Pages

Saturday, November 23, 2013

Health Care Reform Articles - November 23, 2013

NOVEMBER 21, 2013, 2:51 PM

Spending More and Getting Less for Health Care

The patient, lean and in his 60s, was in the hospital for the second time in a month with blood sugar levels that were out of control and he was not happy. Despite the nurses’ earnest attempts to cheer him up, he scowled and insisted that all he needed was for us to “fix it” so he could go back home.
“We have to keep looking because you may have other serious problems that caused your blood sugar to go up,” I said, preparing to rattle off a list of potential causes.
“You bet I have other problems, Doc,” he growled back. I watched the color in his face rise as he described the death of one of his adult children in a car accident several years earlier. His mouth quivered as he spoke of another child who had became seriously disabled while fighting in the military. And his eyes teared up as he described losing his job as a custodian at a local office building.
“I can’t pay for my medications, I can’t do enough for my son, and I miss my baby,” he said, now weeping.
At that moment, I knew that I could diagnose as much as I wanted, prescribe, operate and enlist the help of an army of primary care and specialty colleagues; but he would be back. Whatever the reason for his elevated blood sugar levels this time, sooner or later his grief would envelop him, he would be overwhelmed with his caretaking duties or he would run out of money for his medications, and he would be back at the hospital once more.
What I could take care of was only the tip of his health care concerns.
I remembered this patient, and many more like him that I have encountered in practice, while reading a new book, “The American Health Care Paradox.”
Studies since the 1980s have shown that despite spending enormous sums on health care, Americans are less healthy than their counterparts in other developed countries. In the most recent studies comparing the United States to 17 other wealthy industrialized nations including France, Japan, Canada and Britain, Americans had a shorter life expectancy, higher rates of disease, the highest rates of infant mortality and the lowest chance over all of surviving to middle age.
These dismal findings have so befuddled health care experts, policymakers and politicians that they have come to be known simply as “the American health care paradox,” or among the more candid, “the U.S. healthcare disadvantage.” Some experts have attributed the abysmal outcomes to the greed, waste and inefficiency of the payment system, practitioners and the pharmaceutical industry. Others have postulated that the lack of patient access and the American desire for the most sophisticated and newest therapy are the reasons. Still others have pointed to the American malpractice system as a key culprit.
But in 2011, in a well-respected professional journal and in The New York Times, Dr. Elizabeth H. Bradley, director of Yale University’s Global Health Leadership Institute, Lauren A. Taylor, a former program manager at the institute, and their colleagues offered one of the most compelling and cohesive explanations yet.
As with other researchers, they had found that the United States spends a significantly higher percentage of its gross domestic product — as much as 50 percent more than other developed countries — on health services like acute hospital care, rehabilitative care, diagnostic imaging, laboratory tests and health insurance. But when that percentage is combined with the much smaller amounts spent on education, old age pensions, disability and sickness benefits, family support and employment programs, unemployment benefits and housing support, the United States ranking drops precipitously to one more in line with its poor health care outcomes.
Small Group Health Insurance "Cancellations"––The Next Shoe to Drop But a More Complicated One

Obamacare is impacting the small group insurance market in many of the same ways as the individual health insurance market. While employers with less than 50 workers don't have to provide coverage, if they do they are required to comply with the same essential benefit mandates, age rating changes, and pre-existing condition reforms the individual market faces.

That means essentially all small group policies cannot continue as they are––they have to be discontinued.

What makes things a bit easier, if not any less expensive, is that small employers typically have health insurance brokers to run interference for them and help them through this change where individual consumers often get that dreaded cancellation letter telling them they will not have health insurance after a certain date if they do not act quickly in what is a confusing marketplace in the best of times.

The first small group renewals are now occurring––the January 1 renewals that typically have to be delivered during the month of November under state law.

Many employers are facing significant changes in order to comply with Obamacare and therefore price increases. One Maryland broker I spoke to this week has 90 small group accounts and he reports his smallest increase was 15%, his largest was 69%, and most are in the 30% - 40% range. (By comparison, Mercer just announced the average large employer health care cost increase for 2014 will be 5.2%, meaning small groups could have reasonably expected an increase under 10% without Obamacare.) The biggest rate increases are generally going to those employers with the youngest groups the most impacted by the new "age compression" rules.

Does this mean these small employers' coverage has been outright cancelled and they will now send their workers to the exchanges, as I have heard some commentators argue?
http://healthpolicyandmarket.blogspot.com/2013/11/small-group-health-insurance.html?utm_source=feedburner&utm_medium=email&utm_campaign=Feed%3A+HealthCarePolicyAndMarketplaceBlog+%28Health+Care+Policy+and+Marketplace+Blog%29

The G.O.P.’s Health Reform Playbook

No comments:

Post a Comment