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Everyone's complaining about limited and overpriced medical insurance these days, but apparently Wisconsin health insurance was one of the least popular in 2007. At least, it was unpopular until the Office of the Commissioner of Insurance made insurance agencies pay consumers back for their medical treatment. According to the article at The Capital Times, more than 8,000 consumers contacted the office last year to complain about needing reimbursement for Wisconsin health insurance. And the office helped those consumers to recover a total of $8 million in funds. At least 1/3 of the time complaints were ruled in favor of the consumer, meaning that all or a good portion of costs were reimbursed to them. As they say, the squeaky wheel gets the grease, and it pays to fight back when insurance agencies try to shortchange their customers. Could Wisconsin health insurance stand to see some improvement? Clearly, the answer is yes. But health insurance customers in other states should follow the example of Wisconsin's state citizens; don't be afraid to fight an insurance agency that won't listen to your demands, or that denies your rights.
Merck paid big this week, in an effort to end lawsuits that could have cost them billions, and revealed their manipulation of patients, doctors, and even the health insurance market. Well, they paid billions anyway - $4.85 billion to be exact - in order to end lawsuits pertaining to allegations that they downplayed cardiovascular risks caused by the popular drug Vioxx in direct-to-consumer advertisements dating back to 1999. Consumers shelled-out billions of dollars for the designer drug Vioxx, though safer alternatives were covered by almost all health insurance policies in the form of generics. According to Kaiser's Daily Report, Merck is also required to end their policy of ghostwriting studies related to their drugs, and then passing them off as having been written by doctors. Which was one more way that consumers were convinced to purchase these drugs, even when they weren't really that safe, and their health insurance didn't cover it. Last year, as more and more consumers leaned towards generic drugs, prescription drug companies lost a lot of revenue. But, when so many health insurance policies cover generics, which have been around a long time and aren't likely to have any unknown effects, it just makes sense to save money and avoid the kind of dangerous side effects associated with new and controversial medications.
In the struggle between health insurance companies and hospitals to decide who pays what, it's often the consumer who ends up stuck with the bill, and this is especially the case when it comes to "balance billing." As it's explained at Sign on San Diego, balance billing is the process by which too many consumers are forced to pay for medical bills that ought to be covered by their health insurance. The process goes something like this: a sick or injured person goes to the emergency room. Their health insurance is issued the bill, but in an effort to duck the costs the insurance agency denies portions of the bills that they feel didn't come from "real emergencies" (how this is determined is not a process that's been released to the public). The hospital then forwards a bill for the difference to the consumer, who shouldn't have to pay it but usually does. After all, they have health insurance, which should cover a specified amount in terms of emergency care. However, some people pay it because they mistakenly assume it's their copayment. Others are afraid to get into trouble with creditors, and end up paying bills on medical debt that they simply can't afford. In response, doctors and hospital officials met today with health insurance companies in San Diego over a state plan that would make it impossible for hospitals to bill patients for emergency room care. Hospitals would then have to take their claims directly to insurers to get the problem resolved. Hospital officials argue that they can't afford the time/money required to take insurance agencies to court. Insurance agencies argue that they're expected to pay for things they think they shouldn't. Somewhere in between are consumers, stuck paying for things they shouldn't have to pay, until the big guys can find a way to settle their own disputes.
This week advisers to all three major presidential candidates met to discuss health insurance, and health care woes in general, in order to decide just when America will get around to doing something about this situation. At the forum host Peter Orszag, the Congressional Budget Office Director, voiced a very real concern that Congress might not address health care or health insurance costs next year because lawmakers will have to focus on the economy. According to Kaiser's Daily Health Policy Report, the candidates' advisors responded by renewing the same promises made by McCain, Clinton, and Obama, though with a bit of vague language thrown in (just in case). David Blumenthal, Obama's adviser, reminded us that Democrats "care deeply" about growing health insurance and health care costs, adding, "If there's any way to get to it, I'm confident they will get to it." Not exactly a ringing endorsement that change is on the horizon. Clinton's adviser Jeanne Lambrew said that health care is Clinton's top priority and is consistent with her desire to stimulate the economy. And Douglas Holtz-Eakin, McCain's adviser, suggested that health care and health insurance would be handled in a "day-to-day" manner, with "continuous incremental changes." Just how incremental those changes would be isn't clear. But one thing is certain: those who need coverage ought to do their best to find an affordable plan and hang on to it, since it doesn't look like sweeping reforms are going to take place in 2009.
Group health insurance used to be the best bet in town when it came to insuring the American workforce. But now, as jobs overseas pay their employees more and yet save costs on medical insurance, making sense of insurance has become very difficult for employers and employees alike. We've already heard that Americans pay more for their health care than any other industrial nation, and we also know that we rank among the lowest when it comes to minimizing preventable deaths. But now, it seems that these same issues are leading workers and businesses alike to go abroad for lower costs on everything from production costs to group health insurance. This week's article at CQ Politics reports that "the ever-rising costs of health care puts American businesses at a disadvantage when trying to compete with firms overseas." The study released by the New America Foundation found that U.S. firms spent twice as much on health care in 2005 as their competitors, a particularly dangerous problem when up to 60% of all insured Americans are covered by the group health insurance policy offered by their employer. And employees aren't getting off lightly either; the average worker contribution for family health insurance has increased by 102% since 2000. The effect for both employers and employees alike is that it's much more affordable to take your business overseas. One of the co-authors of the study suggests the legislation of Ron Wyden (D-Ore.), whose bill (s 334) would require employers to "cash out" of group health insurance and convert health care contributions into raises workers could use to purchase medical insurance. Unfortunately, Wyden's bill has yet to see any real action.
Prescription drug companies have found themselves in a lot of hot water lately for predatory behavior when it comes to selling their drugs to the public. To stop them from unfairly raking in billions of our money, consumers need to stick with the generics covered by most health insurance policies. Earlier this year it came out that Merck and Schering-Plough's medication Vytorin wasn't any more effective than the generics available on the market. However, by spending billions in direct marketing these companies were able to make even more billions of dollars from sick Americans. And for those people with health insurance being fooled like this stings even more. In most cases generic drugs are covered by their health insurance policy, while new and expensive drugs like Vytorin fall into the "out-of-pocket" expenses category. Now the ads that these companies use to sell their drugs to consumers and doctors alike are under fire. According to ABC News, in 2006 drug companies spent nearly $5 billion on direct ads to consumers, an 80% increase over what they were spending in 2002. And these ads work; for every dollar spent on consumer advertising prescription drug companies made $6 in increased sales. Too often these drugs aren't what they're supposed to be, or simply aren't any more effective than generics. This is why we always suggest that consumers go with a health insurance plan that covers generics, and avoid expensive new drugs whenever possible.
This week the Senate Finance Committee held the first of at minimum eight meetings designed to address health insurance, health care issues, and especially, the future of Medicare. Featuring testimony from former Health and Human Services secretaries Tommy Thompson and Donna Shalala, the committee is already struggling over what to do with a broken health care system, employer based health insurance, and the future of Medicare. According to Kaiser's Daily Health Policy Report, Thompson suggests a primary focus on Medicare, specifically with goals of "changing Medicare by cutting benefits, increasing revenue and raising the age for eligibility." This would be designed to counteract Medicare's growing costs - Medicare's hospital trust fund will begin paying out more than it is taking in by 2013 and it could be insolvent by 2019. Shalala believes otherwise - she suggests that by streamlining the "political system" surrounding Medicare, positive changes could be made there as well as in hospital procedure, and by extension, in health insurance itself. She believes that the "private sector" will "follow Medicare" in an effort to minimize medical costs. Both arguments have been heard before, each struggling to make both Medicare and health care more functional for all Americans. It's not clear how either plan would interact with the health insurance promises being made by Republican presidential nominee John McCain and Democratic hopefuls Hillary Clinton and Barack Obama. However, if American politics on both sides of the aisle could agree on how to make health care in America really work, something productive just might actually happen.
This week a bill has been passed to President Bush that would make genetic discrimination illegal, guaranteeing that our jobs and health insurance coverage could never hinge on what might happen with our health. FoxNews reports that Bush is expected to sign the "Genetic Information Nondiscrimination Act", which lawmakers and advocates are calling "the first major civil rights act of the 21st century." Already too many Americans have been refusing to take genetic tests that could reveal a tendency towards dangerous conditions, even though earlier treatment could save their lives. Others have been using false names and paying cash for these tests because they don't want the information used against them by their employer or health insurance company. It sounds like a crazy science fiction novel, but health insurance companies and employers have used genetic testing to discriminate before. As it says in the article, in the 1970s, several insurers denied coverage to black Americans who carried the gene for sickle cell anemia. Thankfully, once the president signs the bill into law, neither health insurance companies nor employers will be able to use genetic information regarding what we might, or might not have, to discriminate against us.
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