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Wednesday, July 3, 2013

Health Care Reform Articles - July 3, 2013


Piracy Is Alive and Well in Maine

“In faith, there is light enough to see, but darkness enough to blind.”
Blackbeard, notorious pirate from Maine
I’m not sure at what point outrage will completely devour my inner self and I’ll just morph into a sarcastic, snarky, semi-conscious citizen riding a total wave of disgust.
These days, almost everywhere I look – from endless wars, to funding and manufacturing kill machines (drones, cluster bombs) to destroying the environment (and water, food supplies) through fracking, mountaintop mining, drilling, to gutting social programs which help the poorest of the poor (food stamps, Medicare, Social Security), to the staggering assault on civil liberties (Supreme Court recently ruled silence can be used as an indicator of guilt), to the free-for-all predatory financial practices of the banking and student loan conglomerates – it is abundantly clear common sense and humanity are not on the side of the decision makers for We The People in the “Land of the Free”.
But what boils my blood the most is the corrupt, asinine, immoral, totally inequitable practices of our medical industrial complex and its system of byzantine rules of empire (aggressively more so under the Orwellian-named Patient Protection and Affordable Care Act (PPACA FOR DUMMIES) which is proximate cause for America having the worst health care system on the planet.
Here is what I’m talking about.
If you are going to run a hospital in the good old USA, the first thing you have to do is lie.  And, of course, not give a damn whether or not your facility actually provides health care services.  Your sole purpose is to bank hefty paydays for a select few while aggressively pursuing the poor, under and uninsured for unpaid hospital bills puffed up by as much as 1000 percent.
While for-profit hospitals get away with murder, nonprofit hospitals aren’t any better.  They have special exemptions from the IRS to operate as a “charity”, which allows them to pay no income, sales, and property taxes, yet they are totally in bed with the profit-first insurance and pharmaceutical industries who fix prices between them to financially cripple patients into a debt of servitude and despair.  No one seems to care that they can doggedly pursue payment to the point of stealing patients’ sanities, pensions, savings, home equity, college funds, rainy day stashes, and anything you’ve hidden under the mattress to pay for grandma’s cremation (to supplement the meager $255 death benefit from Social Security).

Everything you ever wanted to know about Canadian health care in one post

By Sarah Kliff, Updated: 

We spend a decent amount of time talking about the Canadian health care system in our health care debate. Today being Canada Day (yes, really), it feels like a good time to brush up on how our northern neighbors actually deliver health care and how well it works. Without further ado, a completely painless guide to the Canadian health care system.
So, how exactly does the Canadian health care system work?
The Canadian health care system was built around the principle that all citizens will receive all “medically necessary and hospital physician services.” To that end, each of Canada’s 10 provinces and three territories finance and 
run a statewide health insurance program. There is no cost-sharing for the health care services guaranteed under federal law.
While Canadians are guaranteed access to hospital and physician services, it is up to each province to decide whether to cover “supplementary” benefits, like dental care and drug coverage. About two-thirds of Canadians take out private, supplemental insurance policies (or have an employer-sponsored plan) to cover these services.
While Canada is traditionally thought of as a publicly financed system, spending on these supplemental benefits means that 30 percent of health spending comes from private sources. One 2011 study found that nearly all Canadian spending on dental care came from non-government dollars, 60 percent covered by employer-sponsored plans and 35 percent paid out of pocket. Some Canadian legislators have made pushes to increase the scope of Canada’s public health plan, to cover more services, but have so far proved unsuccessful.
While Canada’s health care system is publicly financed, many providers are not government employees. Instead, doctors are usually reimbursed by the government at a negotiated fee-for-service rate. The average primary care doctor in Canada earns $125,000 (in the United States, that number stands at $186,000).
How much does it cost? 
In 2009, Canada spent 11.4 percent of its Gross Domestic Product on health care, which puts it on the slightly higher end of OECD countries:

Health Mandate for Employers Delayed to 2015

WASHINGTON — In a significant setback for President Obama’s signature domestic initiative, the administration on Tuesday abruptly announced a one-year delay, until 2015, in his health care law’s mandate that larger employers provide coverage for their workers or pay penalties. The decision postpones the effective date beyond next year’s midterm elections.
Employer groups welcomed the news of the concession, which followed complaints from businesses and was posted late in the day on the White House and Treasury Web sites while the president was flying home from Africa. Republicans’ gleeful reactions made clear that they would not cease to make repeal of Obamacare a campaign issue for the third straight election cycle.
While the postponement technically does not affect other central provisions of the law — in particular those establishing health insurance marketplaces in the states, known as exchanges, where uninsured Americans can shop for policies — it throws into disarray the administration’s effort to put those provisions into effect by Jan. 1.
“I am utterly astounded,” said Sara Rosenbaum, a professor of health law and policy at George Washington University and an advocate of the law. “It boggles the mind. This step could significantly reduce the number of uninsured people who will gain coverage in 2014.”
At the White House, Tara McGuinness, a senior adviser on the law, disputed that.
“Nothing in the new guidance regarding employer reporting and responsibility will limit individuals’ eligibility for premium tax credits to buy insurance through the marketplaces that open on Oct. 1,” she said.
Under the law, most Americans will be required to have insurance in January 2014, or they will be subject to tax penalties. The announcement on Tuesday did not say anything about delaying that requirement or those penalties.
Administration officials sought to put the action in a positive light in the online announcements, and they emphasized that the existing insurance coverage of most Americans would not be affected.

White House delays penalties against employers that don’t provide health insurance

By Mike Dorning and Alex Wayne, Bloomberg
Businesses won’t be penalized next year if they don’t provide workers health insurance after the Obama administration decided to delay a key requirement under its health-care law, two administration officials said.
The decision will come in regulatory guidance to be issued later this week. It addresses vehement complaints from employer groups about the administrative burden of reporting requirements, though it may also affect coverage provided to some workers.
The two officials, who asked not to be identified to discuss the move ahead of its announcement, said the administration decided to wait until 2015 before enforcing the employer mandate in order to simplify reporting requirements and give businesses more time to adapt their health-care coverage.


Anthem's proposed network wouldn't cover all Maine towns

Posted: July 2
Updated: Today at 12:06 AM
 

Central Maine HealthCare, which wouldn't be in Anthem's network, says Anthem's proposal underestimates the driving time to doctors in central and western Maine.

By Jessica Hall jhall@pressherald.com
Staff Writer
GARDINER — Anthem Blue Cross and Blue Shield on Tuesday acknowledged that not every town in the state would have a doctor in the health insurance network it has proposed.
Anthem has proposed creating a health insurance network with MaineHealth that includes 32 of the 38 hospitals in the state. It previously said the network was structured to allow every subscriber to reach a primary care physician within a 30-minute drive and a specialist within an hour's driving time.
In a hearing held by the state's Bureau of Insurance, Anthem said the network was built around MaineHealth, the largest network of hospitals and care providers in the state.
The company said it does not know how many Mainers would join the network. It used an estimate of 45,000 subscribers, however, to calculate various ratios of doctors to patients that the state will use in deciding whether to approve the network.
http://www.pressherald.com/news/Anthem-Maine-network-wouldnt-include-a-doctor-in-every-town.html

Patients struggling to afford medical bills go online to raise money and morale

By Caroline Mayer, Kaiser Health News
Even with Stage IV lung cancer, there are moments when 32-year-old Chip Kennett feels blessed. Over the course of two weeks in April, those moments were many, as 325 friends and family members contributed $56,800 over the Internet to help defray his out-of-pocket medical costs.
Kennett’s wife, Sheila, says she was overwhelmed by the generosity. We “kept saying how lucky we were!” she wrote in her blog Team Kennett. “Now just how messed up is that?”
The Kennett family of Alexandria, Va., is one of thousands turning to the Internet to raise money for medical bills. The sites that host these campaigns operate much like online business fundraising sites like Kickstarter. It takes only a few keystrokes for a family to set up a Web page, where they tell their story and state a fundraising goal; later, they can spread the word on social media sites such as Facebook. Donations can be made with credit cards or via PayPal.
The contributions, which can be given by name or anonymously, typically range from the very small (as little as $5) to the extremely generous ($1,000 and up). In the Kennetts’ case, donations ranged from $10 to $2,000. Most sites are for-profit and charge a fee, between 3 percent and 12 percent of the money donated, to cover processing costs and the expenses of running the website. GiveForward, the site the Kennetts used, charges 7 percent.
http://bangordailynews.com/2013/07/03/health/patients-struggling-to-afford-medical-bills-go-online-to-raise-money-and-morale/


Giving up on Insurance System: Falmouth Practice's 10-Year Experiment

When Dr. Sunny Raleigh gives a physical at True North health center in Falmouth, it differs from what most patients might expect. For starters, patient Cathy Patnaude hasn't changed into her exam gown yet. And instead of sitting on an exam table, she sits in a chair directly across from Raleigh, who wants her to feel as comfortable as possible as she asks detailed questions about all aspects of Patnaude's life - things like family, work, and food.

"So, can you kind of walk me through your last 24 hours of nutrition?" Dr. Raleigh asks Patnaude. This is just the beginning of an appointment that can take up to 90 minutes. It's what distinguishes True North from other health practices, says Medical Director Bethany Hays.

"Probably the biggest difference is the practitioner who sits down with you and says, 'Tell me your story, and give me the long version,'" Raleigh says. "That doesn't happen in many doctor's offices, and I'm not being critical of doctors - it's the system."

True North was opened just over 10 years ago by a group of nurses and physicians who were disenchanted with the health system. They wanted a practice that would allow them to get to the root cause of patients' health issues. That requires time, which is something in short supply when you're tied to insurance reimbursements.

"The business of medicine has gotten so complex and so burdened by administrative and organizational issues that physicians are tearing their hair out," Raleigh says.
http://www.mpbn.net/Home/tabid/36/ctl/ViewItem/mid/5347/ItemId/28780/Default.aspx



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