insurance

RECENT POSTS

Dr. Tim’s Top Ten Health Reform Points


There’s something about Dr. Tim Johnson, the longtime ABC medical correspondent. You trust him. If he wrote you a prescription, you’d fill it. These days, he’s writing a prescription for the entire country, trying to cure the health care system of its spiraling costs. (He’s currently scheduled to appear Nov. 8 on WBUR’s “On Point.”)
As mentioned here, he has a new e-book out, “The Truth About Getting Sick in America.” He kindly consented to distill the whole thing down into its ten most essential points:

1) The US spends more than twice as much per person on health care as the average of all other industrialized countries ($7538 vs.$3060 in 2008) BUT we get no better outcomes AND we are the only industrialized country without universal insurance coverage.

2) For example, the five-year survival rates for 17 cancers are virtually the same in the US and Canada even though we spend almost twice as much per person ($7538 vs. $4079 in 2008).

3) And even within our own country, there are enormous differences in expenditures (adjusted for cost of living) with no difference in outcomes. For example, in Medicare spending in 2006: over $14,000 per person in Miami vs. under $6000 per person in Salem, OR.

4) One of the major factors encouraging this high spending without better outcomes is our “fee for service” payment system that basically says to doctors, hospitals, drug and device companies: the more you do or sell, the more you make. In other words our payment system incentivizes health care providers to do more whether or not it makes any difference in outcome.
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Mass. Health Insurers Punt On Premiums

WBUR's Martha Bebinger


WBUR’s Martha Bebinger reports today:

The state’s largest health insurers are hedging their bets on premium increases for businesses with fewer than 50 employees.

The approach boils down to: let’s wait and see who wins the tight race for governor. One candidate, Governor Deval Patrick, capped small business insurance premiums earlier this year — a step the insurers expect him to take again if re-elected.

To avoid another fight, with lawsuits and public battles, the insurers have decided to punt. The state’s top three health plans have all filed an extension of the capped rates, just under 10%, for the first three months of next year.

All the insurers continue to say they will lose money without a higher increase later next year. But they are leaving negotiations over what rate increase the state will allow until they know with whom they will be negotiating. Republican candidate Charlie Baker, a former Harvard Pilgrim CEO, does not support the insurance rate caps.
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Daily Rounds: ‘Biggest Loser’ Study; Denial of Insurance; ‘Myth Of CSI’; Hospitals Lure Doctors; Vaccine Language

'Biggest Loser' workouts drop fat without losing muscle mass – USATODAY.com“The grueling boot-camp workouts on NBC's The Biggest Loser help contestants lose large amounts of body fat while preserving their muscle mass, a new study shows.”(USA Today)

Insurers Denied Coverage to 1 in 7 – WSJ.com “The four largest U.S. for-profit health insurers on average denied policies to one out of every seven applicants based on their prior medical history, according to a congressional investigation released Tuesday.” (Wall Street Journal)

The myth of CSI – The Boston Globe “The quality of American crime scene forensics is wildly inconsistent: many labs have poorly trained investigators, antiquated equipment, and cases backed up for weeks. In some labs, investigators have purposely altered test results in order to get findings that favor the prosecution.” (Boston Globe)

Hospitals Lure Doctors Away From Private Practice : NPR “Last year, half of new doctors were hired by hospitals, according to the Medical Group Management Association, a professional organization for physician practices. According to a 2009 report by the American Medical Association, 1 in 6 doctors works for a hospital, and the number is quickly growing.” (npr.org)

Supreme Court Hears Arguments in Vaccine Case Against Wyeth – NYTimes.com “Much of the argument concerned the meaning of the word ‘unavoidable.’” (The New York Times)

Cost Hike: Levy Blames Insurers For Lack Of Efficiency, Insurers Fight Back

Paul Levy, the perpetually newsworthy CEO of Beth Israel Deaconess Medical Center, makes a crisp argument today blogging about the rising cost of health care.

Levy says while insurers often whine about the “underlying rise in medical costs” as the key driver of higher health insurance premiums, there is, in fact, another critical culprit: outsized administrative expenses racked up by the major health insurers, on average about 9.3 percent annually.

Levy’s Exhibit A is a February 2010 report issued by the state Division of Health Care Finance and Policy on premium levels and trends in the private insurance market:

“How can this be the case?” Levy wonders. “In other financial services industries, unit costs of transactions have gone down, not up. What is it about health care that suggests the opposite should be the case?”

Not to be outdone, the Massachusetts Association of Health Plans gave me a fairly lengthy response. Touche:

Reducing administrative expenses in health care is important and efforts are underway, but those costs are not what is driving health plan premiums. More to the point, talking about administrative costs distracts from focusing on the the major cost driver, which is escalating medical expense. Continue reading

Trying To Insure The Last 20,000 Kids

Even here in Massachusetts, in the state with the most insured people bar none, there are still at least 20,000 children who are not covered. Why, oh, why, with all the help available, are there still children without health insurance?

“We ask ourselves this question every day,” said Dayanne Leal of the advocacy group Health Care For All. Today, Leal and a team of 13 volunteers are trying a new tactic to get children signed up: A “got coverage?” phone-a-thon, from 9 a.m. to 9 p.m., inviting anyone who still has uninsured children or teens to call 1-800-272-4232 and get help signing up. More than 40 children have already been enrolled, Leal said at noonish today, and about a hundred messages are still pending.

“It’s going crazy, which is good,” she said.

So why is it? Why haven’t these children been signed up already? Continue reading

Health Care Law Coming Out Day: Are You Feeling Reformed?

Kaiser Health News has a great big roundup of stories today, marking the day that the first set of consumer protections take effect, six months after the enactment of national health care reform.

We want to know how the new law is affecting you. Are you now able to get insurance even though you have pre-existing conditions? Are your twenty-something kids now covered under your policy? Have you started getting preventative care without co-pays? Tell us if the law is filtering into your lives, and how.

Squeaker in Mass. Health Plan Ratings


You may not feel yourself overflowing with love and appreciation as you pay your premium, but the fact is that several Massachusetts insurance plans are considered excellent — in fact, tops. (Our premiums also tend to be higher than elsewhere, by the way.) Massachusetts dominated the top ten in the latest national rankings that the non-profit National Committee for Quality Assurance issued. The top of the rankings looked like this:

1. Harvard Pilgrim Health Care

2. Tufts Associated Health Maintenance Organization

3. Harvard Pilgrim Health Care of New England

4. Capital Health Plan

5. Geisinger Health Plan

6. Grand Valley Health Plan

7. Group Health Cooperative of South Central Wisconsin

8. Fallon Community Health Plan

9. Kaiser Foundation Health Plan of Colorado

10. Health New England

11. Blue Cross and Blue Shield of Massachusetts

All the top-rated Massachusetts plans are non-profits. And just a bit of inside baseball: If you look at the complete list here, you’ll see that Harvard Pilgrim edged out Tufts for the top spot by just a hair: an overall ranking of 90.5 vs. 90.4. Last year’s scores followed a similar pattern, and the two plans have been neck-and-neck at the top for five years now. Readers, what do you think is up?

Questions for ‘Connector’ Chief Glen Shor?

'Connector' Chief Glen Shor

Anything you’re burning to ask the new executive director of the “Commonwealth Health Insurance Connector Authority Board,” better known as The Connector? It’s the independent state agency that acts as an insurance broker of sorts in the post health care reform era here in Massachusetts, and we’re slated to meet with its new chief, Glen Shor, late this afternoon for his first in-depth interview since taking the job. Post your question as a comment on this post, and we’ll do our best to get an answer and write it up tomorrow.

$1,000 Prize — And The Chance To Vent About Health Costs

Costs of Care founder Neel Shah

Wanted: Hair-raising or heartbreaking tales about health care costs.

Say you’re a doctor. Your patient asks you how much the surgery you’re recommending will run him, and you have to confess that you don’t have the faintest idea. Or another patient says, “I’m still feeling a little tired. I think I”ll wait until tomorrow to go home from the hospital,” and you think but do not say, “Do you understand that this will cost you $2,500??”

Or say you’re the patient. You assume your health insurance will cover the procedure you need, and find out only weeks later that you’re facing thousands of dollars in bills. Or you go into the emergency room after a fender bender and find yourself undergoing head-to-toe body scans that will leave you deep in debt.

A Boston non-profit group, Costs of Care, has just announced a national contest aimed at gathering “the best anecdotes from patients and clinicians illustrating the importance of cost-awareness in medical decision-making.” The judges include former Gov. Michael Dukakis; Jeffrey Flier, the dean of Harvard Medical School; and surgeon/New Yorker writer Atul Gawande. The deadline is Nov. 1, and details are here.

Dr. Neel Shah, the founder of Costs of Care and a resident in obstetrics and gynecology at Brigham and Women’s Hospital, says the contest stemmed from “my belief that one compelling story is worth 100 academic papers on a subject.” Continue reading