July 17th, 2009 by Emergiblog in Better Health Network
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What is this?
An illustration from “Physical Therapy for Zombies”?
Seriously.
The crutches are way too long and there is no banister on the stairs.
Actually, I don’t even see a second crutch.
Is the nurse is standing by or running up to rescue this guy?
If he is trying to elope, he isn’t going to get far!
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I figure if you are trying to understand something, begin with how it affects you. Make it personal, and it’s easier to grasp.
So I took on my health insurance coverage. I am covered through my employer, but surely I could get comparable coverage as an independent buyer.
Right?
*crickets*
*****
I am covered by Anthem Blue Cross. You know, Blue Cross. The company that used to be the Gold Standard of health insurance? The one my physician no longer accepts because of their reimbursement rates? I figured my best bet was to check out and compare coverage from the same company, so I hit the Anthem Blue Cross website to try and get a quote.
You can get an overview of policies, but they make you put in your phone number so a representative can call you. I didn’t mind, as I had some questions. I spoke with Danny, who was very helpful.
But before I go any farther, you should know one thing. Just in case you are looking to purchase a private plan.
If you have insulin-dependent diabetes, Anthem Blue Cross will not issue you a private policy.
Whoa. Found that out when I asked about pre-existing conditions. I had always heard that folks were denied coverage for pre-existing conditions, but to actually hear it coming from a representative floored me.
*****
If I wanted to quit my nursing job tomorrow and make my living blogging (offers accepted), I would need to purchase insurance. I could go with COBRA and buy through my hospital for 18 months, or I could buy my own policy.
The payment for COBRA coverage for a family of three adults (ages 55, 52 and 19) is $2157.00 per month. That is $25884 per year, and includes everything from pediatric well-baby checks to maternity coverage.
Twenty Five Thousand, Eight Hundred and Eighty-Four dollars a year.
Pardon me while I go take a meclizine, just typing that number gave me vertigo.
Private PPO insurance for the same family of three, through the same company, with coverage for brand-name medications is $897, or $10,764 per year.
Huge difference.
On the surface.
*****
To get the private-pay plan you must be vetted. Screened. They will take you if you have high blood pressure, but only if you are controlled and have been on meds for a certain amount of time. Same with high cholesterol. Same with GERD. I’ve already mentioned the diabetes. If you don’t meet their criteria, it’s “buh bye”.
My friend in Human Resources told me that our insurance coverage was “more robust” than what was offered in the private plan. Our deductibles are less, our out-of-pocket per-year expenses are less, our co-pays are much less.
She was right.
But I am still confused.
And I have a lot of questions.
- Why is my employer paying for coverage I no longer need? I’m long past needing the services of a pediatrician and maternity coverage is not an issue (been there, done that, may my ovaries Rest in Peace). Why can I not opt out of these things, saving my employer money? What if I did not want coverage for mental health, for example? The private pay plan is available without maternity care.
- Why can’t I have the money that is spent on my health insurance premiums (more than some people make in an entire year!) put in a savings account that allows me, as an individual, to choose what type of coverage I want to have? And have whatever is left available to pay co-pays and deductibles? They are paying the money anyway – why not put it in the control of the patient/employee.
- Where the hell does the private insurance industry get the authority to decide who they will and will not cover? Is that not discrimination?
- What happens when/if I develop an illness that would have denied me private coverage to start with? Am I dumped? Is the illness covered? For how long?
And I still don’t understand…
- Why my doctor charges $140 for a visit, I pay $15 and the insurance company pays another $40, and my doctor winds up with only 39% of his fee? No wonder he doesn’t take new patients with Blue Cross. What other profession has no control over their reimbursement?
- Why, with my background as a nurse, I still am unable to make sense of an “Explanation of Benefits” report. There is an actual fee, a negotiated fee, a deductible, a co-insurance portion and then what is left is for me to pay. And trust me, the amount paid by either the insurance and/or myself never, ever amounts to the actual fee. Ever.
- Why I have a bill for lab tests and screening exams that far exceeds what my deductible is for the year, and yet the deductible is not yet satisfied. Seems to me I’ve paid out the deductible-times-five and yet it is still not satisfied.
I don’t even know where to start to try and get an handle on this.
Either I’m an idiot or the system is way out of control.
Maybe both.
But I do know this. I am a 52-year-old woman who is welded to her employment solely for the medical benefits. I’m getting older, I am going to need coverage for conditions and diseases that I did not have to worry about in my 30s. Every decision I make, whether it be a new job or attending school full-time at a university will be decided by the availability of health insurance and what it covers.
Thank god I have that coverage.
I just wish I had more control over how it was applied.
Lord knows I could do it more efficiently.
*This blog post was originally published at Emergiblog*
July 17th, 2009 by Paul Auerbach, M.D. in Health Tips
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In the May 14, 2009 issue of the New England Journal of Medicine, in an article entitled “Antivenom for Critically Ill Children with Neurotoxicity from Scorpion Stings,” Dr. Leslie Boyer and colleagues report the results of a study in which the efficacy of scorpion-specific F(ab)’2 antivenom was compared to placebo in the treatment of 15 children ages 6 months to 18 years who were admitted to a pediatric intensive care unit with clinically significant signs of scorpion envenomation (N Engl J Med 2009;360:2090-8). The primary clinical end point was the resolution of the clinical syndrome within 4 hours after administration of the study drug. Secondary end points included the total dose of concomitant midazolam (Versed) – a sedative – and quantitative plasma (bloodstream) venom levels, before and after treatment.
The results showed that the clinical syndrome resolved more rapidly among recipients of the antivenom than among recipients of placebo, with a resolution of symptoms in all 8 antivenom recipients versus one of 7 placebo recipients within 4 hours after treatment. More midazolam was given to the placebo recipients (by necessity to treat symptoms) than in the antivenom recipients. Plasma venom concentrations were undetectable in all 8 antivenom recipients, but in only one placebo recipient one hour after treatment, which indicates that the antivenom neutralized circulating antivenom.
The conclusions are very helpful for clinicians treating scorpion envenomation syndromes with neurotoxic manifestations in critically ill children. They are that intravenous administration of scorpion-specific F(ab)’2 antivenom resolved the clinical syndrome within 4 hours, reduced the need for concomitant sedation with midazolam, and reduced the levels of circulating unbound venom.
This is very important new information. It is estimated that in North America, predominately in Mexico, more than 250,000 people per year are stung by scorpions. The major culprits are of the genus Centruroides. The antivenom used in this study was scorpion-specific F(ab)’2 antivenom (Anascorp, Centruroides [scorpion] immune F(ab)2 intravenous [equine], Instituto Bioclon).
The authors note that there has never been an approved, marketed antivenom therapy for scorpion envenomation in the United States. The only previously available scorpion antivenom in the U.S. was a goat-derived whole IgG (immunoglobulin G) preparation that has not been produced since 1999. Based on the current study, it now appears that there is a relatively safe product for treatment of critically ill children. Its use for critically ill adults and for children and adults with non-critical scorpion envenomation syndromes remains to be studied with the degree of rigor necessary to suggest its regulatory approval for use in the U.S.
image courtesy of about.com: Phoenix
This post, At Last: An Antidote For Scorpion Stings, was originally published on
Healthine.com by Paul Auerbach, M.D..
July 16th, 2009 by DrRob in Better Health Network, Health Policy, Opinion
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It seemed like a reasonable plan.
I was having trouble keeping track of my chickens – they kept somehow escaping from their coop. So I figured that I would set guards to make sure none of them got out any more. I got some rabid wolves and put them outside of the coop, figuring that they would scare the chickens enough to stay in their place.
But here’s the problem: these rabid wolves are eating my chickens! Can you believe it?? You would think they’d have the moral decency to respect the fact that I hired them to guard my chickens, but now they try to bite me whenever I go out there! It’s amazing to me that these wolves would act in such a way. What’s the world coming to when you can’t trust rabid wolves to guard your chickens??
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What? You think I’m crazy? Take a look at our healthcare system! This is exactly what we are doing with our healthcare dollars.
In a recent article, Ezra Klein (coincidentally mentioned in two consecutive posts) discussed Wendell Potter, a disillusioned insurance executive who shared why he left the industry. Potter explained that the for-profit insurance industry (Cigna in this case) uses the following tactics to maximize profits:
The industry, Potter says, is driven by “two key figures: earnings per share and the medical-loss ratio, or medical-benefit ratio, as the industry now terms it. That is the ratio between what the company actually pays out in claims and what it has left over to cover sales, marketing, underwriting and other administrative expenses and, of course, profits.”
So it seems that a for-profit company is in it for the profit. Disgusting. Klein goes on:
The best way to drive down “medical-loss,” explains Potter, is to stop insuring unhealthy people. You won’t, after all, have to spend very much of a healthy person’s dollar on medical care because he or she won’t need much medical care. And the insurance industry accomplishes this through two main policies. “One is policy rescission,” says Potter. “They look carefully to see if a sick policyholder may have omitted a minor illness, a pre-existing condition, when applying for coverage, and then they use that as justification to cancel the policy, even if the enrollee has never missed a premium payment.”
So the insurance industry is “cherry-picking” healthy people to insure – people they won’t have to pay much on – and dumping unhealthy people. How can this happen? How can the insurance industry be taking money from the system and using it for their own profits?
But who is actually the problem here? Are the Wolves evil for eating my chickens? No, they are just acting like wolves. I am the fool for trusting them to watch my chickens without getting taking advantage of their position. Putting for-profit insurance companies in charge of huge sums of money is just as foolish. As Klein states:
The issue isn’t that insurance companies are evil. It’s that they need to be profitable. They have a fiduciary responsibility to maximize profit for shareholders. And as Potter explains, he’s watched an insurer’s stock price fall by more than 20 percent in a single day because the first-quarter medical-loss ratio had increased from 77.9 percent to 79.4 percent.
Actually, I think Mr. Klein understates it a touch. It isn’t that the insurance companies need to be profitable; they are under huge pressures from shareholders to maximize their profits. They are being pressured to milk as much money from the system as possible. Maggie Mahar underlines this fact:
Potter is right. Disappointed shareholders can be brutal. And it doesn’t take much to disappoint them. In this case investors sent the share price plummeting because the insurer had the poor judgment to increase the amount that it paid out to doctors, hospitals and patients by 1.5 percent.
Even if an intelligent CEO wanted to do the right thing, take the long-term view, and provide labor intensive chronic disease management so that, over the long term, customers would be healthier—the CEO of a large publicly-traded insurance company probably wouldn’t keep his job long enough to find out whether or not his ideas worked. This helps explain why for-profit insurers have not followed the example of non-profit insurers and created “accountable care organizations” like Geisinger or InterMountain.
Those who have followed this blog have heard me say it before: the system won’t change until we stop trusting for-profit insurance companies to guard the money. Those who are morally indignant over the fact that these companies would milk the system as they do are blustering in the wrong direction. You don’t blame wolves for acting like wolves, and you don’t blame for-profit publicly-held companies for trying to maximize profit. They are just being themselves. We are the idiots – assuming they could be trusted in this position.
Obviously, the best solution is to put the politicians and lobbyists in charge. Surely they are trustworthy.
Image Credit
*This blog post was originally published at Musings of a Distractible Mind*
July 16th, 2009 by Joseph Banken, Ph.D. in Better Health Network, Opinion
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Since the publication of Norman Vincent Peale’s 1952 book called The Power of Positive Thinking, the world has been bombarded with a plethora of self-help books guaranteed to show us the way to happiness. But is there a down-side to these suggestions?
If we do as instructed, by a multitude of sources, to push away the negative, or bad thoughts and focus only on the positive, or good thoughts, how do we prepare for the bad times of reality?
Come with me, if you will, on a journey through the cluttered half-baked theories of my mind, but watch your step, there’s no liability insurance in here. If you trip into the corpus callosum, you’re on your own.
Part one of the half-baked journey begins with the extreme outcome of pure positive thinking. If I am truly thinking positively, then nothing at all could possibly go wrong, I have nothing to worry about, I am perfect just the way I am, and the world exists just so that I might gain pleasure from it.
If nothing could go wrong, why should I plan for a rainy day? My job will last forever, the roof will never leak, and my kids will remain perfectly healthy. There is only sunshine in my world.
If there is nothing to worry about, then I can count my life savings while walking down a dark alley without fear, my car will last forever- that banging under the hood means nothing and adds an interesting beat to the music playing on the radio, and I will never grow old. Throw away the botox; there are no wrinkles here.
If I am perfect just the way I am, why should I exercise to take off that extra ten pounds, why should I try to improve my mind with literature, the theater, or a higher degree. Why should I get off the couch?
If I buy into this extreme sport of pure positive thinking, why would I work like a dog to get ahead? Wouldn’t I be perfect enough for everything to be given to me?
Now for part two of the half-baked journey; are you still with me? We are getting really deep in the frontal lobes now.
If I remain in a positive thinking mode until I gain a serene, carefree state, does that mean my brain is unstimulated? And in turn, does that mean that the firing of neurons has diminished so much that if danger were to occur, I would not be able to act quickly enough for self-preservation? Would I react at all if I were a true positive thinker? What could happen if I stayed on the couch?
Let’s go back to the unstimulated idea. If I continue to not stimulate my brain, will my brain begin to deteriorate? After all, the old adage “Use it or Lose it” has been around longer than “Think Positively”. Let’s throw in another adage: Necessity is the Mother of Invention. That being said, if we have no necessity because we are positively thinking about everything and therefore need nothing new, why would we trouble ourselves to invent new things?
If I remain unstimulated for an extended period of time, what will happen to my mood? If there are no highs or lows, no release of adrenaline to handle excitement or danger, no need for the release of serotonin or dopamine to stimulate my brain, will these receptors be decommissioned as no longer needed? Will my mood sink into depression?
Now for the flip side of this saga.
What if I experienced continual negative thoughts? Would my life mirror the same lack of moving forward I found while hanging out on the couch with positive thinking? I may have more supplies stored in the basement with negative thinking and the door would be locked, but would my life be any more interesting? Would it be just as flat, but in a negative way?
If danger startled me off of the couch, would I be too paralyzed by negativity to react in time? If I think nothing good will ever happen, have I made this come true simply by closing the door to the possibility?
This leaves us with the good old fence straddlers.
Ordinarily, sitting on the fence is thought of as a bad thing. We are urged to choose a side, be decisive and stick with our convictions. What if I had a mixture of positive and negative thinking tempered with a good dose of reality thinking? Would my life attain a better balance necessary to survival? Would I have happy little neurons firing quickly and efficiently because they were getting a healthy dose of exercise and rest? If I use reality thinking with a mixture of both positive and negative thinking, will I be better prepared to weather hard times?
If I have a huge project due at work, would I be more effective if I used a dose of negative thinking that I don’t have enough time to complete this project, mixed in a little anxiety that if I don’t finish then my job may be finished, added some positive thinking that all I can do is my best, and stirred it around with reality thinking that I’ve proven myself by meeting hard deadlines in the past and have the ability to do so again. My project will most likely be completed on time because I have made this mixture of positive, negative, anxiety and reality work for me instead of against me. Too much positive thinking and I won’t push myself hard enough to make the deadline. Too much negative and I will give up before really trying.
The fence straddlers can enjoy a healthy mixture of both positive and negative thoughts, knowing each has its own value if kept in balance. And the view from the fence is not bad either.
Thank you for coming along on this trip through the half-baked theory region of my mind.
Now that I’ve shared some of my thoughts, feel free to share some of your own.
*This blog post was originally published at eDocAmerica*
July 15th, 2009 by Gwenn Schurgin O'Keeffe, M.D. in Better Health Network, Health Policy
2 Comments »
One of my favorite summer activities is watching reruns of Star Trek Next Generation. It’s become somewhat of a summer tradition in my family the last few summers. Having become trekkies themselves, my kids were able to very much enjoy the recent movie, and get the history and lore behind it.
The longevity of the Star Trek enterprise is fascinating. Decades after it’s first launch, it still captures the imagination of inquiring minds and still provides endless hours of entertainment to viewers of all ages.
Even more amazing than the longevity of it’s run is the technology it represents. When the show first debuted, the sci fi components seemed truly out of reach. Today, much of the technology in the new movie and even some of the older shows doesn’t seem that implausible, especially when it comes to health.
Early Trek was a preview of our current Health 2.0 world. When first portrayed, that was not a concept any of us could grasp. Think about it. In the original series, and continuing through to the latest movie, they used communicators in high tech ways with online computers to search data bases and emails and video calls to talk between doctors at different inter-stellar locations. The doctors even had high tech gizmos to look inside and offer a 3-d look within. All medical records were online and available anywhere. New advances in medicine came from experience, science as well as other cultures and the experience of the treating physician. Patients and doctors could review information online and use that to improve their own care.
What wasn’t so out of reach was the portrayal of the practice of medicine and the limitations of what the human physician could achieve. The bedside manner was always first and foremost the key element to a patient’s survival. The physician treated all patients, regardless of species, and had tolerance for different cultural beliefs in treatment. And, not all patients made it through their ordeal. After all, the doctor was “just a man, not a miracle worker”.
So, Trek’s docs were all health 2.0 with a healthy dose of health 1.0 in that they had these important features:
1. high tech gizmos and computers to diagnose and treat
2. traditional docs to take a history and offer counsel but computerized medical records
3. limits on what could be done
4. online communication with “Googling” ability
5. New advances and lessons from other species to tackle new issues and problems
Sounds a great deal like our health system, minus the insurance headaches, huh?
The practice of medicine is begging to be more health 2.0 but with doctors who very much want and need to be involved and keep their health 1.0 skills. Today we have gizmos that keep becoming more high tech…think robotic surgeons. Today we have doctors still driving clinical care with bedside manner still crucial to the success of an outcome. Today we still have limits of what can and can not be done, with a limit of human life, regardless of our efforts to prolong it. Today we have very robust online communication between doctors, between patients, between doctors and patients, and between everyone and the computer, but with an importance still placed on the face-to-face visit.
There’s one big difference between the docs on Trek and us…insurance. Because of that, what we see on Trek is still just a dream. Those docs can do their jobs so admirably and with great patient satisfaction because they are not burdened with an insurance system gone awry and not forced into cycles of defensive medical practices.
Until health reform sorts out how to allow us to have a patient-focused, physician driven system again, what we see on Trek will remain a dream. What’s sad and discouraging is that is this is one sci fi dream that is actually within reach. Don’t you think it’s time we stopped the insurance companies from preventing us from grabbing on?
*This blog post was originally published at Dr. Gwenn Is In*
