Wednesday, May 27, 2009

Uninsured Driving Healthcare Costs for the Insured

A recent Associated Press article found that the uninsured are adding $1000 to a family's health insurance premium annually and an additional $370 per year for an individual. Families USA which sponsored the study called this additional surcharge a "hidden tax" that is simply growing as more people becoming uninsured.

No one should be surprised about the findings. When people require medical care and are uninsured, they still get medical care. They might not be able to pay the bill. Since the medications, professional services, laboratory, and imaging testing all have costs and are not free, who ends up paying the bill? Those employers and families who purchase health insurance.

Clearly this must stop. We need to require an individual mandate that requires everyone to purchase health insurance to stop this escalating cycle. As Aetna CEO Ron Williams noted:

  • "Our members then say, 'Well, why is health insurance so expensive?'" Williams said in an interview. "And the answer is because you're paying for your own care as well as for the care of some of the uninsured in the community."

Understanding the basics of insurance it is clear why insurers want an individual mandate. Risk of the few must be spread across the entire population. Anything less than that will simply result in cost shifting and increasing premiums resulting with more uninsured. Repeat cycle.

The entire AP article follows:

Study says uninsured are costly for all
By ERICA WERNER, Associated Press Writer Erica Werner, Associated Press Writer – 1 hr 1 min agoWASHINGTON – The average family with health insurance shells out an extra $1,000 a year in premiums to pay for health care for the uninsured, a new report finds.
And the average individual with private coverage pays an extra $370 a year because of the cost-shifting, which happens when someone without medical insurance gets care at an emergency room or elsewhere and then doesn't pay.
The report was being released Thursday by advocacy group Families USA, which said the findings — which it calls a "hidden tax" — support its goal of extending coverage to all the 50 million Americans who are now uninsured. Congress and the Obama administration are working on a plan to do that.
Families USA contracted with independent actuarial consulting firm Milliman Inc. to analyze federal data to produce the findings.
"As more people join the ranks of the uninsured, the hidden health tax is growing," said Ron Pollack, Families USA executive director. "That tax hits America's businesses and insured families hard in the pocketbook, and they therefore have a clear financial stake in expanding health care coverage."
The report found that, in 2008, uninsured people received $116 billion in health care from hospitals, doctors and other providers. The uninsured paid 37 percent of that amount out of their own pockets, and government programs and charities covered another 26 percent.
That left about $43 billion unpaid, and that sum made its way into premiums charged by private insurance companies to businesses and individuals, the report said.
The major government insurance programs — Medicare for the elderly and Medicaid for the poor — are structured in a way that doesn't easily allow payments to insurers to adjust upward. And somebody has to pay.
Ronald A. Williams, chairman and chief executive of Aetna Inc., gave the example of a local community hospital that provides care to someone without insurance who arrives at the emergency room. When it's not paid for, the hospital has to raise its rates to insurance companies, and they pass that on in higher premiums, Williams said.
"Our members then say, 'Well, why is health insurance so expensive?'" Williams said in an interview. "And the answer is because you're paying for your own care as well as for the care of some of the uninsured in the community."
Aetna was not involved in writing or funding the report but Williams planned to appear at a news conference Thursday with Families USA officials to release its findings.
On the Net:

Thursday, May 21, 2009

Regulation Increases Health Insurance Costs. California Cheaper than New York.

I recently tried to help a relative purchase individual health insurance. He is in his 20s and lives in New York City. His current job does not provide health insurance benefits. He is healthy, does not smoke, and unfortunately since he is a college graduate he no longer qualifies for health insurance under his parents plan.

So naturally he asked me for help. What is absolutely shocking is how health insurance premiums very dramatically between the states. Using, I punched in his date of birth, smoking status, and ZIP code. He only had 12 choices of health insurance coverage with the least expensive being offered by Empire Blue Cross and Blue Shield at $151 per month and this is just for and indemnity plan.

A more comprehensive health insurance plan and the least expensive was $310 per month. This was being offered by Atlantis health plan which is a regional health plan, essentially restricted to the people of New York city. Because this insurance plan is so small, unfortunately, there isn't a lot of information externally about the quality of care delivered. The benefits however was that the co-pays were reasonable at $20 and there was no deductible. The down side is there is no prescription drug coverage. For that option it would be an additional $46 per month.

The next option, was offered by Oxford health plans. For a mere $372 per month, my relative could get a PPO plan but would have a $2850 deductible that would need to be met before health insurance kicked in. If there is any blessing in disguise, then it is that this program is attached to health savings account also known as an HSA. This is where people can defer money tax free, invest tax free, and spend tax free on qualified medical expenses.

If my relative moved to San Francisco, his health insurance rates will be far better with better options. Given the same information, he would have 115 choices with the least expensive being offered by Blue Shield of California at $52 per month, PPO plan with a $2900 deductible, 40% coinsurance, and $40 office visits. The next offering was from Aetna at $61 per month, PPO plan with a $5,000 deductible, 30% coinsurance, and $40 office visit. The first plan offers prescription drug coverage for generic medications, but not brand name. The latter covers both with generic medications at $15 and brand-name at $35, and those brand names nonpreferred list must meet a $500 deductible for medications before paying $50 per prescription.

Kaiser Permanente's least expensive offering was at $141 per month for a $1500 deductible, $30 office visit.

Why is this important? Although we live in the same country, and one could argue that the cost of living in San Francisco and in New York City are comparable, health insurance premiums vary wildly. This is most likely due to state regulations. Both New York and New Jersey have some of the most expensive health insurance plans in the nation. What if people in New York could get coverage at rates comparable to those in California? What would that mean to those who are uninsured, as well as reimbursement for doctors, hospitals, drugstores in New York?

What is even more critical to understand is that regulation although some well-intentioned can often increase costs and result in less than desireable outcomes. The huge variation in costs between health insurance and California and New York is more likely due to coverage and benefits insurers must offer in the latter state.

President Obama with his vision of improving the healthcare system, which I completely agree with, and his administration must be very careful on how it approaches that goal. For example, with the recent passage of credit card bill and increased regulation, we can expect fewer people to have access to credit. Don't believe what politicians are saying. Since two thirds of the U. S. economy is based on consumer spending and with tightening of credit due to increased regulation, we can expect that the insatiable appetite for goods and services will fall. Although the economy will ultimately turn around it will never be like it was in the past decade.

Good intentioned regulation may in fact increase healthcare costs. If the government tries to impose benefits and mandate an artificially low price, then we will find ourselves not with a privately run healthcare system but one run by the federal government. That would be a critical mistake.

Thursday, May 14, 2009

2009 National Indie Excellence Award Winner and Finalist!

Pleased to report that my book Stay Healthy, Live Longer, Spend Wisely - Making Intelligent Choices in America's Healthcare System recently was awarded

WINNER - 2009 in the Health category
FINALIST - 2009 in the Medical category

These awards follow the 2008 Next Generation Indie Book Award

WINNER - 2008 in the Health and Wellness category

As well as awards from the Northern California Publishers and Authors in 2007

WINNER - 2007 in the Best Nonfiction How-To Book, Best Interior Text Layout

Why so many awards? Simple. Partially luck. More importantly, healthcare is an area of much bewilderment and confusion for most individuals except for insiders like myself, doctors. If you don't have a doctor in the family, who do you turn to?

From one of the nation's most respected doctors and experts on patient safety and improving quality, Dr. Robert Wachter, Author of Internal Bleeding: The Truth Behind America's Terrifying Epidemic of Medical Mistakes. Professor and Associate Chairman, Dept. of Medicine, University of California, San Francisco notes that:

“Our health care system is becoming increasingly complex and confusing. More than ever, staying and getting well requires that patients be informed about their care. This thoughtful and engaging book is all you need to get the right care – reading it is like having a doctor in the family.”

As much as I appreciate the awards, what is more important is that I hope to empower you to take charge of your health, because no one else will be more interested or vested in having the best care except for yourself.

Wednesday, May 13, 2009

Medicare Won't Cover Virtual Colonoscopy - the Right Decision

In a clear blow to CT device manufacturers like General Electric, the Centers for Medicare and Medicaid Services (CMS) has decided not to cover virtual colonoscopy, which is a non-invasive way of screening for colon cancer.

It's the right decision. Although virtual colonoscopy was recommended by the American Cancer Society (ACS) as a reasonable alternative to the more invasive flexible sigmoidoscopy and colonoscopy, the issue with virtual colonoscopy is radiation exposure when other ways of screening already exist. Certainly from the perspective of ACS, which is an organization focused on increasing cancer screening and awareness, I understand the reason for adding virtual colonoscopy as an option.

But in the reality of the healthcare crisis and the goal of President Obama to make healthcare more affordable for all, decisions like this are inevitable where someone won't be happy with the outcome, in this case CT device manufacturers. With the announcement earlier this week that hospitals, insurers, doctors, device manufacturers will decrease the rate of health care expenses by 1.5% per year over the next decade, tough decisions will be made. Private insurers often follow CMS decisions, so don't expect to have virtual colonoscopy covered by your insurance company to screen for colon cancer.

The funny thing is this decision by CMS will be one of the easier decisions to make because other, although less comfortable procedures exist to screen for colon cancer. (Note that the preparation for all three procedures is the same. One needs to take a laxative to clear the colon of stool so that colon polyps can be visualized).

The other is that CMS will be using guidelines from the US Preventive Services Task Force in basing decisions. USPSTF bases recommendations on scientific evidence and tends to be the most conservative of any organization, like the American Heart Association, American Cancer Society, and various physician organizations.

CMS left the door open for reconsideration of virtual colonoscopy in the future, which is reasonable. Certainly the technology may evolve where radiation exposure is minimal to justify exposing people of average risk to a modality that potentially could increase other forms of cancer.

Review my March entry - Virtual Colonoscopy - Just Say No.

The entire article from the Associated Press follows:

Tue May 12, 10:18 pm ET
WASHINGTON – Medicare won't pay for the so-called virtual colonoscopy procedure, concluding Tuesday that there's inadequate evidence to support the cheaper, less intrusive alternative to the dreaded colonoscopy.
Some experts had hoped that popularizing the X-ray procedure would boost screening for colon cancer, the country's second leading cancer killer. Screening to spot early cancer or precancerous growths has resulted in fewer deaths over the last two decades.
But in a decision posted on its Web site, the Centers for Medicare and Medicaid Services said that the test does not qualify for Medicare coverage. The memo noted that the procedure is performed on people without symptoms and cannot, in itself, rid a patient of precancerous growths, like a regular colonoscopy can.
Medicare does cover regular colonoscopies, in which a long, thin tube equipped with a small video camera is snaked through the large intestine to view the lining. Any growth can be removed during the procedure.
CT colonography, also known as virtual colonoscopy, is a super X-ray of the colon that is quicker, cheaper and easier on the patient, but involves radiation. Both procedures involve preparation to clean out the bowels.
The Medicare memo notes that the virtual colonoscopy has shown better precision in detecting larger polyps than smaller ones.
There's been some division of opinion in the medical community over the virtual colonoscopy. Some doctors question its utility since, if a polyp is found, a regular colonoscopy would typically have to follow, anyway.
Others support it, saying it can result in early cancer detection. The American Cancer Society recommends it as an alternative to a regular colonoscopy.
A concern for Medicare officials, according to their decision Tuesday, was the effectiveness of the procedure for the Medicare population — people 65 and older — as opposed to younger patients. More data is needed to answer that, Medicare said.
The U.S. Preventive Services Task Force opted last fall not to give its stamp of approval to the virtual colonoscopy, citing the risk of radiation among other factors. Medicare said it took that decision into account in reaching Tuesday's determination, which is final.
Some private insurers cover the virtual procedure but others don't. Colonoscopies cost up to $3,000 while the X-ray test costs $300 to $800.

Wednesday, May 6, 2009

Hydroxycut Dietary Supplement Not Safe? FDA Warning

You may have seen the ads for Hydroxycut dietary supplement touted to help you lose weight. Just the other day, the Food and Drug Administration (FDA) warned consumers to stop taking the product immediately.

Liver injury and one death occurred at dosages recommended by the manufacturer.

The manufacturer has agreed to recall many of its products.

A different question is are dietary supplements safe? It depends. What perhaps is more concerning is how little legal authority FDA has in regulating herbal or dietary supplements. From their website:

How Are Supplements Regulated?

You should know the following if you are considering using a dietary supplement.

* Federal law requires that every dietary supplement be labeled as such, either with the term "dietary supplement" or with a term that substitutes a description of the product's dietary ingredient(s) for the word "dietary" (e.g., "herbal supplement" or "calcium supplement").
* Federal law does not require dietary supplements to be proven safe to FDA's satisfaction before they are marketed.
* For most claims made in the labeling of dietary supplements, the law does not require the manufacturer or seller to prove to FDA's satisfaction that the claim is accurate or truthful before it appears on the product.
* In general, FDA's role with a dietary supplement product begins after the product enters the marketplace. That is usually the agency's first opportunity to take action against a product that presents a significant or unreasonable risk of illness or injury, or that is otherwise adulterated or misbranded.
* Dietary supplement advertising, including ads broadcast on radio and television, falls under the jurisdiction of the Federal Trade Commission.
* Once a dietary supplement is on the market, FDA has certain safety monitoring responsibilities. These include monitoring mandatory reporting of serious adverse events by dietary supplement firms and voluntary adverse event reporting by consumers and health care professionals. As its resources permit, FDA also reviews product labels and other product information, such as package inserts, accompanying literature, and Internet promotion.
* Dietary supplement firms must report to FDA any serious adverse events that are reported to them by consumers or health care professionals.
* Dietary supplement manufacturers do not have to get the agency's approval before producing or selling these products.
* It is not legal to market a dietary supplement product as a treatment or cure for a specific disease, or to alleviate the symptoms of a disease.
* There are limitations to FDA oversight of claims in dietary supplement labeling. For example, FDA reviews substantiation for claims as resources permit.

Troubling, isn't it?

FDA has valuable information about dietary supplements that everyone should find helpful. Like many things if it sounds too good to be true, it is!


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