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Last Updated:
Health Care
“As goes GM, so goes
Look around any parking lot and it becomes apparent why GM is in trouble. Most of the cars are not American made and many of the American brands are SUVs, now passé. Within the last few days GM announced that it was canceling the health insurance coverage for retired non-union workers age 65 and over (a couple of years ago GM froze its contribution toward the under 65 retirees health benefits so that in a few years the premium will equal nearly one-third of the average retirees pension). That is reprehensible, pure and simple. The fault lies with the company and the UAW who, for years, failed to adapt to the changing auto market but rather clung to benefits and work practices that were not competitive or sustainable. Now, innocent retires who were promised these benefits, and who theoretically paid for them as part of their total compensation during all the years they worked are on the short end of the stick. Sure, GM is upping their pension by $300 a month, about what it costs for one person to buy Medicare supplemental coverage, but that will not help much as the health insurance premiums rise and the $300 does not.
July 16, 2008
Affordable Is An Illusive Goal (See Below This Article) However, that doesn’t stop politician from making the problem worse as they decry the cost of health care. In
Almost anyone, from children to adults, can benefit from orthotics. Orthotics can alleviate many common foot problems that cause pain and discomfort in otherwise healthy people. An analogy can be made between orthotics and eyeglasses—both devices adjust problems that can impair physical function. In both cases, a physician (e.g., eye doctor or foot care specialist) performs a complete examination and then prescribes the proper amount of correction. There are several common symptoms that may indicate misalignment of the feet. These signs and symptoms include the following · Abnormal shoe wear (e.g., one side of the sole of the shoe wears out faster than the other) · Bunions · Chronic heel (e.g., plantar fasciitis), knee, or low back pain · Flatfeet · Frequent ankle sprains · Gait abnormalities (e.g., feet point inward or excessively outward during walking) · Shin pain (e.g., shin splints) “ In case you have a keen interest in learning more, here you go On a more significant level the House of Representatives has passed a bill requiring more details and substantiation to back up the use of Health Savings Account (HSA). I am no big fan of HSAs at least when they are used to replace more traditional health benefits, but they are certainly better than no insurance and more “affordable” than traditional coverage. In other words, they provide catastrophic coverage for those who can take the risk, or have no alternative coverage. Apparently, our representatives who passed the law allowing HSAs in the first place now see fit to make their use more complicated Imagine what they could to improve national health care.
Excerpt From the Wall Street Journal And you thought the problem was the uninsured in Insured Children Often Lack Associated Press As The findings, from the first comprehensive look at children's health care quality, are particularly troubling because nearly all the 1,536 children in the nationwide study had insurance -- 82% were covered by private insurance. Three-quarters were white, and all lived in or near large or midsized cities. Two experts called the findings "shocking." Others said minority children, those with more-restrictive government insurance, and the millions with no insurance at all certainly fare even worse. They said the results highlight the importance of the debate over the proposed expansion of the State Children's Health Insurance Program, which Congress approved and President Bush vetoed. A vote to override the veto is set for next week. The study, by the Seattle Children's Hospital Research Institute and the nonprofit Rand Corp. research group, concludes that overall, doctors gave children the appropriate outpatient medical care only 47% of the time. "They got an "F'," said Joseph F. Hagan, a "It's sad, but I think it reflects some unpleasant realities about our current health care system or, I might say, non-system," Dr. Hagan said. The compliance rate was even worse than that found in a study of adults: They got only 55% of recommended care…
For more on this article visit the Wall Street Journal Online http://online.wsj.com/article/SB119205030710755042.html
Health Care Management Government Style The following from an AP news item.
I wonder how many insurance companies or even employer self funded plans would set their premiums based on an anticipated reduction in payments to providers and one not yet approved by the governing authority. And, even if successful, I further wonder how providers will make up the 10% reduction in payments if they are made. Well, I actually know and that would be by charging more to everyone who is paying for health care outside of Medicare. I cannot help but also wonder what would be the result if a Medicare type program covered all Americans and the same cut in payments were implemented to “control costs.” Would some providers cease to exist, would provider expenses not be covered, would supplemental plan costs increase and become less affordable? Would there be longer waits for care? Who knows, but one thing is for sure, simply refusing to pay for something does not make the cost disappear. As the story goes, if those payments are not reduced, the shortfall will have to be made up in future years, like after the next election. That simply means that a future increase that would be say, 4% may be 5 or 6%. In the final analysis somebody pays for the care that is provided…just like any insurance company. But not to worry, fixing a two year old accounting error shifts costs from Part B where there is cost sharing to Part A where there is not. Oct 1, 5 Medicare participants to face 3 percent increase in monthly premiums By KEVIN FREKING
WASHINGTON (AP) -- Elderly and disabled people will see their Medicare premiums rise 3.1 percent next year to $96.40 a month - the lowest increase in six years.
The good news is temporary, though. The formula used to calculate the premium assumes that physicians will take a 10 percent cut in their reimbursement rates next year, an unlikely occurrence. If, as expected, Congress acts to offset some of that pay cut or to eliminate it, premiums in future years would go up to reflect the additional expense.
Another factor in the lower-than-usual premium increase was the fixing of an accounting error that otherwise would have added $2.50 to beneficiaries' monthly premiums in 2008.
The Medicare program pays for most of the health care received by about 43 million elderly and disabled people. The program's expenses have soared in recent years as health care costs go up faster than most other segments of the economy and as more people join the program.
Beneficiaries will be most concerned about expenses in two key segments of Medicare First, there is Medicare Part A, which covers inpatient hospital and hospice care as well as short stays in nursing homes. For this program, participants don't pay a monthly premium. However, they do pay a deductible when they have to go to the hospital. That deductible will increase from $992 to $1024 next year.
Second, there is Medicare Part B, which covers services received at a doctor's office and in outpatient settings. The program also pays for medical equipment such as wheelchairs and oxygen tanks. About a quarter of the revenue for this program comes from beneficiaries' monthly premiums. The vast majority of participants will pay the $96.40 premium next year, though wealthier participants will pay more. Officials said an accounting error occurred beginning in May 2005 when Medicare Part B paid for certain hospice benefits that should have been paid for by Medicare A. Fixing that error will give beneficiaries a break on their premiums, but that also will hasten the depletion of the Medicare trust fund. Currently, the trust fund is expected to be depleted in 2019. 10/2/2007 5
Let’s Deal with the Health Care Issue Realistically As a corporate employee benefits professional for nearly forty-six years, I have been dealing with health care benefits for a long time. During that time, I have utilized every possible technique, and various plan designs to control costs and provide value to workers and to the employer. Nothing has worked. We simply do not understand the nature of the problem. For example, I recently heard a speaker at a conference call for national health care so that everyone will have access to “free” health care. Of course, we all know or should know that health care is hardly free under any scenario. There is widespread talk of “affordable” health care, but exactly what is affordable? Workers who do have coverage balk when a co-payment increases to $25 for an office visit that costs $160. What is an affordable premium or total out of pocket costs for a family? And equally interesting, why does an office visit cost $160 (or more)? One fundamental problem with paying for health care in There are some 47 million Americans without health care coverage (not exactly the same as not having access to health care). At the same time, roughly 75 million Americans do not have a retirement program through their work (and generally not saving on their own for retirement). Both Medicare and Social Security are facing financial crisis in the years ahead, which problem do we solve first? What is the role of government and the individual? Making the health care crisis go away is easy in the minds of some; simply establish a government run system covering everyone or mandate that all Americans have coverage. However, covering everyone without dealing with the fundamental problems does little except create a new financial problem to go along with Medicare and Social Security. Mandating that every citizen buy health insurance does not deal with costs, requiring insurers to offer “affordable” policies does not deal with costs and neither do high deductible health plans and health savings accounts currently in favor by many employers. Of course, legislative mandates on coverage that do exist exacerbate the problem. Some talk about competition and allowing workers to shop for the best price, but our system is so convoluted that no one knows what the price really is. Any given doctor may have a different price for each health plan he or she has an agreement with, and yet another price for those without coverage or coverage with a plan not on the doctors list. My daughter recently had a baby and the hospital bill was $30,000, but her coverage was actually billed $7,000. The cost of health care is what drives many to be uninsured, prevents employers from offering coverage and causes more and more cost shifting to workers. Why does health care cost so much and escalate many times general inflation? That requires a complex answer dealing with issues ranging from lifestyles, an aging population, indifference to what health care costs, overuse of technology, the structure of the system including hundreds of thousands of physician entrepreneurs linked to know one, advertising by drug companies, hospitals and others, the structure of malpractice insurance and even the inability for Americans to objectively deal with the cost benefit equation. Merely imposing a national health plan within this environment is a formula for financial disaster or a formula for health care rationing, price controls and the like. The message to Those who call for national health care and focus only on the uninsured are doing all Americans a disservice. Throwing about “affordable” without a common understanding of what that should be is misleading. Ignoring the fundamental realities of health care in What we need to think about A uniform data base for coverage and patient health care information that is accessible by any health care professional to help avoid unnecessary care and tests and to improve overall quality Some level of uniform pricing (no discounts) that forces health care providers to become competitive based on quality and the efficiency of their own operations Quality and other health care information that is accessible to all Americans so that decisions can be based on facts and not the latest TV or radio ad. In other words, cost, quality and coordination. The American people must understand that the lack of universal coverage is not THE crisis in health care; it is a symptom of the real crisis of cost and quality. Surely all Americans must have access to quality and affordable health care, but waiving a magic wand of universal coverage alone will not do that.
October 2, 2007
On September 26, the House of Representatives Ways and Means Committee passed The Paul Wellstone Mental Health and Addiction Equity Act (H.R. 1424) by voice vote, in the process defeating a substitute amendment that would have incorporated language from the Senate-passed Mental Health Parity Act (S. 558). The legislation:
Most people will view the above as a good thing, after all who can argue with providing the needed care to individuals with mental problems. On the other hand this is just one more example of government mandating coverage and leaving employers and employees to pay for it. Such mandates in total (mostly from state legislation) are estimated to add 25% to the cost of health care premiums. So what is better, to mandate all types of coverage and thus make health insurance unaffordable to many employers and individuals or expand basic coverage to the most people possible? What is the purpose of health insurance, to 100% insulate people from any personal responsibility or to protect individuals from unforeseen and catastrophic financial risk – just like all other forms of insurance? There are good reasons to limit mental health benefits (unfortunately). Among them are a high potential for abuse by patients and providers-if someone else is paying why not go talk to someone? Mental health care can mean a lifetime of visits - is a person ever 100% cured from a mental problem? It is very difficult to conduct an independert evalaution of care being provided and thus managing such care is problematic. On the other hand there are very good reasons to assure that people who need care receive care. Now what? Who pays, healthy Americans, the "government", employers? How to we assure adequate, but not unnecessary care? Shifting health care to the government does not change a thing, it merely changes the way we pay for it. How much would you pay for health care? If we use what a typical employer pays, that may be 8% of your pay or more. And, by the way that is more than you pay for Social Security and Medicare via payroll taxes. It is one thing to call for parity, for “free” coverage, for no limitations, for no oversight on medical necessity by the big bad insurance company, but it is quite another to make it “affordable.” Interestingly, while Congress has no trouble mandating coverage for employer groups, not true with Medicare. Here is how Medicare coverage mental health benefits. LIMITATIONS ON REIMBURSEMENT Reimbursement for certain psychiatric services differs from the usual Medicare reimbursement rules. Medicare Part B generally reimburses doctors at 80% of the approved amount; the patient pays the remaining 20% coinsurance amount. When a claim is for mental health services, Medicare makes an initial deduction of 37½ % before paying 80% of the charge. As a result, the Part B reimbursement is, on average, about 50% of the charge. The coinsurance for mental health claims is therefore 50 percent, which is more than for other Part B-covered services (usually 20%). September 27, 2007 2:30 pm
Should You Believe Everything You Hear?
Is all that is true, I have no idea and I bet neither do other people listening to that advertisement? If it were true and doctors knew it to be true and sent their patients to Sloan Kettering as one would expect was their duty, then why would Sloan Kettering have to advertise, you would think they would be turning people away. I also have to ask, that if our health care system is so great as many people think, why don’t hospitals like Sloan Kettering that are doing such wonderful things share that knowledge with other institutions so all Americans can have the best cancer care and better outcomes? If you want to know what needs fixing in the 9/22/2007 2
How Not to Fund Expanded Health Care Reports are that democratic presidential candidates believe they can expand health care for all Americans and fund such coverage in large part by streamlining the bureaucracy that operates Medicare (WSJ 9-21-07). Really? The typical self-funded employer plan spends less than 10% of total costs on administration which naturally leaves 90% resulting from claims incurred by plan participants. Medicare claims to spend less than 4% (but that’s highly debatable when there is an apples to apples comparison of the components of these costs). In any case, let’s assume that a plan’s total costs are $1,000,000 a year and $100,000 of that is for administration. Being generous we are able to eliminate all administrative costs so our plan costs drop to $900,000 a year. But wait, health care costs are rising at, let’s be generous, 8% a year so in less than two years our costs are back over $1,000,000 and rising from there. Then what, and remember, we have not added any new participants in this example. Com'on guys give Americans a little straight talk. Oh, one more minor point, if we can readily streamline Medicare’s bureaucracy and save money why haven’t we done it these last 40 years so that Medicare would be in better shape and seniors would not be paying $100 a month for coverage?
September 21, 2007 7:20 AM
Candidate Whether it is tax credits, stop loss coverage or any other scheme which shifts costs to the government, the cost problem remains. The If the health care problem in the
September 20, 2007 12:00 PM
Consumer Driven? Those who see salvation in consumer driven health care and high deductible plans support the notion that an educated consumer will act as a consumer and make prudent health care decisions. But at the same time such plans find it necessary to entice prudent behavior when it comes to preventive care by removing deductibles and hence the need for a financial decision. One would think that a truly educated consumer would need no such financial relief to make the most obvious prudent decisions about ones health.
How do you define affordable? “My proposal will provide for affordable health care.” Sounds good to me, but what is affordable health care and how will it be achieved? You see, it is quite easy to rail against drug companies and health insurers, but when all is said and done, unaffordable health care is not the result of the profits of drug companies or the administrative overhead of insurance companies and isn’t it a shame that politicians can’t tell Americans the truth. Medicare is government run and supposedly has low administrative costs (some say too low to effectively administer the program) and yet to keep that “affordable” the federal government constantly cuts payments to providers which in turn shift those costs to the private sector. If Medicare is an example of a good health care system why are its costs increasing at unacceptable rates? Well, for the same reasons the entire system is doing so; an aging population, overuse of technology, inefficient delivery systems, financial incentives for providers to provide care, government mandates on coverage, the poor state of health of many Americans and Americans who continue to believe that more of everything means better health care…and guess what, not one of those things is the fault of insurance companies. No, I have no interest whatsoever in any insurance company or drug company, but I do have a great deal of experience in dealing with the health care system, forty-five years worth as a matter of act and I know the root cause of the health care crisis is not to be fixed by any scheme to cover the uninsured. The overwhelming portion of all health insurance premiums is simply the cost of care, not the profit or administrative costs of insurers. Large employers don’t use insurance at all and aggressively negotiate low administrative fees and yet, their claim costs continue to rise a 9% a year or more. Making health care affordable without fixing the system is like trying to stop a leak by turning off a facet without first fixing a broken washer. Finally, before we jump on any bandwagon, we should frame the understanding of “affordable.” Is it $5,000 a year for a family, $10,000 or 1% of income and who pays the difference if the amount selected is not affordable to everyone? The cost of Medicare is about $200 a month for a couple receiving those benefits, but that is only 25% of the actual cost? Is $200 a month out of a Social Security check affordable?
Quality, Cost and Coverage…in that order. The health care crisis is the 47 million or so uninsured Americans. Just ask anyone, especially people in The state of I suppose one way to “solve” this problem is simply to raise the income level so that state subsidies are available to more families and I suspect some people will suggest that. However, isn’t that like continuing to charge on a credit card when you are only able to make the minimum monthly payment? Is that what we mean by affordable health care? Affordable to whom? Just for the record, these insurance rates include many state mandated benefits that drive up the rates even more than basic coverage would require. Worse, there are 164,000 citizens who now have insurance, but their policies do not include the state mandated benefits so they are now considered uninsured for the purposes of the new universal coverage law. The idea that somehow waiving a magic law will make health care affordable is a myth, the premiums reflect the cost of care, and it’s the cost stupid! However, that really does not matter because politicians will react to what Americans think and Americans do not understand the problem. For example: When asked what two issues Americans would most like to hear the presidential candidates talk about, 42% of Republicans and 51% of Democrats said Iraq, but 22% R and 30% D said health care was number two. Ok, that makes sense. When asked what two health care issues they wanted to hear the candidates talk about, 35% R and 37% D said coverage and the uninsured. 34% R and 34% D listed health care costs as number two and down the list quality of care had a 2% interest by both Republicans and Democrats. This section of the survey [1] was open-ended meaning any response could be the answer. When asked to choose from a list of responses to the question, “Which of the following health care issues would you most like to hear the candidates talk about and focus on in any health reform plan they may develop?” 22% R and 38% D checked expanding coverage for the uninsured. 38% R and 28% D checked reducing health care costs while 16% R and 7% D said improving quality of care. I will resist trying to analyze the difference between Republicans and Democrats on this one, but it seems to me that you cannot solve a problem without first addressing the route cause of that problem. If Americans understood the nature of the cost problem and what lies ahead for Of course, Americans do not understand the problem and politicians even if they do understand will respond to these kinds of surveys and focus on expanding coverage in a seriously flawed and unaffordable system. Keep in mind that many candidates are looking to Worrying about coverage, cost and then quality is as dumb as the person trying to lose weight who walks to the ice cream store, has a large hot fudge sundae and then walks home. Walking helps one lose weight, right? Poor quality has the highest long-term cost of all. Cost is driving the uninsured problem (even in My Grandmother’s Hospital Bill – the Real Crisis in Health Care Last Saturday I was enjoying myself perusing my family archives when I came across a hospital bill for my grandmother’s delivery of my uncle in 1932. You are probably thinking who cares, what does this have to do with anything that interests me? . Today the television, Internet and newspapers are full of stories about the “health care crisis” in Based on what you hear and read and what politicians say, you may conclude that the health care crisis is the 47 million (give or take a thousand) Americans without health care coverage…and you would be wrong. Certainly, Americans without health insurance is a serious problem and the problem does add to the cost of health benefits for those of us who have coverage. However, here are a few facts; the 47 million is not a fixed group of people. The average person is without health insurance for six to nine months, some people who could afford coverage simply choose not to buy it, many of the people in the 47 million are children, many have no need for health care during the period for which they are uninsured and having no coverage does not mean you do not receive health care. Still the lack of universal coverage is a major problem. Now, back to that hospital bill from 1932, my grandmother Lillian entered the hospital on October 28 had a baby that night and was discharged on November 8th. Clearly, we have made progress in the length of stay to have a baby. The total hospital bill for that eleven-day stay was $120.10 (paid in cash by the way-no insurance back then) and I suspect my grandfather cared greatly how much that hospital stay cost. If I apply that $120.10 to an inflation calculator available on the Internet I find that in 2006 dollars, the hospital stay would cost $1,538.62. In January 2007, my daughter had a baby, she was in the hospital two nights and the bill was $30,000, well not really, her health insurance actually paid about $7,000. The $30,000 will only be paid (or not) by a person without health insurance. She paid nothing. Nevertheless, two days in 1932 cost $14.00 ($179.36 in 2006 dollars). Why does a bill that should cost $179 cost $7,000 (or $30,000)? Part of the difference is the result of advances in medicine, to new and better technology, but that is not the whole story. In 1961 when I first began working in health benefits an office visit was $5.00, applying general inflation an office visit should cost $32.88 today, but you are lucky if such a visit is $60.00. When you enter the health care system, whether through an office visit or hospital admission, you expect to receive the right amount of care, the appropriate care and the best care possible for your condition. You expect a minimal number of mistakes and you certainly do not expect to have surgery that is unnecessary. In fact, that is a matter of luck and statistically speaking there is a fair chance that your expectations will be unfulfilled. In addition, for the most part you have no way of knowing anything about the quality of the care you receive. Some general information is available on hospitals if you seek it out, but virtually nothing is available about the quality of care rendered by a physician. Your chance of receiving more or less care or different methods of care varies widely simply by where you live. Just because Aunt Millie likes Dr. Jones does not mean he is up on the latest treatment protocols or that he is rendering the best care possible. Did you ever wonder why you see and hear so much advertising by hospitals and drug companies or how a hospital can claim to be the best at this or that or have the best doctors or the latest equipment? Did you ever ask yourself that if those claims are true why what they do best isn’t shared with all hospitals? Is the quality of care you receive dependent on the hospitals advertising budget? Our system of health care…. whoa, let me start over. Our non-system of health care is wasting money, lowering the quality of care and hurting all of us. Our health care non-system is based on hundreds of thousands of individual doctors operating small businesses and hospitals that are in competition with each other and focused on their own survival, not because that is what is best for patients’ or the communities they serve, but because…but because, good question. If I don’t get my own mircooptimumradioscanner I am going to have a tantrum...and if I do, I am going to be sure I darn well use it to pay off the $3,000,000 if cost. There is another one three miles away? That’s their problem! If you are visiting four different doctors do they talk with one another, do they even know whom you are seeing, not unless you tell them? Do they know all the medications you are taking, not unless you tell them? Is there a risk of serious interactions with the medications you are taking? Yes, unless you are lucky enough to go to only one pharmacy or you are in a plan where the pharmacy benefit manager monitors that sort of thing. Why can you do all your banking with one card or online while there is no single system for processing health care claims and information? Why do three doctors sharing one office each have separate billing and recordkeeping system? Why does a doctor’s staff have to worry about the claim process for a score of different health plans, why do health plans have different procedures and reimbursement arrangements? Do you know there is a tool available today and being piloted in New Jersey that allows a doctor to enter your prescription into a hand held device and instantly see all the medications you are taking, display possible interactions, show the cost of the drugs, tell the doctor if generics are available and instantly transmit the new prescription to your pharmacy? Well, there is, but who is going to pay the $700 or so for each device and who is going to assure that the physician takes the time to learn and effectively use the system? What is the incentive for the physician to even bother with the thing? What can you do? We all need to enter the debate and hold our leaders accountable for solving this problem. You need to challenge the claim that solving the health care crisis in American is merely providing universal coverage. In fact, if we “solve” the problem that way, we are going to exacerbate the real problems because we will add more demand to a broken, inefficient system and we may face the same issues that other countries deal with – long delays in care, budget cuts, a slowing of technological advances and various forms of rationing. It will be far easier to provide coverage to all if we have a cost efficient system first. People don’t have coverage, and employers do not provide coverage because it is too expensive, not because it is not available. Health care is a very complex issue with no easy solutions, but there comes a time when you have to act and that time is very close. I wrote an article in 1978 about the cost of health care, about the problems being faced by GM and other employers. I could take every word of that article and publish it today and readers would never know the difference because little has changed. In the early 1990s President Clinton gave a State of the Union speech and held up a sample universal health care card for every American to coordinate claims and health care data and more than fifteen years later nothing has happened. Every president since Richard Nixon has promised to address the health care crisis in Employers cannot remain competitive and continue to deal with health care costs. Individuals will continue to struggle with of out of pocket costs; even governments like New Jersey are stressed under the burden (translate that into the taxes you pay). We need a real solution. If you are concerned about health care costs (and, of course your health), take care of yourself. The best way to control health care costs is to avoid entering the health care system. Control your weight, keep your BMI in the acceptable range, eat healthy, stop smoking and get off your duff and huff and puff (otherwise known as exercise). When you do have a health issue take medication as prescribed by your doctor, follow your doctors instructions, use disease management programs. In short, be involved, ask questions, and ask about alternative less costly treatment options (this is not a suggestion to compromise your care), use generic drugs. When you come to the bottom line, the health care crisis in Stay healthy, stay involved. [1] Here is the latest. As you can see, the emphasis is on coverage and the words affordable are widely used, but it is difficult to make something affordable if the price for the service is beyond your control.
Why We Can't Get It Right I am sitting here watching CNN do a special town hall on the “middle class” not yet defined by the way. One example of the problems facing the middle class is health care. On the show is a family whose child had major medical problems with costs over a $1 million and inadequate health insurance with the result the family filed for bankruptcy. CNN is now asking for donations and a speaker talks about new legislation expanding health for children. Ok, a sad situation, but nobody asks, “Why does health care cost what it does?” Instead, we only ask why we do not have more coverage, which is not the essential problem.
So, what's new? I love to look back and see how smart I was. Hey, how many of us have the luxury of writing something years ago and reading it today and then reflecting on the accuracy of our predictions. I have that luxury. If I go back really far I can see how dumb I can really be, but on the other hand I sometimes find that I actually do have a relevant thought now and then. Here is something I wrote in 2002 over four years ago. It doesn't matter if you are not a corporate benefits person, take a look at this from a personal point and view. Has your employer mentioned "consumer driven health plan?" No, well you probably won't have to wait too long so there is no time like the present to find out what it means to you. HInt, hold on to your wallet. Health benefits, 21st century style Employee Benefit News On-Line benefitnews.com Love it or hate it, you have to take a position on the phenomenon of consumer-driven health care plans Clearly, employers are facing a dilemma. Costs are rising rapidly while employees are enrolled in unmanaged care plans where out-of-pocket expenses are minimal. The only way to hold the line on health care costs is either to increase the portion paid by the employee or to lower the payment to health care providers. But we aren't going to squeeze more from providers -- in fact, providers are squeezing back. And employers are reluctant to shift more costs to employees, at least directly. Enter the new strategy of the 21st century, consumer-driven health care. Whether you agree with consumer-driven health care or not, you can't ignore it. Your CEO and CFO will read about it, and the press will tout its value. The logic seems simple, and perhaps it is deceptively simple. All we have to do is to educate consumers to take a more active role in obtaining health care. Typically, however, employee-consumers are largely unconcerned about costs and want only the flexibility to go to any doctor they choose. No matter that $10 co-payments do not reflect true health care costs. No matter that schools continue to teach physicians professional autonomy, despite the need for coordinated group practices that share information and treatment methodology in hopes of reducing widely divergent practice patterns and medical errors. Some employers are attempting to improve health care consumerism purely through education, others are testing multiple-choice medical plans, and still more are putting strong financial incentives within a new plan design. Regardless of the method, the premise is the same: Employers are betting they can get employees to buy health care as they do a new car or television. In essence, we will expect individuals to buy health care without emotion, knowledgeably assessing value and quality while remaining unaffected by the mystique of the medical profession. Is this a transition from managed care to "manage thyself"? Employers, the federal government and large insurers have failed to change the way health care is delivered, largely because employee-patients rebelled against even the mildest controls intended to improve care. Now we will give each individual a crack at the task. Good luck to us all. If we fail again, the financial crisis will mean the end of health benefit sponsorship at some companies. That's my opinion. What's yours?
What me pay?
I recently spoke with a person on an elevator who was on her way back to work after taking a “smoke break, not that there is really such a thing of course, it’s kind of a made up perk because the company has a no smoking policy anywhere in the building. Therefore, every day and every working hour there are employees gathered about the entrances to the building smoking. In the heat of the summer, in the rain, in the icy days of winter they are there (and being paid while on this break) and probably getting pneumonia between December and March. Back to this lady, I jokingly (sort of) said to her, “You know we are charging more in health insurance premiums next year for people who smoke.” "Really?" she asked. “No not really, but it’s a good idea don’t you think?"I replied avoiding the logical health reasons why a person may not want to fill her lungs with smoke. “You know, I want to stop smoking and I was planning to try, but the patch isn’t covered.” “What do you mean?" I inquired. “Well, you can get it over the counter now so our prescription plan won’t pay for it anymore.” Dum de dum dum, dum. Think about what she said and you will understand why in part it is so hard to solve the health care cost problems in the Another women called me a few years back during the Lyme disease scare and asked why our plan didn’t cover the immunization. She said she lived in an area with many deer and if her children got the disease and died, she would hold me responsible. That is to say, her children’s lives were not worth her paying $60.00 for the immunization, but someone else had better well cough the cash. “Well, you could get the shots anyway,” I suggested somewhat incredulous at her comments. “You expect me to pay for them?" She shouted and hung up the phone. Wow, I bet if someone else didn’t pay for her to have those kids she wouldn’t be worried about the immunization. Doing the right thing for your personal benefit is doing the right thing, does that change depending on who is paying? While they may not say it, for most people the answer is yes. Ummmm, the stories I could tell you and someday I just may.
Means Testing Medicare 2007
The debate over health care in America rages on and many people seek universal coverage under a government run plan. Unfortunately such a program may expand coverage, which is a good thing, but no one talks about how it will control costs. However, that is another story. The big question is who should pay and how much. If there is universal coverage, should everyone with the same coverage pay the same or should the “wealthy, well off and affluent” pay more? And, how do you define the wealthy? Is it the Bill Gates wealthy, the Wall Street executive wealthy or the two-income family earning over $100,000 wealthy? One problem is that politicians or the IRS frequently make that call and in doing so appeal to the average Joe in making their case. There is a general assumption that if you have worked hard made a few bucks, have an income above the average that you are now one of the bad guys, like you rolled out of bed when you were eighteen and puff, you were wealthy. Well for most people it doesn’t work that way, it takes a lifetime of work to:”make it” as they say. Ok, so I know this sounds like sour grapes and yes there is a need for fairness, but the idea of people earning a couple of hundred thousand a year being grouped with the truly wealthy is a bit galling don’t you think? And keep in mind that the higher income folks have been paying more than twice the average in payroll taxes for both Social Security and Medicare during most of their working lives. What will be at the end of the path if we continue to segregate our society and tax the “wealthy” to support the bad decisions of government? Beginning in 2007 Medicare Part B premiums will be means tested. That is if you earn more, you pay more. So, for example, if your total retirement income is $100 to $150 thousand you will pay $130.70 per month for Medicare while those under $80k will pay $98.20. What a person pays in 2007 will be based on his or her adjusted gross income from 2005. Rather then tackle the real problems facing Medicare it is far easier to create the impression that getting more money from a few will help the crisis. It won’t. Even the AARP disagrees with this approach saying it undermines the “everyone in the same boat” nature of Medicare. Logically, we should be charging more to the overweight, out of shape, smokers and others who create costs by not controlling controllable events in their lives. Do you pay more for auto insurance based on your income? In reality, studies show that the higher income folks are lower users of health care services. Others see not only value in means testing but would go even further. According to a story in the Wall Street Journal, August 21, 2006 professor Mark Pauly of the University of Pennsylvania says that under his plan new technology, innovative devices and certain drugs would only be covered for low-income beneficiaries under Medicare. That’s kind of scary stuff. Regardless of your point of view, means testing the affordability of health care is a slippery slope. You have the government defining the means; you run the risk of no indexing on the various income levels with more and more people paying even higher premiums – not like it hasn’t happened before. Most of all, we are deceived into thinking that a relatively few people paying more for Medicare will in any way solve the basic problems facing the program. Is Medicare a welfare program or a broad based insurance program? We need to get that fundamental question right now before we try and tackle universal coverage.
Spending soars as more people join up with diabetes, heart disease, experts say
By Steven Reinberg, HealthDay Reporter
TUESDAY, Aug. 22 (HealthDay News) -- The epidemic of obesity sweeping America is the prime culprit behind recent sharp increases in Medicare spending, researchers report. The reason: Older, heavier people are much more likely to enter the program with pre-existing medical issues, the experts say. "The rise in Medicare spending is largely traced to the doubling of obesity among the elderly and obesity-related conditions like diabetes, high blood pressure, bad cholesterol and so on," said lead author Kenneth E. Thorpe, the Robert W. Woodruff Professor and Chair of the Rollins School of Public Health at Emory University, Atlanta. However, policy makers are not taking the burden of obesity and its related illnesses into account as they look at ways to reduce costs to preserve Medicare, experts say. While increases in the program's cost have been attributed to causes such as medication costs, hospital and doctors fees, 90 percent of the increases can be attributed to people entering the program with diabetes, metabolic syndrome and other diseases associated with obesity, concluded a report published in the Aug. 22 online issue of Health Affairs. For the full story go to http://health.msn.com/centers/highbloodpressure/articlepage.aspx?cp-documentid=100143413
Nail fungus, yeast infection, acid reflux, cramps, hemorrhoids, genital herpes, incontinence, gingivitis, scalp itch, impotence, head lice, and vaginal dryness. Think I’m copying from a medical dictionary? Think again. I learned about all of these ailments from television commercials. Is there no thing sacred any longer? Can’t we simply suffer our little indignities in anonymity? Apparently we cannot. If you add dandruff to the list, the advertising agencies have managed to cover our bodies from top to bottom and stem to stern. Before I was educated by television I thought old men were supposed to have thick yellow toenails, belch and occasionally scratch at their shorts. Now I realize that using one of a number of products I see regularly advertised between the Today Show and the late night news could have prevented all this. Speaking of shorts we have also recently been educated as to the horrors of male itch. I never realized that itching was gender based, but at least now I know there is more to men having their hands between their legs than simply a relaxing glow. I too am concerned about the inaccuracy of pregnancy tests. I mean if a person can’t tell the difference between blue and pink or + and - what are they doing getting pregnant in the first place? One ad seems to indicate that the false readings are the result of the deficiencies of the product, but the words of the ad make it clear that it’s patient errors. I live in fear they are going to demonstrate the proper technique. Now in Did you ever notice that as prescription drugs come off patent there is a dramatic increase in the diseases the over- the -counter successors are intended to treat? I mean did we first discover nail fungus in 1997? Television advertising isn’t limited to over- the -counter drugs either. Drug companies have found that by advertising their more sophisticated prescription drugs they can get patients to ask for a specific drug without even knowing what it is for or what it’s supposed to do. Check out TV and see if I’m right. There are ads for drugs and they say nothing about what they are intended to treat. I can just see an 82-year-old patient insisting that her doctor prescribe Flouamixinze |
Today that appears to be truer than ever. The “economy” of GM is in shambles and it appears that we have talked and worked our way into an equal mess for the 
Listening to the radio this morning I heard an advertisement from 
Here Come the Brilliant Ideas
