Women pay more than men for identical individual insurance policies October 31, 2008
Posted by Obi Jo in health insurance access, health reform.Tags: affordable health insurance, gender discrimination, health insurance, health Insurance exclusions, health reform, insurance access, insurance benefits
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Insurance rating is not a new concept. However, in the case of individual policies, health insurers have taken it to a new and disturbing level. First, the often deny coverage at all for any preexisting conditions either in total or for a period of time which ranges usually from 12 months to as much as 5 years. Second, they aggressively seek to drop individual policy owners who become ill, use what are deemed to be “excessive services”, require surgery or are felt to represent a major health related expenditure risk. Third, the premium structure is not credible as it lacks any transparency vis a vis an insurers true financial status, reserves, profits, executive compensation and so forth. In the end, rating is well known, such as young male drivers face, even if they are not all high risk. So charging a STANDARD premium adjustment for certain types of conditions which are gender, age, occupation or health related can be justified, but ONLY if regulated, consistent and applied evenly across all policies such that the result is premium surcharges which are not so onerous as to prevent individuals from obtaining coverage . . . obi jo
FROM AMA NEWS . . .
Striking new evidence has emerged of a widespread gap in the cost of health insurance, as women pay much more than men of the same age for individual insurance policies providing identical coverage, according to new data from insurance companies and online brokers.
Price quotes and rate tables indicate that the disparities are evident in premiums charged by major insurers like Humana, UnitedHealth, Aetna and Anthem.
Although in job-based coverage, civil rights laws prohibit sex discrimination, the individual insurance market is notoriously unstable.
Some insurance executives expressed surprise at the size and prevalence of the disparities, others, such as women’s advocacy groups, have raised concerns about the differences, and members of Congress have begun to question the justification for them.
Still, citing more use of healthcare services among women, especially in the childbearing years, insurance companies say they have a sound reason for charging different premiums.
Read more of this NY Times article @ http://www.nytimes.com/2008/10/30/us/30insure.html?_r=1&hp&oref=slogin
Some hospital professionals say Medicare’s never event reimbursement policy may be setting an “impossible” standard. October 23, 2008
Posted by Obi Jo in health insurance.Tags: health reform, Medicare, Hospitals, patient care, hospital billing, CMS, preventable injuries, preventable illnesses, nursing care, AHA, health savings
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Never and always. I believe along the path of life, my parents, family, teachers or events in general taught me to try and avoid those words. While the CMS policy is laudable in many ways, and certainly focusing on preventable errors is something upon which we can all agree, the payment policy associated with this may be misguided. There is NO WAY to prevent all complications of hospitalization. In fact, any doctor or surgeon worth his or her salt will tell you that avoidance of the hospital is beneficial to your health, UNLESS you NEED to be there for a more pressing health condition. The projected savings of this pronouncement are miniscule in comparison to the federal expenditures on health care. Still, seat of their pants non-provider bureaucrats in DC feel that this will show the public the seriousness of their intent on reining in costs. There are better ways to spend federal dollars and better methods to increase the quality of care at hospitals, than by adopting another “score card / report card” mentality based approach . . . jomaxx
Hospitals will no longer get paid for some specific treatment errors . . . CMS . . . including infections, bed sores and objects left inside patients after surgery, under a new Medicare policy
Hospital professionals say the government is setting an impossible standard . . . AHA
Hospitals will no longer get paid for some specific treatment errors, including infections, bed sores, and objects left inside patients after surgery, under a new Medicare policy that went into effect Oct. 1. The move may save the government an estimated $21 million annually by not paying for…follow-up procedures to correct complications from the hospital hall of horrors. Notably, that’s a drop in the catheter, compared with the $110 billion in payments Medicare makes to hospitals each year. But hospital professionals say the government is setting an impossible standard. Nancy Foster, of the American Hospital Association, said that there are items on the list that ‘we don’t know how to make never happen, including bed sores and falls, which are tough to prevent when a frail patient might already have skin problems, or a patient doesn’t call a nurse for help moving and then falls. Still officials say the payoff will be in improving the standard of care, focusing hospitals on prevention, and saving patients the pain of unnecessary treatment.
Regulators at the Centers for Medicare and Medicaid Services told about 3,500 U.S. hospitals that as of Oct. 1, they won’t be reimbursed for such so-called “never events” that patients should never acquire during a hospital stay. The dozen treatment areas on the list are considered “reasonably preventable” and aren’t present when a patient checks in.
In an Aug. 19 final rule, the government estimated that some $21 million would be saved annually by not paying for 500,000 follow-up procedures to correct complications from the hospital hall of horrors. That’s a drop in the catheter compared with the $110 billion in payments Medicare makes to hospitals each year.
Read more @ http://www.washingtonpost.com/wp-dyn/content/article/2008/10/20/AR2008102002772_pf.html
AMA To Politicos:Find Common Ground October 23, 2008
Posted by Obi Jo in health insurance, health insurance access, health reform, patient care.Tags: health care reform, health insurance, health insurance access, health insurance reform, health plans, health reform, mandated health coverage, Medicare, patient care
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The AMA and others in the arena have offered noble attempts at arguing for health reform. But all plans seem to lack a method to address the fundamentals of access and cost. While all are to be commended for trying, this site URGES the AMA and others to read and understand “The Plan”. It is the perhaps the only real way to retain a private health system with patient responsibility. Government must referee the game, not play it. Despite obvious successes in some ways with Medicare, there are many flaws and we should look to the government to foster innovations that will achieve the desired results without the need for massive new or expanded entrenched federal bureaucracies. . . obi jo
In a (10/21) blog entry, Marilyn Werber Serafini wrote, “With expensive healthcare reform proposals questionable for next year, some in Washington are giving a second, more serious look to ideas for changing the tax treatment of healthcare.” But, she asked, “is there a sensible way to change the tax treatment of healthcare that would be palatable to both Republicans and Democrats?” In response, AMA President Nancy H. Nielsen, President, wrote, “Reforming the tax treatment of healthcare would help advance the goal of achieving healthcare coverage for all Americans.” In an AMA questionnaire provided to “both campaigns, and available online at the AMA’s Voice for the Uninsured Campaign website ( ),” both campaigns “expressed support for tax credits.” Dr. Nielsen noted that the “AMA supports refundable, advanceable tax credits that are inversely related to income,” and supports “capping the employee tax exclusion for employer-sponsored health insurance as an incremental way of generating revenue to offset the cost of the tax credits.” She concluded, “We must find a way to common ground, for the sake of the many Americans who live sicker and die younger, simply because they do not have health insurance.”
Read more on ideas on health reform @ http://healthcare.nationaljournal.com/2008/10/tax-changes-for-health-care.php
and on the AMA’s plan @ http://www.voicefortheuninsured.org/
Politics and Real Health Reform October 23, 2008
Posted by Obi Jo in health insurance, health insurance access, health reform.Tags: affordable health insurance, health care reform, health insurance access, health plans, health reform, medical care access, personal health mandates, personal health responsibility
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The article noted below published in the New York Times yesterday gives just a glimpse into the fact that NEITHER candidate for President has a truly credible health plan. In fact, if they were really interested in real health reform, you would see many of the ideas listed in “The Plan” that has been put forward on this site incorporated into their proposals. However, save for some rhetoric from Mr. Obama about preventing insurers from denying coverage for pre-existing conditions and some rhetoric from Mr. McCain about assisting individuals via tax incentives to buy health insurance, there is little substance to their plans. Mr. Obama’s cannot be sustained financially and Mr. McCain’s does not solve the access issue. In the end REALH HEALTH REFORM, that purports to keep the “best” of the private insurance system while expanding opportunities for coverage to all through federal GUIDANCE (not necessarily only direct intervention), can only be achieved by adoption of the majority of the items outlined in “The Plan”. Let’s only hope that someone who actually understands health care will read it and share it with the candidates . . . jomaxx
On Health Plans, the Numbers Fly
Economics, it is said, is the dismal science. Anyone paying close attention to the campaign debate over the economics of health care might wonder about the science part.
As Senators Barack Obama and John McCain battle over how best to control spending and cover the uninsured, they are both filling their speeches, advertisements and debating points with authoritative-sounding statistics about the money they would save and the millions of Americans they would cover.
But the figures they cite are invariably the roughest of estimates, often derived by health economists with ideological leanings or financial conflicts. Over time, these forecasts have become so disparate and contradictory as to be almost meaningless . . . read the entire article @ http://www.nytimes.com/2008/10/22/us/politics/22health.html?_r=1&ref=health&oref=slogin
Always a Doctor . . . Even to the End October 16, 2008
Posted by Obi Jo in patient care.Tags: medical care access, physician behavior, physician education, Physicians
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The link below to this powerful article by Dr Kenneth Weinberg in the NY Times is well worth the read. It should remind all that the call to be a physician is life long and does not ever end. Even when a doctor has put down their stethoscope or scalpel the desire to understand more fully the workings and failings of human health remain. The desire to continue to learn remains. The desire to educate their fellows about what they know remains constant. Most doctors I have ever met fit that mold. The tragedy is that in the current modern health care climate, we are losing more and more talented, dedicated physicians, and fewer and fewer are seeking to fulfill that calling. We must reinvigorate medical education and expand opportunities for American sons and daughters to enter medical school. That mission is long overdue . . . obi jo
Always a Doctor, Even in the Dying of the Light
“Kenny, I want you to see something.”
As he spoke, my father pulled up a corner of the bandage on his right forearm. I watched a BB-size rent in his skin glisten and begin to bleed.
“Now feel my blood,” he told me. “It’s cold.”
I looked at his face and then back at his arm, unsure how to proceed. The limb was bruised and discolored, damaged by countless needle sticks and transfusions.
We were sitting in the bedroom of his house in Florida. I’d flown down the day before, Sunday, after my mother called to say it appeared that his longstanding, dangerously low blood counts were finally bringing his life to an end . . .
read more of this moving story in the NY Times @ http://www.nytimes.com/2008/10/14/
health/views/14case.html?ref=views
Waging Health Battles by Fax October 4, 2008
Posted by Obi Jo in health insurance, health reform, patient care.Tags: health, health insurance, health insurance reform, health plans, health reform, physician behavior, physician education, Physicians
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Yes, sadly, fully trained, certified (and re-certified) doctors, licensed to practice the full spectrum of medicine, are still second guessed it would seem almost every step of the way by insurance companies. Even the smallest decision, such as knowing a patient and the drugs he or she really needs, is questioned with demands for justification of the choice (read the COST to the insurer since that is really the ONLY major concern the health insurers have) . . . let our doctors practice medicine ! . . . obi jo
Waging Health Battles by Fax
Benjamin Brewer, M.D., writes, “There is a battle that goes on behind the walls of the family doctor’s office every day. We try to get the medications and tests and referrals that our patients need, while also seeing patients who require care.” Health “insurance companies don’t mind me taking heat from the patients when they don’t get the medication I recommend. And, they don’t have to worry about the liability that I, as a doctor, face for using cheaper drugs that may put the patient at higher risk of complications.” Insurers “want me to incur the overhead and frustration that comes with trying to prove to a non-doctor that I know my patient and what I’m talking about.” Dr. Brewer notes that a 2001 study found that “a doctor seeing 22 patients a day averaged one insurance hassle lasting for every four or five patients. More than 40 percent of hassles were reported as interfering with quality of care, the doctor-patient relationship, or both.” . . . link to more info on this article @ http://online.wsj.com/article/SB122281241415292049.html?mod=rss_Health
Accreditation council says medical education needs to be revamped October 4, 2008
Posted by Obi Jo in E Health, health reform.Tags: e-medicine, health care reform, health reform, medical education, medical licensing, physician behavior, physician education, Physicians, resident training
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Without question, any attempt at Real Health Reform, must include all aspects of physician education and training as well a total revamp of the antiquated, century or more old system of medical licensing for trained professionals. We need to be sure that young physicians understand the integration of “information therapy” into the clinical equation. That is the use of the internet to access and collate large volumes of relevant data to assist in making correct judgements during the diagnostic and therapeutic process. Additionally, at some point, we need to face the need for national licensing of physicians and surgeons, with uniform standards and an ability for professionals to move freely and practice at all levels in all 50 states . . . and this includes forms of e-medicine based in the internet now in evolution . . . obi jo
Medical education training needs to move into the 21st century by focusing more on clinical outcomes and other quality measures along with information technology adoption, representatives from the academic medical community told the Medicare Payment Advisory Commission.” According to Thomas Nasca, chief executive officer of the Accreditation Council for Graduate Medical Education, “The current system rates a ‘C’ in terms of its proficiency in training physicians.” Nasca also noted that “standards on accreditation for these programs have primarily been driven by what happens in the field first,” with residents “accumulating medical knowledge instead of specific skills.” He added that he hopes “over the next five years, accredited residency and fellowship programs will move toward a more proactive, innovative approach, where curricula will be driven by clinical outcomes measures.” . . . for links to more info on this topic go to:
https://home.modernhealthcare.com
http://www.cq.com/login.
http://www.medpac.gov/documents/20080916_Sen%20Fin_testimony%20final.pdf
