Health and Sanity category archive

. . . because a health insurance industrial complex whose primary purpose is paying the country club memberships of its executive bonus babies by denying health care is likely to have a whatchamaycalllit oh! right conflict of interest:

Blue Cross Blue Shield of Delaware violated state law by signing a contract with a company that guaranteed the health insurer would save money by denying high-tech imaging tests such as nuclear cardiac exams, according to findings of an investigation by Delaware’s Department of Insurance.

MedSolutions was hired in July 2009 to review claims before doctors administered tests such as knee MRIs and CT scans of the brain. The firm stood to lose money if it did not reach its 20 percent savings target, according to the report. Such a contingency violated state law. It was removed from the contract last summer.

The high cost of health care in the U. S. all about the country club memberships–and not for the doctors. Derrick Jackson in the Boston Globe:

IF MASSACHUSETTS is the model, then national health care reform is ultimately doomed. That can be the only conclusion after this week’s news that Blue Cross Blue Shield of Massachusetts is in the homestretch of paying out nearly $28 million in retirement and severance pay in the last five years to its last two CEOs.

(snip)

But Massachusetts is not alone. Blue Cross Blue Shield of Michigan doled out $1.54 million to 34 board members, even as the company was losing $145 million, the Detroit Free Press reported in 2008. In 2009, Blue Cross Blue Shield of North Dakota, nationally touted as a well-run alternative to the vilified “public option,’’ was exposed for paying out millions in bonuses, charter flights, Caribbean junkets, and severance for a CEO who had been busted for drunk driving.

Read the whole thing. Then you will need a doctor for those heart palpitations.

The week before Crystal Stringfield’s health insurance expired, her 5-year-old daughter was diagnosed with attention-deficit hyperactivity disorder and prescribed a medicine that cost $179 a month.

Stringfield, 31, had been laid off in October from her job as a retail manager at an Exxon-Mobil station. Her health coverage ended on Dec. 31, and she wasn’t able to immediately find insurance she could afford on her unemployment check.

Sitting at her kitchen table in Chesapeake recently with Katelyn and 3-year-old Brianna, Stringfield could only shake her head. “I don’t know. I really don’t know,” she said. “I could care less about me.”

This lady was able to get insurance for her daughter through the state.

Many cannot. Later in the same article:

Most children without coverage live in households with income less than 200 percent of the federal poverty level but with at least one adult working, according to a report from the foundation. More than 50 percent are white, and about 26 percent are black. All but a few are U.S. citizens.

In case you wonder where the money goes:

Former El Camino Hospital president and CEO Ken Graham may be out of a job, but he won’t be hurting for a paycheck anytime soon.

Fired “without cause” by the hospital’s board of directors on Wednesday, Graham is now entitled to nearly $1 million in severance pay, according to his contract, which the hospital provided to The Daily News on Friday.

Noz reports from the trenches, where’s he’s fighting to get coverage for his son (emphasis added).

His son has a pre-existing condition. He’s alive:

what brings this up now is that we added noz jr. as a dependent and suddenly i’m wasting a ton of time again fighting for what should be a fairly simple matter of having his effective date of coverage reflect when my work started paying his premiums. and this follows last week’s battle when the insurance company notified me that it had dropped my primary care physician as an acceptable provider and i was told that i would have to choose a new one. (no need to fear the government taking over and telling me who i can have as my doctor when private for-profit bureaucrats are doing that already) i won last week’s fight. this week’s fight is still currently pending as i am still on hold as i type this. and yet, so much of the resistance to health care reform seemed to be driven by people’s fears of no longer having insurance they already have. who are these people? have they ever tried to actually deal with their insurance company?

Also, this, for which I have no words.

From the San Jose Mercury-News:

The Health and Human Services department unveiled a new requirement Monday that health insurance companies spend at least 80 cents of every premium dollar on medical care and quality. For employer plans with more than 50 people, it’s 85 cents on the dollar.

Gotta pay those country club memberships:

The Justice Department alleged Monday in a lawsuit that Michigan Blue Cross Blue Shield is discouraging competition by engaging in practices that raise hospital prices, conduct an assistant attorney general vowed to challenge anywhere else it is found in the United States.

(snip)

The lawsuit said that Michigan Blue Cross Blue Shield intended to raise hospital costs for competing health care plans and reduce competition for the sale of health insurance.

“As a result, consumers in Michigan are paying more for their health care services and health insurance,” Assistant Attorney General Christine Varney, who runs the Justice Department’s antitrust division, told reporters.

BCBS, natch, claims that it has done nothing improper. Follow the link for the details of its denials.

The BBC reports on a study by Columbia University. You can see the study here. From the BBC report:

The US healthcare system is to blame for declines in the country’s life expectancy ranking, a study suggests.

The Columbia University report rejects claims that factors such as obesity have shortened life-spans for Americans relative to other wealthy nations.

The study blames reliance on costly and fragmented specialised care, and calls for systemic reform.

(snip)

“We speculate that the nature of our health care system – specifically, its reliance on unregulated fee-for-service and specialty care – may explain both the increased spending and the relative deterioration in survival that we observed,” the authors wrote.

“If so, meaningful reform may not only save money over the long term, it may also save lives.”

Making money has become the goal of the United States health care industrial complex (though I must emphasize not of doctors, nurses, technicians, and others who deal daily with sick people) as what used to be non-profit hospitals, clinics, and insurance companies have become “for profit.”

As long as the goal of the health care industrial complex is making money, that’s what it’s going to put first.

Because it doesn’t tell enough and it misses the point.

Case in point missed:

The Daily Progress reports on a study by the University of Virginia in conjunction with the Dial Soap people. The study purports to prove that alcohol hand sanitizers–the kind the everyone set out in the waiting room last flu season–aren’t very effective against colds and flu.

Here’s the two crucial pieces from the Daily Progress story:

Study subjects who used the sanitizers had 42 rhinovirus infections per 100 volunteers, compared with 51 infections per 100 volunteers who didn’t take special precautions. Influenza infections hit 12 of 100 subjects who used the sanitizer, compared with 15 per 100 subjects who didn’t take special precautions.

(and the last paragraph)

Turner said his findings aren’t cause for panic. He said studies have shown that hand sanitizer is effective for gastrointestinal diseases, particularly in the developing world. According to a 2002 CDC study, sanitizers did a better job reducing bacteria on hands than did antibacterial soap.

The Daily Progress is the hometown paper for Charlottesville, Va., the site of the University of Virginia. The version that went out over the wires is much shorter, more like this.

To evaluate this, the reader needs to know how large the sample was. The results are given in pseudo-percentages, such as “42 our of 100.” A someone skimming the story could conclude that 100 persons were in the sample, but that’s neither stated nor implied under a careful reading.

I also find the conclusion questionable. Here’s the lead from the Daily Progress and most wire versions I’ve found:

Using alcohol-based hand sanitizer doesn’t significantly decrease how often someone is infected with a cold or flu, a University of Virginia study has found.

Look at the figures: the incidents of colds was reduced by 9 per 100, to use the story’s construct. That’s 18%. Given the pervalence of colds, that’s not insignificant.

The incidence of flu was reduced from 15 per 100 to 12 per 100. Let’s do the math:

3 case reduction divided by 15 cases in control group = 20%

Again, not an insignificant reduction.

I suspect that the stories are based on a UVa press release; I haven’t looked for it and it’s not the issue any way. The issue is that the numbers do not support the headlines. If the headlines are based on the wording of press release, reporters ought to have done the math and pressed (heh) for more information.

Frankly, an ad campaign that X may reduce your chance of catching the common cold by 20% would be a pretty good ad campaign, especially if it didn’t include fully dressed people in bath tubs.

Full Disclosure: I don’t commonly use alcohol hand sanitizers unless I’m visiting someone in the hospital, something I fortunately haven’t had to do lately.

In the old days, it would be called a “Trust.” Bloomberg analyses the effects of overpowering market share in health care:

Sutter’s price for the knee scan was $1,271, payable by Logsdon and his insurer. Exactly the same MRI at one of the local imaging centers owned by Radiological Associates of Sacramento would have cost $696 — 45 percent less.

It turns out that Logsdon didn’t know something that his insurance company does: Sutter Health Co., the nonprofit that owns Sutter Davis, has market power that commands prices 40 to 70 percent higher than its rivals per typical procedure — and pacts with insurers that keep those prices secret.

Sutter can charge these prices because it has acquired more than a third of the market in the San Francisco-to-Sacramento region through more than 20 hospital takeovers in the last 30 years, according to executives of Aetna Inc., Health Net Inc. and Blue Shield of California, who asked not to be named because their agreements with Sutter ban disclosure of prices.

Read the whole thing.

From the Philadephia Inquirer:

It’s no surprise that the struggling economy has made it harder for hospitals to collect money from patients who have lost their jobs – and their health insurance.

But a local hospital group says the fastest-growing part of what hospitals call “bad debt” – basically, uncollectible bills – is money owed by patients who have insurance.

As employers dump costs onto workers, so now are workers dumping costs onto hospitals.

Because of rising deductibles and cost-sharing rules, patients are increasingly faced with bills that would have been unusual for someone with insurance a few years ago.

Read the whole thing. It goes on to point out that

• Hospitals are increasing asking for payment, if not up front, then very quickly. If you are admitted, you might be visited by a “financial counselor” before you get your first lab work back.
• Persons who have been released sometimes pay their cable bills before they pay the hospital bills. (Aside: This is not surprising. They probably have enough money to pay the cable bill. Hospital bills can be more than they will make in a decade or a lifetime.)
• Hospitals don’t much like the current system either.

The larger story is that hospitalization is getting so expensive that only the very very rich can afford it. The whole damn system is not just broke, it’s broken.

Insurance that doesn’t insure, but you can bet your bippy it stills pays the country club memberships of insurance execs.

So we don’t have to have “festivals” like this one:

Throckmorton participated Saturday in the three-day clinic held at the Wise County Fairgrounds.

According to Houchins, there were 4,222 teeth extractions, 1,200 fillings, 1,117 cleanings, 51 root canals, 1,247 X-rays made and 20 dentures made. The clinic opened early Friday morning and continued through Sunday.

“I saw about 21 patients on Friday, 24 on Saturday and 12 on Sunday,” Dr. Houchins noted. “We started at 6 a.m. and were there until 7 p.m. We took a short break and got some crackers and then went back to work.”

Stacy Houchins added, “It was 98 degrees under the tents one day. The people were very patient. Sometimes there was a five to six hour waiting period.”

When I read this, I couldn’t wondering, what does an overbite have to do with anything? Then, I realized, it was just an excuse to take the money and run:

Nine years ago at age 8, Nora Kenny was diagnosed with a deformity that contributed to the need for braces. When her parents’ insurance company found out about it two years ago, her coverage was rescinded.

That congenital deformity was an overbite. Now 17, Kenny again has coverage after her parents successfully fought back with the help of state insurance regulators — a battle that no longer will be necessary because a key provision of the health care reform law bans rescission of insurance.

Zandar has the evidence.

Excerpt:

More than a decade ago, Congress set up a formula that governs how doctors get paid by the Medicare program. The intent was to slow the growth of Medicare costs, but the result was a formula that has proposed cutting payments for America’s doctors year after year after year. These are cuts that would not only jeopardize our physicians’ pay, but our seniors’ health care.

Since 2003, Congress has acted to prevent these pay cuts from going into effect. These votes were largely bipartisan, and they succeeded when Democrats ran Congress and when Republicans ran Congress – which was most of the time.

This year, a majority of Congress is willing to prevent a pay cut of 21% — a pay cut that would undoubtedly force some doctors to stop seeing Medicare patients altogether. But this time, some Senate Republicans may even block a vote on this issue. After years of voting to defer these cuts, the other party is now willing to walk away from the needs of our doctors and our seniors.

Continually cutting doctors’ reimbursements to the point that doctors cannot afford to take Medicare and Medicaid patients is indeed wrongheaded. Doctors’ take home pay is not driving the cost increases for health care.

Uwe Reinhardt, from the New York Times:

Besides, cutting doctors’ take-home pay would not really solve the American cost crisis. The total amount Americans pay their physicians collectively represents only about 20 percent of total national health spending. Of this total, close to half is absorbed by the physicians’ practice expenses, including malpractice premiums, but excluding the amortization of college and medical-school debt.

This makes the physicians’ collective take-home pay only about 10 percent of total national health spending. If we somehow managed to cut that take-home pay by, say, 20 percent, we would reduce total national health spending by only 2 percent, in return for a wholly demoralized medical profession to which we so often look to save our lives. It strikes me as a poor strategy.

I have been looking for a new doctor because of my move. The (lousy overpriced private) insurance I have is from a carrier which often provides Medicare supplemental insurance. I had difficulty getting an appointment because the office staff thought I was on Medicare (I’m hoping to live long enough to qualify) and their “quota” of Medicare patients was full. I had to get my phone call bucked up to a supervisor who was experienced enough to realize that my policy was primary, not secondary insurance, so as to get an appoint.

There’s something truly wrong about a cost-containment strategy that ultimately results in denying health care to persons who need it.

I think it’s a Republican thing. The odds are that the persons this policy ultimately penalizes–old folks like me–don’t get corporate country club memberships or have corporate jets (and, if they did, they wouldn’t be worrying about Medicare).

Republicans are all about the corporate country club membership constituency. All the rest is window dressing.