Even with insurance, you can't afford to get sick

The latest scheme devised to shift the burden for healthcare from insurance companies to the sick, those upstanding humanitarians of the insurance industry have implemented a new pricing scheme that has patients paying a percentage of actual cost of the drugs instead of the traditional set-amount co-pay. This means that patients have seen their monthly expenses for lifesaving drugs skyrocket, sometimes to hundreds, or thousands, or dollars per month.

It isn't clear how many patients have been negatively impacted by the shift to this pricing scheme, commonly referred to as "Tier 4 Pricing" but the drugs subject to this price structuring are used to treat relatively common disorders such as Multiple Sclerosis and Rheumatoid Arthritis, as well as some cancers and communicable diseases such as Hepatitis C. Drugs to keep the effects of these diseases at bay, preserve quality of life and alleviate pain and suffering can cost in excess of $100,000 per year.

The result is that many patients are faced with monthly drug bills that exceed their monthly income. They either have to pony over the dough or do without their needed medications.

The concept of "Tier 4 pricing" got underway with the advent of Medicare drug plans, and spread like a cancer throughout the entire system, now being a component of a full 86% of those plans in force today. It has also spread to the private sector. Where it was practically unheard of in private and employer-offered health plans five years ago, it is a component of a significant portion of those plans. Private companies started offering a "Tier 4" pricing scheme in order to offer an option to help employers keep premiums down.

But the new system sticks seriously ill people with huge bills, said James Robinson, a health economist at the University of California, Berkeley. “It is very unfortunate social policy,” Dr. Robinson said. “The more the sick person pays, the less the healthy person pays.”

Traditionally, the idea of insurance was to spread the costs of paying for the sick.

“This is an erosion of the traditional concept of insurance,” Mr. Mendelson said. “Those beneficiaries who bear the burden of illness are also bearing the burden of cost.”

And often, patients say, they had no idea that they would be faced with such a situation.

I first noticed the trend starting exactly five years ago. I was working for a local hospital system that sold to Hospital Corporation of America on April Fool's Day 2003. We all had to go to a seminar led by the benefits coordinator, who explained the new policies and what they offered. What caught my ear was the "prescription rider" option. If you needed expensive drugs that had no generic equivalent, you were encouraged to sign up for the additional rider. Our copay for generics was going to go up to ten dollars from five, and if we needed name-brand drugs, we would have to pay a percentage rather than the traditional $35 copay we had been paying under the insurance we had through Health Midwest. (I want to say it was 25% we would be responsible for, but I can't recall exactly - not needing any name-brand meds, I passed - but a year later when I got a prescription for Ambien, it cost me $55 to fill it at Costco - only to find out after one dose that I can't take Ambien, I turn into Patrick Kennedy.)

I do know that my coworkers and I got really cynical really fast, and questioned whether or not what they were peddling could even be accurately classified as "insurance." Now, the Fristification of American healthcare is just about complete.

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Time To Stop Small-Time Legal Bribery Of Doctors

For years, it hasn't been such an uncommon sight to keep a doctor appointment in the early afternoon and see leftover pizza, or Chinese takeout, or such, around the joint. Then, a pharmaceutical salesperson emerges from the back, a walking drugstore with a big valise, after making a "sale." This person has apparently treated everybody in the clinic to lunch. (And then, written it off on the taxes as a business expense.) There are free drug samples galore, and lots of Cialis pens and coffee mugs; but it's understood that prescriptions will be written along with distribution of those samples.

I've witnessed this firsthand, and so has my wife. It's under $100 worth of perks, so it's currently accepted practice (pardon my choice of words). Not every doctor accepts these small perks, but they are legal. And, this kind of unethical coziness between the medical profession and drug companies is one facet, among many, of the U.S. health-care debacle.

The Senate has a bill, the Physician Payment Sunshine Act (S. 2029), currently in the Finance Committee. It would, according to The Associated Press: "...create a database disclosing the names and addresses of doctors who receive gifts or payments. It would also include pharmaceutical company names and the value of the gift or payment."

More specific information is on WashingtonWatch.com. The bill would:

... amend title XI of the Social Security Act to provide for transparency in the relationship between physicians and manufacturers of drugs, devices, or medical supplies for which payment is made under Medicare, Medicaid, or SCHIP.

Sadly, this bill has been mired in committee since September, despite support from medical ethics groups. AP reported, tersely: "Drug companies oppose the act."

What are the "pro" arguments? I'll quote more from the AP story, which was not merely about doctors accepting perks. It was about doctors acting as actual shills, giving testimonials to peers for new drugs, under corporate sponsorship for damned good pay:

Pharmaceutical companies argue that doctors are an essential part of educating colleagues as new drugs are developed. ...

To summarize, their argument is: How can doctors know about new medicines, their potential side effects, their proper use, and so forth, unless they hear it from experienced peers? But, to have the symposiums sponsored by the drug companies, who are paying the doctors who are giving testimonials, seems like a pretty big ethical conflict of interest.

More from AP: PhRMA (the drug industry's lobbying arm) adopted voluntary rules in 2002 that limit the value of gifts to $100 or less and says that all forms of free entertainment, including sporting events, are inappropriate.

All very nice, but I'm offended by even seeing these reps feeding my doctor and his staff fully loaded pizza, beef broccoli and moo goo gai pan, and a lot of sales bullshit. The bill that's bogged down in the Senate committee isn't nearly strong enough. This is legal bribery, even if it's on a small scale. And I realize that any action won't have more than a tiny effect on the American health-care morass.

But on principle alone, it should be banned. And, any effect it has might work toward curbing what is clearly the chronic overmedication of the American people.

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The Video Of The Campaign So Far

I have already posted the campaign video of the day. What follows is the most important campaign clip so far.



This was posted on YouTube by TPM. Putting the video in context, Steve Skvara is a disabled steel worker. Because he is disabled he has medicare coverage. His wife, who is under 62, and probably spends a lot of time taking care of her husband, doesn't yet qualify for medicare. This video puts a human face on the choices politicians make and why we need to elect politicians with real courage.

Yesterday in a comments thread over at Political Animal theAmericanist bitched at me for not being sufficiently loyal to Hillary Clinton. Stories like Steve's inform my unease about Hillary Clinton. Based on our experiences with her back in the early 1990s, I don't think you can depend on her to actually push universal health care, which is my top domestic issue. She learned her lesson years ago during Bill's administration. If she is true to Clinton form she will talk a good game, but will never deliver. If she were to deliver the issue would be taken off the table for the 2012 election cycle, and more importantly, the Federal lobbyists bundling insurance company and big Pharma donations would be pissed. That might mean fewer campaign contributions for Team Clinton. She couldn't have that.

If you are lucky she might have a secretary write you a nice little personalized note, signed by a machine pen, as a token of her appreciation for helping her with some failed effort to pass universal coverage. I have one of those notes on Bill's White House stationary, signed by Bill's machine. It is suitable for framing and hanging on my wall. Of course, Steve's wife still doesn't have health care.

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Why income inequality matters

I don't know about you, but I could make do with only $1 million or $2 million a year. I bet I could cut a few corners and still pay my bills with those measly sums. Apparently, though, a mere millionaire's lifestyle doesn't work for certain folks, as The New York Time's Paul Krugman notes today.

Last year, according to Institutional Investor’s Alpha magazine, James Simons, a hedge fund manager, took home $1.7 billion, more than 38,000 times the average income. Two other hedge fund managers also made more than $1 billion, and the top 25 combined made $14 billion.

Why does this matter?

How much is $14 billion? It’s more than it would cost to provide health care for a year to eight million children — the number of children in America who, unlike children in any other advanced country, don’t have health insurance.

That's the Bushies Law: Send more money to those who don't need it by cutting taxes for the superrich and keep yelling about how the U.S. doesn't have the money to take care of our children. Yup, that's America for you. Ignore the poor. Help the rich.

Are you as outraged as I am? Talk about hogs.
---------
Alas, the Krugman column is hidden behind The Time Select paywall.

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Matt Blunt: Liar or Idiot?

I know, I know the choices are not mutually exclusive. But at the very least, one or the other must be true, in light of the following statement from the Boy Governor:

"Patients should not have to go to an abortion clinic to access life-saving
tests"

This statement was issued in defense of his ending a long-standing relationship with Planned Parenthood of Southwest Missouri to provide free breast and cervical cancer screenings through the state's "Show Me Healthy Women" program. In a callous move to make the severance acceptable, Blunt has promised to seek an extra half-million dollars for the "Show Me" fund. As the program was previously operating with a budget of only $70,000, the extra funds are desperately need for women with low income or those without insurance. But, this leads us back to the previous statement:

"Patients should not have to go to an abortion clinic to access life-saving
tests."

Governor, the Planned Parenthood clinics in Springfield and Joplin do not offer abortion services; they never have. Blunt is either incredibly ignorant of an important service organization in his home district, or he is viciously lying in order to further anti-abortion sentiment and shore up support on his right flank, support he'll definitely need as he stands for re-election next year. And just in case one might believe that the governor simply misspoke, or was taken out of context, he elaborates:

“Today I put an end to taxpayer dollars going to Planned Parenthood in
Springfield and Joplin through the Show Me Healthy Women Program. This ensures women may access important preventative care without contributing to abortion providers’ goal of facilitating the destruction of innocent life."

Oh, so noble sentiments, Governor. And again, not an ounce of truth therein. Planned Parenthood of Southwest Missouri has participated in the "Show Me Healthy Women" program for 15 years (right about the time that the Boy Governor was old enough to legally drink) and has provided free breast & cervical cancer screenings through the program to over 1,500 needy women over the past five years, on essentially shoestring funds. Governor, if you'd like to truly support needy women of this state with needed preventative cancer screenings, why not donate the funds used for your daily Suburban Jefferson City-to-Springfield caravan? Oh right, there's no political hay to be harvested from your right wing if you were to do the right thing.


Cross-posted at Welcome to the Revolution

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Senator, Heal Yourself

U.S. Sen. John Cornyn (R) a member of the Senate Judiciary Committee is at it again. While he has yet to break through to the upper tier of party flackdom (think Jon Kyle), he certainly is consistently knocking on the door.

His official web site trumpets the news that the former Texas Attorney General cosponsored “two important bills aimed at providing patients with greater access to health care by enacting key civil justice reforms.”

Both The Medical Care Access Protection Act, S. 243 and The Healthy Mothers and Healthy Babies Access to Care Act, S. 244 will “increase health care access and decrease costs….” Wow! Is one the most doctrinaire conservatives growing some social conscience?

Ah…no.

Medical liability reform is the goal here.

“These important bills will increase health care access and decrease costs by limiting the effects of runaway frivolous lawsuits that are driving doctors out of practice,” Sen. Cornyn said. “In 2003, Texas put a model in place for the nation that has proven successful. Congress should act now to provide a national solution so that all Americans can benefit from medical liability reform….The current system greatly decreases hope for accessible and affordable health care in America. The time for that to change is now, so I hope we’ll see bipartisan support for these key bills.

http://cornyn.senate.gov/index.asp?f=record&lid=1&yid=1&rid=237286&pg=1

Cornyn’s logic is thus:

1. Litigator are greedy
2. They bring frivolous law suites to slack their money lust
3. Noble insurance companies get hurt
4. To repair their unjust losses, insurance companies charge doctors higher premiums
5. Higher premiums drive doctors out of business

The evidence of this seen by this observer is at best anecdotal. One of the biggest motivations that insurance companies had in increasing premiums was to expand their float and try to undo the damage done to their investment portfolios 1999-2003.

Sure higher premiums increase the cost of doing business, but a key question is: What is the real reason a medical liability insurance company feels the need to increase its premiums?

Sen. Cornyn is sure he knows the answer.

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