A Health Insurance Detective Story
By FRANK LALLI
I’VE had a long career as a business journalist, beginning at Forbes and including eight years as the editor of Money, a personal finance magazine. But I’ve never faced a more confounding reporting challenge than the one I’m engaged in now: What will I pay next year for the pill that controls my blood cancer?
After making more than 70 phone calls to 16 organizations over the past few weeks, I’m still not totally sure what I will owe for my Revlimid, a derivative of thalidomide that is keeping my multiple myeloma in check. The drug is extremely expensive — about $11,000 retail for a four-week supply, $132,000 a year, $524 a pill. Time Warner, my former employer, has covered me for years under its Supplementary Medicare Program, a plan for retirees that included a special Writers Guild benefit capping my out-of-pocket prescription costs at $1,000 a year. That out-of-pocket limit is scheduled to expire on Jan. 1. So what will my Revlimid cost me next year?
The answers I got ranged from $20 a month to $17,000 a year. One of the first people I phoned said that no matter what I heard, I wouldn’t know the cost until I filed a claim in January. Seventy phone calls later, that may still be the most reliable thing anyone has told me.
Like around 47 million other Medicare beneficiaries, I have until this Friday, Dec. 7, when open enrollment ends, to choose my 2013 Medicare coverage, either through traditional Medicare or a private insurer, as well as my drug coverage — or I will risk all sorts of complications and potential late penalties.
But if a seasoned personal-finance journalist can’t get a straight answer to a simple question, what chance do most people have of picking the right health insuranceoption?
A study published in the journal Health Affairs in October estimated that a mere 5.2 percent of Medicare Part D beneficiaries chose the cheapest coverage that met their needs. All in all, consumers appear to be wasting roughly $11 billion a year on their Part D coverage, partly, I think, because they don’t get reliable answers to straightforward questions.
In the VA system, the future of primary health care
By Yogesh Khanal,
Yogesh Khanal is a resident in internal medicine at Yale-New Haven Hospital and the VA hospital in West Haven, Conn.
At the height of the debate over the Affordable Care Act three years ago, I was in my last year of medical school, juggling rotations at private hospitals, a large university hospital and charity county clinics.
But it was my rotation at the local Veterans Affairs health system that showed me the future of primary medical care and taught me the virtues of attacking illness on many fronts. It’s a lesson that will be acutely needed nationwide once the Affordable Care Act goes into effect and sends legions of newly insured patients into clinics and hospitals.
My first patient in medical school was a 25-year-old Iraq war vet from a small farming town in Idaho. A star high school football player, he had enlisted in the Army on his 18th birthday so he could see the world and afford college. Within his first month in Iraq, a satellite pole fell on him during a brutal sandstorm. Multiple leg surgeries later, he was sent back to America battling chronic pain and dependent on narcotics. Using a cane to walk, my patient grew depressed, gained 30 pounds and became a diabetic.
I had 30 minutes with him, and my attending physician had just 15. We were already running late. But my attending calmly introduced our team’s social worker and psychologist. They booked visits for the patient with the VA pain-management clinic, the mental health clinic for post-traumatic stress disorder and a physical rehabilitation specialist. And we saw the patient the very next day to begin treating his diabetes.
This multifaceted and coordinated approach to treatment — all of it at minimal or no cost for veterans at the VA — is rarely practiced in other American hospitals and clinics. If this patient had hobbled in and found me at a private clinic outside the VA system, his lack of insurance and a job would have put him in the Medicaid ranks. Specialists might have refused to accept Medicaid, and he might have had to pay out of his own pocket — or not see them at all.
Moreover, like nearly all private patients, he would have needed to coordinate these visits on his own, carry his medical chart with him and later ensure that I received the specialists’ recommendations. To see me again, he might have needed to wait weeks for an opening.
The VA system could be a model of how to change all that. Indeed, it’s a model of changing itself.
Ex-Treasury secretary visiting Maine tackles medical errors
Posted Nov. 30, 2012, at 7:05 p.m.
As a former U.S. Treasury secretary and one-time CEO of the Pittsburgh industrial giant Alcoa, Paul O’Neill is no stranger to management at the highest levels. But the world of health care still strikes him as exceedingly hierarchical.
“If you’ve got a white coat and a lot of degrees, whether you’re right or you’re wrong, you’re always right,” he said Friday in an interview with the Bangor Daily News.
O’Neill, who led the Treasury under George W. Bush and later became a critic of the administration, will visit Maine on Dec. 6 to speak at the annual symposium of the Maine Health Management Coalition, an employer-led nonprofit in Portland that’s dedicated to improving the quality and value of health care.
Outside of government, O’Neill is best known for his leadership of Alcoa, one of the world’s largest aluminum manufacturers. As chairman and CEO, he doubled the company’s market share and revived its profits while flattening the management structure, creating a new corporate culture focused on worker safety.
He has since translated his private-sector philosophy to health care — as well as speaking out about the ballooning national debt and America’s education system — with an aim toward reducing medical errors and infections.
In 1997, O’Neill teamed up with the Jewish Healthcare Foundation to found the Pittsburgh Regional Health Initiative, a coalition of healthcare stakeholders that adapted the principles of the Toyota Production System to improve health care quality in the region.
At the city’s Allegheny General Hospital, the changes led to a 67 percent drop in central line infections, O’Neill said.
His approach focuses on preventing medical errors and learning from mistakes and problems when they do occur. That requires health care leadership that engages employees at every level, O’Neill said.
“The surgeon is accorded the same level of wonderful dignity and respect as the people who clean the rooms,” he said.
O’Neill sees room for significant productivity improvements that can lead to better health care and reduce costs. For example, a typical nurse spends half of her time on tasks that don’t help patients, like searching for equipment, he said.
“They’re unbelievably busy, but 50 percent of the time they’re not doing something valuable,” he said.
O’Neill isn’t optimistic that federal health reform will address the country’s health care problems to meaningfully improve patient care or reduce costs. The health care law only eats at the fringes of the $1 trillion worth of waste in America’s $2.5 trillion health care system, he said.
Walmart's New Health Care Policy Shifts Burden To Medicaid, Obamacare
Posted: 12/01/2012 10:14 am EST Updated: 12/01/2012 12:42 pm EST
Walmart, the nation’s largest private employer, plans to begin denying health insurance to newly hired employees who work fewer than 30 hours a week, according to a copy of the company’s policy obtained by The Huffington Post.
Under the policy, slated to take effect in January, Walmart also reserves the right to eliminate health care coverage for certain workers if their average workweek dips below 30 hours -- something that happens with regularity and at the direction of company managers.
Walmart declined to disclose how many of its roughly 1.4 million U.S. workers are vulnerable to losing medical insurance under its new policy. In an emailed statement, company spokesman David Tovar said Walmart had “made a business decision” not to respond to questions from The Huffington Post and accused the publication of unfair coverage.
Labor and health care experts portrayed Walmart’s decision to exclude workers from its medical plans as an attempt to limit costs while taking advantage of the national health care reform known as Obamacare. Among the key features of Obamacare is an expansion of Medicaid, the taxpayer-financed health insurance program for poor people. Many of the Walmart workers who might be dropped from the company’s health care plans earn so little that they would qualify for the expanded Medicaid program, these experts said.
http://www.huffingtonpost.com/2012/12/01/walmart-health-care-policy-medicaid-obamacare_n_2220152.html
