Greed, fear and other barriers to health care as a human right
Posted April 18, 2013, at 5:36 a.m.
Of all the wealthy countries, only the United States has so far failed to treat health care as a human right. A human right to health care means that everybody receives the same health care whatever their age, gender, health or employment status, racial or religious background, sexual orientation, or wealth and income level.
One reason I often hear cited for our failure to join all other wealthy nations in making health care a human right is that we can’t afford it. Some argue, “We’re already spending too much on health care and cannot afford to expand coverage to everybody.”
They have it backwards. Our failure to expand health care to everybody is a major cause for our high costs, not a reason for not doing more. Slicing and dicing our population into “risk categories” (the fundamental business of the commercial insurance industry), having thousands of different insurance companies (all with their own rules), then arguing about who pays what is very expensive.
The Institute of Medicine recently reported that around 25 percent of the approximately $3 trillion we spend as a nation annually on health care is wasted. Much of this waste is traceable back to the way we pay for that care, segmenting the population into categories and paying for them separately: the elderly, the poor or near-poor, the employed, the unemployed, young people, sick people, well people, veterans, Native Americans, and so on.
Each category and its attached financing pool receives its own treatment — range of benefits, prices, utilization review programs, amounts of co-pays and deductibles and more. This complexity is very costly, not only for the private insurers and public programs, but also for doctors, hospitals and health care systems to administer.
I recently heard the CEO of a large Medicare Advantage plan in Maine say that he could cut his overhead by 50 to 60 percent if we reduced the number of payment plans he had to deal with to one. He then went on for the first time publicly to endorse a universal plan for Maine — everybody in, nobody out of the same plan.
Our system of financing health care in the U.S. leaves many people without coverage (about 35 million in the case of Obamacare, even in the unlikely event everything works perfectly), leading to high rates of avoidable human suffering and personal bankruptcy. Obamacare is far too complicated, as was Maine’s ill-fated Dirigo program. Both made the mistake of trying to build on our current, badly flawed employment-based health insurance system.
Obamacare’s rollout is already over budget and behind schedule, mostly because of its complexity. Maine’s Dirigo program is on life support and slated to be phased out. I’m afraid their problems are only going to get worse.
Other countries figured out long ago that simplicity works and as a result have health care systems that cover everybody, get better results than we do for most health outcomes, are far more popular with both their publics and politicians, and cost about half of what ours does.
How to handle medical bill problems
For those with confusing or huge hospital bills, experts advise knowing rights, getting written explanations, turning to the right places for help and filing complaints if necessary.
By Lisa Zamosky9:42 PM PDT, April 5, 2013
When Keith Yaskin and his wife, Loren, rushed their 2-year-old son to the hospital with a dangerous infection in his neck, they weren't thinking about how much his care would cost. After his three-day inpatient stay with nonstop intravenous antibiotics, they were hit with $8,900 in charges.
But the toughest lesson for the Scottsdale, Ariz., couple came a month or so later when they began to sort out the hospital bills. Their insurance policy had a $10,000 deductible. So they scrutinized every item, made some calls and had a few surprises.
When, for instance, they asked a medical group they had never heard of why it was charging them $839.25, they said they got no clear answers, just threats if they failed to pay.
After 21/2 months of calls and a complaint to their state attorney general, the Yaskins finally learned that a pediatrician affiliated with the group had treated their son in the hospital. The medical group eventually cut the bill in half.
None of this surprises Pat Palmer, the founder of Medical Billing Advocates of America. "We get feedback from consumers saying that providers are telling them 'We can't give you an itemized statement' or 'You should have asked for it before you left the hospital.'"
The idea is to discourage patients from asking for the details behind the charges, she said.
Experts offer a range of suggestions for dealing with medical billing problems.
Know your rights. Most states have laws saying that patients are entitled to an itemized medical bill that details what services and supplies are included in their charges.
"You can't be billed if they can't tell you what they are charging for," Palmer says.
Contact the billing department at either the hospital or medical group where you received services, she said. Let them know that you want an itemized bill, and tell them you are aware of your legal right to have it.
Also, a few states have laws limiting how much hospitals can charge patients who pay for care on their own. In 2006, California passed a law to prevent hospitals from collecting more money from uninsured patients than what Medicare or other public programs would pay for the same service.
"Once a patient contacts the hospital and shows evidence of their financial situation, state law requires us to offer a discount based on Medicare rates," says Jan Emerson-Shea, vice president of external affairs for the California Hospital Assn.
Get explanations in writing and take protests to the top.
http://www.latimes.com/business/la-fi-healthcare-watch-20130407,0,7462049,print.story
Nation's biggest movie theater chain cuts workweek, blaming ObamaCare
Published April 15, 2013
| FoxNews.com
The nation's largest movie theater chain has cut the hours of thousands of employees, saying in a company memo that ObamaCare requirements are to blame.
Regal Entertainment Group, which operates more than 500 theaters in 38 states, last month rolled back shifts for non-salaried workers to 30 hours per week, putting them under the threshold at which employers are required to provide health insurance. The Nashville-based company said in a letter to managers that the move was a direct result of ObamaCare.
“In addition, some managers have requested guidance on what they should tell those employees negatively impacted and, at your discretion, we suggest the following,” read the memo obtained by FoxNews.com. “To comply with the Affordable Care Act, Regal had to increase our health care budget to cover those newly deemed eligible based on the law's definition of a full-time employee.”
“To manage this budget, all other employees will be scheduled in accord with business needs and in a manner that will not negatively impact our health care budget,” the message continues.
Regal, which had revenue of $2.8 billion in 2011, is the latest company to respond this way to the Affordable Health Care Act's requirement that employees at companies of a certain size who work more than 30 hours per week be provided health coverage. Applebee's and Olive Garden also scaled back the hours of workers. A handful of colleges have cut hours because of the law, including Palm Beach State College in Florida and New Jersey’s Kean University. Critics say the law is boomeranging on working folks.
Read more: http://www.foxnews.com/us/2013/04/15/nation-biggest-movie-theater-chain-cuts-workweek-blaming-obamacare/print#ixzz2QksJaIscThe Impossible Workload for Doctors in Training
By PAULINE W. CHEN, M.D.
One spring morning during the second year of my surgical residency, I learned that two of my classmates, junior residents like me, had suddenly been fired.
Their dismissal left just four of us to cover two hospitals and the work of six junior residents. I quickly did the math in my head. We would have to split up into pairs, and we would have to work through every other night for the rest of the year.
The prospect of such a grueling timetable inspired us to come up with equally extreme solutions. One month we tried “power 60s,” working a 60-hour shift every other weekend so that the other of the pair could have at least one full day’s break.
That experiment didn’t last long.
But my most enduring memory of that year is not the exhaustion; it is the panic and anxiety that enveloped us as we struggled to cover far more work than four people — however willing — could reasonably complete. Our lives had been distilled down to a simple math equation with three variables: the work to be done, the time needed to complete it and the number of people available to do it. We worked longer hours not because our senior surgeons told us to, but because that was the only way we could balance the equation.
If only doctors in training these days had it so easy.
Over the past decade, in response to public concerns about medical errors arising from fatigue, the Accreditation Council for Graduate Medical Education, the organization responsible for accrediting American medical residency programs, has been progressively limiting the number of hours that trainees can work. Thelatest mandate, which took effect in 2011, is the most stringent and deals most specifically with interns. These youngest doctors are allowed to work no longer than 16 hours in a day; and residency programs that violate the restriction risk losing their accreditation.
In response to the 16-hour mandate and faced with a Rubik’s-cube conundrum of covering all the work with the same number of interns working fewer hours, training programs across the country came up with several innovative scheduling configurations. Some created complicated and overlapping shifts where outgoing doctors “signed out” their patients, passing off their responsibilities to the incoming shift. Others adopted a “night float” system that meant a resident just a year out of internship had to carry the work of as many as 12 interns at night, looking after more than 100 patients and fielding questions about those patients at best every 20 minutes and at worst every 11 minutes throughout the night.
How to build a better health-care system
By Tom Daschle, Bill Frist, Pete Domenici and Alice Rivlin,
Tom Daschle, a Democrat and former senator from South Dakota, was Senate majority leader from 2001 to 2003. Bill Frist, a Republican and former senator from Tennessee, was Senate majority leader from 2003 to 2007. Pete Domenici, a Republican and former senator from New Mexico, was chairman or ranking minority member of the Senate Budget Committee from 1981 to 2003. Alice Rivlin is a former director of the Congressional Budget Office. The four co-chair the Bipartisan Policy Center’s Health Care Cost Containment Initiative.
The four of us came together to change the conversation around how to improve health care and constrain cost growth. What we learned is that, until better care is prioritized over more care, our nation will continue to face a problem with health-care costs. The good news is that, through thoughtful policy, health-care practitioners can be encouraged through rewards to focus far more on what is best for their patients and less on the number of tests and procedures they can order. The even better news is that such a health-care vision can not only produce better care but also cost less.
With the Bipartisan Policy Center, we will release a report Thursday with more than 50 recommendations to achieve the critical goal of improving the quality and affordability of care for all Americans while containing high and rising health-care spending. This report is the culmination of nearly a year of work, including stakeholder outreach, thorough research and substantive analytics to quantify the impact of our proposed policies.
Too often we in Washington talk about health care as though it is little more than a line item on a budget table. Those of us who have experienced the best of health care know that is not how care should be delivered or policy crafted in this most personal of issues. Our country can achieve a higher-value health-care system — meaning both higher quality and greater efficiency.
Health-care cost drivers are complex and interwoven, but the most problematic ones we identified are the inefficiencies, misaligned incentives and fragmented care delivery in the current fee-for-service reimbursement system. To address these, we seek to promote coordinated and accountable systems of health-care delivery and payment, building on what has proved successful in the private and public sectors. Organized systems of care emphasize the value of care delivered over the volume of care. These systems are often better able to meet patients’ needs and desires and are able to effectively reimburse providers and practitioners for delivering high-quality care.
In all our proposals, we sought to avoid simple cost-shifting as a means to generate federal budgetary savings, instead promoting transparency and protecting patient choice. We also focused on reforms that will incite transformation across the health-care system, not limited to Medicare. We believe, however, that the power of Medicare can be leveraged to lead the way in transforming U.S. health care.
In brief, our recommendations:
●Preserve the promise of traditional Medicare while adding more choices and protections for beneficiaries, including accountable systems of care and a stronger, more competitive Medicare Advantage program.
●Strengthen and modernize the traditional Medicare benefit, including adding a catastrophic cap, rationalizing cost-sharing and premiums and expanding access to assistance programs for those with low incomes.
●Reform the tax treatment of health insurance to limit the taxfavored treatment of overly expensive insurance products.
●Empower patients by promoting transparency that is meaningful to consumers, families and businesses, and streamline quality reporting.
●Advance the nation’s understanding of potential cost savings from prevention programs, through support for research and innovation on effective strategies to address costly chronic conditions.
●Offer incentives to states to promote policies that will support a more organized, value-driven health-care delivery and payment system, such as supporting medical liability reform and strengthening their primary-care workforce.
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