If stress kills, why aren't things that soothe our spirits covered by insurance?

As we continue through the theater of the bizarre with health insurance reform, it's amazing that the stress caused by health insurers and providers isn't addressed as one of the top controllable factors in our environment that contributes to poor health. Naturally, insurers would argue that we are in control of our responses to stimuli in the environment, but this dismissive approach is very un-American as insurers and providers fail to take responsibility for this aspect of their conduct that contributes to the poor health of Americans.

So as health insurers generate thousands of pages of provisions and explanations, we are now forced to take a back seat in the theater of the bizarre that is the health reform bill which has been reduced to a, pardon the expression, pissing contest between Democrats and Republicans. All of whom still enjoy the superior health insurance benefits available to non-military government workers at our expense. And from our back seat, let's talk stress reduction, whether it's a walk, a movie, or some quiet time at home.

Votive candles, that's right, votive candles. The soothing glow of a candle on the dinner table, or as part of a celebration, with a variety of scents and styles that can appeal to any personality. Votive candles, some of my favorites found at http://www.dlightonline.com/-strse-Votive-Candles/Categories.bok.

Safer than older style candles where lead levels in the environment are increased because of old-style wicks, newer candles include modern scents and modern substances including soy candles that avoid hot wax burns. And for all those on the preventive "medicine" bandwagon, don't dismiss the power of aesthetics to calm our spirits and give us each a break from the routine of frustration about our world.

So let's ask why these simple, affordable and effective pleasures aren't covered by insurance? Just for this moment, let's take charge of our stress and use some votive candles to carve out our own islands of calm in this storm.

Take a look at votive candles at http://www.dlightonline.com/-strse-Votive-Candles/Categories.bok, and see whether you don't feel better!

WHY ARE DEMOCRATS FED UP WITH OBAMA? Scott Brown Should Not Be the Lightning Rod to Measure President Obama

A new year and a new disappointment for Democrats who voted in this President based on his singular promise to make sure that each of us would have the opportunity to choose health plans as good as his and other members' of Congress. Empty words, and too many words (exact page count of this Health Care Bill?) that have left most of us fuming at the commitment our government has shown to preserving itself as a huge and growing lumbering reminder that our institutions have exploited US citizens to preserve their own dominance in controlling, manipulating and meting out scraps to the people who placed them in power.

After the "surprise" election of Scott Brown to the Senate, NOW we're hearing about the millions of dissatisfied Democrats? The wake up call to the President is that it should NOT have taken an election for him to step up and acknowledge that he's losing ground. Mr. President, you're making a mess. Go back to those who elected you and answer why your ego demands a bill called health care reform that excludes the very options, the public option that was the hope of which you spoke during your candidacy? Why does your bill sound like a regurgitation of John McCain's leper colony policies where those of us who dare to get sick are placed in Special Needs pools that have no limits on what they can charge? Why are you patting your own back that we can't be denied insurance without acknowledging the fact that without caps on how much we can be charged this option means less than nothing? If these key promises are not part of your health bill, only your ego will be happy with the proposed legislation.

Thank you Scott Brown for providing the opportunity for this President to get his act together instead of preparing for re-election by ignoring his continued failure and holding out ten years after your programs as the soonest when their success or failure can be measured. This carrot and the stick is a great scam and if nothing else, the President must stop telling Americans to wait and see what happens ten years down the road. Been there, done that, living in terrible economic times while the banks we bailed out give charity to Haiti and bonuses to their staff.

President Obama was never this Democrat's first choice because he was the same old thing, reform government by addressing the needs of our poorest Americans, ignore the super rich and assume that the middle class can continue to support this nonsense. Terrible disappointment.

So where do they go from here? President Obama is not going to alter his course, like George Bush, he's isolated himself from an American population whom he assumes will hand him the reins of this country for another four years. The biggest question is who the Republicans will run because only those who dislike the Republican candidate more will vote Obama again.

President Obama: Are there premium limits?

Was it there? We heard about limits on out of pocket expenses, inclusion of those with pre existing conditions, the requirement of insurance, but what about how much insurers can charge for policies for those with pre existing conditions?

President Obama must next address how, what, and if limits will be placed on what insurers can charge to those individuals who have pre existing conditions or we are likely to end up with special needs groups of individuals paying exorbitant premium amounts for coverage because of such pre existing conditions. Individuals with such pre existing conditions will be unable to maintain payments for health insurance. Funneling those who cannot afford to pay these into the public option means that the public insurance alternative must base eligibility on the percentage of income required to purchase health insurance coverage rather than income as a sole factor determining eligibility. This means that the public option must be more than a bare bones option in order for the President to successfully maintain the idea that health insurance helps to improve health rather than continuing the idea that "having insurance" is a justifiable tax for individuals whose coverage will not help them pay for needed medical care.

Health Insurance Co-ops: Now we're going into new fields

There is no proposal, no text from which we're working, just the idea of a health insurance co-op, where a group of people "own" the co-op and have options to voice their opinions and the direction of the co-op based on that "ownership."

Typically, such co-ops, in this consumer as owner state do not provide a magic solution to the lack of access to affordable quality coverage but instead provide something less, but at least there is health insurance.

Still, throwing around old concepts with the label "new" accompanying such ideas is ridiculous and for the listener becomes as silly as watching the new generation of "hippies" telling those who lived through that era what being a hippie really means.

So why hasn't this concept of the health insurance co-op caught on before?

Here are some questions:

Who owns the co-op? Is is consumers with a common interest, such as farmers or is it a group of professionals such as physicians, or is it a hospital itself? This group, as owners, has the power to dictate the direction of the "insurance" and the problems with all these examples already exist. Further, ownership models where physicians have a percentage of interest, hospitals have a percentage of interest and administrators have a percentage of interest have also occurred. Listening to all the guesswork, without government involvement and support and OVERSIGHT, it doesn't work for consumers. Issues of conflict of interest arise constantly where physicians refer patients to their own hospitals.

Conflict of interest is a major concern. It is well established that separate interests are WHY we are in this mess, insurance companies seeking profitability have INCENTIVE to erode benefits and eligibility and to raise premiums and co-pays. Physicians have an INCENTIVE to over test and over charge for profit. Consumers have an incentive to grab at cheaper rates without sufficient knowledge of what their medical services experience will be when they get sick. The GOVERNMENT is most influenced by VOTES, gross numbers of citizens who support the government or don't. In the process we watch billions of dollars being spent by the insurance industry and the medical services providers to LOBBY the government because IT WORKS. As consumers we stupidly (and I've carefully selected that word) buy into the NO BIG GUVMENT mantra which leaves us OUT of the significant part that government already plays in this industry. In Health Insurance Co-ops, FAILURE to adequately address the real life experience of conflicts of interests through LEGISLATION and RULES will leave consumers less powerful than ever to battle their "own" insurance company. Administrative costs will go up after YEAR ONE, that's a prediction based on reality. Coverage will go down after year TWO as government dollars are fazed out or reduced. Ownership percentages will shift and consumers will own LESS of their own co-op. How do I dare to predict this? Because this is what happens in the stakeholder game of health insurance...playing to the traditional FEAR of government which is a phobia based on the non real notion that if we ignore government every other stakeholder will and the FEAR of no coverage which has tweaked the cheap gene in humans to our survival's detriment as we BELIEVE that thirty choices of provider for exams will help us at all when we need an oncologist for cancer and find there are two providers.

Co-ops and government money: Governments contributing to these organizations will either become STAKEHOLDERS who support reduced coverages that jump on the cheap three wheeled bandwagon of wellness rather than care for the sick, or will provide "bailout" type dollars, an ongoing stream of government money with little oversight requiring permanent government funding or corruption.

Will the Co-ops REALLY have the power to negotiate a better rate of insurance companies for their members than the government? The only edge that small co-ops will have at a negotiating table will be what they're willing to give up because they represent a less diverse group of people than any "national" group. So, farmers can negotiate for coverage of accidents from machinery and give short shrift to other health services needs that the national government cannot do without alienating some Americans. But do you really believe that smaller co ops are better able to make a deal with health insurance companies than the government? Compare the benefits they offer their members with the benefits offered the members of Congress and if you still say yes, clearly there are other issues influencing your decision. This "issue" is the same one that seems to leave all the big mouths jumping on the go it alone bandwagon from DEMANDING that their non-pro-national health insurance representatives OPT OUT of the cushy government benefits they enjoy year after year. Further, if you examine the Massachusetts health co-op hybrid sort of offering you'll see that MA GAVE AWAY the bargaining tool in a valueless hope that continued "competition" would ultimately force health insurers to modify their rates lower...so far, MA is in the hole on that one.

The continued REFUSAL to address controls and oversight over physicians and insurers will prevent progress from ANY proposal. If you smoke you pay more, if you are old you pay more and if you get sick, welcome to the gift of higher premiums that keeps on giving. And it's not just you. In the last five years have you, your parents or grandparents had cancer, or have your grandparents, parents or yourself EVER suffered a heart attack...these are the real questions that come out. A mandate that everyone be offered health insurance without a LIMIT on what can be charged for such insurance (remember until recently the right to COBRA included the cost of 102% of premium which kept many from using COBRA). Without meaningful limits on physicians pay which currently includes defensive medicine costs which the consumer carries in the real dollar cost of over testing, means that no matter what label we smack on something the issues will be the same: Less cost only obtained by less coverage.

In our current environment a national health choice is the ONLY means we have of negotiating lower costs: If this insurance doesn't provide me with affordable rates of coverage after I have my cancerous mole removed then I will choose the national option. It won't be great because of the lack of firm mandates on physicians and insurers, but it will be better. Ultimately, mandates on insurance companies and providers will be the ONLY way left to manage costs. Ultimately, you can weed out any ill person into a special group but ultimately, an insurance industry that only provides insurance to the healthy will erode their own profits as the healthy realize they don't NEED insurance and that when they NEED insurance it will not be there.

HSA's...yes, they need reform

As the benefits election season looms over the horizon, the marketing push for HSA's is back. Health Savings Accounts have been addressed here before and in general, they stink. Access, Affordability and Quality: Typically, access and quality face the same challenges as other health insurance plans. It is Affordability, that sells these "policies", and here's the rub. For a lower premium you get less coverage and higher deductibles, no magic pill in terms of finding something special. In order to distract away from this fact is the "savings account" feature of these plans. This allows around two thousand for an individual and around six thousand for a family to be put into a savings account with PRE TAX dollars. It's that pre tax dollars feature that catches the attention of shoppers along with the fact that unlike "flex" accounts, amounts remaining in such accounts after the year are NOT forfeited, they can be used for future medical expenses. Further, with interest rates being paid on savings accounts at abysmal levels, these accounts typically pay more in interest than other "savings" accounts. And there are other options for how to "invest" these dollars. And suddenly, the healthy purchaser of the plan isn't talking about health insurance at all, he/she's talking about savings.

But look further. With higher deductibles and often higher co payments, in the event you actually need health services, AND you need to actually use those pre-tax dollars for such care, your neat little savings account will be gone in very little time (even $5,000 does not go far if you are ill). Further, you're now simply stuck with an inferior health insurance policy. But if you can afford to pay for your health co payments and fees up to the magic "pre tax" number out of another account, you can leave that money to grow in your health savings account. This is where the TAX FREE savings come in. And what could be wrong with that? Right now it's another way to save several thousand dollars a year tax free. Like a 401k (traditional), the health savings account keeps growing. UNLIKE the traditional 401k, however, this money is SUPPOSED to be used ONLY for medical expenses. But, right now no one is watching the store and although the IRS can check on the validity of withdrawals being used for medical expenses, insurance companies typically don't pay attention at all and in fact have argued that they'd have to charge higher fees if they were expected to verify that such money was being used for medical expenses. Fees? Another aspect of these plans is that they charge administrative fees. With interest rates very low, such fees might eat into or exceed the meager profits individuals were hoping for by selling out and purchasing these plans. In that case, of course, ROLLOVER into another HSA is possible. And for the rich or those using the HSA as a second policy (being insured by their spouse under another insurance plan), often this choice is not so out of whack that it's laughable. But as a primary insurance policy BEWARE insurance that sells itself primarily as a means of saving money tax free.

So with all the legislation, why is it we don't hear about including MANDATORY reporting and verification of withdrawals from such accounts for medical purposes by the INSURANCE companies? Is it not of note that when we apply for insurance or heaven forbid seek coverage for medical services that we must provide every piece of relevant and irrelevant information for insurance companies before they pay? And that's the reason. When you seek COVERAGE from your plan, once the deductible is met, you can expect current insurance industry game-playing from stalling to refusal to appeal to providing every piece of information available if you want coverage. As an INSURANCE policy the HSA insurance coverage is the same (with higher deductibles) as other insurance. But the SAVINGS ACCOUNT is your money. Insurers don't care how you spend your money and in fact, FAILURE TO REVIEW withdrawals from HSA's works to their benefit because it becomes a tacit incentive to sell their plans. Only an individual faces the RISK that the IRS will come a calling. Win? Win? Not so. First, in the event of real medical need, your insurance policy has a higher deductible and as anyone knows, $5,000 of your money will probably NOT amount to $5,000 worth of deductible after you consider usual and customary charges that have exploited the carrot and the stick of have I met my deductible yet.

Second, the profits to insurers of selling these "savings" plans provide another revenue option as they get to charge an administrative fee for the accounts. Such fee is subject to insurance company increases EVEN THOUGH they do not review the spending from such accounts. Such fees often erode the individual PROFIT from the HSA.

Is it just mean-spirited to desire mandated insurance company verification? It is a shocking number of dollars that account for insurance fraud. Such fraud amounts to billions of dollars and while individuals are gung ho about stopping fraud when insurance companies blame individual fraud for out of this world costs of health insurance, the oversight, prosecution and recoupment of fraud within insurance companies is not good. Fraud costs you more than covering your diabetic neighbor, go look up the stats on that. Individuals argue against government run insurance based on "fraud" yet with reams of paper spent on "reform", we are not hearing about new mandates (including huge financial penalties) for insurance company fraud.

Mandates for insurance company review of withdrawals from HSA's is legitimate, insurance companies are getting money from these "policies". Tacit tolerance of threats by insurance companies that they would have to raise administrative costs of such accounts if they reviewed them is ridiculous because arguing that without tolerating fraud the product doesn't work means that the product doesn't work. Further, the stress on our governmental system where now only the IRS can catch the cheats using HSA money for other than medical expenses means that we will need more IRS staff to enforce the legal constraints of these plans or that the government itself will have to buckle under insurance company refusal to monitor these accounts.

Walmart and Health Insurance

Well, it's interesting to read about Walmart in today's WSJ online and its "turnaround" regarding employer contributions to health insurance for employees...they now support it. (http://online.wsj.com/article/SB124640564559176649.html#mod=testMod)

But like a bad relationship, avoiding the sticking points of health policy doesn't fix anything though there's something to be said for keeping the topic in the forefront. So why Walmart's turnaround?

First off, acknowledged within the article is the fact that Walmart has a point in saying that if they provide health insurance options, all businesses should. Not necessarily a CHARITABLE approach, but true. This argument is the same as this blog's argument that "REFORM" that burdens one segment of people...in this case the middle class because they are the only disorganized group of individuals instead of representing a GROUP and in obtaining health insurance being part of a group can't be beat. Look at our governmental workers...you've been encouraged to do so before. After all this time we still don't hear any of the governmental talking heads addressing the unbelievably GOOD benefits available to civil servants vs the benefits available to the average citizen.

Second, Walmart emphasizes the need to control costs. Duh. But the only way that we've attempted to control costs is to penalize the sick, those with bad habits, or those with a history of less than perfect health...charging more in premiums. This is a doomed policy because as Americans get "healthier" for insurance purposes, health insurers and service providers like doctors do NOT lower their charges. Quite the contrary, these have gone up for people who have never used their insurance coverage for anything but "preventive" care. So what gives? Until the amount charged is controlled and until there is a mandate of return of percentage of premium for every benefits year that is UNDER utilized, there is NO incentive for providers and insurers to control what they charge.

The "FREE" market is a myth and I for one will not listen to any sadly misinformed individual spout ideas of the free market. In this blog we've gone over the endless legislation (you know laws) passed after pressure from lobbyists ranging from insurer lobbyist like AHIP to physician lobbies like the AMA. And if you still want to argue that this heavily legislated benefit for these segments is "free", think of your own bill...how's that free market working for you? The only way a person gets cheaper health insurance is to buy less coverage. So give it up. And regarding the STATES RIGHTS issue, have you actually LOOKED at where your health insurers are located? They are already NATIONAL.

So, in the spirit of being upbeat, what good is going on? The discussion is good because the issue is upfront. Unfortunately right now, however, President Obama wants reform without hurting big business's feelings. He wants reform without physicians threatening people that they will stop practicing. He wants reform without pointing out that all the die hard "capitalists?" in Washington who are using Federal health plans while they tell their constituents tough luck need to opt out of the bloated federal benefits program. Until Obama man's up and acknowledges that continuous squeezing of the middle class, or the mere expansion of government programs without applying pressure to the endless greed and unmonitored overcharging of the American people by insurers and providers, this "reform" will go nowhere and Obama risks a legacy of "attempted health care reform" that was the lethal blow to Hilary Clinton's attempts. And regarding Walmart...no specific mention of covering PART TIME workers...interesting.

Basically we're spinning our wheels. Health insurers don't HAVE to charge more because there are actually sick people using their product. Their product is only VIABLE if it covers the sick. Physicians aren't being crushed by their costs...look up their income levels, go ahead, I dare you! Right now we're talking about moving money around, not reform because CONTROLLING COSTS FROM OVERPRICED INSURANCE AND OVERPRICED SERVICES is being omitted.

Maybe the common ground is starting to show.....COST CONTROL

Common ground for "Republicans" and "Democrats": In an op-ed piece today in the WSJ by Michael Gerson called "Obamacare's Antidote", the man makes a good point: Obama rules with his throwing money at problems but of course, this is just a distraction and at the end of the day, until there are COST controls put on the COST of health care services we're just going to keep robbing peter to pay paul. Obama's ideas are crystallizing into an ill-organized long-term game of hope-enomics of shifting costs rather than addressing costs of the services, equipment and pharmaceuticals individuals require.

WSJ Op-ed writer views: As Gerson notes: "The administration, it turns out, has no serious plan to control health-care costs. Government health programs of the type Obama seeks to create are not good at cost control (as Medicare has proved) -- unless they aggressively ration expensive care to the seriously ill and elderly (as more muscular European models have done)."

Gerson concludes: "The political fight on health care remains lopsided in Obama's favor, but the policy argument is growing more balanced. On the Republican side, Americans will see scary changes and more individual costs; on the Democratic side, government control and possible rationing, at a price we can't afford."

Gerson is right on the money in pointing out issues: Without COST controls someone's paying and the idea of RATIONING health services to control costs will not be successfully sold to the American people.

Here's the common ground: We agree with the problem. However, we don't agree with the solution. So in Obama land, with the avoidance of "conflict" that appears almost pathological, we see failure to make decision as the preferred route which in Washington speak always means delay action by throwing out money.

Health Services are the goal and health insurance is the means of obtaining that goal:So what's an administration to do? The first problem is that it's been a long time since President Obama had to worry about the cost of or the availability of health insurance or the ability to pay for it. Similarly, the civil servants in government have not had the worry of being denied coverage. In an effort to AVOID health care conflict between different opinions, Obama is EXPANDING the number of civil servants and therefore the number of people who will get this cushy health insurance option. But civil servant benefits, including those of our representatives are a sacred cow that must lose their sacred status. Our lawmakers have no skin in the game, their health insurance coverage is good and tweaking medicare, medicaid and every other program makes the commitment to NOT touching the giveaway of civil service health benefits ridiculous. Now, the Republicans want to tax employer sponsored health care and this option should ONLY be explored if it applies to civil servants.

Rationing is not the answer but is a by-product of our current system: Rationing health services is not especially scary, we already have rationing in coverage of one exam a year, ten visits to a physical therapist or psychologist, drug coverage up to a limited amount. Rationing is not the problem, the problem is that the COST of services means that those with more money can buy better health services and "care"...of course, this also already exists. A seventy two year old patient with Medicare and benefits from being a civil servant already receives better care than an individual on Medicaid. Rationing, therefore, should not be a policy, but is already a result of a system that charges too much for health services, that has many services available as medical technology expands, and that motivates its providers to utilize all those services to cover their own butts in terms of defensive medicine. Even if an insurer won't pay for a rich person's self-attention, that person can simply go and purchase it on his own, receiving the additional benefit of being able to avoid the invasions of privacy that go with going through an insurer. Rationing could be controlled by charging more and TAXING people who run to the doctor for more than one check up a year, who routinely submit to test after test just because they can. This form of rationing would address the PERMA PATIENT, the guy you know who sneezes and runs to the doctor.

The MYTH of COMPETITION: It's unbelievable that the competition argument is still going on. Insurance companies already are present in multiple states AND within those states, there are usually one or two that dominate. Competition among COSTS of insurance are based solely on the amount of coverage people obtain AND the profile of the consumer. There is no other competition. Further, services providers work with codes and while some providers charge more, the COST of these services is pretty much the same otherwise the USUAL and CUSTOMARY concept could not exist. The idea of competition has really devolved into turning consumers against one another so that people say why should I pay for that fat smoking guy, this is not competition that will solve the health services problem because if anyone who is sick is subject to exclusion or overcharging then only well people will have "insurance".

The good news is that the IDEA of controlling COSTS is correct otherwise we have to keep coming up with more money to pay for less medical care. The idea of controlling costs requires that health insurers, including the governmental groups that can pressure insurance companies MUST negotiate better rates for services instead of negotiating away quantity of coverage. This requires someone who is willing to face conflict: Insurers must take less without providing less and providers must charge less. Obviously this impacts their profits which are compensated for through increased numbers of patients. Increased numbers of patients are accommodated by limiting the number of times people visit physicians and obtain other services that are NOT necessary which can be determined by categorizing the perma patients as CHRONIC and thereby eligible for higher rates being charged.

At least, the common ground exists.