Medicare: Coming Accessibility Crisis

In 1995 I started teaching a series of health education programs for Elders known and well-respected as "Healthy Options".  The program originally were sponsored by Secure Horizons and later were offered at community colleges, for business and government, as well as community organizations. One of the most popular versions was "Healthy Options for Seniors".  I even had 'groupies' that would go from place to place to hear me speak.  Of course this is what I have been advocating for decades, learn what you can do for your health, and please learn it from the best resources!   Learn more about "Healthy Options"

Access to medicine in question for future Medicare patients who suffer from disabling hip and knee arthritis

ScienceDaily (2010-06-01) -- Healthcare reform -- and the many options for fixing a broken system -- have appeared in the news headlines for months. According to a new article, Medicare patients -- many who suffer from disabling arthritis of the hip and knee, among other age-related ailments -- may end up facing an accessibility crisis to medical care. ... > read full article

Thinking Required

Yes, Globalization is a Factor in Health Reform -

Please carefully consider the points raised in this article, make a point to read it.

New Health Law Brings More From Big Insurance Lobbyists

If you haven't quite figured out that Big Insurance is acting to protect Big Insurance under alleged "health reform" then you should refer to other posts on Natural Health News that explain how there were numerous back office deals with Obama and this industry prior to bill passage.

Most of what has changed will do very little to improve health care quality of service, and you should be watching at every step.

Health Insurance Companies Try to Shape Rules
By ROBERT PEAR

WASHINGTON — Health insurance companies are lobbying federal and state officials in an effort to ward off strict regulation of premiums and profits under the new health care law.

The effort is, in some ways, a continuation of the battle over health care that consumed Congress last year.

Insurance lobbyists are trying to shape regulations that will define “unreasonable” premium increases and require them to pay rebates to consumers if the companies do not spend enough on patient care.
For their part, consumer groups say they worry that their legislative victories could be undone or undercut by the rules being written by the federal government and the states.

The health care overhaul provides a classic example of how the impact of a law depends on regulations needed to interpret it. The rules deal with relatively technical questions but go to the heart of the law, pushed through Congress by President Obama and Democratic leaders with no Republican support.
More than 40 provisions of the law require or permit agencies to issue rules. Lobbyists are focusing on two whose stated purpose is to ensure that consumers “get value for their dollars.”

One bars insurers from carrying out an “unreasonable premium increase” unless they first submit justifications to federal and state officials. Congress did not say what is unreasonable, leaving that to rule writers.

Another provision, effective Jan. 1, requires that a minimum percentage of premium dollars be spent on true medical costs related to patient care — not retained by insurers as profit or used to cover administrative expenses. Insurers must refund money to consumers if they do not meet the standards, known as minimum loss ratios.

Michael W. Fedyna, vice president and chief actuary of Aetna, underlined the importance of this issue, saying no other aspect of the law would be so “influential in shaping the future of the health care marketplace in the United States.”

The definition of medical loss ratio will “determine the willingness of health plans to enter new markets and remain in existing markets,” he said.

Senator John D. Rockefeller IV, Democrat of West Virginia, said the definition would be just as important for consumers and small businesses.

“The health insurance industry has shifted its focus from opposing health care reform to influencing how the new law will be implemented,” he said.

The law requires insurers to spend a minimum percentage of premiums on health care services and “activities that improve health care quality” for patients.

Insurers are eager to classify as many expenses as possible in these categories, so they can meet the new test and avoid paying rebates to policyholders.

Thus, insurers are lobbying for a broad definition of quality improvement activities that would allow them to count spending on health information technology, nurse hot lines and efforts to prevent fraud. They also want to include the cost of reviewing care by doctors and hospitals, to determine if it was appropriate and followed clinical protocols.
Some consumer advocates, like Carmen L. Balber of Consumer Watchdog, favor a strict, narrow definition of quality improvement activities, limited to those that produce measurable benefits to individual patients.

Alissa Fox, a senior vice president of the Blue Cross and Blue Shield Association, said that if the definition is too narrow, “health plans will come under enormous pressure to cut back quality improvement activities, including highly effective programs to reduce hospital infection rates.”

But Charles N. Kahn III, president of the Federation of American Hospitals, a trade group, said he feared that the quality improvement category would become a “catchall for a wide variety of expenses not directly related to patient care.”

Under the new law, insurers in the large group market are generally supposed to spend 85 percent of customers’ premiums on “clinical services” and quality-enhancing activities. The minimum is 80 percent for coverage sold to individuals and small groups.

Insurers and insurance regulators say that some companies will be unable or unwilling to meet the new standards. http://www.nytimes.com/2010/05/16/health/policy/16health.html?ref=health

Another Health Reform Bill Conundrum

As I understand it, hidden deep inside the 2700 or more pages of the recently passed health bill is a small detail I think my readers should know.

As you may know the issue of pre-existing conditions was a major PR focus in the efforts to ram this bill through Congress, and get the citizenry to think they were really getting something.

What's missing is this tiny detail I fell upon in the past day or so about exactly what happens to one of the Big Insurance carriers that will be allowed in the "pool" to sell you something that will continue to give their CEO at least $13 million a year in salary without perks.

And you might end up not getting your claims paid if you happen to have one of these items, obscure and otherwise, deemed "pre-existing" by insurance profiteers.

It just so happens that whomever has been writing this bill, and of late it always seems that industry is writing the legislation, they sure seem to favor industry over Joe or Jane Citizen.

The slap on the hand for denying coverage for "pre-existing" is a paltry $100 a day. To Big Insurance the $100 a day fine doesn't even measure up to pocket change.

In the interim, you or a loved one could die.

Don't you think it might be a good idea to start taking back responsibility for your health?

See also "health care problem is far from solved"

United Steel Workers Blog and Health Reform

USW Blog

Healthcare law full of unknowns

Thom Hartmann did a good explanation of some of the points in the new mega bill that give you some clues into how the dark forces are at work in this bill.

Another point to consider is that Medicaid usually pays about 60% of costs and Medicare pays about 80%. With these figures in mind, is it a wonder that doctors aren't accepting or are cutting back on providing care to these people.

Perhaps the omen is that we need to do a better job of taking care of our selves and our health needs, just like it used to be.

And you can do it!

About the only thing Dr. Philip Schwarzman can be sure of under the national healthcare overhaul is that he is adding his daughters, ages 23 and 25, to his health plan immediately.

Much less clear to Schwarzman is how the sweeping law will affect the emergency department at Providence St. Joseph Medical Center in Burbank, where he is medical director.

"It's incredibly complicated," said the white-haired physician, whose department sees 50,000 patients a year. "It's hard to predict what's going to happen."

That pretty well sums up the Patient Protection and Affordable Care Act. Potential effects of the law, passed last month, can be described as profound and prosaic, obvious and unknowable.

Some of its most complex and far-reaching changes won't take effect for years, including the requirement that, by 2014, all Americans have health insurance. But the law also contains immediate changes, such as the one allowing parents to add or keep dependent children up to age 26 on their health insurance policies.

Over the next decade, many of its consequences will play out at places like St. Joe's, a 431-bed nonprofit hospital founded by the Sisters of Providence in 1943, and in surrounding community clinics.

Article continues here -

Related article here on the state of Social Security

Kiplinger reports as well...

More to consider re: Health Reform

A time to consider taking responsibility for your health.  You can do it!

Seniors wary of health overhaul impact on Medicare

N.Y. Times columnist: Death panels will save 'a lot of money'

Health Care Battle Ends; War on Social Security Begins 

Refer to this article for more information.

Why Insurance Reform Doesn't Get You Better Health

Senator Lieberman who is holding positive movement on insurance reform in limbo may have reason to be concerned, especially where women's health is concerned.

It seems as if the controversy over Hadassah Lieberman, the Senator's wife, is on the payroll of the Komen Foundation to the tune of about $300K a year.  Gary Locke's wife is on their payroll too, most likely lobbying while she's living in DC.

The problem with this is that Komen has no interest in CHANGE. For them it is PhRMA all the way, along with cancer promoting mammogram.

It might be why there is no effort to do more for prevention or more for research into the known environmental causes of cancer.

Nancy Brinkerman, CEO and sister of Susan Komen, is also suspect because she is on some PhRMA director's boards.

Do you wonder why the so-called health reform effort and the "race for the cure" keep circling the wagons and make deeper ruts?

Health Lobby Fights Against Progress with $$$

If you aren't aware that the health insurance reform bills aren't being bought, here's an update on how the battle is moving from Congress payoffs to the state level -

" Insurance companies, hospitals and other health care interests have been positioning themselves in statehouses around the country to influence the outcome of the proposed health care overhaul. Around the 2008 election, the groups that provide health care contributed about $102 million to state political campaigns across the country, surpassing the $89 million the same donors spent at the federal level, according to the institute. " Health Lobby Takes Fight to the States

Affordable Health Care

As we listen to the progaganda on health reform today remember that a worker in New Hampshire pays $8000 more than their Member of Congress for health insurance.  They also have to pay a tax on it.

If you don't inderstand that this so-called "health reform" activity is more about payoffs to Big PhRMA and Big Insurance then you aren't on track with what is actually happening.

There is no change and there is no health reform.

Make sure you let your representatives know what you think!

Taxol Boosts Odds of Chronic Pain

More drugs needed to deal with pain following Taxol?  I guess no one is questioning the impact of these drugs, just another source of higher health cost.

Breast cancer patients getting the chemo drug may suffer long-term neuropathic discomfort, study finds
MONDAY, Nov. 30 (HealthDay News) -- The chemotherapy drug paclitaxel (Taxol) increases the risk of chronic neuropathic pain in breast cancer survivors, a new study shows.

It included 240 women who took part in clinical trials of Taxol between 1994 and 2001. Those who experienced chemotherapy-induced peripheral neuropathy during their treatment with Taxol were three times more likely to eventually be diagnosed with chronic neuropathic pain.

The study is published in the November issue of the Journal of Pain.

The findings indicate that patients treated with Taxol should be regularly monitored for neuropathic pain after their chemotherapy ends, said the researchers from the University of Texas M.D. Anderson Cancer Center.

In certain cases, patients and doctors should review the risks and benefits for continuing treatment with Taxol if a patient is likely to experience worsening neuropathy, the study authors added.

They noted that the same cellular mechanism that's altered by Taxol to kill tumors can be toxic to normal tissue.

People Who Read This Also Read
10 Health Habits That Will Help You Live to 100
Long-Term Problems Linked to Testicular Cancer Chemo

Aetna cuts 650,000 health policies to raise profit

At the same time Senate Republicans forced Democrats to vote in favor of cutting billions from providers of home care for older people, profit motive revealed to be more important than delivering service, an Aetna philosophy for years.  Now Aetna plans plan to do it again in 2010, and I guess these policy holders will become more of the masses of uninsured.

See the "Insurance Puppets" in Congress

article by Sam Stein

Health insurance giant Aetna is planning to force up to 650,000 clients to drop their coverage next year as it seeks to raise additional revenue to meet profit expectations.

In a third-quarter earnings conference call in late October, officials at Aetna announced that in an effort to improve on a less-than-anticipated profit margin in 2009, they would be raising prices on their consumers in 2010. The insurance giant predicted that the company would subsequently lose between 300,000 and 350,000 members next year from its national account as well as another 300,000 from smaller group accounts.


"The pricing we put in place for 2009 turned out to not really be what we needed to achieve the results and margins that we had historically been delivering," said chairman and CEO Ron Williams. "We view 2010 as a repositioning year, a year that does not fully reflect the earnings potential of our business. Our pricing actions should have a noticeable effect beginning in the first quarter of 2010, with additional financial impact realized during the remaining three quarters of the year."Aetna's decision to downsize the number of clients in favor of higher premiums is, as one industry analyst told American Medical News, a "pretty candid" admission. It also reflects the major concerns offered by health care reform proponents and supporters of a public option for insurance coverage, who insist that the private health insurance industry is too consumed with the bottom line. A government-run plan would operate solely off its members' premiums.

Aetna actually made a profit in 2009 but not at levels that it anticipated.

"They were surprised by an acceleration in medical costs in 2009 which pressured their earnings," Josh Raskin, an industry analyst for Barclays Capital, told the Huffington Post. "In an effort to get back to a more profitable level, they are raising their prices to match cost trends. When you raise rates, you run the risk of losing your membership. Health insurance is a very competitive marketplace."

As Williams told investors on the call: "The pricing that we put in place for 2009 turned out to not really be what we needed to achieve the results and margins that we had historically been delivering."

Aetna is one of the largest insurers in the private market, covering roughly 17.7 million people according to its 2008 annual report. It is also a major player in the current health care debate and inside Washington D.C. The insurance company has spent more than $2 million on lobbying just in 2009, according to the Center for Responsive Politics.

American Medical News, which first reported the story, noted that this is not the first time the insurance giant has cut the rolls in an effort to boost profit margins. "As chronicled in a 2004 article in Health Affairs by health economist James C. Robinson, MD, PhD, Aetna completely overhauled its business between 2000 and 2003, going from 21 million members in 1999 down to 13 million in 2003, but boosting its profit margin from about 4% to higher than 7%."

A spokesperson at Aetna did not return calls and emails for comment.

Lawmakers have wooed seniors into the hole

Readers should not that Obama made a deal with Big PhRMA to reduct the donut hole, not to close it.  What needs to happen is for the Plan D to be eliminated and go back to co-pay along with price negotitation.  As long as Obama is bought off by Big PhRMA there will never bee price negotiation in Medicare.

All this political nonsense harms people who have been made captives through drug advertising and doctor pay-offs to Rx specific drugs.  And for a minute, don't forget AARP sold out Seniors on this drug plan and are doing the same in health reform because they have to much to lose in their close deal with United.

Why not give this woman supplements that we know help memory issues and cover these?  Sure would save a million or much more on health costs and would not require Big Ins demands for lower medicare reimbursement.

It's a racket Magee!  Don't ya see?

Note too that some drug companies want the sales of their drugs so badly they will help you cover the costs.

'Doughnut hole' unites seniors wary of health bill

By MATT SEDENSKY, Associated Press Writer
Fri Dec 4,

MIAMI – Lawmakers have wooed seniors skeptical of the health care overhaul by emphasizing the plan would close the "doughnut hole" — a gap in Medicare drug coverage that can cost thousands of dollars a year.

But getting support for the entire overhaul from this powerful voting bloc has been difficult, despite Democrats' repeated mentions of the issue in town hall meetings, interviews and congressional hearings.

Janet Cohen, 75, would like to see the doughnut hole closed, but like many, she still is uncertain about the health bills.

Cohen and her 97-year-old mother are both in the doughnut hole because their out-of-pocket drug costs exceeded $2,700 this year. Rather than just a copay, each one now must foot the entire cost of their medications for the rest of the year, or until their annual spending reaches $4,350, which isn't likely to happen. If it does, the government will again subsidize the costs.

The Cohens, who live just north of Miami, are both on Social Security and eating through savings. Janet Cohen just learned she was in the doughnut hole when she went to pick up her supply of Aricept, which she takes for memory loss. Instead of the copay, she was charged nearly $200.

"I can't afford my medicine, is it OK if I miss like one month?" she asked the pharmacist.

He suggested taking the drug every other day, but said the effectiveness could be compromised.

Medicare Part D established a new prescription drug benefit in 2006. The doughnut hole was designed to reduce the overall cost of the program. An estimated 3.4 million seniors fall into it each year.

Most people never see the other side of the doughnut hole. They simply wait for New Year's Day. The House health care bill would close the gap gradually until it's eliminated in 2022.

There are about 39 million people aged 65 and older in the U.S. and they voted at a higher rate than any other age group in the 2008 election, according to the Census Bureau. The 40-million-member AARP has endorsed the House's version of the bill, but voters aren't yet sold on the plan.
The latest Kaiser Health Tracking Poll, released last month, found just 32 percent of those 65 and older believed passage of a health bill would leave them and their families better off, compared with 44 percent of respondents under the age of 65.

When asked about elements of the health overhaul plan that are "extremely" or "very" important, the doughnut hole was the No. 3 issue for Republicans, and No. 4 for both Democrats and independents.

Rep. Kathy Castor, D-Fla., saw a summer town hall meeting become a shouting match. In subsequent visits to senior centers, constituents expressed worry their Medicare costs would increase or that they would no longer be able to see their doctors.

The doughnut hole, she said, has helped garner support for the overhaul.

"It's easily understood that eliminating the Part D doughnut hole will put cash back into the pockets of seniors who need it desperately," she said.

Some will grovel to avoid the doughnut hole. Maida Genser meticulously keeps track of her 72-year-old husband Morton's drug costs, trying to determine when he'll hit the threshold for his numerous pills to control diabetes, blood pressure and other problems.
As the limit approached in October, 66-year-old Maida had a strategy: "I just kept begging different doctors for samples."

Others aren't sure what to do. Evodkia Kresch, 83, takes pills for glaucoma, diabetes and heart problems and has been in the doughnut hole for several months. She grew up in Ukraine and lost her parents and six siblings in the Holocaust. Her husband died two years ago and she lives off a Social Security check of about $1,300 a month. She doesn't have much hope things will change in Washington.

"They talk, they talk," she said. "But I need to live. And they just talk."

A recent round of refills cost her $412. She paid for them with her meager savings.

"I never asked the government for a penny. I came and I worked every day and I don't know what to do," she said, slipping into a soft sob. "It's terrible. I don't know what to do. I come back and I cry."

http://news.yahoo.com/s/ap/20091204/ap_on_bi_ge/us_health_overhaul_prescription_drugs/print

Politics as usual in health debate

Top 10 Health-Care-Reform Players

As President Obama ramps up his efforts to overhaul the country's health-care system, these are the personalities on both ends of Pennsylvania Avenue who will most likely determine whether he succeeds or fails.  Read more

Drugmakers' Payments Draw Heat

Following its settlement of kickback allegations with Omnicare, the Justice Dept. continues to probe Johnson & Johnson.  Read more

Where Did Health-Care Reform Go?

What about President Obama's pledge to pass a measure that reins in the larger forces driving up health care costs? Or his vow that a reformed system would deliver more-efficient care, with better results for patients? That's where the legislation could fall well short of the promises. Read More

Who Really Benefits in the Health Overhaul

Some questions and answers on the House-passed bill and the version the Senate will begin debating in the week ahead; both measures were written by Democrats  - for the full article...

Health overhaul: Understanding the pros and cons

By Associated Press Writer Ricardo Alonso-zaldivar, Sat Nov 28

WASHINGTON – Maybe you've been reading the health care bill in your spare time. Then perhaps you can answer this question:

If Congress makes history and puts a bill on President Barack Obama's desk by Christmas, how long before the uninsured get medical coverage?

If you said three years or more, you'd be right. Yet many people don't realize that to keep costs down, lawmakers made compromises that might not appeal to consumers.

"There's going to be a long period of great expectations and very modest deliveries," said economist Robert Reischauer, president of the Urban Institute public policy center. That's assuming Democrats prevail.

Photo courtesy Jeff Rense

Microchip included in Health Bill ?

UPDATE: 3/30/10 - Current speculation is that the chip provision has been removed, or at least reference to mandatory compliance. It is prudent,IMHO, to be diligent in your observations, and fail to yield to diversionary tactics so this does not become and oversight.

ORIGINAL POST:11/15/09
Microchipping included in Healthcare Bill ?

“Buried deep within the over 1,000 pages of the massive US Health Care Bill (PDF) in a “non-discussed” section titled: Subtitle C-11 Sec. 2521— National Medical Device Registry, and which states its purpose as:

"The Secretary shall establish a national medical device registry (in this subsection referred to as the ‘registry’) to facilitate analysis of postmarket safety and outcomes data on each device that—‘‘(A) is or has been used in or on a patient; and ‘‘(B) is a class III device; or ‘‘(ii) a class II device that is implantable.”

In “real world speak”, according to this report, this new law, when fully implemented, provides the framework for making the United States the first Nation in the World to require each and every one of its citizens to have implanted in them a radio-frequency identification (RFID) microchip for the purpose of controlling who is, or isn’t, allowed medical care in their country.

waysandmeans.house…

Bravo to the Brave Members of Congress Who Voted NO

UPDATE:  While Pfizer is taken to task for its erroneous ways, members of Congress may be in the same pack -

EVIDENCE OF PhRMA’S SWEET DEAL – TNR’s Jonathan Cohn reports: “Critics have complained that a drug industry got a sweetheart deal when it struck a bargain with the White House and Senate Finance Committee over health care reform. There’s new reason to think those critics were right. It comes from an October forecast by IMS Health, a respected global research and consulting firm. The report, which IMS distributed to clients and which a source provided, projects that the drug industry will see average annual growth of 3.5 percent between 2008 and 2013. Back in March, IMS had projected no growth at all during that same five-year stretch. In fact, it projected the drug business would actually contract slightly--with negative annual growth of 0.01 percent. What changed? A major factor, according to IMS, was the emerging details of health care reform.”

-------------------------------------------------------------------------------------------------------------

If you aren't aware that Pelosi's latest FOC bill, HR 3962, is just another handout to Big Insurance and Big PhARMA then you aren't paying close enough attention.

The main policy difference between then and now is that the House and Senate bills require individuals to buy health insurance. The requirement is in there because it was demanded by the insurance industry; it assures them of tens of millions of new customers, many of whom will be relatively young and healthy. Read the rest of this article

This 1993 page bill contains some things that may end up creating, once again, zero sum change -

Today, Ranking Member of the House Ways and Means Committee Dave Camp (R-MI) released a letter from the non-partisan Joint Committee on Taxation (JCT) confirming that the failure to comply with the individual mandate to buy health insurance contained in the Pelosi health care bill (H.R. 3962, as amended) could land people in jail. It is made clear that Americans who do not maintain “acceptable health insurance coverage” and who choose not to pay the bill’s new individual mandate tax (generally 2.5% of income), are subject to numerous civil and criminal penalties, including criminal fines of up to $250,000 and imprisonment of up to five years.

Camp said: “This is the ultimate example of command-and-control style of governing – buy what we tell you or go to jail. It is outrageous and it should be stopped immediately.”

Key excerpts from the JCT letter appear below: “H.R. 3962 provides that an individual (or a husband and wife in the case of a joint return) who does not, at any time during the taxable year, maintain acceptable health insurance coverage for himself or herself and each of his or her qualifying children is subject to an additional tax.” [page 1]

“If the government determines that the taxpayer’s unpaid tax liability results from willful behavior, the following penalties could apply…” [page 2]
“Criminal penalties - Prosecution is authorized under the Code for a variety of offenses. Depending on the level of the noncompliance, the following penalties could apply to an individual: Section 7203 – misdemeanor willful failure to pay is punishable by a fine of up to $25,000

And I am pleased to know that Dennis Kucinich, D-Ohio, had this to say after he cast his NO vote:

But instead of working toward the elimination of for-profit insurance, H.R. 3962 would put the government in the role of accelerating the privatization of health care. In H.R. 3962, the government is requiring at least 21 million Americans to buy private health insurance from the very industry that causes costs to be so high, which will result in at least $70 billion in new annual revenue, much of which is coming from taxpayers. This inevitably will lead to even more costs, more subsidies, and higher profits for insurance companies—a bailout under a blue cross.  Read complete article

And did you stop to question why the IRS is involved in this debate?