USPSTF AND MAMMOGRAMS

From the Reid bill:

‘‘SEC. 2713. COVERAGE OF PREVENTIVE HEALTH SERVICES.

(a) IN GENERAL.—A group health plan and a health insurance issuer offering group or individual health insurance coverage shall provide coverage for and shall not impose any cost sharing requirements for—
(1) evidence-based items or services that have in effect a rating of ‘A’ or ‘B’ in the current recommendations of the United States Preventive Services Task Force..."

From the AHRQ website:

"The USPSTF recommends against routine screening mammography in women aged 40 to 49 years. The decision to start regular, biennial screening mammography before the age of 50 years should be an individual one and take patient context into account, including the patient's values regarding specific benefits and harms. Grade: C recommendation."

That means that insurance companies do not have to cover mammograms through their policies. It is their option.

ABORTION IN HEALTHCARE

The Reid bill makes it very clear that abortions will not be paid through public funds:

...abortions for which the expenditure of Federal funds appropriated for the Department of Health and Human Services is not permitted, based on the law as in effect as of the date that is 6 months before the beginning of the plan year involved.

So there!!! It can't be more clear.

Okay so the weasels can change the law and some abortions might be covered.

They go on to make it even more restrictive. First, if any insurance companies decide to continue to provide health coverage ( which I consider very doubtful) through the Exchange, they must offer one policy which covers abortions. HOWEVER, if the policyholder qualifies for a hc credit or a hc cost-reduction, such credits/reductions may not be used to pay for the abortions. AND the amount of the premium for such policy pertaining to abortions must be determined and cannot be less than $1 per month per policy. That amount must be kept separate to be applied to the abortions.

Does anyone recall be told that SS funds would not be used for general operations...that they would be in a lock box?

Now for the next step...

Just imagine all this goes through and it's time to buy a policy. A person goes to the Exchange (or DMV or wherever we're supposed to go) and starts negotiating for their perfect policy. "And be sure to include the abortion clause. I definitely need that (ie. family history).

Or how about that Progressive Insurance girl making a pitch...

"And if you would like, for not less than a $1 a month, we can include the abortion clause. Would you be interested?"

MAMMOGRAMS CONTINUED

The news about guidelines related to mammograms and now pap smears has many concerned about rationing.

Rationing is not beginning with women's health issues. That's just what's in the news. "Women," "black," "children" are buzzword topics. Put those in the headlines, and tears immediately start flowing. Put "men" in the headline, and you start kicking and throwing things. In the Reid bill, the word "women" shows up 97 times; children 83 times; men just twice.

Uncle Sam is going to protect us. From the Stimulus bill we have:

FEDERAL COORDINATING COUNCIL FOR COMPARATIVE EFFECTIVENESS RESEARCH.
PURPOSE.—The Council shall foster optimum coordination of comparative effectiveness and related health services research conducted or supported by relevant Federal departments and agencies, with the goal of reducing duplicative efforts and encouraging coordinated and complementary use of resources.

And from the Reid bill we have:

PATIENT-CENTERED OUTCOMES RESEARCH INSTITUTE
PURPOSE.—The purpose of the Institute is to assist patients, clinicians, purchasers, and policy-makers in making informed health decisions by advancing the quality and relevance of evidence concerning the manner in which diseases, disorders, and other health conditions can effectively and appropriately be prevented, diagnosed, treated, monitored, and managed through research and evidence synthesis that considers variations in patient sub populations, and the dissemination of research findings with respect to the relative health outcomes, clinical effectiveness, and appropriateness of the medical treatments, services....

I feel all warm and fuzzy now.

The term "cost-efficiency" is not found in either bill related to these topics. But in a CBO paper (December 2007) "Research on the Comparative Effectiveness of Medical Treatments: Issues and Options for an Expanded Federal Role" it is found 59 times.

There is a cost difference associated with alternative treatments. If any recognized group issues a statement related to treatments for a disease, illness, etc., they will issue it for a purpose. It will impact our insurance coverage, including the government insurance.

The question then is "May I pay for the treatment myself?" I wonder?

IT ISN'T ABOUT MAMMAGRAMS

"The Annals of Internal Medicine" has discussed other recommendations in past issues. Where are the 100's of article related to those? They don't exist.

None of the articles discuss the other recommendations of the USPSTF which pertain only to women. There are many. My conclusion is that the writers of these articles like the topic because it is a hot-button issue. They have a myopic view and therefore miss the true issue.

The issue is the USPSTF itself. It is making 69 recomendations. In the Foreward, Carolyn Clancy, Director, AHRQ says:

"The USPSTF recommendations on clinical preventive services can help you collaborate with your patients to make better-informed decisions about offering preventive services, and it can help you improve the preventive services that you provide."

Each of us is responsible for the cost of our own healthcare. We buy insurance to help reduce our cost. If an insurance company does not pay for an exam that my doctor recommends, then I must pay. But when we get universal healthcare, will I be allowed to pay that cost. Or will I be told that it is not recommended, therefore it cannot be done?

I believe that is where all this is headed. It is all about cost-effective services, Comparative effectiveness, and death panels I've discussed those highlighted terms in previous posts.

Mammograms and Other Trivial Matters

Wow!! What an uproar. Such ghastly information: Don't get a mammogram until age 50 and then do it every two years. Why is everyone so upset? That inormation has been out since March of this year. Doesn't anyone do any research anymore? I'm a retired accounting teacher and I new what was recommended months ago. Check out the colonoscopy screening recommendation.

The USPSTF seems to be a funtion of the AHRQ. Here is how they describe themselves in the back pages of the AHRQ website:

The U.S. Preventive Services Task Force (USPSTF), first convened by the U.S. Public Health Service in 1984, and since 1998 sponsored by the Agency for Healthcare Research and Quality (AHRQ), is the leading independent panel of private-sector experts in prevention and primary care. The USPSTF conducts rigorous, impartial assessments of the scientific evidence for the effectiveness of a broad range of clinical preventive services, including screening, counseling, and preventive medications. Its recommendations are considered the "gold standard" for clinical preventive services.
The mission of the USPSTF is to evaluate the benefits of individual services based on age, gender, and risk factors for disease; make recommendations about which preventive services should be incorporated routinely into primary medical care and for which populations; and identify a research agenda for clinical preventive care.

The website indicates that it is part of the Dept. of HHS. On page ii of the "Guide to Clinical Preventive Services - Recommendations of the U. S. Preventive Services Task Force," it states that these recommendations are independent of the U. S. Government.

It gets its money from the government and is part of AHRQ which is part of Dept HHS, but it is independent.

So what are these recommendations? Can you say "cost-effective?" Here's a small part of what it says about colonoscopies:

"Despite the increasing incidence of colorectal adenomas with age, for individuals previously screened the gain in life-years associated with extending screening from age 75 years to 85 years was small in comparison to the risks of screening people in this decade." In other words, if we test, find something, and operate, you will probably end up living the same number of years as if we had done nothing. And how about this:

"For persons older than 85 years, competing causes of mortality preclude a mortality benefit that outweighs the harms." Hon, don't bother testing. You're going to die anyway.

To be continued....

YOUR COST OF THE PELOSI BILL

On August 2, I blogged about the cost of HB 3200. The Pelosi bill is about the same.

The Kaiser Family Foundation produced some numbers in its report: "Employer Health Benefits - 2008 Annual Survey" It found that the average cost of an insurance policy for individual was $4,704 and $12,680 for family coverage. If there is average increase of 5% from 2008 to 2013, those numbers will be $5,975/16,185. If you are single and currently earn $43,320 (subject to COLA) or less, you will be allowed a credit to reduce your cost. The income level for family income is $88,200. If you make less than those income amounts, your credit is greater.

As an example:

You are single earning $32,490, your net cost would be about $2,725.
You have family coverage and earn $66,150, your net cost would be about $10,775

This does not assume employer coverage. KFF determined that employers covered about 85% for individuals and about 75% for family coverage.

Some assumptions that could be made:

Healthcare costs will increase because of government incompetence.
Employers will not cover as much as in prior years.
Employers will no longer cover employees.

Elephantiasis

I've read 400 pages of the Bausus bill. Those people must be suffering from Elephantiasis. They've grown some really big ones!!

Saved Jobs

Today I'm proud to state that I have saved 20 jobs. It took very little effort. It was easy. Each one of us can do it. C'mon everyone. Pitch in. Individually we can save our country. Just imagine how great our economy would be if everyone made such an announcement.

There are millions of us. Step up and announce that you have saved some jobs. Money will start flowing again in the right direction; the government can quit throwing our money out in the wind.

We'll all be so much better off if we would save just at least 2 jobs.

THOSE NOT IN CHARGED WERE IN DC ON 9/12

We are no longer in charge. But many of us not in charge showed up in D C on Saturday, 9/12. I was unable to be there, but I believe each person there represented several others.

The appearance of that massive group was a message to the members of Congress. The visual effect had to be much greater than a letter from each of them. Those of us not in charge told the members that they must start representing US again. They should now consider us "special interest."

We can't increase their wealth nearly as much as other special interests. But we can control their political destiny. In Federalist Papers #57, Hamilton or Madison wrote about the two year terms in the House:

"The aim of every political constitution is, or ought to be, first to obtain for rulers men who possess most wisdom to discern, and most virtue to pursue, the common good of the society; and in the next place, to take the most effectual precautions for keeping them virtuous whilst they continue to hold their public trust. The elective mode of obtaining rulers is the characteristic policy of republican government. The means relied on in this form of government for preventing their degeneracy are numerous and various. The most effectual one, is such a limitation of the term of appointments as will maintain a proper responsibility to the people."

He went on to say about members of the House:

"Before the sentiments impressed on their minds by the mode of their elevation can be effaced by the exercise of power, they will be compelled to anticipate the moment when their power is to cease, when their exercise of it is to be reviewed, and when they must descend to the level from which they were raised; there forever to remain unless a faithful discharge of their trust shall have established their title to a renewal of it."

He was saying that if those members don't do right by us, they will return to live among us. That is our job now. Determine those who have abused their power and send them home.

We must fire the incumbents at the next election.

WE'RE NOT IN CHARGE ANYMORE

I read the ARRA (stimulus) , the ACES (cap and trade) bill, and the ...Health Choices bill (health care). Some of our Senators and members of Congress have admitted they have not read the health care bill. I seriously doubt they have read the other two.

I can draw only one conclusion. None of them contributed to the their content. So who wrote them? I can only guess.

The stimulus was presented in late January. Most everyone had been on vacation. It took me several days to read it once with limited comprehension. This thing had been pre-packaged and given to one of the Members who started the ball rolling. I can't find anyone with a direct benefit. Sure, a few people received some checks but they didn't write the bill. Those checks were just a form of bribery. "Hey, look what we're doing for you. Be sure to vote for us next election." So the Democrats may benefit; but they didn't write it. Who was it? The unions? Moveon.org? George Soros? Acorn?

The same goes for ACES. The people certainly don't benefit. Oh sure, they tell us a clean environment is good for us. In the background some cronies will make a ton of money. Someone will be in charge of the buying and selling of carbon offsets. Commissions will be made and some money will pass under the table.

So who else benefits with the passage of ACES? Companies in the renewable energy industry? They can sell their offsets; they are receiving and will continue to receive grants and other forms of cash from the government coffers. Did these groups write it?

What about the health care bill? Believe it or not, I see unions all over this one. I have read articles and have seen news accounts of various organizations which have a generous retirement package demanded by their unions. They are now in trouble. People have retired as early as the plan allows, generally while they are in their 50's. The organization, and in some cases the union, must pay their benefits. That includes health care. Sec 164 helps them with a "reinsurance program." It says that we taxpayers will "provide reimbursement to assist participating employment-based plans with the cost of providing health benefits to retirees and to eligible spouses, surviving spouses and dependents of such retirees."

Someone wants absolute control over us. They don't like us being a free people. They must find ways to control our lives. The stimulus bill - if we don't pass it, we'll have greater unemployment. We got it anyway. ACES - hasn't passed yet but will determine what we drive, how much electricity and other power we use, where we live and work, and how much we pay for the power we use. Health care - they will have the power to determine when and how much health care we get; they will control what businesses can produce by measuring their products effect on our bodies.

They are using fear to get what they want. If we don't pass ACES, the planet will disintegrate within 50 years. If we don't pass health care, people will die.

We must say no to these and all the other bills that are written for them.

Death Panels Again (Palliative Care)

Sec 1233 of HB 3200 covers topics related to end-of-life care. Questions were immediately raised about it. The President of the AMA, J. James Rohack MD, said "...the bill would create a new Medicare benefit to pay physicans for time spent on advance-care planning consultations with seniors."

That raises two questions for me:

Was there legislation approving heart transplants or kidney dialysis?

Do doctors currently hold advance-care planning consultations with seniors?

Approval of such consultations is an administrative function and should not require legislation. Surely, doctors have such consultations and find some Medicare code to provide payment. Dr. Rohack's statement is misleading.

In a paper by National Quality Forum ( National Priorities Partnership. National Priorities and Goals: Aligning Our Efforts to Transform America’s Healthcare. Washington, DC: National Quality Forum; 2008 - Page 39) it is stated: "Patients receiving palliative care in the hospital who were discharged alive saw a net savings of nearly $1,700 in direct costs per admission and nearly $300 in direct costs per day." And "When palliative care patients die in the hospital, the savings are nearly $5,000 in direct costs per admission, and nearly $400 in direct costs per day..."

Sec 1233 is not about paying doctors for their services. It's about cutting costs. And that is a good thing.

We are concerned about the decision-making process. When do we, the patient and family members, lose control. If we want to continue our fight for life, will Medicare step in and demand that we switch into palliative care mode?

President Obama and Personal Responsibility

I liked the President's speech this morning - encouraging the children to be responsible.

He named several young people who have become successful. They "set goals for themselves. And I expect all of you to do the same."..."Don't be afraid to ask for help when you need it. I do that every day."

Mr. President, you should take those same thoughts to the adults.

Discuss disparities in health care with them. The Center for Health Equity Research and Promotion defines disparities as differences in the prevalence, mortality, and burden of disease and other adverse health conditions that exist among specific population groups.

That organization has found there are five factors contributing to disparities:

• Individual - cultural, socio-economic position, biological and clinical, behaviors, and living conditions.
• Environmental - poor air quality, crime, contaminated water, and exposure to toxic chemicals.
• Social - characteristics of human society that contribute to health and health care disparities - racial segregation, social cohesion, income, and education.
• Policy - legislation
• Provider - the knowledge, attitudes, practice patterns, communication style and cultural competence of the health care provider.

Many non-profit organizations have written many papers about those who are not getting a fair share of health care. Mr. President, you told the children that the circumstances of their lives should not be used as excuses. Tell the adults that the circumstances listed above must not be used as excuses. Speak to those people as you did the children. If someone believes they are not getting appropriate care, tell them to ask questions. "Asking for help is not a sign of weakness, it's a sign of strength," you told the kids. Now tell the adults.

If someone cannot communicate with their doctor, encourage them to learn the English language better. Or encourage them to take multi-lingual person with them. Tell them to never "give up on yourself." Tell them that they can get good health care. Tell them to demand it. Demand it from their providers not from the government.

Tell them, Mr. President, that you can sign bills expanding health care or establish a health care czar, but..."at the end of the day,...none of it will matter unless all of you fulfill your responsibilities."

Health Disparities

Since about 2001 there have been numerous studies related to healthcare disparities. The 2007 National Healthcare Disparities Report, produced by the AHRQ, found these disparities among others:

• "Blacks had a rate of new AIDS cases 10 times higher than whites.
• Asian adults age 65 and over were 50% more likely than whites to lack immunization against pneumonia.
• American Indians and Alaska Natives were twice as likely to lack prenatal care in the first trimester as whites.
• Poor children were over 28% more likely than high income children to experience poor communication with their health care providers.
• ...The factor most consistently related to better quality is whether a patient is insured."

So it is not surprising to see the word disparities 30 times in hb 3200. For instance, on page 125:

"Sec 224 - Modernized Payment Initiatives and Delivery System Reform

(b) Requirements for Innovative Payments -

The Secretary shall design and implement the payment mechanisms and policies under this section in a manner that seeks to...

2. Reduce health disparities (including racial, ethnic, and other disparities).

In my previous post, I pointed out that hb 3200 appears to transfer health care from those who currently have it to those who do not. The frequent use of this term (disparities) indicates that one goal is to bring those who have insufficient health care up.

If the Universal health care is to be revenue neutral (which it is not, yet), then someone must be sacrificed. Medicare is being cut, so some of the elderly will be sacrificed. In the Disparities Reports, it is pointed out that Whites have the advantage. So will that group get less until everyone has equal treatment?

A Transfer of Health Care

In my first post, I was inquiring about the number of uninsured. The number I keep hearing in the news these days is 47 million. In that post, I challenge that number. The number seems to be valid except that some of those individuals are choosing NOT to be covered. A government health plan will REQUIRE that they pay a premium (to an ins. co. or to the gov't) to be covered.

In a later post, I questioned the use of the term "Death Panel." I showed in the various parts of the bill that there will be government controls on the allocation of care through Comparative Effectiveness, Quality Adjusted Life Years, and Health Information Technology (HITman). HITman will determine whether or not you get a needed procedure.

What we accomplish with government health care can be easily stated. We will be reducing the cost of healthcare at the elderly and disabled level and increasing it at the younger (uninsured) level. It will be nothing more than a trade off. Someone does not get health care.

Lies and other Falsehoods

I was watching On the Record (Greta Van Susteren) last night. The topic was John Mackey's editorial in WSJ in which he offered an alternative reform to health insurance. Her first guest in that spot was Russell Mokhiber. I'ver never seen nor heard about him before. He was encouraging a boycott Whole Foods Grocery Stores (Mackey is CEO). Mr. Mokhiber said Mackey is a bad man for suggesting something other than a public option. He then said that there are 60 people dying everyday because they lack insurance; and in Canada there are none.

When someone throws out statistics, I immediately become wary. When those stats don't "feel" right, I immediately question. No one in Canada dies without insurance. Isn't that a comfort? You're dead but you had insurance when you died.

But I really questioned the "60" number. I got on the internet and found what he was referring to. The Institute of Medicine had done a report in 2003 that essentially determined how many people would have died if everyone had had insurance. Then they compared that to the number that had died. The difference was the assumed number that died without insurance.

There are many articles establishing the flaws in the study. But it was a number Mr. Mokhiber could use to his advantage. He threw it into his discussion and Greta didn't challenge it. Perhaps she had never heard it before and couldn't for that reason.

You really have to watch these people carefully.

Insurance company ripoffs

On July 22, President Obama said “you know, there had been reports just over the last couple of days of insurance companies making record profits. Right now, at the time when everybody’s getting hammered, they’re making record profits and premiums are going up.”

I pulled up some government statistics (National Health Expenditures) about health insurance. Hard working Americans paid $775 billion for premiums in 2007. The insurance companies paid out to our service providers $680 billion. That leaves them with $95 BILLION. No wonder he's attacking them. That means the insurance companies enjoy a 12.3% profit off of our premiums.

Oops. I must have done something wrong. Let me check my figures. Hmmm...still 12.3%. It's my understanding that they must pay administrative costs, state and federal fees, AND taxes from that 12.3%.

I don't understand. Why is he trying to tell us that the insurance companies are ripping us off? $95 billion sounds like a lot of money but a 12.3% profit before other expenses and taxes makes it sound more reasonable. Don't we want them to make a profit? Many of us are invested in insurance companies. If not directly, then we are invested through our retirement plans. Insurance companies are not the villains although Nancy Pelosi has called them that.

The reciprocal of the 12.3% is 87.7%. That is what is called the actuarial value or cost sharing. Under hb 3200, the basic plan requires a cost sharing of 70%; under the enhanced plan, 85%; under the premium plan, 95%. Seems to me the insurance companies already offer plans that pay out more than 85%.

HB 3200 will require the insurance companies to accept clients with pre-existing conditions and with a non-cancellation clause. If they don't raise premiums, what will those two things do to their 12.3% profit. They will also be required to cover at no cost to us any preventive medical procedures.

Do you really think they will stay in that business if they can't make a profit? Now you can answer the question that is frequently posed. "Can I keep my current policy?" Of course, you can; as long as the company stays in the business.

End of Life

Within Sec 1233 it says that there will be consultations between the patient and the doctor and such conultations will include:

‘‘(B) An explanation by the practitioner of advance directives, including living wills and durable powers of attorney, and their uses."

So what's the problem with that. Many responsible people have done this without consulting with their doctors. I did. Those documents are on the top of my desk and occassionally I pull them out to make sure they state my desires. My children know that if something happens, they should go into my office, find those papers and follow my directives.

Also in 1233 it says the consultations will include:

‘‘(E) An explanation by the practitioner of the continuum of end-of-life services and supports available, including palliative care and hospice, and benefits for such services and supports that are available under this title."

OK. I've got that covered. So what's the problem? I guess this is where the "death computer" comes in. Who or what determines that "end-of-life" is here? Is it the doctor/patient or is it the computer/doctor? Remember that on page 58 paragraph D we are told that when the doctor dials up the computer, he/she may be told "nope, can't do that."

Most of us, I believe, are ready to accept that we have reached the point at which all future medical procedures, while heroic, are futile. We just don't want the government to be the one telling us that. And with so much in this bill, that's the way it seems.

This bill is not about health care. It is about control - absolute control of our lives by the government.

Obama is correct

In every townhall (or other forum), President Obama chides the evil ones, the capitalist, those who are trying to make a buck. They take advantage of others. Like thieves, they take money from someone and hoard it or give it to others who are just as evil.

Last month we saw a blatant example of it. They stepped up, said their capital has a greater value and therefore, should get more for it.

Such greed.

And now that they are getting $7.25 per hour, they’re planning to ask for more. Will those filthy capitalists ever stop wanting more? They believe that their years of training is a sufficient reason to demand more. They go to work for 40 hours per week and probably give only 30 hours of effort. They believe they have a right to text-message, tweet, and facebook on the job. Train conductors and bus drivers have been proven to be doing this.

President Obama said he would reduce health care cost by reducing “hundreds of billions of dollars in waste and inefficiency in federal health programs like Medicare and Medicaid and in unwarranted subsidies to insurance companies that do nothing to improve care and everything to improve their profits.”

Obama is correct. We should get rid of all unwarranted subsidies, including food stamps, housing assistance, unemployment benefits, and minimum wage.

The President's lips are moving...

...and I have a tendency to not believe what he is saying. He and the others seeking socialism speak in half-truths. An example:

Lori Robertson of factcheck.org said that Division B Title II Subtitle C sec 1233 of hb 3200 does not address "death panels" or "pulling grandma's plug." That is true.

But anyone who has read the bill, knows it has many parts. So combine 1233 with Title IV - Quality, Subtitle A Comparative Effectiveness Research and also with Title I Subtitle G Sec 163 and voila', you've got the equivalent of death panels.

Another half-truth:

"President Obama has never said he believes in the public option." True. But as State Senator and presidential candidate, he has.

Others who are half-truthing for the President point to a clause in the Stimulus Bill about the Federal Coordinating Council for Comparative Effectiveness Reseach. It says:

"Nothing in this section shall be construed to permit the Council to mandate coverage, reimbursement, or other policies for any public or private payer." Whew!! That's a relief.

Ooops. They don't tell you that within hb 3200 a Center for Comparative Effectiveness Research is established within the Agency for Healthcare Reseaerch and Quality. And there will be a Comparative Effectiveness Research Commission which will oversee the CCER. Included in its duties is:

...to make recommendations to the Center for the broad dissemination of the findings of
research conducted and supported under this section that enables clinicians, patients, consumers, and payers to make more informed health care decisions that improve quality and value.

So the FCCCER will not mandate anything, but CCER will?

Watch out. Their lips are moving.

Is there a DEATH PANEL?

What was Sarah Palin thinking? She believes there is a DEATH PANEL!!

Sarah! Sarah! Sarah!

Obviously, she has not read hb 3200. There is no DEATH PANEL mentioned anywhere in the 1018 pages.

There is a DEATH COMPUTER!!

So she isn’t too far off the mark.

Here’s how it works. In a previous post, I talked about Comparative Effectiveness, cost-benefit, and quality-adjusted life years( QALY). TRILLIONS of our dollars have been (or will be) given to various governmental groups to study medical procedures. The results which come from these “consensus-based” organizations will be put into the master-computer data base. This is done by ‘‘TITLE XXX—HEALTH INFORMATION TECHNOLOGY AND QUALITY” which was part of the Stimulus Bill. It established the National Coordinator of Health Information Technology. I call it HITman (or woman).

So CE info is in the master data base. Now let’s put all of your heath info in there, too. Can they do that? Check this:

Sec 3000 (13)
QUALIFIED ELECTRONIC HEALTH RECORD.—The term ‘qualified electronic health record’ means an electronic record of health-related information on an individual that—
‘‘(A) includes patient demographic and clinical health information, such as medical history and problem lists; and
‘‘(B) has the capacity—
‘‘(i) to provide clinical decision support;
‘‘(ii) to support physician order entry;
‘‘(iii) to capture and query information relevant to health care quality; and
‘‘(iv) to exchange electronic health information with, and integrate such information from other sources.

HITman has put info about CE, cost-benefit, and now your personal data. With that, your QALY is calculated.

So you go to your doctor because you have a serious problem. He dials up the computer and inputs your current situation and the computer sends back an answer. Let me remind you of page 58 paragraph.

…such standards shall…
“(D)enable the real-time (or near real time) determination of an individual’s financial responsibility at the point of service and, to the extent possible, prior to service, including whether the individual is eligible for a specific service with a specific physician at a specific facility, which may include utilization of a machine-readable health plan beneficiary identification card… “

There you go!! It’s a DEATH COMPUTER.

This is post #7 discussing some critical parts of hb 3200.

Sec 1233 Advance Care Planning Consultation

This section adds to the Social Security Act:

(hhh)(1)…Such consultation shall include the following:

(E) An explanation by the practitioner of the continuum of end-of-life services and supports available, including palliative care and hospice, and benefits for such services and supports that are available under this title.

2(B)(3)(A)
…the Secretary shall include quality measures on end of life care and advanced care planning that have been adopted or endorsed by a consensus-based organization, if appropriate. Such measures shall measure both the creation of and adherence to orders for life sustaining treatment.

I have no problem with my doctor discussing this situation with me. But this is our government saying that this must be done. The government expects my doctor to discuss measures endorsed by a consensus-based organization. That organization is Federally funded and Federally controlled through the Agency for Healthcare Research and Quality. The measures are those that are appropriate based upon a comparative-effectiveness study considering a cost-benefit using quality-adjusted life years. Now I remind you of the portion of the bill related to computerization where it says (p58 of the bill) the system will determine if you may have such services from that particular doctor at that particular facility. So if you are not ready for end of life care and want to continue fighting for life, the computer may say “Sorry, you can’t have that.”

The government has already put 1.1TRILLION dollars of our money into CE. An additional $90 MILLION will be taken in 2010, $100 MILLION in 2011, and $110 MILLION in 2013. After that, it will be $375 MILLION each year. If that amount is invested, what is a fair return (savings) each year and where is it saved? Medicare!!! Where is the biggest problem in Medicare? END-OF-LIFE

Comparative Effectiveness in hb 3200

This is post #6 related to the proposed h b 3200. Hopefully, you have read the others.

On page 502 of the bill, the Sec. HHS is given the power to establish within the Agency for Healthcare Research and Quality (AHRQ) a Center for Comparative Effectiveness Research to conduct, support, and synthesize research…with respect to the outcomes, effectiveness, and appropriateness of health care services and procedures in order to identify the manner in which diseases, disorders, and other health conditions can most effectively and appropriately be prevented, diagnosed, treated, and managed clinically.

That sounds pretty nice doesn’t it? How in the world could that be bad? It seemed so good, I just had to check out the term “comparative effectiveness” because I knew the geniuses in Congress wouldn’t have create that on their on.

In “Comparative Effectiveness: Better Value for the Money?” (August, 2008) issued by the Alliance for Health Reform, they state: “…CE aims to assess how various procedures or interventions for a given ailment compare with each other.”

Can the government which controls the research establish health cost ceilings and floors for payments to providers (and therefore, the patient)?

I found a paper (“Comparative Effectiveness of Health Interventions: Strategies to Change Policy and Practice”) from 2007 issued by ECRI Institute. They are an Evidence-based Practice Center as designated by the U. S. Agency for Healthcare Research and Quality (AHRQ) and a Collaborating Center of the World Health Organization. I added the color. In the executive summary on page 1, I found this:

“Proponents of comparative effectiveness research say objections and counter-arguments should be anticipated. Comparative effectiveness guidance will be resisted if it is seen as primarily a tool to control healthcare costs. On the other hand, it is more likely to be embraced if the information helps patients and providers raise the quality of healthcare and reap greater value.” Again, my color added.

OK so don’t tell us that the goal is to reduce cost; tell us that the goal is to improve the quality of health care.

I also found a CBO report to Congress by Peter Orszag in December, 2007. This paper presents the pros and cons of CE research, who should perform the research, and whether or not cost-effectiveness should be considered in the research. This is very important because such an inclusion requires the use of another set of values called “quality-adjusted life years.” Included in the report is this:

“By convention, cost-effectiveness analyses report results as the cost per QALY gained, so a lower dollar amount indicates a more cost-effective service. If that metric is used to determine whether specific health procedures are covered by an insurance program, choosing a cost-effectiveness threshold can be a controversial endeavor.”

As an example, assume a procedure will cost $57,000 and the patient would “gain” 35 quality years (determined by a gov’t chart). That is a cost of approximately $1,629 per life year. Suppose that same procedure is considered for someone with only 5 quality years gained. That would be $11,400 per life year. Hmmmm, better not do that one.

But my gov’t wouldn’t do that.

Members of Congress like to model things by the way other parts of the world do them. QALY is applied all across Europe. Why not here?

The stimulus bill allowed for 1.1 TRILLION dollars set aside for such research. The current health care bill allows for an addition 90 MILLION in 2010, 100 MILLION in 2011, 110 MILLION in 2012. Then in 2013 and thereafter, there is a formula based upon fees charged to insurance companies and self-insured plan AND a transfer based upon the number of us in the Medicare program. That money is transferred from the Medicare fund!!!

Let me see if I understand this. TRILLIONS of dollars are going to be spent to find ways to save money in health care costs. What amount of annual savings should be expected if we invest TRILLIONS of dollars for research?

Health Choices Administration and hb 3200

This is post #5 on the proposed health care bill h b 3200.

The HCA is a new independent agency in the executive branch. The president will appoint a Commissioner with the approval of the Senate.

The Commissioner will:

1. establish qualified health benefits plan (QHBP) standards (define specific coverage)
2. enforce those standards
3. establish a Health Insurance Exchange (HIE)
4. administer affordability credits
5. promote accountability Quallified Health Benefits Plan offering entities (ins. cos.)
6. conduct random and targeted audits of ins. co. and employers
7. recoup audit costs from QHBP offering entities
8. collect data to promote quality and value, protect consumer, address disparities in health and health care, etc; share such data with Sec HHS
9. provide for civil money penalties
10. suspend enrollment of individuals in the plan
11. terminate the plan, if necessary
12. set standards for insurance definitions
13. issue regulations for the effective and efficient administration of the HIE
14. appoint an ombudsman
15. other duties as assigned

Through the HIE, the commissioner shall

1. establish standards for QHBP offering entities (ins. co)
2. negotiate with those entities for the basic, enhanced, premium and premium-plus plans
3. enter into contracts with those entities
4. facilitate outreach and enrollment into the plans (advertisements and door knockers)
5. establish risk pooling mechanisms
6. define: ‘‘employer’’, ‘‘employee’’, ‘‘full-time employee’’, and ‘‘part-time employee’’
7. may set an enrollment phase-in period for very large employers
8. execute a survey. The goal of the survey is to determine if there are significant groups and types of individuals and employers who are not Exchange eligible individuals or employers, but who would have improved benefits and affordability if made eligible for coverage in the Exchange. Specificall, the study shall examine the terms, conditions, and affordability of group health coverage offered by employers and QHBP offering entities outside of the Exchange compared to Exchange-participating health benefits plans; and the affordability-test standard for access of certain employed individuals to coverage in the HIE.
9. establish range of cost-sharing (ie 70%-97%)
10. ask the Sec of Treasury (tax cheat) for info about you.
11. seek info about you through means other than your tax return
12. establish penalties if you don't follow the rules

How will h b 3200 impact employers

This is post #4 related to the health care discussion. Be sure to read the three previous.

Page 74
Qualified employers with fewer than 11 employees shall be eligible to enroll in the Health Insurance Exchange in 2013.
Qualified employers with fewer than 21 employees shall be eligible to enroll in 2014.
Page 133
An employee who enrolls in the employers qualified plan cannot get the affordable credits (mentioned in a previous post) unless the amount charged by the employer is greater than 11% of the family income.
Page 144
If the employee opts out of the employee plan, the company must make a contribution to the Health Information Exchange. The rate paid is discussed below.
Page 145
The employer must provide substantial information to the Health Choices Commissioner, the Sec. of Labor, the Sec. of the Treasury (tax cheat) and the Sec. of HHS. This is modeled after the W-2 form - Name, SS#, were you covered, for how many months....etc
Page 146
If the company provides insurance for the employees, the co. must contribute at least 72.5% for single coverage and 65% for family coverage.
The co. must enroll an employee who fails to make a choice among plans provided by the employer. The plan for this employee must be the one with the lowest premium.
Page 147
The company must provide insurance coverage for part-time employees on a pro-rata basis.
Page 149
If co. does not provide insurance coverage or if the empployee opts out, the co. must pay an amount to the Health Choices Commissioner. The amount is determined by multiplying the applicable percentage times the average wages:

1. less than $250,000 per year 0
2. less than $300,000 per year 2%
3. less than $350,000 per year 4%
4. less than $400,000 per year 6%
5. over $400,000 8%

So if one employee opts out, the co must make a payment for that one employee.
Page 153
If the co. offers coverage, the co. is subject to insurance audits.
Page 189
The co gets a new tax credit. It is equal to 50% of qualified ins. costs. It is phased out:

1. If the average employee compensation is greater than $40,000, the tax cr. = 0
2. If the co has more than 25 employees the tax cr. = 0
3. Wages of any employee earning greater than $80,000 are not available for the credit.

If a co has elected to participate in coverage but later fails (determined by audit?), the co will be fined $100 per day per employee, until the error is corrected.

What a deal for companies!!!!

What will h b 3200 cost me?

This is part 3 of my coverage of the health bill. The House Energy and Commerce Committee has submitted something new but I haven't found that yet.

What will it cost each of us?

As a point of reference, the average cost of a plan provided by the employer in 2008 was approximately $12,700 for family and $4,704 for single coverage. Employers get the best deal from insurance companies because of the expanded risk pool. So let's assume that every family will have to pay $12,000 (a nice round number) in this gov't required plan. That's just the premium.

Good news!!! You may have a credit available to reduce that premium (page 137). If your income in terms of the FPL is $88,200 (family of 4), then you only pay $9,720 per year. In addition, your cost-sharing portion is 30%. As near as I can tell, the law means that after your initial deductible ($10,000) you must pay 30% of all covered healthcare services that you receive. Of course, in Part 2 of this discussion I mentioned that there are some health care items which must be free to you.

If your income is $66,150, then you pay $7,277 and your cost-sharing rate is 28%.

I use the $12,000 arbitrarily because if employers can get the best deal, then a gov't controlled environment would get at least that. However, nowhere in h b 3200 is a premium stated. It only mentions that the Secretary of HHS will determine premiums.

If your income is over $88,200, then you get no premium reduction. You pay the full $12,000 and your cost-sharing is 30%.

Let's try and example for your income over $88,200. Your family has been healthy all year. One child is hospitalized and released after 5 days. Assume total health care charges are $50,000. Your portion is $10,000 (the deductible) plus 30% X (50,000 - 10,000). That's a total of $22,000. Add that to your premium and your total cost is $32,000. In part 2 I mentioned medical bankrupcties, so get in line.

Let's assume all ins. co. will jump on this band wagon and you choose a policy from one and it is a Qualified Health Benefits Plan. It is possible that it later fails to qualify. If so, you may be penalized (not taxed) at the rate of 2.5% of your AGI - $26,000 (family of four). Less than $26,000 and you are not required to file a return and therefore will not be penalized. You can't cheat by covering only the adults and not the children. The penalty still applies.

If you are obstinate, and refuse any insurance, the penalty still applies. They will catch you. You know how your income is reported on W-2s and other forms. There will be reporting forms for insurance coverage. There will be a knock at your door and ..."I'm here from the government and I'm going to sign you up."

What will you get with hb 3200?

Hope you read my first post. This is part 2 of a discussion of h b 3200.

You will have access to a public or private plan. I'll describe the public plan. Keep in mind that all private plans must be equal to or better than the public plan.

The plan will have three levels: basic, enhanced, and premium. And there can be a "premium plus." The basic plan must include:

Guaranteed issue; guaranteed renewal; rescissions prohibited;
Hospitalization;
Hospital, clinic and emergency room out-patient services;
Health professional services;
Such services, equipment, and supplies incident to the services of a physician’s or a health professional’s delivery of care in institutional settings, physician offices, patients’ homes or place of residence, or other settings, as appropriate;
Prescriptions;
Rehabilitive and habilitive services;
Mental health/substance abuse disorder services;
Preventive services;
Maternity services;
Well baby and well child services.

The preventive services must be at not cost to you.
Your out-of-pocket expenses will be limited to $5,000 (single)/$10,000 (family).
There will be no annual or lifetime limit.
Benefits must be provided that are actuarially equivalent to approximately 70 percent of the full actuarial value of the benefits in the package.

BUT WAIT - THERE'S MORE!!

You can choose the Enhanced package. You get all the items listed above except for this change:
Benefits must be provided that are actuarially equivalent to approximately 85 percent of the full actuarial value of the benefits in the package. This just means you will pay less out-of-pocket.

AND THERE'S MORE!!

You can choose the Premium package. You get all the items listed above except for this change:
Benefits must be provided that are actuarially equivalent to approximately 95 percent of the full actuarial value of the benefits in the package.

OH, AND ONE MORE THING:

You can choose the Premium Plus package. In that, you get adult oral health and vision care. Children already get that under the Well Child coverage above.

That's a great list, so you know that private ins. co. will be jumping into that. There are big profits available!!

So...can you keep your current plan? Of course you can. If you have an individual plan, your ins. co. must model its benefits to the basic plan detailed above. You know it will jump on that advantage.

So...can you keep your doctor? Of course you can. Your ins. co. must provide "adequate networking." That means it must offer lots of choices of drs. and other services. Then there is this that really concerns me (it's on page 58):

One of the goals for financial and administrative standards specified in paragraph D on page 58 states that such standards shall

enable the real-time (or near real-time) determination of an individual’s financial responsibility at the point of service and, to the extent possible, prior to service, including whether the individual is eligible for a specific service with a specific physician at a specific facility, which may include utilization of a machine-readable health plan beneficiary identification card...

What a deal!!! How can anyone pass this up?

I'm exasperated!!

I cannot find enough coherent discussion of the healthcare bill (h b 3200). Television segments of 6 or 7 minutes don't provide enough time for the interviewees to get a thought going on the 1000+ page bill. They shout at each other and talk over each other.

For how much of health care cost is each of us responsible?

My answer is 100%. Then it's up to me to find someone to share that cost - an insurance co. Once a third party got between us and our doctors, we lost control. Let's tell our employers we no longer want them to provide our insurance policies. Give us the money and let us buy our own policies. Something tells me that the ins. companies will find many ways to sell us a policy at or below the same premium amount. We, the consumer would be back in power. If the consumer is young and single, the deductibles could be set higher because they get sick less. Got kids? Lower deductibles because they get sick more. No matter how you design YOUR policy, you can design your savings account such that you have the money set aside when you need it.

How many people are involuntarily uninsured?

I've heard 40 million, 45 million, 47 million, 50 million and 85 million.

In 2007, there were 45 million uninsured, but only 29 million of those were at or below the low income level. Seems like the gov't could pay the premiums for their insurance for less than $1.5Trillion over ten years. I guess everyone else above the low income level choose not to be insured or fail to budget for such.

And...

What about those medical bankrupcies?

Researchers at Cambridge Hospital, Harvard Medical School, Harvard Law School and Ohio University found that in 2007, 60% of individual bankruptcies were prompted by medical bills.
They found that medical bills ranged from $6500 to just under $27,000.

Their total debt exceeding their assets averaged about $44,600. So were the medical bills part of the problem or the entire problem. The articles which cite the research were written such that the reader was to believe that the medical costs were the only cause of the problem. I'm not so sure after reading the study online in The American Journal of Medicine.