Archive for the ‘Health Care’ Category

McHealth No Care Plan

Bush, McCain - BFFOK, so McCain has come out with his health care plan and the verdict is – Won’t help, might hurt. Surprised? Me either.  If I recall correctly it’s similar to an idea that McCain’s BFF, Bush proposed only worse in some ways. Worse than Bush. Chew on that for a while.

He’s talking about a tax credit of $2,500 a year for individuals and $5,000 for families, and maybe – just maybe – working with the states to arrange for people who would currently be denied coverage due to health problem to be allowed to purchase coverage. If they can afford it, of course. Tax breaks currently afforded to business for the provision of health insurance to employees would be ended. Of course, for a lot of people employer tax breaks are moot because either their employers have stopped offering coverage or their employers have stopped employing them. We are having a recession, after all.

The organization I work for pays an average of  $15,600 a year per employee for a family plan and approximately $6,000 for individual coverage. McCain’s plan would leave a family with over 10 grand a year to pay. That’s not going to cut it. What is there about people not being able to afford things that  Republicans find so very hard to understand?

An Ounce of Prevention Is Still Expensive

From the Washington Post, last Tuesday – In the Balance

This article caused a little outrage in some of the comments, but I have to agree with the basic premise. Health care wonk, Ezra Klein does, too. The article makes the case that the prospect of reducing medical costs by preventing illnesses is somewhat overrated. There was some very wonky disagreement with Ezra, too. That’s not to say that preventing illness isn’t worth doing. No one is saying that. There are things with value that can’t be measured with dollars. It’s just always seemed fairly logical that healthy people might live better and longer, but we all start to deteriorate eventually. A real strong heart and unclogged arteries can draw that deterioration out for a lot of very expensive years.

For anecdotal examples I don’t have to look any farther than my parents. My father, who was never too interested in best practices, healthwise, literally dropped dead at age 69. He’d been retired for only six months. He and my mother had gone into the antiques business upon retirement and he was happily engaged in that when his heart stopped. It was a shock to the family, but put little strain on the medical system or his health insurance. My mother, on the other hand, tried to keep up with the dos and don’ts of keeping one’s health and lived to eight-five. That far outstripped expectations of longevity based on her .She didn’t come from a long lived family. Preventative care staved off the conditions that took her parents and aunts and uncles so much earlier in life.

Out of her eight-five years, all but the last year and a half were good one. She was vital, busy and productive. She was also very expensive to the medical system for years before she died. Death took her just before there would have been no choice but for her to be in a nursing home. Lots of other people, many of whom enjoyed good health until they didn’t anymore, spend years in them, due to a need for 24/7 skilled care. We have learned a lot about how to increase longevity, but we have not developed a way to ensure that we’ll go quietly into that good night without developing expensive medical conditions first. No matter how long it takes to come down with something.

I’m not arguing against preventative health care. It is a human imperative to live as long as possible and to seek as good as possible a quality of life while doing that. Hell, I’d be happy as a clam with a single payer system that paid for screenings of every kind, medication as indicated and help with behavior modification if wanted.

I am concerned with the way the national dialogue is focusing on prevention as an important way to reduce costs. That is steadily devolving into a situation where we blame the sick person for costing too much because of choices they’ve made. It seems very similar to the way we now blame people for not having enough money, even if they’ve worked all their lives.

Even Insurance Isn’t Making It Work

Insured People Experiencing More Trouble Paying for Prescription Drugs as Copayments Increase, Economy Worsens

This isn’t exactly a big surprise. The problem of higher co-pays and ever higher prices for prescription drugs has been creeping up on us for a while. With prices going up and the economy down, it looks like the situation is going to worsen for the time being.

Insured U.S. residents are experiencing more difficulty for prescription drugs as higher out-of-pocket costs and a slowing economy “strain family budgets,” according to surveys and health care analysts, USA Today reports. According to the National Patient Advocate Foundation, which helps people pay medical bills, 31% of the 44,729 people the foundation aided in 2007 cited copayments as their top medical-debt problem in 2006, compared with 17% in 2005.

USA Today reports that some people are no longer charged a flat fee for prescription drugs but must contribute a proportion that ranges from 20% to 70% of a drug’s cost. NPAF Executive Director Nancy Davenport-Ennis said, “Some families that have to deal with chronic or critical illness are not in a position to maintain that.” Gary Claxton, a Kaiser Family Foundation vice president and director of the Foundation’s Health Care Marketplace Project, said, “Incomes aren’t going up, but copayments are.”

Let’s be clear about one  thing – chronic illness can strike at any age, but as you get older, some sort of chronic condition that can benefit from modern medications becomes the rule rather than the exception. This can become anyone’s problem.

It has finally become so apparent that we some sort of solution to the problem of health care affordability that even Republicans are pretending to address the problem, but the problems are growing way more and more unmanageable way ahead of any possible plan to address it. Or to put it more succintly, if you’re not in a heap of shit today, watch out for tomorrow.

Are Health Insurance Mandates Constitutional?

Well, this from the LA Times raises an interesting question.

An important element is being overlooked in the healthcare debate between the Democratic presidential candidates: Namely, whether the plans they propose are constitutional.

The largest difference between their healthcare plans is that Sen. Hillary Rodham Clinton would “mandate” that everyone (with limited exceptions) purchase private health insurance. Although Sen. Barack Obama’s plan also contains a mandate, it is much narrower — it is only required for children. Obama principally relies on subsidies, economies of scale and regulation to voluntarily achieve his version of universal coverage.

Are health insurance mandates constitutional? They are certainly unprecedented. The federal government does not ordinarily require Americans to purchase particular goods or services from private parties.

I’m completely in favor of universal health care. I realize we’re going to have to settle for universal health insurance at best in the shorter term. Even so, mandates to purchase private health insurance have always struck me as icky. That’s not to say that the reasons proponents believe in them aren’t valid. They are valid, but that doesn’t mean they’re the right way to go. It just means that there are significant problems with providing universal health coverage via the private, mostly for-profit, insurance market instead proving it as a federal program funded by progressive taxation.

Health insurance mandates have been compared to the requirement to have automobile insurance. It’s never seemed to me that one thing had anything to do with the other. Driving is a thing you do. It might be a necessity for you, but driving a car is not the same as occupying your own body, which, astral projection aside, seems to be the most basic part of the human condition. In fact, you’re not even required to buy auto insurance to be a licensed driver. You have to have it to own and operate your own motor vehicle. That’s all. And even at that, the law is only going to require you to have liability insurance. If there are other mandates it’s because you have a loan on the vehicle and they’re part of the contract with the lender.

Some of my favorite politicians and pundits are in favor of mandates and I respect their opinions, but it does seem possible that the ickiness factor could also be a legal bar to instituting mandates at all. I hope some more constitutional law experts weigh in.

Not so fast

Well, I did go back to work today, but tomorrow’s up in the air. I got home this evening to find that Mr. Yenta had not had an especially good day. He’s cold and he’s weak and tired. He could be getting sick or his blood could be just a little too thin. In any case, he’s got an appointment at the doctor’s office tomorrow morning and he’s in no shape to drive. It looks like it’s going to be another morning out of work for me, at the least. I’m really getting pissed thinking about the doctor whose orders set this thing off.  Would it have really killed her to talk to the doctor who first prescribed the Wayfarin before telling him to stop taking it?

How Government Adds to Ranks of Uninsured

The Wall Street Journal (of all things) explains it all.

Medical care?

One reason that this was a good week to start a new blog is that I’m home from work. I didn’t plan to be. I’m home taking care of Mr. Yenta who is suffering from phlebitis. He had this four or five years ago and no sooner did he show up at the doctor’s office with a pain in his leg they were ultrasounding him and sending him off to the hospital, STAT. He was in for about a week and he’s been on Warfarin ever since with no recurrence of the problem. Yes, things were going fine in that area until a couple of weeks ago, when his endocrinologist sent him to a vascular specialist because she was concerned about the circulation in his feet. Mr. Yenta is diabetic with advanced neuropathy, so he’s at risk for circulatory problems and if they’re in his feet he’s not likely to recognize them by feel or lack thereof.

Vascular specialist seemed more interested in why he had been taking Warfarin for so long. She did tests, told him he was free of phlebitis and that he should stop taking it. Funny thing, though – turns out he was free of phlebitis because he was taking the drug. Not more than a couple of weeks after stopping it, he started having pain in his leg. It felt familiar this time. It felt like clot to him. We packed a few things just in case and I drove him to our family doctor who, unlike several specialists he’s seen, has never tried to kill him.

Things have changed in the last few years and you don’t necessarily have to be hospitalized for this now. That was good news. The doctor still needed an ultrasound and he still needed it STAT, so he sent us to the hospital because they’d be able to do it right away. And they would. But our insurance company wasn’t ready to approve it. Nope, they thought that later on, in the afternoon, when our assigned lab had time would be good enough. From what we heard later, the doctor’s office tried every which way to get an approval for an immediate test, but were unsuccessful. Their flimsy reason – that if he had the suspected condition it could be life threatening if untreated – didn’t impress them a bit.

The lab did indeed find a clot in his leg and sent us back to the doctor’s office, where he got injected, prescriptions and instructions. He has to go back each day until his tests are where they need to be. So I ask again, just how much worse off would we be with universal health care? With a single-payer system, even? How much less choice would we have?