Costs to Increase Under COBRA

7 million unemployed Americans, laid off or downsized between Sept. 1, 2008, and Dec. 31, 2009, get a federal subsidy to help them buy health insurance under legislation known as the Consolidated Omnibus Budget Reconciliation Act. The COBRA subsidy pays 65 percent of their job-based health insurance premiums for nine months.

According to the Kaiser Family Foundation job-based coverage averages $398 per month for families and $144 for individuals, with the subsidy. Without it, premiums average $1,137 for a family and $410 for an individual.

That subsidy expires Monday (11.30.09) for thousands who began receiving it in March, when it first became available as part of the American Recovery and Reinvestment Act.

Before the subsidy was offered, only about 9 percent of people who were eligible for coverage under COBRA took advantage of it because it was so expensive. An analysis found that COBRA enrollment had doubled since the subsidy became available.

But industries with large job losses showed greater increases. Enrollment among industrial manufacturing workers went from 7 percent to 59 percent, while enrollment tripled among construction, leisure and retail workers.

It remains unclear when or whether Congress will address the subsidy expiration with specific legislation or as part of a major jobs bill.

Obama's 4 Pillars - Can He Deal With a Tripod?

According to the NYTimes, "In a conference call with reporters Wednesday to highlight cost-containment provisions, the two senior presidential advisers, Peter R. Orszag, White House budget director, andNancy-Ann DeParle, director of health reform, cited a letter to Mr. Obama by a group of respected economists who strongly endorsed the (independent) Medicare commission ... which some House leaders view as encroachment on Congressional authority over Medicare."

Obama said of the commission, it "can help encourage the adoption of these common-sense best practices by doctors and medical professionals throughout the system — everything from reducing hospital infection rates to encouraging better coordination between teams of doctors.”

Physicianvoice asks, wouldn't anti trust relief, such as limiting the hurdles for clinical integration and accountable care groups encourage better coordination - only better?

The Boobs at the The U.S. Preventive Services Task Force

This week the The U.S. Preventive Services Task Force (USPSTF) released recommendations concerning breast cancer screening that seem stunning.

Among the recommendations is that against routine screening of those age 40-49. Your moderators are generally supportive of the concept of evidence based medicine, when the evidence considered is sufficiently broad. The task force recommendation is limited in that:

• it is based on mortality and longevity data alone, ignoring other positive medical outcomes
• it seems biased by the comparatively larger number of screens necessary to save a life, without considering the comparatively larger economic value of saving that younger life
• it is absolute in its recommendation. The panel could have, instead, recommended less frequent screens in the 40-49 year olds had they created a decision tree that considers the results of an initial screen (this would preserve the existence of a baseline exam, which itself may impact the survival data of those age 50 and up). This action could reduce the number of exams required, under age 50, yet still save the same number of lives as the current protocol does
• It ignores a wealth of unpublished clinical experience
• it fails to consider the recommendations of several specialty societies (themselves experts in the field)
• etc

The HHS Secretary Sebelius then made a statement reflecting her view that this report would not impact upon third party payment decisions. In doing so, she injected this action of the USPSTF into the health care reform discourse.

Basic Needs of Physicians Must Come First

Concerned physicians (both those who do and those who do not oppose the AMA strategy on Health Care Reform) have asked, "Is the AMA ready to 'walk away from the table' IF the 'onerous provisions' remain in the final Senate version?"

• AND IF the SGR is not eliminated without the substitution of another financial nightmare...
• AND IF tort reform remains a mere promise...
• AND IF collective negotiations remain a pipe dream?

PM writes "The basic needs of physicians MUST come first, (for only) then we can help those that desperately need our help to keep them well.

We are not public servants. We are healers that put our patients' welfare before our own personal needs. This time we must look out for us first. We cannot afford to settle for less (because it is politically correct) and hope to change 'onerous provisions' after the fact."

The Hypocrisy of Deficit Reduction & Health Care

Daniel Gross, in a recent Newsweek column, describes the hypocrisy of those who loathe " deficit spending for the purpose of funding social insurance, but love it when it's used to finance military actions abroad".

Too often, "deficit reduction is a form of defense—... a shield for policies ... (that legislators) don't like," according to Maya -MacGuineas, president of the bipartisan Committee for a Responsible Federal Budget.

Hospital Associations and State Medical Societies alike have attempted to quantify the economic impact of health care. But the chart above, from the Bureau of Labor Statistics, suggests the importance of the health care sector on employment. In these times of high unemployment and debate on health care reform, the importance of health care as an employer should not be underestimated.

Gross concludes, "Being obsessed with deficit reduction when the economy has suffered its largest setback since the Depression is like being obsessed with water conservation when your house is on fire."

Can't We Pick One from Column A and One From Column B?

The Republican bill leaves out a number of the key features of the Democrats' legislation (and thus does too little to alleviate the problem of the uninsured):

• It does not require employers to insure their employees
• It does not require nearly all Americans to purchase insurance
• It does not block insurers from denying coverage to people with pre-existinghealth conditions

Instead, the Republican plan

• increases incentives for people to use health savings accounts,
• caps non-economic jury awards in medical malpractice cases at $250,000,
• provides various incentives to states with the aim of driving down premium costs and
• allows health insurance to be sold across state lines.

Link to Boehner Bill (Med Mal pp 150-169)

Universal Coverage and Life Expectancy

From Nicholas Kristof in the NYTimes:

"The United States ranks 31st in life expectancy (tied with Kuwait and Chile), according to the latest World Health Organization figures .... (but) there is one American health statistic that is strikingly above average: life expectancy for Americans who have already reached the age of 65.

At that point, they can expect to live longer than the average in industrialized countries. That’s because Americans above age 65 actually have universal health care coverage: Medicare".

Enough Talk About Deficits, Will I be able to Afford the Premium?

Health Care Reform has become a debate politicized well beyond, in your administrators view, the overriding objectives of

• health care for all and
• the sustainability of the system

The CBO has prepared estimates of the costs to the nation of health care reform under various congressional proposals, and has even estimated the further savings that can be achieved by including provisions such as liability reform into these proposals.

But there seems to be considerably less consideration paid to the affordability of premium. This is despite the fact that the ranks of the uninsured are populated by people simply unable to afford insurance. A mandate alone will not make the premium any less of an individual hardship.

Even if premium (and the proposed subsidy) is 'affordable', there is concern that pending legislation offers insufficient protection against the high payments required to meet deductibles, co-payments, and other out-of-pocket charges.

There is concern that some families would have to strain to pay their premiums and would probably have to cut back on such items as clothing, various household expenses, meals eaten out, and other activities. Additionally, their plight could worsen in coming years as premium would rise faster than wages.

It would be shameful that if due to poor planning and poor politics the under-insured became the under-clothed and the under-nourished as well.