New Health Law Brings More From Big Insurance Lobbyists

If you haven't quite figured out that Big Insurance is acting to protect Big Insurance under alleged "health reform" then you should refer to other posts on Natural Health News that explain how there were numerous back office deals with Obama and this industry prior to bill passage.

Most of what has changed will do very little to improve health care quality of service, and you should be watching at every step.

Health Insurance Companies Try to Shape Rules
By ROBERT PEAR

WASHINGTON — Health insurance companies are lobbying federal and state officials in an effort to ward off strict regulation of premiums and profits under the new health care law.

The effort is, in some ways, a continuation of the battle over health care that consumed Congress last year.

Insurance lobbyists are trying to shape regulations that will define “unreasonable” premium increases and require them to pay rebates to consumers if the companies do not spend enough on patient care.
For their part, consumer groups say they worry that their legislative victories could be undone or undercut by the rules being written by the federal government and the states.

The health care overhaul provides a classic example of how the impact of a law depends on regulations needed to interpret it. The rules deal with relatively technical questions but go to the heart of the law, pushed through Congress by President Obama and Democratic leaders with no Republican support.
More than 40 provisions of the law require or permit agencies to issue rules. Lobbyists are focusing on two whose stated purpose is to ensure that consumers “get value for their dollars.”

One bars insurers from carrying out an “unreasonable premium increase” unless they first submit justifications to federal and state officials. Congress did not say what is unreasonable, leaving that to rule writers.

Another provision, effective Jan. 1, requires that a minimum percentage of premium dollars be spent on true medical costs related to patient care — not retained by insurers as profit or used to cover administrative expenses. Insurers must refund money to consumers if they do not meet the standards, known as minimum loss ratios.

Michael W. Fedyna, vice president and chief actuary of Aetna, underlined the importance of this issue, saying no other aspect of the law would be so “influential in shaping the future of the health care marketplace in the United States.”

The definition of medical loss ratio will “determine the willingness of health plans to enter new markets and remain in existing markets,” he said.

Senator John D. Rockefeller IV, Democrat of West Virginia, said the definition would be just as important for consumers and small businesses.

“The health insurance industry has shifted its focus from opposing health care reform to influencing how the new law will be implemented,” he said.

The law requires insurers to spend a minimum percentage of premiums on health care services and “activities that improve health care quality” for patients.

Insurers are eager to classify as many expenses as possible in these categories, so they can meet the new test and avoid paying rebates to policyholders.

Thus, insurers are lobbying for a broad definition of quality improvement activities that would allow them to count spending on health information technology, nurse hot lines and efforts to prevent fraud. They also want to include the cost of reviewing care by doctors and hospitals, to determine if it was appropriate and followed clinical protocols.
Some consumer advocates, like Carmen L. Balber of Consumer Watchdog, favor a strict, narrow definition of quality improvement activities, limited to those that produce measurable benefits to individual patients.

Alissa Fox, a senior vice president of the Blue Cross and Blue Shield Association, said that if the definition is too narrow, “health plans will come under enormous pressure to cut back quality improvement activities, including highly effective programs to reduce hospital infection rates.”

But Charles N. Kahn III, president of the Federation of American Hospitals, a trade group, said he feared that the quality improvement category would become a “catchall for a wide variety of expenses not directly related to patient care.”

Under the new law, insurers in the large group market are generally supposed to spend 85 percent of customers’ premiums on “clinical services” and quality-enhancing activities. The minimum is 80 percent for coverage sold to individuals and small groups.

Insurers and insurance regulators say that some companies will be unable or unwilling to meet the new standards. http://www.nytimes.com/2010/05/16/health/policy/16health.html?ref=health

Saving Billions without Electronic Health Records

The issue of one single set of rules for insurance billing was promulgated in the 1970s. It is now almost 40 years since this was proposed and someone is actually showing what many, including me, have been saying.

Note that is was always Big Insurances that created more layers, more paper, separate paper, and higher cost during this time.

Simpler medical billing saves $7 billion
BOSTON, April 29 (UPI) -- Simplifying and standardizing administrative procedures for medical bills could save about $7 billion a year, U.S. researchers estimate.

Bonnie B. Blanchfield of Massachusetts General Hospital in Boston and colleagues have created a hypothetical model for medical billing that involves a single set of payment rules for multiple payers, a single claim form and standard rules of submission.

If doctors' offices used the streamlined medical billing system they would save 4 hours a week of physician time and 5 hours a week of staff time, Blanchfield said.

The researchers analyzed the billing system of a physician's group affiliated with a large, urban, academic teaching hospital. The researchers found 12.6 percent of submitted claims are initially rejected, but 81 percent are eventually paid -- after using considerable staff time.

"The savings from reducing administrative complexity could be translated into decreased costs in general," the study authors said in a statement. "Mandating a single set of rules, a single claim form, standard rules of submission, and transparent payment adjudication-with corresponding savings to both providers and payers-could provide system wide savings that could translate into better care for Americans."

The findings are published in the journal Health Affairs at http://content.healthaffairs.org/cgi/content/full/hlthaff.2009.0075v1.

Another Glitch May Impair Access Under New Health Insurance Law

Your benefits under health insurance reform can vary depending on where you live.

This clearly is representative of the failure to connect the dots before penning the law, and establishes the failure of the policy writers and planners engaged in this process.

Perhaps the taxpayers should be repaid for the extensive waste of money and resources in the fiasco that does little but line the pockets of Big Insurance.

Clearly this will raise costs and limit benefits.  It also suggests a bigger push toward privatization.

Some States Are Lacking in Health Law Authority

By ROBERT PEAR and KEVIN SACK, New York Times

WASHINGTON — Faced with the need to review insurance rates and enforce a panoply of new rights granted to consumers, states are scrambling to make sure they have the necessary legal authority to carry out the responsibilities being placed on them by President Obama’s health care law.
Insurance commissioners in about half the states say they do not have clear authority to enforce consumer protection standards that take effect next month.
Federal and state officials are searching for ways to plug the gap. Otherwise, they say, the ability of consumers to secure the benefits of the new law could vary widely, depending on where they live.
Meanwhile, state governments that have for years allowed insurers to set premiums virtually at will are gearing up to establish procedures to review rate increases.
Under the new federal standards, insurers generally must offer coverage to children under 19 and must allow adult children up to age 26 to stay on their parents’ policies. Insurers cannot charge co-payments for preventive services or impose a lifetime limit on benefits; must allow consumers to appeal a denial of benefits; and cannot rescind coverage, except in cases of fraud or intentional misrepresentation.
States have the primary role in enforcing many of the new standards. If a state fails to enforce a standard, the federal government will step in to do so — as it did in several states after passage of a health insurance law in 1996.
The federal government recently surveyed states to assess their enforcement capabilities, and the results suggest a patchwork of protections.
California, Florida, Hawaii, Michigan, Nebraska, Oklahoma, Virginia and Wyoming, among other states, said they did not have authority to enforce federal law.
Some state regulators said they would ask state legislators to expand their authority by putting the federal standards into state law next year. Others said they would rely on their powers of persuasion, the good will of insurers or general state laws that ban unfair or deceptive trade practices.
By contrast, Maryland passed a bill in April that explicitly authorizes its insurance commissioner to enforce consumer protections in the new federal law. Similar bills were signed in June by Gov. Bev Perdue of North Carolina and in July by Gov. John Lynch of New Hampshire.
Kathleen Sebelius, the secretary of health and human services, said she realized that “some states may lack the full authority they might need or desire to fully enforce” the new market rules.
The administration said its general approach was to have “states take a lead role in providing consumer protections, with federal enforcement only as a fallback measure.”
Sara Rosenbaum, a professor of health law and policy at George Washington University, said this was an awkward arrangement. “The new law creates detailed federal standards for insurance, but does not give consumers a right to sue if insurers don’t live up to their obligations,” Ms. Rosenbaum said.
Kim Holland, the Oklahoma insurance commissioner, said, “We will have to seek explicit authority from our State Legislature to make sure we can adequately enforce all the new provisions of federal law.”
Ken Ross, the Michigan insurance commissioner, said, “I fully expect insurers to comply,” even though his office “does not currently have clear authority to enforce the consumer protections enacted in federal law.”
Arizona said it was unlikely to pass legislation authorizing any state agency to enforce federal insurance standards, in view of its participation in a lawsuit challenging the federal law. Moreover, it said, Gov. Jan Brewer has “instituted an indefinite rule-making moratorium, so we have no plans to adopt rules related to enforcement” of the law.
Some states hope to secure compliance by using their power to review insurance policy forms and contracts.
In a recent bulletin, the Texas Insurance Department encouraged insurers to file amendments to standard policy forms that would bring them into compliance with federal law. John Greeley, a spokesman for the department, emphasized the word “encouraged.”
“We don’t have authority right now to require it,” Mr. Greeley said.
Florida said that if insurers did not voluntarily revise their contracts, the state “has no legal authority to force them to do so.”
The Nebraska Insurance Department said it did not have “specific authority to order compliance with federal law in the face of a refusal to comply.”
Wyoming said it did not have the authority, under its insurance code or its Unfair Trade Practices Act, to enforce federal law even if it received consumer complaints.
New Jersey, New York and Ohio said they believed they had the power to enforce federal standards.
Gov. David A. Paterson of New York said his state would require insurers to rewrite their contracts to include the new consumer protections. State officials have developed model language. In addition, Mr. Paterson said, the Legislature will consider amending state insurance laws so they “meet or exceed” federal requirements.
Within days, the Obama administration is expected to announce up to $51 million in grants to states to help them perform one of their new duties: reviewing “unreasonable increases in premiums.”
Thirteen states currently have no authority to review proposed health premium increases for most forms of coverage, according to the National Association of Insurance Commissioners. About a dozen have limited power to review increases after they take effect, while half the states require some form of state approval.
With insurers proposing heavy rate increases this year, possibly in anticipation of tougher regulation, several states have exerted their rate review authority with new vigor.
Sandy Praeger, the Kansas insurance commissioner and chairwoman of the health committee for the National Association of Insurance Commissioners, said states were eager to toughen their procedures to ward off federal interest in obtaining that authority. “The pressure is on us to prove that what we do is effective, and for states that don’t have the authority to get it done,” Ms. Praeger said. Many states will require legislation to change their rate review systems, she said.
States are also waiting for the federal Department of Health and Human Services to define unreasonable rate increases.
“That’s the big question,” Ms. Praeger said. “Unreasonable is a rather nebulous term.”

More Problems with Health Insurance Reform

Experience with Publicly Funded Private Health Insurance -

If you think this will just apply to those who speak English as a second language, don't overlook the great probability that Big Insurance will pull this trick on you, even if you are outside the legal immigrant groups.

To the Editor:

On October 31, 2009, Massachusetts involuntarily transferred about 30,000 legal immigrants (mostly “green card” holders) from Commonwealth Care, the state-subsidized insurance program, to a new private insurance plan. CeltiCare, a subsidiary of the out-of-state, for-profit insurer Centene, agreed to take over their care for only $1,300 per person, one third of the state's previous cost1 and well below the average cost of adequate care nationally.23 CeltiCare excluded several hospitals (and their affiliated community health centers) that have traditionally provided safety-net care for immigrants, including Boston Medical Center and Cambridge Health Alliance (CHA), where we work.

We used internal hospital data to determine the characteristics of patients who were transferred to CeltiCare and who had formerly received their primary care at CHA. A total of 1325 patients who had visited a primary care provider at CHA during the past year were moved to CeltiCare. Of these patients, 73% speak a primary language other than English, including Portuguese (24%), Spanish (20%), and Haitian Creole (9%); 19% have hypertension, and 10% have diabetes mellitus. A psychiatric disorder has been diagnosed in at least 9%.

We then evaluated the adequacy of the provider network for these patients. During the second and third months after the switch to CeltiCare, we searched CeltiCare's Web site4 for primary care providers within 5 miles of CHA's ZIP Code. The search returned 326 providers, of whom 217 were nonduplicate adult generalists. Of these providers, 25% could not be reached at the telephone number provided. Of those available by telephone, only 37% were actually accepting new CeltiCare patients, and the average wait for an appointment was 33 days. In all, only 60 providers were accepting new CeltiCare patients, and only 38 could provide service for even one of the three major linguistic minorities.

Given these findings, we believe that patients who were switched from Commonwealth Care to CeltiCare had inadequate access to primary care 3 months into this new program. We fear that such “rationing by inconvenience”5 shuts patients out of care to the detriment of their health but to the benefit of CeltiCare's bottom line. Policymakers, in Massachusetts and nationally, should reassess the role of profit-driven insurers in the provision of safety-net care.

Ruth Hertzman-Miller M.D., M.P.H.
Malgorzata Dawiskiba M.D.
Cassie Frank M.D.
Cambridge Health Alliance, Cambridge, MA
rhertzman-miller@challiance.org

http://www.nejm.org/doi/full/10.1056/NEJMc1005451

Federal Panel Limits Preventive Care

How an Obscure Federal Panel Limits Preventive Care

This time is isn't Big Insurance limiting your access to health care, its Big GOV!

By requiring that insurers cover certain screening tests and other kinds of preventive services, the Affordable Care Act has thrust an obscure federal advisory panel into the spotlight. The U.S. Preventive Services Task Force(USPSTF), which has been around for a quarter of a century, grades preventive services by their clinical value, and the reform law requires that all services with a grade of “A” or “B” be covered. But what Congress didn’t reckon with in adopting this mandate is the conservatism of the USPSTF, which includes primary care doctors but not specialists.

Read Complete Story: 
http://industry.bnet.com/healthcare/10003056/healthcare-reform-how-an-obscure-federal-panel-limits-preventive-care/

Big Insurance: Another Hidden Agenda

Insurers Push Plans That Limit Health Choices
NYTimes.com17 July, 2010, By REED ABELSON

As the Obama administration begins to enact the new national health care law, the country’s biggest insurers are promoting affordable plans with reduced premiums that require participants to use a narrower selection of doctors or hospitals.
The plans, being tested in places like San Diego, New York and Chicago, are likely to appeal especially to small businesses that already provide insurance to their employees, but are concerned about the ever-spiraling cost of coverage.
But large employers, as well, are starting to show some interest, and insurers and consultants expect that, over time, businesses of all sizes will gravitate toward these plans in an effort to cut costs.
The tradeoff, they say, is that more Americans will be asked to pay higher prices for the privilege of choosing or keeping their own doctors if they are outside the new networks. That could come as a surprise to many who remember the repeated assurances from President Obama and other officials that consumers would retain a variety of health-care choices.
But companies may be able to reduce their premiums by as much as 15 percent, the insurers say, by offering the more limited plans.
“What we’re seeing is a definite uptick in interest because, quite frankly, affordability is the most pressing agenda item,” said Dr. Sam Ho, the chief medical officer for UnitedHealth’s health-care plans.
Many insurers also expect the plans to be popular with individuals and small businesses who will purchase coverage in the insurance exchanges, or marketplaces that are mandated under the new health care law and scheduled to take effect in 2014.
Tens of millions of everyday Americans will buy their coverage through those exchanges, a vast pool of new customers, including many of the previously uninsured, whom insurers expect will be willing to accept restrictions to get a better deal.
“What this does is eliminate the Gucci doctors,” said Peter Skoda, the controller of the Haro Bicycle Corporation, a Vista, Calif., business that employs 30 people. Facing a possible 35 percent increase in its rates, Haro switched to an Aetna plan that prevents employees from seeing doctors at two medical groups affiliated with the Scripps Health system in San Diego. If employees go to one of the excluded doctors, they are responsible for paying the whole bill.
“There wasn’t any pushback,” Mr. Skoda said. Haro’s employees are generally young and healthy, he said, and they rarely go to the doctor. Instead, they want to make sure they have adequate coverage if they go to the emergency room.
The company’s premiums average $433 a month, Mr. Skoda said, with employees paying one-fourth of the expense. A few employees opted for more traditional coverage, enabling them to go where they please. But they are paying significantly higher deductibles and out-of-pocket costs that could add thousands of dollars to their medical bills.
The last time health insurers and employers sought to sharply limit patients’ choice was back in the early 1990s, when insurers tried to reinvent themselves by embracing managed care. Instead of just paying doctor and hospital bills, insurers also assumed a greater role in their customers’ medical care by restricting what specialists they could see or which hospitals they could go to.
“Back in the H.M.O. days, it was tight networks, and it did save money,” said Ken Goulet, an executive vice president at WellPoint, one of the nation’s largest private health insurers, which is experimenting with re-introducing the idea in California.
The concept was largely abandoned after the consumer backlash persuaded both employers and health plans that Americans were simply not willing to sacrifice choice. Prominent officials like Mr. Obama and Hillary Rodham Clinton learned to utter the word “choice” at every turn as advocates of overhauling the system.
But choice — or at least choice that will not cost you — is likely to be increasingly scarce as health insurers and employers scramble to find ways of keep premiums from becoming unaffordable. Aetna, Cigna, the UnitedHealth Group and WellPoint are all trying out plans with limited networks.
The size of these networks is typically much smaller than traditional plans. In New York, for example, Aetna offers a narrow-network plan that has about half the doctors and two-thirds of the hospitals the insurer typically offers. People enrolled in this plan are covered only if they go to a doctor or hospital within the network, but insurers are also experimenting with plans that allow a patient to see someone outside the network but pay much more than they would in a traditional plan offering out-of-network benefits.
The insurers are betting these plans will have widespread appeal in the insurance exchanges as individuals gravitate toward the least expensive options. “We think it’s going to grow to be quite a hit over the next few years,” said Mr. Goulet of WellPoint.
The new health care law offers some protection against plans offering overly restrictive networks, said Nancy-Ann DeParle, head of the office of health reform for the White House. Any plan sold in the exchanges will have to meet standards developed to make sure patients have enough choice of doctors and hospitals, she said.
Ms. DeParle said the goal of health reform was to make sure people retained a choice of doctors and hospitals, but also to create an environment where insurers would offer coverage that was both high quality and affordable. “What the Congress and the president tried to accomplish through reform is to transform the marketplace by building on the existing system,” she said.
But most of these efforts have been limited to a small number of markets. How widespread these plans will become is anybody’s guess, and some benefits consultants wonder if these plans represent any real solution to high medical costs. The narrow network, if it is based on the insurers’ ability to demand low prices, may be “just another short-term fix,” warned Barry Schilmeister, a consultant at Mercer.
What’s more, no one is predicting a wholesale return of the classic H.M.O. as an employee’s only option of health plan. “We went through the choice battle with the managed care wars,” said Andrew Webber, the chief executive of the National Business Coalition on Health, which represents employer groups that purchase health care.
A lot has also changed in the last 15 years. The average premium for family coverage is now more than $13,000 a year, and many businesses have already asked their employees to pay a much greater share of their premiums and more of their overall medical bills.
UnitedHealth is experimenting with a more limited plan in California and Chicago and plans to expand to four or five other markets next year. Patients are allowed to see a doctor who is not in the network the insurer established, but they pay much higher out-of-pocket costs than they would in a traditional plan offering out-of-network benefits.
UnitedHealth is also starting a new plan in San Diego, which was developed for a collection of school districts, representing some 80,000 people. The plan creates tiers of doctors, and employees who use physicians deemed to offer high-quality care at low price will pay the least for their medical care.
Even large employers, worried that the new law will result in higher prices for care as government programs pay less, are reconsidering their earlier stance.
When Cigna informally asked some of its clients about their interest in these plans before the legislation passed, very few were receptive. But that has changed, said David Guilmette, a senior executive for the insurer.
One way insurers say they hope to prevent another consumer backlash is by emphasizing that they are not choosing doctors on price alone. The insurers say they look to see how quickly a doctor’s patients recover from surgery, for example. But how much the insurers emphasize quality remains to be seen.
But many insurers say they are still figuring out how to persuade people to choose these plans rather than force them to enroll. “What’s not changed are the old techniques of black-belt managed care,” said Mark T. Bertolini, Aetna’s president. “We have to create the same kind of model without the ‘Mother, may I.’ What we want is the ‘Mother, should I.’ ”

Health Insurance: Update on Current Issues

If you believe this is just a fluke with or without health insurance reform, be prepared for more.
Blue Shield of California is accused of overcharging for safety-net insurance
A Los Angeles woman says in a lawsuit that the health plan exceeded the state's maximum rates for policies sold to people who have lost their jobs or who have preexisting medical conditions.

By Duke Helfand, Los Angeles Times
July 8, 2010

A Los Angeles woman sued Blue Shield of California on Wednesday, accusing the nonprofit health plan of overcharging thousands of policyholders who bought safety-net insurance for people who were sick or jobless.

Amalia Lample said in her lawsuit that Blue Shield, the state's second-largest not-for-profit insurer, knowingly exceeded maximum insurance rates set by the state and falsely reported to regulators that the charges stayed within official guidelines.

Lample, 64, argued that she is owed $4,475 in excess charges she paid from 2007 to 2009. She said that more than 6,000 Blue Shield policyholders with similar coverage also were overcharged since 2001.

"This is for justice. It's not only for the money," said Lample, who decided to file her lawsuit in Los Angeles County Superior Court after reading a story in The Times about Blue Shield's rates. "It's not right what they do."

Blue Shield spokesman Tom Epstein said the San Francisco company had no immediate comment on the lawsuit, which seeks class-action status.

Blue Shield denied two refund requests by Lample, who filed a complaint with the California Department of Managed Health Care. Regulators said they could not conclude that Blue Shield had violated state law.

But Wednesday a department spokeswoman said the law's definition for calculating maximum rates was ambiguous, making it difficult to determine whether health plans were charging too much.

The department is sponsoring a bill in the Legislature to "eliminate any question" on rates insurers can charge, said the spokeswoman, Lynne Randolph.

At issue is health coverage available under the federal Health Insurance Portability and Accountability Act, or HIPAA. Insurers are required by the federal law to sell insurance to people who have lost their jobs or who would otherwise be ineligible because of preexisting medical conditions.

HIPAA policyholders maintain that Blue Shield and one of its chief competitors, Anthem Blue Cross, have substantially overcharged subscribers for several years.

Blue Shield has long maintained that its HIPAA rates comply with state guidelines.

Anthem determined that it had overcharged customers between 2006 and 2009, and agreed to issue refunds.

But one policyholder, Culver City attorney Les Greenberg, accused Anthem of returning only a fraction of what was due. Anthem had given Greenberg a $12 refund. He took the company to Small Claims Court. A judge agreed in September, awarding Greenberg more than $7,300.

Greenberg filed a lawsuit in December on behalf of another Anthem subscriber, saying the insurer owed additional refunds to more than 10,000 HIPAA policyholders. Anthem issued a statement Wednesday saying its refunds were "appropriate."

Greenberg also is representing Lample in the lawsuit filed against Blue Shield on Wednesday.

"They have gone off on a lark of their own to overcharge their subscribers," he said of the two insurers. "I would call it egregious behavior."

duke.helfand@latimes.com
latimes.com/news/la-fi-blue-shield-20100708,0,1302403.story Copyright©2010, The Los Angeles Times

And at the same time Big Insurance is taking you to the cleaners, the new "health czar" at Medicare/Medicaid wants redistribution of wealth -

You looking to boil your own blood this morning, watch this video. Donald Berwick, Obama’s recess appointment to be the administrator of the Centers for Medicare and Medicaid Services says (with a straight face) “Any health care funding plan that is just equitable civilized and humane must, must redistribute wealth from the richer among us to the poorer and the less fortunate. Excellent health care is by definition redistributional.”
http://www.thetradingreport.com/2010/07/08/your-new-healthcare-czar-we-must-redistribute-wealth/

Health-Insurance Caps to Fail

Once again collusion in Big Insurance raises an ugly head -

Trying to rein in health spending by limiting on insurance rates is like trying to hold down the lid on a pot of boiling water. Aside from the fact that insurance costs partly reflect ever-increasing medical costs over which insurers have little control, the legal justification for saying “no more” has never been clear. This has become apparent in Massachusetts, where an administrative court has ruled against a state-imposed insurance cap, and in California, where insurers have retreated temporarily from big rate hikes but are expected to return with new demands. Complete story

While cost control is often helpful, restraining trade and reducing income for health professionals is against sound economics.

Health Insurance Rewards More for Procedures Than Real Care

Are you wondering why Congress blocked Medicare reimbursements?

I thought this was quite a good report on the current state of health care.  The problem as I see it is that this mentality has been the mainstay of Medicare and Big Insurance since the "managed care" movement moved in with gusto in the 80s.

I just hop my readers will take heed and realize this is what you are up against in regard to REAL health care reform.

It was a case study in what primary-care doctors have long bemoaned: that Medicare rewards doctors far better for doing procedures than for assessing whether they should be done at all. The incentives for overtreatment continue, said Dr. Ted Epperly, the board chairman of the American Academy of Family Physicians, because those who profit from them — specialists, hospitals, drug companies and the medical-device manufacturers — spend money lobbying Congress and the public to keep it that way.

Last year, doctors, hospitals, drug companies, medical-equipment manufacturers and other medical professionals spent $545 million on lobbying, according to the Center for Responsive Politics. This may help explain why researchers estimate that 20 to 30 percent of Medicare’s $510 billion budget goes for unnecessary tests and treatment. Why cost-containment received short shrift in health care reform. Why physicians like Fales net an average of $173,000 a year, while noninvasive cardiologists like Rogan net about $419,000.

The system rewarded nobody for saying “no” or even “wait” — not even my frugal, intelligent, Consumer-Reports-reading mother. Medicare and supplemental insurance covered almost every penny of my father’s pacemaker. My mother was given more government-mandated consumer information when she bought a new Camry a year later.

And so my father’s electronically managed heart — now requiring frequent monitoring, paid by Medicare — became part of the $24 billion worldwide cardiac-device industry and an indirect subsidizer of the fiscal health of American hospitals. The profit margins that manufacturers earn on cardiac devices is close to 30 percent. Cardiac procedures and diagnostics generate about 20 percent of hospital revenues and 30 percent of profits.

According to an analysis by the Dartmouth Atlas medical-research group, patients are far more likely than their doctors to reject aggressive treatments when fully informed of pros, cons and alternatives — information, one study suggests, that nearly half of patients say they don’t get. And although many doctors assume that people want to extend their lives, many do not. In a 1997 study in The Journal of the American Geriatrics Society, 30 percent of seriously ill people surveyed in a hospital said they would “rather die” than live permanently in a nursing home. In a 2008 study in The Journal of the American College of Cardiology, 28 percent of patients with advanced heart failure said they would trade one day of excellent health for another two years in their current state.

Complete article:
http://www.nytimes.com/2010/06/20/magazine/20pacemaker-t.html

An Issue in the Health Care Debate

Has anyone had an update on this story?

Democrats vow to ban domestic violence as 'pre-existing condition'

STORY HIGHLIGHTS

• 42 states have prohibited practice of denying coverage to battered women
• Ban would be part of tougher stance on pre-existing conditions 
• Health insurance association backs proposed change 

updated 4:15 p.m. EDT, Tue October 6, 2009

http://www.cnn.com/2009/POLITICS/10/06/domestic.violence.insurance/index.html?eref=ib_topstories

Health Costs on Steroids

UPDATE: 2/10/10
At the same time McCain and Dorgan are hacking away at your fright of choice and your right of access to health of your choice in their insane effort to play in to the hands of uninformed sports corporate execs, studies show that the use of supplement can reduce cost of care by $2000 per incident.

I just wonder how much lobby money is ending up in the hands of McCain and Dorgan for this one.

And then there is Senator Mikulski who is supporting a move to allow some "CAM" care in a health bill, but only through licensed providers. This ties in directly with Big Insurance because there is no 3rd Party Reimbursement without a license.

So once again those making policy have little understanding of the issues, and this is another stab at the heart of health freedom.

Anytime there is a licensing and insurance control added it means simply that cost increase, and access is limited.

ORIGINAL post 2/4-2/4/10
It is very difficult to have been watching the stupid antics of White House insiders, members of Congress, lobbyists and even POTUS.   No one seems to be listening to the voice of the people.

What is so amazing is the ideas put forward that show absolutely no connection to the issues in health care and sound ways to reduce costs while improving care.

What irritates me even more is the latest form John McCain of Arizona who has decided to propose a bill in the senate to obviate your right of access to choice and your right to use supplements.

I still say all these elected (so-called) representatives need remedial Constitution 101 beginning now.  I think probably it is a good idea to require any elected representative to take remedial Constitution before the take office.

Fact is, supplements do reduce health cost and improve health, but PhRMA doesn't want that to happen because it would cut in to their profit package.  (If you'd like to learn about how much money these politicians get from the corporatocracy, go here http://money.cnn.com/magazines/moneymag/moneymag_archive/1994/11/01/89289/index.htm
and here http://www.citizen.org/congress/reform/drug_industry/contribution/articles.cfm?ID=7827

Under the Influence: Special Interest Money and Members of Congress

If you are interested in supporting health care for all, go here: http://www.madashelldoctors.com/

Now as this discussion remains on the merry-go-round, Senator McCain is proposing a bill to limit DSHEA and supplements.  John receives a big handout from insurance and PhRMA, BTW.

February 4th: Senator McCain Files New Bill That Attacks Your Access to Supplements and Repeals Key Sections of the Dietary Supplement Health and Education Act

Senator McCain has filed a new bill that attacks your access to supplements and would repeal key sections of the Dietary Supplement Health and Education Act. Please contact your senators now. Tell them not to co-sponsor this exceptionally bad bill and instead help to defeat it!

UPDATE from Citizens for Health 2/5/10

Soaring cost of health care sets a record
Spending was 17.3% of the economy last year. The share paid by the U.S. will soon exceed 50%, a study says.

By Noam N. Levey, February 4, 2010, Reporting from Washington

In a stark reminder of growing costs, the government has released a new estimate that healthcare spending grew to a record 17.3% of the U.S. economy last year, marking the largest one-year jump in its share of the economy since the government started keeping such records half a century ago.
 
Read Complete Article:
http://www.latimes.com/news/nation-and-world/la-na-healthcare4-2010feb04,0,1362585.story

STOP THE TRAIN I WANT TO GET OFF!  And while all this is going on cardiologists attack herbs, which will do you more good, along with supplements that the present lot of pharmaceuticals.

And think about this, they now only want you to get less vitamin C than a guinea pig!

If you don't believe Big Insurance controls health think again

1/31/10
Typical Issues in insurance control of health care, bloated inermediaries, Assurant is linked with Blue Shield
http://articles.moneycentral.msn.com/Insurance/InsureYourHealth/battling-the-system-a-patients-tale.aspx

Insurer Steps Up Fight to Control Health Care Cost

UnitedHealthcare says the proposed rule is meant to improve the quality of care and cut costs by allowing insurance case managers to jump in right away. The hospitals say that having their reimbursement cut in half is too much to pay for a clerical error, and that the revenue drain would ultimately hurt their patients.

http://www.nytimes.com/2010/01/25/health/policy/25insure.html

Health Insurers on the Attack

From MotherJones


By Kevin Drum
Wed Jan. 13, 2010 9:12 AM PST

Guess what? It turns out that health insurance companies oppose healthcare reform and are spending millions of dollars to defeat it. That wouldn't be a big surprise except for the fact that healthcare reform is supposed to be a boon to the insurance industry, providing them with millions of new customers (courtesy of an individual mandate that forces everyone to buy insurance). So why are they fighting it? Matt Yglesias takes a stab at explaining: [1]

The fact of the matter is that even though the new mandate/subsidy structure will give at least some insurers a bunch of new customers, the medium-run trajectory of reform is bad for private insurers. Right now, insurers are largely shielded from competition and are almost 100 percent immune to needing to please their actual customers, getting to deal with HR bureaucracies instead. In an Exchange-based world, individuals will be choosing from among several plans and insurers will be accountable to customers. What’s more, the principle that it’s the government’s job to make health care work will lead to pressure for further regulations and further squeezing of industry profit margins.

I think that's pretty much right, and I'd add that community rating (which requires insurers to charge everyone the same price) will add to this pressure. With risk adjustment taken away from insurance companies, they become purely administrative middlemen, and that's a dangerous thing to be. Pure paper shufflers are a lot easier to compare to Medicare's administrative bureaucracy, and they won't benefit from that comparison. The political pressure for them to continually cut costs and profits will just keep growing.

On the other hand, this has always been the case, so why did the insurance industry play nice at first and only turn on the attack ads recently? Hypothesis 1: It took them a while to figure this out. I'm skeptical of this. Hypothesis 2: They feared this all along, but figured the alternatives were even worse. Now, however, they're starting to believe that they might be able to defeat healthcare reform completely, so they're throwing caution to the wind.
All the more reason for Democrats to get their act together and hammer out a compromise that can pass the House and the Senate. Unfortunately, Josh Marshall rounds up some evidence here [2] that Dems are stuck in their usual circular firing squad and aren't making much progress, even though the differences between the House and Senate bills are, frankly, fairly minor. But as a friend of mine likes to say, "Republicans are evil and Democrats are idiots." I sure hope they prove him wrong for once.

Source URL: http://motherjones.com/kevin-drum/2010/01/health-insurers-attack
Links:
[1] http://yglesias.thinkprogress.org/archives/2010/01/insurers-oppose-health-reform.php
[2] http://www.talkingpointsmemo.com/archives/2010/01/are_the_dems_going_to_blow_this.php

Why Insurance Reform Doesn't Get You Better Health

Senator Lieberman who is holding positive movement on insurance reform in limbo may have reason to be concerned, especially where women's health is concerned.

It seems as if the controversy over Hadassah Lieberman, the Senator's wife, is on the payroll of the Komen Foundation to the tune of about $300K a year.  Gary Locke's wife is on their payroll too, most likely lobbying while she's living in DC.

The problem with this is that Komen has no interest in CHANGE. For them it is PhRMA all the way, along with cancer promoting mammogram.

It might be why there is no effort to do more for prevention or more for research into the known environmental causes of cancer.

Nancy Brinkerman, CEO and sister of Susan Komen, is also suspect because she is on some PhRMA director's boards.

Do you wonder why the so-called health reform effort and the "race for the cure" keep circling the wagons and make deeper ruts?