It’s not that they don’t want you covered. They just don’t want one “option” shoved down their collective post office boxes.

Senator Tom Harkin (D-Iowa), the venerable leader of the powerful Health, Education, Labor and Pensions Committee, gave small business owners their chance at the mic. Apparently, they had a lot to say at the Harkin-hosted “Increasing Healthcare Costs Facing Small Business” forum. As you might imagine, all the usual debaters for low-cost insurance advocacy were there. Those lobbying for the — dare I write it, Republicans — “Public Option” — were also on the soap box.

Since small businesses have been among the most vulnerable victims of this long, cold economic downturn, health insurance (by virtue of its current cost-model that favors group rates) has gotten really expensive for these folks. The less people you have on payroll, the more you pay for coverage. The more people you have on payroll, the less you pay for coverage, but the more you pay in salaries and overhead. Roll the dice. Either way, small business owners are taking it on the chin.

“Get it off our backs,” small Iowa newspaper editor and publisher Art Cullen, told Senators, “If that means a public option, fine. If that means an insurance exchange of some sort, fine. But give us a way to get out from underneath this albatross. It’s become expected that small businesses will provide insurance, even if they can’t afford it. And we cannot afford it.” I gotta hand it to the Congressman. The audience was appropriate. Since everyone has a stake in affordable healthcare, ears were burning everywhere. But we’re still waiting for something — anything — to change the bleak outlook.

In spite of all the back-and-forth between hecklers and proponents of more affordable healthcare (and I’ll admit, after Wal-Mart kind of took over the small business niche’ years ago) a plethora of insurance plans are still around, alive, well and thriving. Small Businesss can get it done. Care at less cost can happen. It just takes some entrepreneurial spirit to change the debate. Unfortunately, Congress has never been known for their independent streak.

States have struggled with it. Hospitals pray their patients won’t fall over it. Software makers are grinning over it, like the Cheshire Cat.

The massive rock paperweight that keeps our medical records in an ever-growing stack is fossilizing. Fast. As a result, congress, President Obama and insurance providers are shaking hands, creating partnerships and evaluating vendors to send our medical records into the cloud. Poof! Just like that…Up, up and away goes the latest results of your cholesterol test to that great big server in the sky. Paperless healthcare is supposed to create lower healthcare quotes for consumers. But will it?

“We’ve proven that paperless documentation can save costs for one of the most documented segments in the healthcare industry,” says Gerry Stone, founder of Redoc, an electronic medical records software company that specializes in documentation for physical and occupational therapists. “Believe me, if it works for Physical and Occupational rehab, it will work for the rest of healthcare.”

Stone has a point. He built his software platform from scratch 14 years ago, when electronic medical records were but just a glint in Bill Gates’ eye. Since physical and occupational rehabilitation is usually prescribed by health insurance plans to those who injure themselves on the job, Workers Compensation claims (and in the case of post-65-year-olds, repeated Medicare reimbursements) require an average of one hour of a therapists’ time filling out forms after each session. Stone has managed to reduce the hand-driven process of jotting down billing codes and treatment notes down to mere minutes by designing a simple interface of drop-down and text boxes, key shortcuts and the like. That was w-a-y before big Goliaths like Siemens, SAS and open-source companies jumped into the tepid waters of paperless healthcare.

Now that the President has essentially mandated paperless medical practices, the Cloud is gonna get a lot more crowded now. But how soon is now? Depends on who you ask. Software companies are courting their respective Congress persons and the President is waiting for the sky to open up and accept the first pile of medical paperwork. So far, there doesn’t seem to be any protocols drafted to guide how the information is documented, where and how it’s shared and who backs it up and how often. By the time the paperweight gets lifted, the ACLU and other privacy advocates will have their say on how private medical information is managed.

And what about HIPPA (Healthcare Insurance Portability and Accountability Act)?  When the medical records pile shifts to the servers, we’ll probably have an even L-O-N-G-E-R paper form to read and sign at the pharmacy counter. Figures.

And just a few years ago, we were blaming traffic cameras, public surveillance systems and mall cops for our lack of privacy. Pretty soon, if Microsoft has its way, we’ll all be watching ourselves anyway.

I’m self-conscious enough without CNN reporting this morning that the empire in Redmond is working on a personal surveillance system called “SenseCam,” which will serve as your own personal voyeur — essentially recording everything that you see and do, every minute, of every hour, all day long. Imagine a huge media card inserted in your neck.

Do you remember when Google started developing Google Maps and people starting calling local police departments to tell them about strange cars from the future with UFO-like pods (which we all later found out, was the actual GPS mapping thing) on their roofs? Well, keep that iPhone in its holster on your way to work this morning…Microsoft Beta testers are actually walking around cities across America today with audio and video equipment strapped to their heads. Human droids.

Of course, today’s technology creates opportunities for moment-by-moment documentation. But does that mean we really should document the mundane? More importantly, what does that mean for the future of affordable healthcare when, say, your electronic diary goes viral in the cloud and your insurance carrier watches you smoking a cigarette? Do our health insurance quotes go up?

Mircosoft claims the benefits of the system outweigh the inherent risks to personal privacy. Archives of your blog, Facebook or Twitter feed — both in text and in pictures – would help you remember exactly what you ate on important occasions, the papers you were proud of and the outfits you wore. For sure, such a tool would be a helpful aid for people suffering the horrors of Alzheimer’s Disease or other memory-related ailments.

Come to think of it (pardon the obvious subject pun), I could use a device like this to help me remember my countless log-ins, my parking spot and on those extra crazy days, my name. Not sure my own personal risk (i.e. – I am very clumsy) or the embarrassment of snickering pedestrians is worth me  strapping on a bulbous helmet-cam and wiring harness, a-la Ghost Busters.

So how many Gigs does your brain have, anyway?

Blue Cross Blue Shield is one of the most famous health insurance plan providers. They offer a variety of options to consumers, and part of their opposition to healthcare reform is based on its potential to limit their ability to sell certain types of plans. So why are they only allowing their Florida employees to sign up for a high-deductible health insurance plan in 2010? They’re part of a growing trend of employers passing a larger percentage of healthcare costs to the consumer. These plans are tied to a tax-free Health Savings Account, to which the company will contribute a certain sum (individual employees can add more money to the HSA).

On the positive side, HSAs force people to give more thought to their spending; they could cut unnecessary costs, making healthcare reform more affordable. Unfortunately, many consumers aren’t knowledgeable enough to make informed decisions–they could forgo needed treatment to save money, eventually costing them more in both financial and wellness terms. BCBS is trying hybrid HSA health insurance plans, in which they offer either 10% or 20% co-insurance to lower the cost of annual physicals and other preventative care. In addition, the health insurance company covers basic screenings (e.g. colonoscopies, mammograms) that may otherwise be avoided.

HSAs can be very useful to younger people in good health; they often result in lower premiums, since you only pay for the care you need. However, they’re not for everybody. A PPO or an HMO could be a better option for you. While some employers are no longer allowing you to choose, there are still options on the open market. You should always talk to an insurance agent to see what’s best for you.

Health insurance companies are constantly in search of ways to save money.  Some of their methods, such as refusing to cover those with pre-existing conditions that their underwriters deem too high risk, have drawn fire from consumers and politicians. Now, some insurers are promoting alternative medicine. With some exceptions, consumers pick up the majority of the costs of services like acupuncture and chiropractic, as well as herbal supplements. While most of these remedies are unproven, they have become increasingly popular with consumers. Therefore, promoting it seems to be a win-win situation for insurers.

Kaiser Permanente and Aetna are among the HMOs that offer dietary supplements and herbs to their patients. However, these supplements aren’t covered in most of their health insurance plans. If someone takes a conventional medication, the cost of their prescription will mostly be covered by their insurer, less a small co-payment. If they use a non-prescription herbal supplement instead, the patient must cover the entire cost out-of-pocket. The same applies when someone visits an alternative practitioner as opposed to a physician.  In that respect, it is financially advantageous for insurance companies to encourage the usage of alternative medicine–although they surely won’t admit it.

Some people want Congress to include alternative medicine coverage in the healthcare reform bill. Do you wish alternative medicine was covered in your health insurance plan?

If you chug back a couple of diet sodas a day, you may want to reconsider your choice of beverage.

One study examined more than 3,000 women for 11 years, and found those who drank two or more diet sodas a day were at double the risk for kidney damage.

The researchers did not learn whether it was the soda or the artificial sweetener in the drink that caused the damage.

“You can’t conclude that the sodas caused this problem conclusively but it suggests that there’s an affect on kidney function so people have to be aware that there’s a possible issue in doing anything in excess,” said Dr. David Goldfarb, kidney specialist with NYU Langone Medical Center.

Goldfarb said this is one of the first studies on the effects of diet soda and a lot more needs to be done before people make drastic changes.

Moderating your diet soda intake is the best thing to do for now.

Lenneice A. Drew is an experienced journalist currently focused on healthcare reform. She is working to help others achieve better lives by finding affordable health insurance alternatives and reporting stories related to the healthcare industry. She lives in Miami, Florida.

The H1N1 may spread worse because people say they can’t afford to to stay home if they get sick.

Public health experts are raising concerns that workers who deal with the public, like waiters and child care employees, are jeopardizing others by reporting to work sick because they do not get paid for days they miss for illness.

Tens of millions of people, or about 40 percent of all private-sector workers, do not receive paid sick days, and as a result many of them cannot afford to stay home when they are ill. Even some companies that provide paid sick days have policies that make it difficult to call in sick, like giving demerits each time someone misses a day.

Public health experts say policies like these encourage many people with H1N1, commonly called swine flu, to report to work despite official warnings from the government and most companies that they should stay home.

Some people who are really caught on a weekly income might say they are desperate for money and that they are going into work even though they are sick.

Many of these financially squeezed workers might also send their flu-stricken children to school, infecting others. Many will not see a doctor because they do hot have health insurance. Although there are affordable health insurance plans.

Well before President Obama declared H1N1 a national emergency, the federal Centers for Disease Control and Prevention was emphasizing that businesses should adopt “flexible leave policies” to allow workers with the flu to stay home. In one advisory, the C.D.C. encouraged employers “to develop nonpunitive leave policies.”

Despite such recommendations, some employees say they have no choice but to go to work sick.

Lenneice A. Drew is an experienced journalist currently focused on healthcare reform. She is working to help others achieve better lives by finding affordable health insurance alternatives and reporting stories related to the health care industry. She lives in Miami, Florida.

Although it seems like the Democrats’ healthcare reform bills have been zooming through Congress, Senate Majority Leader Harry Reid predicts that there will soon be roadblocks.  To the chagrin of the Obama administration, Reid believes that a final bill won’t pass before the ball drops on Times Square and 2009 draws to a close. The White House wanted a bill passed prior to Ryan Seacrest’s countdown to the new year. Why is that so important? Well, 2010 is an election year; the entire Congress will be up for re-election. Judging from the few elections held yesterday, things don’t look good for the Democrats. Their prospects will be even worse if the fight to reform the health insurance industry continues to drag on, instead of  allowing the public’s memory to fade.

Unlike the House of Representatives, which is already close to voting on its bill, the Senate may not begin debate until December. There is some speculation that Reid is waiting for the final cost analysis from the Congressional Budget Office. He commented publicly that he doesn’t want to rush such an important bill. However, he is still striving to pass Obama’s top domestic priority by years’ end. They may be worried that waiting too long will make more likely that this administration’s attempt at providing more affordable health insurance will follow the failing path of Clinton’s.

This new development is just another example of why you shouldn’t wait for the public option if you can afford a health insurance plan now.

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)