As we come to the end of 2010, I wanted to leave you all with a few gifts to wrap and give to your friends -- some small gems of health reform that may have escaped attention.
There are a variety of charts that show what health reform has and will achieve by the time it is fully implemented. Some of these charts are being used to scare people about the scope of this law. But these charts and timelines also show how complicated it would be to unravel this law, given that so many of the moving parts are linked together.
As I combed through these charts, I picked out the following 10 gifts -- something between the 8 nights of Hanukkah and the 12 days of Christmas:
1. Here are a package of gifts you should already know about --- In September of this year, the law began prohibiting lifetime limits on your coverage; denial of coverage because of pre-existing conditions for kids; a way for people with serious illness who have been without insurance for awhile to get into a state insurance program, and new prevention programs. And by the end of the year, seniors will have access to preventive services at no cost and the donut hole for prescription drugs will begin to disappear.
2. Do you know someone who has retired but is receiving retiree health insurance assistance from their employer? Are they worried about how they can afford to keep their health insurance or whether their employer will drop the coverage? In June of this year, the Secretary of HHS created a temporary $5 billion fund to hep employers provide health insurance to retirees 55 to 64. This replaces a prior government program that helped employers keep retirees health insurance active, so it's basically an incentive to companies to keep doing that.
3. What to give your friends who are always worrying about fraud and abuse in government programs? There are new efforts at catching doctors and hospitals who cheat Medicare and Medicaid programs with false claims. There was already a big sting in Florida where Medicare caught doctors making fake claims for fake patients to the tune of over $250 million. Monitoring fraud takes resources, but the return on investment is substantial.
4. We all know someone who worries about the costs of health care and thinks health reform will do nothing about it other than jacking up their premiums. There are actually hundreds of ways that reform is going to chip away at costs because of the law. One of the ways the government is going to ensure that your tax dollars and contributions to Medicare pay for what is really needed, is to pressure providers to become more efficient. We have had a system where doctors get paid more when they do more, no matter whether it cures you! Medicare will now begin to pay bonuses to doctors and hospitals that provide better quality care -- the better the quality, the better the bonus. No improvement in quality? Less money. Sounds sensible doesn't it? Should have been done a long time ago.
There will also be better state oversight of insurance companies that announce big increases in monthly premiums. Some states like Connecticut have given themselves the authority to actually deny these increases; other states will try to use persuasion, public shaming, or non-legal methods to keep premiums in line. Bottom line is that these big premium increases will not go unnoticed or unpublicized. And by 2014, you'll have a lot more choice of plans, because these same insurance companies will be directly competing for your business through the Exchanges. If you believe market forces can help keep costs under control, this type of consumer choice could make a difference.
5. What if you have a friend who lives in a rural area and their hospital is small or they have to travel a long way to get care? Health reform is putting resources into hospitals in those communities, to help them with telemedicine (sending your x rays to a medical center where an expert can read them or consulting with the country's expert on your diagnosis, etc.) and money for training physicians, nurses and other practitioners with enticements for them to practice in a rural area. This change may mean little to those of you who live in a big city, but there's nothing scarier than living in a rural area and getting really ill but not being able to get the care you need.
6. Do you have a family member who has dementia and is in some type of assisted living or nursing home? No matter how much you visit, you can't really guarantee they will get the care they need when you're not around. Caregivers who work in these facilities often work at minimum wage with very little training. Starting in March of next year, there will be money available to train staff in those facilities so they understand better how to care for these folks. The shocking fact is that:
According to recent estimates, as many as 2.4 million to 5.1 million Americans have Alzheimers Disease (AD). Unless the disease can be effectively treated or prevented, the number of people with AD will increase significantly if current population trends continue. That's because the risk of AD increases with age, and the U.S. population is aging. The number of people age 65 and older is expected to grow from 39 million in 2008 to 72 million in 2030, and the number of people with AD doubles for every 5-year interval beyond age 65.
If you've visited one of these places recently, no matter how good they are, there's so much more that needs to be done to make the lives of our elders better as they decline. This training doesn't require much money but it can do so much good.
7. Haven't you wondered why we still have a paper based system in health care, when you can go to an ATM anywhere in the country and get your account balance and money out? The reasons for lack of progress are many, but one of the reasons is that so few of the existing data systems talk to each other adequately. Even before health reform passed, President Bush put resources into upgrading our HIT systems, and health reform has given a big boost to that effort. Medicare, which is known to pay claims very slowly, has an outdated system that will be upgraded due to health reform. And doctors and hospitals will have some guidance from experts on how to implement a system whereby they can send your medical records to another facility instantly, should you get sick while you are traveling -- or where you can go online and look at your medical records, know when you need to get a screening or vaccination, see the results of the blood test you had yesterday. In my home town, we already have that and I love the speed and ease with which I can find this information.
8. Anyone hurting here? If you have a friend with chronic pain, you already know that it is truly hard to get good information about what works and what does not. It doesn't matter if you are rich or poor. Even people like Rush LImbaugh who apparently was in a lot of pain recently, got addicted to oxycontin to manage his pain. He may not have known what the alternatives were, because there has not been a huge amount of attention paid to pain management in the past. If you want some real good research on pain and some objective ideas about how to manage it, starting in March of next year, there will be a special coordinating committee to look at pain research and report to Congress on its findings. Hopefully this will lead to options other than oxycontin.
9. Do you know someone who has had trouble finding a physician or who has lost access to the physician they used to have? Health reform releases money this year to train a variety of health professionals, help physicians in training get scholarships and loans, and encourage physicians to practice in rural or underserved areas. There will also be a national workforce committee to look at future needs for physicians and other professionals as we shift focus from emergency care to primary care.
10. Are you one of the people who feel that malpractice reform was neglected and that Democrats don't care about that? Starting in 2011, there will be funding for 5 year grants at the state level to take a close look at what is working and what is not to reduce litigation. We have a lot of interesting malpractice projects going in California, Texas, and other states, but we need to understand why some of these programs seem to reduce lawsuits while others make little impact at all. This has been a major Republican talking point, and this health reform law, which so few Republicans supported, actually puts some money to the problem of figuring out how to do it. It also makes it a state-based initiative, not a big federal mandate, something else Republicans should like. On the other side of the coin, for people who have actually been harmed by bad medical practice, health reform implemented this year a slew of new ways to appeal medical decisions, something the consumer public needs to have.
My point here is that there are many, many changes going on in the health care system at this very moment, and these changes are ultimately going to improve health care delivery. You may not hear much about them; in fact, you probably won't. But gradually we will see fewer medical errors (wrong legs being operated on), better customer service (fewer minutes on hold), more responsiveness from your physician (being able to use email with your doctor), and ultimately, lower costs (once everyone is "in" and paying their fair share).
Those are holiday gifts that won't have to be returned!
Follow Linda Bergthold on Twitter: www.twitter.com/lab08
Roy Schoenberg, M.D.: Telemedicine: The Next Big Thing?
Kathryn Haslanger: 'Tis the Season to Celebrate the Joys of Caregiving
"Monopsony
From Wikipedia, the free encyclopedia
In economics, a monopsony (from Ancient Greek μόνος (monos) "single" + ὀψωνία (opsōnia) "purchase") is a market form in which only one buyer faces many sellers. It is an example of imperfect competition, similar to a monopoly, in which only one seller faces many buyers. As the only purchaser of a good or service, the "monopsonist" may dictate terms to its suppliers in the same manner that a monopolist controls the market for its buyers.
The term was first introduced by Joan Robinson in her influential[1] book, The Economics of Imperfect Competition. Robinson credits classics scholar Bertrand Hallward at the University of Cambridge with coining the term.
A single-payer universal health care system, in which the government is the only "buyer" of health care services, is an example of a monopsony. It has also been argued[2] that Wal-Mart, in the United States, functions as a monopsony in certain market segments, as its buying power for a given item may dwarf the remaining market. Another possible monopsony could develop in the exchange between the food industry and farmers."
There's one for all you "Progressives" -- your cherished "public option" put in the same league with Wal-Mart's dominance! Aptly so.
The problem is that if the truth were told and the true price was displayed, Obamacare would never have made it. So instead the Democrats lied about the Medicare savings and didn't include the Doctor fix.
Government run anything for the most part is a horrible idea. Sometimes it is required, but most times not.
Last year my spouse experienced a serious illness that resulted in four hospitalizations, two operations, two medical procedures, innumerable tests and outpatient visits, and five months of lost work and wages. I'm glad he's alive, but the financial fallout is unmanageable and, for people who have never had to USE their own health insurance, probably unimaginable. For months we received no fewer than 53 separate medical bills. Now many of these are in collections. Few are willing to make payment arrangements. And that's AFTER paying insurance premiums faithfully over the course of 25 years and never having to use the system much at all.
So basically, we have this big fat health care reform bill, but the bottom line plan in the U.S. for actual health care for actual humans, after all of that, is still, "don't get sick."
If you think I'm exaggerating, just try it yourself.
What is happening troubles me greatly, because we are ordinary working people with a dead on average sort of income--maybe a bit above average--so if we are experiencing this kind of hardship I KNOW others are too, and likely even worse. It bothers me that as a country we don't address it openly and that people are ashamed instead of angry.
We live in West Michigan, just outside Kalamazoo. If you have any ideas do share them, I would be grateful. I've worked hard to address this as responsibly as I can, but I admit it's overwhelming and it's hardly going well.
I do think the health reform bill is an overall positive, but I wish something more aggressive could have passed so that we (and so many others) would not be facing this financial stress and fear just when we should be looking forward to retirement.
I hope future generations have better more affordable access.
Was this the fault of the insurance or that of you not knowing or betting that you wouldn't need the services?
The question is did you get what you expected from the insurance company?
Usually insurance companies don't pay everything unless you get the expensive policies. This would be true for any insurance like auto or home.
If you didn't have enough insurance, then who's fault is that?
Most medical costs are end of life care. I would encourage everybody to express their wishes to their next of kin and make advanced directives, which is easy and cheap. People get taken out with car accidents and strokes every darn day. Without advanced planning it's expensive while relatives try to guess what people want, especially after a car accident. Most relatives want to cling in dire situations that one would never want to happen.
Know that Emergency Medical Services (EMS) are obligated by law to do everything they can to prolong your life regardless of your condition without documentation. This includes, CPR, life support and tube feeding. Planning saves lots of money and medical costs would go down. It’s economics.
My suggestion is that everybody make end-of-life decisions when issued a drivers license and they be updated every time a new one needs to be reissued. This is done with organ donation so end of life plans is the next logical step.
This is a must see video:
http://www.pbs.org/wgbh/pages/frontline/facing-death/?utm_campaign=homepage&utm_medium=proglist&utm_source=proglist
Pretty soon the Government can just have the TSA do the invasive procedures since it will be part of the "approved" medical procedures.
My insurance company already does that to protect their profits. You think that's better?
The sad fact is, the lady died the next day of a sudden MI.
Yeah, the government will take GOOD care of you !
Just look at the only purely government run healthcare system in this country- the VA.
I can't tell you how many VA patients I see everyday because they are afraid to go there or the VA won't see them for a couple of months.
And, no, due to the government's insane HIPAA law, as a doctor, it's about impossible for me to get your records from another hospital ( and sometimes our own hospital!).
If those are gifts, I have a few more I could give you. I need the money!
In seriousness, this is an excellent article that demonstrates the sheer scope of the benefits Americans will reap from this historic law. We have President Obama to thank for it, with the able support of Speaker Pelosi.
- The 85% of Americans who currently have health insurance will see their premiums increase. This is the inevitable result of implementing rules and regulations that increase the total cost of the insured pool.
- The 10% of Americans who are uninsured by choice will now be forced to purchase insurance their neither need nor want.
I have written a five page letter to the President and key leaders in both houses of Congress detailing the reasons why Americans are so opposed to this legislation. The letter is too long to post here, but here are the key points:
• It sanctions intrusion of government into private enterprise.
• It expands the size of government.
• It corrupts free markets.
• It lacks fiscal transparency and accountability
• It creates a dependency culture.
• It will cost far more than advertized.
• It steals funds from Medicare.
• It claims offsetting revenues that are illusionary.
• It violates cherished freedoms.
In the letter, each point is backed up by data and facts from the bill or the CBO cost analysis.
I have also included guidelines for a new health care reform bill that I believe would be acceptable to and supported by the American people. This new replacement bill would accomplish most of the objectives of the current legislation without the negatives.
The fight over Obamacare has only just begun. In the end, the American people will prevail.
Thank you for not posting the entire letter.
Thank you for the information.
I think you would be hard pressed to find anyone (including me) who doesn't have reservations about and disappointments in this legislation. Such is the gruel that politics produces. Talk to me, and I'm sure you'll come away thinking I'm yet another complainer. Yet I really do think this is a necessary first step and promising slippery slope to true national health insurance for all.