healthcare reform

10 Surprising Things In Healthcare Reform (Senate version) Part 1

I promised in an earlier blog to list 10 things in the Senate version of the healthcare reform bill that you might not be aware of. Since it’s New Year’s Eve, technically a holiday, I’m only working at partial speed so you only get a partial list today. More to come over the next few days.

1. Support comparative effectiveness research by establishing a non-profit Patient-Centered Outcomes Research Institute to identify research priorities and conduct research that compares the clinical effectiveness of medical treatments.   

In English: The government will fund research to directly compare treatment A to treatment B to determine which works best and is most cost effective.  

Major weakness: the Senate bill specifically notes that the results of such research “may not be construed” as mandates, guidelines, or recommendations for payment, coverage, or treatment or used to deny coverage.

Huh? What is the point of finding out that treatment A works better than treatment B if you don’t use it to make coverage decisions???

Prediction: Most insurers will use this information to make coverage decisions, much to the chagrin of many pharmaceutical and medical device companies. In the not-too-distant-future, Medicare will join the party. After all, … Continue Reading

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healthcare reform malpractice insurance prevention tort reform

They Did It!!

So President Obama, the Democrats, and, yes, the American people got their much-awaited Christmas gift–healthcare insurance reform. Oh, sure, the Senate bill has to be reconciled with the House bill, but I’ll bet you my weekly copy of JAMA that’s a no brainer.

So now (or next Monday when the world returns to work) we can expect a slew of criticism and predictions of doom from people unhappy with the bill as passed. I want to head off some of this at the pass by saying this: No, the bill is not perfect. No, the bill will not reform the healthcare system. No, the bill will not save billions of dollars and reduce the amount of GDP (currently at 17 percent) that our country spends on healthcare.

But, as a wise friend once told me, perfect is the enemy of good.

The reality is that the Senate bill is a first step on a very long journey to contain our out-of-control health system. There will be many more such steps before we even get close to stuffing this evil genie back into the bottle. Why? Because we have allowed our system to become the kudzu of our culture. For those … Continue Reading

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healthcare reform

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

Public Option, Medicare, What’s the Difference?

Warning: This is one of those “policy” posts, so if you’re looking for pithy freelance medical writing verbiage, come back tomorrow.

If you’re still with me, you know that the Senate begins debate today on the healthcare insurance reform bill (apparently we’re no longer calling it “healthcare reform” because there’s still so far to go in terms of reforming the overweight, out-of-control, drunken healthcare system we’ve created over the past 50 years).

One of the big sticking points to getting a bill passed in the Senate, pundits say, will be the so-called “public option.” This component provides a bare bones, government-sponsored health plan, subsidized as needed based on income, to compete with private health insurance plans. The plan would be delivered by private insurers paid by the federal government. In the Senate plan, states would be able to opt out of it if they wanted. Nonpartisan estimates from the Congressional Budget Office show that just 4 to 6 million Americans would go for it. Oh, and it would save billions over 10 years. Yet based on the reaction from most Republicans and some Democrats, you’d think it was a proposal to cut off every American’s right arm!

The main objection? … Continue Reading

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healthcare reform Medicare

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