Still haven't decided what to get your loved ones for the holidays? How about a nose job or a touch of Botox.
Anyone seeking elective plastic surgery may help pay for the nearly $900 billion health care overhaul that was unveiled by Senate Democrats this week.
The White House-backed plan would impose a 5 percent tax on elective cosmetic surgery that is estimated to raise an estimated $5.8 billion over 10 years. The tax would to into effect just after the holidays in early January.
The measure exempts plastic surgery done to remedy a congenital deformity or an injury resulting from an accident or disease.
David Kestenbaum and I have a story on All Things Considered tomorrow about MRI prices. Specifically why does it cost $900 for a shoulder MRI at one hospital when you can get the same MRI down the street for half the price? (If you listened to last week's podcast, you may already know the answer.)
In the process of reporting the story, we came across dozens of other health care pricing mysteries. Dr. Tara Lagu from the Baystate Medical Center has been collecting hospital charges for all sorts of items. She sent us a breakdown of charges from 421 hospitals for 81mg of aspirin, a baby aspirin:
The 50th percentile (the median) of hospitals charged 65 cents for an aspirin. The 75th percentile charged $2.62 for an aspirin. The 90th percentile charged $6.50 for an aspirin.
And the 99th percentile charged $11.42 for an aspirin. One hospital out of the 421 we looked at charged $18.02 for an aspirin, but it's so high we're kind of wondering if it's a mistake!
House Democrats have unveiled their bill for overhauling health care. The total cost over 10 years comes in at $894 billion, just under the $900 billion limit President Obama asked for. The bill is not expected to add to the federal budget deficit for at least 20 years, thanks to new taxes on high income earners and a series of cuts to Medicare payments. The Washington Post reports:
A previous version of the House bill carried an estimated cost of $1.04 trillion over 10 years, but House negotiators were able to lower the price tag -- in part by expanding Medicaid coverage to a broader slice of the population, the equivalent of all individuals who earn about $16,200 per year. The original House legislation had sought an increase to 133 percent of the federal poverty level, or about $14,400 per year, the same level proposed in the Senate bill.
The adjustment reflects findings by congressional budget analysts that covering the poor through Medicaid -- which pays providers far less than Medicare -- is much more cost-effective than offering subsidies for private insurance policies, something the bill would provide to middle-class individuals who lack access to affordable coverage through their employers.
The main revenue sources in the House bill include a surcharge on wealthy taxpayers and changes to Medicaid and Medicare worth about $500 billion in cost savings over 10 years, according to the nonpartisan Congressional Budget Office
Under the bill, individual taxpayers making more than $500,000 and couples making more than $1 million would have to pay a 5.4 percent surtax. House leaders hope to vote on the bill by the end of next week.
Romer first cites the role of the Bush administration, then segues into medical spending:
(Economists) Auerbach and Gale calculate that roughly half of the long-run deficit is due to the policy actions of the past 8 years. According to a study by the Center on Budget and Policy Priorities, just 3 percent of the long-run fiscal problem is due to the ARRA [American Recovery and Reinvestment Act]. The rest of this yawning gap is due to projected rises in spending on entitlement programs, primarily Social Security, Medicare and Medicaid. Some of this is the result of the aging of the population. But the far greater source is the fact that health care costs, both public and private, are rising much faster than GDP.
. . .
Some have argued that it is irresponsible to reform our health care system at a time when the budget deficit is so large and our long-run fiscal problems are so severe. I firmly believe the opposite: it is fiscally irresponsible not to do health care reform.
The city of Braddock, Pa., ranks among America's most difficult places, alongside emblems of decline and depopulation like Detroit and Flint, Mich. People in Braddock, a steel center outside Pittsburgh, have been trying awfully hard to bring about a revival. Their famous mountain of a mayor, John Fetterman, describes some of the efforts at community farming and urban homesteading in the video above.
Now Braddock is sustaining another blow. Its hospital, a branch of the University of Pittsburgh Medical Center, has announced that it will close as of Jan. 31, 2010. At a meeting yesterday, hospital officials told distraught and angry residents that the patient load had dropped by 20 percent since the 2007 opening. UPMC Braddock has been on pace to lose $50 million over the next several years. The hospital says four one out five residents already seek health care elsewhere, and now the others can use one of the UPMC satellites within a five-mile radius.
As the Pittsburgh Post-Gazette reports, people in Braddock say they're losing the only ATM in town and, in the hospital's cafeteria, what amounts to their only sit-down restaurant. In fact, they may be giving up more than that. The hospital had become something of an economic engine in the town, employing 670 people. The state had awarded it $3 million for renovations, which the hospital now says it won't spend. In an economy like Braddock's, that kind of money really counts.
Braddock is an extreme case, but it's hardly alone in benefiting from the presence of a medical center. Nationwide, health care spending takes up something like 17 percent of the overall economy. The Iowa Hospital Association calculates that every hospital job there creates another two jobs elsewhere in the state's economy. The Cincinnati Children's Hospital estimates that for every dollar it spends leads to another $1.25 in economic value.
Massachusetts Governor Deval Patrick wants to help small businesses lower their health insurance premiums. The governor has proposed giving state insurance regulators more authority to review premiums before they go into effect and "disapprove rates if they are deemed unreasonable in relation to the benefits provided."
Patrick also wants to work with small businesses to establish cooperatives which would give them greater purchasing power and allow them bargain for cheaper rates. From the Boston Globe:
"The whole health care reform in Massachusetts had previously been centered around big government and big business,'' said Jon Hurst, president of the Retailers Association of Massachusetts, which represents many small businesses. "We're excited about it, because it puts the big insurers on notice that the administration, the regulators, are not going to put up with these double-digit increases anymore.''
Legislation passed in 2006, requires Massachusetts businesses with 11 or more full-time workers to offer health coverage or pay a penalty. The Health and Human Services Department says on average, small businesses pay up to 18 percent more than large firms for the same health insurance.
Ambulance, two x-rays, two specialists, a neck brace, two CAT scans and set foot = $300 in Turkey. (Tom O'Brien)
Tom O. writes:
My wife, Marion, and I traveled to Turkey this May, just to be tourists. Amazing country and the people could not be much greater. Marion did all the planning and the only thing I knew of health care in Turkey when we arrived there was that we did not need evacuation
insurance. Part of our Regence Blue Shield coverage includes reimbursement for out of pocket medical expenses abroad, I think the limit is $10,000, and this was considered sufficient.
We were staying for a few days in a the Kelebeck Hotel in Goreme, in Cappodicia. Marion became ill and had to stay in bed for a day, and was sick the next day as well. The manager was a man named Hasan who became my favorite Turk. I spoke to him about whether there wass a clinic in town. He did what little convincing was needed to get me to insist to Marion that she see a doc right away.
After a quick look in the mirror at a funny-looking mole, I decided I should make a call. The difference is that I've been living in Bangalore, India, for a little more than a year now, so my experience with the doctors and insurance companies was pretty different. First, there was no insurance involved. I have a catastrophic insurance plan basically just to keep me covered so I don't get denied for pre-existing conditions once I finally come home. At any rate, the health care costs in India relative to my income are so much less than in the States that I don't need insurance here.
The total cost for the original consultation with the dermatologist, the session where she removed three moles, and the pathology lab tests cost $61. This is about 19 percent of one month's salary of $325, which I would guess is roughly equivalent to that of an entry level position for a 4-year college grad in India or a diploma graduate (2 years college) with about 3-4 years experience.
I listened to podcast #101 about health care economics. I am a physician, OB/GYN in Upstate NY, and I feel you are missing the key facts in your health care coverage. In today's podcast you ask: "why do doctors and hospitals bill for high dollar amounts when they know practically no one pays this amount?" Your guest from Aetna says he doesn't know.
The answer is -- our contracts state we will receive the agreed upon amount or up to 75 percent of our fees, whatever is less. Therefore, in order for doctors to receive the maximum amount for our services under contract, we have to bill for a much higher amount. It is entirely driven by the health insurance contract. I would like to reduce my fees for uninsured, underinsured patients, but I risk the insurance companies challenging our fee schedule and reducing our payments.
I agree it is crazy, but we are relatively powerless to change it. The contracts are not negotiated. They are offered as a take it or leave it offer, unless you are the only specialist in your community and you can force a negotiation.
The Commonwealth Fund has rated Vermont, Hawaii and Iowa the top three states in terms of health care system performance. Louisiana, Oklahoma and Mississippi were rated the worst. The ratings are part of the group's second State Scorecord which measures performance based on access, quality, costs and health outcomes.
The group says the scorecard shows improvements made in care since 2007, but regional variation remains a serious problem.
Distinct regional patterns and sharp differences in performance across states--with some persistent gaps even in the best-performing states--attest to the reality that our health care system fails to provide reliable access to the affordable, effective, patient-centered, coordinated care that everyone should expect, given the large and growing share of the nation's economic resources that are invested in the health care sector.
After hearing Monday's podcast about medical billing, Dave Goldberg, a physics professor at Drexel University writes:
I enjoy your show every week, but Monday's episode, in particular, hit on something that's been bothering me for a while. While I understand the hospitals' motivations for charging a lower price to a particular insurance company than an individual, I don't understand why the federal government can't or won't introduce a law saying that medical services can't be charged at a different rate for different customers.
It seems like this would almost be a panacea. Much of the ruinous cost of being uninsured would be at least partially ameliorated. For that matter, the barrier to entry that allows individual regional insurance companies to enjoy a near-monopoly would be greatly reduced.
Why hasn't anyone floated such an idea?
The only objection I could think of is that both insurance companies and Medicare would end up having to pay somewhat more, since in essence they are being subsidized by individuals paying more for the same services.
Senator Kent Conrad's office was not pleased with our piece on health care cooperatives last week. Health care cooperatives are private, nonprofit insurance companies whose members vote on the board of directors. The health care overhaul bill by Sen. Max Baucus (D-MT) would create cooperatives across the country to compete with private insurers. In the radio segment, health reporter Keith Seinfeld and I struggled to understand how cooperatives could gain market share and contain health care costs.
Senator Conrad (D-ND), the main cheerleader behind health care cooperatives, felt we missed the point by looking at cooperatives in today's health care environment. His office writes that, coupled with other changes to the insurance market from the Baucus bill, cooperatives would stand a good chance:
The insurance market reforms included in the underlying bill will do a few things that make it more likely that co-ops will be able to start up: first, the individual mandate requiring all individuals to get insurance means that the risk profile of the market will be changed in a way that will help new firms enter the market. Currently, in the individual market in particular, it would be an incredibly highly risky undertaking for any firm to enter the marketplace, since generally the people who get insurance in the individual market today do so because they are sicker or older (and therefore need insurance). Younger, healthier uninsured individuals generally have stayed out of the market. The individual mandate will bring them in, making the pool less risky.
On Monday's podcast, we tried to help you sort through some of the vague and confusing parts of medical billing, like why does insurance pay only $400 when the charge says $1,200?
Now a new pilot program by Blue Cross Blue Shield and America's Insurance Health Plans will test a fix for the messy billing process. Working with state insurance providers, the national groups are launching websites in New Jersey and Ohio next month that promise a more streamlined system. The sites give doctors a single place to find all of a patient's insurance information. Columbus Business First spoke to Mark Jarvis, senior director of practice economics at the Ohio State Medical Association, about the plan:
Jarvis estimated doctors spend more than three hours a week each on office administration while their staffs spend more than 58 hours on a practice's operation. The administrative cost of the typical way of following eligibility and claims -- through fax transmissions and phone calls -- can add up to $8 per claim but the portal would slash the cost to $1 for a provider.
Ryan Bird writes that he's Canadian, so he's used to the ideal and the reality of government--provided universal health care. Now Bird lives in Taiwan, where he loves the system:
There are no waiting lines, as one can visit a specialist without a recommendation. There is one billing department, so bureaucracy is minimal. Everything is on smart cards, so the doctor knows what's up with you and the government keeps an eye out for abuse (privacy concerns, but Taiwanese give away information about themselves all the time, and they prefer the benefits). And the fact no one will ever go broke for health care, as a visit to any doctor never costs more than $6US. Stop at the dentist to get your wisdom teeth removed? $3US. Popping into a dermatologist to get a growth removed? $3US. Need a hearing test to make sure that your ears are OK after the fireworks festival? $3US. (I include these examples because they are actual costs that I've had or a friend has had.)
Matthew Kime, a freelance photographer and Web designer in Brooklyn, bought health insurance coverage through a freelancers collective. Kime writes from WNYC land:
I consider myself someone young and healthy so I didn't see a point in buying the expensive plans that most people are used to. I did a lot math. To come out ahead, I'd have to go to the doctor about once a month. In a given year, I'm unlikely to go to the doctor at all.
The plan itself is very simple. Under $10k, nothing is covered. I consider to be bankruptcy protection rather than healthcare. However, I do get the negotiated rate for services and that's where things get weird.
Eventually I did make use of the plan. About a year ago I was hit by a car while riding my bike. Thankfully I walked away from the accident.
Michael Green, from Minnesota Public Radio land, describes himself as an Obama supporter and no fan of the "public option" for health insurance. Green argues there's a better way to create competition than having the government start its own insurance plan. He writes:
Since I always enjoy your analogies on the program, I'll start with my own from the healthcare realm. My mother currently takes about ten different medications a day for a variety of reasons. When I asked her to walk me through why she takes each pill, it turned out that only a few were for true underlying medical needs. The rest were to counteract a side effect of the first few and some were to counteract the side effects of each other. I feel like the public option is in the later category.
I think the underlying issue that we are trying to address is lack of competition. So this begs the question "Why isn't there more competition in health care?" Since we are supposed to be in a free market, I'd turn the question and ask "What's broken such that there isn't NATURALLY more competition in health care?"
I found an EOB (explanation of benefits) statement from the insurance company in my mailbox in the foyer of my apartment building. Its contents left me half-shrieking and half-wailing in outrage. As I shook the envelope with its rustling plastic window in one hand, holding the horror of the EOB in the other, all thoughts of anyone being nearby vanished. I ignored the sidelong stares and raised eyebrows of my neighbors to focus on the neatly itemized bill for my fractures: nearly $6,000. My estimated share? Almost all of it.
As the world began to spin, I couldn't help but wonder, "If I swoon in the lobby and hit my head, will insurance cover that ER visit?" Then my eyes drifted to the actual description of charges. Surgery? Why was I being billed for a nearly $2,000 "surgical procedure," not once (and at a nonreferral penalty amount), but twice (denied the second time)?
We'll answer your questions on EOBs and other strange medical billing issues on an upcoming podcast.
The cost of health insurance is far outpacing inflation and the growth in wages in all 50 states, a new White House report says. President Obama has been making a case that the nation needs to overhaul its insurance system to gain control of the costs and give Americans better access to care. With today's release the administration strikes a simple and particular note, that the current situation is not fair:
Health insurance premiums are highly variable across the country, with states experiencing premium growth of between 90% to nearly 150% over the past decade. These differences lead to inequities for families and businesses as well as underlying differences in the uninsured across states.
In the same period, wages have grown by 38 percent, inflation by 28 percent. The portion of Americans with private insurance fell by 6 percent from 2000 to 2008. The White House report says that as a result, people with coverage are paying a "hidden tax of about $1,000."
The White House continued its campaign on HealthReform.gov with report about the cost of cancer. It cites a Kaiser Family Foundation survey showing that 22 percent of people with health coverage burn through their savings after a diagnosis of cancer.
The mezzanine of Bumrungrad Hospital in Bangkok. (Kate Raynes-Goldie/Flickr)
David M. writes:
I am an expat American architect living and working in Bangkok, Thailand. I have been following the US health care debate closely. Bangkok happens to have some of the best private hospitals in the region, and patients fly here from all over the world for excellent treatment at affordable costs.
I happened to go with a friend last evening to the top hospital for "health care tourists" in Bangkok called Bumrungrad. The place felt like a stylish luxury boutique hotel, literally. Starbucks on 2 floors, Au Bon Pain, state of the art everything, etc. US and UK trained physicians.
Economists pretty much agree that one reason for all the waste in the health care system is a simple lack of information. We just don't know which doctors are good, which order too many tests, which order the wrong tests etc. And the doctors don't know, either.
One reader mentioned an area of medicine where the that kind of information exists: the treatment of cystic fibrosis. That reminded Laura here of this great New Yorker article by Atul Gawande called "The Bell Curve" from 2004.
It's a fantastic and moving piece of writing. Cystic fibrosis patients at the best facility were living to age 46, but at average places only to age 30. That information proved incredibly powerful. Facilities that weren't so good tried to figure out why they weren't.
But the knowledge also created agonizing situations. Families wondered if they should move to get the best care. Doctors had good reason to question their own performace. Toward the end of the article, Gawande -- himself a physician -- asks the hard question: "What if I turn out to be average?"
As a side note, if you haven't heard Laura Rothenberg's radio diary about having cystic fibrosis -- "My So Called Lungs," -- I highly recommend it. It's one of those pieces that sticks in your gut for years.
Senator Max Baucus, chairman of the Finance Committee, has been getting some tough marks on his health care bill. Much of the criticism has focused on the bill's proposed insurance subsidies which are much lower than those proposed by the House. The Center on Budget and Policy Priorities does a great job crunching the numbers on how the subsidies will impact low- and moderate-income individuals. While James Kwak, over at Baseline Scenario points out that the lower cost of Baucus' bill may just be some tricky accounting. He writes:
One reason the Baucus bill is "cheaper" than the House bill is that it has lower subsidies. For illustration, let's assume that the whole $140 billion difference is due to lower subsidies. Relative to the House bill, then, the Baucus bill costs the government $140 billion less; but it costs middle-income people exactly $140 billion more, since they have to buy health insurance. The difference is that in the House bill, the money comes from taxes on the very rich; in the Baucus bill, it comes out of the pockets of the middle-class people who are getting smaller subsidies. Put another way, the Baucus bill is the House bill, plus a $140 billion tax on people making around $40-80,000 per year. That' s not only stupid policy; it's stupid politics.
Baucus says his bill will cost $860 billion over ten years, the Congressional Budget Office puts that number closer to $770 billion.
Senator Max Baucus just released the Senate's version of a health care reform bill. As expected it does not include plans for creating a new government-run insurance plan to compete against regular insurance companies.
This "public option" has been billed as a way to contain health care costs. But some economists don't see how that would work.
If you want to read an economic case in favor of the public option, check out this briefing by Jacob Hacker at Yale who has been called the "father of the public option."
You've been talking health care for average folks, but what about those of us who aren't average? There's a saying doctors learn in med school, "When you hear hoofbeats, think of horses," but every once in a while it turns out that what you hear is a zebra.
In medical parlance, I'm one of those zebras: I did a lot of running around getting all sorts of negative or inconclusive tests, until finally my naturopath got me on the right track that led to a good allergist/immunologist (after years wasted with a lousy one), who ordered an expensive ($500) and rare test, twice (second time at a
different lab to confirm, as results were almost too unusual).
Result? Turns out I have a random 1 in 10,000 immune defect (which she treated successfully with a protein vaccine, G-d bless her).
Before that was discovered, I had a lot of doctors treating me like a psychosomatic, since if they couldn't find anything wrong, it must be all in my head. And my concern is that calculations of false economy could result in zebras like me not getting the diagnoses and care that we need to get back to participating fully in life.
By false economy, what I mean is that, on the surface, we are an unfair drain on the system, getting a lot of expensive and inconclusive tests, taking a lot of expensive specialists' time. But in a larger sense, if you look at me not as an economic variable in the health care system, but rather as an economic variable in the greater economy of domestic production, by helping restore me to health, you're getting back many times the health care investment by restoring me to full economic productivity.
'Quality, Comfort & ROI': The return on your investment in the MSK Extreme MRI machine. (ONI)
By Chana Joffe-Walt
Say you're a doctor, hospital or group practice looking to offer MRI services to your clients. MRI machines are expensive. How do you know if it's worth it? You can tape this handy business plan from ONI Medical Systems to the back of the machine. Just use the machine on at least 10 patients a day and you can make $2.5 million over five years.
Take my mechanic's word for it: It's all good now. (Enlarge -- anyone heard of anti-rattle clips?)
By David Kestenbaum
We talked on the podcast about how economists sometimes compare doctors to auto mechanics, because in both cases you, the customer, suffer from a lack of information. If the doctor says you have Takotsubo cardiomyopathy, you:
a) have no idea what that is, and
b) say, "Fix it!"
The same goes with the auto mechanic. My wife and I just took our car in because it was making a rattling sound. The bill we got Friday says simply, "FOUND ANTI RATTLE CLIPS OUT OF PLACE." Cost: $82.
Really? The rattle was because our anti-rattle clips were broken? We trust these guys and paid the bill. But I always have this helpless feeling of not knowing.
Your insurance company, if you're lucky enough to have one, behaves like a monopoly. That's the picture in this map from the AP, and the argument from David Leonhardt in the New York Times today. Leonhardt writes that in the debate over health care, real choice is off-limits:
Health insurers often act like monopolies -- like a cable company or the Department of Motor Vehicles -- because they resemble monopolies. Consumers, instead of being able to choose freely among insurers, are restricted to the plans their employer offers. So insurers are spared the rigors of true competition, and they end up with high costs and spotty service.
I recommend Leonhardt's column this morning, which I so happen to be living in a small way. Since I'm about to get a little personal here, I'll put the rest of the story after the jump.
By now we've all heard about the money being wasted in our health insurance system. You'd think it would be in the insurance companies' interest to get rid of the needless spending. If they could do that, then they could charge lower premiums and attract more patients.
Lately at Planet Money, we've been asking why that hasn't happened. One answer is the insurance folks give us is that hospitals have been joining forces -- agreeing on protocols for treatment and presenting a united front. Insurance companies say that when they try to get hospitals to eliminate unnecessary tests or perform more efficiently or charge less for certain services, the hospitals just say no and there isn't much the insurers can do.
The insurance companies have some backing for their complaint. A study from 2004 by the Center for Studying Health System Change concurs that hospitals now often have the upper hand in these battles. One particular fight was referred to as a "sumo-wrestling match." The group's report from 2001 found showdowns erupting, with hosptials and health care providers willing to play chicken during negotiations.
Vice President Joe Biden and Health and Human Services Secretary Kathleen Sebelius at Mt. Sinai Hospital in Chicago. (M.Spencer Green / AP Photo)
By Caitlin Kenney
The government is handing over $1.2 billion in grants to help health care providers take their medical records digital. A huge chunk of the grants, $598 million, will go towards creating 70 Health Information Technology Regional Extension Centers, which will provide technical assistance to hospitals and doctors. Another $564 million will go to states to support to help them share patient information within and across state lines.
Vice President Joe Biden made the announcement today in Chicago alongside Human Services Secretary Kathleen Sebelius.
"With electronic health records, we are making health care safer; we're making it more efficient; we're making you healthier; and we're saving money along the way, "Biden said in the announcement in Chicago. "These are four necessities we need for healthcare in the 21st-century."
The U.S. has a long way to go before every American has an EMR (electronic medical record). David Blumenthal, the national coordinator for health information technology, says right now "only 20 percent of physicians and 10 percent of hospitals have meaningful electronic records." One notable exception is Massachusetts, a leader in EMRs, it's estimated that 30 to 50 percent of the Bay State currently uses them.
Hippocrates: his oath has had thousands of years of staying power. (Tony the Misfit / Flickr)
By David Kestenbaum
We talked on the podcast last week about how doctors occupy this strange position in the health care market. On the one hand they're like any sales person (most are paid on a fee-for-service basis) but on the other hand, we trust them to have our best interests at heart.
The Nobel economist Kenneth Arrow wrote about this in a famous 1963 paper analyzing the peculiarities of the health care market. He suggested that the reason we keep things like the Hippocratic Oath around and enforce a culture of professionalism among doctors is precisely because they have this financial incentive not to act in our best interests.
Here's a great interview with Arrow by Conor Clark at the Atlantic that got posted recently. And here's a modern version of the Hippocratic Oath with updated economics.
I will apply, for the benefit of the sick, all measures [that] are required, avoiding those twin traps of overtreatment and therapeutic nihilism.
Reading about health care economics can put even a caffeinated person to sleep so as I go I've been keeping a list of quotes. Not from the authors. Quotes used by the authors to try to lighten things up. Here are a few andwe welcome your additions.
The Doctor's Dilemma, George Bernard Shaw (1911) pointed out the obvious problem with the traditional fee-for-service approach: "that any sane nation, having observed that you could provide for the supply of bread by giving bakers a pecuniary interest in baking for you, should go on to give a surgeon a pecuniary interest in cutting off your leg, is enough to make one despair of political humanity."
House Democrats want the country's top insurance companies to reveal some intimate financial details including how much their top executives make and what their profits are. Information requests from the House Energy and Commerce Committee went out to the companies on Monday, with a deadline of September 14. It's still unclear which companies will cooperate but already the industry has showed some apprehension about handing over the information. Robert Zirkelbach is a spokesman for the group, America's Health Insurance Plans:
"This is a fishing expedition that is designed to silence the health-insurance industry," said Zirkelbach. "It's an effort to change the debate to focus on health insurers rather than focus on the solutions to the health care concerns that the American people have raised."
The letter sent to the companies asks them to name all employees who were paid more than $500,000 in a single year between 2003 and 2008. It also asks for details about corporate events held off site since Jan. 1, 2007.
Faced with low polling numbers, the White House is looking to take a different approach to selling health care reform. White House officials tell the Wall Street Journal the Obama Administration is shifting ts pitch for health care reform away from the minutiae of costs and insurance regulation, toward a more emotional appeal.
The president will test out the new approach during a conference call today with liberal religious groups and roll out the new emphasis to a wider audience as summer ends. One official says the new strategy focuses on speeches rather than the type of town hall events that have recently become so heated.
While the new strategy certainly won't bring in some of the more hardened conservatives, the New York Times reports that the Democrats are okay with that. This shift in strategy away from a primary Republican concern -- costs -- demonstrates what some see as a larger move away from bipartisanship. The new key, it seems, is to gain as much support from Democrats and independents as possible to pass reform.
The cozy relationship between doctors and prescription drug companies has long made people queasy. Remember all those free pens and mugs? Now with the health care reform debate in full swing, there are new questions about the financial ties between physicians and industry. Here's a bit from today's Washington Post:
You may not be able to trust your mortgage broker, your car salesman or your congressman, but you can trust your doctor.
Can't you?
Patients might well ask themselves this question when they learn that 94 percent of physicians have "a relationship" with the pharmaceutical, medical device or other related industries, according to a national survey of physicians published two years ago in the New England Journal of Medicine.
It is unclear how much those businesses spend on marketing overall, but Integrated Medical Systems, a research firm, estimates that pharmaceutical companies spend more than $20 billion annually marketing directly to doctors.
The group Pharmaceutical Research and Manufacturers of America says only 1.5 cents of every dollar spent on health care goes to drug company profits, but with outpatient prescription medicines making up 10 cents of every dollar spent on health care in the U.S., it's worth knowing exactly where that money is going. A new bill sponsored by Senators Chuck Grassley and Herb Kohl aims to do just that. The Physician Payment Sunshine Act would require drug manufacturers to report any payments of more than $100 made to a physician.
So the U.S. spends about $2 trillion a year on health care. We here have been trying to tally up how much of that people think is wasted, how much you could bring that down without reducing the quality of care. Where could we save money? Drug company profits? Unnecessary procedures? Fraud?
I had this little fantasy today that if I added up all the possibly exaggerated claims we'd end up with over 100 percent.
That doesn't seem to be the case, though the numbers are hard to find. Let us know if you see estimates out there. Here are a few (and a correction from our recent podcast.)
The notion that the administration was giving up on the public plan ruffled a lot of feathers on the left. Even if it's apparently back on the table, there's going to be huge hurdles to passing it. Yesterday, Democratic Senator Kent Conrad, a ranking member of the Senate Finance Committee, said that there simply aren't enough votes in the Senate in favor of the plan. His committee is likely to endorse a regional health-care co-op program.
If you're confused about what these co-ops are all about, there's a great explainer over at Reuters. In short, these co-ops involve a form of health insurance wherein all policyholders have some ownership rights, and, more importantly, don't have to worry about turning a profit. The government would provide money to help set up national, state, and regional co-ops. However, co-ops already exist, and few have managed to be successful competitors to major insurance companies. If the point of a public plan is to provide a viable, competitive, nonprofit alternative to private insurers, co-ops may not be able to cut it.
Health Care Bluebook describes itself as a guide to the going rate for specific health care services in various parts of the country. Insurance companies have been complaining about big, arbitrary-seeming bills from medical providers.
With Health Care Bluebook, just type in the service you're looking for and your ZIP code, and the "private and independently owned resource" spits out a price. Consumerist took it for a spin:
I tried "nasal endoscopy," a procedure that my New York doctor recently billed about $400 for. According to the Blue Book, the standard cost for this in my area is $386. So my doctor's price is about right. If my doctor charged $800, however, I could print out the estimate on the Blue Book site and use it to haggle with my doctor.
President Obama wants to make electronic medical records a key part of his health care reform. Yesterday at his town hall address in New Hampshire, he called them "a sensible thing to do." But as the current battle over these records in the U.K. shows, figuring out a system may be harder and more expensive than it looks.
The U.K.'s plan to create a single database known as the "spine" has been plagued by cost overruns and delays. In 2008, the company contracted to build the database was fired after a contractual dispute, a new IT services provider has since taken their place.
It's easy enough to guess -- or find out -- the price of a gallon of milk or a loaf of bread or even a house. With medical procedures, that's far, far from the case. "It's the wild, wild West when it comes to prices of anything in the U.S. health care system, whether for a doctor visit or for hospital charges," Dartmouth health economist Jonathan S. Skinner tells the New York Times. The Times reports on a new survey by America's Health Insurance Plans, which finds that insurance companies are just as sick as consumers of getting hit with very big bills.
Opposing the Obama plan in Portsmouth, N.H. (Jim Cole / AP Photo)
UPDATED By Laura Conaway
At a town hall meeting in Portsmouth, N.H., President Obama took a question from schoolgirl Julia Hall of Malden, Mass., telling her his plan won't "pull the plug on Grandma."
Key bit: Obama said of rationing care:
"Right now, insurance companies are rationing care. They are basically telling you what's covered and what's not. They're telling you, 'We'll cover this drug but we won't cover that drug. You can have this procedure or you can't have that procedure. So why is it that people would prefer having insurance companies make those decisions rather than medical experts and doctors figuring out, you know, what are good deals for care and providing that information to you as a consumer and your doctor so you can make good decisions?"
Not a helicopter: the 1997 Geo Prizm. (Edmonds.com)
By Laura Conaway
Friday's podcast about health care included the story of a doctor who'd asked his hospital for a helicopter to use in commuting. That struck Ronald Meyer of WBEZ land as ridiculous, on our part. He writes:
As one who has listened to virtually every podcast since you began last autumn, I can tell you that the foolishness over the helicopter rides for the doctor was not up to your usual standards. Imagine having a show about journalism, and focusing only on the most abject plagiarism. I believe you spent about 10 min acting as though all doctors commute in helicopters. Not true.
I am an anesthesiologist in suburban Chicago in my 26th year of practice. I commute in a 12 year old Geo Prizm. I typically awaken at 5:10 AM so I can get to work and make sure everything is safe for my 7:00 or 7:30 case. The hospital I work at is pleasant, but all they give us is a 9x15 "office" for members of our 16 person group to hang out between cases. An adjoining room is just big enough for a bed for the days I spend 24 hrs there.
Whatever you make of the current debate on overhauling health care in the U.S., the news out of California today is bracing. California Gov. Arnold Schwarzenegger signed a budget package that closes his state's $26 billion funding gap, but not before making a last round of cuts worth $656 million. From AP:
Schwarzenegger made cuts to child welfare, health care for the poor and AIDS prevention. . . . He called the package "the good, the bad and the ugly."
Schwarzenegger said the cuts were necessary to build up the state's reserve fund after the state Assembly blocked a plan to use local transit funds and drill for oil of Santa Barbara.
Before today's cuts, Anthony Wright, executive director of the advocacy group Health Access, called the budget "the biggest rollback of coverage in state budget history," according to the LA Times.
Everyone has an answer for dealing with America's health care crisis. Among the latest: franchise it. Dr. Scott Burger and his two business partners in Maryland are hoping to turn their urgent care center into a national operation with 3,000 centers around the country. Urgent care centers typically fill the gap between emergency rooms and primary care practices, treating acute illness or injury in clinics and keeping extended hours. USA Today reports:
"The emergency room crisis and lack of primary-care physicians is not a problem isolated to New York City, where I used to work, or Maryland. ... This is a national problem," Burger says. "We felt it was something we wanted to bring across this country, and [franchising] has proven to be the most effective way to grow a brand in a quick fashion."
Burger has spent the last few years practicing at Doctor's Express, his clinic in Towson, Md., where he has been figuring out the equipment and strategies needed for franchised care.
"In about 35 minutes, we can see the patients, take the X-ray, diagnose the problem, splint the broken bone," Burger says. "It's about efficiencies."
In "The Hunt For Affordable Health Insurance," NPR's Howard Berkes explores the world of insurance brokers. We're gearing up for a round of coverage on the economics of health care and health care reform. Like so much of modern life, it's complicated -- maybe too complicated.
I am a GenXer, and sometimes hear people in my parents' generation complaining about how we can't manage our finances. I think when it comes to personal finance, there really was a "good ole days." We have to deal with complicated insurance policies, student loans, mortgages.
My aunt opened a safe deposit box for a deceased relative and showed us the one legal size page document from the 1970's that constituted the purchase of her house! I want to spend my time with my family, my career, and things I like to do rather than on picking up personal finance tips. More financial education for young people is NOT the answer -- I don't want my kids wasting any precious time learning about financial traps when the rules are constantly changing. I'm highly educated and fall into traps myself.
