The insurance bottom line

Unintentional honesty

Saw this piece in the Star Tribune a couple days ago, talking about growing frustration and impatience for United Health among the Wall Street crowd, which is expecting better performance and profitability.

This line is symptomatic of so much:

The company expects its medical-care ratio, the portion of premiums that goes toward paying medical bills, to inch up to 81.3 percent this year, from 80.6 percent in 2007. A higher medical-care ratio is bad for insurers because it means narrower profit margins.

Yeah, health care as a business, but what would you think of a charity that lost 20% of its overhead to administrative expense and profit?

Single payer.  Now!

Coming home to roost

WaPo has an interesting story showing that life expectancy is dropping for many Americans.

For the first time since the Spanish influenza of 1918, life expectancy is falling for a significant number of American women.

In nearly 1,000 counties that together are home to about 12 percent of the nation’s women, life expectancy is now shorter than it was in the early 1980s, according to a study published today.

The downward trend is evident in places in the Deep South, Appalachia, the lower Midwest and in one county in Maine. It is not limited to one race or ethnicity but it is more common in rural and low-income areas. The most dramatic change occurred in two areas in southwestern Virginia (Radford City and Pulaski County), where women’s life expectancy has decreased by more than five years since 1983.

The trend appears to be driven by increases in death from diabetes, lung cancer, emphysema and kidney failure. It reflects the long-term consequences of smoking, a habit that women took up in large numbers decades after men did, and the slowing of the historic decline in heart disease deaths.

Now, it might cause one to wonder whether availability of quality health care has something to do with this. But I’m sure the loyal bushies are eager to reassure us it’s purely coincidence that this isn’t happening in other western nations.

Wringing blood from turnips

The New York Times highlights a new practice in pharmaceutical copays where instead of a fixed amount, the victims, er, insured are required to pay a percentage of total cost for certain drugs.  For many people this can amount to thousands of dollars.

With the new pricing system, insurers abandoned the traditional arrangement that has patients pay a fixed amount, like $10, $20 or $30 for a prescription, no matter what the drug’s actual cost. Instead, they are charging patients a percentage of the cost of certain high-priced drugs, usually 20 to 33 percent, which can amount to thousands of dollars a month.

The system means that the burden of expensive health care can now affect insured people, too.

No one knows how many patients are affected, but hundreds of drugs are priced this new way. They are used to treat diseases that may be fairly common, including multiple sclerosis, rheumatoid arthritis, hemophilia, hepatitis C and some cancers. There are no cheaper equivalents for these drugs, so patients are forced to pay the price or do without.

This is criminal.  Single payer, now!

Hat tip to John Cole who observes:

I am suspicious about single payer, but as I have often stated, I think it is an inevitability- big businesses want it, the number of uninsured in this country is untenable, our national standards for care have been declining (and you can choose your own statistic- infant mortality and so on), so my personal opinions really don’t matter much. I think the only questions regarding single-payer in the US are when, and how bad will the special interests loot the treasury in the process (will it be another boondoggle like Bush’s welfare plan for big pharm?).

Regardless, when I read crap like this, my attitude is how can it be any worse than the current system?

He’s right to be suspicious about single payer - it can be done very wrongly - but it’s going to happen.

Walz is right

He makes me proud to be a Minnesotan. One of the shining stars of the freshman class on the hill.

Single Payer for Minnesota?

Interesting bit from Minnesota Monitor:

The Minnesota Health Plan would move health insurance out of the private sector and create a system where one payer — Minnesota — would cover everyone in the state based on their ability to pay. The bill, authored by Sen. John Marty, DFL-Roseville, is an example of a single-payer health care system and it has the support of a majority of physicians in Minnesota, according to the latest survey.

I’m proud of Senator Marty - he’s my senator.  The governor will never sign it, but it’s encouraging that at least the discussion is starting to come forward.

Underperforming medical system

America’s allegedly “best in the world” healthcare continues to overcost and underdeliver in terms of real health benefits.

From The Economist:

A new study by researchers at the London School of Hygiene and Tropical Medicine looks at data from 19 countries for deaths of under 75-year-olds that should have been avoided with proper health care. Preventable deaths declined by 16% on average in these countries between 1997 and 2003. Big improvements were recorded in countries that started with both low levels of avoidable deaths (like France) and those with higher levels (like Britain). But America, where health-care spending per head is highest, is at the bottom of the table.

Follow the link for the graphic.

Perhaps the ultimate outsource

Wow…

Every night in this quiet western Indian city, 15 pregnant women prepare for sleep in the spacious house they share, ascending the stairs in a procession of ballooned bellies, to bedrooms that become a landscape of soft hills.

A team of maids, cooks and doctors looks after the women, whose pregnancies would be unusual anywhere else but are common here. The young mothers of Anand, a place famous for its milk, are pregnant with the children of infertile couples from around the world.

The small clinic at Kaival Hospital matches infertile couples with local women, cares for the women during pregnancy and delivery, and counsels them afterward. Anand’s surrogate mothers, pioneers in the growing field of outsourced pregnancies, have given birth to roughly 40 babies.

Medical tourism

It’s not just “them” any more.

So sad.

Another casualty in the “war” against drugs

Hat tip: Andrew Sullivan

Via The Missoulian:

Robin Prosser, a Missoula woman who struggled for a quarter century to live with the pain of an immunosuppressive disorder, tried years ago to kill herself. Last week, she tried again. This time, she succeeded.

After her earlier attempt failed, Prosser wound up in even more trouble after investigating police found marijuana in her home. She used the marijuana to help cope with pain.

John Cole says it best:

I am tired of being patient with you nannies and your stupid self-serving rules and your slippery slopes and your bullshit and your need to be tough on crime and your earnest concerns about society. Mind your own business, get your own house in order, stop fucking interns and little boys and cheating on your wives and on your taxes and being found dead wearing two wetsuits with a dildo shoved up your ass. Just mind your own damned business, and let people do what they must to deal with their own screwed up lives, and let people handle their pain the best way they can.

I am sick of the bullshit. Life is hard for most people out there, and damned near impossible for people in chronic pain. Quit making it worse, you allegedly compassionate sons-of-bitches.

The fruits of an abortion ban

Three nations, Chile, El Salvador and most recently Nicaragua,  have complete bans on abortion - with Razi’s blessing as one might expect.  Mahablog has an infuriating piece about the cost in human life in Nicaragua.

Last November, Nicaragua became the third country in the world, after Chile and El Salvador, to criminalize all abortions. There are no exceptions; not for rape, not for incest, not for threats to the life of the mother.

So far, this law has resulted in the deaths of at least 82 women.

A lot of people have concerns about abortion as retroactive contraception and reasonable people will disagree over what limits are appropriate.  But the religion wrong is treating this as a zero sum game, and it’s not.  They are playing with the lives of real people.  The American people deserve better.

Operation pointless?

There’s an interesting piece at Americablog about the need for a president to commit to ending the AIDS epidemic.

Of course, to end the AIDS epidemic in America requires leadership. And, we’re not going to have leadership until we have a new President. That’s why the leading AIDS organizations and their allies “have requested that every Presidential candidate commit to developing a results-oriented national AIDS strategy designed to significantly reduce HIV infection rates, ensure access to care and treatment for those who are infected and eliminate racial disparities.” What a concept, huh?

Interesting.  Don’t get me wrong, public health is very much a meaningful topic and something about which presidential candidates should be held accountable.   But there seems to be a rather native optimism here that fails to recognize the limits of governmental reach. How have we been doing against the obesity epidemic?

It’s wonderful to think of eradicating the virus and research toward vaccines must go forward with as much urgency as treatment for those infected.  But when you look at transmission rates and the number of people being infected you can’t escape the realization that our behavior DOES come into play here.  If you don’t engage in risky sex practices and you don’t share needles, your risk of exposure to HIV is inherently reduced.  Attempting to fight the epidemic without recognizing those inconvenient facts will get us nowhere.

Facts and figures

Great piece at Minnesota Monitor on the shape of the abortion debate.

Economic reality

Interesting stuff from Sully

I guess some readers are a little shocked by this statement:

I see no problem with the wealthy having access to better care than the less wealthy.

It seems to me that this is equivalent to saying: I see no problem with living in a free society. Even if Michael Moore achieved his dream of corralling us all into a British-style healthcare system, private medicine would still endure in America. In fact, you’d have to make it illegal to prevent the wealthy having access to better care, newer drugs, faster service, better doctors. I know some leftists would gladly prevent the successful from getting better healthcare, but it won’t happen in a free country.

At a fundamental level he’s correct. Health care isn’t a right, it’s a collection of goods and services for which eventually a bill comes due.

But that’s not the whole story.

The right wing is working itself into a frothy lather in anticipation of Sicko, the new Michael Moore movie. Yes, yes, Moore is an asshole propagandist and presents an attractive target to his critics but it will be unfortunate if they focus on Moore and not on the issue of health care in America.

Because health care, though not a “right” in meaningful terms, is absolutely a public good. And as a public good we can’t afford to continue down the road we’re on.

Let’s be blunt and honest about things here. When it comes to the health care dollar the United States spends more and gets less for it than anywhere else in the developed world. A shocking number of people lack easy accessibility to even basic medical and preventative services. Costs are skyrocketing and it’s coming home to roost affecting not just patients and hospitals, but even our competitiveness in the business world as the marketplace goes global.

Lots of things are public goods - roads, the airwaves, telecommunications networks, etc. We know from practical experience that doesn’t mean the private sector can’t be part of the solution. But it does mean there needs to be an appropriate investment in government oversight and regulation to make sure the public interest is being met. It does mean we can do better in spreading the cost of care out so nobody has to worry about financial ruin from an unforeseen emergency. And in some cases it might even mean the government is in competition with the private sector - if the really believe competition is good for all, they should say, “Bring it on!”

It means we accept the premise that “being human” implies a certain level of shared responsibility within our society such that people are cared for and we are honest and up front about what it takes to do that. I grow tired of critics who use personal anecdotes, “My dad suffered from XXXX and spent however long in the hospital and was taken care of even though he is poor and nobody that wants treatment in America goes without…” when we all know damn well that the cost of his dad’s treatment was made up through accounting tricks and overcharges to other patients. And whatever “dad” says, we all know people who HAVE suffered because of inadequate care.

There is no free ride, let’s be honest and create an infrastructure that’s above board and reduces people falling through the cracks. Sully’s right, the rich by definition will find a way to do what needs to be done, but this isn’t an issue because of a fraction of a percent of the population. It’s the rest of us - and our nation’s economy, that are driving the discussion.

We get the usual whining about “socialized medicine” but there are myriad systems out there, there isn’t a single meaningful definition. Having lived in Europe I know full well there’s no pot of gold at the end of the health care rainbow. But at some point quantifiable results have to enter into the picture and whatever system they have adopted a common feature is they spend less per capita, and get more in terms of lower infant mortality rates, lower rates of lifestyle diseases, longer life span, etc.

We don’t have to endorse every single policy in every single country to recognize they’re doing some things right, and we’d be foolish to not learn from them. where appropriate.

Of course the darwinian capitalists, the insurance companies, the pharmaceutical companies, and many others have a vested interest in keeping things the way they are. But the principle of a safety net is ingrained well in the civic consciousness. People “get” it, they understand why it’s appropriate and even necessary to have the kind of society we want to live in. What we haven’t done well is figure out how health care ties into that.

Recognizing the nature of the discussion is that of health care as a public good is an essential first step. But just as important, we have to do a better job holding our elected representatives’ feet to the fire. What are their plans? How do they propose to move forward?

A lingering lesson of the Hillarycare debacle is that it isn’t safe for candidates to address health care head on. That needs to change. We should demand better.

Number four

A fourth sextuplet has passed away.

Another one of the sextuplets born to a St. Louis Park couple has died, hospital officials said Monday.

Cadence Alana Morrison is the fourth sextuplet to die since the babies were born on June 10. She lived nearly two weeks before dying Saturday morning, officials at Children’s Hospital in Minneapolis said.

Hopes continue for the remaining two.