$634 billion and counting February 26, 2009
Posted by Obi Jo in health insurance reform.Tags: Congress, health, health insurance reform, health plans, health savings, insurance benefits, medical care access, Medicare, President, President of the United States, underinsured, uninsured
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There are a few facts that our President and his giddy health advisers seem to refuse to acknowledge. First, with the aging population, more health related costs are going to be incurred. Unless you decide to ask the elderly to simply crawl away and die (and I have NO DOUBT that some of the bean counters out there think that way), that is a fact that cannot be changed. Second, as you find ways (and we have outlined some simple ones) to increase access to health insurance, more folks are going to access health related services. It is simply a market dynamic. Therefore, overall costs will go up on that count also. In summary, looking at OVERALL health care costs as an isolated statistic is not helpful and in most cases, is detrimental to an intellectually and morally legitimate discussion . . . obi jo
President Barack Obama’s first budget will seek $634 billion over 10 years as a down payment on healthcare reform, a senior administration official said. The $634 billion Obama wants to set aside for healthcare would be almost evenly divided between spending reductions and tax increases. Obama’s plan would also trim $316 billion from Medicare over 10 years. Some of the savings would come from scaling back payments to private insurance plans that serve older Americans, which many analysts believe to be inflated. Other proposals include charging upper-income beneficiaries a higher premium for Medicare’s prescription drug coverage.
Read more @ http://www.modernhealthcare.com/apps/pbcs.dll/article?AID=/20090225/REG/302259966&nocache=1
http://www.modernhealthcare.com/apps/pbcs.dll/article?AID=/20090225/MODERNPHYSICIAN/302259943&nocache=1
HIT yes, Big Brother no! February 25, 2009
Posted by Obi Jo in health insurance.Tags: dependent health coverage, E Health, health, health care reform, health information technology, health reform, healthcare, patient care, Physicians
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We hope the president-elect of the AMA has it right. Adoption of uniform medical information technology standards is essential to get to a more well established health information system. However, we must resist at all turns attempts by federal bureaucrats to interject THEIR beliefs about what is proper care and leave that to professionals and patients. Government assistance is needed to help move health information technology adoption forward, government control is not . . . jomaxx
GAMA president-elect advocates for HIT provisions of stimulus bill
In a letter to the editor in the Wall Street Journal , American Medical Association President-elect J. James Rohack, M.D., responds to a Feb. 11 editorial on electronic medical records (EMRs). He states that the AMA agrees that EMRs “might do some actual good,” and therefore supports “the health information technology [HIT] provisions of the economic stimulus bill.” The bill would “create important national HIT interoperability standards,” which are “essential to…help increase patient safety, improve care coordination and reduce unnecessary paperwork,” he explains. Dr. Rohack also notes that the “bill does not authorize the government to dictate clinical guidelines or national coverage decisions.” Rather, it “provides physicians with significant financial assistance for HIT purchases” that will allow patients to “begin to reap the benefit.”
Nurses form mega-union February 20, 2009
Posted by Obi Jo in Nursing.Tags: healthcare, Hospitals, nurses, nursing care, patient care, physician behavior, Physicians, unions
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The history of unions in the United States is both good and bad. The history of unions in the healthcare sector has been generally negative. While some of the goals of this new association are laudable, it is not clear what some of them really mean, such as “healthcare justice”. That may mean something quite different depending upon which group or individual you speak with. In the end, nurses are an indispensable part of the acute health care system and deserve fair treatment at all levels. But also, nurses are not doctors, hospital administrators or necessarily health care experts. One can only hope that this new organization will use the clout of its size for overall improvement in the health care system. This site would urge them to initially advocate for insurance reform so we can keep a private, market based system, and allow for government programs to underpin that system . . . obi jo
Nursing associations merge to create nation’s largest nurses’ union
Three unions that together represent about 150,000 registered nurses said Wednesday they are forming a new organization that would be the nation’s largest nurses’ union. The organization will be called the United American Nurses-National Nurses Organizing Committee and is affiliated with the AFL-CIO. The three unions to merge are the United American Nurses, California Nurses Association/National Nurses Organizing Committee, and the Massachusetts Nurses Association. The union could create a formidable political power in the country’s healthcare policies. The group’s goals include building a movement ‘to defend and advance the interests’ of direct-care nurses nationwide and organize ‘all’ non-union direct care RNs. The group also intends to provide a powerful national voice for ‘RN rights, safe RN practice, including RN-to-patient staffing ratios under the principle that safe staffing saves lives, and healthcare justice.
Read more @
New nurses’ union would be nation’s largest – http://www.chron.com/disp/story.mpl/ap/business/6269544.html
Nurses unions to combine – http://www.sfgate.com/cgi-bin/article.cgi?f=/c/a/2009/02/19/BU6I1609SJ.DTL
3 of nation’s largest nursing unions merge, will target Dallas-Fort Worth area – http://articles.custombriefings.com/articlelink.aspx?tlid=1727308,jomaxx@aol.com&p=ama-090219-C¶m=aHR0cDovL3d3dy5kYWxsYXNuZXdzLmNvbS9zaGFyZWRjb250ZW50L2R3cy9idXMvc3Rvcmllcy8wMjE5MDlkbmJ1c251cnNldW5pb24uM2RhNDQ5ZS5odG1s
California RN union, two others join forces to form new 150K-member association – http://www.bizjournals.com/sacramento/stories/2009/02/16/daily29.html
Nurses’ associations join forces to create giant RN union – http://www.sacbee.com/business/story/1635111.html
Three groups form 150,000-member nurses union – http://www.modernhealthcare.com/article/20090218/REG/302189989
Another one bites the dust February 20, 2009
Posted by Obi Jo in health insurance, health insurance reform.Tags: affordable health insurance, health, health insurance reform, health plans, Insurance, insurance fraud, Insurance Profits, underpayment
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Again, we see, now the sixth in a line of health insurers admitting by this action that they knowingly used faulty data to deny, delay and prevent – in essence, defraud – patients and providers of payments. One can only hope that this type of action by the AG in New York will prompt health insurers to begin moving toward a fair system based on reasonable profit over costs (see “the plan” on this site). That would be a great step forward in helping to address payment inequities between and among carriers . . . jomaxx
WellPoint settles with New York over out-of-network reimbursement rates
New York Attorney General Andrew Cuomo said Wednesday that WellPoint Inc., the nation’s largest health insurer, will pay $10 million to help establish a new independent database to determine the rate it pays doctors and hospitals out of its network.” In doing so, WellPoint “becomes the sixth insurer to help fund the new database.” Cuomo has reached similar agreements with UnitedHealth, Aetna Inc., and Cigna Corp. WellPoint also agreed to no longer use a controversial database maintained by UnitedHealth Group Inc.’s Ingenix unit to determine the ‘usual and customary’ rate for out-of-network insurance reimbursements. The Ingenix database skewed downward the ‘usual and customary’ rates through faulty data collection, poor pooling procedures and lack of audits, thus forcing consumers to pay more out of their own pockets for healthcare.
According to Cuomo, the out-of-network cost to consumers dropped about 20 percent once Ingenix was removed from the mix. WellPoint Executive Vice President and Chief Executive Officer Ken Goulet stated that “the company ‘acknowledges the conflicts of interest in the Ingenix database.’” He added that the company supports Cuomo’s “efforts to increase the transparency of healthcare costs.
Meanwhile, American Medical Association President Dr. Nancy Nielsen urged all health insurers to reject the fatally flawed Ingenix database. And, although the new, independent database is a major step forward in reforming the health insurance industry, she noted that serious damages resulting from…prior use of the flawed Ingenix database still need to be addressed. The association is currently “involved in unsettled class-action lawsuits against Cigna and Aetna.
Read more @
WellPoint Will Fund Insurance Database – http://online.wsj.com/article/SB123497909811513833.html.html
Nation’s largest insurer WellPoint, Inc. agrees to $10 million settlement with the state, says Cuomo – http://www.nydailynews.com/ny_local/2009/02/18/2009-02-18_nations_largest_insurer_wellpoint_inc_ag.html
More Ingenix fallout: WellPoint will contribute – http://www.modernhealthcare.com/apps/pbcs.dll/article?AID=/20090218/REG/302189976
Another Insurer Drops Flawed Reimbursement Database – http://www.medpagetoday.com/PracticeManagement/Reimbursement/12940
Cuomo: Health insurers rigged out-of-network rates – http://www.newsday.com/news/local/ny-liinsu0219,0,2343028.story
Is healthcare really a cost? February 19, 2009
Posted by Obi Jo in Hospitals, health reform.Tags: employment, health, health care reform, health reform, healthcare, healthcare employment, jobs, medical care access, medical socioeconomics, nursing care
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So is healthcare a cost, or a growth industry? Depends upon your point of view. If expenditures on healthcare are viewed SOLELY as a cost, then the best course is to try and eliminate ALL of these expenditures. This mindset leads to rationing, denial of care, limitation of benefits and access. If healthcare is properly viewed as a positive resource and growth industry, it takes on a different perspective. With this mindset, one can properly balance the positive economic impact derived from healthcare expenditures against excessive spending and waste, which is the case in all industries. The healthcare dollar covers a wide array of the population and provides income to employees across a vast swath of this economy. It is time to recall that healthcare dollars spent do not disappear from the economy, and are almost totally expended locally and domestically. The healthcare economy is not being shipped overseas, nor are the jobs it provides . . . jomaxx
Data indicate growth outlook for healthcare sector will be strong through 2016
The overall employment picture in the US continues to be dismal after employers shed about 2.6 million jobs last year, but the healthcare sector is one of the few relative bright spots. According to the Bureau of Labor Statistics, healthcare saw a net gain of 419,000 jobs in 2008, and its growth outlook continues to be strong through 2016. Last year, the number of registered nurses, in particular, grew the most, adding 168,000 jobs through November as hospitals and agencies tried to address a nationwide nursing shortage. Experts indicate that although healthcare employment is expected to continue growing this year, the increase will not be uniform. A survey of 329 hiring managers” conducted by CareerBuilder showed that the portion of large healthcare companies planning to increase the number of full-time employees this year is about equal to the percentage planning to reduce jobs in 2009.
read more @ http://online.wsj.com/article/BT-CO-20090120-716545.html
http://www.bls.gov
http://www.careerbuilder.com
Compartive Effectiveness = Health Rationing February 18, 2009
Posted by Obi Jo in Physicians, health insurance, health reform, patient care.Tags: access, benchmarking, Congress, health, health care reform, health reform, healthcare, medical care access, patient care, patients, physician behavior, Physicians
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Make no doubt about it, this legislation has opened a door that will be difficult to close. It is also a slippery slope to rationing health care based on cost-benefit analysis versus care of individual patients. The agenda, stated or not, is to herd physicians into a federal employee mindset, with dictates about what is and what is not allowed. Physicians, by oath, are advocates for patients. Individual patients. When you are sick, you want a physician caring for you individually, not you as part of a demographic group or entry on a balance sheet. We must resist this move to the “dark side” of medical care and decision making. Such actions have led in the past to sad moments in medical history most typified by the atrocity of Nazi euthanasia and eugenics programs . . . obi jo
Expert criticizes proposed “comparative effectiveness” entity for new medical products
Dr. Scott Gottlieb, resident fellow at the American Enterprise Institute, wrote, “In Britain, a government agency evaluates new medical products for their ‘cost effectiveness’ before citizens can get access to them. … President Obama and House Democrats embrace the creation of a similar ‘comparative effectiveness’ entity that will do research on drugs and medical devices.” While they say “that they don’t want this to morph into a British-style agency that restricts access to medical products based on narrow cost criteria,” Dr. Gottlieb contends that “provisions tucked into the fiscal stimulus bill betray their real intentions.” He noted that the “centerpiece of their plan is $1.1 billion…for studies to compare different drugs and devices to ’save money and lives.’ Report language accompanying the House stimulus bill says that ‘more expensive’ medical products ‘will no longer be prescribed.’” Furthermore, the former nominee as “Health Czar” Tom Daschle previously argued “that the only way to reduce spending is by allocating medical products based on ‘cost effectiveness.’”
read more @ http://online.wsj.com/article/SB123241385775896265.html
http://www.aei.org
Stimulus bill includes funding for comparative effectiveness research
The $787 billion economic stimulus bill approved by Congress will, for the first time, provide substantial amounts of money for the federal government to compare the effectiveness of different treatments for the same illness. Specifically, researchers will receive $1.1 billion to compare drugs, medical devices, surgery, and other ways of treating specific conditions. The bill creates a council of up to 15 federal employees to coordinate the research, and to advise President Obama and Congress on how to spend the money. The program responds to a growing concern that doctors have little or no solid evidence of the value of many treatments. Supporters of the research hope it will eventually save money by discouraging the use of costly, ineffective treatments. Critics worry that the legislation would allow the federal government to intrude in a person’s healthcare by enforcing clinical guidelines and treatment protocols.
read more @ http://www.nytimes.com/2009/02/16/health/policy/16health.html?hp
The “Gradual Creep” of Goverment Control of Health Insurance February 18, 2009
Posted by Obi Jo in health insurance.Tags: access, affordable health insurance, Congress, government, health, health care reform, health insurance, health insurance access, health insurance reform, health reform, healthcare, universal healthcare
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There are many, from all sides of the health care debate who have applauded the expansion of SCHIP. However, the income levels included in SCHIP and the age levels have created essentially a federal monopoly on this type of coverage. Private carriers best beware. This site has argued for reform that could allow for a robust private health insurance market to survive, albeit with major reforms. However, actions like this, if applied as feared in this article to Medicare, could well doom the long term prospects for any major free market for health insurance to survive, beyond those of major means . . . jomaxx
WSJournal argues SCHIP is Democratic model for later quantum jump in government healthcare
The House passed a major expansion of the State Children’s Health Insurance Program (SCHIP), which the Senate is also expected to pass. SCHIP is the Democratic model for a quantum jump in government healthcare down the line, opening to everyone up to 300 percent of the federal poverty level, or $63,081 for a family of four, thereby having an eligibility ceiling higher than the US median household income. Every time the program grows, it displaces private insurance. Should the President introduce a government insurance program modeled after Medicare but open to anyone of any income, then, as with SCHIP, any net increase in insurance coverage will come by having taxpayers gradually supplant the private system. Mr. Obama has been making noises about the necessity of entitlement reform. This is no way to start
read more @ http://online.wsj.com/article/SB123249769747600423.html
Health insurers underpay doctors and patients via corrupt system February 12, 2009
Posted by Obi Jo in Physicians, health insurance, health insurance reform, health reform.Tags: health care reform, health insurance, health insurance reform, Insurance Profits, physician payments, underpayment
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Yet again, we find health insurers, this time giants Aetna and Cigna in the cross hairs of legal action over their use of systemic means to reduce, deny and withhold legitimate payments due to physicians and patients for medical services. All other attempts at health reform will fail unless and until there is fundamental insurance reform. The major private health insurance firms are playing into the hands of those who seek a universal, government run payment system. The only way to salvage a robust, vital, private health insurance market is with major reform in the behavior of the insurance industry. Health care costs are not costs which should be viewed as a burden, which is too often the case. They are a necessity which should be viewed as an investment in our nation, since all health care is by definition local. Health insurance reform’s time has come . . . obi jo
AMA, several medical groups sue Aetna and Cigna over out-of-network reimbursements.
The American Medical Association and several state associations have filed lawsuits against Aetna Health Inc. and Cigna Corp., alleging the insurers used ‘a corrupt system’ to underpay physicians and patients. The associations claim that Aetna and Cigna used a UnitedHealth Group Inc. subsidiary’s database rigged to cheat doctors and patients for out-of-network medical expenses. Last month, UnitedHealth agreed…to pay $400 million to settle allegations it underpaid doctors and patients for 15 years by using” the database, which “minimized payments for services by doctors outside insurance company networks.” In a related settlement with New York State, Aetna agreed to pay $20 million . . . read more at at these sites . . .
Aetna, Cigna Cheated on Payments, Doctors Say in Suit – READ @ http://www.bloomberg.com/apps/news?pid=20601103&sid=aQB7LldrUbyU&refer=us
AMA, others suing Aetna, Cigna over payments – READ @ http://www.google.com/hostednews/ap/article/ALeqM5iFJamegsgw0B62EY3mBwq38eunPwD968R95O0
Legal Woes For Cigna, Aetna: Health insurers are accused by AMA of rigging their reimbursement systems – READ @ http://www.forbes.com/2009/02/10/ama-aetna-cigna-markets-equity-0210_lawsuit_18.html
Medical Groups Sue, Say Aetna, CIGNA Shortchanged Doctors - READ @ http://www.courant.com/business/hc-medsuit0211.artfeb11,0,526654.story
AMA, others join lawsuits against Aetna, Cigna – READ @ http://www.healthcareitnews.com/news/ama-others-join-lawsuits-against-aetna-cigna
AMA Sues Aetna and Cigna Over Out-of-Network Reimbursements - READ @ http://blogs.wsj.com/health/2009/02/10/ama-sues-aetna-and-cigna-over-out-of-network-reimbursements/
Anthem Blue Cross pays $1 million fine for dropping sick subscribers February 11, 2009
Posted by Obi Jo in health insurance, pre existing conditions.Tags: health insurance, health insurance access, health Insurance exclusions, health insurance reform, insurance access, insurance benefits, Insurance Profits, medical care access, pre existing conditions, underinsured
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Once again, a case of health insurers not being in the health insurance business, but the investment and premium arbitrage business. What better way to increase profits than to drop sick patients, who use services. This site again calls for REAL HEALTH REFORM which MUST begin with REAL HEALTH INSURANCE REFORM. We do not need Federal Commissions and centralized data mining to determine how to save money and extend coverage. Real reform of health insurance will do most of that for us without the interference of another bloated, wasteful, detached Federal bureaucracy. No one should be denied coverage because of pre-existing conditions or dropped from coverage because they are ill and use services. These practices must end . . . obi jo
Anthem Blue Cross agrees to take back clients, pay $1-million fine
Anthem Blue Cross, the state’s largest for-profit health insurer, has agreed to pay a $1-million fine and offer new coverage — no questions asked — to 2,330 people it dropped after they submitted bills for expensive medical care.
As part of a deal that the California Department of Insurance is set to announce today, Anthem also will offer to reimburse those people for medical expenses that they paid out of pocket after they were dropped. The company, a subsidiary of Indianapolis-based WellPoint Inc., estimated that those reimbursements could reach $14 million . . .
read more @ http://www.latimes.com/features/health/la-fi-bluecross11-2009feb11,0,4156502.story?track=rss
“Stealth” health measures under guise of information techology fix February 11, 2009
Posted by Obi Jo in health reform.Tags: Congress, health information technology, medical care access, medical treatments, physician behavior, physician profiling, physician tracking
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The stimulus plan as been debated ad nauseum but yet many of the details are unknown, unpublicized and little discussed. This is one that is most important. While it is true, that modern data systems are important to the future of medicine, and this site has voiced strong support of information technology integration into the medical system, it is also true that fully Federalized and centralized data collection can be misused. The most disturbing facets of this are as outlined in the article from Bloomberg below. A counter argument from AARP misses the point – the approach being outlined in this bill is similar to programs established by the NHS in England which essentially are designed to ration care. We can be thankful that socialized medicine affecinado Mr. Daschle has driven off into the sunset with his limo and driver. Nevertheless, we must guard against this potentially evil – and that is the word I mean – usurpation of individual rights and professional autonomy in the care of the sick. Afterall, physicians have been at this officially for over 2,500 years. The US government, not so long . . . jomaxx
Ruin Your Health With the Obama Stimulus Plan
Republican Senators are questioning whether President Barack Obama’s stimulus bill contains the right mix of tax breaks and cash infusions to jump-start the economy. Tragically, no one from either party is objecting to the health provisions slipped in without discussion. These provisions reflect the handiwork of Tom Daschle, until recently the nominee to head the Health and Human Services Department. Senators should read these provisions and vote against them because they are dangerous to your health. (Page numbers refer to H.R. 1 EH, pdf version).
The bill’s health rules will affect “every individual in the United States” (445, 454, 479). Your medical treatments will be tracked electronically by a federal system. Having electronic medical records at your fingertips, easily transferred to a hospital, is beneficial. It will help avoid duplicate tests and errors.
But the bill goes further. One new bureaucracy, the National Coordinator of Health Information Technology, will monitor treatments to make sure your doctor is doing what the federal government deems appropriate and cost effective. The goal is to reduce costs and “guide” your doctor’s decisions (442, 446). These provisions in the stimulus bill are virtually identical to what Daschle prescribed in his 2008 book, “Critical: What We Can Do About the Health-Care Crisis.” According to Daschle, doctors have to give up autonomy and “learn to operate less like solo practitioners.”
read more @
http://www.bloomberg.com/apps/news?pid=newsarchive&sid=aLzfDxfbwhzs
http://www.aarp.org/aarp/presscenter/pressrelease/articles/Health_Research_Investment.html
