Interestingly, the amendment wording does not make any attempt to reverse the provisions in the PPACA that require health insurance carriers to accept all applicants as of 2014.

If I understand it correctly, the backers of the Right to Health Care Choice Initiative want a health insurance system that would require health insurance carriers to accept everyone who applies (since they seem to have no problem with that part of the PPACA), but with no requirement that people purchase health insurance.  While I can understand the desire to be free from government regulations that direct how we conduct our lives, this particular freedom only works if the health insurance carriers can be free to determine which applicants they will accept and which they won’t (the way our system currently operates).

Most people I’ve talked to can see the problem we would have if we were to remove the guaranteed issue aspect of health care reform but keep the mandate portion (ie, require everyone to purchase health insurance but still allow health insurance carriers to underwrite based on medical history).  For some reason, the opposite scenario doesn’t seem as far-fetched to a lot of people.  But in reality, it just wouldn’t work.  I cannot see any conceivable way that health insurance premiums wouldn’t dramatically increase if all individual policies had to be guaranteed issue but people could come and go as they pleased from the health insurance system.

Regardless of whether amendment 63 passes or not this fall, federal law still overrules state law and Colorado will have to go along with the provisions of the PPACA unless there are changes to the law on a federal level.  But it will be interesting to see what the people of Colorado think about this issue.

The text of the bill is relatively clear on some of the specifics:   It states that all group and individual health insurance policies…

“…shall insure against the expense of normal pregnancy and childbirth or provide coverage for maternity care therefor and provide coverage for contraception in the same manner as any other sickness, injury, disease, or condition is otherwise covered under the policy or contract.”

I would take that to mean that the policy out-of-pocket costs in terms of deductible, coinsurance, hospital and doctor copays, etc. would have to be met by the patient, and the rest of the costs would be covered by the insurance carrier.

The bill also states that individual policies (but not group policies) are still allowed to exclude pregnancy as a pre-existing condition:

“Individual sickness and accident insurance policies or contracts may exclude coverage for pregnancy and delivery expenses on the grounds that pregnancy was a preexisting condition.  The exclusion for the pregnancy as a preexisting condition under the policy or contract shall not apply for any subsequent pregnancies.”

But does that mean that the insurance carriers have to accept pregnant women and just exclude the pregnancy and delivery from the coverage?  Currently, no individual health insurance carrier in Colorado (or most other states) will accept any expectant parent (mother or father) at all until after the baby is born.  The pregnancy is considered a pre-existing condition, and because new babies can be added to either parent’s existing policy in the month following birth with no underwriting, health insurance carriers have all opted to deem pregnancy as an automatic decline.  As of 2014, this will no longer be the case, but I have heard nothing indicating that there will be any changes to the universal underwriting guideline that states that an expectant parent cannot get a new individual health insurance policy.

In terms of what policies will be affected, the bill states that the new requirements wills apply to policies “issued or renewed on or after the effective date of this act.”  (January 1, 2011).  My interpretation of that would be that new policies issued beginning January 1, 2011 will include maternity coverage, and that as existing policies renew throughout the year, maternity will be added to them.  So for example, the policy that Jay and I have for our family renews each year on November 1.  So I would assume that for the first 10 months of 2011 we will continue to not have maternity coverage, but then as of our renewal date in 2011, maternity will be added to our plan.

Of course my guesses in terms of how this will all work are just that – guesses.  And I have not been able to find anyone who has more concrete details at this point.  We still have several months left in 2009 for regulators and insurance companies to work out the details, and I’m sure we’ll know more by the end of the year.  When you combine this with the new Colorado law banning gender rating on health insurance policies, and the myriad of reforms coming from the federal government, I’d say that health insurance regulators in Denver are going to have their hands full for a while.

I’ve arranged the cavalcade roughly by topic, but I wanted to start off with an article from Jon Coppelman of Workers Comp Insider.  It’s the story of flight data recorders, invented by David Warren, who lost his own father in a plane crash when he was a child.  Warren never profited financially from his invention, but it’s safe to say that all of us who travel by air are better off because of his work.

Healthcare

The Healthcare Economist, Jason Shafrin, shares some interesting data about healthcare utilization in conjunction with Medicare Part D.  Not surprisingly, the availability of Part D has resulted in an increased demand for prescription drugs.  Although that increased utilization is partially offset by a decreased usage of other non-pharmaceutical medical services.  But the most intriguing aspect is that “gaining prescription drug coverage was associated with worsening health.”

Evidence based medicine has had plenty of air time recently, and is often touted as a way to reduce health care costs and improve the quality of care.  But Jaan Sidorov of the Disease Management Care Blog reminds us that succession – the idea that an observable outcome must have been caused by a specific intervention – isn’t always accurate in a system as complex as health care delivery.  There are many factors that have to be accounted for, and it’s difficult to point to any single intervention as the cause of a particular outcome.

Health Business Blog’s David Williams explains a new technology that allows hospitals to create an online patient portal that is linked to the patient’s medical information.  Once the patient signs in, the website generates ads and content based on the patient’s specific medical information, much the way Amazon makes recommendations based on your previous purchases.  As David points out, there is some room for problems here.  Not to mention the increased utilization that could result from specifically targeted pharmaceutical and medical device advertising.

Brian from Business Risk Management tells us about the actuaries who discovered the mistake in Anthem Blue Cross Blue Shield’s initial CA rate increase request, and how correcting the problem lowered the rate increases from an average of 25% to an average of 14%.

InsureBlog’s Bob Vineyard gives us his take on health insurance for children starting this fall:  scarce and expensive.  There is no way that it’s going to be a simple or cheap process for all children to gain access to guaranteed issue health insurance (especially in the absence of any mandate requiring all children to have coverage).  There has been confusion around this part of the law for months, and it’s reasonable to assume that other states will follow suit in terms of setting up new plans for children or ceasing to offer child-only coverage for the time being.

The Notwithstanding Blog addresses President Obama’s alleged hostility towards consumer directed health plans.  It’s true that consumers tend to want the latest and greatest in health care, which leads to over-utilization.  We here at the Colorado Health Insurance Insider are big fans of HSA qualified policies and consumer directed health care in general, but we recognize that it has it’s limitations.

Offshore Drilling And Risk Management

Claire from the Insurance Industry Blog discusses the potential for litigation surrounding the health of workers who are involved in the Deepwater rig disaster clean-up efforts.  If we recall the health problems that arose for rescuers and demolition crews after 9/11, it makes sense that something similar could happen this time too.  Hopefully all possible precautions will be taken to protect the thousands of people who are working to save the Gulf.

In keeping with the oil rig theme, and with a fascinating discussion of managing unthinkable risk , we have an article from Actuary Info called “the LORD and Risk Management”.  Check it out.  I know you’re curious.

Life And Long Term Care Insurance

Miranda from Budget Life reminds us that funeral costs can be a burden on loved ones when you die, and that they are one more reason to have at least some life insurance in place, or a reserve of funds to pay for the funeral.  She also gives us a look at some of the most expensive funeral options out there… want to be made into a diamond?  For 25 grand, you can do just that.

Free Money Finance explains four scenarios that increase the chances you’ll eventually need long term care (and thus long term care insurance unless you’ve got some other way of paying the often very steep bill that can go along with long term care).

Liability, Auto, And Business Risk Management

If you’re an uninsured motorist in the UK, you better get some insurance soon.  Car Insurance Blogger tells us about a new system in the UK that is linking the Motor Insurance Database with the Driver and Vehicle Licensing Agency, automatic plate recognition systems, and police national computers to track down uninsured motorists.  I wonder how feasible such a system would be here?  Probably a bit more complex, given that we have 50 states, all with their own laws concerning auto insurance, and their own licensing system.

Attorney Nina Kallen takes her daughter’s camp to task for not having liability insurance.  It sounds like the camp is covering it’s legal bases by having the parents sign a waiver releasing the camp from liability if something happens to one of the kids, but I’d say that Nina’s right in this situation… liability insurance is a good idea.

Being in the health insurance industry, we tend to think of pre-existing conditions in terms of medical issues.  But an article by Tred R. Eyerly about a flawed construction project illustrates how pre-existing conditions can cause nasty litigation between P&C carriers as well.

Nancy Germond writes about the various insurance policies that you may need if you’re starting a new business.  The example she uses is a roofing business, but a thorough discussion with an experienced insurance agent is a must when starting any kind of business.

Risk Management In Investing

Should you buy gold as a means of diversifying your assets?  The Silicon Valley Blogger explains how adding gold to your portfolio can be helpful as a risk management tool, and also provides several avenues people can use to buy gold.

Ritter and the other three governors have asked a federal judge to consider their arguments in favor of upholding Obama’s Patient Protection And Affordable Care Act, despite the fact that their Attorneys General have filed a lawsuit to block one of the most important changes included in the new law.  The mandate is a viable way to make guaranteed-issue health insurance an affordable possibility.  There are other options that could be worked into the system via the tax code, but one way or another, we have to have everyone paying into the health insurance system in order to be able to provide guaranteed issue health insurance to everyone, regardless of pre-existing conditions.

The Attorneys General who are trying to block the mandate are arguing that it’s unconstitutional to require people to purchase a product against their will.  But by that argument, isn’t is unconstitutional to require private health insurance companies to accept all applicants, regardless of medical history?  The provision in the new law that would make pre-existing conditions a non-issue is overwhelmingly popular, and yet the provision requiring everyone to have health insurance isn’t nearly as popular.  But we can’t really have one without the other.

HDHP Minimum Deductible
You must still have coverage under an HSA-qualified “high deductible health insurance plan” (HDHP) to open and contribute to an HSA. Federal law still requires that in 2011 the health insurance deductible be at least:
Single          $1,200
Family         $2,400

HSA Contribution Amounts
Single          $3,050
Family         $6,150
Catch-up      $1,000

Maximum out-of-pocket amounts
Single          $5,950
Family         $11,900

How To Cope With Pain brings us a truly amazing video.  It’s a reminder to be thankful for all that we have, and for the things in life (like this video) that inspire us.  It’s well worth the five minutes it takes to watch it.

Amy Tenderich of Diabetes Mine shares a “would you rather…?” moment from her 9-year old daughter.  It’s a poignant reminder, seen through the eyes of a child, that all of the parts of our lives – even the bad parts – combine to make us who we are.

Kerri Sparling, of Six Until Me, has a very moving story about her pregnancy and how the online diabetes community has helped her along the way.  Kerri has put an immense amount of effort into getting her body ready for a baby, and it’s wonderful to know that things are going well for her and her husband as they expand their family.

The Hippocratic Oaf gives us some glimpses of life as a medical student, detailing interactions with patients and highlighting incidents that remind him to be grateful for his own life and health.

The rest of the articles cover a wide range of subjects, from the perspectives of patients, doctors, nurses, and policy makers.  Read on…

Dr. Val Jones, writing at Get Better Health, has written a very insightful article about how medical malpractice insurance premiums make it nearly impossible for primary care doctors to practice part time.  The premiums aren’t affordable unless the doctor is a specialist, or a full-time PCP.  She points out that our PCP shortage could be remedied by adding more part-time docs.  But in order to do that, malpractice premiums have to become more reasonable.  And in order for that to happen, we need tort reform.  Hopefully the lawmakers are listening.  Maybe if they’re trying to find a PCP in Washington DC they’ll notice the problem Dr. Val describes.

Health Business Blog’s David Williams brings us an interview he did with Dr. Henry Anaya of the VA, a research scientist working with HIV.  Dr. Anaya describes new rules at the VA that require less paperwork in order to give consent for an HIV test, and the benefits of a rapid result HIV test that is done with a swab instead of a needle, with results in 20 minutes.

Dr Rich, writing at The Covert Rationing Blog, gives us a very colorful depiction of the migration of cardiologists to other specialties.  It conjures up images of marauding Huns and defeated Roman Empires.  But in addition to the Western Civilization lesson, it brings up several good points about the territorial nature of specialists, the Medicare reimbursement cuts for certain cardiology procedures, and the options that are available for doctors seeking to replace lost income once the Medicare cuts take effect.

Lauren, from Novel Patient, describes her recent visit to a Sjogren’s specialist.  Instead of getting the answers she was looking for, she is now on a quest for a new diagnosis, as the specialist thinks there is an underlying condition.  While she’s in the midst of such a frustrating situation, Lauren manages to keep a positive outlook.  We wish you well Lauren, and hopefully the visit to Johns Hopkins will provide some answers.

Barb Olson, of Florence Dot Com, writes a very interesting article about a survey of 1000 non-profit hospital board chairs regarding the quality of care that their hospitals delivered.  Only 1% rated the quality of care at their hospitals as worse or much worse than a typical hospital.  But as Nurse Olson points out, it’s typical for people to overestimate their own positive attributes when self-evaluating (the Lake Wobegon Effect).  And in addition, the hospital board chairs generally weren’t well trained on quality measures, so it’s hard to expect them to have a clear understanding of what constitutes quality of care.  Good food for thought for people who are responsible for improving quality of care standards at our nation’s hospitals.

Clinical Cases and Images Blog has an article about a study showing that for married couples, having children has a positive impact on life satisfaction – and that the level of satisfaction increases with the number of children.  I know that our son has added a great deal of happiness to our lives, but I don’t think I’ll test this theory by having a dozen children!

Laika Spoetnik of Laika’s MedLibLog is making it easy for people to combine social networking with an interest in science and medicine.  She’s created Twitter lists pertaining to biomedical journals, medical journals, and scientific journals – making it easy for a person interested in one or all of those subjects to find up-to-the minute articles and commentary.

Dr. Jolie Bookspan, the Fitness Fixer, brings us a detailed post about how to look upward without placing strain on our necks.  I like the part about how our necks are not Pez dispensers – good visual image.  The article is a good reminder that we need to use proper form in all of our daily activities, not just while we’re at the gym.

Nancy Brown, PhD, of Teen Health 411, brings us some insight into what teens want when it comes to their relationships with their parents.  If we think back to our own teen years, I imagine we can all relate.

InsideSurgery has written about Dr. Nidal Hasan, the Fort Hood shooter.  The article delves into the responsibility that doctors have for their patients, and the moral obligation they have to seek help for themselves if they feel that they are being overwhelmed by their responsibilities.  In addition, the article address the fact that physicians who get their training paid for by the military have to expect that during their required years of service to the military, there may be a war, and they may be deployed.  Especially during times of peace, this is food for thought for anyone who would consider having the military pay for their training in return for military service.

Healthline’s Dr. Paul Auerback writes about how physicians who receive training in high-tech environments and then go on to work in settings with less technology often feel uncomfortable about their ability to provide quality care to their patients.  Most teaching hospitals are more technologically advanced then the average small town hospital or clinic where the doctor might end up working, so it might be advisable for the teaching hospitals to incorporate some low-tech training for their students, in order to better prepare them for situations where they might need to improvise in order to help a patient.

InsureBlog’s Hank Stern brings us a very interesting article about a British hospital that will no longer admit expectant mothers with a BMI of more than 34 (210 pounds for a 5’6″ woman).  The hospital’s labor and delivery unit is run by midwives, and not high-tech.  Because they have patients who want to delivery in a low-tech setting (which I can very much understand), they have no plans to make the facility more capable of handling complicated births.  In addition, one has to assume that there would be significant expense involved in making the hospital equipped to handle birth complications.  The ban on very obese mothers (the lower edge of obesity is defined as a BMI of 30) has to do with the higher risk of delivery complications associated with obesity.  I can understand the hospital’s position, but it seems that it would make more sense to go on a case-by-case basis, evaluating the mother’s health during her pregnancy to see if complications arise (for thin mothers, as well as obese ones).  If they do, it makes sense to have them deliver at a hospital that is better equipped to handle complicated deliveries.  It seems that this might serve their purpose better than a blanket ban on all mothers with a BMI over 34.

Dr. Catherine Busch of Child Psych explains the impacts of the mental health parity law that was passed last year.  The law takes effect on January 1, 2010, and will apply to group health insurance policies covering more than 50 employees.  Individual and small group plans are not required to comply with the law, and the law does not require policies – even for large groups – to offer mental health services.  If they do offer mental health services, the benefits have to be equal to the coverage offered for any other medical condition, but we might start to see policies discontinuing their mental health benefits all together under the new law.  Time will tell.

Eve Harris, writing at A Healthy Piece Of My Mind, gives us a clip of comedians Larry David and George Lopez discussing the results of an ancestry DNA test.  It’s lighthearted, but does make one wonder about the accuracy of direct-to-consumer DNA testing that claims to be able to scientifically determine our ancestry.

HealthBlawg’s David Harlow gives us an intro to what he calls Son of HIPAA – the new federal regulations that went into effect in September regarding protected health information and how data breaches are to be handled and reported.  As medical data is increasingly stored and transmitted electronically, these rules are both necessary and cumbersome, depending on your perspective.  David’s article is a good primer for providers and patients alike.

Allergy Notes explains that IL-33 is a newly-discovered marker of severe asthma.  In a study of people with mild, moderate, and severe asthma, along with non-asthmatic control subjects, those with asthma showed higher levels of IL-33 than those without, and the difference was especially pronounced in cases of severe asthma.

Elyse Nielsen, writing at AntiClue, details the information technology component of opening a new hospital.  One of the aspects that stood out for me was that we should work to eliminate multiple systems that serve the same purpose.  IT is the way of the future in medicine, and much has been said about the ability of technologically advanced systems to save health care dollars.  But this will be especially true if we make sure that our IT systems are as efficient as possible, with no redundancy.

Ryan DuBosar, writing at ACP Hospitalist, tells us about the results of a study that indicates that men with sleep apnea who are treated with nasal positive airway pressure (NPAP) improve their golf handicaps compared with control subjects.  Not surprising, since a better night’s sleep is probably linked to improved performance in nearly every activity.  But promises of a better golf game might make people more likely to be compliant with their treatment.

Laurie Edwards, writing at A Chronic Dose, reminds us all that unsolicited advice is rarely appreciated.  The H1N1 vaccine (along with the seasonal flu shot and pretty much any other vaccine you can think of) is a controversial topic, and it gets people fired up.  But each of us need to make our own decisions, for ourselves and our children, regarding whether to get the shot.  Our health care providers can be expected to weigh in with advice – that’s their job.  But no matter how strongly any of us feel one way or another about the vaccine, it’s not right to give unsolicited advice to other people, especially when we know nothing about their medical history.

Dr. Charles, of The Examining Room, has a very thorough article about Desiree Jennings, the Redskins cheerleader who was supposedly stricken with dystonia following a seasonal flu vaccine in August.  I remember seeing the clip on the news of Desiree, but hadn’t followed the story since then.  Dr. Charles’ article uncovers quite a few details that are worth reading.

ACP Internist’s Ryan DuBosar explains how easy it was for him to get the H1N1 vaccine.   He was able to get it at the county clinic without even standing in line – even though his baby’s pediatrician and his family doctor didn’t have the vaccine available at all.  It does seem to be pretty random in terms of where the vaccine is available and to whom.  In our own family, we have childless adults who have been able to walk right into their doctor’s office and get the shot, along with families with small children who were told they had to continue waiting.

Thanks to everyone who submitted articles for this edition of Grand Rounds.  They were a pleasure to read, and we’re honored to be your hosts this week.  Grand Rounds next week will be hosted by How to Cope with Pain.

Flickr Photo Credits:

• Thanksgiving dinner – CarbonNYC
  
• Leaf – ZedZap
  
• Thanksgiving drive – katmere
  
• Tree – OakleyOriginals
  
• Thanksgiving Turkey- xybermatthew

First, we have an overview of the bill.  Then there’s an article devoted to the public option and insurance exchange.  Next, you can read about how the reforms will impact delivery systems.  And to round things out, there’s an article that details the last minute changes to the bill (like the Stupak amendment).  A big thanks to Professor Jost for making the reform bill so easy to understand.

Now that we all understand what the House of Representatives has been up to lately, I’d like to highlight a few other posts that I particularly enjoyed this week:

Dr. Glenn Laffel, writing at EHR Bloggers, has a very insightful article about how the public option “compromise” that would allow states to opt out is likely to only muddy the waters and create a fragmented “public option” available to people depending on where they live.

Dr. Roy Poses shares a fascinating account of alleged transplant fraud involving liver transplants, Japanese organized crime bosses, and the UCLA medical center.  Transplant lists are the norm for people awaiting new organs in the US, but apparently – for a price – one can jump to the front of the line.  Well worth reading.

Dr. Brad Flansbaum, writing at the Hospitalist Leader, gives us a gem of an article about how health care reform is portrayed in the media, what people – including lawmakers – really understand about the various reform proposals, and the impact of buzz words on popular perception.  I particularly liked his take on comparative effectiveness research, which some have said would put a “government bureaucrat between you and your doctor.”  Dr. Flansbaum’s response is that the “government bureaucrat” is “likely a health services researcher, and someone [he] would look to for guidance even for [his] own family’s health.”

Jaan Sidorov of the Disease Management Care Blog examines a published medical article that reviews the merits of “decrementally cost effective treatments.”  These are treatment options that involve a tradeoff between significant cost savings and a relatively smaller loss of effectiveness.  When it comes to medical treatment, we (especially here in the US) tend to focus on newer and better all the time.  But our medical innovations are often much more expensive than the treatment they are designed to replace.  And sometimes we can have treatment that is nearly as good, for a fraction of the cost.  Jaan says that our failure to bend the cost curve (terminology that Dr. Flansbaum specifically allows to be included in a worthwhile article) means that we’ll need to examine this closely in the not too distant future.

I decided to include two articles from Brad Wright, the voice behind Wright On Health Care.  They were both too good to pass up, and both good enough to land themselves in my editor’s choice section.   First, he gives us a visual breakdown of who the uninsured are, where they live, how healthy they are… demographics in general.  And he comes to the conclusion that the people voicing the strongest opposition to health care reform are part of the same demographic that makes up the largest uninsured sector of the population.  This isn’t a new idea, but the way Brad goes about detailing the evidence is highly compelling.

Brad also brings us his take on the Stupak amendment, which would prohibit health insurance from paying for abortions unless the mother’s life is in danger, or in cases of rape or incest.  He points out that the vast majority of abortions are currently not paid for by health insurance.  I agree with him that this amendment was designed as a wedge to divide people over a hot button issue, rather than as something of substance.

Rounding out the rest of the Health Wonk Review are a variety of good articles organized roughly by topic:

HEALTH INSURANCE:

Anthony Wright gives us an article about the weak employer mandate in the health reform bill, which would only impact large companies, and would only penalize employers by a fraction of the actual cost of providing health insurance if they choose to ignore the mandate.  Anthony points out that throughout the entire health care reform debate, lawmakers have repeatedly said that people can keep their current health insurance if they like it.  More Americans get their health insurance from their employers than any other single source, but that percentage has been declining in recent years as the cost of health insurance continues to climb.  Anthony notes that if employers keep discontinuing health insurance benefits, people might not actually have a choice of keeping their current plan, regardless of whether they like it or not.

Health Access Blog’s Beth Capell brings us a sobering discussion about the ramifications of being an uninsured child.  While it’s relatively rare for a child to die, Beth looked at a study that found that half of the children who died following a hospitalization between 1988 and 2005 were uninsured.  This is far higher than the proportion of uninsured population in the general population, and speaks volumes about the perils of being uninsured.  Beth points out that the Children’s Health Insurance Program (SCHIP) was in effect for the second half of the study, and yet there are still seven million uninsured children in the US (nearly 170,000 of them are here in Colorado).

POLITICS AND HEALTH CARE REFORM:

InsureBlog’s Hank Stern wrote about a recent blogger teleconference with Rep. Joe Wilson, for a glimpse at a right wing Representative’s take on all things health care.

Mad Kane has written a limerick for Fox News and a limerick for Joe Lieberman. I don’t think she’s particularly fond of either of them.

My Wealth Builder has an article about why the government isn’t fit to run our health care system.  I think most of us agree that the income tax system is way too complicated, and that some government programs could be run more efficiently.  But indeed there are plenty of people who believe that Medicare is a good example of a well-run health care system that could be a model for providing care for the rest of the population.

Chris Langston, writing at the John A Hartford Blog, has drafted a “Declaration of Innovation” (modeled on the Declaration of Independence) pertaining to health care.  He’s primarily focused on geriatric care and health care for an aging population, but his words are appropriate for health care in general.

Tinker Ready, of Boston Health News, writes about the relationship between medical academics/doctors and the medical industry (think: “consulting” fees for docs, vacations to exotic destinations sponsored by drug companies, speaking fees for medical professors, etc.).  Part of the health care reform bill includes long-overdue “sunshine provisions” intended to increase transparency when it comes to the relationship between doctors and industry.

INFORMATION TECHNOLOGY:

Healthcare Technology News brings us an article about provisions in the House health care reform bill that would eliminated a lot of the complexity and frustrations that go along with our current (non-electronic) health care reimbursement system.  Real time determination of a patient’s financial responsibility for a service, either before the procedure is scheduled, or at the time of service, would be a huge improvement over our current system of waiting for the bills to arrive with only a sketchy idea of how much they will be.  In general, the adoption of an electronic and standardized health care administration system is a definite positive in the House bill.

David Kibbe, writing at the Health Care Blog, details the importance of a Continuity of Care Record for every patient, ideally in an electronic, easily accessible format.  Allowing doctors and nurses to see at a glance a patient’s health history, allergies, medications, and basic vitals would eliminated the need for redundant testing (a cost-saving plus), and would enhance decision making when it comes to current care.  David points out that while most of our health data is currently being entered into a computer somewhere, it tends to be in disparate systems that aren’t easily compiled into one continuous record for each patient.

Elyse at AntiClue has written an article about the various technologies available to help reduce the incidence of adverse drug effects.

EVERYTHING ELSE:

Dr. Ira Byock, director of palliative medicine at Dartmouth-Hitchcock Medical Center in Lebanon NH, puts a personal face on advance directives in an article that should encourage all of us to add an advance directive to our to-do lists.  As he says, “you don’t have to be dying for these discussions to matter.  You just have to be mortal.”

Workers’ Comp Insider’s Julie Ferguson brings us an article about the largest fine ever levied by OSHA – $87 million in penalties – directed at BP for a refinery explosion four years ago that killed 15 people and injured 170.  Incidentally, the second-largest fine they ever levied was also against BP, related to the same explosion.  BP is contesting the fine, saying that it is an example of big government intruding on private business.  Without knowing anything more about the situation than what I just read in Julie’s article, my bet would be that BP is probably more concerned about profits than they are about the health and safety of their workers.

Susan DeVore, CEO of the Premier Healthcare Alliance, writes about the collaborative efforts of 157 hospitals working together to improve patient outcomes and control costs through a program called QUEST (Quality, Efficiency, Safety, and Transparency).  The hospitals shared data and information with each other, and after a year the hospitals had 14% fewer deaths than expected, and had saved $577 million.  Systems like QUEST, implemented throughout the country, encouraging collaboration and transparency among all hospitals could result in even more impressive results.

But while hospital collaboration can produce better outcomes and save money, we don’t want to take a good thing too far, as hospital mergers are a factor in driving up health care costs.  Ken Terry, writing at BNET explains how costs have grown much faster than usual over the past decade, following a period of unprecedented hospital mergers that resulted in much less competition between hospitals in most metro areas.

Amer at Healthcare Hacks tells us about the FDA’s Emergency Use Authorization for Peramivir, a drug that can be used to treat H1N1 – without the normal extensive trials that drugs must go through in order to be approved.  He also throws in a reminder about hand washing, since prevention is always the best strategy.

While we’re on the topic of H1N1 treatment, Eric Turkewitz has an interesting article about drug wholesalers trying to peddle flu vaccine for eight times the normal price, while also refusing to say where the vaccine originated.

Thanks to everyone who submitted articles; it was a pleasure reading them.

Colorado barely squeaked into the green state designation, with 15.2% of adults eating at least two servings of fruit and three servings of vegetables each day.  That means that 84.8% of our population isn’t eating that much produce.  Our health care costs are soaring; the incidence of obesity and illnesses like diabetes and heart disease continues to climb.  Yes, we need to address the issue of health insurance – everyone needs it, and we must find a way to provide it.  But even with health insurance, the likelihood of achieving life-long good health without consuming fruits and vegetables is slim.

Eating habits become ingrained in childhood, which makes school lunch programs vital to the cause of eating more fruits and vegetables.  In northern Colorado, there are local farmers tackling this issue through farm to school programs, but such programs are still relatively rare.  Among high school students, nine out of ten aren’t meeting the recommendations for fruit and vegetable intake.

The government is actively involved in shaping the diets of the American people through farm subsidies.  In terms of dollar amounts, feed grains are by far the most heavily subsidized crop (this is effectively a subsidy on the price of meat and dairy products, since the grains are used to feed the animals).  This is followed by subsidies on cotton, wheat, and rice, with those four crops receiving more than 80% of all of the agriculture subsidy dollars in the United States.  You won’t find crops like carrots and tomatoes and blueberries on the list.

There are people who advocate personal responsibility as the crux of health care reform, and to some extent I agree with them.  No matter how good our doctors are, and no matter how comprehensive or affordable our health insurance is, we won’t be healthy without a good deal of personal commitment.  But it’s unrealistic to expect people to purchase fruits and vegetables over less expensive grain products.  And as long as we continue to subsidize the grain products, they will continue to be less expensive and more widely available.

Now, an insurance company called GuideOne Mutual actually had a question about “religious denomination.” And it seems that Atheists and Agnostics were charged more.

The Department of Justice sued GuideOne in federal court in Kentucky after receiving complaints about the insurer’s “FaithGuard” policy that offered homebuyers, owners and renters in 19 states special benefits and discounts if they were churchgoers.

I wrote about HB 1224 last month, and have been watching its progress over the last several weeks.  Unlike some of the other health care bills in Colorado right now, I doubt that HB 1224 will have much of an effect on the number of people in Colorado who are uninsured.  It’s true that premiums for younger women would decrease if gender could no longer be considered in setting rates.  And this would likely result in an increase in the number of insured women in Colorado.  But on the other side of the equation, young men would pay higher premiums than they currently do, which would likely mean that fewer of them would purchase health insurance.  For myself and Jay, and all of the other families that include a husband and wife, the net effect will probably be negligable – my premiums will go down, Jay’s will go up, and the total amount we pay each month will remain virtually unchanged.

I can see the point of this legislation – equality and fairness should be sought after whenever possible.  But there’s a stereotype about men and women and health care.  We’ve all heard it: that a man has to be bleeding to death before he’ll go to the doctor, whereas women will go in at the first sign of a sore throat.  Obviously this is an exaggeration of the truth, but there is a grain of truth in it.  As with any stereotype, it doesn’t apply to all members of either group (I’m a woman, but other than preventive care, I have been to the doctor three times in my life – maybe I should petition to get male rates?)  All joking aside, women do tend to seek medical care more often than men.  While I can see the point of the legislation in terms of fairness, it doesn’t seem fair to penalize men by making them pay more for their health insurance even when as a group they seek medical care less often.

I would prefer to see more focus on addressing ways to lower our overall utilization of health care, especially among women.  I’m seeing more news articles lately about health insurance companies looking into reimbursing doctors for email and phone consultations with patients (which I assume would be less expensive than an office visit), and I think this is a good start.  Patient education in terms of which illnesses are self-remitting and which need medical attention would be helpful too.  The ad campaign to convince people that antibiotics don’t work on viral infections like colds and flus is another good start.  Overall, I think that the focus needs to be on reducing health care costs (which requires addressing all aspects of the health care system, from patients and doctors, to pharmaceutical companies and health insurance carriers) rather than redistributing the costs among men and women.