The House’s healthcare reform bill looks like it’ll cross the $1 trillion mark, according to the nonpartisan Congressional Budget Office. Many Democrats have promised a bill that would cost less, and initial CBO estimates agreed with them. However, they have since added billions more in funding health insurance for the retired, as well as more spending on public health and increased reimbursements for preventative care services. Some of these provisions are intended to garner more support from important populations, such as senior citizens. These modifications bring the estimated total of the bill to at least $1.2 trillion over ten years.

Breaking the trillion dollar threshold makes reform of the health insurance industry more difficult to achieve. Nancy Pelosi has previously claimed that the bill would cost about $900 billion; still a massive sum, but short of the trillion mark.  It seems to be a sort of psychological block, even among Democrats whom are otherwise supportive of the bill. The new CBO estimate is closer to Republicans’ claims of $1.3 trillion. The big question is whether it’s worth the price. Supporters would argue that the eventual savings from health insurance plans would allow the nation to pay off that debt in time (after all, America managed to pay off its decades-long national debt by the end of Bill Clinton’s second term), but others feel that it’s a pointless gamble.

With all the controversy over the public option proposed by Democrats in their healthcare reform bills, the number of Americans who will actually be covered by the public option is surprisingly low. Speaker of the House Nancy Pelosi estimates that just six million (2%)  of the population under 65 years of age will choose the government run health insurance program. One out of five individuals who are buying insurance on their own or in a small group (and will participate in the insurance exchanges central to the House’s bill. would take the public option. The most important issue that has been lost in the debate is providing affordable health insurance to the nation, whatever form it takes.

The public plan might not be the panacea to increased health care costs its supporters claim it will be. The people most likely to be attracted to it will be those with pre-existing conditions private insurers are less likely to cover. Therefore, average health insurance quotes would be cheaper with a private plan, steering the healthier segment of the population away from the public option. Less stringent regulations that allow the less healthy to use more medical services and see more specialists would also drive up costs. (Private insurance companies sometimes limit their offerings based on profitability.)

All in all, the public option doesn’t seem to be as far-reaching as first expected, at least for now. Most Americans will continue to have health coverage through their employers. Senior citizens already have Medicare. What about the masses of low-income uninsured individuals and families? It turns out that most of them will be covered through Medicaid, another government program that will be expanded.

(Image: Speaker Pelosi under CC 2.0)

Last year, a representative from Texas was the true Republican maverick in the presidential race. Ron Paul may not have won the nomination, but he is still bringing his unique libertarian perspective to Congress’ table. His proposals for healthcare reform are no different. He recognizes that the current health insurance situation is untenable, but is against governmental involvement. Recently, he presented several intriguing bills to the House of Representatives.

1. The Comprehensive Health Care Reform Act of 2009 would give Americans a 100% tax credit on their health care costs (e.g. prescriptions, hospital stays, doctor visits). Health Savings Accounts (HSAs) with high-deductible health insurance plans would also be tax-free. Low-wage employees who don’t file tax returns can have the credit refunded against their payroll taxes, so the bill would help those who need it most afford healthcare. Currently, only medical expenses that reach over 7.5% of an individual’s income can be deducted.
2. Dr. Paul’s Coercion Is Not Health Care Act of 2009 would forbid the government from enacting a health insurance mandate. There has been some speculation as to the legality of such a mandate. Congressional Democrats, along with the Obama administration, believe that it has to be part of healthcare reform legislation. Their view is that universal coverage must include the young and healthy in order for the insurance pool to afford covering those with pre-existing conditions. This interference in the free market is anathema to Paul. Incidentally, if there is no public option, such a mandate might not be necessary.
3. Finally, his Freedom From Unnecessary Litigation Act of 2009 would save money through indirect tort reform. This act would establish so-called “negative outcomes insurance”, which would pay off if a patient’s medical treatment goes wrong; it would also offer a tax credit to make the purchase more affordable. The goal is to decrease some of the unnecessary (and costly) testing done in order to avoid malpractice liability, as well as lessen the need for hospitals and physicians to carry billions of dollars in insurance.

As Paul is himself a doctor, his views on the healthcare industry are worth listening to. His opinions tend to be shortchanged in the House because he doesn’t walk in lockstep with either party’s platform, giving his bills little chance of passing.  However, many Americans–who fear socialized medicine, yet acknowledge that we need more affordable health insurance as soon as possible–could find something to applaud in his plans.

Sometimes having the wrong health insurance is even worse than being uninsured. An recent article in Chester County’s Daily Local News made that clear. After becoming unemployed, many people are left in dire straits once their employer’s COBRA coverage expires. With little money, most are only able to buy inferior health insurance plans. At that point, millions of individuals and families become underinsured. Imagine if your insurer refused to cover even one emergency room visit! No wonder some people decide to go uninsured instead; they’d still have to pay for their medical care, but at least wouldn’t still be paying premiums.

Unfortunately, some people doesn’t find out what their health insurance plan does and doesn’t cover until it’s too late.  Avoid the underinsurance trap by reviewing your plan and talking with an insurance agent. The best solution is to find a plan that suits your needs and provides the most value. It’s important to save money on insurance, but don’t forget your health. If you are currently underinsured, you can get an affordable health insurance quote for a better plan.

(Image: Commonwealth Fund)

So far, Republicans in Congress have mainly expressed opposition to the healthcare reform plans proposed by the Democrats. They haven’t offered many solutions of their own, but that’s about to change.  John Boehner, the most powerful member of the minority party in the House of Representatives, has promised that the GOP will present an alternative bill that doesn’t entail major government involvement or adding to the national debt. Obviously, there will be no public option in this version.

Boehner acknowledges that the current system isn’t ideal. How does he plan to give more Americans access to health insurance? These are several things Republican healthcare reform bill would do:

• Severely decreasing the number of medical malpractice lawsuits. This would lower health care costs through a reduction in the unnecessary tests given by overly cautious doctors. Malpractice insurance can also cost doctors millions of dollars per year. As a bonus, it doesn’t hurt that trial lawyers tend to support and contribute to Democratic politicians; this measure wouldn’t affect many GOP supporters.
• Creating a pool that allows small businesses and individuals to buy affordable health insurance in large groups. That proposal is similar to part of the Democrats’ healthcare plan. It’s pretty noncontroversial.
• Repealing the regulations that prevent people from going across state lines to buy health insurance plans. Some states, such as New York, regulate the industry more than others. These regulations include prohibitions on denying insurance to people with pre-existing conditions, for example. While these measures allow more people to be insured, they also result in higher health insurance premiums. Boehner believes that creating a nationwide free market will be more effective in lowering healthcare costs than a public option.

A Republican plan wouldn’t include a health insurance mandate, and would avoid tax increases. It sounds nice, but would it actually be successful? Even party leaders admit that their proposals wouldn’t come close to covering most of America’s uninsured.

All of the usual suspects have spoken on healthcare reform: the uninsured, the already insured, politicians, doctors…but McDonald’s? Their CEO, Jim Skinner, recently spoke about affordable health insurance during a meeting in Boston. Like many people, Skinner believes that the current system needs an overhaul as soon as possible. However, he didn’t reveal whether or not McDonald’s supports the public option, preferring to take a cautious approach on the issue.

Skinner’s remarks, as reported in the Boston Globe, mainly focused on the need to protect small businesses in any healthcare reform bill. You may wonder why a massive multinational corporation such as McDonald’s cares about the plight of small business owners. Well, the vast majority of McDonald’s restaurants (85%) are owned by franchisees who operate independently, albeit with support from the corporation. He believes that while increased access to a health insurance plan is important, it shouldn’t come at the expense of small business. There is a possibility that reform might come with an undue burden on companies and franchise owners buying small group health insurance for their employees. If their savings were jeopardized, millions of Americans could lose their coverage. Clearly, this would defeat the purpose of Congress’ health care reform efforts, and would be opposed by McDonald’s.

What does Jim Skinner think about the charge that his company and other fast food restaurants are part of the problem of soaring healthcare costs by promoting obesity? He pointed out the offering of milk and fruit in some children’s Happy Meals, as well as the expansion of the menu to include healthier selections. Above all, it’s a choice to eat at McDonald’s. Although they could certainly do more to support health (i.e. post calorie counts prominently on the menu everywhere, as they are legally required to do by New York City), there is merit to Skinner’s perspective. As a franchise, McDonald’s has a unique perspective on health insurance from both the small business and large corporation side.

(Image: Official McDonald’s Corporate Website)

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?

(Image: stevendamron under CC 2.0)