healthcare reform

Three Weeks and Counting

Can you feel the excitement in the air? Yes, it’s fall. Yes, it’s football season. Yes, wrestling is back in the Olympics. But that’s not what I’m talking about. I’m talking about the launch of the state and federal health insurance exchanges–the cornerstone of the Affordable Care Act–on October 1.

I don’t know about you, but I can barely sit still I’m so excited!

Ok, I admit that I am a health policy addict and I’m looking for a 12-step program. But seriously, these exchanges have the potential to revolutionize how we get health care in this country, provide an important burst of energy to the development of small businesses and entrepreneurship, and impact the health of a large chunk of the population.

These are grand goals, I know. So let’s swoop down from the 50,000-foot view that most of us have received from the media to the ground level. Let’s talk about two women, Sharon and Karen.

Sharon is a good friend of mine, a Realtor in her 50s. As such, she’s self-employed and has to purchase her own health insurance. Sharon is very healthy today–but she had a severe cardiovascular complication after her son’s birth 26 years ago. … Continue Reading

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Affordable Care Act health insurance health insurance exchanges healthcare reform Obamacare

Wise Words From a Retired Hand Surgeon

Those of you who know me know I like wine. A lot. And food. Even more.

Put the two together and I’m there! So that’s where I was last night, at a wine tasting dinner enjoying the wines from Ferrari-Carano, which, by the way, are excellent and very reasonably priced (we bought a case).

We were sitting across from an older couple and, of course, got to talking. Turns out he’s a retired hand surgeon from New Jersey who retired to Williamsburg. He heard me say that I was giving a talk about healthcare reform.

“I figured out how to fix the healthcare system,” he said.

At this point, I kicked my husband under the table. I was sure I was about to be treated to some diatribe about “Obamacare” and getting the government out of healthcare, and vouchers and moochers (most members of the wine club that hosted the dinner are, ahem, somewhat conservative).

But I’m learning about Buddhism, trying to be more patient and to listen, really listen, rather than always jumping in. So I bit my lip, took a deep swallow of the red, and listened. Then he said the sentence that brought joy to my heart:

… Continue Reading

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Affordable Care Act healthcare reform healthcare system; Obamacare

Elective Deliveries: A Sign of a Healthcare System Out of Control

My husband is always getting on me about the number of tabs I have open in my browser at any one time. I think one time I had more than 100 open.

Within the past few days, at least 10 of those tabs dealt with the same topic: medical tests and procedures that we either don’t need or that don’t work. There are simply too many for a single blog, so I’m focusing on one here and will write more about others in the coming days.

The lucky winner? Births.

Seems like an obvious medical procedure, doesn’t it? Baby is delivered when mom goes into labor or, if problems develop or mom goes over her due date, labor is induced. So why, as  Kaiser Health News recently reported, are 10 to 15 percent of U.S. babies  delivered early without medical cause, up to 40 percent in some hospitals?

Early delivery increases the risk that the baby will have feeding and breathing problems, infections, and developmental problems, requiring a stay in costly neonatal intensive care units. It also increases the risk that mothers will need caesarian sections (indeed, many of these births are scheduled c-sections).

Why the early deliveries? Convenience for … Continue Reading

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fraud get better health healthcare costs healthcare reform healthcare system; ineffective procedure payment Uncategorized waste

Healthcare Reform 2.0: Five things you need to know to grow your business in 2013

How much do you know about healthcare reform — and I don’t mean just the Affordable Care Act (aka “Obamacare”). I mean the coming tsunami of change that has the potential to completely revamp one of the most dysfunction systems in our country (as you know from reading my blog).

Do you know. . .

Why we need healthcare reform? What healthcare reform means for your employees and employer? How healthcare reform will change your interactions with the healthcare system? How healthcare reform may make it safer for you to get sick? Why healthcare reform will save you money?

If you can’t tell me the answers to these questions, then you need to block off 1-2 p.m. (eastern) February 5 for my webinar: Healthcare Reform 2.0: Five things you need to know to grow your business in 2013. You can also view it on demand.

And, as a “thank you” for reading this blog, I’ll give you half off the registration fee. Just use code GS12713 when you register.

 

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Affordable Care Act health insurance healthcare costs healthcare reform healthcare system; managed care Obamacare patient-centered healthcare payment

Preparing for a (Gulp!) Colonoscopy: What It Says About Our Healthcare System

As of November 30, I am now, as my gastroenterologist puts it, 39 + 11 years old. You know what that means! So, a couple of weeks ago I called his office to make an appointment.

I would have preferred to simply make the appointment online or even e-mailed the office, but since the practice didn’t offer this, I fought my phonaphobia and punched in the numbers. Of course, I went through five prompts before getting a live person and was put on hold for a few minutes. About 10 minutes later, I finally had my appointment.

I was told to arrive at 2:30 p.m., which I dutifully did. Then the receptionist gave me a stack of paperwork to complete. And a pen. Among the information I had to provide:

• My husband’s Social Security number, since our insurance comes courtesy of his job. Not sure why this was needed, since the receptionist made a copy of my insurance card, which has all pertinent information on it. Not to mention that in this day and age of identity theft, I don’t like giving out Social Security numbers to anyone. But the last time I refused to provide a Social Security number … Continue Reading

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Affordable Care Act customer service doctor offices get better health good health health insurance healthcare costs healthcare reform healthcare system; patient-centered healthcare prevention

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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Affordable Care Act health insurance healthcare reform mammograms Medicare vouchers

$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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health insurance healthcare reform healthcare system;

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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Affordable Care Act health insurance healthcare reform Supreme Court

Happy Birthday Health Reform!

Who would have thought when we first looked upon you a year ago, barely formed, still somewhat embryonic, that you would have grown so much in just a year, and created so much, well, trouble? Yes, I’m talking about you, health reform. After all, aren’t you the reason for the sea change in Washington? Aren’t you behind several pending appeals that will get to the Supreme Court? Aren’t you the reason that the country is going to hell in a handbasket?

But wait. Let’s look at some other major milestones of the past year.

— You sent $250 checks to Medicare beneficiaries to help cover the “donut hole” in their drug coverage.— You created special insurance pools designed to provide health care NOW to people with preexisting conditions who can’t get coverage.— You allowed parents to keep their kids on their health insurance until the children turn 26, providing a major safety net. — You did away with lifetime caps, enabling those with some serious medical conditions to continue receiving health insurance.

And that’s just in a year. Imagine what the next year and the year after that will bring. So I’ll say it again, Happy Birthday, Healthcare Reform. … Continue Reading

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healthcare reform