Re: Greedy HMO Slowly Killing 4 Year Old Boy
- From: "Offshore Eddie" <eddie@xxxxxxxxxx>
- Date: Tue, 08 Nov 2005 09:21:53 GMT
"scooter34" <momofpeanutLiz@xxxxxxxxxxxx> wrote in message
news:1131383118.953578.326740@xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx
>
> Kris Baker wrote:
>
>
> >
> > So the HMO is paying for a trip for three people for "a visit" to
> > MacKenzie. If this condition is as dire as is stated, and incurable,
> > perhaps the family needs to consider moving to Delaware from
> > California?
> >
> > If I were these parents, and believed that only one doctor could
> > save my son, I'd do that.
> >
> > Kris
>
> Sadly, this is the problem with American health care versus American
> expectations of health care. While I acknowledge the fact that, if it
> were my child, I would feel the same, I can also look at it as a
> consumer and know that my rates are drastically impacted by every case
> like this.
>From the San Francisco Chronicle:
Some 40 years after the enactment of Medicare and Medicaid and more than a
decade after the Clinton administration failed in its bid to extend coverage to
all Americans, the nation's system of funding health care is on the verge of
breaking down.
Employers, consumers and governments at every level are straining under the
burden of a health care bill that is growing at a pace five or six times the
rate of inflation.
Businesses, squeezed by soaring health insurance costs, are passing an
increasing share of the price tag to their workers. That's forcing employees to
dig ever deeper into their pockets, prompting millions to forgo coverage
altogether and gamble that their families will stay healthy.
The public health care system is overwhelmed by the country's 45 million
uninsured who turn to hospital emergency rooms for even routine care. And
Medicare -- the crown jewel of government health programs -- is projected to run
out of funds by 2019 at the current rate of expenditure growth.
The soaring cost of health care has emerged as one of the top issues in the race
for the White House. Both President Bush and Sen. John Kerry, D-Mass., are
offering programs to make health coverage more affordable and reach more of the
uninsured. (See accompanying article.) But experts say the fixes proposed by the
two candidates would not fundamentally alter the dynamics that are putting
health care costs out of reach.
"When we have faced these so-called crises in health care before -- health care
cost spikes, an increase in the uninsured -- there was always a sense that there
was some big solution coming," said Drew Altman, president of the Henry J.
Kaiser Family Foundation. "What's different now is there is no sense there is a
big reform idea out there that might save us."
Consider these symptoms of a system on the critical list:
-- Employer health care insurance premiums jumped an average of 11.2 percent in
2004, lower than the 13.9 percent reported last year but still more than five
times the rate of inflation, according to a survey by the Kaiser Foundation and
the Health Research and Educational Trust.
-- The United States spends nearly $5,000 per person on health care -- more than
twice the amount of some other industrialized countries. But it's not making us
live any longer. Canada, for example, spends about 60 percent less per person
than the United States but has longer life expectancies.
-- The number of people without health coverage rose to more than 45 million
nationwide in 2003, 15.6 percent of the population compared to 15.2 percent in
2002. California is home to the greatest number, with 6.4 million uninsured, or
18.2 percent of the population.
-- Battles over health care costs have moved to the top of labor- management
agenda. A 139-day strike by Southern California grocery workers was resolved
this year when union negotiators reluctantly agreed to a contract that requires
new workers to wait 12 months before getting individual coverage and 30 months
before family coverage kicks in.
-- The California Public Employees' Retirement System, one of the country's
largest buyers of health care, accepted health maintenance organization rate
increases of 25 percent in 2003 and 18 percent in 2004 before pushing back by
dropping costlier hospitals from its 2005 network.
As insurance costs climb, employers find themselves forced to make harsh choices
about the kinds of coverage to offer.
At Cosco Marking, a Seattle firm that owns the San Francisco Rubber Stamp Co.,
premiums on a health plan covering 60 employees have gone up between 11 percent
and 15 percent during each of the last five years. To save money last year, the
company added a $750 deductible and raised co-payments, making insurance so
expensive that six workers who were their families' sole breadwinners opted not
to take it.
"When I look at the plan I have now versus the plan I offered five years ago,
it's much worse," said Rick Roddis, Cosco's general manager.
Those who deliver care say the system is held together with gauze that is
getting more frayed every day.
At Marin General Hospital in Greenbrae, Dr. Myles Riner, an emergency room
physician, is seeing an increasing number of uninsured and underinsured
patients, or people with such high deductibles that they put off seeking care
until they have a serious health condition.
"The system is not going to fail like a volcano blowing its top off or the
Golden Gate Bridge crashing into the ocean," he said. "What's going to happen
here (in America) is not a 9/11. It's going to be a war of attrition where
patient care falls apart one patient at a time."
Consumers, like Robert Bushansky, 60, who ran his own cleaning services for 26
years, never expected that he or his loved ones would be without health care.
After his business failed in part because of his ulcerative colitis, Bushansky
got Medicare disability coverage. But his wife, who continues to work, is
uninsured because her employer doesn't offer health coverage.
"We tout ourselves as being the richest, the biggest economy and being the best
country in the world and here we have 45 million without health insurance. It's
a contradiction in terms," said Bushansky, who lives in the North Coast town of
Elk.
In 2004, premium increases haven't been as big as they were last year because
insurers are already enjoying hefty profits from price increases they imposed in
previous years. In addition, employers are buying cheaper and less comprehensive
plans and passing more costs on to their workers. Consumers, now feeling more of
the pain in their pocketbooks, appear to be using fewer discretionary health
services.
But such trends do not significantly stem the underlying pressures that are
pushing health care costs up at double-digit rates.
Why are medical costs rising so fast when overall inflation is relatively tame?
"It is hard to boil it down to one bogeyman," said Dr. Mark Smith, president of
the California HealthCare Foundation, a nonprofit health research group based in
Oakland.
New medical technologies -- everything from faster CT scans and drug- coated
stents to targeted chemotherapies -- may be responsible for as much as 50
percent of U.S. medical cost growth, according to some health economists.
Drugs represent the fastest growing part of the health care bill, with Americans
paying the world's highest prices for medication. While the industry says it
needs to charge high prices to finance research and development, the largest
pharmaceutical companies in 2002 spent 14 percent of their revenues on research
and development while devoting 31 percent to marketing and administration.
Laurence Baker, an associate professor of health policy and research at Stanford
University, doesn't see this changing any time soon. "Really reducing health
care costs will mean reducing what we do for patients," he said.
Experts say costs are also rising fast because the American health care system
is fragmented, with thousands of insurers, hospital groups, physicians groups,
benefit administrators, medical equipment providers, drugmakers and health care
unions all trying to get the biggest cut of the health care dollar they can.
The combination of that quest for more revenue and the lack of any outside
restraint -- in a market in which consumers frequently have little choice about
buying services -- is a recipe for fast-rising costs.
Many health care corporations, including insurers, hospital networks and large
medical groups, have posted significant earnings gains in recent years.
WellPoint Health Networks Inc. of Thousand Oaks, which Indiana's Anthem Inc. is
trying to buy to create the country's largest health plan, reported a 34 percent
increase in earnings for the second quarter compared with the same period in
2003. Nonprofit Sutter Health, which has 26 hospitals in Northern California,
saw its income increase nearly 64 percent from 2002 to 2003.
In many countries, medical costs are kept down by government regulation. But the
United States lacks meaningful health care price controls and powerful health
care groups lobby to limit government regulation.
Meanwhile, lawsuits against health care institutions and practitioners, many
initiated by class-action attorneys looking for big payouts, drain cash from the
system. In many states, high malpractice insurance costs have caused shortages
in certain specialties. Some argue the practice of "defensive" medicine -- the
ordering of additional tests or procedures to avoid litigation -- has added to
the health care dollar.
There are other factors pushing up costs:
-- A big part of U.S. health care expenditures have little to do with patient
care. Harvard Medical School researchers reported earlier this year that the
United States spends $399 billion per year on health care bureaucracy,
essentially the administrative costs of insurers, hospitals, doctors, nursing
homes and other institutions. In California, $45 billion of the $163 billion
spent on health care, or 28 percent, went to administration.
-- Doctors are becoming more aggressive in administering treatment. A study
published in the August journal of Health Affairs found the top 15 medical
conditions accounted for about half the overall growth in spending, with most of
the costs associated with a rise in treatment rates rather than just the cost
per treatment going up.
-- Providing care to the uninsured takes up a significant share of the health
care dollar.
California has some cost drivers that are particular to the state. Hospitals are
required to seismically retrofit their facilities and maintain certain nursing
staff levels. In addition, hospital and medical group consolidations --
especially in Northern California -- have created powerful provider groups that
can command higher reimbursements and all-or- nothing contracts from payers.
When health experts look at what's coming down the pike -- aging Baby Boomers,
growing obesity and other conditions that boost demand for health care -- things
go from bad to worse.
The last time the nation went through a period of soaring health care costs, the
response was the adoption of a new way of administering treatment - - a system
that went under the name of managed care and was delivered through a new type of
institution, the health maintenance organization.
The HMO kept a tight reign on expenses by changing the way doctors and hospitals
were reimbursed for their services and requiring authorizations before covering
certain treatments and services.
One of the principal missions of HMOs was cost control and this they did with a
vengeance. Horror stories were legion, including people denied essential
treatments by administrators looking to save money. Consumers, frustrated by
restrictions on which doctors they could see and which treatments they could
get, fueled a well-publicized backlash. That groundswell led employers to choose
less restrictive plans. But that loosened the grip on costs.
Meanwhile, hospitals and doctor groups, drained by low reimbursements from HMOs
and government payers such as Medi-Cal, started going bankrupt. To protect
themselves, they banded together to form larger networks with greater bargaining
power.
As the cost of care started rising rapidly again in the late 1990s, insurers
rushed to catch up by raising premiums. The economy was booming. Employers,
scrambling to keep workers, swallowed those increases.
Then the economy tanked. Costs companies could live with in good times turned
into heavy loads in bad times.
In the wake of these shifts, coverage offered to working Americans eroded.
Premiums and out-of-pocket costs increased. In California, workers paid 30
percent of their premium costs in 2003, up from 26 percent just a year earlier,
according to the Kaiser Foundation.
Now, some health plans are returning to the unpopular policies they adopted in
the heyday of managed care. Techniques such as reviewing inpatient hospital
services to shorten stays, steering members toward low-cost providers and
scrutinizing whether specialists are necessary are becoming more common,
according to a study published in August in the journal Health Affairs.
The United States has a health care system unique in the developed world. Costs
are high, employers pay most of the bills and tens of millions have no coverage.
Polls show that most Americans believe the system doesn't work and want
universal coverage.
Some advocates argue that the only way to achieve universal coverage would be to
replace the American health care system with a system in which the government
pays the bills, a so-called single-payer system. Other experts argue that
universal coverage could be achieved without a government takeover.
Californians in November will vote on a referendum that would require employers
over a certain size to provide coverage. But there is nothing on the horizon
that would move the country toward universal, affordable care.
In that stark context, employers are scrambling to cope. Increasingly, they are
opting for health care plans that make the patient more accountable for health
decisions and give them incentives to choose the most cost- efficient options.
Christopher Renz, a principal in Mercer's San Francisco offices, said the stakes
are high: "If the employers don't solve it, the government is going to have to
provide a solution, and most people in the private sectors don't want that."
--------------------------------------------------------------------------------
What's driving medical costs?
-- Medical technology: New medical devices and the latest pharmaceuticals are
pushing prices up fast.
-- Litigation: The rising cost of malpractice insurance is also increasing the
practice of defensive medicine.
-- Uninsured: The growing number of uninsured is an increasing burden on the
medical establishment.
-- Administrative costs: Health bureaucracy consumes money that does not go
directly to patient care.
[Posters Notes: And greed -- Healthnet's top execs get paid over $1 million
each, and they have a hefty ]
--------------------------------------------------------------------------------
Percentage of all workers receiving health coverage through their employers
2001: 65%
2004: 61%.
Average annual amount workers contributed for individual coverage
2001: $360
2004: $558.
Percentage of large firms offering retiree health coverage
1988: 66%
2004: 36%.
Number of uninsured Americans working full time
2001: 19 million
2003: 20.6 million.
Amount workers contributed for family coverage
2001: $1,788
2004: $2,661.
Amount premiums for family coverage have increased
Since 2000: 59%.
Percentage of insured Americans covered under an HMO
2003: 24.6%.
Percentage of Californians covered under an HMO
2003: 48.5%.
Percentage drug spending increased
2002: 15.3%.
Sales of drugs sold in U.S. retail pharmacies
Year ending December 2001: $132 billion
Year ending July 2004: $170 billion.
Sources: The Henry J. Kaiser Family Foundation, U.S. Census, IMS Health.
.
- References:
- Greedy HMO Slowly Killing 4 Year Old Boy
- From: zuzu22
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