August 1st, 2009 by MotherJonesRN in Better Health Network, Expert Interviews, Health Policy
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I love the Internet. It has a way of bringing people closer together. I saw Governor Howard Dean at a town hall meeting in Washington D.C earlier this month. He’s a dynamic speaker. I wanted to ask him some questions, but the place was packed, so I couldn’t get close to him. Not to be deterred, I emailed Governor Dean in hopes of getting a response to a couple of my questions. He not only responded to my email, he agreed to an interview for my blog. See, the Internet really can bring people closer together. I want to thank Governor Dean for stopping by Nurse Ratched’s Place to talk about healthcare reform.
Question: What is your take on the state of our healthcare system? What do you envision for our system, and how do we get there from here? Can America really afford a public option plan?
Answer: Our system is in disarray. We need a system in which the American consumer has real choices, including allowing people under 65 to sign up for Medicare, which is what the public option will look like. That way people can get affordable insurance which can never be taken away, which can’t be denied, and which will follow them through every job, every loss of job, and every move. We can’t afford NOT to have a public option.
Question: How flexible is the public option: will a person be able to move between the public option and private options as their needs and circumstances change?
Answer: People will be able to move back and forth between the public option and private insurance plans as they see fit, up to once a year.
Question: Given your unique perspective as a physician, can you tell us one aspect of the public option that you like and one aspect that you might not be happy with?
Answer: As a physician I would sign up for the public option at once if it is cheaper than what I have now. I would definitely sign my twenty something kids up; it would give them insurance for life at a reasonable cost no matter what they were doing and where they were living.
Question: One of my nursing coworkers wanted me to ask you this question. How will healthcare reform impact nursing workforce issues? Will we see mandated caps on salaries, and how will healthcare reform impact nurse to patient ratios?
Answer: Workforce issues are not addressed in any of the health care options being discussed in Congress. Most Democrats I know favor nurse/patient staff ratios to protect quality of care.
Question: Preventative healthcare is a key component in the healthcare reform debate. What are your thoughts on a proposal that would make the Chief Nurse Officer of the United States Public Health Service the National Nurse? In your opinion, would establishing the Office of the National Nurse have any impact on health promotion or on healthcare reform?
Answer: As a lot of people know, I am a huge supporter of the Office of National Nurse, and since Congress has been slow to act, I am hoping some changes can be made directly by HHS while we await more complete action by Congress.
*This blog post was originally published at Nurse Ratched's Place*
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 7th, 2009 by Emergiblog in Better Health Network, True Stories
1 Comment »
Why shouldn’t we have to pay for our health care?
Why….we don’t have that sort of money!!! How dare you even suggest that we should pay!!!!
We manage to buy cigarettes. We manage to buy fast food. Often. We manage to get all the channels we want via cable or satellite television. Some of us even have satellite radio in our cars. And GPS. Our cell phones are really nice, but all that texting costs a pretty penny. We drop a few bucks at Starbucks every week without thinking twice.
And then we roll our eyes when we have to pay for….god forbid…..health care!
*****
Think I’m heartless? Think I’m an elitist?
Think I’m talking about the Medicare patients in my ER who bring in a super-sized number 8 from McDonalds for the entire family and hold out their right arm for a BP while they text rapidly with their left hand?
I could be.
But I’m not.
The patient rolling their eyes at having to pay was me.
*****
Yeah.
Me.
Showed up for a colonoscopy yesterday and the receptionist went over what would and would not be covered by my insurance.
My out-of-pocket payment would be $216.
And my first thought was “why the hell am I paying anything out of pocket for this? I have insurance!”
I was ticked.
*****
But why was I ticked?
Why shouldn’t I have to incur out-of-pocket expenses?
I have insurance. Good insurance. Insurance I don’t pay a single penny for. It’s a benefit I get from my employer for working 24 hours a week.
Did I think I was entitled to full coverage because I was insured?
Entitled?
Me?
*****
Isn’t that term used to describe some patients who get their health care for “free” through a public plan?
Well, I get my coverage for “free”, too, and god help me, the emotion I felt in that office yesterday was “entitlement”.
Now I understand.
And I won’t use that term again.
Ever.
*This blog post was originally published at Emergiblog*
July 6th, 2009 by MotherJonesRN in Better Health Network, Health Policy
2 Comments »
My apologies to James Carville. I plagiarized his tagline because the insurance industry has forgotten about sick people during our national healthcare debate.
I remember when nurses and insurance companies use to get along with each other. Back in the 1960s, these nurses even took time out of their busy schedules to pose for one of their ads. We took care of patients at the bedside, and the insurance companies paid the hospital bill. It was as simple as that, but then things started to change. It began with three little letters—HMO.
Insurance companies are spending a lot of time and money trying to scare people into opposing President Barack Obama’s ideas on health care reform. They are especially working hard to torpedo the public option plan. That plan would allow you to keep your own private health insurance policy or buy affordable health insurance through a public plan. Insurers are going all out to make you hate this idea by making claims that aren’t true. They are saying that the government is going to ration health care by dictating which doctor you can see, and by making you wait weeks to see a specialist. Ironic isn’t it? The insurance industry is already doing these things to patients everyday via their HMOs. We wouldn’t even be having this debate if they were playing fair in the first place.
Insurance companies make their money a couple of different ways. They rack in the bucks by not insuring people who are sick, a practice known as cherry picking, and by not paying out claims. They also make money by cutting out competition. This is the real reason why insurers are trying to muscle Uncle Sam out of the insurance business. Medicare administrative costs are equal to about 2 percent of what it pays out to providers. For private insurers the ratio over expenses to payments is typically over 15 percent. Why the big difference? Insurance companies have high overhead. Their CEOs take home mega-million dollar paychecks, they have to take care of their shareholders, and they have to pay for fancy ads that convince consumers that they will have health coverage when they really need it. They need those fancy ads. Insurance companies are always looking for ways to deny our claims, but I digress. Competition between private companies and a public plan would hit insurance companies right where it hurts—in their wallets. Fewer customers in private plans means less profits, and less profits, up to 20 to 30 percent by some estimates, means fewer martini lunches for those at the top of the corporate food chain. To make matters worse, those greedy folks who make money by NOT paying for care would have to lower their profit margin on the customers they do keep in order to compete with the government.
I’ll never forget the day that I learned about HMOs. I came into work and found red dots on the side of a few patient charts. My head nurse told me that the dots were put there to prompt doctors to discharge patients as soon as possible so that the hospital and the insurance company could make more money. That was twenty-five years ago and the system has been in freefall ever since. Year after year, nurses are voted as the most trusted profession in America in Gallup’s annual survey of professions for their honesty and ethical standards. We are patient advocates, and we never put anything above what’s best for our patients. That’s why I’m putting my seal of approval on President Obama’s public health insurance plan, and so are the American Nurses Association (ANA) and the SEIU. The insurance companies want your money. Nurses want to take care of their patients. We want all Americans to have affordable, high-quality healthcare.
*This blog post was originally published at Nurse Ratched's Place*
June 28th, 2009 by Emergiblog in Better Health Network, Health Policy
4 Comments »
Well, apparently they call a nurse!
Either that or Nurse Nellie caused the headache.
But we know that nurses never cause doctors to have headaches, so that can’t be what’s happening.
Ha!
Trust me, there have been a few doctors over the years that have given me major headaches and I have no doubt that I have been the impetus behind a few MD migraines myself!
**********
The guy in the Anacin ad must be doing what I’ve been doing for the last two days.
Trying to get a grip on healthcare reform.
That alone is enough to give you a migraine.
There is so much information and conjecture and opinion and debate, it is difficult to know where to start.
Who gets covered? What gets covered? Who pays? Who decides the charges? Who decides the fees? Who has an agenda: political, financial or otherwise? Private or public plan?
And the most important question of all: Who is fighting for what is best for the patient?
Because, when all is said and done, WE are “the patient”.
*****
Okay, so I’ve come up with some foundations; these are things that I feel must be at the heart of any health care reform debate:
1. Every citizen must have health care coverage.
2. Every citizen needs to own their health care coverage.
3. There should be a choice between private and public plans.
4. Every citizen must be able to choose between a private or a public plan and switch between as necessary.
5. Each plan must cover basic health care: physicals, screening, immunizations, well care.
6. Each plan must cover chronic or catastrophic illnesses. (Diabetes, asthma, MS, cancer – just a few examples)
7. After basic health care and chronic/catastrophic illness, each citizen should be able to choose how they want to be covered. I have heard this called the “cafeteria plan”.
*****
Gee, I don’t ask for much, do I?
We don’t have to invent the wheel here. Other countries have gone before us; there are models of universal coverage we can study.
The operative word here is “study”. Take what is good, understand what does not work and use that knowledge to form a unique form of universal health care that meets the needs of the citizens of the United States.
*****
Probably the easiest way to tackle health care is from a personal angle.
I just found out what my COBRA payment would be if I left my job tomorrow.
I’m hoping my jaw heals before I go to work on Thursday.
But that’s a topic for the next post.
*This blog post was originally published at Emergiblog*
I love the Internet. It has a way of bringing people closer together. I saw Governor Howard Dean at a town hall meeting in Washington D.C earlier this month. He’s a dynamic speaker. I wanted to ask him some questions, but the place was packed, so I couldn’t get close to him. Not to be deterred, I emailed Governor Dean in hopes of getting a response to a couple of my questions. He not only responded to my email, he agreed to an interview for my blog. See, the Internet really can bring people closer together. I want to thank Governor Dean for stopping by Nurse Ratched’s Place to talk about healthcare reform.
