Is there a “Right” to Medicare? Should 'Grandma' Pay for Her Own Cataract Surgery?

There has been quite a rumpus in articles about whether Medicare should refuse to pay for certain procedures due to the financial straits it once again is in.
In other words, do well-off seniors have the right to have Medicare pay for procedures that they could afford to pay out of pocket? And would this really help Medicare’s financial predicament anyway?

From someone called

the Happy Hospitalist believes that it is time to “say No” to seniors. “No to dialysis. No to life support. No to elective procedures [which would include artifical hips and knees] . No to brand name drugs. No to the latest expensive technology. We will have to place greater weight on quality of life over quantity of life. We will have to demand hospice care in futile situations. We will have to demand palliative comfort over slice and dice. We will have to reject marginally effective proceduralization and imaging of our elderly. We have to. We don’t have a choice. There is no other way.”

When I look at this list I agree on some items. “Futile care” is clearly unnecessary care. But often, we don’t know whether or not it will be futile. Every day elderly people do emerge from ICUs and go home to play with their grandchildren. As for “brand new drugs,” and “the latest expensive technology” regular readers know that I believe that everything depends on whether the new technologies have been tested and proven effective. We cannot afford to squander Medicare dollars on drugs, devices and procedures without knowing whether the patient will benefit. And I certainly prefer palliative care over “let’s try another surgery. Can’t do any harm.” (Except to the patient who suffers through it).

I agree with some measures but not others. Maybe all these joint replacements are unnecessary because we have been going about it all wrong. But cataract surgery keeps seniors active and involved and self-sufficient -- those are good things, dammit.
http://www.healthbeatblog.org/2008/08/do-seniors-have.html#more

Millions With Chronic Disease Going W/O Insurance or Treatment

A new study to be published this Tuesday in the medical journal Annals of Internal Medicine estimates that one of every three working-age uninsured adults in the U.S. has been diagnosed with a chronic illness -- diseases such as diabetes or high blood pressure.

Even though their conditions could be successfully managed, they are going without even doctor visits to monitor their progress. Instead, they rely on very expensive emergency room visits.

The actual figure now of uninsured Americans is 47 million; the study estimated that about 11 million (of the 36 million uninsured in 2004) had been diagnosed with a chronic condition. Nearly a fourth of the uninsured said they had not visited a doctor in the past year. The total number with such a condition may be higher for two reason: the growth in the number of total uninsured since 2004, and the fact that people may have developed such a condition in past year and not know it.

We can do better than this, people. Forty seven million uninsured is a disaster waiting to happen.

Info from New York Times report at http://www.nytimes.com/2008/08/05/business/05health.html?_r=1&adxnnl=1&oref=slogin&ref=health&adxnnlx=1218316447-mchkYD402MaReOGqwa1txg

McCain Health Care Plan Glosses Over Fact that Key Provider Info Hard to Come By; How Then is Consumer to Choose?

One of the big campaign issues is what each candidate proposes to improve the state of health care in this country. The United States spends far more per capita and seems to get less for the dollar compared to nations with some form of national health plan.

The McCain campaign claims that consumers will benefit by being empowered to choose their own providers and buy their own health insurance. He plans to eliminate the tax incentives to employers for providing coverage to their employees. It seems reasonable that if the tax breaks are in fact eliminated, then employers will no longer offer any form of insurance coverage as a benefit to their employees.

Left to their own devices, Americans may think that they can just muddle ahead but will soon find that the data one would need to make these provider choices is difficult if not impossible to come by. And while some providers may post some information on their websites, it may not be in the same format as another provider’s. Consumers are left trying to compare apples and oranges.

The federal Agency for Health Care Research and Quality (AHRQ) found that there are 12 different rating schemes for doctors, 26 for medical groups, and 81 for hospitals, and 86 for health plans. Even the most intrepid, determined consumer is hard pressed to research all of that data and find a doctor who meets their needs. How many of us have the time to research even a fraction of those databases or of the health care providers in their county? Good luck to you even if you do have the time.

The Alternet website has a good article in their recent issue. I cannot quote any excerpts, but here is a link to the story -- http://www.alternet.org/mediaculture/94154/?page=entire. You may also check amednews.com

Michelle’s Law Languishes in Congress; Would Allow Medical Leave

Those of us who live outside New Hampshire probably never heard of Michelle’s Law. But it is a provision for college students to continue their student health insurance coverage even if they have to take a medical leave from school for a year. That way, they do not have to exercise the COBRA provision of the student health coverage, under which policyholders pay 102% of the full premium cost.

HB 2851 was the United States House of Representatives’ version of the bill; this bill passed unanimously on July 30, 2008. The sister bill SB 400 is languishing, however, in the Senate. The bill is endorsed by the American Hospital Assn., the National Patient Advocate Foundation, the American Heart Assn., and America’s Health Insurance Plans.

The bill is named for Michelle Morse, a student at Plymouth State University who took chemotherapy treatment for colon cancer. To avoid losing her student insurance, she enrolled in a full course load. The premium to continue her coverage under the COBRA law would have cost over $500 a month, a charge her family could not afford.
What follows is excerpt from MichellesLaw.com about the bill when it was signed into law by Gov. Lynch of New Hampshire.

Joined by the family of Michelle Morse and legislators, Gov. John Lynch today signed "Michelle's Law," helping ensure that college students do not lose their health insurance when they need it most.
The legislation, HB 37, ensures that seriously ill college students can continue to receive health care insurance through their family's health insurance policy even if they are unable to maintain their full-time student status.
"College students should not lose their health insurance just when they need it the most. Now, in New Hampshire, they won't. Michelle's Law will provide an important protection for New Hampshire families," Gov. Lynch said.
Michelle Morse was a student at a Plymouth State University when she was diagnosed with colon cancer. Although her doctor suggested she take a leave of absence from school, Michelle Morse maintained a full course schedule in order to keep her health insurance coverage. Michelle Morse died in November [2005].

Read the background behind this bill at http://www.michelleslaw.com/index.php.

You May Want to Lower Your Home Insurance to Keep Up with Deflation

If your home’s value falls due to a softening market, do you still have to insure it for the value it had last year?

This is a question, not a conclusion. And it may be a question that no one can really answer. But the query arises because of a report released this July by the Center for Economic and Policy Research called The Impact of the Housing Crash on Family Wealth. [Note that it acknowledges that there is a housing crash.]

It outlines three different scenarios for housing prices in 2009. Number One assumes no further decline in housing prices. This does not seem likely given the fact that prices are declining about 2% a month this year. That is more in line with Number Two, which assumes a further 10% decline in housing prices in 2009. Then there is Number Three, which assumes a drop of 20% in housing prices in 2009.

[Note that none of these assume a rise in housing prices. The best case scenario is -- stable prices. Pass me the aspirin, Martha.]

In fact, it calculates that some family homes are now worth what they were in 1989.
So that leads to my question: Can I get away with insuring it for less, and at least save a couple bucks a year that way?

You can insure your house for as little as you want, really, but you really should not underinsure. You need to at least figure out the replacement cost. The good news is now that the overheated building boom has cooled off, the prices of every kind of lumber product is down dramatically.

But frankly, I bet a lot of homeowners are going to be awfully tempted to burn down houses to get insurance settlement cash in hand so they can start over.
Few will get away with it, of course. Chemical accelerants can be detected by insurance investigators and law enforcement. So remember that because you really don’t want your next home to be a concrete prison cell.

If You Depend on Your Employer for Health Ins., Don't Vote McCain

Hi, --
I don't generally talk about politics at all on this site. However, there are some clear differences between the two major presidential candidates when it comes down to how your health insurance will be affected.
It is already pretty clear that Sen. John McCain has plans to torpedo employer-paid health insurance coverage. How can a president do that? Pretty easy if he is able to push thru a proposed elimination of the tax break for the employer.
Currently the only way that employers are able to offer group coverage at all is because of the tax exclusion employer-paid health insurance.
Ostensibly the goal is to push individuals into state-run pools. But that means that individuals will have to pay 100% of their premiums, whereas now they pay anywhere from 20% to 50%. Some employers do not contribute anything now; they just sign up with an outside administrator like Administaff and let employees pick and choose what they need. And pay 100% of the cost.
Americans are being squeezed between spiraling increases in food bills, gas prices, and often in their mortgages if they got caught in the mortgage credit crunch. Where are they going to get the extra dollars to pay for 100% of their health insurance coverage too? AND pay income taxes on the benefits from your insurance plan??? Are they crazy???Here's a link to a great article on the changes being proposed; this is part one of a two-parter. I hope you benefit from reading it.
HEADLINE: McCain's Health Care Plan: Gut Employer-Based Insurance
http://www.alternet.org/mediaculture/93734/?page=entire
An Excerpt: So far, the press has failed to examine what's at stake here for workers and their bosses -- that, in the long run, employer coverage could disappear, and that, in the short run, they may have to pay taxes on some portion of their health benefits, no matter who wins in November. In effect, it's an unspoken tax increase which has yet to surface in campaign conversation.

Do You Have a Vision Plan? A list of carriers to research to find a plan that fits your needs --

Right now this is just a list of insurance carriers that offer vision insurance plans. I also give their website address and which states they operate in. Will follow up later with something on what to ask for when talking to an agent.

Advantica Eyecare -- AdvanticaEyecare.com (available in all states)
Aegis Administrative Services Inc. -- Aegisadmin.com (all states)
AIG Accident & Health Division -- AIG.com (all states)
AIG Employee Benefit Solutions -- AIGebs.com (all states)
AlwaysCare Benefits Inc. -- AlwaysCareBenefits.com
All states EXCEPT MA, NY
Avensis -- Avensis.com (all states)
BEST Life -- bestlife.com (all states)
Block Vision -- BlockVision.com
ONLY available in CT, DE, MD, NJ, NY, PA, TX, WI
Brokers National Life Assurance Co. -- BNLAC.com
All states EXCEPT CT, MA, NH, NY, VT
Co/op Optical Vision Designs -- COOPoptical.com (all states)
Companion Life -- CompanionLife.com
All EXCEPT CA, CT, HI, IL, ME, MT, NJ, NY, NC, WA
Denali Vision -- DirectBenefits.com (all states)
Dental Select -- DentalSelect.com (ONLY in NV TX UT)
EyeMed Vision Care -- EyeMedVisionCare.com (all states)
Group Link -- GroupLinktpa.com (all states)
Insurance Design Administrators -- idatpa.com (all states)
Kansas City Life Ins. Co. -- KCLgroupbenefits.com
All EXCEPT CT, MN, NJ, NY, PA, VT
New Benefits -- NewBenefits.com (all states)
OptiCare -- Opticare.com
All EXCEPT AL, IN, NY
OUTLOOK Vision Svcs. -- OutlookVision.com (all states)
Patriot Health Inc. -- PatriotHealthFamily.com (all states)
Preferred Vision Care -- PreferredVisionCare.com (all states)
Primary Vision CareServices Inc. -- PVCS-usa.com
ONLY in AR CO FL KS LA MO OH OK TN TX
Principal Financial Group -- Principal.com
All EXCEPT MD, VT
Shenandoah Life Ins. Co. -- ShenLife.com
ONLY in DE IN KY OH SC TN WV WI
Spirit Vision -- DirectBenefits.com
All EXCEPT FL ME MA NH NJ NY RI VT WA
Standard Ins. Co. -- Standard.com
ONLY in AL AR CA CO CT DE FL GA ID IN IA KS KY LA MN MS MO MT NE NH NM ND OH OK
OR SC SD TN TX UT WV WI WY
Superior Vision -- SuperiorVision.com (all states)
Transamerica Worksite Mtg. -- TransamericaWorksite.com (all states)
US vision & dental -- USAvision.net (all states)
Vision Ins. Plan of America Inc. -- VisionPlans.com (WI only)
VSP Vision Care -- VSP.com (all states)

In addition, please note that discounts on laser vision correction are offered by:
All EXCEPT Co/op Optical and Kansas City Life. Discounts vary per carrier.
[Good Luck to all of you considering a plan. Also you could possibly do just as well by shopping the sales, going to a local discount outlet, and buying a spare pair at the same time. Lots of times, I have bought at 2-for-1 sales.]

A Free Health Insurance Card? It could be coming your way

The concept of a free healthcare discount card is being pioneered by Jonathan Edelheit’s Florida based company, Free Health Inc. It sounds like it is not offered independent of group health insurance such as that bought by employers. Rather, it is an extra sweetener to a deal with the employer to make the insurer stand out when bidding for the company’s business. The employer may have employees who cannot afford to enroll themselves or their families -- so they are simply given a discount card (rather than a regular insurance card) so that they can at least access specialized health care services.
Such a plan appeals to employers because it helps them retain employees. Employees like it for obvious reasons, which includes access to online medical advice and discounts on prescriptions.
Free Health has a network of 285,000 providers across the country, and the free cards promise discounts of anywhere from 10% to 50% on a wide variety of services. Providers include family physicians, specialists, surgical facilities and hospitals. Blood work and MRIs, for example, are half price.
The 53,000 pharmacies in the network give discounts of 20% to 50% on generic and brand name drugs, while vision services include LASIK surgery (40% discount) and eyeglasses.
The online medical advice website is eDocAmerica.com. It charges a one-time fee of $8 and no copay.
It sure seems like a promising avenue for working people in low-paying service jobs to get any access at all to medical care. Workers in the food and beverage, and retail, sectors tend to have the lowest rates of insurance coverage.
Right now there are only a few hundred agents signed up with Free Health Inc. so finding someone to explain the whole program may be difficult. On the horizon are plans to add dental discounts and some free prescriptions.
Edelheit’s company is getting inquiries from large corporations interested in his plans, so it may be only a matter of time before this approach becomes an everyday thing.

Auto Insurers Offering Premium Reductions to Safe Drivers via Hi-Tech Monitoring

I don’t usually cover auto insurance matters, but this is something that I am interested in because one of the states where this program is offered is Minnesota (where I live).

Auto insurer Progressive Corp. has begun offering its drivers the chance to cut their costs based on how they actually drive, not only on their age, credit score and number of tickets or accidents on their record.
The monitoring device - sort of like a black box for cars - tells Progressive what time people drive, how many miles they've driven, how fast they accelerate and how often they hit the brakes. It does not track where people go.

Other insurers are offering similar programs, and if this pans out, we could see this become a common feature. American Family Insurance is offering a teen driver monitoring program to help reduce premiums and accidents. GMAC and OnStar have rolled related programs that give a discount to those who drive fewer miles.
The AOL story is at http://autos.aol.com/article/news/_a/car-insurer-offers-discount-to-drivers/20080729124709990001?ncid=AOLCOMMautodynlsec0004&icid=200100397x1206607179x1200366511

Singapore an Interesting Case Study in Healthcare

Singapore has made it a point to guard against a glut of expensive technology, high-volume care, too-long hospital stays, and an excess of physicians and specialists. These reforms helped Singapore reduce its per capita health care spending from 1997 to 2001 by 13 percent—even as the United States increased its per capita health spending by 24 percent over this same period. Today Singapore spends one-seventh what the U.S. does per capita on health care.
The above excerpt is from a very good article on the Singapore system of health care. They do some things very well, altho there are some ways in which their society is different from ours. A major difference is that Singaporeans are on average much younger than Americans or Europeans. That figures into the demand for health care, surgery, and hospitalizations.
Read the whole article in Health Beat at http://www.healthbeatblog.org/2008/07/health-care-in.html#more

Kudos for a great article on world health care.