Archive for October, 2009
Funny thing pain, if you’ve never had a severe pain then the suggestion of taking simple analgesia and resting the affected area all seems quite reasonable. I was reminded of this when I read recently of a doctor’s advice to someone who was suffering from sciatica. Having personally experienced sciatica, it’s a condition I would not recommend to anyone who wishes to walk, sit, laugh, sleep, or to just simply pull up your trousers. It’s a bit like a dentist drilling your teeth without an anaesthetic, but it affects your whole leg. In other words the pain is consuming, exhausting and without respite. Clinical studies do show that in the majority of cases the pain will eventually subside and surgery may not be necessary, but in the meantime the patient has to deal with the pain or deal with the medication required to dull the pain. Remember, pain-killers are not selective to the area affected. They affect the whole of the nervous system and elsewhere so there may be significant side-effects from these medications.
Dealing with severe pain can be a complex issue, but I suggest that you have to treat this sort of pain fairly aggressively as acute severe pain is relatively easier to treat than chronic severe pain. In the early stages of an injury or insult to an area of the body, most of the pathological processes are happening at the site of the injury or insult. Throughout time the brain begins to modulate this pain and so no only do you have the injured area to deal with, but you also have complex neural pathways within the brain to deal with as well. This often means a far more complex management plan and a far more protracted recovery time. Specialists are very skilled at dealing with these issues but they do rely heavily on the stories their patients give them. That means being honest in answering their questions and not being heroic with a grin and bear it grimace! Often the use of a pain scale is helpful with zero being no pain at all and a 10 being the worse pain you have ever experienced.
Another health issue we commonly down play is influenza. Over the years I have frequently heard people say that they would not have the flu vaccine because either they never get the flu or that they had it last week for a couple of days and then it was all over! Influenza is a serious debilitating disease that will usually last from 10 days to two weeks and often leave you flat on your back exhausted. It’s not a happy 10 days either as patients do not have the energy to read a magazine or even watch a DVD. You will literally feel ancient with every movement being a real challenge and that doesn’t include the aching all over or the fevers and sleepless nights. The influenza virus is also extremely contagious and most people are unaware that if you spread it to someone who is more frail than yourself that you may actually be putting their life at risk.
With the ‘flu the big challenge is to vaccinate as many people in the community as possible, including children, those employed and unemployed, the elderly and the infirm, to reduce the chance of an epidemic occurring. Recent research has also showed that vaccinating pregnant women in the last trimester of their pregnancy will help protect their new born infants born during the ‘flu season.
Medicine has evolved over the last 40 years, but the change has been fairly slow with doctors by nature being very cautious and conservative people. But we can’t leave the doctors to take all the initiatives. As patients we need to be good listeners in our approach to health by heeding all the great health messages that keep being given to us about vaccinations, smoking, alcohol, exercise and healthy eating. We also need to be good communicators and tell our doctors how we are feeling with conditions such as pain. If the team treating you doesn’t have the best information then it may be that you will not end up getting the best treatment!
Why? Because Congress wants to levy a $6.7 billion premium tax on all private health plans each year for the next decade to pay for reform.
That’s a $67 billion tax.
Health plans will have no choice but to pass these costs on to the consumer. This tax will make it tougher for families to afford coverage, increase the difficulty for small-business owners trying hard to insure workers, and stifle job creation.
In Florida, small businesses are the bedrock of our economy. This tax will hit our economy especially hard. It’s just not what families and small businesses need as they dig their way out of a severe recession.
The Congressional Budget Office evaluated this tax and found it will lead to “higher premiums for private coverage.” The nonpartisan CBO estimated that premiums for individual coverage could rise by as much as 13 percent.
This tax also might be disruptive to policyholders, because it could damage the ability of health plans to deliver all the benefits that members expect.
That’s because Congress is ready to impose this health-insurance tax in 2010. That’s after families have already signed up for coverage for next year, and after small businesses have already negotiated coverage contracts.
The result? Health plans may not receive enough premium to cover the costs of the massive tax, and benefits might suffer.
Unfortunately, health plans have been demonized in the pursuit of reform. But in reality, it’s not true to claim that health plans make a lot of money; their profit margins are actually pretty small.
In 2008, private health plans made $8.61 billion in total profits nationally, according to Forbes magazine. The industry’s profit margin was just 2.2 percent, ranking health plans 35th out of 53 industries in terms of profitability.
As the president and CEO of SantaFe HealthCare — the parent company of AvMed Health Plans — I am truly concerned by this proposed tax. As one of Florida’s oldest and largest nonprofit health plans, AvMed reinvests its earnings each year to continually improve on the benefits and services it offers to members in Orlando and elsewhere.
Obviously, a health-insurance tax that wipes out most of our annual earnings is counterproductive to our mission. Surely, congressional leaders must grasp that this tax doesn’t make sense.
There are better ways to pay for the systemic health-care reform that AvMed and other health plans support.
Instead of taxing health insurance, Congress should focus on the underlying costs of medical care. We can achieve huge cost savings by ending unnecessary treatments and services, rooting out rampant fraud and ending frivolous medical lawsuits filed by trial lawyers.
Health reform shouldn’t hurt Florida’s families and small businesses. It shouldn’t hamper the ability of health plans to provide benefits.
Time’s running out.
Please contact your congressional representative and Florida’s two senators today. Ask them to vote against this harmful health-insurance tax. We can achieve true, lasting reform in better ways.
Oleta Fitzgerald, director of the Children’s Defense Fund’s Southern Regional Office, says she is concerned over the welfare of Mississippi children if either of the two health-care reform packages considered by the U.S. House and Senate ever make it into law.
The House passed H.R. 3962 earlier this month, and Senate Democrats managed to beat back the threat of a Republican filibuster a few weeks ago, allowing the Senate to move forward with debate on the Patient Protection and Affordable Care Act, H.R. 3590. Both bills promise big reforms in the health-care and health-insurance industries. The Association for American Medical Colleges states that nearly 15 million people will be newly eligible for Medicaid and the Children’s Health Insurance Program under H.R. 3590, at an estimated cost of $374 billion over 10 years.
Fitzgerald says both bills contain huge holes regarding CHIP coverage for Mississippi children: “Right now, the fight over health-care reform in the House and Senate is all about abortion and the public option, but the children are getting lost in this discussion,” Fitzgerald said.
The issue, she said, centers on Mississippi’s unconventional requirement for CHIP eligibility.
Many states recently expanded their Medicaid program requirements to accept people who are a little further from the federal standard for poverty. Eleven states recently extended CHIP-eligible families’ income levels up to 200 percent of the federal poverty level, or higher. ($20,800 for an individual or $35,200 for a family of three).
But instead of expanding Medicaid, Mississippi set up a new health insurance program that contracts with private insurance companies. The states that expanded Medicaid will continue to receive federal support for those programs under both the bills under discussion in the House and Senate. But in Mississippi, all children and their families over 150 percent of the federal poverty level ($16,245 a year for an individual and $27,465 a year for a family of three) would go into an insurance exchange created by the House and Senate bills. The Senate bill plans to put CHIP-eligible kids in an exchange by the year 2019, while the House bill has them transferred by 2013.
Insurance exchanges do not promise the reliability of a government health program, Fitzgerald warns.
“Going into the exchange could require co-pays and premiums, the children would get lumped in with adults, and it’s not clear what requirements the insurance companies would have for their benefit packages,” she said.
There is also the question of permanence. Exchanges like the ones proposed by the House and Senate bills have not always been long-lasting. Texas, Florida, North Carolina and California all attempted—and failed—to create enduring insurance exchanges, primarily because private insurers tampered with the market.
A July report issued by the California HealthCare Foundation tried to pinpoint some of the factors that killed the California insurance exchange, which closed its doors in 2006. According to the report, the California exchange became too expensive when the clients it served became too costly. An exchange requires a certain number of healthy individuals to complement the more sickly participants of the exchange’s customer base; otherwise the cost of participation becomes too high for all participants.
But insurance companies in California lured healthy customers with lower premiums and steered the more sickly individuals into the exchange, creating a disproportionately expensive customer base.
“People involved in operations of the California exchange agreed that when there is competition for the same customers within and outside the exchange, the exchange is in ‘extreme peril’ of becoming a victim of adverse selection,” the report states. “If an exchange attracts a disproportionate share of higher risk individuals and groups as the California exchange did at various times, it cannot succeed.”
Fitzgerald said Mississippi’s eagerness to boot CHIP-eligible children from the program to keep down state costs is another factor complicating the new bills.
“Another problem is enrollment. We need enrollment in the exchanges to be simplified, because enrolling in state health programs have a history of being anything but simple in Mississippi,” Fitzgerald said, referencing a Medicaid policy championed by Republican Gov. Haley Barbour, which requires Medicaid recipients to meet Medicaid personnel “face-to-face” to be considered for program renewal.
CDF is working with its national office in trying to insert an amendment in the Senate bill though Democratic Sens. Robert Casey and Jay Rockefeller, which would keep all children up to 300 percent of the federal poverty level in the CHIP program until the new insurance exchange is thoroughly vetted.