Americans Finding They Can No Longer Afford Insurance

QUOTE: ‘What we're seeing is a market that's gotten so mature and beyond its customer[s] that people can literally no longer afford to buy the product,’ said Sheryl Skolnick, an analyst with CRT Capital Group. ‘The number of uninsured is growing faster than any player in the game, and it's getting bigger.’

That was from a Wall Street Journal story about the insurance industry. --

When our country decided back in 1919 that it was not going to go the same route as several European nations and embrace national health care, we never imagined that the private health insurance industry could price itself out of the market.

Health care bills have been rising even though doctor bills have been pretty steady. The reason is that more services are ordered -- the X-ray or MRI, the technician to take the X-ray or MRI, the physician specialist to read the X-ray or MRI, the drugs needed for the MRI, the nurse assistant to administer the drugs so that they can take the MRI, etc. You get the idea.

Even managed care has been unable to keep the cost of medical care down. The insurer may arbitrarily decide on a fee for a mammogram, usually $100. The provider may actually bill $300 to cover costs, etc. A mastectomy really costs $5000, but the insurance may only pay $800 or so. Where is the difference going to be made up?
The patient cannot afford to pay both the insurance premiums AND the balance of his medical bill. All too often, he or she may decide, hey, I am not getting my money’s worth out of this deal so I am foregoing the insurance. And this is the decision being reached by employers, too.

Stop and digest this figure -- 6.4 million fewer workers had employer-sponsored health insurance in 2006 than in 2000, according to the Economic Policy Institute. By the way, there are a total of roughly 47 million Americans without health insurance at all, and about 9 million kids with no coverage. How did we come to this state of affairs, and what do we do about it?

Part of the problem is that a nice system, the HMO, was twisted around to serve as a profit-generating mechanism. In the process, premiums rose from 1993 to 2003 by over 7%, but administrative costs rose by 500%. No one can stay in business for long with those kinds of statistics.

I can attest that insurers are under big pressure to reduce their costs. I used to work behind the scenes and saw the cuts in staffing, the reliance on faster computers and software to process mountains of claims (about 4,000 to 6,000 claims a day were received by that company), and the many small cost-cutting measures that affected worker morale.
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PS --
I found a blog about health matters that was very interesting. Here is that writer’s take on “The Managed Health Care Roller Coaster” at http://www.healthbeatblog.org/2008/07/the-managed-car.html.

Congress Overturns President’s Veto of the Medicare Bill

The House and Senate both voted today to overturn the President’s veto of H.R. 6331, (Rah! - L.A.S.) the Medicare package that includes the bidding changes and the physicians’ pay adjustment. The key HME provisions are described on the American Association for Homecare website at www.aahomecare.org.

The House voted 383 to 41 to override the President’s veto in mid-afternoon. The Senate then took up the debate in the evening and voted to over turn the veto by a vote of 70 to 26. With the two chambers voting by two-thirds majorities to override the President’s veto, the bill becomes law.

Thank you to all of the providers, state and regional associations, manufacturers, buying groups, consumer groups, disability organizations, and other stakeholders who have worked hard to accomplish this success for homecare providers and patients.
The American Association for Homecare will be working in the weeks ahead to ensure that patients and providers have minimal disruptions. Just today, AAHomecare met with the Acting General Counsel of the Department of Health and Human Services and was advised that if the override were successful, CMS would issue an immediate fact sheet on the impact of the legislation on providers.

This is a press release from AAhomecare.org -- Check www.aahomecare.org for continued news and details when they become available.

Funeral Planning Goes Online

Say you want to tell your kids what kind of funeral you want, what kind of music played, who to invite or not invite -- but your kids don’t want to talk about it. “Oh, Mom/Dad, don’t even think about that stuff yet,” they might say.

Go online to MyWonderfulLife.com and plan out your funeral. You can fill in details about music and burial, flowers or charitable contributions. Up to 6 loved ones (ie family members) can have access to your record there, plus notes on where to find your will or other papers. A British counterpart is called YourDeathWish.com -- Brits have such macabre humor sometimes but we love it so.

CAUTION: You might be better off NOT prepaying funeral expenses. You are definitely better off NOT buying funeral insurance. There have been scandals where funeral insurance policies sold by one funeral home were not valid or not honored if the seller closed or was bought out by a competitor. Read the awful truth in the excellent book by Jessica Mitford, The American Way of Death Revisited.

Americans Shave Insurance Bills Just by Shopping Around.

Everyone’s looking to save money somewhere, anywhere now that food and gas prices have cut deep into disposable income. Do you at least compare auto insurance offers at renewal time every year?

Go to NAIC.org (National Organization of Insurance Commissioners) and click on NAIC states to find your state of residence. You can compare rates by matching yourself to a set of profiles; this is very imperfect but it’s a starting point. Other places you can start checking premiums are insweb.com and insurance.com.

I might add that if you belong to any organizations you may be eligible for special plans and rates. Members of AARP always get a competitive rate. Members of trade or fraternal groups almost always get some offers every year for their business. (This is true of life and health insurance also, and even IRA accounts.)

This is not a plug for AAA, but I just want to mention that as a member of AAA I get a discount on insurance, and by combining house and auto insurance I feel I am getting a nice package deal. You may belong to some other group or organization that gives you a similar benefit, and I say you’re very lucky to find deals like that. Go for it.

The Dutch appear most satisfied with their system and Americans the least satisfied, according to a new survey of 10 industrialized countries

Harris Interactive combined results of three different polls to come up with citizen ratings of their national health care system (or lack of it).

The Dutch rated their system tops although 70% of their French said their system was the envy of the world.

The Dutch system is rather new -- they contribute payroll taxes into a central fund, then receive a voucher to buy coverage from nonprofit or for-profit private insurers. This actually sounds a lot like some of the proposals in this country for a voucher system.

France has a very expensive healthcare system which costs 11% of it GDP. There is a high priority on good access to both primary care and specialist care, with an accent on patient choice. Their system is financed largely from taxes but patients also chip in copays with no deductibles.

Americans spend much more in terms of GDP (16%) and yet feel that they are not getting their money’s worth. Prices are high, the number of uninsured is high, and even those with insurance must dip deep into their own pockets to pay bills. They are also stressed by the prospect of losing health coverage if they lose their jobs -- in the current recession, that is a justifiable fear. While they generally love their doctors, the hassles of buying insurance and handling claims makes them lose confidence in the whole private pay scenario.

Countries polled included, the U.S., Holland, France, Great Britain, Italy, Germany, Spain, Canada, New Zealand and Australia.

The full story is at MarketWatch here -- http://www.marketwatch.com/News/Story/Story.aspx?guid=86f29d04fc2d466fadf62435468ce406&siteid=nwtpf&sguid=LlmgTGWqaUW33IjDVFDo2Q

Medication managers, CVS drug stores merge networks (AP)

Some drug store and pharmacy information systems are merging their networks to better serve the health care industry. This vendors involved are the CVS chain, Caremark, Express Scripts, and MedcoHealth Solutions/Surescripts. The transaction closed on July 1, and will make electronic efficient and convenient for physicians. It is also touted as a way to reduce prescription errors by moving away from handwritten Rxs.
In 2007 only about 2% of prescriptions were electronically submitted. Physicians have embraced it in medical schools. But private doctors have complained that the whole cost of conversion falls solely on their shoulders, only to benefit the pharmacy managers.
The combined company is named Surescripts-RxHub. Unions have lobbied in support of electronic prescriptions as a way to manage healthcare costs.

Story at the AARP Bulletin online at http://bulletin.aarp.org/yourhealth/medications/articles/medication_managers_drug_stores_merge_networks.html

AARP Files Suit to Release Medicare Claims Data

AARP and Consumers’ Checkbook have filed freedom of information act requests to get Medicare claims information released to the public. Their purpose is to better serve the public and provide a better understanding of the operations of this government agency. The court however did not agree, so now the suit has gone to the U.S. Court of Appeals for the District of Columbia.
Maybe you feel, as AARP does, that the 43 million Americans who are serviced by this department deserve to have better information as a basis for comparing hospitals and other medical providers.
AARP’s brief notes that transparency is particularly needed because the current state of publicly reported health care quality and cost information is inadequate with regard to physician-level data in the Medicare program, which has lagged behind private efforts to make physician-specific health care information more transparent.
You may contact either of these two AARP employees to voice your concerns or give a show of support.
Stacy Canan at scanan@aarp.org -- Bruce Vignery at bvignery@aarp.org (202) 434-2060
Story URL: http://www.aarp.org/research/legal-advocacy/aarp_asks_court_to_order_release_of_medicare_data.html