ISS - Senate Dems against public option come from states with near-monopoly insurance markets

ISS - Senate Dems against public option come from states with near-monopoly insurance markets

...

Yet these Democrats represent states that may be most in need of a public insurance choice to compete with private plans. Four out of five of the Democrats who voted "no" on Rockefeller's amendment come from states where one insurance company controls 42% or more of the market -- a level of market dominance that the Department of Justice legally defines as "highly concentrated."

Here are how these senators' states rate for insurance market concentration:

STATE -- % OF MARKET CONTROLLED BY BIGGEST COMPANY*

NORTH DAKOTA -- 89% controlled by Noridian/Blue Cross Blue Shield ND
ARKANSAS -- 75% of health insurance market controlled by Blue Cross Blue Shield AR
MONTANA -- 75% controlled by Blue Cross Blue Shield MT
DELAWARE -- 42% controlled by CareFirst/Blue Cross Blue Shield
FLORIDA -- 30% controlled by Blue Cross Blue Shield FL

Only one of the Democrats -- Sen. Bill Nelson from Florida -- comes from a state without a "highly concentrated" health insurance market, although it's notable that the state's top two insurers (BCBS and Aetna) together control 45% of the market.

Nation-wide, 94% of insurance markets are near-monopolies -- and as Facing South reported earlier, the metro area with the worst concentration in the country (Texarkana, 97%) falls in the district of fierce public option opponent and Blue Dog Rep. Mike Ross (D-AR).

* Most of this data can be found in the American Medical Association's 2007 report on competition in health insurance [pdf]; the North Dakota figures come from this recent reportpublished by Health Care for America Now! Note that North Dakota figures include accident and health coverage.

14% of the value reaches beneficiaries and 86% of it goes elsewhere (profit or cost).

Medicare Advantage Cuts: Once More with Feeling | The Incidental Economist

Abstracting from the economics wonkery a bit, let me put research findings on Medicare Advantage (MA) payments plainly.

Payment to MA plans has gone way up since 2003. Did the payment increase largely benefit beneficiaries or not? This is a current political and policy debate, about which much has been written in the media (both traditional and blogospheric). It turns out the answer is known and quantifiable. My work (with Steve Pizer and Roger Feldman) shows that for each additional dollar spent by the federal government (taxpayers) on the program since 2003, just $0.14 of it can be attributed to additional value (consumer surplus) to beneficiaries (see also: findings brief).

What do we make of the other $0.86? That goes to the insurance companies but doesn’t come out “the other end” in the form of value to beneficiaries. In part it is accounted for by the costs of the additional benefits and in part it is captured as additional insurer profit.

So, do higher MA payments produce little value to beneficiaries, as Obama claims, or are the benefits they fund important to maintain, as Republicans would have us believe? The balance of the evidence is on Obama’s side. In fact, it is a landslide: for each dollar spent, 14% of the value reaches beneficiaries and 86% of it goes elsewhere (profit or cost).

Cuts to MA should be a no brainer.

Economic Scene - Malpractice System Breeds More Waste in Medicine - NYTimes.com

Economic Scene - Malpractice System Breeds More Waste in Medicine - NYTimes.com

The debate over medical malpractice can often seem theological. ... has inspired a lot of research by economists and others with no vested interest. And after sifting through years of data, these researchers have come to some basic factual conclusions.
...

The fear of lawsuits among doctors does seem to lead to a noticeable amount of wasteful treatment. Amitabh Chandra — a Harvard economist whose research is cited by both the American Medical Association and the trial lawyers’ association — says $60 billion a year, or about 3 percent of overall medical spending, is a reasonable upper-end estimate. If a new policy could eliminate close to that much waste without causing other problems, it would be a no-brainer.

At the same time, though, the current system appears to treat actual malpractice too lightly. Trials may get a lot of attention, but they are the exception. Far more common are errors that never lead to any action.

After reviewing thousands of patient records, medical researchers have estimated that only 2 to 3 percent of cases of medical negligence lead to a malpractice claim. For every notorious error — the teenager who died in North Carolina after being given the wrong blood type, the 39-year-old Massachusetts mother killed by a chemotherapy overdose, the newborn twins (children of the actor Dennis Quaid) given too much blood thinner — there are dozens more. You never hear about these other cases.
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Medical errors happen more frequently here than in other rich countries, as the Robert Wood Johnson Foundation recently found. Only a tiny share of victims receive compensation. Among those who do, the awards vary from the lavish to the minimal. And even though the system treats most victims poorly, notes Michelle Mello of the School of Public Health at Harvard, “the uncertainty leads to defensive behavior by physicians that generates more costs for everyone.”
...
All told, jury awards, settlements and administrative costs — which, by definition, are similar to the combined cost of insurance — add up to less than $10 billion a year. This equals less than one-half of a percentage point of medical spending. ...
The problem is that just about every incentive in our medical system is to do more. Most patients have no idea how much their care costs. Doctors are generally paid more when they do more. And, indeed, extra tests and procedures can help protect them from lawsuits. ...
...

Imagine if the government paid for more research into which treatments really do make people healthier — a step many doctors don’t like. Such evidence-based medicine could then get the benefit of the doubt in court. The research would also make it easier to set up “health courts,” with expedited case schedules and expert judges, which many doctors advocate.

Similarly, you would want to see more serious efforts to reduce medical error and tougher discipline for doctors who made repeated errors — in exchange for a less confrontational, less costly process for those doctors who, like all of us, sometimes make mistakes.

A grand compromise along these lines may be unlikely. But it’s a lot more consistent with the evidence than narrower ideas. The goal, remember, isn’t just to reduce malpractice lawsuits. It’s also to reduce malpractice.

How Does the Quality of U.S. Health Care Compare Internationally? - RWJF

How Does the Quality of U.S. Health Care Compare Internationally? - RWJF
...

What they do show is that the evidence for American superiority in quality of care (or lack thereof) is a mixed bag, with the nation doing relatively well in some areas—such as cancer care—and less well in others—such as mortality from treatable and preventable conditions.

And while evidence base is incomplete and suffers from other limitations, it does not provide support for the oft-repeated claim that the “U.S. health care is the best in the world.” In fact, there is no hard evidence that identifies particular areas in which U.S. health care quality is truly exceptional. ....

Baucus Bill Would Exempt Large Companies from Regulations

Daily Kos: State of the Nation
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Igor Volsky at the Wonk Room explains:

The Senate Finance Committee’s legislation does not require large employers that self insure to abide by the same rules and regulations as insurers operating in the Exchange or the individual health insurance markets. As Rockefeller explained during mark-up, "you are grandfathering in an unfairness in the insurance market, where you treat 50 percent of the American people in one way...and 46 percent in a very favored way without restrictions, without discipline." "Most people don’t know that they are treated so differently. Most people don’t know that they have these restrictions on them," Rockefeller said....

Self-insured plans — which are regulated by a law called ERISA — do not have to accept Americans with pre-existing conditions, or remove caps on out-of-pocket or lifetime expenses. "As many as 73 million people, or 55% of those who get insurance through private-sector jobs, are covered in self-insured plans, according to the non-partisan Employee Benefit Research Institute. Workers are often not aware their plans are self-insured because employers hire insurance companies to process claims."

No wonder the insurance companies loved the Baucus bill.

Profits up 428% ... No wonder they don't want competition.

Robert Creamer: Growing Momentum for Public Option: "
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... over the last ten years wages have gone up 29%, health insurance rates have gone up 120% and the profits of the private health insurance industry have gone up 428%. No wonder they don't want competition.
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Last weekend's New York Times poll showed that 65% of all voters support giving Americans the choice of a public option and only 26% oppose it.

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Overall, 58% of voters believe the health care system is in need of major reform or a complete overhaul, and almost 59% are concerned that Congress will not take action on health care reform this year. The risks of inaction to Democrats in swing districts increases if voters perceive opposition stems from ties to the insurance industry, as 74% are concerned that the health insurance industry will have too much influence over reform. [i.e. congress is being bribed ?!]
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Second, the Congressional Budget Office has found that it will save the Government huge amounts in subsidy monies that it would otherwise have to pay to make more expensive for-profit plans affordable. The most robust version of the public option saves over $100 billion over ten years.
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It's wrong to think about the public option in isolation from other elements of reform. Forcing an individual mandate without a public option is a clear political loser (34% Favor / 60% Oppose), and only becomes more palatable when a public option is offered in competition with the private sector (50% Favor / 46% Oppose)

Turns out that a public option provides a political inoculation against backlash to a mandate.
...

electronically alerting doctors ...doesn't mean doctors will (a) open them (b) do anytihng ...

Electronic records, medical errors -- and the inescapable human factor | Booster Shots | Los Angeles Times
...
... A study published in the Archives of Internal Medicine, has found that electronically alerting doctors of suspicious test results doesn't mean doctors will a) open the electronically delivered alert or b) act on it if they do.

And though you'd think that alerting more than one physician would reduce the chances that a patient would slip through the cracks, the study found just the opposite: Suspicious test results were less likely to be acted on, not more, presumably because each physician assumed the other doctor had taken the necessary steps.

...

Of the alerts, 217 (18.1%) were unopened after two weeks.

And of the 1,196 alerts, 92 (7.7%) didn't receive timely follow-up, such as a call to a patient or ordering of more tests. (The definition of timely follow-up was within four weeks.)

Perhaps surprisingly, the rates of poor follow-up were about the same for reports that were unopened and reports that were opened.

But in cases when a radiologist actually got on the phone and talked to a physician about a test, follow-up was more likely. (This may have partly been due to those results being more serious than other abnormal tests, the authors said.) ...

Leading Dem Plans To Blow Up Deal With Big Pharma

Leading Dem Plans To Blow Up Deal With Big Pharma
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It's one of the simplest ways to reduce health care costs but was ruled out by the agreement, which limits Big Pharma's contribution to health care reform to $80 billion over ten years.

North Dakota Sen. Byron Dorgan, a member of Democratic leadership, isn't a party to that bargain. "Senator Dorgan intends to offer an amendment to the health reform bill and his expectation is that it will be one of the first amendments considered," his spokesman Justin Kitsch told HuffPost in an e-mail. "Prescription drug importation is an immediate way to put downward pressure on health care costs. It has bipartisan support, and has been endorsed by groups such as the National Federation of Independent Businesses and AARP."

U.S. patients pay far more than the rest of the world for prescription drugs. The Canadian government keeps prices down by using its purchasing power to negotiate for lower rates. Dorgan wants American consumers in on the deal.

A bill to allow re-importation -- S. 1232 - has 30 cosponsors, several Republicans among them, including Olympia Snowe and Susan Collins of Maine, John Thune (S.D.) and David Vitter (La.). ...

The Congressional Budget Office estimates that the bill would result in $50 billion in direct savings over the next decade, with $10.6 billion of that being savings to the federal government.

Read more at: http://www.huffingtonpost.com/2009/09/28/leading-dem-plans-to-blow_n_302235.html...

Mom Goes Blind So Her Daughters Can See (VIDEO)

Mom Goes Blind So Her Daughters Can See (VIDEO)
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Monique Zimmerman-Stein has been nearly blind for the last two years from Stickler syndrome, a rare genetic disorder. She recently decided to forego her own treatment to save funds to treat her two daughters, who also suffer from the condition, reports Lane DeGregory of the St. Petersburg Times.

The family is covered under husband Gary's Blue Cross/Blue Shield plan, but that coverage only pays for 80 percent of medical expenses.

She will no longer get treatment to preserve that last slice of light. The injections that might help cost $380 after insurance, and she needs one every six weeks. She could be spending that money on her daughters' care.

If forgoing treatment might help them see, she said, "That's a choice any mom would make."

No one should have to make such sacrifices, said her husband. He hopes the new health plan will include a public option and won't exclude people with pre-existing conditions -- like his wife and daughters.

Read more at: http://www.huffingtonpost.com/2009/09/28/mom-goes-blind-so-her-dau_n_301947.html

Huge California study concludes soda consumption undeniably linked to obesity by Mike Adams the Health Ranger

Huge California study concludes soda consumption undeniably linked to obesity by Mike Adams the Health Ranger

(NaturalNews) Much like Big Tobacco once did with nicotine, the soda industry and high-fructose corn syrup producers of America have maintained a ridiculous state of flat-out denial about the links between soda consumption and obesity. "Sodas don't make you fat," they insist. Meanwhile, as Americans guzzle down insanely large quantities of soda and liquid sugar with each passing year, rates of obesity and diabetes continue to steadily climb. Surely diet must have something to do with it, right?

Thanks to a new California study, soda companies can no longer hide behind the defense of uncertainty when it comes to links between soda consumption and obesity. This massive study questioned the soda consumption habits of 43,000 adults and 4,000 adolescents and concluded this: Drinking one or more sodas a day increases your chances of obesity by 27 percent. A whopping 62% of adults who drink at least one soda each day are overweight or obese.

The study also found that Californians are gulping down sodas at an unprecedented rate: At least one soda is consumed daily by 41 percent of children, 62 percent of adolescents and 24 percent of adults. Through the study, another shocking statistic was revealed: The average California teen consumes 39 pounds of liquid sugar a yearsolely from soda consumption.

Sadly, the study didn't look at rates of diabetes and bone loss -- the phosphoric acid in sodas causes osteoporosis, even in males -- but there's little doubt that a similar correlation exists between soda consumption and those diseases, too. ...

Editorial - The Numbers and Health Care Reform - NYTimes.com

Editorial - The Numbers and Health Care Reform - NYTimes.com
..
... A study by the Treasury Department found that almost half of all Americans below Medicare age have gone without insurance at some point over the last decade.

The Kaiser study, conducted jointly with the Health Research and Education Trust, an affiliate of the American Hospital Association, found that the average premium for a family policy offered at work rose above $13,300 in 2009 — up from $5,800 in 1999. The average employer paid more than $9,800 of that, while the workers contributed more than $3,500. The workers were also hit with larger co-payments and deductibles, while their policies often offered fewer benefits.
...

Kaiser estimates that, if increases revert to the average of the last 10 years, health insurance premiums in 2019 will average a whopping $30,800, which it calls “a very scary number.” More immediately, a fifth of the employers surveyed said they are very likely to increase the amount that employees pay for premiums next year.

Meanwhile, the Treasury Department’s study highlighted how vulnerable Americans are to losing their coverage.

It found that, between 1997 and 2006, 48 percent of nonelderly Americans went without health insurance for at least one month, 41 percent lacked coverage for at least six months and 36 percent were uncovered for a year or more. That happened during a decade of strong economic growth. The number of uninsured is likely to be higher over the next decade, the study warns. ...

France's National Health Insurance Wrestling With Rising Costs - washingtonpost.com

France's National Health Insurance Wrestling With Rising Costs - washingtonpost.com

...

Despite the prospect of an expensive two-week hospital stay, Aloy, 58, did not worry. France's national health insurance, supplemented by a private policy for co-payments, covered the entire bill -- from doctor's fees to medication to a private room with a view -- and Aloy would not even know the total.

"All I have to do is fill out some papers and send them off to the insurance company," he said during a smoke break on a sunny terrace in front of the hospital two days after the surgery.

France has long been proud of its national health insurance, part of a many-tentacled and costly social protection system designed to embrace almost everyone who is legally in the country. Most French people have grown up with the idea that the government is the ultimate guarantor of health care, even for people who cannot afford to pay. The concept has become so ingrained over the past half-century that it is an untouchable part of the political landscape, making the debate over President Obama's proposals in Washington and the fading chances for a public option seem, in the words of the newspaper Le Monde, "altogether surreal." ...

...But despite the drawbacks, the outcome is relatively cost-effective in comparison with the situations in other industrialized nations, according to tracking by the Paris-based Organization for Economic Cooperation and Development.

...Spending less apparently has not lowered the quality of health care. Despite their reputation for guzzling red wine and eating fatty cheese, French people have for years enjoyed a longer life expectancy than their counterparts in the United States, currently at 80.98 years compared with 78.11.

Affordable mandated private insurance - the BIG lie - A look at the actual numbers on a MA site - Democratic Underground

Affordable mandated private insurance - the BIG lie - A look at the actual numbers on a MA site - Democratic Underground
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Well, I just went to the site in Massachusetts that helps uninsured families find and enroll in these plans. I typed in my income was above the 54,936.00 limit for assistance for a family of three and choose to find plans for a family of three of the following ages - 38, 41, & 14.

Here are the results:

Low premium. Most have deductibles and co-payments. Prescription drug coverage included. 4 plans $836.84 - $952.45/mo

- Okay, there is your first option....for between 836.84 - 952.45, you can buy a family plan with high premiums, deductibles, and co-payments. Now if you make 55,000 dollars a year, you and choose this plan, you would be paying 19.63 percent of your income for health insurance that DOES NOT FULLY COVER YOU, CAN DENY CLAIMS, & WILL COST YOU MARKEDLY MORE IF YOU ACTUALLY USE IT....(I used 900 dollars a month as a mid-way figure between the costs presented for purchasing this plan). It may be slightly more or slightly less.
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Low co-payments. No deductible. Prescription drug coverage included. 4 plans $1,493.62 - $1,739.38/mo

Whew, I am getting sticker shock at this point. Okay, let's start with the mid-level range for one of these plans, say 1,600 bucks a month. Or, to put it another way, for a mere 34.9 percent of your income you can have nearly full coverage health insurance that still can be denied, but it may cover a lot of if you ever need to use it. Fingers crossed.

Looking at a plan that matches the price I choose, the maximum out of pocket expenses is 2000.00. You STILL HAVE out of pocket expenses with the most expensive plan. Co-payments for meds were as high as 90.00 dollars per script. Durable medical equipment costs were 1,500 dollars before they pay a dime.

There you have it! That is the reality of health insurance costs for a family that makes too much to get government subsidies. And, from what I am reading about the national plan, the income rate for subsidies will be much lower. Also, you might want to know that the MA plan is becoming financially insolvent and they have been paying for the subsidies for purchasing health insurance by cutting benefits to lower income people...the poor sacrificing for the slightly better off. A reality that will be happening to people on Medicare and Medicaid across the country, if this current plan passes.

Here is the link to the site -

https://www.mahealthconnector.org/portal/site/connector /

The Raw Story � Insurance company fined $10m for rescinding policy of HIV-positive teen

The Raw Story � Insurance company fined $10m for rescinding policy of HIV-positive teen

In a landmark decision that perhaps offers a preview of legal setbacks for insurance companies, the South Carolina Supreme Court has fined an insurance company $10 million for rescinding the policy of a college student after he tested positive for HIV.

Murray Waas, writing at the Huffington Post, said the court found the insurance company's decision "reprehensible."

... "In Febuary 2008, a private arbitration judge in Los Angeles ordered Health Net Inc. to pay more than $9 million to a breast cancer patient whose health insurance it revoked shortly after her diagnosis and while she was undergoing chemotherapy. The plaintiff in that case, Patsy Bates, a then-52-year-old grandmother and hair-salon owner, was unable to continue her chemotherapy for several months. During the case, evidence emerged that Health Net had paid bonuses to employees to reward them based on the number of policyholders they had rescinded. The judge who awarded Bates the $9 million said in his decision: "It's difficult to imagine a policy more reprehensible than tying bonuses to encourage the rescission of health insurance that keeps the public well and alive."...

Health Care Deceit:

Health Care Deceit : Information Clearing House - ICH
By Paul Craig Roberts

September 14, 2009 "Information Clearing House" --- The current health care “debate” shows how far gone representative government is in the United States. Members of Congress represent the powerful interest groups that fill their campaign coffers, not the people who vote for them.

The health care bill is not about health care. It is about protecting and increasing the profits of the insurance companies. The main feature of the health care bill is the “individual mandate,” which requires everyone in America to buy health insurance. Senate Finance Committee chairman Max Baucus (D-Mont), a recipient of millions in contributions over his career from the insurance industry, proposes to impose up to a $3,800 fine on Americans who fail to purchase health insurance.

The determination of “our” elected representatives to serve the insurance industry is so compelling that Congress is incapable of recognizing the absurdity of these proposals.
The reason there is a health care crisis in the US is that the cumulative loss of jobs and benefits has swollen the uninsured to approximately 50 million Americans. They cannot afford health insurance any more than employers can afford to provide it.

It is absurd to mandate that people purchase what they cannot afford and to fine them for failing to do so. A person who cannot pay a health insurance premium cannot pay the fine.

These proposals are like solving the homeless problem by requiring the homeless to purchase a house. ...
...
The private sector is no longer the answer, because the income levels of the vast majority of Americans are insufficient to bear the cost of health insurance today. To provide some perspective, the monthly premium for a 60-year old female for a group policy (employer-provided) with Blue Cross Blue Shield in Florida is about $1,200. That comes to $14,400 per year. Only employees in high productivity jobs that can provide both a livable salary and health care can expect to have employer-provided coverage. If a 60-year old female has to buy a non-group policy as an individual, the premium would be even higher. How, for example, is a Wal-Mart shelf stocker or check out clerk going to be able to pay a private insurance premium?

Even the present public option--Medicare--is very expensive to those covered. Basic Medicare is insufficient coverage. Part B has been added, for which about $100 per month is deducted from the covered person’s Social Security check. If the person is still earning or has other retirement income, an “income-related monthly adjustment” is also deducted as part of the Part B premium. And if the person is still working, his earnings are subject to the 2.9 percent Medicare tax.

Even with Part B, Medicare coverage is still insufficient except for the healthy. For many people, additional coverage from private supplementary policies, such as the ones sold by AARP, is necessary. These premiums can be as much as $277 per month. Deductibles remain and prescriptions are only 50% covered. If the drug prescription policy is chosen, the premium is higher.

This leaves a retired person on Medicare who has no other retirement income of significance paying as much as $4,500 per year in premiums in order to create coverage under Medicare that still leaves half of his prescription medicines out-of-pocket. Considering the cost of some prescription medicines, a Medicare-covered person with Part B and a supplementary policy can still face bankruptcy.
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Despite the rise in premiums, payments to health care providers, such as doctors, appear to be falling along with coverage to policy holders. The system is no longer functional and no longer makes sense. Health care has become an incidental rather than primary purpose of the health care system. Health care plays second fiddle to insurance company profits and salaries to bureaucrats engaged in fraud prevention and discovery. There is no point in denying coverage to one-sixth of the population in the name of saving a nonexistent private free market health care system.

The only way to reduce the cost of health care is to take the profit and paperwork out of health care. ...

Sebelius: No public abortion funding in health care bill | McClatchy

Sebelius: No public abortion funding in health care bill | McClatchy

Dylan Ratigan: Health Care: Let's Liberate the Masses

Dylan Ratigan: Health Care: Let's Liberate the Masses
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But if you decide you want to buy your appliance someplace else, no problem, the GE Appliance Store is there if you want it at any time, but there is certainly no obligation to buy there. And they certainly don't pay me in expensive GE stoves, because I would much rather have actual money that I could then go and use it to buy any stove I want, maybe even a smaller, cheaper one since I live in New York City. Or if I didn't need a new stove, I could just use the money for something I did need.

The same is true for all of the non-health insurance I have. They have nothing to do with where I work, so I can change my homeowners insurance and car insurance at any time, and the insurers are forced to compete based on my preferences.

And yet that is exactly the opposite of how the Employer-based Health Care model works: they decide your choices, and if you don't like their limited selection, you end up having to forgo their entire subsidy and pay for the plan you want completely out of pocket. It would be like getting partially paid in stoves that you don't need and can't sell.

However, when you compare my predicament to the 47 million people without health insurance, I couldn't seem more whiny. The fact is that GE does provide me with excellent health insurance, so this really has nothing to do with benefiting me personally. But the cost of health insurance in this country is out of control, and it is not only keeping millions from accessing proper medical care, but it is also hobbling our large companies in the global marketplace and strangling at birth many of the small businesses we need so desperately to get job growth going.

Meanwhile, innovative health care programs like the Mayo Clinic are out of reach of most of the 174 million Americans currently on Employer-based health care, protecting the majority of insurers from competing against the Mayo Clinic's amazing advances. This in turn prevents the smarter, less-expensive large scale health care companies from growing large enough to cover the currently uninsured.

As it stands now, being forced into an Employer-based health care system encourages the exorbitant spending that is bankrupting our country.

...

Raw Story � Rep. Mike Ross Raises Eyebrows With Healthy Haul

Raw Story � Rep. Mike Ross Raises Eyebrows With Healthy Haul
...

Arkansas Rep. Mike Ross — a Blue Dog Democrat playing a key role in the health care debate — sold a piece of commercial property in 2007 for substantially more than a county assessment [2] (PDF) and an independent appraisal [3] (PDF) say it was worth.

The buyer: an Arkansas-based pharmacy chain with a keen interest in how the debate plays out.

Ross sold the real estate in Prescott, Ark., to USA Drug for $420,000 — an eye-popping number for real estate in the tiny train and lumber town about 100 miles southwest of Little Rock.

“You can buy half the town for $420,000,” said Adam Guthrie, chairman of the county Board of Equalization and the only licensed real estate appraiser in Prescott.

But the $420,000 was just the beginning of what Ross and his pharmacist wife, Holly, made from the sale of Holly’s Health Mart. The owner of USA Drug, Stephen L. LaFrance Sr., also paid the Rosses $500,000 to $1 million for the pharmacy’s assets and paid Holly Ross another $100,001 to $250,000 for signing a non-compete agreement. Those numbers, which Ross listed on the financial disclosure reports he files as a member of Congress, bring the total value of the transaction to between $1 million and $1.67 million. ...

Big drop in heart attacks after smoking bans, studies say - CNN.com

Big drop in heart attacks after smoking bans, studies say - CNN.com

The ban on smoking in public places, such as bars and restaurants, has been one of the greatest public health debates of the early 21st century. Now, two large studies suggest that communities that pass laws to curb secondhand smoke get a big payoff -- a drop in heart attacks.

Overall, American, Canadian, and European cities that have implemented smoking bans had an average of 17 percent fewer heart attacks in the first year, compared with communities who had not taken such measures.

Then, each year after implementing smoking bans (at least for the first three years, the longest period studied), smoke-free communities have an average 26 percent decline in heart attacks, compared with those areas that still allow smokers to light up in public places.

The findings, published independently by two research teams using similar data, are in the medical journals Circulation: Journal of the American Heart Association and Journal of the American College of Cardiology.

The new studies should grab the attention of cities as well as states -- such as Tennessee and Virginia -- that still permit smoking in (at least certain sections of) bars, casinos, restaurants, and other public places. ...

Study: 45,000 Americans die each year for lack of insurance

The Raw Story � Study: 45,000 Americans die each year for lack of insurance

Harvard researchers published Thursday in the American Journal of Public Health a study which reveals roughly 45,000 American adults die every year because they are not covered by health insurance.

Researchers specifically noted that lack of health insurance now kills more adults than kidney disease.

Lead author Dr. Andrew Wilper, who worked at Harvard Medical School when the study was done and who now teaches at the University of Washington Medical School, said, "The uninsured have a higher risk of death when compared to the privately insured, even after taking into account socioeconomics, health behaviors and baseline health. We doctors have many new ways to prevent deaths from hypertension, diabetes and heart disease - but only if patients can get into our offices and afford their medications."

The study, which analyzed data from national surveys carried out by the Centers for Disease Control and Prevention (CDC), assessed death rates after taking education, income and many other factors including smoking, drinking and obesity into account. It estimated that lack of health insurance causes 44,789 excess deaths annually.

Previous estimates from the IOM and others had put that figure near 18,000. The methods used in the current study were similar to those employed by the IOM in 2002, which in turn were based on a pioneering 1993 study of health insurance and mortality.

Number Of Claims Denied Remains A Mystery -- 21% ??

In Health Care, Number Of Claims Denied Remains A Mystery

...

This is one of the dark corners of the black box that is private health insurance," said Karen Pollitz, a professor at the Georgetown University Health Policy Institute.

Data on how often insurance claims are denied -- and for what reasons -- is collected and analyzed by the insurance companies themselves. But except in California, the companies aren't required to provide those records to any state or federal agency. "The number is knowable, but not known by regulators or policy makers or patients," Pollitz said.

The main health-care reform bill being considered in the House does seek to address the matter. It would require health insurance companies to report data on claims policies, practices and denials to a central commissioner.

The issue of claims surfaced recently in California. The state Nurses Association issued a press release saying that data it obtained from the Web site of the state's Department of Managed Health Care showed that in just the first half of 2009, California's six largest HMOs had rejected more than 31 million claims -- 21 percent of those they had received.

The way the nurses group tells it, state officials didn't even know they had the data.

Read more at: http://www.huffingtonpost.com/2009/09/18/in-health-care-number-of_n_291881.html ...

Daily Kos: Congratulations, It's A Rescission!

Daily Kos: Congratulations, It's A Rescission!
.. and this:

Many insurers consider a Caesarean-section pregnancy a pre-existing condition and refuse to cover women who have had the procedure.

... and this:

The Pregnancy Discrimination Act of 1978 requires employers with more than 15 workers to include maternity benefits in their insurance packages. But only 14 states require maternity coverage in policies sold on the individual market, according to the Kaiser Family Foundation.

And a report last fall by the National Women's Law Center found only 12 percent of 3,500 individual insurance policies included comprehensive maternity coverage. Another 20 percent offered it with a rider that cost as much as $1,100 a month. Others required a two-year waiting period. .

Firm cancels health insurance coverage for girl, 17, after celiac disease diagnosis -- chicagotribune.com

Firm cancels health insurance coverage for girl, 17, after celiac disease diagnosis -- chicagotribune.com

American Community Mutual's rescission numbers 'cause for concern,' says director of Illinois Department of Insurance

In the months that followed her diagnosis, her insurance company, American Community Mutual Insurance, combed through her medical records and ruled that her parents lied on her application last year.

In May, American Community not only canceled her policy, but also rescinded coverage all the way back to the day it started -- Nov. 1.

Her parents, Dale and Pat Rice of Deerfield, insist they were truthful on Brianna's application and say the insurance company is trying to back out of covering their daughter because of the February diagnosis.

American Community disagrees, saying that if the Rices had given the company Brianna's full heath history when they applied for coverage, it would never have been granted.

The Rices filed a complaint with the Illinois Department of Insurance, then fired off an e-mail to What's Your Problem?

"We are livid," said Dale Rice, who, along with his wife, is out of work. "When a private insurer gets legitimate claims and seeks to find excuses not to pay them, they are clearly demonstrating morally and ethically bankrupt behavior."

The family's situation shows just how quickly health insurance problems can lead to financial ruin. With their daughter's unpaid medical bills exceeding $20,000 and mounting, the Rices fear losing their home. Pat Rice said she cashed in some of her retirement account to pay bills.

"The next step is really bankruptcy," her husband said. ...

RJ Eskow: Top Five Reasons the Baucus Bill Is Really, Really Bad

RJ Eskow: Top Five Reasons the Baucus Bill Is Really, Really Bad

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So in order to clarify this complicated issue, here are the top five reasons why it's a really bad bill:

1. Premium rules that are a giveaway to the insurance companies.

The first shocker in the Baucus bill came early on in the draft. Since I've worked in health insurance underwriting I have a certain familiarity with these kinds of numbers. I was stunned to see that the bill allows insurers to charge up to five times as much for some enrollees as for others, based on age. (By contrast, the House draft bill only allows them to charge up to twice as much based on age.)

.... High-cost medical conditions, including chronic (and therefore pre-existing) conditions, aren't restricted to older people, of course. But they become increasingly common as we age -- so much so that indexing costs to age addresses a lot of the difference. The Baucus bill allows insurers to use age as a proxy for costly medical conditions and make coverage prohibitively expensive for those who need it the most ,,,

The net result would be to make insurance increasingly unaffordable to Americans as they age. Nevertheless ...

2. The individual mandate is in there anyway.

Although I've been critical of the way many proposals have structured the individual mandate, I've always said that I understand the logic behind them: If you're going to force insurers to take all comers at a relatively average price, the healthy as well as the sick need to enroll. But if you're allowing insurers to charge much more for the (probably) sick than they do for the (probably) healthier, why have a mandate at all? You're not pooling risk in the manner originally proposed, so this is a heads-I-win-tails-you-lose proposition for the health plans.

3. It taxes benefits, slowly but surely.

I've been opposing the idea of taxing so-called "Cadillac benefits" for a long time. This plan does just that, although they're not likely to be "Cadillac plans" for long. As I feared, the tax isn't based on plan design. It targets plans above $21,000 indiscriminately, regardless of the reason for the added cost.

How is this terrible? Let us count the ways. First, it will hit plans hardest when they enroll older employees (who, you will remember, can cost five times as much to cover). That will penalize older employee groups, and will encourage employers to discriminate on the basis of age. Next, it will hurt people who live in urban and coastal areas where medical costs are higher (not that the Senator from Montana cares about that, I suppose). Lastly, if medical costs continue to increase at 10% per year, $21,000 will be the cost of the average plan in five or six years.

This plan's good CBO forecast rests in part on this new tax income. In other words, it achieves much of its vaunted "budget consciousness" on the backs of the middle class.

4. No public plan option.

But you knew that already, didn't you?

5. Co-ops can't always "cooperate."

... But they can't pool their negotiating ability to get better deals from providers on behalf of the American consumer. (Congratulations, Dems -- more money out of the taxpayer's pocket.)

...

The plan does other bad things, too, like the provision that will encourage employers to discriminate against lower-income workers. But hitting you with more than five of them at once could conceivably be bad for your health.

Stephen Green: America's Strange Health Care Debate

Stephen Green: America's Strange Health Care Debate

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So, relative healthcare costs. The United States as a government, according to the 2009 World Health Report, expends $3,076 US on healthcare per capita per year, which puts it third in the world behind Luxembourg ($4,992) and Denmark ($3,239) and then followed (top ten)by:

1. Netherlands ($2,785)
2. Austria ($2,737)
3. France ($2,727)
4. Germany ($2, 664)
5. Iceland ($2,628)
6. Canada ($2,587)
7. Sweden ($2,583)

These, however, are only government healthcare expenditures, and all of the other countries listed here have essentially national, not free-market healthcare systems.

The Report also tracks total national healthcare expenditure as a percentage of gross domestic product, public and private. Here then are those relative figures, for the top ten countries:

1. United States (15.8%)
2. France (11%)
3. Denmark (10.8%)
4. Switzerland (10.8%)
5. Germany (10.6%)
6. Austria (10.2%)
7. Canada (10.0%)
8. Sweden (9.2%)
9. Spain (8.4%)
10. Japan (8.1%)

The United States relative to its GDP expends, counting both government and private funds, 43% more on health care than does the next highest country, which is France.

Compared with Canada (aren’t we always comparing our HC system to Canada’s?) the US expends, in public and private funds together, 63% more on healthcare. So with the highest healthcare costs in the world, what are we in the United States getting in the way of results, i.e., HEALTH?

One standard measure of the effectiveness of our healthcare system might be life expectancy at birth, in years. According to WHO, the nation with the highest life expectancy is Japan, at 83 years, followed by Italy, Australia and Switzerland, at 82 years. You may expect to live to be 81 if you live in Canada, Israel, Netherlands, Norway, Singapore, France, Sweden, New Zealand and Andorra. People in Austria, Belgium and Cypress live to the age of 80, on average. Costa Ricans and people in Finland live on average to be 79. Citizens of the U.S., along with those of Chile, Denmark and Cuba die on average at age 78.

The infant mortality rate calculates the number of deaths at birth, per 1000 births, for both sexes. The U.S. is tied at six deaths per thousand with the countries of Thailand, Slovakia, Lithuania and Hungary. Among the countries with FEWER than six deaths per 1000 live births are Slovenia, Singapore, San Marino, South Korea, Lithuania, Estonia, Cuba, Cyprus and Andorra.

It is worth noting, in respect of the infant mortality numbers just cited, that the WHO annual report also tracks the percentage of births attended by skilled health personnel. While the number for attended U.S. births is high, at 99%, there are 46 countries that have 100% of births attended. These include Albania, Barbados, Bosnia, Brunei, Canada (oops!) Chile, Croatia, Cuba (again) , Cyprus and the Czech Republic, along with Kazakhstan, Kuwait, Poland, Quatar , Moldova, Malaysia, and Libya. Also Turkmenistan, United Arab Emirates and Uzbekistan.

Maternal mortality rates per 100,000 live births are also rated. The United States loses 11 mothers per 100,000 live births. Countries which lose fewer than that include Canada, Croatia, Czech Republic, Hungary, Israel, Kuwait, Latvia, Malta, Poland, Slovakia and Macedonia. In all, a total of 31 countries suffer fewer than 11 maternal deaths per 100,000 live births.

The point here is not to denigrate the “American Healthcare System.” It is among the finest in the world…..AMONG the finest in the world. It is indisputably the most expensive in the world….. by far. A little realism and a dash of humility would probably help us to improve it further. ...

Huff TV: Roy Sekoff Blasts Max Baucus' Health Care Bill On Ed Show (VIDEO)

Huff TV: Roy Sekoff Blasts Max Baucus' Health Care Bill On Ed Show (VIDEO)

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... took the opportunity to blast Sen. Max Baucus and the bill he is scheduled to release from the Senate Finance Committee tomorrow. Reacting to former insurance executive Wendell Potter, who told a House committee today that the Baucus bill is an "absolute gift" to the insurance industry, Sekoff said, "Truth be told, it's not technically a gift since the insurance and health industry actually paid for it with the over $3 million it has donated to Baucus since 2003." Sekoff also lamented that the debate over a public option is winding down to "is a watered down public option better than nothing?" ...

Treating Domestic Violence as a Preexisting Condition is Only One Example of the Rampant Sexism in the Healthcare Debate | BuzzFlash.org

Treating Domestic Violence as a Preexisting Condition is Only One Example of the Rampant Sexism in the Healthcare Debate | BuzzFlash.org

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The Service Employees International Union (SEIU) is bringing attention to the fact that it is legal in eight states and the District of Columbia for insurance companies to deny coverage due to previous instances of domestic violence. This is not merely a legalistic exercise, either: SEIU also notes that half of the largest insurers have used domestic violence as a reason to limit and/or deny care to customers in the past.

When you remove the public relations element, it makes sense that insurance companies would do this to minimize risk. After all, 35 percent of all calls to emergency rooms are related to domestic violence, and 37 percent of women making emergency room visits do so because of abuse from their current or former partner. Surely it gets expensive.

...

The information that the SEIU cites on domestic violence as preexisting condition comes from a study published last fall by the National Women's Law Center, which illustrated that there are plenty more ways in which private insurance companies discriminate against women (because around 85 percent of victims of domestic violence are women according to the Bureau of Justice Statistics, I don't consider it a stretch to say that denying such victims insurance coverage amounts to sexual discrimination).

But the study also found that individual insurance is more expensive for women due to the practice of "gender rating," even though women are generally healthier -- and engage in more cost-saving preventative care -- than men. Also, they found affordable maternal health insurance is notoriously difficult to obtain, leading this cartoonist to quip that just "being a woman" a preexisting condition.

The realities of the job market for women also means fair reform of health insurance may effect women more than men. Women are more likely to work part-time and inundervalued "pink collar" industries, both of which commonly lack healthcare insurance coverage. Furthermore, though there's no broad scientific data on this, at least twostudies I found confirmed my suspicion that women tend to work at smaller companies, which routinely have less secure health insurance profiles on the whole due to their limited bargaining power.

Even before they enter the job market, women are discriminated against in access to affordable healthcare. The Deficit Reduction Act of 2005 gave drug companies an economic incentive to stop offering birth control pills to colleges and other low-cost providers at a discount, meaning that a month's worth of pills that once cost from $3 to $10 skyrocketed to somewhere between $30 and $50. ...

������������������ : Information Clearing House - ICH

Sick and Wrong : Information Clearing House - ICH

By Matt Taibbi

Watch Matt Taibbi break down his report on the sad state of health care reform in his blog, Taibblog.

September 14, 2009 "Rolling Stone" September 03, 2009 --- Let's start with the obvious: America has not only the worst but the dumbest health care system in the developed world. It's become a black leprosy eating away at the American experiment — a bureaucracy so insipid and mean and illogical that even our darkest criminal minds wouldn't be equal to dreaming it up on purpose.

The system doesn't work for anyone. It cheats patients and leaves them to die, denies insurance to 47 million Americans, forces hospitals to spend billions haggling over claims, and systematically bleeds and harasses doctors with the specter of catastrophic litigation. Even as a mechanism for delivering bonuses to insurance-company fat cats, it's a miserable failure: Greedy insurance bosses who spent a generation denying preventive care to patients now see their profits sapped by millions of customers who enter the system only when they're sick with incurably expensive illnesses.

The cost of all of this to society, in illness and death and lost productivity and a soaring federal deficit and plain old anxiety and anger, is incalculable — and that's the good news. The bad news is our failed health care system won't get fixed, because it exists entirely within the confines of yet another failed system: the political entity known as the United States of America.

Just as we have a medical system that is not really designed to care for the sick, we have a government that is not equipped to fix actual crises. What our government is good at is something else entirely: effecting the appearance of action, while leaving the actual reform behind in a diabolical labyrinth of ingenious legislative maneuvers. ....

Majority Of Doctors Back Public Option: New England Journal Of Medicine Study

Majority Of Doctors Back Public Option: New England Journal Of Medicine Study

A new study finds that a majority of physicians support the creation of a public health care option.

A Robert Wood Johnson Foundation (RWJF) study published in Monday's New England Journal of Medicine shows that 63 percent of physicians support a health reform proposal that includes both a public option and traditional private insurance. If the additional 10 percent of doctors who support an entirely public health system are included, then approximately three out of four physicians nationwide support inclusion of a public option. Only 27 percent support a private-only reform that would provide subsidies for low-income individuals to purchase private insurance.

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"We found that no matter how you sliced the data, physicians demonstrated majority support for a public health insurance option, regardless of their type of practice or where they live," said Keyhani.

Among those physicians who identified themselves as members of the American Medical Association, 62.2 percent favored both the public and private options. The AMA has opposed a public option, saying that it "threatens to restrict patient choice by driving out private insurers."

A majority of physicians surveyed (58 percent) also supported expanding Medicare eligibility to those between the ages of 55 and 64.

"These results give voice to individual physicians in the national discussion about health reform," said Federman. "Most often we hear the opinions of special interest groups rather than doctors themselves, but we know that Americans want to hear the opinions of doctors like those who treat them. This study lets us hear the unfiltered views of physicians on key elements of health reform and should be useful for lawmakers."