Lonesome Tree in Sandhills

Friday, August 28, 2009

Health Reform: Part III - Confusion vs Facts

No one shouted or booed at health care forums held last spring, which were aired on C-Span and made available online. People were rational in their concerns that ranged from access to costs to insurance. People expressed quite a bit of fear but not boorish behavior like the town hall meetings. People are now scared and want straight answers.

Newspapers and news magazines would do everyone a huge favor by publishing a series based on facts to inform and educate its readers. TV producers could do likewise for folks who never read newspapers or magazines. The rest of us could help by getting informed ourselves and then asking our local newspaper editors to publish the facts.

First the news could explain how Medicare reimbursement works and varies widely by state. Physicians and hospitals accepting assignment are reimbursed 80% of charges set by regional areas. They agree to collect the remaining 20% from patients or their insurers. The difference between actual charges and what Medicare allows averages 65% nationwide, but reimbursement rates vary by regional areas that overlap state boundaries. In rural areas especially, the average charge is much lower than in metropolitan areas. Yet studies show there is no correlation between high costs and more effective medical care.

The Dartmouth Institute for Health Policy and Clinical Practice began the Dartmouth Atlas Project over 20 years ago. They used 20 years of Medicare data to study distribution and use of medical resources. Researchers found glaring variations in efficiency and effectiveness of the nation's health care system.

Check out Dartmouth's Interactive Map: Medicare Reimbursements Per Enrollee by State See: "Taming Wide Variations in Spending Key to Health Reform" Published February 26, 2009 in the New England Journal of Medicine.

We could reduce confusion by understanding the basics of health reform. The Kaiser Foundation's Explaining the Basics of Health Reform

We can also get informed about the uninsured in our states and in the nation from Robert Wood Johnson Foundation's Cover The Insured

At least then maybe... just maybe... we could have less emotionally-loaded discussions about health care reform!

Tuesday, August 18, 2009

Sons of Maxwell: 2 | United Airlines: 0

Need a break from all the blather about health/medical care - reform?  Check out Sons of Maxwell's 2nd video taking United Airlines to task for breaking Dave Carrol's $3500 guitar (full story here).  They plan to release a 3rd & final song & ask people to vote for their favorite on YouTube. Enjoy Song #2 in the sidebar!

Saturday, August 15, 2009

Health Care Reform - Time For Cooler Heads To Prevail

Senator Grassley spoke at an AARP meeting in Iowa & began by mentioning that both he & Senator Harkin, a Democrat, had worked for many years on legislation that affected the entire nation.  He went on to say this has always been a bipartisan process in both houses of Congress & in the White House, and he had no reason to believe this legislation would be any different.

HB 3200 was expected to be bloated with provisions squeezed in by lobby firms for clients.  The rubber will really hit the road when the Joint Committees begin working the differences out, putting combined draft legislation through 100’s of legal “car washes” until all the lawyers on both sides will be sick of it.  David Sloan, VP of Gov Relations for AARP, said on C-Span’s Washington Journal a few days ago that AARP’s lawyers & accountants have yet to finish analyzing the bill.  So as a retired energy lawyer, I am amused by all the hyperbolic opinions.

I invite you to read why 450,000 physicians support the proposed Health Care Reform Plan: Health Care Reform: Part II - Physicians Support Health Care Reform

Older people especially are ill-served by the ”Four Horsemen of the Apocalypse” approach  on talk shows or otherwise pressing their panic buttons. Thankfully, cooler heads are beginning to speak up on Network News, PBS & NPR.

I recommend listening to the President’s weekly address today at WhiteHouse.gov -- or read the transcript (here).

It might help to have a little faith in this President like everyone had to when the Republicans were in power. Try reading about how the Weapons System Acquisition Reforms Act finally got done, which is overhauling a procurement systems bloated with cost overruns.  DOD’s procurement is a complex monster that many in both parties had tried to reform for quite some time.  Obama promised Senator McCain when they met after the election that he would do everything in his power to get it done and the WSARA was signed into law on May 22nd.  He was also able to convince Bob Gates to remain as Sec. of DOD to implement the WSARA.

I agree with Senator Grassley, it is past time for people in both parties to put aside the bitter vitriol for the sake of the whole country.  It is WAY past time for cooler heads to prevail.

Health Care Reform: Part II - Physicians Support Health Care Reform

The MAJOR BATTLE over Health Care Reform is being fought between physicians and insurance companies, HMO's and PPO Networks -- not in town hall skirmishes. The nation's FAMILY DOCTORS believe our current health care system IS dysfunctional and that significant benefits in patient care and cost reduction can be realized from a system built on primary care and diagnostic skills.

Now those 450,000 physicians want YOU to know THEY SUPPORT the HEALTH CARE REFORM PLAN proposed by Congress and President Obama, to overhaul the financing, delivery and reach of health insurance - especially a vigorous assault on unnecessary, unproductive and complex administrative requirements imposed by multiple level requirements of the current health care system. They have tried to make their support abundantly clear through the following efforts:

1.   American Academy of Family Physicians - Statement of Support
"The American Academy of Family Physicians agrees with President Barack Obama that the American people cannot wait for health care reform. Family physicians see first hand the fallout from our broken system, as more patients are priced out of health care coverage or lose health insurance and forgo needed health care services. -- Our nation must redesign the way we deliver health care so that we pay for quality of care, not the quantity of tests and procedures performed. We must have a health care system that fosters the doctor-patient relationship and ensures the preventive care that saves lives and money."
The AAFP was organized in 1947 and represents 94,000 family physicians.  AAFP is a member of the Herndon Alliance, a coalition of more than 200 nonpartisan organizations, including the American Academy of Pediatrics, the American Nurses Association, the AARP, the Mayo Clinic and the Families USA.

2.   Physicians Launch: Heal Health Care Now
The AAFP & Herndon Alliance launched Heal Health Care Now as an online information resource to counter the most potent anti-reform arguments with their most trusted spokespersons. Primary care FAMILY DOCTORS describe how health care reform will improve their care of patients by:  a) increased quality, affordability and access of care; b) assuring the patient's choice of doctor and health plan; and c) bringing insurance in line with what is medically best for patients. (See video in sidebar)

3.   Letter of Support for Reform to U.S. Senate.
Organizations representing 450,000 doctors signed and delivered a joint letter supporting the Health Care Reform Plan to leaders of the Senate. The doctors are members of the American Academy of Family Physicians (AAFP), American College of Physicians, the American Osteopathic Association, the American Medical Student Association, Doctors for America and the National Physicians Alliance. Their letter reads in part:
"We are confident that the reforms being proposed will allow us to provide better quality care to our patients, while preserving patient choice of plan and doctor."
4.   Medical Management Coalition Plan: Voluntarily Reduce Red Tape & Costs.
Healthcare Administrative Simplification Coalition (HASC) released its report:  
"Bringing Better Value: Recommendations to Address the Costs and Causes
of Administrative Complexity in the Nation’s Healthcare System
The 34-pg. report outlines HASC's nationwide plan to reduce bureacratic red tape causing treatment delays and costly paperwork largely related to billing and payment. HASC estimates that 25% of all health spending is wasted by unnecessary duplication and complex administration requirements. Their plan would save an estimated $50 billion a year - $500 billion over 10 years - and permit physicians to spend more time on patient services.  Expected savings represents 1/2 of the estimated costs of the Health Care Reform Plan - $1 trillion cost over 10 years.  The Report can be download here

HASC's Plan calls for physician practices, hospitals, insurance payers, benefits managers and others to voluntarily adopt coordinated nationwide key administrative processes. The Report focuses on provider credentialing, eligibility verification, patient IDs and prior authorization:
* Physician and Clinician Credentialing: One standardized credentialing form to eliminate administrative costs of completing multiple different forms for insurance payers, hospitals and others.
* Patient Eligibility for Insurance: Adoption of an industry-wide standard for interchangeable electronic data to quickly and accurately verify a patient's insurance coverage.
* Patient Identity Cards: Standardized machine-readable patient ID cards to significantly reduce costly errors and delays in the medical claims billing process.
* Prior Authorization of Radiology and Pharmacy:  Standardized request and receipt of patient eligibility for radiology and pharmacy services to reduce treatment delays and costly paperwork.
HASC was organized in 2005 by the American Academy of Family Physicians (AAFP), the American Health Information Management Association (AHIMA) and the Medical Group Management Association (MGMA). HASC now includes some of the nation’s leading physician and hospital organizations, health and benefits plans, employers, government agencies, and other groups that share the goals of simplifying administrative processes in the nation’s public and private health care financing programs.

FAMILY PHYSICIANS are the cornerstone of a health care system increasingly fragmented by specialties.  The number of family physicians in training has drastically declined - a significant need addressed by the Health Care Reform Plan.

AAFP provides charts and graphs on family physician primary care. AAFP Media Center at: www.aafp.org

Thursday, August 13, 2009

Health Care Reform - Part I-A: Insurance CEO Compensation

I encourage you to watch the video in the sidebar where Wendell Potter, former V.P. of Public Relations for CIGNA, explains how he came to have a crisis of conscience and blew the whistle on how these executives operate the major insurance companies.  He testified before a Congressional Committee as to their practices & is now speaking out about their PR that is threatening to block reform.  Whistle-blower: Health care industry engaging in PR practices (CNN.com 8/13/09).

Below is a list of insurance CEO's and compensation in 2008 - taken from SEC filings by healthcare management & recruiting firm, Fierce Health CareLeading health plan CEO paychecks (5/14/09).  The amounts do not include perks like corporate jets, memberships in country clubs, or security services.
2008 Total CEO compensation (SEC filings):
Ron Williams - Aetna   $24,300,112
H. Edward Hanway - CIGNA  $12,236,740
Angela Braly - WellPoint  $  9,844,212
Dale Wolf - Coventry Health  $  9,047,469
Michael Neidorff - Centene  $  8,774,483
James Carlson - AMERIGROUP  $  5,292,546
Jay Gellert - Health Net  $  4,425,355
Richard Barasch - Universal American $  3,503,702
Stephen Hemsley - UnitedHealth Group $  3,241,042
Karen Ignagni, AHIP (2007 total comp) $  1,580,000
(America's Health Insurance Plans)

Tuesday, August 11, 2009

Health Care Reform - Part I

Health Care Reform Affects 20% of Economy
Consumers Ultimately Pay Health Care Bills

People who are clueless believe whatever drivel is dished out on  talk shows. Then they spout ignorant opinions as if they really know!  Liberals and conservatives scream & shout, both deadly certain their precious ideologies are more important than those who's life or mind hang in the balance.  So, first things first ~ this isn't about labels!

Next, use your common sense reasoning to answer a couple of simple questions:
1. Do we enjoy public-funded fire, police, road/bridge maintenance, education, Social Security and Medicare?
2. How did private medical insurance have $168 million to give campaigns in 2008 plus $485 million to lobby Congress last year?  In the first 6 months of this year, the health insurance sector alone has paid out over $128 million to lobby Congress.  Where did they get that money and what do they expect to get for it?

Insurance is a "paper" industry, but it can't print money! So-called "health" insurance is very profitable! It used to be called medical insurance but now they insure only healthy people if they can get away with it. They exclude coverage for pre-conditions and rescind coverage for any excuse they can find AFTER YEARS OF ACCEPTING PREMIUMS!

Consider a doctor that started his private practice 10 yrs ago. He or she could NOT see a patient until 30 contracts with insurance, networks and HMOs were signed. NONE were negotiable! Only 1 was with Medicare. The COMPANIES DETERMINE:  how much can be charged and what is routine service - anything else must be pre-approved.  Many decisions are made by non-medical personnel using insurance protocol intended to increase profits to the company and reduce profits for your doctors.  Payment can take 3 to 6 mo. after being billed, which makes doctors and hospitals de facto lenders to the insurance companies.  Otherwise the companies would pay banks for short-term lines of credit.

If the doctor brings in partners, more employees are needed to handle insurance-related administrative work in order to get reimbursed. Almost 60% of total medical costs are insurance-related administrative costs.  The doctors overhead increases, but not their charges to cover it. They must see more patients and do more procedures to make ends meet.

Many doctors feel so squeezed they worry about being neglectful of patients. Patients feel they get shorted, too.

Private doctors are actually a small business providing medical services to patients while also providing jobs and medical insurance for employees at a HUGE premium. That, too, is overhead that must be covered by their charges. CHARGES THAT ARE SET BY THE VERY SAME INSURANCE COMPANIES!!!

Many small businesses have not been able to provide medical insurance any more. Large businesses spend money on  resources to find and negotiate new coverage every 2 years. To reduce the costs of insurance, coverage is then reduced by larger co-pays and deductibles.

People spouting off about "socialism" are being manipulated by TV and radio talk shows, paid for by insurance and drug company ads. Such ads are tax deductions so they actually are paid with lost tax revenue as well.

People need to think about insurance company executives with high salaries and bonuses, country club fees, golfing fees, skyboxes and other entertainment perks that are legally deductible marketing expenses - like advertising.

Insurance executives have a vested interest in keeping their golden lifestyles - hence their willingness to pay out well over $780 MILLION to elect and lobby congress in only 18 months - just to derail health care reform legislation. They also handsomely support talk show hosts through ad revenues (again tax deductible).


It is WAY past time people get a clue! We are getting manipulated alright - by "health" insurance companies!!

What exactly is "socialistic" about these specific consumer protections that Obama's pushing for? What is so wrong with these being legislated by Congress and enforced by the Obama administration?  In my humble opinion, these 8 specific items address only the most egregious infractions by "health" insurance companies.
  • No discrimination for pre-existing conditions
  • No exorbitant out-of-pocket expenses, deductibles or co-pays
  • No cost-sharing for preventive care
  • No dropping of coverage if you become seriously ill
  • No gender discrimination
  • No annual or lifetime caps on coverage
  • Extended coverage for young adults
  • Guaranteed insurance renewal so long as premiums are paid
What is so wrong about Obama pushing for public health measures to promote health and prevention of illness?
So SPEAK UP to counter the self-serving arguments of crass partisans, special interests and their fear-mongering news shows!

Monday, August 3, 2009

Sons of Maxwell: 1 | United Airlines: 0

The Sons of Maxwell, a band from Nova Scotia, flew to Nebraska for a 1-wk tour in the Spring of 2008. United Airlines's baggage handlers in Chicago threw guitars into the hold, breaking Dave Carroll's $3500 Taylor guitar. He watched in horror and immediately protested but was told, “hun, that’s why we make you sign the waiver” and to take it up with the ground crew in Omaha. He hadn't signed a waiver and there were no employees in sight when the plane arrived late at 12:30 A.M. - besides they were tired and needed those few hours to sleep.

Tuning up for the first gig on their Nebraska tour, Dave realized his guitar was broken.  Returning to the Omaha airport 7 days later, Dave was told he would have to start his claim where he began the trip - in Halifax, but was told by Canadian Air in Halifax that United didn't have a presence there.  Thus began an incredible, unsuccessful quest to get United to either fix or replace his Taylor guitar.

Dave's efforts give new meaning to "getting the run-around" - including calls to customer service in India. Over the past year, United steadfastly refused to accept responsibility for damaging Dave's $3500 Taylor guitar.  Meanwhile Dave had it repaired at a cost of $1200, but it doesn't have the same sound.  Dave told United's last representative that he would write 3 songs about his experiences, post a video of the songs on YouTube and ask people to vote their favorite - hoping to get a million hits in a year. Dave's video has had almost 5 million views so far.  Its a great song (in the sidebar or here).

United's parent company executives are compensated richly (not necessarily "earned").  Glenn Tilton (UAL Chairman/CEO), Kathryn Mikells (UAL Ex.VP & CFO), and John Tague ( UAL Ex.VP of UAL & United Airlines Pres.) were paid $6.47 million, $1.02 million, and $3.2 million, respectively.

No matter ~ let's just enjoy listening to Dave Carroll's lovely laid-back song "A Woman Like You" (in the sidebar)... ummm, SO nice!  I'll not hold my breath waiting for United's richly-paid execs to invite Dave to have a beer with them....