Friend George is at it again, educating me about the ways of the world. It hadn't occurred to me that giving to Haiti relief, or any other charity for that matter, through my credit card means less for the relief agency and more for the card company and banks. Here's a NY Times article documenting the practice, and reporting that "some" card fees have been waived for Haiti relief.
Why not stay away from giving through credit cards altogether? I'm afraid I was lazy and ignorant this past holiday season and used credit cards to give to some of my favorite charities online. Now I'm reformed. It's direct checks from here on in, with my own postage attached. That has the added bonus of helping the struggling but vastly improved newly privatized US Postal Service stay solvent. (No, I'm not being sarcastic. Have you checked out how hard the USPS is trying these days? There's nothing like competition.)
Jan 11, 2010
Wellness Discounts in Health Reform a real problem
Having already admitted that I cannot read the 4000+ total pages of legislative language in the two final bills (House and Senate) without giving up all other aspects of my life, I'm depending on secondary sources to uncover aspects of one or the other bill that are problematical. Here is what Kaiser Family Foundation says about one provision that sounds discriminatory against those with "lifestyle" issues. This affects people with employer based health insurance. Read KFF News on Wellness Program.
Dec 27, 2009
A good link to comparison of House & Senate Health Reform bills
Here's a good Q&A analysis of differences between the House and Senate bills as passed. Easy To read, from Kaiser Family Foundation.
Dec 6, 2009
Medco, Federal Employees Health Plan, and Vitamin D
Here's a great little piece of "evidence based medicine" courtesy of my Federal employee health plan (GEHA) and Medco, its designated pharmacy benefits manager. Just received in the mail a notice that Medco will not pay for any vitamins, even those available only by prescription. That includes my Vitamin D, which I am directed to take at doses of 50,000 IU every two weeks for the rest of my life. Without it, I don't seem to be able to keep my Vitamin D levels in the territory of normal. Why that is nobody knows, but my family has witnessed the rapid improvement in my post-hip-replacement pain (after two years of getting weaker and weaker post surgery) following the initiation of an anti-Rickets therapy of high-dose Vitamin D. So, in its wisdom, GEHA/MEDCO has said that Vitamins are out as covered drugs.
Now, Rx Vitamin D isn't very expensive. I can buy 12 capsules (3 month supply) at Costco for about $15. So, forcing me to pay for it isn't going to make any difference in my adherence to the therapy. But, it's a perfect example of how little subtletly there is in insurance coverage. Here's one medical technology (vitamin d) that's both cheap and effective (see my previous Vitamin D post for links to the strong evidence that keeps emerging. Needless to say, the blunt instrument that is coverage policy discourages its use.
Now, Rx Vitamin D isn't very expensive. I can buy 12 capsules (3 month supply) at Costco for about $15. So, forcing me to pay for it isn't going to make any difference in my adherence to the therapy. But, it's a perfect example of how little subtletly there is in insurance coverage. Here's one medical technology (vitamin d) that's both cheap and effective (see my previous Vitamin D post for links to the strong evidence that keeps emerging. Needless to say, the blunt instrument that is coverage policy discourages its use.
Nov 22, 2009
Some early analysis of the Senate "Reid" Bill
Here is a great analysis of the Senate Bill by Keith Hennessey, a conservative, I think, but nevertheless, we should know what's in the bill, and his blog is accurate, though opinions are slanted. So I'm putting it up here, because I am just out of gas when it comes to analyzing the details of another 2000 page tome!
AND what's worse, these bills HAVE NO WORKABLE TABLE OF CONTENTS! Yes, they have a list of provisions, but they don't tell you the page. That's just a little bit of Congressional humor. "We want to tell you how to run an industry, but we can't adopt technology modern enough to create a table of contents for legislative proposals."
AND what's worse, these bills HAVE NO WORKABLE TABLE OF CONTENTS! Yes, they have a list of provisions, but they don't tell you the page. That's just a little bit of Congressional humor. "We want to tell you how to run an industry, but we can't adopt technology modern enough to create a table of contents for legislative proposals."
Nov 6, 2009
Why the House Health Care Reform bill is fatally flawed
Confession: I still haven't read beyond the first 225 pages of the House bill. I got that far because I wanted to understand the structure of the Health Insurance Exchange (HIE), especially how the public option (PO) would work. In a previous post, I concluded it was good enough, but worrisome in the long run .
But, today Martin Feldstein, a noted Harvard economist (not my favorite, but way smarter than I) has an op-ed piece in the Washington Post (Obamacare's Nasty Surprise) that lays out clearly why the House bill will not work as presently structured.
The basic flaw is that the law requires health plans to enroll all comers, regardless of health risk, but it doesn't provide carrots/sticks to individuals or businesses that are strong enough to induce the young and healthy to enroll. So, premiums will go up, kicking off a cycle of adverse selection into the HIE by the sick or high risk and opt out by the healthy.
There are ways to fix this problem, but apparently they are not in the bill, or surely Feldstein would have mentioned them.
One solution would be to charge anyone who does not sign up (or have qualified coverage) within the first year of the program a "premium penalty" for the rest of their lives. That's what happens with Medicare Part B, and why even the healthiest 65 year old is willing to pay right away. For every year of delay after you reach 65, Medicare adds 10% to the Part B premium for the rest of your life.
Another solution would be to increase income tax penalties.
A third solution would be to increase subsidies.
I like first idea, though, because instead of being seen as a "tax," the penalty would be seen as just retribution for a young person trying to game the system by delaying enrollment until he/she encounters the inevitable need for health care.
BUT... so far as I know, this solution isn't in current health reform proposals. Why not? That's where Feldstein sees the invisible hand of the single-payer lobby. As the cost of insurance goes up and up, and as fewer and fewer people are insured, a single-payer system will be the only alternative.
Design a HIE market to fail and you'll end up with a single-payer system. So many of my dear friends, family members, and readers want this outcome that I am in despair. Why do we think that a government monopoly is any better than a phone company monopoly in the way it will treat us? Supporting a move toward public monopoly of payment for health care is to say we want health care to be run the way that public education is currently run. Good teachers underpaid; average income children underserved; rich children opting out.
That's the best I can do by way of diatribe right now.
Have a great day.
But, today Martin Feldstein, a noted Harvard economist (not my favorite, but way smarter than I) has an op-ed piece in the Washington Post (Obamacare's Nasty Surprise) that lays out clearly why the House bill will not work as presently structured.
The basic flaw is that the law requires health plans to enroll all comers, regardless of health risk, but it doesn't provide carrots/sticks to individuals or businesses that are strong enough to induce the young and healthy to enroll. So, premiums will go up, kicking off a cycle of adverse selection into the HIE by the sick or high risk and opt out by the healthy.
There are ways to fix this problem, but apparently they are not in the bill, or surely Feldstein would have mentioned them.
One solution would be to charge anyone who does not sign up (or have qualified coverage) within the first year of the program a "premium penalty" for the rest of their lives. That's what happens with Medicare Part B, and why even the healthiest 65 year old is willing to pay right away. For every year of delay after you reach 65, Medicare adds 10% to the Part B premium for the rest of your life.
Another solution would be to increase income tax penalties.
A third solution would be to increase subsidies.
I like first idea, though, because instead of being seen as a "tax," the penalty would be seen as just retribution for a young person trying to game the system by delaying enrollment until he/she encounters the inevitable need for health care.
BUT... so far as I know, this solution isn't in current health reform proposals. Why not? That's where Feldstein sees the invisible hand of the single-payer lobby. As the cost of insurance goes up and up, and as fewer and fewer people are insured, a single-payer system will be the only alternative.
Design a HIE market to fail and you'll end up with a single-payer system. So many of my dear friends, family members, and readers want this outcome that I am in despair. Why do we think that a government monopoly is any better than a phone company monopoly in the way it will treat us? Supporting a move toward public monopoly of payment for health care is to say we want health care to be run the way that public education is currently run. Good teachers underpaid; average income children underserved; rich children opting out.
That's the best I can do by way of diatribe right now.
Have a great day.
Nov 3, 2009
Two Doses of H1N1 vaccine better for children
Here are the findings, in CIDRAP's News of yesterday. Still, if you can get just 1 dose for your child it's worth it, as the first dose confers some immunity and will probably make the flu less virulent in him/her. (This from a non-doc, mind you.)
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