Here is an important piece of the puzzle about why health care costs (for both delivery and insurance) rise year after year: " . . . a fundamental reason that private-plan costs have outpaced Medicare fee-for-service spending: 160 million Americans with employer-sponsored coverage are quietly subsidizing seniors’ coverage through cost-shifting. When confronted with inadequate Medicare reimbursements, doctors, hospitals and other providers learned long ago to shift costs to the under-65 population by demanding higher payments from private insurers. This cost-shift, in turn, has fueled premium increases and rising medical costs for working families. Meanwhile, traditional Medicare fails to provide seniors with a comprehensive benefit akin to what working Americans currently have. If Medicare “as we know it” is such a good deal for seniors, why is it that nearly 90 percent of beneficiaries supplement their traditional Medicare plan with Medicare Advantage, employer-sponsored retiree coverage or Medigap policies?" The latter is a good question, but the answer is self evident: MediGAP (my emphasis) fills the coverage "donut hole" in Medicare.

But, we may well ask, why do these kludges, patches, tweaks, and other "baby steps" exist? Everyone knows how to fix health care insurance and delivery so everyone receives insurance and treatment cost effectively. Just apply the formula: Universal. Cradle-to-grave. Single-payer. Problem solved. Of course, everyone also knows that the moneyed and powerful strive mightily to prevent implementation of these principles. Perhaps the best explanation, though, comes from an observation by Winston Churchill on the American character: "America will always do the right thing, but only after exhausting all other options."

Another result of the abysmal U.S. healthcare "system"

More Pregnant Women Dying in CA, Says Study

By Jen Phillips | Wed Apr. 27, 2011 3:14 PM PDT

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Despite what the protesters at your local Planned Parenthood may say, abortion is not unsafe. In fact, you're about 20 times more likely to die from childbirth-related ailments than you are from getting an abortion.* In California, a disturbing new report [1] shows that more pregnant women are dying than before, due to increased obesity rates, more Cesarean sections, older mothers, and limited health care access. Part of the rise is also attributed to better data reporting methods.

The study (PDF [2]) says that the maternal mortality rate in California is about 14 out of 100,000 live births. In 2005, it was around 12 and in 2002 it was around 10. The rate (and increase) may not sound high, but take into consideration that more than half a million women give birth in California each year, and the state accounts for 1 of 8 births in the US.

In 2004, 82% had insurance that covered maternity services. Today, only 22% do.

The rise in mortality seen in California also reflects national trends, the report says, which is bad news for moms, especially moms of color. African-American women suffer maternal mortality rates far higher than any other ethnic group: about 46 of 100,000 African-American mothers die due to childbirth, as compared to much lower rates in Whites (12.4), Hispanics (12.8), and Asians (9.3). The authors of the report are still not sure exactly why African-American women are four times as likely to die than women of other races, but they suspect a combination of higher obesity rates, lower use of prenatal health care, less adequate care, and various risk factors as a result of lower socioeconomic status (e.g. higher stress). But the authors still seemed to be scratching their heads about how one ethnic group could make up only 6% of all California births, but 22% of maternal deaths.

Another anomaly: although Hispanics overall account for 51% of all California births, foreign-born Hispanics had much better health than those born in the US. "Immigrant Hispanics tend to have better health than the average American population, in spite of what their aggregate socioeconomic indicators would predict," write the study's authors. It could be because foreign-born women give birth at younger ages, when they are less likely to encounter complications. Or it could simply be that the American lifestyle, and health care system, is so unhealthy that it's actually a liability. The high Cesarean rate, which accounts for a third of all births, in particular, is directly related to maternal mortality. And then there's the question of care, and of cost. Only 22% of people with health insurance in California (the report says) have coverage for maternity services: In 2004, 82% of them did. For those who can't get, or can't afford, private health insurance, there's Medi-Cal, which paid for 47% of all prenatal and pregnancy-related costs in 2008. An especially interesting tidbit found in the report is that 7% of women in Medi-Cal's maternity program actually HAVE private insurance: their insurance just doesn't cover maternal services.

There's something seriously wrong when your health insurer doesn't cover your prenatal care. Maybe this could be a new torch for the pro-life movement, or a larger one for the pro-choicers. It seems like a perfect platform for a "family values" Republican, no?

*This is provided your abortion is in the first trimester, as 90% of all abortions are. The risk goes up for later abortions.

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Source URL: http://motherjones.com/blue-marble/2011/04/new-study-shows-more-pregnant-women-dying

Links:
[1] http://www.cdph.ca.gov/data/statistics/Pages/CaliforniaPregnancy-AssociatedMortalityReview.aspx
[2] http://www.cdph.ca.gov/data/statistics/Documents/MO-CA-PAMR-MaternalDeathReview-2002-03.pdf

Making an offer employees can't refuse

I never thought I would find a reason to relate to Sarah Palin's phrase "death panels," but a headline in the Boston Globe made me revise that position: "Plans steer patients to lower-cost hospitals" (you can read the full article at http://www.boston.com/business/healthcare/articles/2011/02/10/plans_steer_patients_to_lower_cost_hospitals/). The reporter, Liz Kowalczyk, writes that Blue Cross/Blue Shield (BC/BS) of MA lauched a new "product" purportedly to help small businesses continue to offer health insurance to their employees.

Once again, the health insurance establishment shows itself to know the price of everything but the value of nothing. This cost shifting by BC/BS reflects the belief that patients won't mind going to a community hospital instead of a teaching hospital because doing so will save money for themselves and, wink-wink, their insurers (Three guesses: What will the insurers do with the money saved?). After all, a hospital is a hospital and a specialist is a specialist, right?

Here's the tenor of the deal offered: "The Blue Cross Hospital Choice plan, which went on sale last month, charges members, for example, an extra $1,000 for an inpatient stay or outpatient surgery, and $450 more for an MRI, at 15 higher-cost hospitals, including Massachusetts General and Brigham and Women’s hospitals, Children’s Hospital Boston, and UMass Memorial Medical Center in Worcester. Companies and workers that sign up get a significant break on their health insurance premiums: a 4.5 percent increase for the first quarter of the year instead of a 10 percent increase."

What a deal! You can pay $1,000 more in your choice of ways: Either stay in the hospital following surgery or go home the same day as the surgery. In other words, you will pay $1,000 more no matter which choice you make! And, to sweeten the deal, BC/BS says that, while everyone pays an increase every year, if you choose this new plan, your increase will be less--but only for the first three months of the first year. To seal the deal, the state will pay each employee's three-month share of the premium when the employer enrolls. With choices like these, how could anyone refuse to enroll?

Wait until employees referred for medical treatment to a hospital find out they can't choose the hospital. For "those" people not affected by price--I guess you can call them "price inelastic"--it's no big deal. They will continue to go where they want for the services they need, regardless of cost. But, for the working-class guy or gal and their families, the new plan means they've been "price triaged"--they have less money to spend on their treatment, so the system sends them to the lowest-cost provider. As Stevie Wonder put it: "Livin' just enough for the city." Or, rather, dyin'.

To add insult to injury (pun intended), the reporter quotes the head of an insurance agency on why this plan is such a good idea: "These plans 'really help the employer and the employee start to understand what is driving health care premiums higher', said Paul Pietro, chairman of Mid-State Insurance Agency Inc., an insurance broker in Worcester. 'Simple things, like MRIs and CAT scans, if you’re just able to stay out of those hospital settings, that can save money. It helps everybody'." If you can't believe an insurance broker about what is good for your health, who can you believe?

So, while I don't want to encourage use of Sarah Palin's "death panel" phrase, the BC/BS MA plan comes closer to what Ms. Palin meant than President Obama's initiative.

What do you think?

I read the following today in the New York Times medicine section: "Republicans recalled, however, that they secured approval of two huge changes in domestic social policy that worked much better than Democrats had predicted. They remade welfare programs in 1996 and added a prescription drug benefit to Medicare in 2003. 'The idea that Republicans are just not interested in health care and won't do anything is belied by history', said Stuart M. Butler, director of the Center for Policy Innovation at the conservative Heritage Foundation." My interest lies in the second observation, that adding the prescription drug benefit to Medicare in 2003 demonstrates Republican in health care.

If you recall the phrase "donut hole," you understand why I question the facts behind Mr. Butler's superficially true statement. Here's how Reason magazine wrote about it at the time: "The cost is also likely to rise because of demands to close the drug plan's weird gap in coverage: After a $250 deductible, it will pay 75 percent of prescription drug expenses, up to $2,250 a year; but between $2,250 and $5,100, the point at which the plan starts paying 95 percent of costs, there will be no coverage at all." When one runs the numbers, one realizes that (a) Medicare enrollees are reimbursed up to $2,250 per year and (b) at that point, Medicare enrollees reimburse insurance companies for the same amount, up to $5,100. How did this come about?

As you might guess, the insurance industry had a lot to do with it. In fact, it was an insurance industry lobbyist who wrote the bill! Only in America.

What everyone forgets but should remember: The bulk of the new health insurance law won't kick in until 2014. No one knows how all those changes will affect care, cost, universality, etc. Of course, that hasn't stopped those who throw slings and arrows about ObamaCare, death panels, and other points on the right-hand side of the Sane<------>Lunacy scale from turning the dark sides of their imaginations loose:

• It will bankrupt the country
• It's a socialist plot
• "I don't want no gummint messin' with my healthcare!" (often heard from those ignorocrats who don't know that Medicare, Medicaid, etc. are government-run programs)

It will be a long time before the populace and those elected to govern them acknowledge that the real solutions--universal, cradle-to-grave, single payer--will take the concerns about who get what and how much and at what cost off the table. Then, we can focus on more important problems:

• Food
• Water
• Education
• Industry & jobs
• Security

Let me know your thoughts.

Laughter is the best medicine!

Healthcare--service delivery, insurance, portability, coverage--is serious business. However, even in the face of life-and-death decisions, occasionally a beam of levity emerges. Often, it seems even funnier because of the extremem alternative. Here are some examples:

1. Check out the Summer 2009 Lahey Clinic magazine (they didn't print a URL in the issue, so you will have to root around on the Internet). In New England, the Lahey Clinic is one of the top medical empires, rivaling even esteemed Mass General Hospital. But, in the article entitled, "New Wing To Open This Summer", white-haired white men in suits are pictured as the drivers behind the project. But, the hilarious--if pathetic--photos attest to the lack of understanding these senior executives have about the needs--and interests--of their patient base.

There are five non-people photos. The first shows the building. This is, of course, an example of the navel-gazing vision of 19th-century New England mill owners; the edifice complex. In a way, they want to show their tomb, as they believe it is something that will outlive them, and that succeeding generations will remember THEM because of the building they caused to be built; a.k.a. paid for.

This pales in comedic comparison to three of the four other shots, depicting (a) The Sophia Gordon Cancer Center, The Pain Center, and Opthalmology's State-of-the-Art (SOTA) Clinic. Well, let me rephrase that description. Pictured are NOT the cancer treatment facility, or pain center treatment rooms, or cutting-edge (no pun intended) eye treatment equipment. What the pictures do show are--wait for it--WAITING ROOMS!!! That's right. They're giving patients--people in pain, fear, and medical need--better, more modern, roomier places in which to WAIT FOR TREATMENT!! The fourth picture, of the new Emergency Room, shows not SOTA treatment rooms, but a pristine, well-lighted carefully constructed sign-in desk and filing cabinet (no doubt for paper files, which are SO 20th century).

You can't make this stuff up! But wait, there is more!

2. Read "The Immortalists", an article in the July 26 Boston Globe Sunday magazine by a freelance writer (and boomer) Jennifer Graham. The lead sentence reads:  "The baby boomers are the first generation that will-let's be honest-actually live too long." While she doesn't mention the word "euthanasia", that is exactly what she means. I won't quote other parts of the article here, but I will mention how she justifies expressing this opinion:  "Meanwhile, maybe they could lighten up on the All Bran and hit the trans fat. Just sayin'. For posterity's sake." Well, when it comes to being made into Soylent Green, Jennifer Graham can have my place in line.

That's the current phrase that's being used by all manner of people to justify their loony, loopy opinions:  "Just sayin'." I think the Globe printed this article because the author does make an attempt to take a tongue-in-cheek tone, but she totally fails. I'm just sayin'.

3. Like The Wall Street Journal? Who doesn't? It's a non-stop source of comedic content. Take, for example, the Friday, August 7th, front-page article headlined, "France Fights Universal Care's High Cost". The lead example provided by the author, David Gauthier-Villars, of the collapse of the French system--widely acknowledged as the finest health care delivery system in the world--is that a woman named Laure Cuccarolo went into early labor and had to call the local fire brigade to take her to hospital 30 miles away! C'est horrible!! In the United States, these things happen all the time. Thousands of moms have given birth in taxi cabs, subways, apartment bathrooms, etc. Mostly, they're just victims of circumstances, traffic jams, and poor planning. Years later, I bet their kids get a kick out of being told their godfather is a Russian taxi driver. 

The real reason, of course, that the Journal printed this story is not because it has any real news or even feature story value, but because propaganda theory demands such an approach. After all, if you can't attack the best example from the opposition of why its approach makes sense, then you try to tear that example down. Some people will believe it to be true. And, for the propagandist, that's the key:  Not whether something is true or false, but whether it is believable.

I am sure you can add to the list of examples I've provided--and, I wish you would. There is a tinge of gallows humor about all these citations, because we realize instinctively the insidious intent of the authors. Still, it is good to step back and laugh in the face of so much seriousness.

I'm just sayin'.

Let me know your thoughts.

No One Is Willing To Say, "Yes!"

Lots of people say, "No!" to President Obama's proposed healthcare reform package; mostly Republicans, whose entire legislative strategy for this session of Congress can be summed up in that one word. Unfortunately, even some Democrats are saying, "No!", too. Why they are doing this is a mystery, because if Obama's plan fails to be enacted, the Democrats will have handed the next election to the Republicans. 

Even in the contorted realm of political logic, this one defies description. Here's the situation:  the Democrats control both houses of Congress and the White House. Celebrating this outcome the day after the elections, any Democrat--be he yellow dog, blue dog (why do politicians have to have colors for everything?)--would be justified in thinking, "Now we're gonna turn things around and get this country back on its feet!"

But, hey--these are politicians we're talking about. They've got no spine or moral compass. All they care about, regardless of which party they're in, is getting re-elected. Want an example? If you were a U.S. Senator in 2002, knowing then what you know now, would you elect Harry Reid to be your leader? He's a textbook definition of gutless wonder. And Nancy Pelosi in the House? All I'll say is that she's even worse than Reid.

However, they're what we've got to unite the legislative troops behind President Obama's many initiatives, healthcare reform being the most pressing and immediate. We need people who can stand up and say, "Hell, YES! I'm gonna support my President and his programs!" Obama must feel like he's being nibbled to death by ducks. Here he's the head of a party that has all the pieces in place to go out and make real change in this country, to turn it around from the descent into Hell the previous administration engineered over eight years of rule by the foulest, most despicable, inbred, power-mad, war-hungry criminals this country has ever seen.

Even my wife, who is one of the smartest people I know, complains that she doesn't want a plan that takes her tax dollars to subsidize the healthcare of people who are obese and unexercised because they brought on their own health problems, like diabetes and heart failure. She's drunk the Republicans propaganda Kool-Aid, leading her to link this societal problem to Obama's healthcare reform package. THEY'RE MUTUALLY EXCLUSIVE! TWO SEPARATE PROBLEMS! YOU CAN WORK TO FIX THEM BOTH AT THE SAME TIME WITHOUT ANY CROSSOVER!

What do I mean? Obama's plan addresses the three key aspects of healthcare:  coverage, services, delivery. When his plan is enacted--never mind getting true universal coverage, like the rest of the civilized world--yes, fat people and their problems will be covered. BUT, THEY'RE NOT FAT BECAUSE THEY'RE COVERED. THEY'RE COVERED BECAUSE THEY'RE AMERICANS. Two separate problems. Get it?

Let me know your thoughts.