Medicare bled $10.4 billion in improper payments in FY 2008.  Improper payments are any incorrect payment made to a service provider.  Not surprisingly, the majority tend to be overpayments.

Miscellaneous

Bush’s False Claims About Children’s Health Insurance (by FactCheck.org) President Bush gave a false description of proposed legislation to expand the 10-year-old federal program to provide health insurance for children in low-income working families.

Another “free market” phenomenon, as reported by the New England Journal of Medicine, is that 94% of physicians receive some form of consulting fee or financial favors from drug and device manufacturers, and then are expected to prescribe without favoring one product’s capabilities over the other. Thus the very corporations that espouse the free market are doing everything they can to subvert it, all while our politicians turn a blind eye. Beyond the issue of medical ethics, these industry costs that corrupt the system are also passed on to the patient.

We are all paying for everybody’s health care, no matter how you figure it. Whether through employer premiums, cost shifting because of someone’s unpaid emergency room visit, or someone’s bankruptcy costs. Or lastly, when employers add their costs to the price of their product and we reimburse them at the cash register. Nobody gets a free lunch, not even the unemployed or welfare recipients.

So why don’t we simply eliminate the enormous waste in the system and provide healthcare to all? We could provide first class healthcare (call it CheneyCare) to 100% of our population for the same 16% of Gross Domestic Product that we are spending today. And in the process we’d relieve employers of the healthcare burden and make them more competitive with foreign products that do not have healthcare built into their costs.

Do we need controls? Of course. But high deductible HSAs are not the answer. Perhaps the first three doctors visits per year are free, then an independent nurse facilitator determines whether a chronic problem justifies further free visits or a co-pay kicks in. But co-pays can be counterproductive and further study is needed here.

Competition in healthcare is wishful thinking. Few people will go to the lowest bidder, because low cost often indicates a physician not able to attract patients or a hospital that skimps on cleanliness or technology. So the opposite will be true as the higher priced providers will be at an advantage.

Ten needed fixes for the health care system — First and foremost, the solutions are political. Totally! Not because politicians don’t know how to fix the problem, but because they are being paid not to.

Is Canadian health care right for Wisconsin? — Not totally, but the model is ideal. Healthy Wisconsin will be 50% better funded to eliminate wait times. We’ll use the same private doctors and hospitals, just redirect the 31% of bureaucracy waste toward health care instead.

Health care and the free market — Politicians prefer “the free market” even though it is the free market that took over in 1994 that has gotten us into today’s mess. They favor “privatization” because, they argue, it “adds competition and controls costs.” That’s pure hogwash. It does neither.

Big Pharma, the other elephant in the room— Over 80% of pharmaceuticals are me-too drugs, designed to improve profitability rather than care.

Paying for health care is not rocket science — The best, simplest, least costly, most effective thing we could do is expand what has been working so well for 50 years, Medicare. You get sick, you get care, and the caregiver gets paid. Guaranteed. Nothing could be simpler.

Price competition in health care is a pipe dream — There is no such thing as price competition in the health care industry, at least not the way we might perceive it. And should we ever get to that point, few patients who are really sick will seek out the lowest bidder for themselves or their kids. It isn’t going to happen.

Competition in a publicly funded healthcare system — Are the UK and other countries right to adopt a market based model for improving their health services? Steffie Woolhandler and David Himmelstein believe that the appropriate response to the US experience with such policies is quarantine, not replication. Why would anyone choose to emulate the US healthcare system? Costs per capita are about twice the Organisation for Economic Cooperation and Development average. Forty seven million people are completely uninsured. Many others with insurance face high out of pocket costs that hinder care and bankrupt more than a million annually. Mortality statistics lag behind those of most other wealthy countries, and even for the insured population, clinical outcomes and patient satisfaction are mediocre.

Many Doctors, Many Tests, No Rhyme or Reason– By Sandeep Jauhar, M.D. – “I recently took care of a 50-year-old man who had been admitted to the hospital short of breath. During his monthlong stay he was seen by a hematologist, an endocrinologist, a kidney specialist, a podiatrist, two cardiologists, a cardiac electrophysiologist, an infectious-diseases specialist, a pulmonologist, an ear-nose-throat specialist, a urologist, a gastroenterologist, a neurologist, a nutritionist, a general surgeon, a thoracic surgeon and a pain specialist.” (click above to view complete article)

MedicareAdvantage plans are usually fine, until you get really sick and need care. The Medicare Rights Center found serious problems when, too often, these plans did not provide the care they promise. This has prompted several state attorney generals to sue the companies on behalf of patients.

Links:

Healthy Wisconsin and its FAQ sheet.

HSAs? Delaying the inevitable

Consumer-Directed Health Plans

Medicare-for-all is best corporate bailout…

See this excellent video on single-payer

10 Myths About Canadian Health Care, Busted

Canadian Doctors for Medicare

Canadian Health Coalition

Canadian Health Services Research Foundation

Canadian “Mythbusters”

Healthcare-Now.org

Medicare-for-all

Physicians for a National Health Program

Stories on Medicare Advantage Plans:

How about these salaries? Resource

CEO Company Total
Compensation
Ron Williams Aetna $24,300,112
H. Edward Hanway CIGNA $12,236,740
Angela Braly WellPoint $9,844,212
Dale Wolf Coventry Health Care $9,047,469
Michael Neidorff Centene $8,774,483
James Carlson AMERIGROUP $5,292,546
Michael McCallister Humana $4,764,309
Jay Gellert Health Net $4,425,355
Richard Barasch Universal American $3,503,702
Stephen Hemsley UnitedHealth Group $3,241,042

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One Response

  1. […] the private industry uses to deny care to patients that have gotten overly sick (see descriptions HERE). These are what the private industry takes care not to call “pulling the plug on […]

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