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.
Sunday, November 22, 2009
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?"
...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?"
Saturday, November 21, 2009
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?
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?
Wednesday, November 18, 2009
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.
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.
Tuesday, November 17, 2009
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....
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....
Tuesday, November 3, 2009
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.
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.
Subscribe to:
Posts (Atom)