Changing the Affordable Care Act

One of the big claims by all the candidates for president is to reform healthcare. I can understand the desire to change a healthcare plan which is hated by some and loved by others simply because it was the first pass at a national health plan. Obviously it needs some tweaks. Some want to add to it, some want to change it, and some want to replace it. I hope none would remove it.

While I understand the need or desire for change, I really hope that health insurance is not taken away from anyone who already received it under the current plan.If the ACA allowed someone to finally get health insurance, could they really take it away?

Many of us sick unhealthy people previously faced the barrier of not being able to get or keep health insurance after a not so good diagnosis. I hope those days do not return. Seriously could some of the people who most need health insurance have it taken away?

This is a real concern for me. I realize that one of the biggest complaints of the ACA is the mandate that all citizens have health insurance or face a penalty. I can accept that. Some people just don't want a requirement like this in their life, whether it is desire not to have the government intruding in their life or that they do not feel the need for health insurance.. That is their right.

But the people who want health insurance and couldn't afford it, were rejected by their insurance company, or any other reason, should still be able to have health insurance.

Health insurance should not be taken away from anyone who has it and wants to keep it. Also any one who still does not have health insurance and wants it should still have it accessible. I hope the politicians are listening to us unhealthy people.

How good is your health care?

Now that we have a national healthcare system in place, a recent study on the quality of healthcare available in the US, state by state. They looked at things like dental care and tooth loss, obesity, death rates, and more.

I am lucky/happy to live in Massachusetts which has many good hospitals and doctors and had a mandated healthcare system for nearly 10 years. I have always thought I have received good health care over the years.

I read through the article and was appalled on some level at the level of health care available in differing states in this day and age. But then I read through the full report (17 page pdf) and was generally impressed with the improvements in the past five years.

So overall, while some parts of the country still do not have access to quality medical care, improvement is visible.

Some lessons to learn

We can learn some lessons here. In the US we are busy being annoyed with the new healthcare system or happy to use it. But we have it and have to learn to live with it or legislate it into something else.

I did not know this but Germany has a very similar health care system with the same issues - trying to reduce costs. We are busy thinking we are doing something new but we aren't. Except for a few differences, it already exists pretty much.

I am not saying the German system is perfect. But if you read about it, there are some key similarities.

My point is that while we are trying to reinvent the wheel we can learn from others who have already done so.

Deciphering the new health care plans

Finally after years of bickering, litigation, threats, name calling, elections, fear of change, and all sorts of nastiness, we are finally at the point where Americans should be able to sign up for the new health care plans. For the icing on the cake, the morons engineers who put the site together obviously did not do their jobs and few can sign up.

Once the first sign ups occurred, we hear all about the stories of how bad the new plans are. One woman in California went on TV to complain about her new plan. She has to pay more and doesn't like her new coverage. Here's the real story. She currently has a catastrophic plan through Anthem where she pays $293/month which entitles her to a $5000 deductible, limits her out of pocket to $8500, and a $40 copay for each of the two doctor appointments she is allowed each year. Everything else is all out of pocket. The new Affordable Care Act considers this an nonconforming plan.

She was quoted a new plan for $478/month. Which she didn't like. But the real story is that is way  more than she will pay. Due to her income she is eligible to discounts. She could get a discounted plan for $333/month which has a $2000 deductible, $6350 out of pocket maximum, and as many doctor appointments as she wants with copays of $45 for primary care and $65 for specialists. At her age, 60, I think this would probably be a good fit but if its still if its more than she wants to pay there is another lower cost plan available for $194/month which allows as many doctor visits as she wants and a $5000 deductible and a $6350 out of pocket maximum.

Finally her income fluctuates and currently she would be eligible for subsidies to help pay the premiums.

If I was her I would go for one of the two plans where I can go to the doctor as many times as I need. Being limited to two covered visits per year works if you are a healthy 20 something.

A little more research might have discovered these options for her.

And a little less bias in the media might have made these options more visible.

On the other side of the coin is the story of the woman who found a plan for a premium of $1.11 per month. Yes that is one dollar and eleven cents each month.

Now that would be a pretty damn good deal. Did I say she used to pay $509 each month?

Going without health insurance

One of the biggest arguments with the Affordable Care Act or Obamacare is that some people do not like to do what they are told. I fully support the freedom of choice and if people choose to go with out insurance and pay the annual fine because they want to, why not?

The main goal of the ACA is to make health insurance affordable and accessible for more Americans. I think it will do that. People have not gotten insurance because they were told they had pre-existing conditions, low income, or whatever reason. Now there are options for all.

A recent story listed some people and why they did not want to have health insurance. That is clearly their choice and as the penalties rise in the coming years more of them may change their minds. Also, as people age they have a tendency to develop ailments which need expensive treatments.

I think in the future, there will be care for families with small children and they will grow up with health insurance and expect to continue you having it. I do think there will always be those who choose not to. That is their choice.

Me I will always have health insurance.

Sharing the burden

Recently UPS was criticized for dropping employee health insurance coverage for spouses who are eligible for health insurance through their employers. But that's only 15,000 people. The majority of their drivers and other employees are covered through Teamster's Union benefits so they will not be affected by the change.

A recent article called Employers Play Obamacare Blame Game discusses reactions to the shared costs complaints and how other companies are reacting to the upcoming changes.

The whole point of mandatory health care is to have a healthier population. This requires change. So of course employers are going to start shifting burdens around as much as they can. Companies which have provided the most benefits I am sure will be some of the first to start making changes.

There is a separate requirement, starting in 2018, where employees who offer richer policies will be required to start shifting more of the costs to employees or start paying a penalty.

People are dying or going bankrupt due to lack of medical care or the high costs associated with it. We need to share the burden and can't assume our employers or the government will hand us everything we need. Its part of taking our place in society and being a contributing human being.

There are those, including me, who face health or other issues, who can't contribute as much as others. But that doesn't make them any less of human beings.
If you do not like the current and upcoming changes for whatever reason, then you can do your part by cooperating with the existing legislation and work to find ways to change it.

What this is all called is change. Get over it. Change is needed to make health insurance more affordable and health care more available. Our current system does not work. Insurance companies, not doctors, are making decisions about the health of people.

 

This is an ad for a CNN Special called "Escape Fire: the Fight to Rescue American Healthcare" which premiered last night (after my bedtime so I recorded DVRed it and will watch in the next few days).

It was included with this article titled US Manages Disease, Not Health which states that though Obama care represents change and has the goal of helping more Americans get health insurance and access to health care. But tjhat is the wrong question to answer.

They claim the real question that healthcare reform needs to answer is: "How can we improve medical care so that it's worth extending it to more people? In other words, how can we create a health care system that helps people become and stay healthy?"

Personally I would like to believe that both questions should be answered. We need everyone to have access to health insurance and health care and we need a better medical system that helps people become and stay healthy.

As this article claims more focus needs to be on prevention and keeping people healthy where treatments are less expensive and less arduous. We do need to focus on healthier life styles. More exercise - go for a walk instead of watching tv. Provide better food - meaning less processed food, fewer ingredients.

I have seen changes which help make Americans healthier by offering free annual physicals as a preventative measure. There has also been a movement coupled with the recent recession where people are eating healthier, farmers markets are showing up everywhere, and there has been public awareness of the dangers of obesity.

But we have a long way to go. We need health care reform, we need to focus on keeping people healthy, and we need financial reform in the way doctors, medical centers, and insurance companies pay and charge fees.
 

Health care reform

Now that the stupid election is over and we can  now focus on more important things than candidate hair styles, scandals, and mud slinging, we can take another look at health care reform. If Mr. Romney had been elected health care reform would probably have been on the chopping block. In the meantime, now that it is still alive, the poor insurance companies and hospitals have to make changes - note the sarcasm and lack of sympathy.

In the next five years more and more changes will be rolled out. Of the 91 changes, 60 are already in effect. You can see the full implementation timeline on at the Kaiser Foundation here. The last one takes effect January 1, 2018.

Some of the good changes are already in place - up to age 26 on parents health plan and temporary insurance for those with pre-existing conditions. There are still some new ones yet to start such as:

• Financial Disclosure: Requires disclosure of financial relationships between health entities, including physicians, hospitals, pharmacists, other providers, and manufacturers and distributors of covered drugs, devices, biologicals, and medical supplies. The first report is due to Congress April 1, 2013.   Ooh, all these hidden payments will now become visible.
• No Annual Limits on Insurance coverage
• Guaranteed availability of insurance: Requires guarantee issue and renewability of health insurance regardless of health status and allows rating variation based only on age (limited to a 3 to 1 ratio), geographic area, family composition, and tobacco use (limited to 1.5. to 1 ratio) in the individual and the small group market and the Exchanges.

I admit there are some parts of the bill that I don't like as much but overall I think this is forcing change on health insurance, medical device, and pharmaceutical companies as well as on medical centers, doctors, and hospitals.  The system was broken and I hope to see some positive outcomes for patients. After all, we are the ones that receive all this care so we should be better off.

Politics and healthcare

I always think politics and healthcare should be separate issues. I am also not blogging about political issues - I am in my quadrennial political avoidance mode. But I find this issue interesting. Would you change your presidential vote based on the issue of healthcare? According to CNN it is making people think in several swing states (they just use the term swing to confuse us all).

The big issue is that people who have always voted with the Republican party and enjoying the benefits of the healthcare reform act. They realize that if Romney wins they may lose these benefits.

I think this shows how divisive politics have become and how messed up our healthcare system  is. If Americans' politics are swayed by a single issue, our health care system must be in very bad shape.l

The power of health insurance

If you wondered what life was like without health insurance? Here's a little statistic: 26,000 Americans die prematurely each year due to lack of health insurance. They didn't get preventive care or they didn't get needed care. Many of these are caused by high premiums or denial of coverage.

As we await the Supreme Court's decision on healthcare reform, what do we do for those people who die prematurely if the act is struck down, all or in part? I am not saying the healthcare act as proposed is right or wrong, I just think the current system is broken.

I know you can blame people like me with a million little bitty ailments who are driving up health care costs with all my medical adventures. But I do feel everyone should be able to get health insurance if they want it. Call me optimistic but it would be nice.

Secrets of the health care reform act

Of course there are secrets hidden in the health care act. There are 2700 pages of government 'gobble-de-gook' that I haven't had the pleasure of deciphering - because, frankly, I am lazy and that would mean I would have to work. However here are some of the secrets, courtesy of CNN (where would I be without CNN to quote?):

1. As of 12/2014 drug, device and medical supply companies would need to annually report payments and items of value they give to doctors and teaching hospitals. This means your doctors would actually be giving you the right drug, not the one they are paid to give you. How's that for smart thinking?
2. As of March 2010, working mothers got a more appropriate location for expressing breast milk - employers must give them a  place to do this and allow breaks to do this as well.What are they supposed to do - stand in the ladies room or hide under their desk?
3. Every chain restaurant with more than 20 locations would need to provide calorie counts for all items - but no date is set for this. In some ways I hate this because it takes all the fun out of eating a cookie to find out it contains 300 calories. But on the other hand, it keeps me from cheating on my diet.
4. Abstinence only sex education would receive matching federal funds. Too much teen pregnancy going on so I think this is good.
5. Flexible spending account requirements get tighter. As of 2013, there will be an annual limit and they can no longer be used to buy OTC medications and vitamins. Of course, not everything is good.
6. The tanning tax. If you must 'fake bake' your skin, you get taxed on it. 10% is the amount. This went into effect in 2010.
7. Work wellness programs can be funded through grants for small businesses and companies are incentivized to have them. Hmmm.... Does this mean if you run on the company treadmill for 10 minutes you can get a candy bar from the vending machine?
8. Free preventive care as of 2010. Well free to the patient but insurance companies must fully cover mammograms, physical exams, colonscopies, vaccinations, and more including genetic counseling for women with the BRCA gene. The idea is to find problems early before they get expensive. While it sounds like insurance companies are taking the hit here, they really aren't. It costs much less to remove a precancerous polyp than it does to treat stage IV cancer.
9. Home visits for expectant parents. The idea is to reduce child abuse and neglect and promote the health of mothers and their children. This began in 2010. Taking care of moms and new babies can prevent millions of dollars in care down the road.
10. This one is my favorite - health insurance policies which do not require a secret decoder ring to decipher. As of September 30, 2012 the plans must be concise and understandable and make it easier to compare plans.

So its not just about insurance for pre-existing conditions, life time caps, young adults on their parents insurance until 26, and requiring everyone to have insurance, it does include other little but important changes. I have to say I am sick of news on health care reform and can't wait for the Supreme Court ruling so everyone will just shut up about it. And I really hate the fact that the media things the average American can't handle news that isn't broken down in to top ten lists. But I found these interesting and can't wait to receive my first legible health insurance policy.

The health care controversy

Next week the Supreme Court will tackle health care reform, or the Affordable Care Act, or Obamacare - or whatever you want to call it. Some people like it, some people hate it. I am relatively impartial. While I like some of the changes - no pre-existing condition exclusions, no more life time caps on benefits, children can remain on parent's health insurance for another three years, more well people scans, and other items. I am also not looking forward paying any more than I already am or having to wait longer for care.

But I have also taken a wait and see approach. I see no need to jump up and down and take a stance that 'it will not work' or 'it must happen the way it is written' because we don't really know how it will work. Already, there is insurance available for those with pre-existing conditions but only 50,000 people have signed up - which is much lower than what was expected.

I do believe the current situation has to change - the insurance companies should not make medical decisions for the patients and just because you get sick  your insurance company should not be able to cut off your benefits. That's like your car insurance company saying because you get in an accident, they can cut you off. Oh, that's right they do that too. Insurance companies should not rule the world.

I recently had a Facebook 'discussion' with someone who is against the proposed changes. She had been told by her child's doctor that it was wrong. She could quote from various right wing online sources that were against the ACA. But could she articulate more? No, quoting from others was about it.

While I welcome dissension and embrace my inner rebel, I believe I need to form my own opinions and don't need to use others' rants to express an opinion. While I cite articles, I use mainstream sources and don't refer to extremist opinions to explain my stance.

If you agree or disagree with anything, please state your own words and have a discussion with me. After more than 30 years with cancer and worrying about not having health insurance or being told I had a pre-existing condition, I welcome change that would allow me and others not to have to worry about life time caps or loss of insurance just because a whim of the industry.

More on health care reform

When the health care reform law was passed in 2010 (was it really two years ago?), nearly half of Americans were against it. That has changed to 32% are against it. In those two years, I have heard many stories of people who were against it and then found they were finally eligible for health insurance with the new laws. Or I know people who due to a cancer diagnosis had a pre-existing condition and could not find insurance until this new law went into effect.  There are still people who appreciate the benefits of the law for themselves but still do not think its good for the country.

Seniors have the strongest opposition as they are concerned that Medicare cuts were used to finance cover for younger, unhealthy people. Okay, I have a problem with this one. Medicare is a government benefit - the key word is BENEFIT. I know its not perfect and doesn't cover everything. If it did, that would be socialized medicine as is common in European nations. And that's one of the big concerns a lot of opponents have - that the new health care is socialized medicine. So let me get this straight, you want the benefits of socialized medicine but don't want socialized medicine?

Everyone is entitled to their own opinion (and my blog is clearly full of my opinions) but sometimes I don't understand other people's brains. Not that I understand my brain always either. My opinion on this is it happened, the Supreme Court is going to make a decision or three about it, and you can't undo it. The Supreme Court can say its unconstitutional and if they do, how are we going to take away insurance from all those people who now have it and couldn't have it before? 'I'm sorry ma'am, we are going to have to discontinue your chemotherapy as you no longer have insurance.'

That Supreme Court Case Explained

Or its a good thing I am not a lawyer... I find this very complicated. You know that Supreme Court case where they are going to hear six whole hours of arguments on the new health care law and then make a ground breaking decision. If you read the article it is a brief summary of something that is very complicated and citing laws going back over 130 years and deciding if it is a tax or not.  The two contended issues are mandating Americans to purchase health insurance and opening Medicaid to more people.

The Supreme Court gets to decide:

• If this is a tax and if it is a tax it can't be disputed until after it has been in effect so the whole thing would be put off until 2014 or later.
• Then if it is not a tax, then is it legal for Congress to require people to pay for insurance or pay a penalty and it might be an intrusion on individual liberty.
• Next if it is unconstitutional can this requirement be split from the rest of the whole health care reform act. 
• Finally they get to decide if the Medicaid expansion is unconstitutional or not.

I find it pretty amazing that this can be settled after only six hours of arguments and then the Supreme Court justices get to go think, talk over coffee, play basketball, or whatever it is they do and a decision will be announced and life will go on. Until another big issue is brought to the Supreme Court.

I once visited the Supreme Court. I worked for a legal non profit which was part of ACLEA, a legal education organization. They had their annual conference in Washington DC and we got a special tour by someone important at the Supreme Court, but not by a justice. I learned all sorts of fun things about the Supreme Court.

• They didn't have a court house until the 1930s. They bounced around different places in Washington DC.
• The newest member of the Supreme Court gets to be the secretary and take notes for the rest of them. If you think about it - it can be 20 years or more between each new justice and that's a lot of note taking. (So next time one is sworn in, listen for a big sigh of relief from Washington.)
• There is a higher court that the Supreme Court. There is a basketball court upstairs. (See wikipedia for proof I'm not making this up and check the notes on the fifth floor.)

But I digress. This is a big case, which is why it gets six hours instead of a lot less, so we should all pay attention to its outcome.

A blip or a sign of the times

Health care spending has slowed drastically. In 2010 and 2009, health care costs grew at a paltry 3.9% which were the lowest increases in decades.

"The main reason for the slowdown was that Americans were more frugal in their use of health care, from postponing elective surgery to using generic drugs and thinking twice about that late-night visit to the emergency room."

So when the economy tanked in 2008, people started to cut back on their spending, including health care - which is usually the last thing to be cut. One side of the argument on why this happened is employers are putting more downward pressure on health care costs - in other words this would be a sign of the times and will continue to happen. On the other side is that people are simply postponing what they can and when the economy picks up, the costs will go back up - in other words this would be just a blip.

My take on this is that in the latest economic debacle/bank bailout/mortgage scandal/foreclosure central, the impact on the economy forced many people to make deeper decisions with longer term impact in their lives.We see these little decisions everywhere. When we go to the grocery store we now bring our own bags. This used to be considered a 'crunchy granola' decision at best. In addition we bring our own bags to lots of other stores or skip bags for smaller purchases we would automatically take in the past. Walkability indexes are now available - mine is a 62 in case you were wondering.

We consider gas mileage in a car purchase - something that hasn't received such scrutiny since the gas crisis of the 1970's. We shop at farmer's markets. 10 years ago there was one local one, now there is one in almost every nearby town, six months of the year. We care where our food comes from - produce, seafood, and meat. Alternative medicines are now in the forefront - acupuncture, naturopaths, etc. We don't just look for an MD after a doctor's name when we go for treatment, we want other credentials. The concept of integrated and personalized medicine are apparent.

I think with out of the economic downturn, people have changed a lot of their values. People think about their pennies and what they put in their bodies. This has gone on to affect health care spending and acceptance of alternatives and new ideas in treatment. If you had said to me 18 months ago, would I ever consider acupuncture - I would have said an emphatic no. Now I go every two weeks.

So I think this is more of a sign of the times - not that employers are helping reduce costs but that patients are people and are making their decisions more carefully. They look for alternatives to the ER, they look for homeopathic treatments instead of rushing to their primary care. I think this will go on.

That scary term - managed care

We all can remember when the concept of managed care came out. It was done by insurance companies and designed to benefit us. Yeah right. It meant we couldn't see the doctors we wanted because of they are out of network or the care we needed was denied. Well, now there is a new concept in health care which has two key differences from managed care.

1. The name. Its now called Accountable Care.
2. Its now focused on improving patient care. The managed care version was designed to "benefit everyone but patients".

So we have a fancy new name that is supposed to improve patient care. Why do we think us cynical Americans have no faith or trust in their health insurance companies? Because possibly we don't trust them? You mean the people who approve a procedure and then decide to 'unapprove' it once you have it done and you are stuck with a giant bill? Once burned twice shy, as the saying goes.

So what is Accountable Care anyway? Its called team work. Accountable care includes doctors, nurse care managers, pharmacists, health coaches, and more. Its a new concept being piloted by Medicare in certain parts of the country, including Eastern Massachusetts.

"Primary care doctors and some specialists increasingly are leaning on other staff members to help care for such patients. Staff pharmacists explain patients’ medication schedule and watch for negative drug interactions, health coaches teach people about their diseases or help them to lose weight, and nurse care managers take on a wide variety of tasks, including making sure a patient gets necessary lab work and follow-up care.

“Patients will feel that there’s more contact, that there are people who know them better, who are looking after them and providing them with more feedback,’’ Gilfillan said."

Traditionally doctors are paid for face to face appointments with their patients. Under Accountable Care,they will be compensated and rated on: "the care that their patients get throughout the health care system. That’s meant to encourage more coordination between hospitals and with other providers, so that physicians, for example, become more involved in the care their patients receive at rehabilitation facilities."

As a professional patient, I am all for looking at the big picture. Now I think medical facilities and doctors are concerned with the care that the patients receive under their care and less on the overall big picture. They don't care because there is no compensation for other care or for focus on the big picture. Patients are responsible for juggling appointments and getting test results from one place to another. We can't see our doctors or anyone with the flexibility we need to get the emotional support that our health is really being cared for.

When did the 'care' leave 'health care'? Maybe under 'accountable care', there will be 'care' again. But its still a pilot program so we will need to be patient patients while we wait for the 'care' to return.

Cancer changes everything

Its funny how a cancer diagnosis can change your opinion of things. I am not taking a political stance here but I find it intriguing how some one who was so completely against health care reform, once diagnosed with cancer, is now one of its biggest supporters.

Spike Dolomite Ward, a columnist with the LA Times, was originally for Obama but then against health care reform. Then after having to choose between her mortgage and her health insurance, the house won, she was diagnosed with cancer. Because of health care reform, she was entitled to insurance under the preexisting condition clause. This changed her mind. I don't know Spike and I don't really care about the politics of health care reform.

I realize some people are upset about the idea of being forced to buy health insurance. I can understand that. No one wants to be forced to do anything. I also realize that some people don't want health care reform because they dislike Obama simply because of his politics. That attitude isn't one I am very comfortable with. Obama is president. He was elected by the majority. He signed the health care law as he said he would. You can't undo that so stop complaining. If you don't like him, don't vote for him. (This obstructionism in US politics is getting out of hand - don't let me get started). I don't really care about the politics of the situation. It is not about politics. It is about patients and people who are trying to pay their bills.

I am some what disappointed that it took a cancer diagnosis to make one person change their mind about health care reform. I think there is a lot of energy being wasted on the concept of health care reform and not enough energy being spent on using the benefits of it. Young adults in their 20's now can stay on their parents health insurance instead of going without insurance. Those with preexisting conditions now can get coverage. More preventive care is covered. I know taxes are going up as a result but they are always going up.

Health care reform is here to stay. I am not saying that the so called Obamacare will be the program that sticks with us. But health care in this country has and will continue to change. The system as it stands now is failing us. Insurance premiums are skyrocketing. Doctors and hospitals are being squeezed financially. Patients are choosing between feeding their families, saving their homes or paying health insurance. Medications and medical equipment costs are more and more expensive. Insurance companies claim they are being pinched as well.

Cancer changed one person's view of healthcare reform because she all of a sudden was the patient who needed insurance. This is the point. The system isn't working. People are going bankrupt and dying from lack of insurance. 

And they still want to raise rates

I live in Massachusetts. We are not that big a state with a population of just over 6.5 million. The largest health insurers have announced their third quarter earnings. They claim they had a good quarter because of 'seasonal improvements' and fewer health claims due to a sluggish economy.
That's a lot of hogwash to me. What are seasonal improvements? I mean I understand that there is less flu in the summer but people are active and they drive more, enjoy potentially dangerous outdoor sports, etc. And fewer claims because of a sluggish economy? People don't go to the doctor when the economy sucks? I can understand delaying your nose job until after you get a job but I'm not sure its covered by insurance anyway. But cancer diagnoses still happen. I do understand that people might be reluctant to go back to the doctor for a follow up and pay another co-pay when they are tight for money but people still get sick.

I like this quote from the article: "Blue Cross said it was pressing forward with its campaign for health care affordability, both by managing its own administrative expenses and by holding down reimbursement increases for doctors and hospitals." Hmmmm.... So BCBS is getting rich but hospitals and medical professionals are barely making ends meet. I like the idea that insurance companies are working on their own administrative expenses but dislike their reimbursement reductions. Insurance companies should not be making medical decisions.

Anyway, on to the numbers. Remember the state population of 6.5 million:

Blue Cross Blue Shield of MA - earnings of $78.9 million, up from $75.8 million last year
Fallon Community Health of Worcester - earnings of $12 million, up from $7.2 million last year
Tufts Health Plan didn't do as well as the rest - earnings of $52.6 million down from $59 million last year
Harvard Pilgrim Health Care also didn't do as well - earnings of $37.9 million down from $44.5 million last year

Total for third quarter earnings this year are $181.4 million, against last year's $186.5 million. So maybe they weren't quite as good as last year but they still made money. And they want to raise rates. I am not sure the exact numbers and think they are slightly lower than previous trends but they are still substantially higher than the cost of living increases most of us see in our paychecks.

Scary numbers

[This is not a political post.] I read this article this morning about the state of health care in Texas. I find the numbers appalling. 24.6% of Texans do not have health insurance and this number has grown by 35% in the past decade.

As a result of this low insurance rate, people die of treatable or vaccine preventable diseases, people with pre-existing conditions cannot afford health insurance, and people are not getting regular screenings such as mammograms and colonoscopies. The numbers look like health statistics from a third world country but are instead from a state with some of the best medical centers in the country.

If you are unsure of the importance of change here are some stories from the article for you from Texas:


- a yoga instructor who makes $20,000/year is $30,000 in medical bill debt because she can't afford insurance as she has Parkinsons - a pre-existing condition.


- a 16 year old boy died from a tumor in his chest that was found too late.


- a 15 month old died from dehydration due to diarrhea because his family waited to bring him to the doctor because they thought they couldn't afford it.


This is an example of why the health care system in this country needs to change. As I said I am not making a political statement and frankly I don't care what people think of Obamacare, Governor Perry's presidential run, or the state of the economy. What I do care about is that people are dying unnecessarily or are horribly in debt trying to get basic medical care.

I am not sure anyone has it right yet but change is clearly needed. I am personally for health care reform and what some call Obamacare as it is change. If anyone has a solution to prevent people from dying unnecessarily, I am in favor of it. I know this is a sensitive subject for many and people resent government interference in their lives in being forced to buy health insurance. I do not see it as the government telling me what to do (I am a rule-breaker/rebel by nature). I look at it the other way, it is the government stepping in to do something good and making health insurance more accessible and affordable for all.

A good change

In 2009, I believe, a law went into effect in Massachusetts prohibiting drug and medical device companies from paying doctors to promote their products. I think a stricter federal law which will be along the same line is coming. Now that we have some data, the numbers are dropping significantly.

I am all for this. While I do believe everyone should be allowed to earn extra money in anyway they (legally) can, sometimes we need to put some reins on what people are doing. If a doctor is making significant income from a drug or medical device company, their loyalties are clearly to their richest employer. So are they then a doctor or are they a professional promoter?

I want a doctor who is focused on treating patients impartially with what is best for the patient in mind. Not with how they, the doctor and his pockets, will benefit the most.  If a doctor wants to work for the pharmaceutical companies and promote their products because they get paid better, are sick of treating patients, or whatever, then they should consider themselves a professional promoter and not a doctor.

I also like to see that doctor's employers are making it easy for the doctors too. They are incorporating these restrictions into their employees requirements. I realize that until the federal law kicks in, in 2012 or 2013 (I think), the drug and medical device companies are getting doctors as speakers from other states. But once the law does kick in, they will need to change how they promote their drugs.

My background is marketing so I can understand this. By hiring the doctors to speak about their products, they are hiring the decision makers to influence their peers from a medical point of view, instead of just being a sales pitch from another corporation. It gives a lot more credibility to their products to have a peer stand up and say 'it works very well'. Now they will need to find another way to promote their products. Millions of television ads promoting the medications to the general public really aren't effective as they raise awareness of a product's name but the patient can only ask their doctor about it, they can't go buy it themselves. I see a real restructuring of their promotional programs as a result.

But as a patient, I am very happy about all this change. I see it as just another step of change in the bigger healthcare reform where the patient's improved care is more of a focus than deep pockets by doctors, hospitals, medical centers, insurance companies, and medical device and drug manufacturers. The goal is to have the patient win in the end - which makes it a good change.