There has been panic over the H1N1 (a.k.a. swine flu) vaccine shortage. Unfortunately, the pharmaceutical companies responsible for producing the vaccine have had various production problems. These corporations, including GlaxoSmithKline and AztraZeneca, have been working with the U.S. government to get the vaccine out as soon as possible. In addition, as Health & Human Services Secretary Kathleen Sebelius explained to the New York Times, the actual reproduction of the vaccine in eggs chicken eggs has grown slower than expected. While the goal is to get all Americans vaccinated, only 30 million doses of the vaccine will be available by the end of this month.

Still, the situation’s not as scary as it sounds–even though it’s Halloween! Supplies are steadily growing, and H1N1, while serious, is not yet a nationwide pandemic. There’s still time for the vaccine to roll out, which it has been doing. Moreover, it’s only a subset of the population that is at higher risk:

• Children
• Pregnant women
• Teenagers & young adults
• and those with existing health problems.

Those groups need the vaccine as soon as possible, and most clinics have been rationing the vaccine for the moment. High-priority populations are moved ahead of the line, and others will receive any leftover vaccines. Some regions are seeing higher demand than others–and live vaccines for the H1N1 virus eventually expire. The worst scenario is for the vaccine to be thrown away; therefore, it should be then be offered to lower-priority populations, e.g. senior citizens (unlike the seasonal flu, senior citizens aren’t at high risk for the swine flu). Remember also that you only need a single shot of the vaccine for it to be effective.

Does your health insurance plan cover the H1N1 vaccine? It most likely does, if your primary care physician has it. If he or she doesn’t have a supply on hand, there are free and low-cost clinics available from county and state governments, as well as pharmacies like Walgreens and CVS.

(Image: Ben Chau under CC 2.0)

Rationing: It’s a dirty word.  Some politicians and activists warn of the dangers of a public option that would have the government ration out health care, and point to Europe as a cautionary tale; others claim that care is already being rationed indirectly by a patient’s health insurance plan. Either way, the thought of being denied needed medical treatment because of a callous calculation is scary. Costs need to be cut, either by the federal government or private insurance companies looking to maximize their profits–therefore, everyone’s looking for whatever procedures may be considered unnecessary and wasteful.

How do you know if you’re a victim of rationing, as opposed to a recipient of high-quality, sensible health care? In Newsweek magazine, medical school professor Christopher Moore acknowledged this dilemma. Sometimes, excess treatment can hurt the patient more than it helps. Take CT scans, for example. Admittedly, they are costly, with prices continuing to rise (and also being passed onto your family health insurance bill); but CT scanners are amazing medical technology that can identify if a head injury is life-threatening. However, studies have shown that the probability of that being the case are relatively tiny. Meanwhile, there is up to a 1-in-1,000 chance of each CT scan causing eventual death from cancer (due to the radiation involved), even more so for younger patients. The medical risks of doing a CT scan on a teenager with a concussion could outweigh the benefits, even after removing cost from the equation. Keeping a close watch on the patient might be a better bet.

So if your doctor refuses to perform an expensive test or other procedure, it’s very likely that he or she has a legitimate medical reason for it. If you get more affordable health insurance because of the reduced cost, so much the better, but that’s not the #1 priority.  Occasionally, a physician who performs the procedure might be doing it solely to avoid a malpractice lawsuit. The prospect of a government-run public option won’t stop that. Moore insists that a doctor who genuinely believes an expensive procedure is sorely needed won’t let cost concerns stop him or her from ordering it. Let’s hope so.

(Image: Akira Oghaki under CC 2.0)

Obesity has become an epidemic in America, and has been blamed for a significant percentage of rising healthcare costs. In the past, ambulances have had to improvise when transporting morbidly obese patients over 500 pounds to the hospital, and companies have eaten the cost. Now, with an increasingly obese population, ambulance providers are starting to pass the increased cost onto insurers, either public or private. This may be necessary, but it will probably reduce the availability of affordable health insurance policies. As for the uninsured, patients will also have to cover the cost of an ambulance ride themselves.

It’s two-and-a-half times more expensive to transfer an extremely obese patient than one at normal weight, according to the Associated Press. Reasons for this include the need for new vehicles and helicopters with larger doors and lifts, extra-large stretchers, as well as the need to hire more emergency crew members (and have them work longer hours) to lift obese patients. Insurance companies operating in Washington and Oregon already pay increased rates to cover those extra costs, despite fat-acceptance groups considering it to be another example of weight discrimination in medical care. Other advocates of the obese, however, are appreciative of the improvements that allow them to be transported with dignity.

The cost of specialized ambulances will certainly be passed on. Increased regulation in the healthcare reform bill may prevent people from charging extremely obese patients more for a health insurance plan. Therefore, everyone’s plan will cost a little bit more.  Medicare and Medicaid are resisting increased reimbursements, but the industry is fighting for fair compensation for their services. Without it, they claim that they will be unable to provide quality care that serves the needs of a significant percentage of the nation’s people.  Promoting public health (e.g. reaching a healthy weight and not smoking) would do a lot to reduce healthcare costs, and should be part of any healthcare reform. Otherwise, the population of morbidly obese will rise from its current 5%, requiring more specialized, costly care.

(Image: NIOSH – National Institute for Occupational Safety and Health under CC 2.0)

The medical device industry, which manufactures and sells items such as heart stents and artificial hips, has kept a low profile during the healthcare reform debate. However, that doesn’t mean that they won’t be affected. Their products are very important to many patients, but help drive up the cost of your health insurance plan. That’s probably why the House of Representatives’ healthcare reform proposal includes $20 million in taxes–coming from a 2.5% sales tax. AdvaMed, the industry’s lobbying group, is obviously unhappy with this and believes that the tax will be detrimental to the American economy.

What would medical device makers consider a more acceptable bill? One that:

• Exempt small companies, defined at those making less than $100 million
• Would be tied to specific products, presumably with more profitable products being taxed a higher rate
• Was at least partly deductible as an expense and,
• Doesn’t take effect until 2013.

As it turns out, the medical device industry was lucky. An initial Senate proposal doubled the fee to $40 million, so AdvaMed has expressed its gratefulness for the reprieve. Such a break was probably going to happen anyway, in exchange for moderate Democratic Senator’s Evan Bayh’s support. Bayh represents Indiana, a state that is the headquarters to many medical device companies. Will the goal of affordable health insurance still be achieved with this corporate giveaway?

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For years, Americans have been struggling to find an affordable health insurance plan that fits their needs. Some insurers are more reputable than others. Unfortunately, some unscrupulous providers have promised healthcare coverage but failed to deliver, leaving consumers stranded. Reuters recently exposed Florida couple Renée-Marie Stephano and Jonathan Edelheit and the bogus health insurance they sold.

Their health insurance plans were sold under the name OptiMed Health Plans, a subsidiary of United Group Programs (not to be confused with United HealthCare). The states of Montana and Washington have accused OptiMed of selling fraudulent, unauthorized policies from 2003 to 2007. People duped into buying discount health insurance from them ended up saddled with thousands of dollars in medical costs, since OptiMed failed pay its customers’ claims. It’s another example of why you should be careful when looking for health insurance. Speak with an agent to find reliable, affordable health insurance.

Following her Senate counterpart’s reveal of his healthcare reform plan earlier this week, Speaker of the House of Representatives Nancy Pelosi has now unveiled her chamber’s proposal for expanding affordable health insurance coverage. As expected, the House’s plan is farther-reaching than the Senate’s and more similar to the one outlined by President Obama during his campaign.  Here’s a quick Q&A on Pelosi’s plan:

Q: How much is this going to cost?

A: It’s projected to cost a whopping $894 billion over ten years.

Q: How is the government planning to pay for reform?

A: It will raise income taxes on couples making over $1 million and individuals making over $500,000 yearly. In addition, Medicare spending will be cut by an unknown amount.  Liberal representatives also floated the idea of having the government dictate the rates paid to health care providers by the public option, but moderates managed to strip out that provision. (The government, as well as private insurers, will instead negotiate payment rates with hospitals and doctors.)

Q: Is a public option included?

A: Yes. Unlike the Senate version, the House’s bill doesn’t allow states to opt out of it. So far, it doesn’t include a so-called “trigger” either.

Q: Will illegal immigrants be covered by the public option?

A: As of now, it’s unclear. That’s one of the main sticking points preventing the House bill from reaching a vote. However, remember that illegal immigrants are already receiving a form of public healthcare: hospital emergency rooms are required to serve everyone who comes in.

Q: What about abortion? Will it be covered?

A: That’s another controversial topic that will see much debate before the bill hits the House floor. A handful of pro-life Democrats will probably try to have abortion coverage removed from the public option in order for it to receive their votes. Meanwhile, some pro-choice representatives oppose a bill that doesn’t include abortion services. Either way, the Democrats have a solid majority in the House and can afford to lose some votes in either direction.

Q: What if I have a pre-existing condition and can’t get insurance?

A: These reforms are supposed to change that. Health insurers will no longer be allowed to deny coverage to people with pre-existing conditions. They won’t be able to charge those with pre-existing conditions significantly more, either.

Q: When will healthcare reform take effect?

A: It’s hard to believe, but the bill won’t fully kick in until 2013. By then, a mandate will require everyone who can afford it to buy health insurance. They can be insured via the newly created exchange (consisting of private insurers, in addition to the public option), by their employer, or an existing government program such as Medicare or Medicaid.

Q: But I need health insurance now! What can I do in the meantime?

A: The government is putting together a temporary program to insure individuals and families that have been rejected by private insurers. Otherwise, do you really want to wait for the government’s health insurance plan? Keep in mind that the House bill needs to be reconciled with the Senate bill before there’s a final vote, and that could take months.

(Image: U.S. House of Representatives Portrait)

Over the past week or so, the public option has been on a roll. Democratic leaders of Congress have insisted that some form of a public option be included in their healthcare reform bill, considering it an essential step in providing the nation with more affordable health insurance. It wasn’t going to be an easy battle. Senator Joe Lieberman has expressed his opposition to such a government-run plan. The independent senator–who used to be a Democrat and still caucuses with the party–cites budget concerns as his primary reason for rejecting it, and believes it isn’t the right time to go into even deeper debt. A less charitable view is that he wants to continue receiving funds for his re-election from major health insurance companies, many of which are headquartered in his home state of Connecticut. Only Lieberman himself knows his motivations for sure.

Lieberman has stated that he will vote with Harry Reid in the initial procedural vote that allows the bill on the full Senate floor for further debate, but vows to be part of the inevitable Republican filibuster against any final bill that includes the public option health insurance plan. Leaders should take him seriously, since he’s well-known for switching sides: he even campaigned for John McCain during last year’s presidential campaign. Nobody said getting 60 votes in the Senate would be easy; don’t be stuck without a health insurance plan in the meantime.

(Image: Official U.S. Senate Portrait)

Senate Majority Leader Harry Reid has joined the strong push for a public option in Congress’ healthcare reform bill, but its inclusion is not guaranteed. The provision’s fate is in the hands of moderate Democrats. Despite the ability for individual states to opt out of the government-run health insurance plan, centrist Democrats like Senators Ben Nelson and Max Baucus are still leery of voting for it. You should get a health insurance quote while you wait for the endless wrangling of votes to finish, since garnering 60 Senate votes to pass this bill will no doubt take awhile. The fact that several politicians in the party have received large campaign contributions from the health insurance industry doesn’t help.

Why the delay? The Senate and the House of Representatives have to debate exactly what form the public option will take, and moderates hold its fate in their hands. They need to compromise between comprehensive health coverage and cost. Gaining Republican votes is a lost cause at this point, so party leaders will be forced to exert their power. For example, Reid may try to convince a swing vote with a seat on a prestigious Senate committee–that a Senator will only get if he or she votes with him on healthcare reform. The more liberal House has a more comprehensive public option proposal included in its bill, and it must be combined with the bill in the generally more conservative Senate prior. Afterward, it’ll see even further amendments by the rest of Congress before a final vote. There is also the possibility, albeit less likely, that some liberal politicians will vote against the bill because it doesn’t do enough to reform our health insurance system. However, centrist politicians receive more attention from leaders because they are the wild card. Can you wait for Washington to decide, or would you prefer to be safe and get health insurance quotes from multiple insurers now? If, years from now, you like what the public option shaped up to be better than your existing health insurance plan, you’ll be able to switch–but if you’re caught uninsured before then, you’ll wish you hadn’t waited.

A recent story in the Boston Globe, while sad, has given me a deeper appreciation of those health insurance companies that provide mental health coverage. During a therapy session at Massachusetts General Hospital’s Bipolar Clinic, a patient with bipolar disorder stabbed his psychiatrist. The psychiatrist is recovering, thankfully; the patient was soon killed by a security guard after he failed to stop.

Many people forget that psychiatrists are also medical doctors that treat a variety of conditions and put themselves in harm’s way each day. While it appears that this particular patient was too far gone, millions of individuals with mental health disorders have seen significant improvements with the help of psychiatric treatment. People who need treatment are more likely to get it if they have health insurance with mental health coverage. There are insurance plans that cover most or all of the cost of psychiatric and therapy visits, as well as medications.

Please don’t wait to get help until it’s too late. If you or someone you love is struggling with paying for treatment of their mental illness, get a health insurance quote instead of giving up. I wish you the best of luck.

(Image: Pink Sherbet Photography under CC 2.0)

Recent studies have found that women under the age of 55 are more expensive to insure than their male counterparts. Why are their health insurance costs higher? A lot of it seems to come from the unfairness of biology:

• Most women need maternity care at some point in their lives, while men don’t. (Still, women who choose not to have children don’t get discounted health insurance quotes.)
• Although this disparity reverses in old age, cancers that almost exclusively affect women (e.g. breast and ovarian cancer) tend to strike at a younger age than exclusively male diseases like prostate cancer. In addition to the high cost associated with cancer treatment, health insurers must also cover preventative measures, such as Pap smears and mammograms.
• On average, women visit the doctor more regularly and use more prescription medication than men. This is most likely primarily due to a higher tendency for women to be proactive when it comes to their well-being, rather than a case of the female gender being sicker.

All of these factors cause insurance providers to consider women’s health insurance policies higher risk, and they charge more as a result.

Many consider the practice of gender rating discriminatory and counter intuitive, as it penalizes women for using greater quantities of preventative care–even though prevention is a proven way of reducing health care costs by a far larger sum.  Health insurance companies are willing to eliminate gender rating in certain instances. The Senate Finance Committee’s healthcare reform bill bans insurers from giving individuals and small groups a different health insurance quote based on their gender, but the definition of a small group is arbitrary. It could be as small as 50 or 100 employees. A firm with just 51 employees and a predominately female workforce could pay up to 20% more than the national average to insure its employees–and employees will have to cover more of that cost themselves.

Democratic Senator Barbara Mikulski is calling for the end of this practice altogether, including in large corporations. While she has been gathering support from other congresspersons in her quest, the health insurance industry’s lobby has been fighting to retain the exception that would allow gender rating to continue in the large group market. Their argument is that some businesses will decide to offer their own insurance (as opposed to buying it in the group market) after seeing their premiums increase. It’ll be extremely interesting to see how this plays out. Will Congress give into the insurers, believing that their support in eliminating gender rating for individual and small business health insurance is more urgent? After all, at least those working for large companies tend to have at least some form of employer-sponsored health insurance plan.

(Image: jfrancis under CC 2.0)