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: http://www.familiesusa.org/

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 www.ehealthinsurance.com, 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.

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.

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.

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!

Swine Flu – What You Must Know

Background
Swine flu is a respiratory virus which is caused by influenza A that occurs in pigs. Typically the virus would spread from pig to pig and at times would move from pig to humans, usually due to direct contact with the animals. The virus usually is not able to transmit effectively among people and would not infect beyond three individuals.

Since late March and early April of 2009, a particular strain of swine flu influenza A (H1N1) has been identified first in Texas and Southern California which appears to spread more efficiently among people. The Centers for Disease Control (CDC) is tracking the number of cases in the United States as well as various other health agencies like the World Health Organization (WHO). Although the cases in the US have been mild without any reported deaths at this time, in Mexico, already about 1800 cases have been confirmed with nearly 90 deaths, mostly in young healthy individuals.

It appears to be spreading by the respiratory route, that is from exposure to infected respiratory droplets from coughing and sneezing.

Since the 1918 Spanish flu pandemic which killed millions of individuals, mainly young and healthy, scientists are always concerned that the next flu outbreak is the next big one. It is currently too early to tell. As of now there is no vaccine for the swine flu. There are steps you can take to prevent it.

What You Must Do
Recommendations from the CDC are common sense and apply not only to preventing the flu but also the common cold. These include:

Cover your nose and mouth with a tissue when you cough or sneeze. Throw the tissue in the trash after you use it.
Wash your hands often with soap and water, especially after you cough or sneeze. Alcohol-based hand cleaners are also effective.
Avoid touching your eyes, nose or mouth. Germs spread this way.
Try to avoid close contact with sick people.
If you get sick with influenza, CDC recommends that you stay home from work or school and limit contact with others to keep from infecting them. What is the best way to keep from spreading the virus through coughing or sneezing?

Although it is unlikely that one can find the past year’s influenza vaccine available, getting vaccinated probably won’t help protect against the swine flu.

Ideally, the best prevention is to avoid individuals who are ill. Facemasks may be helpful if needed to care for someone ill. A N95 disposable respirator is a better option than a facemask. More important tips on caring for an ill person from the CDC.

Watch Out for Symptoms
Symptoms of the swine flu are similar to that of the human flu, influenza, which occurs seasonally in the winter.

Sudden onset of high fever, shakes, chills.
Muscle aches
Dry cough
Fatigue
Low back pain

Unlike the common cold where symptoms build up gradually, patients with the flu always seem to remember what they were doing when they were overcome by symptoms. “Doctor, I was fine until about 4pm when all of a sudden I felt muscle aches all over.”

If you have symptoms of the flu, it is important to contact your doctor right away, ideally within 2 days of onset. There are prescription medications that can be helpful, but must be taken within 2 days of symptoms.

Don’t Believe the Myths
You don’t need to worry about eating pork or pork related products. It doesn’t spread by food.

Stay Informed and Educated
Learn more from the ongoing investigation from the CDC.

Generic Lipitor - Not Yet. Other Excellent and Less Pricey Alternatives

On a recent radio ad for LIPITOR, Pfizer's best selling cholesterol lowering medication, the announcer states two interesting points.

• There is no generic LIPITOR.
• Your doctor may ask you to switch to a less pricey alternative, but if everything is working fine with LIPITOR, why would you switch?

Indeed, why would you switch?

For a full court press, at the LIPITOR website, they've dedicated an entire section on questions you should ask your doctor as well as other things you should consider.

Now I'm all in favor of empowering individuals with information, so the wise patient needs to be a wee bit skeptical when a pharmaceutical company appears to be providing "helpful" information that promotes their product.

Let's look at each point objectively.

• LIPITOR is the #1 prescribed branded medication in the world. -- True. Number one doesn't mean it is the best. Note that the recalled VIOXX anti-inflammatory and its related CELEBREX competitor were pulled of the shelves because of research that suggested increased heart attacks compared to other less pricey alternatives, NAPROSYN. CELEXBREX was the number one prescribed anti-inflammatory on the market at the time.

• LIPITOR is FDA-approved to significantly reduce the risk of: Heart attack, Stroke, Certain kinds of heart surgeries, Chest pain. -- True. Other cholesterol lowering medications are also approved for the same indications.

• LIPITOR is one of the most widely studied medicines in the world—with more than 15 years of research.-- True. Incidentially there are other cholesterol lowering medications that have been around for even longer.

• If you switch, you may not get the same cholesterol-lowering results you get with LIPITOR. LIPITOR is proven to lower LDL ("bad" cholesterol)- 76 to 115 points, or 39%-60% (average effect depending on dose). The cholesterol level you've achieved could change. -- True. This part is a little trickier. LIPITOR is one of the most potent cholesterol lowering medications in the family of medications called STATINS. The one that lowers the most at this time is called CRESTOR (and obviously it isn't generic either). But does lower LDL (bad) cholesterol mean better outcomes, that is less likelihood of heart attack and stroke? It depends. The cholesterol lowering medication VYTORIN, which contains two cholesterol lowering medication - ZOCOR and ZETIA, actually lowered LDL cholesterol better than ZOCOR alone, yet the study which looked at how much the carotid artery (neck artery) blockage decreased showed little to no change. So lower doesn't necessarily mean better, even though intuitively we want to believe it to be the case.

Indeed the four questions that Pfizer has you ask your doctor or pharmacist really hinge on the last point.

• No generic LIPITOR. This means, you will pay more until LIPITOR goes generic.
• Is generic ZOCOR proven to lower cholesterol as well as LIPITOR. No, ZOCOR, also known as SIMVASTATIN, isn't as potent. But don't get fooled, the real question is if I reach my LDL (bad) cholesterol goal with ZOCOR or LIPITOR, is one far better than the other in protecting my heart?
• If I switch could the cholesterol level I've achieved change? Yes it can. But better question, is it possible to achieve the same change with a different medication?
• If I switch could my body respond differently? Yes, but is it also possible that it might not?

Pfizer is doing what most pharmaceutical companies do when their product will soon lose its patent and become generic. They are trying to increase loyalty to their brand, even though LIPITOR is the dominant cholesterol lowering medication in the market.

Want reasonable alternatives and analysis that is objective? Consumer Reports has a free drug report which is fantastic. Here's what they say:

Taking the evidence for effectiveness, safety, and cost into account, we have chosen four statins as Consumer Reports Best Buy Drugs:

* Generic lovastatin and pravastatin — if you need to lower "bad" (LDL) cholesterol by less than 30%
* Generic simvastatin (20mg or 40 mg) — if you need 30% or greater LDL reduction and/or have heart disease or diabetes, or if you have had a heart attack or have acute coronary syndrome and your LDL level is not highly elevated.
* Atorvastatin (Lipitor) (40mg or 80mg) — if you have had a heart attack or have acute coronary syndrome and your LDL is highly elevated; use for two years and then reconfirm need or switch to generic simvastatin. Generic pravastatin and simvastatin became available in 2006. The price of these two medicines will decline in 2007, creating a significant savings opportunity compared to brand-name statins.

There you go. This is the nuance that is heart of a candid conversation between you and your doctor. Pfizer wants you to think the LIPITOR is the only cholesterol medication for you. Medicine is never quite that black and white. Smart patients will realize that there is always a deeper story and shouldn't get fooled by 30 second sound bites. Consumer Reports does say LIPITOR is a good choice for certain conditions. Note however they also say that generic SIMVASTATIN is also for patient who has had a heart attack or acute coronary syndrome, just like LIPITOR.

So why is Pfizer pushing now? Well if you check the FDA website on medications and when they lose their patent, LIPITOR 10 mg will no longer have protection in September 2009, this year!

So if it is too expensive to continue with LIPITOR, don't worry that you aren't getting the right care. Do some research by going to the Consumer Reports website. Ask more questions than the spoonfed ones by Pfizer. It is possible that you do need LIPITOR. It is also a very good chance you don't and others will do the job just fine at keeping you healthy and perhaps saving you money so you never have to choose between your health and all of the other important things you need to take care of.