With health care legislation on perpetual pause in Congress, Republicans are proposing some new ideas for getting the deal done. From hybrid health insurance exchanges to mandates requiring everyone to be covered, the debate has shifted to what is likely to close the debate and get a bill on the President’s desk: allowing Americans to buy health coverage across state lines.
Currently, people can buy health policies only from health insurance companies licensed by the states in which they live. This is why you find, for instance, Blue Cross and Blue Shield plans that are essentially privatized entities incorporated and sold exclusively in the states in which they are sold. Auto and home insurers have used this same approach for years.
Remember when Allstate and its Good Neighbor competitor dropped coverage on houses in hurricane-prone Florida and other coastal states? Insurance companies can cut bait in states where they have a subsidiary company underwriting their policies. Allstate wasn’t writing your policy, Mr. Homeowner. It was Allstate Floridian – a separate, but equally capitalized company that was set up to take cover when floods rolled in.
The Republican idea of buying health insurance across state lines has been altered a bit, but it is incorporated into the Democrats’ House and Senate bills, and expected to be the centrepiece of any health care legislation that wins final passage.
Congressional Republicans have proposed the concept in the past and Sen. John McCain, R-Ariz., embraced it as part of his 2008 presidential campaign. Advocates — including some insurers and small business groups — say it would give the more than 17 million Americans who buy individual coverage a greater choice of plans and the possibility of lower prices.
But critics, including the National Association of Insurance Commissioners say the provision would erode state government consumer protections, leave policyholders with inadequate coverage and could actually lead to higher premiums for some people. On the flip-side, allowing people to buy health insurance from any company regardless of where they call home would encourage competition for your business. That usually leads to lower prices and, in effect, more affordable health insurance for all.
Regardless of what Congress decides to do about health care reform, there are options readily available. Insurance companies report an increase in short term health insurance which in essence, provide guaranteed coverage for major medical expenses for a pre-determined amount of time. With the rise in unemployment and prospects of new job growth ever-stagnant, we can expect to see short term medical plans grow in popularity and affordability.
No matter how you slice it, insurance by its very nature is risk. Risk breeds fear. Fear breads inaction.
Critics say that selling insurance across state lines might not save much money, and point to a 2005 CBO report that says: “if only those benefit mandates imposed by the states with the lowest-cost mandates were in effect in all states, the price of individual health insurance would be reduced by about 5 percent, on average.”
But when you consider the cost of a major medical insurance plan for a chronically ill individual can approach an average of $400 per month, that 5 percent “on average” is money in the bank.
Insurance Without Borders: Will Buying Health Plans Across State Lines Help?
Pharmacy Profits Up In Down Economy
Investor backlash over its aggressive acquisition and merger strategy in recent months, CVS Caremark Corp (CVS.N) said recent problems at its pharmacy benefits management unit have been corrected and it posted a slightly better-than-expected rise in quarterly profit, driving the company’s shares up as much as 8.8 percent. CVS also said 2010 earnings could top analysts’ views.
CVS Chief Financial Officer Dave Denton told Reuters during the earnings conference call that consumers were still “very cautious” with regard to their spending, which could affect CVS stock value in future quarters.
Retail pharmacies are taking a hit on in-store, non-drug items as the current economic recession continues to drag. Non-drug items like groceries, photo finishing and the like account for more than one half of a typical pharmacy’s profit. Last week, Walgreen posted its second consecutive monthly drop in same-store sales, with January falling 1.1 percent, while smaller Rite Aid Corp’s (RAD.N) same-store sales have fallen for eight months in a row.
CVS had no new comments about the U.S. Federal Trade Commission’s investigation into some of its business practices, which followed its acquisition of Caremark.
CVS and Walgreens have recently launched retail medical clinics in many of their locations to participate in insurance company networks that pay benefits on individual and group health insurance plans when walk-in, immediate care clinics are used for routine medical care. The clinics were very popular during the recent U.S. H1N1 Flu outbreak when vaccines were made available at CVS, Walgreens and other retail drug chains.
Natural Medicine & Prescribed Medicine Don’t Mix
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Many people feel that natural medicine is always safe to consume, but this is not always the case. Infact, studies show that mixing herbs with medications can cause harm. Researchers are warning that popular herbs and supplements, do not mix well with common heart drugs and can also be dangerous for patients taking statins, blood thinners and blood pressure medications.
Health experts say whatever you put in your mouth has the potential to interact with something else. The medication that is taken by mouth travels through the digestive system in much the same way as food and herbs taken orally do. So, when a drug is mixed with food or another herb, each can alter the way the body metabolizes the other. Some drugs interfere with the body’s ability to absorb nutrients. Similarly, some herbs and foods can lessen or increase the impact of a drug.
According to a newly released New York Times article, researchers said St. John’s wort raises blood pressure and heart rate, and garlic and ginger increase the risk of bleeding in patients on blood thinners, Even grapefruit juice can be risky, increasing the effects of calcium-channel blockers and statins, they said. Such decisions jeopardize your health and may also increase your health insurance cost.
The important thing to remember is to talk to your doctor about the measures you are taking to improve your health. You should also keep an eye for unusual symptoms. Very often, this may foretell the symptoms of a drug interaction.
Google: Broadband Good for Health Care
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An increasingly popular trend in health care is the virtual doctor’s visit. Blue Cross Blue Shield health insurance has pioneered one such program in Hawaii. Patients will be able to consult with their doctors more conveniently. In addition, experts will be more accessible–especially to those living in far-flung rural areas. Medical insurance companies are fans of the trend because it has the potential to cut overhead costs. Meanwhile, many patient advocates believe the virtual visit can improve the quality of care.
Google policy analyst Derek Slater also thinks that online consultations could change the face of the medical insurance system of the United States. However, it will be nearly impossible for them to take effect without improved broadband infrastructure. The U.S. has fallen behind many other developed nations in our speed and access to broadband Internet. Slater thinks that health care will see improved efficiency if those improvements are made. It is a potential avenue for cost savings in healthcare reform, while spurring job creation due to the needed construction of broadband lines.
How Portable Are Your Medical Records?
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The University of California at San Francisco is the latest source of a potential patient medical record mishap after a laptop was stolen and later recovered earlier this week.
Officials with the university’s medical center said that personally identifiable information and confidential medical records from some 4,000 patients went missing from an employee’s luggage following a domestic flight on November 30. His computer was recovered on January 3, though no information was given about how far or where the computer traveled during its month-long hiatus. Investigators have not yet determined whether any of the information contained on the laptop was compromised or otherwise copied from the laptop hard drive, but the university said data including patient names, health insurance plans, social security numbers and other medical information is most likely compromised.
This is the second incident of a patient data breach stemming from the University of California at San Francisco in recent days. Last month, a university professor admitted that he was the victim of a phishing scheme in which some 600 patients’ information was sent over the Internet to an undisclosed server by mistake. Insurance company Kaiser Permanente recently informed 15,000 of its health insurance subscribers that it lost sensitive information, also from the company’s laptop computers and external, portable hard drives (including one that was stolen from an employee’s automobile) between 2008 and 2009.
Such high-profile incidents of medical records breaches are likely to become a side-debate in the battle over health care reform. Some Senators have publicly called for a review and update of current HIPPA laws that do not adequately address data storage requirements now that health insurance companies and medical providers are storing information on servers that are housed away from their own facilities.
Dear Mr. President, Explain your Health Bill
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Mr. President, please tell us what your health bill is all about. This seems to be what the public is calling for. Many are down right confused about exactly how he plans to make medical insurance more affordable and how his plan will lower surging healthcare costs. Opposing views and political pundits have blurred the lines between what’s real in the more than 200-page bill and what’s not. However, President Obama seems to be standing by while the opportunity to explain and pass the bill goes by.
Ordinary Americans without the power to change the law aren’t the only ones waiting for President Obama to explain the health bill, Congressional leaders are frustrated too. Senator Al Franken apparently recently laid into White House senior adviser David Axelrod during a tense, closed-door session with Senate Democrats.
Franken criticized Axelrod for the administration’s failure to provide clarity or direction on bringing affordable health insurance and the other big bills it wants Congress to enact.
President Obama has pushed for more transparency where the health bill is concerned. He has also called for a public debate on healthcare reform for Americans hear Republicans and Democrats ideas. “If we can go step-by-step through a series of these issues and arrive at some agreements then procedurally, there’s no reason why we can’t do it a lot faster than the process took last year,” Obama said.
Whatever, the reason for the health bill confusion if the President doesn’t act fast the bill may never be understood and may never pass.
Don’t Try This At Home! DIY Operations
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In these tough economic times, many people are struggling to pay for basic needs. Health care is one of those essentials. For pet owners, Fido or Fluffy is a part of the family, and their health is also a priority. Due to their smaller size and simpler physiology, health care for pets is far less expensive than human health insurance. However, some owners will go to desperate measures when their pets are very sick and uninsured–even if they are not in the pet’s best interest.
A man in Rhode Island was recently arrested for taking matters into his own hands and operating to remove a cyst from his 14-year-old dog’s leg. He was unable to afford a visit to the veterinarian, so he used local anesthetic. Unfortunately, he chose the wrong way to go about treating the Labrador mix. As it turns out, the surgery was completely unnecessary: the cyst was benign, and vets believe that the dog had been feeling no pain from it. What the man did was inexcusable, but it holds some lessons for people.
The dog required a second surgery by medical professionals to reverse the first surgery, which was even more expensive. Do-it-yourself surgery on another person is similarly dangerous. On a more realistic note, skimping on quality and visiting a quack physician–or skipping regular check-ups–to save money will also cost you more in the long run. It is better to save your money for individual health insurance, even if it’s only a catastrophic health plan for emergencies.
Health Insurance and Rationing: Many vs. One
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How much would you be willing to pay for a couple to screen their child for a rare genetic condition? Would you want your medical insurance pay $4.7 million? That’s the amount it costs to prevent one child from being born with Spinal Muscular Atrophy (SMA). SMA is incurable and cannot be treated; a child born with it will never be able to move at all. There is an accurate test for it, but routine screening would end up costing your health insurance nearly $5 million to save one child from that fate. That’s because the SMA gene is carried by relatively few Americans and has no symptoms, meaning that the general population–as opposed to just those considered high-risk–must be tested. 11,000 women must be tested at $400 a pop to prevent one case (either by terminating the pregnancy, or using donated sperm or embryos to conceive). By contrast, it costs a relatively frugal $260,000 to provide a person with SMA lifetime care.
The idea of a single child being born with that condition is horrifying. Health insurance companies or the government using cost-effectiveness tests and rationing techniques to decide on health care is scary; cold, hard numbers hold a child’s fate in their hands. Decades worth of studies have shown that, perhaps counter-intuitively, the image of one individual’s suffering is more striking than the suffering of untold masses. Our minds find it easier to feel empathy on a smaller scale. A recent study from the American Journal of Public Health estimates that about 45,000 Americans die each year as a result of going without family health insurance, yet fewer people are willing to risk an increase in their medical insurance rates to prevent their deaths. Proponents of healthcare reform have an uphill battle psychologically; President Obama has attempted to give a name and face to the plight of several uninsured Americans in recent speeches, but his specificity appears to have had little impact.
Family Health Insurance Steers Pregnant Women Towards C-Sections
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It was recently found that almost one-third of the pregnant women in the United States give birth by Cesarean section, a far higher rate than other developed nations. While C-sections are often necessary, they are nevertheless surgical procedures that can harm both mother and child. Many doctors believe that they be performed in only 10% of pregnancies at most.
A common misconception is that American women choose to have C-sections–sometimes even scheduling them–but that is actually relatively rare. Another explanation for the high Cesarean section rate in the U.S. may be our health insurance system. Unlike many other countries, family health insurance reimburses physicians and hospitals with a flat fee for the birth, regardless of how it is performed. Some doctors may unconsciously steer their patients towards a C-section, since medical insurance doesn’t offer an incentive for them to perform longer vaginal labor instead. To the contrary: some medical insurance companies actually have higher reimbursement rates for C-sections!
Meanwhile, most hospitals can charge far more for a Cesarean section birth, which gives them more opportunity to pad their maternity care profit margins. In addition, doctors may also be performing C-sections in order to lessen the risk of a medical malpractice claim being filed against them; physicians tend to be sued for failing to take action more often than taking the wrong action. Breech babies (which are in the wrong position for vaginal birth) can sometimes be turned around through changes in positioning and waiting, but time pressures and legal concerns reduce the likelihood that an obstetrician would take that risk. All of those factors combine, and the cost is passed onto the new mother through her family health insurance premiums.
Pharma Takes A Hit: Reform Taxes Overseas Prescription Profits
With health care reform likely off the table this year, aside from a few legislative tweaks for health insurance companies, one of the biggest former beneficiaries of what was to become a major overhaul of the U.S. health care system will be feeling the pain.
Big U.S. pharmaceutical companies learned Friday that they will most likely face huge new taxes on what was once untouchable profit: overseas sales of presciption medications. New York-based Pfizer, the largest medical research and manufacturer in the U.S., will be hit the hardest. With nearly 90 percent of its income residing from overseas sales, the company and other large medicine makers are staring down the barrel of a corporate tax gun. Current proposals in Congress call for as much as a 35 percent tax on at least some of its foreign profit if President Obama’s idea gains traction.
Pharmaceuticals are often criticized for holding lengthy rights on patents for the drugs they manufacture. Since generic drugs are cheaper for those with and without affordable health insurance, the pressure is on the pill makers to shorten their exclusive rights on the drugs they sell since Obama is also looking at generating tax revenue by penalizing companies that park on their patents too long. The proposals seemingly shocked big pharma, dragging down Wall Street stocks for a bit on Friday morning.
In an interview with the New York Times, economist and former Treasury Department official Martin Sullivan said pharmaceutical companies will soon suffer the same chokehold that many lucrative and wealthy Americans parking money overseas suffered soon after Obama took office.
“Typically when a pharmaceutical company develops a new drug, it transfers it to a holding company in a tax haven like Bermuda or the Cayman Islands, usually on very favorable terms,” said Sullivan. “it pretty much came out of the blue…There’s a tremendous amount of income taken out of the U.S. and put into the tax haven. This proposal seems targeted to just that type of situation.”
The change in tone over health care reform was perhaps the biggest about-face for pharmaceutical companies, who agreed under the original health care reform bill to pay $8 billion per year in drug discounts in exchange for getting access to new business from tens of millions of uninsured Americans who would have received access to more affordable health insurance. The pharmaceutical industry is an estimated $246 billion business, according to the government statistics.
