Welcome to Grand Rounds! It’s the third time we’ve hosted Grand Rounds at the Colorado Health Insurance Insider and we’re honored to be hosting again. It was a pleasure to read so many great articles for this edition. Since our blog tends to focus on health care policy and reform, I’m starting things off with the posts that pertain to that topic. Enjoy!
The first of the Baby Boomers turn 65 this year, and health insurance carriers are paying attention. Aetna has agreed to purchase Genworth’s Medicare supplement business for $290 million. Going forward, Aetna expects to post yearly gains from the Medicare supplement (also known as Medigap) business. This makes sense given that the Baby Boomers will be flooding into the Medicare (and Medicare supplement) system over the next two decades. […]
[…] One way or another, we need to seek solutions that will enable Medicare to pay the 10% shortfall that is currently predicted for a decade from now. That can be accomplished by cutting costs, increasing revenues, or both. But we don’t need to start from scratch and overhaul the entire system, especially with the improvements that the PPACA has already created.
[…] If the government can tell the health insurance carriers that no more than 15 – 20% of premium dollars can be spent on administrative expenses, including profits, why can’t similar guidelines be enacted for the pharmaceutical industry? Perhaps then we wouldn’t need to worry as much about who is going to pay the cost of prescription drugs for seniors. And maybe individual health insurance policies could start covering prescriptions with basic copays again.
[…] He tackles the question of whether Medicare beneficiaries have to wait longer than privately insured patients for a routine appointment, and finds that they do not. In fact, it appears that the opposite is true, with more privately insured patients reporting that they had to wait longer than they wanted to get an appointment (although most insureds, regardless of whether they had Medicare or private health insurance, were able to get appointments within the time frame they wanted).[…]
[…] Dr. Perednia makes some excellent points about the inability of patients to be true “consumers”, even in cases where they have their own money on the line. He notes that if you call your doctor’s office to find out the price of a procedure, they won’t be able to tell you because there are too many complexities in the health insurance system for the doctor to give you an accurate idea of what the cost will be. And if you call your health insurance carrier directly […]
[…] But the shortage of doctors who will accept new Medicaid patients could definitely be seen as a significant obstacle to receiving care for people who rely on Medicaid to cover their healthcare costs. It’s likely that there is a long list of reasons why people on Medicaid have poorer health outcomes (and we have to be careful to not mistake correlation with causation). But it’s reasonable to assume that the difficulty Medicaid patients experience in finding a doctor isn’t doing anything to improve their health outcomes.
In a continuation of the string of healthcare-related legislation we’ve seen recently, Colorado Senate Bill 168 was introduced earlier this week. SB 168 would create a nonprofit healthcare cooperative to act as the benefits administrator and payer for health care services in Colorado. Similar to several other healthcare bills we’ve seen over the years, this one would implement change in a multi-step process: first by creating a proposed Colorado Health Care Authority, which would design the cooperative and take it to the legislature and then voters for approval. […]
[…] We seem to be caught up in a wave of screening test excitement lately, with new advanced testing available for every disease under the sun. Rather than focusing on things that can truly prevent health problems (the old, and decidedly low-tech diet and exercise ideas…), we are fixated on developing newer and better screening tests. This exacerbates the problem of over-consumption of health care and rising health care costs.
[…] While these changes might not have been warmly welcomed, they will ultimately help to make the system sustainable in the long term. The same could be said for the rest of the health care industry if similar cuts are implemented in other areas. Although the physician reimbursement cuts are unpopular with most doctors, they may be the only way to keep Medicare as a viable payer for seniors’ health care needs. And ultimately, it’s in the best interest of both doctors and seniors to keep Medicare around.
[…] One of the rumors that has been circulating via email lately proclaims that the PPACA includes a 3.8% tax on all real estate transactions. This is simply not true. […] Most houses do not sell for profits of anywhere near the capital gains threshold. And most families don’t qualify as high income households. So most real estate transactions will not be impacted in any way by the new Medicare tax.
[…] We need to make sure everyone has health insurance (first step in expanding access). We need to make sure there are enough primary care physicians (and other care providers) to go around. And then we need a systematic, coordinated effort between health care providers, hospitals, and health insurance carriers to make sure that everyone is on the same page. Expanding access to primary care is part of the solution, but it will only work in tandem with the other parts.
Earlier this summer, HHS announced that businesses could begin submitting applications to the newly-created Early Retiree Reinsurance Program in order to receive federal funding to help pay for retirees’ health insurance until they become eligible for Medicare. To date, 2000 businesses have been approved for the program, and HHS Secretary Kathleen Sebelius says that this is just the beginning. Businesses have shown great interest in the reinsurance program… […]
[…] Private health insurance companies tend to take some of their cues from Medicare in terms of what they cover, so if Medicare eventually makes home visits more available, it stands to reason that people with private health insurance might also have access to house calls from doctors, even if they can’t afford to pay full price to a non-network provider.
[…] Individual health insurance is a great option for people who are healthy, and especially those who are relatively young… But the price increases with age, and many early retirees find it a challenge to pay for health insurance during the years before they are eligible for Medicare. My guess is that even if private individual policies could be purchased by people over the age of 65, very few people would take that option, simply because of the price.
[…] I feel fortunate to live in a state where we have a solid high risk pool (Cover Colorado) and lots of options for policies in both the individual and group market. But I can’t help but think of people who live in states where there aren’t any health insurance policies available to people who are sick and not covered by an employer’s plan. For them, health care reform on a state level has a long way to go, and might not happen at all.
[…] No insurance company – public or private – can withstand a significant influx of sick insureds without balancing it out by adding additional healthy insureds. That’s why the mandate requiring everyone to purchase health insurance is a necessary part of the reform bills that would require health insurance companies to accept all applicants, regardless of health history.
Ezra Klein recently interviewed George Halvorson, Chairman and CEO of Kaiser Permanente (which operates our largest HMO here in Colorado). Both the questions and answers were insightful and on target in terms of addressing the cost conundrum that is so often glossed-over in the health care reform debate.
Mr. Halvorson pointed out that while many developed countries have some form of private health insurance, they also have medical fee schedules that are set by the government and are far lower than average costs for the same procedures in the US. When average fees for various medical procedures in several countries are shown on graphs, the US bar looks like a giraffe standing in a herd of gazelles.
But Halvorson acknowledged that while fees in other countries are even lower than Medicare reimbursement amounts here in the US, half of hospitals here are losing money, and do so especially when they treat Medicare patients. So it’s not as simple as just saying that we need to create set fee schedules that are more in line with those of other countries […]
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 […]
Welcome to the Health Wonk Review. 2009 has been an exciting year for health care reform, and last Saturday’s passage of HR3962, the Affordable Health Care for America Act, has given us plenty to talk about. For anyone who hasn’t kept up on the details of the House reform bill, I want to start things off with a four-part series from Tim Jost, who holds the Robert L Willett Family Professorship of Law at the Washington and Lee University School of Law. His articles were published at Health Affairs Blog, and amount to an excellent primer, written in plain English, for people who want to understand HR3962, but don’t have time to read all 1990 pages […]
My father has been on dialysis for eight years. He has Wegener’s Granulomatosis, a rare autoimmune disease, and it destroyed his kidneys very suddenly in 2001. His illness came out of the blue, following a lifetime of good health, and has given my parents an up-close look at our health care system. Because he has kidney failure, my father qualified for Medicare. But until the advent of Medicare Part D in January 2006, my parents had to pay for all of his medications out of pocket.
Dialysis does not remove phosphate, so my father has to be on a drug that prevents phosphate from building up in his blood. In 2002, he was on PhosLo, a brand name drug, because the generic wasn’t available. At that time, a three month supply cost $108.25. Now, seven years later, he takes the generic version (calcium acetate) and a three month supply is $528.29 (a 488% increase in price). Humana, his Medicare D carrier, picks up the tab, but we all know that claims […]
[…] There is all sorts of competition and cooperation that already exists between the private and public sector. One way or another, I’m hopeful that we’ll end up with some sort of compromise that results in expanded access to health insurance and health care for more people.
[…] I agree with Mike that we need to be having more of a discussion here in the US about how to better fund long term care. Private insurance policies work well, for the relatively few people who purchase them. But I think more intensive public education is needed in terms of what is and isn’t covered by Medicare.
[…] would a disproportionate number of sick people join the public system? Or perhaps more healthy people would switch to the public option? Would the premiums increase substantially over the first few years as the new system tried to balance costs? Would people be able to switch back and forth between the public and private systems? A lot remains to be seen. […]
[…] most doctors are trying to provide the best possible care for their patients and simply get paid for what they do. Medical billing is fraught with complications and headaches. To eliminate mistakes, it seems that making the billing system less complicated would be a better solution than audits. […]