Stop The Health Insurance Marketplace Modernization Act
(Before or after you read this, please, please take action. Especially physicians–Congress listens to you!)
I don’t know how I missed this disaster of a possible policy decision, but luckily Kate informed me of the bill. It’s supposed to allow small businesses to band together to buy health insurance together, but in the process also cancels many states’ required coverage items–that is, areas of health care that the state requires all insurers to cover. (The thinking being that small businesses could purchase cheaper plans if the plans don’t have these required restrictions. And this is big; small businesses employ half the work force in the US.) By a wide margin, these items are prevention programs. And what are prevention programs? Screenings that catch disease early so that it doesn’t cost us orders of magnitude more down the line–either in health care, education, long-term care, etc. Here’s how I view these programs, as a future provider (and likely future pediatrician). I’ll use California examples. If we cancel…
- Alcoholism Treatment: We have more drunk drivers, more deaths and more permanent disabilities. We have more fetal alcohol syndrome, which leads to learning disabilities and more costs for special ed. We have more lost workdays.
- Blood Lead Screening: We have more children with learning disabilities, permanent brain damage and mental retardation.
- Bone Density Screening: We have more women break their hips and require surgery.
- Colorectal Screening: More men and women get colon cancer, the second most common, deadly cancer in the US. In most cases, if you detect it early, you remove a polyp and STOP a possible cancer completely.
- Contraceptives: More teen births, more unwanted pregnancies.
- Diabetic Supplies/Education: Education and supplies are absolutely key to diabetes care. The complications: early heart attacks, amputations, blindness, non-healing ulcers, infections, more ICU stays.
- Emergency Services: People with these plans will pay 4 times as much for ER visits.
- Hospice Care: People die shitty, painful, scary deaths. Sigh.
- Mammography Screening/Prostate Cancer Screening: Hi breast and prostate cancer, the second most common of cancers in women and men, respectively.
- Metabolic Disorders (PKU): Near and dear to the Pediatrician’s heart, the newborn screening. This picks up diseases like PKU and hypothyroidism, which if caught early, can be treated and the patient can have a normal life. If not treated, kids die early, mentally retarded. (The treatment for PKU? Avoid certain foods, especially those with the artificial sweetener, aspartame–this is why diet drinks say “Phenylketonurics, contains phenylalanine.”)
- Off-Label Drug Use: This requires companies to pay for drugs that doctors prescribe for non-approved uses. For example, some drugs for seizure disorders also work for mental illness or chronic pain; doctors are allowed to prescribe it for seizure disorders as well as other diseases it might work for.
- Well-Child Care: When you take your healthy kid to the doctor to make sure he or she is growing and doing well. In these visits we look for hearing problems, cataracts, childhood cancers, hip deformities, brain problems, broken bones, child abuse, undescended testes, and other signs of possible abnormalities.
I can’t believe some of the stuff that I just wrote that Congress is considering allowing people not to cover. And I can’t believe we’re willing to go this route–allowing companies to provide crappy, inadequate insurance to maintain an already broken, patchwork, pathetic health care system.
(Before or after you read this, please, please take action. Especially physicians–Congress listens to you!)
Graham,
I admire your passion. But passion is no substitute for common sense. Folks who can’t afford expensive health plans (like me) are nevertheless forced to pay for services that I and my covered lives don’t need!
The plan deprives no one of coverage, it simply removes burdensome requirements on payors and small businesses so that we can do business with one another.
Forgive me for saying the following: If and when you strike out into the cold, cruel world as I have done, you might understand what I’m talking about.
best,
Flea
I generally think your advice is pretty sound, Flea, but you’re off your rocker on this one–and I can’t believe you’d support something like this when you clearly know the ill effects it will have on children and adults alike.
I find it incredibly difficult to understand why people are willing to sacrifice so much important and necessary preventitive care to keep a broken system running. This is an absolutely terrible policy decision.
If you want a system where payors and small businesses can do incredibly efficient work, try a country with some sort of national health plan.
I don’t know, flea. For me, this is kind of a case where some of us who don’t need things support others.
My mom and dad can’t afford insurance because of their health. I wouldn’t mind paying an extra bit on mine to make theirs affordable. That is the trade-off we are talking about, with insurance.
My take is that the basic idea, that everyone pays a monthly fee (perhaps scaled to income) for health care, works. But I think it is unethical for anyone not directly involved in health care to make a profit off of the suffering of individuals. That would be insurance companies, or more specifically, the stockholders of those companies. I think it is unethical for someone without medical training to make decisions one what health services an individual may or may not have.
Flea,
Would you please come to my house and I’ll set the Daily Racing Form in front of you so you can tell me which horses are going to win tomorrow because you, apparently, can predict the future. How do you figure preventive services are things you “don’t need (exclamation point)”?
You know what diseases you’re going to not catch? You know your genetic propensities and know that certain cancers are not in your future? You know you’re not going to wind up in the ER for anything?
You miss the point of these mandates. They’re there because not having them is more expensive for all the rest of us in the long run, and counting on the tender mercies of insurance companies has never worked out.
What’s the point of diversifying coverage packages? You guys, who actually pay attention to this issue, are clearly dead-set against choice of coverage/choice of premium. If that’s so, then there’s no point in trying to convince the general public that isn’t paying attention and can’t understand what’s at stake.
I give up. Bring on the government!
Flea
I agree with Graham on all the items on the list EXCEPT off label drug use.
If there is really a wonder drug that works for 10 different illnesses, then have the FDA APPROVE IT FOR THOSE PURPOSES.
the bottom line is that many many “off label” uses are a total waste of money and NOT backed up by sound evidence based medicine.
EBM must be our guide for drug usage. IF EBM/FDA doesnt support it, then it should NOT be covered
Also, some states REQUIRE that infertility treatments be covered. Thats absolutely outrageous. Infertility should NOT BE MANDATED COVERAGE
Graham,
In your response to Flea, in the last sentence of your comment, you said to, “try a country with some sort of national health insurance.” We were in Ireland, a country with national health insurance, in October, 2004. We had read several articles in the newspapers about the appalling conditions in the government hospitals. One of them detailed the case of a woman in her 70’s, who was brought into a local hospital that had three well trained general surgeons on staff. Because no ICU bed was available, she couldn’t be treated there. Every hospital in Dublin was contacted and no ICU beds were available. She finally was transported to Belfast for her surgery. By that time she had a ruptured bowel.
A couple of evenings later, my wife and I were in a restaurant and my wife approached two young women eating at a nearby table. She asked them what they thought of the Irish health system and they responded by saying that anyone that could afford it bought private health insurance so that they could be assured of getting treatment. There were no bed problems in the private side of the hospitals, only in the public.
You decried the elimination of some of the mandates that this new bill would allow. You seem to think that people should have every need covered by insurance. I doubt that a PKU test is very expensive and contraceptives are probably not out of reach of most working women. Many health plans, such as those negotiated by unions, cover everything and as a result look what has happened to GM. When people don’t have to pay for any part of their medical care they are going to overuse the system. All of the mandates that states have required, though laudable, are responsible for part of the massive increases in health insurance premiums. I agree with Flea. If you someday open your own office, or join a small group you may look at the issue differently when you have to pay the bills.
You continually point out the defects in our system and laud the “national health plans” of other countries, but you don’t present any of the problems that the citizens of these countries have with long waiting periods for elective surgery, which is a form of rationing, the limited number of organ transplants allowed, due to cost, and etc. The “grass is not always greener” on the other side of the fence.
I agree with Graham on all the items on the list EXCEPT off label drug use.
Joe Blow, you’re right, often there’s not data to back up the off-label uses. But there’s also not data to backup most of what we do in medicine, sometimes because no one would pay for the study, sometimes because it would be unethical to withold treatment. To get FDA approval, you have to run a number of big expensive trials proving safety and efficacy for each indication. Manufacturers aren’t going to do that.
Thompson and Flea: You both seem to think there is some magical way to separate your life from mine, such that your costs will not relate to mine, but that’s not how the world works. Just because someone doesn’t have health insurance doesn’t mean they don’t get care. Let’s say we allow parents to opt-out of PKU screenings. It saves them $5. 1 PKU case that is not caught will have far more future costs to OUR social systems that we ALL pay for with insurance premiums and taxes: more NICU/PICU stays, more special ed, more long-term care, more education costs. But the family with the PKU kid will not pay all these costs–the system will. And who pays for the system? Us.
It’s like allowing someone to opt out of receiving police assistance. Someone might want to save $10 by saying “I won’t need the police this month,” but what if they do have an emergency? Are the police just not going to come? And if they do, because they haven’t budgeted for it, it’s going to cost the police more on average to pay for the emergency.
Thompson: I would much rather deal with a system where everyone has care and deal with the flaws of that system than one where 46 million have little care and no benefits. And honestly, if the Irish spent as much per person (7.3%)for their health care as Americans do, they’d have plenty of ICU beds.
Isn’t manditory coverage for certain conditions also a way of ensuring that people who aren’t as well educated about medicine are able to afford to get the tests they probably didn’t think they needed when the need arises? For example, I don’t think a lot of lay people I know would skim their medical insurance policy for something like PKU screening before they signed up because they don’t know what it is. Then, down the road when they’re popping out little ones and needing the screening they’re possibly stuck not being able to afford it (I know, it’s a cheap test, it’s just an example). Or, they didn’t know before they got diabetes just how much those supplies cost, etc. Maybe it’s because I’m not from a private health care country, but I think the government has a duty to put measures into legislation that ensure that the public gets adequate health care regardless of the specialized medical knowledge they have.
Flea,
I’m not sure if government is the answer, I just don’t think federal government should be taking away state mandates and I don’t see the measure as doing much help for underinsured or uninsured persons. And I’m still thinking it is unethical for stockholders to make a profit off of the fear and suffering of people.
I live in a state where we have just about the least amount of mandated services. But we seem to have them covered. So I know this wouldn’t cause a lot of people to lose their coverage on things they want. But what I think would happen is that insurance would suddenly get more expensive. Why? Because now they don’t have to cover certain things for you, and because it is an option, they can charge you more for it. And this is especially true since the insurance caps that many states keep would be removed by this federal mandate.
So, states lose power, feds gain power, and patients lose out. I’m not sure how this bill could be helpful. I’m open to another explanation for it though.
I’m stealing your post. I’ve written about this before. I’m not sure Congres listens to poeple who can’t give them thousands of dollars though.
This seems to be an argument with two valid sides. It’s sad that we support so many countries and so many wars and can’t find the money to fund basic health care for natural born citizens of this country. But here’s my two cents worth. If I could have cut services and saved on my health care, mamograms would have been the area I nixed from the mix. I come from a big family and nobody had problems with breast cancer. But I work for a fortune 500 organization and they expect 100% compliance with preventative health care measures. So in a like manner I went to the breast bus when it came around and got my screening. But because I was under 50 and had no other risk factors every 2 years was acceptable. In October 2002 I had a clean mammogram. In April 2004, eighteen months later I was diagnosed in stage 3a breast cancer. My insurance carrier spent $122,500.00 of negotiated fees to get me into remission. Skipping mammograms didn’t save the company any money. It didn’t save me any greif. If I’d been caught a year earlier I could have had a lot less treatment and I could be healthier now. A manager in the group that I work in was caught in stage one with no lymphnode involvement. She had a lumpectomy and radiation to the area. It cost the company 35k and they don’t have to pay for all the complications that I’ve had. She certainly isn’t paying for it in the loss of health that I’ve experienced. Fudging on preventative care isn’t going to get this country any farther in the battle of bringing health care to the masses. The farther along you are in an illness usually means the more money it will take to treat it and a worse prognosis in the bargin.