July 27th, 2009 by EvanFalchukJD in Better Health Network, Health Policy
Tags: Cost Shifting, Costs, Employer, Finance, Guarantee Issue, Health Insurance, Health Insurance Rates, State Coverage Mandates, Stop Loss
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Gary Schwitzer links to a Business Week article that says health insurance is a very uncompetitive market. Schwitzer notes this hasn’t gotten much attention, and wonders if it is a reason why health insurance premiums keep going up.
It is – and it isn’t. As with most things in health care, there’s more to it than it seems.
Business Week and Schwitzer are right that the market for health insurance is not especially competitive. Most states have one or two dominant health insurers, and a number of other much smaller players. The smaller insurers are often at a big disadvantage. I blogged about this a couple of months ago.
But the question of the cost of health insurance is something that mostly affects small employers – the companies that employ some 55 million Americans.
As companies get bigger, they minimize their exposure to the insurance market. Mid-sized employers (between about 500 and 2,500 employees) buy so-called “stop loss” coverage. Under these plans, they self-insure for some of the risk, and buy coverage for unexpectedly high expenses. It’s sort of like a high deductible plan, except it’s for the company. That market is, in fact, highly competitive, and serves many of the 14 million Americans who work for companies of this size.
Really big companies – which employ 43 million Americans – don’t buy health insurance at all. They hire a health plan to administer their expenses, but have completely opted out of the health insurance market.
So is the uncompetitive health insurance market driving health care premium increases?
It doesn’t help, but there here are three other things that we don’t talk enough about that are driving these increases:
1. State coverage mandates. Each state requires that insurers who wish to sell there comply with a huge variety of coverage mandates. In fact, there are nearly 2,000 mandates, some of which add significant costs to health insurance. Adding new mandates is a regular activity of state governments, based on the political clout of patient groups, pharmaceutical companies and others. State governments have had an important role to play in driving premium increases.
2. Guarantee issue requirements. The other thing some states have done is outlaw medical underwriting. This means that if an uninsured person gets diagnosed with an illness, he can just go out and buy an insurance policy and, for the cost of an annual premium, get all the care he needs. He can even cancel the policy after he’s done being treated, and buy one again if he gets sick again. There may be valid public policy reasons to make health insurance guarantee-issue. But the reality is that insurers have to add in additional premium to account for the fact that their risk pool includes in it much more costly individuals than otherwise would. There is no free lunch.
3. Other cost-shifting. Studies show that tens of billions of dollars a year of uncompensated health care to the uninsured is provided by medical providers. They try to offset these costs by negotiating higher payment rates from private insurers. The same is true for government-funded programs. As these programs have attempted to control costs by simply paying less, providers have tried to recoup those reductions through higher fees to health plans. In each case, the ultimate cost is passed on to the consumer. Some groups think this kind of cost-shifting adds 5-10% to annual premium rates.
There are, of course, lots of other reasons for the rapidly increasing health insurance rates. These are few of the less discussed that we ought to talk about more.
*This blog post was originally published at See First Blog*
July 26th, 2009 by scanman in Better Health Network, True Stories
Tags: Cheating, Delayed, Dictation, Radiology, Surgery
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via The Trial of a WhiteCoat – Part 14.
The radiologist that read the film had a habit of going to the surgeons the following day and asking them what they had found. He would open up a blank report so that it looked as if it was dictated at the time of the exam, but would then hold the reports as “preliminary” and finalize them after dictating in the results of the surgeries. That way it looked like he had picked up on all these small findings before anyone else knew about them. He was a decent radiologist, so no one seemed to mind that he was adding all these findings after the fact. Now it burned me.
I’m offended.
No.
That’s too light.
I’m pissed off as hell.
I believe the Americans call this kind of thing “Monday morning quarterbacking.”
Whatever you might call it, this is cheating in my book.
I don’t know why they let that radiologist get away with this kind of behaviour.
Moreover, I can’t believe that anyone would take the man’s reports seriously, leave alone the surgeons that he got information from. If by chance I was a surgeon in that hospital, I would intentionally throw him red herrings.
In case you haven’t been following Whitecoat’s account of his malpractice case, see previous posts of his epic saga here. Far better than reading any crime/legal thriller, cheap or otherwise. John Grisham could take lessons from Whitecoat.
*This blog post was originally published at scan man's notes*
July 26th, 2009 by Joseph Banken, Ph.D. in Better Health Network
Tags: Depression, Job Loss, Mind-Body Connection, Psychiatry, Psychology, Rejection
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Two very interesting articles were published recently on the health effects of job loss and on-the-job rejection.
The first article looks at the health of people who have been fired. They limited their study to previously healthy adults who got sick after they lost their jobs. It didn’t seem to matter why they were let go or how quickly they found a new job. Kate Stully, an assistant professor in sociology at the State University of New York at Albany and author of “Job Loss Can Make You Sick” found that losing a job is linked to a higher risk for high blood pressure, heart disease, heart attack, diabetes or depression. I would also add an increased risk of suicide to this list.
The second article looks at what happens when you’ve been left out (or just think you’ve been left out) of the loop at work. Purdue University’s professor of psychological sciences, Kipling D. Williams, reported that hurt feelings for a perceived slight can affect morale, hurt job performance and productivity, and can even hurt the company financially in his article, “Avoid the Dark About Effects of Leaving Others Out of the Loop”.
The first article looks at how we define ourselves and our place in society by our jobs. The second looks at how damaging a perceived slight can be to productivity. Now these two articles on the surface seem to be talking about two different things. But if we take a closer look, aren’t both of these articles talking about the effects of rejection?
No matter how much we would like to say we don’t care what other people think, we really do care much more so than we might think. And it hurts when we feel left out or feel unwanted. According to the first article, it can even make us physically sick. It matters that we feel needed and accepted by those who play a large part in our lives. And let’s face it; we spend a lot of time with our coworkers so it would naturally follow that these people would have some influence over how we feel about ourselves.
The second article explains how just a small amount of the cold shoulder can have a significant impact on how we feel about ourselves and how we perceive others feel about us.
So how do we cope with feelings of rejection in the workplace? Most of us spend more time with coworkers than we do our families, so they often become our second family. In some cases, our work family may be the only one we’ve got. And family rejection is often the most devastating to our self-worth.
The first step in dealing with any rejection is a critical look at the rejecter as well as the rejected. Is she really rejecting me by talking with another coworker? Sure, we were a team in the meeting, but after the meeting she talked to someone else in the hall. Does this mean rejection, or does this mean she had a follow-up comment to something that person said in the meeting? Is my being fired from my job a reflection on my job performance or downsizing of the company? If it is my performance, was the job really a good fit to begin with? How could I have changed the outcome to better serve me? Could I have stepped up my performance, or changed jobs to one that I liked better? How will I deal with this in the future? Do I really want to be a part of this group in the first place? Is my desire for alliance with this group solely based on popularity? Does this group fit with my own morals and ideals? We all want to fit in, but not at the expense of losing ourselves in the process.
The second step is to realize that in order to feel rejection we must first give someone else the power to do so. Am I setting myself up for rejection? According to psychiatrist, Karen Horney, we tend to move toward, away from, or against others. Am I open and meeting others half way? Am I waiting for others to come to me or making others work harder to approach me? Or am I mistakenly pushing others away from me by rubbing them the wrong way or coming on too strong when all I really want to do is connect? Am I trying to alienate others before they get the chance to alienate or reject me?
The third step is to understand that rejection is a negative experience just like any other and that the hurt lessens when shared with others. Sometimes we can “feel” rejection when we are not being rejected at all. If I was cheated on by a loved one, or a family member raked me over the coals for showing up late for dinner, I would find a sympathetic ear to talk it out with. By discussing rejection, we find that we are not alone. We may even find that our story is not so bad when others share their horror stories of rejection. And don’t worry about fearing that we’ve blown the situation out of proportion. Maybe we have not been rejected at all. Our true friends will be the first to tell us when we are full of hot air. Our fake friends will be the last to tell us when we are wearing our underwear on our heads!
I’ll leave you with a couple of quotes on fitting in:
“I refuse to join any club that would have me as a member” Groucho Marx
“I want my individuality, so why can’t I get a tattoo? Everyone else is.” My neighbor’s teenager
The floor is now open for your comments. Please join in.
*This blog post was originally published at eDocAmerica*
July 26th, 2009 by KerriSparling in Better Health Network, True Stories
Tags: Antibiotics, Clinics, Dexcom, Diabetes, Dumb Doctor, Infectious Disease, Primary Care, Type 1 Diabetes, Urinary Tract Infection, UTI
1 Comment »
Earlier this week, I had a bit of a medical issue. Painful urination, high blood sugars, and the constant need to pee. (Ladies, I know you already know what’s up.) Urinary tract infection looming large. I was livid, because it was the day before I was scheduled to travel for this week’s business.
I haven’t got time for the pain, so I called my primary care physician, Dr. CT. “Hi Nurse of Dr. CT! It’s Kerri Sparling. Listen, I’m pretty sure I either have a kidney stone or a urinary tract infection, and I need to rule it out before I leave for a week-long business trip.”
Dr. CT was on jury duty. Damnit. So I had to call a local walk-in clinic, instead.
The clinic was a hole in the wall. Part of a strip mall structure. My confidence wasn’t high, but my blood sugars were and my whole body was screaming for attention, so I knew I had to follow through.
The receptionist was very nice. The nurse was even nicer. They took my blood pressure (110/74), my temperature (98.8) and a urine sample (ew). 
I should have known from the moment the sample cup was given to me that it wasn’t going to be a fun visit. The very kind nurse handed me this —>
That is not a urine sample cup. That’s like a party cup that you use for lemonade on a hot summer day. Not for pee. Oh God.
And then the doctor came in. For the sake of anonymity, we’ll call him Dr. Idiot.
“Hi. I’m Dr. Idiot.”
“Hi, I’m Kerri.”
“Kerri, I see you are here for pain when urinating. Are you urinating frequently? You see, you are spilling a significant amount of urine. I believe we may have found the source of your troubles.”
He closed his file, proud of himself.
“Dr. Idiot? On my chart there I wrote that I have type 1 diabetes. I know my blood sugar is elevated right now, which sucks but at least it’s not a surprise. But that’s not why I’m here. I actually suspect that …”
He cut me off.
“I think we need to address this first problem. You are aware of your diabetes, you say? How many times a month do you check your sugar? You know, with the glucose machine and the finger pricker?”
If I wore bifocals, it’s at this point that I would have slid them down my nose and given him a hard, Sam Eagle-type stare.
“I test about 12 – 15 times a day. But the real reason …”
“You mean a month,” he corrected me.
“No, I mean a day. I have type 1 diabetes. I wear a continuous glucose sensor. And also an insulin pump. I’m very aware of my condition, and I’m also very aware that it’s slipping out of control today because of this other issue, the pain issue. Can we talk about that?”
He looked at my chart again. “So you don’t use a meter?”
“Sir, I use a meter. And a machine that reads the glucose levels of my interstitial fluid. This is in addition to my insulin pump. I don’t mean to be rude but …”
Now he gave me a hard look. “Why the interstitial fluid? Why not the blood directly? I mean, you could have more precise readings with the blood.” He picked up my Dexcom from the chair next to me and pressed a few buttons to light up the screen. (Mind you, he did not have permission to touch it, but I’m again not saying anything.)
“You mean like a pick line? I don’t know. I’m sorry. Ask them?”
“Yes, but it would make much more sense and …”
I just about lost it.
“I’m sorry. I didn’t come here to talk about that. I want to talk about the issue I’m here for. Which is not diabetes. Or your ambitions to know more about CGMs. Please can we address what I’m here for?”
“The sugar in your urine.” With finality, he says this.
“NO. The fact that I think I have a UTI or a kidney stone. Please. Help. Me?”
I kid you not – we went ’round and ’round about this for another ten minutes. He didn’t believe me that I was at least sort of familiar with diabetes. His ignorance included, but wasn’t limited to, the following statements:
- “High sugar causes frequent urination. Maybe that’s why you are peeing often?” (Not because I was drinking a liter of water per hour to flush my system? Nooo, couldn’t be that.)
- “Did you have weight loss surgery?”
- “Grape juice also causes high blood sugar.”
- “That thing should really be pulling blood samples. Pointless otherwise.” (Meaning my Dexcom.)
- “The urinalysis won’t be back until Friday, and in the meantime you should start on a regimen of insulin immediately.”
- And also: “I didn’t peg you for a pink girl.” (Are. You. Serious??)
The end result, after an escalating argument that involved me yelling, “Stop. Talking about my diabetes and PLEASE focus why I’m here!” was a prescription for Macrobid that I could elect to take if my symptoms didn’t alleviate, and the instructions to call back on Friday for official lab results.
“Thank you. Really. Can I go now?”
He at least had the decency to look ashamed.
I’ve had some wonderful doctors over the last 30 years, and my health is better for it. But this guy? Complete disappointment.
*This blog post was originally published at Six Until Me.*
July 25th, 2009 by DrWes in Better Health Network, Humor
Tags: Better Health, conference, Event, Medblogger, National Press Club, Paul Ryan, Putting Patients First
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Once again, I have to thank Dr. Val Jones for setting up the Putting Patients First event at the National Press Club in Washington DC on Friday. For a full summary of the pagentry, Dr. Rich does a much better job summarizing the whole event than I ever could, though I was uh, surprised about what he said of me (thanks, dude).
But one thing he forgot to mention was the moment when our moderator asked us what struck us most about what Congressman Paul Ryan had to say in his speech to us. I, being ever soft-spoken, piped up that I was struck that no one had read the bill and it was already on its way to the floor after being completely “marked up” early that very same morning.
So, while we might not have been chasing windmills at this event, I couldn’t help but wonder if it might come to this (with appologies to GA Harker, whose illustration I couldn’t help but Photoshop):
Click image to enlarge
-Wes
*This blog post was originally published at Dr. Wes*
