Michigan Personal Injury Blog - Healthcare

Drug Makers Raise Prices Despite Promises of Cost Reform

David Mittleman — Wed, 18 Nov 2009 09:39:28 GMT

Drug makers pledged to help cut down healthcare costs by $8 billion a year, but now it doesn’t look like they are making good on that promise. Instead, in the last year alone, the pharmaceutical industry has raised their wholesale prescription drug prices by 9%. Instead of cutting down on costs, that raises the nation’s drug-related healthcare costs by $10 billion, and represents the highest annual rate of inflation on drug prices since 1992.

Originally, drug makers had touted their agreement with the White House and the Senate Finance Agreement chairman to trim $8 billion a year from the nation’s drug costs, or $80 billion over 10 years, by giving rebates to older Americans and the government. However, the recent increase in prices would essentially cancel out the savings for at least the first year of the plan, if not the entire 10 years.

Nevertheless, drug makers argue that there are valid business reasons for raising prices. Specifically, they argue that they are forced to raise their prices in order to invest in future research and development of new drugs, especially as patents expire on previous drugs. While drug makers claim their “reasons” for raising their prices, many Americans who do have drug insurance will be forced to pay out-of-pocket for the leftover cost of overpriced drugs that insurance won’t entirely cover.

Originally posted at InjuryBoard by David Mittleman

RNC Fiasco: RNC Health Insurance Plan Covers Elective Abortions

David Mittleman — Fri, 13 Nov 2009 09:34:36 GMT

Recently, Devon Glass wrote about Representative Stupak’s decision to vote against abortion coverage in the healthcare reform legislation. Despite most Republicans' claims that they are and always have been vehemently against taxpayer dollars covering abortion procedures, it seems that they didn’t actually follow these convictions in practice.

According to recent reports just released this morning, the Republican National Committee has just decided that it will remove abortion coverage from the insurance plan that it offers to its employees. Apparently, the RNC’s insurance plan with CIGNA has covered elective abortions since 1991, although the party opposes abortion rights.

Chairman Michael Steele recently stated: “money from our loyal donors should not be used for this purpose." Luckily, the RNC’s actions will finally line up with its supposed convictions on one of the most hotly contested political issues of today.

Originally posted at InjuryBoard by David Mittleman

Most Vulnerable Continue to Suffer While Healthcare Debate Carries On

David Mittleman — Tue, 29 Sep 2009 14:58:36 GMT

The National Eye Institute has devised several amazing devices to essentially remedy blindness. In fact, the New York Times recently reported on an amazing device that consists of 67 electrodes that are surgically implanted in the eye, a camera that is strapped to the bridge of the nose, and a video processor that is strapped to the wrist. This might sound like a funny invention, but it has helped the woman featured in the NYT article, 56-year-old Barbara Campbell who lost her sight to eye disease, to see once more.

Similarly, the Brain Port is just as unique and innovative as the last invention—except it uses the tongue to “replace” the eye. Dr. Paul Bach-y-Rita came up with the idea of sensory substitution, or replacing one sense with another, but to do the same thing. His concept was based on the idea that sight does not come from the eye alone. Instead, the eye receives visual information, which it then sends as electrical impulses to the brain for interpretation. Specifically, the Brain Port is a head-mounted camera that collects white, gray, and black pixels of visual information. A computer in the device then transmits the information via electrical vibration to the tongue. Essentially, a blind person can “see” with their tongue.

Sadly, there are many blind people who will never get an opportunity to benefit from these amazing devices. It obviously isn’t because these technologies aren’t available. Instead, it is primarily a fault of how ill equipped our current healthcare system is to evenly distribute currently available treatments.

For a moment, let’s forget remedying already-lost eyesight. What about preserving eyesight in those who can still see a little, and could be helped by continued treatments? Monique Zimmerman-Stein is one of these people. She and her two daughters, age 9 and 10, are plagued by a genetic condition called Stickler’s Syndrome. This syndrome causes joints to dissolve and retinas to detach. Monique began losing her eyesight at age 16, but has received injections to help her retain some of her sight. However, her two daughters have also suffered from Stickler’s-related complications and procedures, including a tracheotomy, arthritis, and lost vision. Unfortunately, the Zimmerman-Stein’s health insurance is not enough to cover all of their complicated medical procedures. In fact, Monique and her husband spend $90 a week on Blue Cross Blue Shield, which only covers 80% of their bills. They are swimming in medical bills that are yet unpaid. They have tried to pay what they owe—including taking a second mortgage out on their home (which they later lost to foreclosure), sold furniture, cashed in on life insurance policies, borrowed $50,000 from a family member, and got some creditors to forgive a portion of their debt. As a result, Monique has decided to forgo her eye treatments to preserve her eyesight, and instead will dedicate all of the family’s little money to her daughters’ medical expenses.

In his September 9 address to Congress, President Obama urged lawmakers to set a limit on the amount that anyone would have to pay out-of-pocket for their healthcare. A lifetime maximum would help many people, especially those like Monique who need serious and continued medical care, to keep their heads above water. I pose this question: what good is it to limit health care to those who are already healthy and happen to have health insurance or the money to pay out-of-pocket? The most vulnerable need help and this isn’t best accomplished by our current healthcare system.

Originally posted at InjuryBoard by David Mittleman

Small Texas Border Town Serves as Proof of Why Health Care Costs Are on the Rise

David Mittleman — Sun, 20 Sep 2009 13:33:39 GMT

The small town of McAllen, Texas lies right across the border from Mexico. It’s also a relatively poor town, with a per capita income of $12,000. However, besides holding the title for “square-dancing capital of the country”, McAllen also happens to hold the top spot for the nation’s most expensive heath-care market. In fact, in 2006 alone, Medicare spent $15,000 per enrollee. To put it in another way, that’s $3,000 more than what most people in McAllen make in a year.

What makes McAllen so unique? It’s neighbor, El Paso, doesn’t have the same astronomical health care expenditures. Surely it’s the poor standard of living—including bad diets and heavy drinking—but no, that doesn’t happen to be the reason either. Indeed, El Paso, just eight miles up the border, has similar public-health statistics. In a similar vein of thought, most people want to blame the “excessive medical liability suits” in McAllen. However, tort reform doesn’t happen to serve as a very good scapegoat, either. Actually, Texas passed a tough malpractice reform law just a few years ago that capped pain-and-suffering awards at $250,000. The reality is that doctors in McAllen like to rack up charges on extra procedures, services, and tests.

In analyzing Medicare payment data from two private firms, D2Hawkeye and Ingenix, it was revealed that McAllen patients received more diagnostic testing, more hospital treatment, more surgery, and more health care than their neighbors in El Paso and across the country. Specifically:

The Medicare payment data provided the most detail. Between 2001 and 2005, critically ill Medicare patients received almost fifty per cent more specialist visits in McAllen than in El Paso, and were two-thirds more likely to see ten or more specialists in a six-month period. In 2005 and 2006, patients in McAllen received twenty per cent more abdominal ultrasounds, thirty per cent more bone-density studies, sixty per cent more stress tests with echocardiography, two hundred per cent more nerve-conduction studies to diagnose carpal-tunnel syndrome, and five hundred and fifty per cent more urine-flow studies to diagnose prostate troubles. They received one-fifth to two-thirds more gallbladder operations, knee replacements, breast biopsies, and bladder scopes. They also received two to three times as many pacemakers, implantable defibrillators, cardiac-bypass operations, carotid endarterectomies, and coronary-artery stents. And Medicare paid for five times as many home-nurse visits. The primary cause of McAllen’s extreme costs was, very simply, the across-the-board overuse of medicine.

Simply stated: most Americans want to believe that the rising cost of healthcare is due to irresonspible lawsuits and/or the general poor health of the population. Don't get me wrong, preventative medicine is very important, and is a desperately lacking feature of health care in this country. But, what is also a problem is the culture of profit. Liability costs often serve as the classic argument that doctors use for ordering excessive tests and for employing the most aggressive procedures, even when less-invasive procedures or a "watch-and-wait" approach might be the most appropriate answers. However, in the case of McAllen, Texas, lawsuit payouts were capped--a facet of tort reform--and medical costs did not miraculously go down. Why? Because doctors continued to order the unnecessary tests and procedures because it puts more money in their pockets. Adding insult to injury, patients aren't even "better off" from all these extra tests and procedures:

In a 2003 study, another Dartmouth team, led by the internist Elliott Fisher, examined the treatment received by a million elderly Americans diagnosed with colon or rectal cancer, a hip fracture, or a heart attack. They found that patients in higher-spending regions received sixty per cent more care than elsewhere. They got more frequent tests and procedures, more visits with specialists, and more frequent admission to hospitals. Yet they did no better than other patients, whether this was measured in terms of survival, their ability to function, or satisfaction with the care they received. If anything, they seemed to do worse.

That’s because nothing in medicine is without risks. Complications can arise from hospital stays, medications, procedures, and tests, and when these things are of marginal value the harm can be greater than the benefits. In recent years, we doctors have markedly increased the number of operations we do, for instance. In 2006, doctors performed at least sixty million surgical procedures, one for every five Americans. No other country does anything like as many operations on its citizens. Are we better off for it? No one knows for sure, but it seems highly unlikely. After all, some hundred thousand people die each year from complications of surgery—far more than die in car crashes.

Maybe we just need to take a step back, stop listening to all the finger-pointing used by insurance, pharmaceutical companies and the like. Are all doctors inherently consumed by this "culture of profit"? Of course not. I'm arguing no such thing--doctors are a vital and necessary group of people. What I am arguing against is bad medicine--kickbacks and conflicts of interest alike--that is, medicine that wants to go that "extra mile" simply because it means more money in someone's pocket.

Originally posted at InjuryBoard by David Mittleman

Poll Finds Americans Support Healthcare Reform Despite Worries Over Cost

David Mittleman — Sat, 19 Sep 2009 10:00:00 GMT

Amidst all of the supposed “grassroots” opposition to President Obama’s healthcare reform plans, a Bloomberg News poll recently found that 8 out of 10 Americans actually support the President’s goals to change the U.S. healthcare system. In fact, 8 out of 10 of those polled, support covering the uninsured, curbing costs, creating an insurance-purchasing exchange, and preventing insurers from dropping or refusing coverage to people with preexisting conditions.

The poll, conducted September 10-14, found that 48% of respondents favored Obama’s plan, while 42% oppose it. Moreover, respondents felt that Obama’s September 9^th speech helped debunk false rumors. In fact, 6 out of 10 respondents do not believe that Obama would set up “death panels” to decide who would receive care, or that federal money would be used to provide abortions. Similarly, respondents did not believe that Obama plans to cover illegal immigrants—despite what South Carolina Representative Joe Wilson might say.

However, what does seem to be the problem is the cost of healthcare reform. What most Americans are concerned about is the legislation contributing to the federal budget deficit. Nevertheless, the majority of those polled stated that employers should have to offer insurance, and that individuals should be required to have coverage. Most telling of Americans’ attitudes toward healthcare reform is that 6 out of 10 of those polled felt that the current healthcare system has problems that need to be fixed. Who’s to blame for most of the healthcare system’s problems? According to most polltakers, insurance companies are the biggest culprits, followed by pharmaceutical companies. In fact, 50% viewed health insurers unfavorably, while more than half blamed pharmaceutical companies.

Originally posted at InjuryBoard by David Mittleman

Public Option Could Increase Competition Amongst Private Health Insurers

David Mittleman — Tue, 25 Aug 2009 10:00:00 GMT

One of the many arguments critics are using against the proposed health care reform legislation is that a public option would kill competition in the private health insurance market. However, a recent study found that private health insurers, themselves, are actually already accomplishing this task in many parts of the U.S.

For example, in Maine the lack of competition amongst private health insurers is non-existent. In fact, according to the American Medical Association, one health insurance company, WellPoint Inc., accounts for 71% of the Maine market with Aetna holding a 12% share. Republican Senator, Olympia Snowe, stated: “there is a serious problem with the lack of competition among insurers”. Maine is indeed one of the highest-cost states for insurance premiums.

As the system currently operates, just a few insurance companies hold the majority of the market in their control: a monopoly, in essence. These monopolistic conditions drive up the premiums paid by employers and individuals. A government plan could restore the competitive balance, forcing private health insurance companies to maintain lowered (and more reasonable) premiums to keep up with a public option. A study by the Urban Institute public policy center estimated that a public plan could save taxpayers $224 billion to $400 billion over 10 years by lowering the cost of subsidies for the uninsured, while also preserving private coverage for those who choose to keep their current health insurance.

Nevertheless, private insurers continue to argue that market conditions are already competitive and that a public option is unnecessary.

Originally posted at InjuryBoard by David Mittleman

Insurance Industry Claims Low Profits, High Expenditures on Medical Care

David Mittleman — Sat, 08 Aug 2009 10:00:00 GMT

America’s Health Insurance Plans (AHIP), the lobbying arm of the insurance industry, claims that “for every dollar spent on health care in America, approximately 1 penny goes to health plans’ profits.” Moreover, the group’s health care reform website alleges that only one one-hundredth of the premium dollar is revenue for the insurance provider, with the going towards providing medical care for insurance holders.

AHIP numbers seem to indicate that insurance companies are making very little in profits and spending a lot on providing coverage for their customers. However, the data fails to clearly explain that insurers are measuring their profits against total health care spending in the U.S., not in comparison to insurance company revenue. In other words, according to health care economist Uwe Reinhardt: “[a]ll that statement says is, if you eliminated all our [insurance company profits], national health spending in America would be 1 percent lower.” AHIP numbers only have meaning within that context—otherwise, within the context of actual insurance companies’ revenues, insurers skim between 15-20% of premium dollars to pay for administrative costs and profits. Moreover, even more alarming is the fact that within the last 10 years, insurers have been spending less (from plan premiums that their customers pay) on medical care and more on administrative costs and profits. Indeed, a report by Families USA found that some insurers maintain a ratio of 60% on medical payouts to 40% for administration, marketing and profit. You may think there is nothing wrong with that payout to profit ratio. However, that figure represents a two to ten percent difference from what AHIP claims insurance companies make in profits.

If the above data is not enough to convince you that health insurance companies are not looking out for the average consumer, here are a few additional facts that demonstrate that the insurance industry is more interested in profits than anything else:

The top five earning insurance companies averaged profits of $1.56 billion in 2008, with more than 18% of those earnings going towards revenue, administration and profits. Furthermore, CEO compensation for those same companies ranged from $3 million to $24 million. That’s actually a decrease in CEO compensation from previous years—a survey by Modern Healthcare failed to find one healthcare CEO who earned more than $15 million last year. But don’t get too disappointed for the CEOs lowered earnings just yet—the performance of the stock market in 2008 was a major factor for the decrease in compensation, not because they aren’t still skimming a hefty amount off their customers’ premium payments. Too top it all off, there is sturdy proof that insurance companies are willing to shell out the major bucks when it comes to a cause they truly feel worthy of their “hard-earned” dollars: health-care firms and their lobbyists are spending money at a rate of $1.4 million a day to campaign against the public healthcare legislation currently moving through congress.

Originally posted at InjuryBoard by David Mittleman

Republican's Use Private Insurance Front Group To Argue Against Health Care Reform

Devon Glass — Fri, 24 Jul 2009 15:05:41 GMT

Republican lawmakers are doing everything they can to stop health care reform, and one of their tactics is to site the “non-partisan” Lewin Group as a source of support against reforming the current health care system. A recent Washington Post article calls into question the supposedly unbiased opinion of The Lewin Group.

The political battle over health-care reform is waged largely with numbers, and few number-crunchers have shaped the debate as much as the Lewin Group, a consulting firm whose research has been widely cited by opponents of a public insurance option.

To Rep. Eric Cantor (Va.), the House Republican whip, it is "the nonpartisan Lewin Group." To Republicans on the House Ways and Means Committee, it is an "independent research firm." To Sen. Orrin G. Hatch (Utah), the second-ranking Republican on the pivotal Finance Committee, it is "well known as one of the most nonpartisan groups in the country."

According to the article, The Lewin Group is wholly owned by UnitedHealth Group, one of the largest private health insurance companies in the country, as part of a subsidiary company called Ingenix. This past January, UnitedHealth Group settled a lawsuit with the New York Attorney General and the American Medical Association (AMA) for $400 million after they allegedly shifted costs to individual health insurance policy holders for out-of-network treatment based upon information provided by Ingenix. Basically, Ingenix low balled the price for what doctors would charge and then charged the patient the difference.

The most cited statistic from The Lewin Group is that nearly 100 million people will lose their insurance from their employer if a government run public option is available. This argument address the fear, recognized in study after study, that people who currently have insurance are happy with their coverage. If you make it sound like you will lose your coverage, then it will cause fear and then support will drop for a strong public insurance option. The only problem is that this argument is more harmful to private insurance companies than it is for any government run health insurance plan.

The thing is, these people are not losing their insurance if there is a government health insurance option, they are looking at all the options available and choosing the government run plan because it's either better or less expensive. The real concern insurance companies like UnitedHealth Group have is losing profits. Having a strong government run public health insurance option available will cause private health insurance companies to lose profits. That's what the debate about health insurance is currently about.

There can be little doubt The Lewin Group is acting at the behest of the company that owns it by scaring everyone into delaying or killing health care reform. They have a huge financial incentive to keep the health care system the way it is; dysfunctional, deadly, and extremely expensive. When you hear a your elected representative talk about The Lewin Group and how scary health care reform is, think about whose interests they are protecting. It's not you or me, it's UnitedHealth Group, Blue Cross Blue Shield, and the rest of the private insurance industry. It's not surprising they would try to game the debate about health care reform, it's just surprising that so many elected officials are buying into it.

Originally posted at InjuryBoard by Devon Glass

Rick Scott: Health Care Reform Opponent

Devon Glass — Tue, 21 Jul 2009 10:32:33 GMT

Rick Scott, a name you might not have heard too commonly, if at all, is a name that everyone should be watchful of during this era of health care reform. He is much more conservative on the issue of health care reform than the Republican Party. He is the master mind behind a 20 million dollar deal trying to squash President Obama’s health care reform. Scott, the would be spokesperson of his own version of health care reform, is arguable the antithesis of positive reform.

Defraud and Rick Scott should never be more than four words apart in any sentence. Scott, while bolstering himself as an advocate of patient’s rights, helped found a for-profit hospital chain that had a habit of defrauding the government for hundreds of millions of dollars. Scott argued that health care reform was happening in the market place, not in the government. Scott was on a mission to put nonprofit hospitals out of business, stating that no health care reform was taking place in these “nontax paying’ hospitals”

The only thing that Scott’s hospitals reformed was their book keeping practices. This chain of for profit hospitals would keep two sets of financial records. An internal copy, which actually documented the hospitals expenses, and an external (government) copy, which inflated the hospital’s costs and expenses. Scott’s hospitals also over exaggerated patient’s illness and gave doctors kickbacks if they worked with this system.

Scott’s plans of future health care reform seem just as misguided as his past. Scott was recently quoted as saying “Congress wants to spend all that cash on a plan nobody wants”. The truth of the matter is that approximately 69% of Americans are actually in favor of a Government Health Care Option, more commonly known as the public option. It appears Scott thinks most Americans are nobodies.

The public option, or as Scott states “a nice way of saying ‘government run’ health care,” would actually be an improvement on premiums to the public, estimated at 23 percent lower price than similar private premiums. Scott’s for profit hospitals have made their money from the private health care field, so the opposition to the public option seem to be purely self involved.

Rick Scott has been very careful to hide his past while voicing opposition to this idea of health care reform. When making an informed decision about your opinion as to the issue health care reform, be sure to research not only the facts, but those who are giving you the facts. Do not be swayed by Scott’s ad campaigns or inflated statistics. Because as we have seen, Rick Scott seems to do a great job of inflating statistics.

Originally posted at InjuryBoard by Devon Glass

We Need Insurance Reform Now

David Mittleman — Wed, 01 Jul 2009 14:27:00 GMT

Insurance companies have been in the spotlight recently, particularly with President Obama’s proposals to reshape the health care industry. Millions of Americans are without health insurance, and access to quality care seems to be more and more elusive. As employees are losing their jobs, they are also losing employer-provided health benefits, assuming they had them to begin with. Even individuals with insurance are being pushed beyond the limits of their finances. I believe it is fair to say that America is in the middle of an insurance crisis.

Newspapers are replete with headlines describing some of the most flagrant abuses by insurance companies. In addition to denying benefits that should be paid, insurance companies have been accused of committing staggering amounts of fraud and waste. Despite this, insurance reform has yet to take hold.

Insurers steadfastly continue to oppose any attempt at insurance reform. Meanwhile, individual claimants continue to suffer as they wait for benefits that may never come. These people are truly victims of the insurance industry. Already injured or sick, they are forced to make do without much-needed services or to pay for them out of their own pockets. They can be forgiven for wondering what their premium payments have been used for if not to pay for the benefits they eventually seek.

Now is the time for insurance reform. You have an opportunity to take part in this process. Contact your Senators and Representative and tell them you want insurance companies to be held accountable for the benefits they have promised to provide.

Originally posted at InjuryBoard by David Mittleman