Health Insurance

HEALTH POLITICS: Jockeying for Position

Pundits might debate whether health reform will remain on top of a crowded domestic agenda for the next president and Congress, but health industry and advocacy groups aren't flagging.

As The Politico notes, "Giants such as AARP, the insurance industry, Health Care for America Now and the American Medical Association used the August congressional recess to blanket the country in a similar, if not coordinated, message: The country needs health care reform."

The campaigns serve two purposes—to stake out positions for next year, and to keep the issue on the minds of voters when other domestic priorities including energy, the housing and credit markets, and the overall economy, are clamoring for attention. You could argue—and we do (and we even have some polling data to back us up) that health care is a key component of voters' worries about the economy. Gas prices can pinch us economically but a health catastrophe can ruin us.

COST: Palliative Care Savings Measured

We've known that a palliative care team in the hospital can improve care for seriously ill adults, but there's been less consensus on whether it also saves money. A new study concludes it does—an average of $300 per patient per day.

The paper in the Sept. 8th edition of the Archives of Internal Medicine by Dr. Sean Morrison of the Mt Sinai Hospital and the Center to Advance Palliative Care and colleagues matched palliative care patients to "usual care" patients. The palliative care patients who were discharged alive had an adjusted net savings of $1,696 in direct costs per admission, or $279 per day. Amongst those who died, the adjusted net savings were higher, $4,908 per admission, and $374 per day. The savings came from reductions in laboratory work, intensive care cost (and for the patients who died, pharmaceuticals.) The team checked to make sure that the savings could be attributed to palliative care, not to a clinical course of action already determined before the palliative care team got involved with the case.

HEALTH POLITICS: A Conservative Says Fix Health Care ... And Maybe Win Elections

Conservative commentator David Frum in the New York Times Magazine this weekend surveyed the political landscape for Republican economic policies. His conclusion? Growing economic inequality is not good for Republican candidates—and lack of attention to health care reform is one big reason the middle class is having such a rough time.

"As America becomes more unequal, it also becomes less Republican. The trends we have dismissed are ending by devouring us," he wrote.

Frum argued that during the Bush presidency, 2001–2008, employers paid more for labor, about 25 percent more. "Yet almost all of that money was absorbed by the costs of health insurance, which doubled over the Bush years." In the 1990s, he said, the advent of HMOs helped slow down health inflation.

"Out of their flat-lining incomes, middle-class Americans have had to pay more for food, fuel, tuition and out-of-pocket health-care costs. In the past few months, they have suffered sharp tumbles in the value of their most important asset, their homes. Their mood has turned bleak," he wrote, urging fellow conservatives to "stop denying reality" and respond to middle class income stagnation.

HEALTH REFORM: The Health Agenda of a Hockey Mom

We just posted an item about how health played at the conventions. Now for those of you who want to learn something about Gov. Sarah Palin's health reform history, here's some recommended reading.

The Washington Post and the Wall Street Journal both look at her record on health care in Alaska, and find it's fairly slim. Her focus was naturally in keeping with her free market philosophy. She pushed for more transparent information for consumers, and waged an unsuccessful fight to end the state's certificate of need rules, even after an expert panel she appointed recommended that the CoN law remain on the books.

HEALTH REFORM: Conventional Words

The New York Times today has some cool graphics (below) about the words that dominated the Democratic and Republican conventions—and "health" cropped up more in Denver than in Minnesota. Uttering a word a lot of course is no guarantee that a party will aim higher, better or more successfully, but it's still a signal of what candidates are thinking, or at least what they think voters want them to be thinking. The Times gave us two measurements. First, how often a word appeared per 25,000 words in convention speeches. Second, how often the four key speakers used certain words.

By the first measure, health was No. 5 for the Democrats (after Change, McCain, Bush, Jobs, before Economy and Iraq.) It was tied for eighth for the Republicans—(after God, Taxes, Business, Change—those two were tied—Obama, Energy, Iraq, and tied with Economy.) Health was, however, ahead of Hockey Mom.

The second measure tracked how often four speakers on each side used the words "health care." It was 23 for the Democrats—Obama and Bill Clinton seven times each, Hillary Clinton five, and Joe Biden four. It was four for the Republicans, and all four mentions came from McCain. The other speakers were Lieberman, Giuliani and Palin (hockey mom, three; health, zero).

COSTS: What Goes Up... Must Get Shifted

Health insurance costs will go up again next year, though not the double-digit hikes we saw earlier in this decade. Once again, some of the costs will come out of workers' pockets. The cost of health benefits has been going up about six percent in the last few years, and HR benefits experts Mercer in its preliminary forecast for 2009 predicts a slightly lower increase next year, 5.7 percent, the lowest in more than a decade.

"It's a relief to see cost growth trending down, even slightly," Blaine Bos, a senior Mercer health and benefits consultant based in Minneapolis, said in a statement released by the company. "But this is not an unqualified success story. While some employers are holding down cost growth with innovative methods of improving health care quality and efficiency, more typically employers struggling with increases they can't handle resort to the tried and true method of shifting cost to employees."

That means higher deductibles, copayments, coinsurance and out-of-pocket spending for workers. From 2003 to 2007, the median family deductible for in-network services in a PPO (the type of plan offered by the most employers) rose from $1,000 to $1,500.

QUALITY: A Medical Home -- at the Office

You've heard of a medical home? What about a medical home-away- from-home, or more specifically a medical-home-at-the-office?

Stacey Burling at the Philadelphia Inquirer writes about the national trend of having company doctors or company clinics to provide primary care, wellness, screening and related services at the workplace. The idea is to keep workers healthy—and keep them out of the emergency room when they are sick. And, they hope, put a dent in rising health care costs. Bunting writes of Cardone Industries, which remakes auto parts:

Too many of its 4,000 employees, a melting pot of immigrants from dozens of countries, lacked primary-care doctors. Rather than deal with problems early, they'd wait until they were really sick, then head for emergency rooms, the priciest place to get health care. On top of that, a small but growing number of workers was turning down the company's health insurance plan because it was too expensive.

COVERAGE: ER Rhetoric and Reality

Emergency physicians are chiming in about the comments by self-described McCain adviser John Goodman. As you probably heard, Goodman, president of the National Center for Policy Analysis in Dallas, told the Dallas Morning News last week that we don't have uninsured people because they can all get care in ERs. "The next president of the United States should sign an executive order requiring the Census Bureau to cease and desist from describing any American—even illegal aliens—as uninsured," Goodman said.

Now the American College of Emergency Physicians has shot back, the LA Times' health blog tells us. The group's president Dr. Linda Lawrence said:

Emergency physicians can and do perform miracles every day, but taking on the full-time medical care for 46 million uninsured Americans is one miracle even we cannot perform. Access to care in the emergency department is no substitute for the comprehensive healthcare reform policy that should be at the heart of the platform of any presidential campaign.

HEALTH INSURANCE: Don't Put the Check in the Mail

Too confused by your E-O-B to ask W-H-Y?

If you get a bill from a doctor or laboratory or hospital saying you owe more than you think you did, don't assume the mistake was yours. In fact, don't assume it was a mistake. According to Business Week, US consumers are paying an estimated $1 billion a year in medical bills that they don't really have to pay. It's a practice called balanced billing - charging insured patients more than their co-pay and deductible - and it's illegal in 47 states. (Exceptions are made for certain elective and out of network procedures etc). People pay because they think they have to, fear damage to their credit rating, or don't know how to fight back.

COSTS: More Florida Hospitals Seek Payments Up Front

Cash or charge?

That seems to be the question on the minds of more and more nonprofit hospitals, who are asking even insured patients to pay up front for their share of nonemergency treatment—anything from an elective cosmetic procedure to a scheduled cardiac catheterization test.

The Wall Street Journal took a look at this trend, focusing on cancer patients and chemotherapy, back in April and today the South Florida Sun Sentinel examines how the payment pattern is playing out in Florida.

Hospitals argue that rising health care costs and hard economic times have caused an explosion in care for which they are not paid. An IRS survey in 2006 found that 14 percent of 481 nonprofit U.S. hospitals required patients either pay or work out a payment plan before admission.