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Health Care Under Your Control

Health Savings Accounts (HSAs) may be the smart choice, according to the 28 May issue of BusinessWeek.

Only 12% of companies with 1,000 or more employees offer HSAs.  The insurance component is a catastrophic policy that must, by law, have a $2,200 minimum family deductible and an out-of-pocket limit of $11,000.  According to the Kaiser Family Foundation and Health Research & Educational Trust, the average deductible for a family is $4,000.  The most a family can contribute to the tax-sheltered account is $5,650 a year.  If you change jobs or retire, the account goes with you.

HSA contributions are made with pretax dollars and withdrawals are tax-free as long as the money goes toward qualified medical expenses.  The money is usually parked in a bank-like account and beneficiaries receive a checkbook or debit card for paying bills.  HSAs are like flexible spending accounts (FSAs) except that with FSAs, you forfeit what's not spent in a calendar year while unused HSA money rolls over.  In addition, some 82% of high-deductible HSAs fully covers preventive care to encourage sound medical habits, immunizations, well-child care, and annual physicals and mammograms.

Many plans allow participants to invest in a variety of securities, including certificates of deposit, stocks, bonds, and mutual funds.  Overall, however, consumers who want to spend their health-care dollars wisely still lack good information to compare the cost and quality of physicians, procedures, hospitals, and health plans.■

Clinton Healthcare Reform Redux

On 24 May, Senator Hillary Clinton (D-NY) launched her latest attempt at healthcare reform.  At George Washington University, Clinton laid out her plans to reduce the cost of health care for all Americans.

Clinton called the current health care system broken and itemized a 7 point plan, including:

• focus on prevention and wellness
• implementation of electronic medical records
• increased use of chronic disease management medical homes
• individual and small business access to larger insurance pools
• improving quality of care
• lower prescription drug cost through increased use of generics
• medical malpractice reform

Despite none of the seven points being new or ground-breaking, Clinton rightly states that reform efforts will meet with considerable opposition.  She also rightly accepts the need for political consensus if reform is to be achieved.

As each candidate's healthcare reform initiative takes shape, BLOG Medicine is preparing a comparison to share with you so that we can all make the most informed decision.■

$650 Million in Emergency Funding Proposed for SCHIP

The emergency funds were included in a $120 billion war spending package, over initial objections by the White House, and is expected to win President Bush's signature by the end of the week.  The House and the Senate are expected to vote on the package this week.

Georgia was $131 million short and had frozen enrollment in PeachCare plan in March.  Iowa was about to drop 13,300 from the state's Hawk-I plan.  North Carolina, Alaska, Illinois, Maine, Maryland, Massachusetts, Minnesota, Mississippi, Nebraska, New Jersey, Rhode Island, and Wisconsin also have budget gaps.

SCHIP's current budget is $5.5 billion and Democrat's have proposed nearly tripling that amount.■

State Senate Decides Maine Should Go Into the Health Insurance Business

State of Maine lawmakers have decided the wisest route for the failed Dirigo Health program is to venture yet further into health insurance with a self-insured plan.  The bill, supported by Governor John Baldacci, was approved by an 18-16 vote, but faces further House and Senate votes.

As a self-insured plan, the risk pools and reserves of Dirigo Health and any public purchaser may not be commingled.  Self-insured health insurance is normally undertaken by only the largest of employers, primarily because they have both a sufficiently large risk pool and are financially able to withstand catastrophic cases.  Due to the complexities involved, such plans are most often administered by contracted third-parties such as Anthem, Aetna, CIGNA Healthcare, and the like.

The Dirigo program, which was created in 2003 to move Maine toward universal health care has failed to meet enrollment expectations and has been plagued with funding disputes finally settled via the courts and judicial appeal process.

In passing this latest proposal, Maine lawmakers, clearly unable or unwilling to differentiate between what they want and what state residents need, are once again playing free and loose with state monies that residents can ill-afford to see misused.  Baldacci submitted a package of Dirigo changes, which includes milestones for mandated coverage for individuals and businesses that remains in committee.■

Peanuts and Popcorn and Arthroscopic Surgery?

A recent Boston Globe article reported that the New England Patriots, Massachusetts General Hospital, and Brigham And Women's Hospital have partnered in a new sports medicine clinic in Foxborough, part of the Patriot Place complex the Kraft family is building around Gillette Stadium.

The plan has been generally well-received, but isn't sitting well with everyone.  Some community hospitals view the partnership as yet another attempt by Boston's academic medical centers to strip the highest paying services, such as MRIs and outpatient surgical procedures, out of local hospitals.

The Foxborough facility completes a competitive horseshoe around the greater Boston area by Partners HealthCare, the parent company of Mass General and Brigham, that will draw patients from as far south as Rhode Island.  The facility will be approximately half the size of a small community hospital, but provide care in some of the most lucrative specialties.  It will have four operating rooms and a collection of advanced imaging machines.  Up to 30 primary and specialty care physicians will work at the facility.

Similarly, Tufts-New England Medical Center plans to build a suburban facility on a yet-to-be-chosen site; it's been reviewing sites in Waltham and Westwood.  Beth Israel Deaconess Medical Center and New England Baptist Hospital are establishing satellite orthopaedics services at Beth Israel Deaconess Hospital-Needham.  Cardiac care, orthopaedics, and oncology services are common "halo" services.  It would be surprising if similar satellite services for cardiac care and oncology aren't already in the works.

Academic medical centers/tertiary care facilities creating feeder networks of community hospitals and outpatient surgery centers through ownership or affiliation isn't a new healthcare business strategy.  University Hospitals of Cleveland and the Cleveland Clinic began utilizing a similar strategy in the late 80s and early 1990s, more or less successfully.  Subsequently, some surrounding community hospitals merged with each other or shut down, decreasing access and increasing healthcare costs.  The Boston market should expect similar fallout.

Patient outcomes, however, should be the factor determining the success of this continuing trend.  If patients gain access to higher quality care, yielding improved outcomes, then the Foxborough facility is a successful community benefit.  If not, then the move is strictly a financial one meant to leech the few remaining dollars available to community hospitals whose mission to provide access to high quality, low cost care will suffer as a consequence.■

Uninsured Americans, By the Numbers

A recently revised U.S. Census Bureau report states that some 45 million Americans, or about 15% of the population, were without health insurance in 2005, while health care spending hit $2 trillion, more than any other industrialized nation.  Texas had the highest percentage of uninsured, followed by New Mexico, Florida, Oklahoma, and California.

At face value, the numbers can appear frightening; however, lacking context, the numbers lose their meaning.  Reporting of such statistics, without context or requisite analysis, is unnecessarily provocative.  All such reports should be read with a discerning eye, include a review of the original data, and adhere to acceptable standards of critical thinking.  Such important societal issues must not be allowed to be reported with the same shoddy tabloid journalism as a pop princess rehab stint.■

Healthcare Reform Coalitions Prompted to Collegiality by BLOG Medicine?

A recent Congressional Quarterly HealthBeat report indicates that several health care advocacy groups have partnered in an effort to encourage presidential candidates to focus on universal health insurance.

The CEOs of AARP, the Alzheimer's  Association, the American Cancer Society Cancer Action Network, the American Diabetes Associates, and the American Heart Association each held rallies on 22 May to discuss goals for universal health care.

It gives us hope that those CEOs may have been prompted to such collegiality by reading BLOG Medicine.  Let's hope the the leaders of the plethora of other related, and disadvantageously independent, coalitions soon follow suit.■

Sicko Documentary by Michael Moore

Director Michael Moore has has turned his attention to an ailing U.S. healthcare system that he says is driven by greed, previewing his latest documentary, "Sicko," at the Cannes Film Festival.  The film portrays a country where government is more interested in personal profit and protecting big business than caring for its citizens.

The two-hour documentary is out of the main Cannes competition, but has had packed audiences.  Allegations raised in the film have prompted a U.S. government investigation that could hold Moore personally liable for potential fines or jail time, if proven false.  The film is due to be released in the United States on 29 June.■

5 States Standout Allies to Beleaguered Business Owners

Massachusetts, Oregon, Tennessee, Wisconsin, and Pennsylvania are all standouts that seem particularly good allies to small business owners where rising health care costs are concerned, according to a recent Entrepreneur article; meriting a closer inspection.

Massachusetts, as of 1 July, is the first state to require all residents to have health insurance coverage.  However, recent revelations about the accounting behind the program appears questionable with the program collecting no money in year 1 and only $24 million in year 2.  The program had originally been expected to generate $171 million in its first two years.

Oregon has modeled the Oregon Health Fund on the Fred Meyer Company, which self-insures and focuses on early health care for 65,000 employees.  The Fund would leverage lower rates and share health care costs.  Residents would receive benefits through a provider of their choice and receive incentives for healthier living.

12,000 Tennessee small businesses have pre-qualified for the Cover Tennessee program, since starting in April 2007.  The program focuses on preventive and primary care , provides guaranteed, affordable, basic health care coverage for employees of Tennessee's small businesses and has a shared premium.  Cost is divided equally among the employee, employer, and state.

Wisconsin has 3 universal health care plans making their way through the state legislature.  In the meantime, healthcare co-ops have gotten much attention.  Small businesses can join a group that purchases health insurance, gaining strength by pooling their numbers.  Since 2006 only 2 co-ops have formed: a state-wide group for farmers and a Milwaukee co-op that has the potential to cover some 240 entrepreneurs, as well as their employees and families.

Prescription for Pennsylvania is meant to address quality initiatives, access, and costs.  It includes Cover all Pennsylvanians, a program that offers access to affordable basic health care coverage to small businesses without insurance and the uninsured.  Businesses that don't offer their employees coverage would pay an assessment used to cover the cost of the program.

Healthcare reform isn't one size fits all, but we should watch each state's attempt, learn from the mistakes and apply the successes, as applicable.■

Obama Promises Universal Health Insurance if Elected

The Asbury Park Press reported that Presidential candidate Senator Barack Obama (D-IL), while at an AFL-CIO event in Trenton, NJ, has said that there would be universal health insurance by the end of his first term, if elected.

He would fund his universal health proposal with $750 billion in savings from increased use of preventive care, improved care for individuals with chronic diseases and the implementation of technologies to reduce paperwork.

I've never enjoyed politicking and, frankly, when I read the Asbury Park story, my train-of-thought ran from politicking to empty promises to fairy tales.  With seeming prescience, Obama's campaign website includes an Issues' section titled, "Creating a Health System that Works" that addresses our inner-skeptic in its third paragraph.

I was surprised when the campaigning for the 2008 Presidential Election effectively began 2 years before the vote -- we'd barely even gotten over the previous campaign. I'm afraid that, in starting so early, we run the risk of losing the momentum for change, for healthcare reform and so many other important issues.

We're a little over 18 months from election day.  Initial Republican Party debates began within the last few weeks and the first Democratic Party debate is schedule for 23 July, as each party begins to winnow its wheat from its chaff; currently, a field of some 8 Democratic and 11 Republican candidates.

We still have a long way to go before this election is over.  We each have a lot of homework to do, to look with a discerning eye on all of the campaign promises, the rhetoric, and the mud-slinging; so, I'm willing to temporarily suspend my sense of disbelief when I see a blurb like the one on Obama in the Asbury Park Press, but if what continues are promises without substance, then we'll already know that this fairy tale doesn't have a happy ending, after all.■