health insurance

Five Reasons Why Privatizing Medicare is a Bad Idea

We now interrupt our regularly scheduled programming to bring you a wonky blog post. 

So a few people out there are suggesting that we privatize Medicare and give out vouchers for recipients to purchase their own insurance on the open market. This is such a bad idea for so many reasons, and shows that some people simply don’t understand how Medicare works. Here are my top five. . .

1. Medicare is the closest thing we have to a single payer system. Medicare covers one in seven Americans, 97 percent of those 65 and older., or 49 million Americans. In 2030, the number of Americans covered is expected to nearly double, with one out of five Americans covered.

This huge cohort of individuals provides enormous opportunities to test  new reimbursement and quality initiatives with a large cohort. In fact, Medicare is leading the country in many of these initiatives, including accountable care organizations, pay-for-performance options, DRGs for hospital reimbursement (which reimburses based on diagnosis, not on how many aspirin you get), and financial penalties for hospitals if patients with pneumonia, heart failure, or heart attacks are readmitted within 30 days. Those penalties are expanded to vascular surgeries/procedures in 2015.

… Continue Reading

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$25,000 and Counting: The Cost of an Infected Tooth

I’m  happy to report that all repercussions from the tooth saga have resolved. The only way you’d know anything occurred is  the small scar just under my jaw and the hole in my mouth where my second molar once resided.

Oh, and the pile of bills growing like mold in a petri dish.

Let’s look at the numbers, shall we?

So far, my insurance company informed me last week, we are up to $25,554.98 for the outpatient, emergency room, and inpatient care, including two CT scans, that I received in August thanks to the aberrant tooth infection that morphed into an abscess that required surgery to drain.

With the discounts the insurance company negotiated with providers, that amount fell to $22,903 (a 10.3% discount for those keeping track).

My share of the cost so far is $2,413.67. That doesn’t count any dental expenses, which are covered under my dental insurance. I estimate they total about $1,500 so far for  two visits to the dentist, three visits to the oral surgeon (including one tooth pulling under general anesthesia), and one visit to the endodontist. Oh, and my out-of-pocket cost will be at least half of that, if not more.

Thankfully, my … Continue Reading

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SCOTUS Decision: Waiting with Bated Breath

I don’t know about you, but I am as anxious about the Supreme Court decision on the Affordable Care Act expected momentarily as I was the first time I turned the car keys over to the 16-year-old. Heck, I’ve been in Jamaica all week on vacation and was still checking the news several times a day.

Why? Because I believe that this decision–whether positive or negative for the law–will send ripples, no, waves, through the economy, the political spectrum, and millions of individual lives.

Our healthcare system is out of control. It is out of control in terms of spending, poor quality and complexity. It is out of control when the major reason for declaring personal bankruptcy in this country is the inability to pay medical bills. It is out of control when, as I read in a recent book by the Medical Director of the American Cancer Society (How We Do Harm: A Doctor Breaks Ranks About Being Sick in America) a woman walks into the emergency room at Grady hospital in Atlanta with her breast wrapped in towels in a bag; the breast that necrosed from lack of blood because the tumor that had been growing there for … Continue Reading

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Swimming in the Health Insurance Risk Pool

swimming poolGather round boys and girls. Today’s lesson is on “risk pools.”

Before you pull out your iPhone to ward off the boredom you assume will come, know this: the concept of risk pools is at the heart of today’s healthcare reform debate.

To understand risk pools, you first have to understand the basic concept of insurance. Insurance is something you buy in case something happens. The more people buying the same type of insurance, the less risk the insurer faces that it will have to pay out for that aforementioned “something.”

So, for instance, if an estimated one out of eight women (about 12%) will get breast cancer in their lifetime, and an insurance company only insures eight women, then it knows, for sure, that one of those women will get breast cancer and it will have to pay large medical claims (in addition to all expenses) from the premiums it collects from just those eight women. So you can bet those eight women are going to pay huge premiums!

Now imagine that same health insurance company insuring 8 million women. Of those … Continue Reading

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The TRUE Cost of Health Care

Medical Records & StethoscopeThree years ago, my husband left his perfectly secure job (read: with benefits) and became a full-time consultant for his old company (read: without benefits) so we could have a much nicer lifestyle in Williamsburg, Va than we did in the small Pennsylvania town in which we’d lived for nine years (no offense to Pennsylvanians, but I’m a Virginia born-and-bred gal and I needed to get back to the Commonwealth, where the daffodils bloom in February and we can wear flip flops before June).

Needless to say, we lost the benefits (read: employer-provided health insurance) that had allowed me to go out on my own as a freelance medical writer seven years before.

No problem, I thought. I’m a healthcare expert. Heck, I once managed the provider relations department for a mid-sized managed care company, contracting with doctors and convincing them that they hated our HMO less than the other HMOs in the area (I was pretty darn good at it, too). I’ll just go out and find us some health insurance.

I started on the individual market. For my sons … Continue Reading

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health insurance healthcare reform high-deductible health plan mammograms

The New Mammogram Recommendations

I have one word for those who are freaking out over the United States Preventive Services Task Force’s new mammogram recommendations suggesting that most women in their forties should not undergo  regular screening mammograms.

Chill.

Good lord! You would have thought the task force recommended witholding treatment from any women in her 40s who had breast cancer, or banned her from getting a mammogram, or threatened to jail any insurance company that had the nerve to pay for said mammograms.

Could we all please take a breath and look at the facts for a moment?

Fact. The USPSTF is just one of three major bodies (including the National Cancer Institute [NCI]  and the American Cancer Society [ACS]) that releases screening mammogram guidelines. The ACS has already said it has no plans to change its recommendation that women in their 40s have regular screening mammograms; the NCI is reviewing the data. Fact. The issue of mammograms for women in their 40s has been controversial for decades; the USPSTF has updated its recommendation based on new evidence. Fact. The USPSTF did NOT consider any economic data in making the new recommendation–only scientific data. Fact. What is appropriate for a large population … Continue Reading

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health insurance healthcare reform high-deductible health plan mammograms