[…] How would it help to have health insurance exchange boards negotiating with health insurance carriers to try to lower premiums – without addressing the root problem, which is the ever-increasing cost of healthcare? […] Much of the focus of the healthcare reform rhetoric has been on health insurance (availability, premiums, etc.), and some important issues have been addressed in the process. But we cannot continue to focus primarily on the cost of health insurance (or try to artificially lower it) without reducing the cost of healthcare.
[…] Although I’m a bit perplexed by the $99,000 median household income figure cited in the Rand study, I think that the gist of the study – basically the fact that health care is eating up a huge portion of family and government income in America – is important for people to understand. We can’t tackle a problem without first knowing what the problem is. And one of the obstacles in the way of curtailing health care costs in the US is that our current system is so convoluted and complex that it’s nearly impossible to see all the areas where health care spending is impacting us – at the federal, state, and household levels.
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!
[…] 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.
[…] Posts like this are good to keep in mind whenever we read stories in the media regarding new technology in healthcare, recommendations for medical treatment, and cutting-edge pharmaceuticals. Is the article truly research-based journalism, or is it a press release in disguise? Was the magazine/newspaper/website paid to run the article, or did the author receive an incentive to write the article in a particular fashion? […]
[…] Over the last several years, most of the major health insurance carriers in Colorado have increased the out of pocket portion that an insured has to pay for prescriptions. Most individual policies now have prescription deductibles, and a lot of carriers have designated very expensive drugs as a separate tier that requires a percentage copay from the insured, rather than a flat amount. And of course, premiums continue to climb. The Makena story is an example of why this happens, and it has nothing to do with health insurance carrier profits. When insureds see their health insurance premiums skyrocket again, where do you think they will point their finger?
[…] 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.
Health care costs are rising at a dizzying pace. For most Americans, this translates into increasing health insurance premiums, which are driven mostly by the cost of health care. Getting health care costs under control is a necessary step, and one that politicians generally say is important. But what is said and what is done are not always in line with each other. This outstanding article on Emergency Physicians Monthly is a perfect example of health care costs run amok. […]
[…] Time will tell, but it seems that as long as doctors, hospitals, medical device makers, and pharmaceutical companies are exempt from any rules concerning profits and administrative costs, the MLR rules might not have much long term impact on the actual cost of health insurance. Premiums will keep rising (at a pace similar to what we’ve seen over the last several years) as long as the cost of healthcare continues to climb at the same rate it has for the last decade or so.
[…] Much has been said about how we need to reign in health care costs in order for health insurance to be universally affordable. But we also need to figure out how to just use less medical care all around. We need to find ways to support health rather than react to illness (diet is a good place to start). And we need to question just how much we want our lives to revolve around medical intervention, pharmaceutical concoctions, and beeping machines. As Dr. Welch noted, some medical interventions are absolutely essential and worthwhile. But that is not the case for all medical care, and a “less is more” approach might create a healthier population and lower health care costs.
[…] The thought of 30 percent of adolescents being on medication for chronic conditions should make us all sit up and take notice. Hopefully it will fuel the cry for better school lunches and increased attention to prevention of obesity and mental health problems in kids. As a society, we simply cannot afford to continue to increase our utilization of prescription drugs.
[…] Maybe if doctors and patients were all aware of the fact that exercise is more beneficial in the long term than anti-depressants, we could start to cut down on the number of anti-depressant prescriptions being written. Lower utilization of pharmaceutical products would be helpful in terms of limiting the overall cost of medical claims and thus the price of health insurance as time goes on. […]
[…] It’s easy to criticize the length of the health care reform bills (and I would agree that it would be more helpful if they were written in plain English), but perhaps they are so long simply because there is such a wealth of ideas contained within them. It will take the test of time to determine which of those ideas are true winners, but without including them in the language of the bills, we’ll never know.
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 […]
Dr. William Foster has written a very thoughtful editorial about the state of our health care system, and it’s well worth reading. He points out that as a society, we’re always looking for the latest and greatest in health care, but at the same time we want it to be more affordable. We run more tests and perform more procedures than ever before – and our health care costs reflect this. […]
Pfizer was also illegally marketing Bextra, Lyrica, and Zyvox. They have settled for a record $2.3 billion, but Dr. Zhang points out that the sum is equal to three weeks of sales at Pfizer. Seems a bit paltry when you think about it. It’s like fining the average family a couple thousand dollars. Sure, it would sting a bit, but it wouldn’t really take that long to pay it off and forget about it. […]
Has anyone else noticed that the the term “health insurance reform” has started to be used in place of the term “health care reform”? Perhaps reform proponents are counting on the poor perception of the health insurance industry held by many Americans. By renaming the reform, perhaps they believe that more people will support it. […]
The Colorado House killed a bill today that would have required Colorado health insurance companies to cover oral chemotherapy pills. Diane Primavera (D-Broomfield), sponsored Senate Bill 250 in the House, and had support from patient advocate groups and the pharmaceutical industry. But the House Health and Human Services Committee voted 7 – 4 to kill the bill. […]
[…] There are plenty of people who advocate a free market approach to health care, and are complaining that the government shouldn’t be allowed to dictate that a particular treatment isn’t cost effective. But private health insurance does exactly the same thing. They don’t pay for unproven treatments, and it wouldn’t make sense for them to do otherwise […]
[…] If a rep presents a new med to a doctor, mentions that it’s a whiz-bang drug, and brushes the cost off by saying something like “it’s a brand name drug, but the copays on brand names are usually only about 20 bucks more than generics” the fact that the drug actually costs more per month than most car payments will probably not factor into the doctor’s prescribing decisions. […]
[…] With other private industries, we have more of a choice in terms of quality, price, and whether we want the product in the first place. Somehow it doesn’t feel right that healthcare is set up just like all of our other industries, with executives making 7 and 8 figure salaries while millions of Americans are without health insurance and don’t have realistic access to healthcare at all.
[…] There are plenty of people in the health care industry who are genuinely interested in making the system more efficient and inclusive. And regardless of their views on health care reform, people who are in the health care industry should have just as much of a voice in this as anyone else.