Tag: health insurance

Affordable Healthcare: How to make it work

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I live in Florida. As I read the newspaper today, I was appalled to see that Florida Tea Party members were testifying before the state legislature encouraging them…no insisting…that they flaunt the Federal Affordable Care Act insisting that it is illegal in spite of the Supreme Court decision to the contrary.

Then I read a new issue of FierceHealthPayer, an industry newsletter for Healthcare Plan Executives. This issue had two separate articles and a commentary that made me wonder how we will possibly get to affordable healthcare in this country.

The first article reported that the American Medical Association (AMA) has reviewed health plans across the country and opined that 70% of commercial insurance markets are anti-competitive. This means that in 70% of the locales in this country, the vast majority of the health insurance is provided by one company. One of the primary arguments of the insurance industry and their Congressional supporters against a single payer national health plan is that competition is necessary in order to achieve quality and control costs. If that is so, we will not get to affordable care or adequate quality given this current anti-competitive situation.

The second article discusses the trend toward self-insurance on the part of large employers. There has been a steady increase since 2006 in the number of large employers who are managing administrative costs and avoiding variable state laws by self-insuring. In 2011, approximately 60% of workers were covered in a self-insurance program run by an employer. Small employers generally do not have this option. The risk of self-insuring for a small group is much greater than the outrageous cost of group coverage through one of the major insurance companies. Self-insurance often tries to control costs by limiting benefits.

The final item that grabbed my attention is a commentary in this same newsletter. The editor reported on the confused state of smoking cessation coverage among private insurers. She pointed out the requirement in the Affordable Care Act for such coverage and the indications by surveyed insurers that they do include smoking cessation coverage.

Yet when Georgetown researchers studied 39 health plans, they found that none of them took all of these vitally important steps: clearly stated that tobacco cessation treatment is covered; provided coverage for individual, group and phone counseling and tobacco cessation medication; provided treatments with no cost-sharing for members; and provided access to treatment without members having to meet prerequisites.

Read more: Why wouldn’t insurers cover smoking cessation? – FierceHealthPayer

These are the factors that are most likely to result in successfully quitting the use of tobacco products. You would think that insurers would want to have this particular benefit in their plans and that it be used. After all, the direct medical costs and productivity losses caused by smoking-related illnesses each year is almost $200 million.

The juxtaposition of these four items today reminds me of my personal conclusion…we need a single-payer national healthcare system if we are ever going to get our costs under control and provide quality healthcare services to most U.S. residents. Just by removing the 22% growth in earnings posted by the five major insurers in 2010, we might get a start on controlling some of the costs involved. Standard benefits across the country would make the system easier and more consistent for employers with workers in multiple states. And real implementation of preventive measures like smoking cessation would make all of us healthier.

And now I will wait for the comments….

Caring for the Caregiver: 5 Self-care Tips

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When I worked as a psychotherapist, I constantly struggled with the issue of self-care. I was always much better at taking care of others than I was at taking care of myself. I attended workshops and became involved in my professional associations because those activities felt good and were part of my self-nurturing, but they also ate up energy, so they were not as restorative as necessary.

When I had the opportunity to move out of the practice of psychology and into business, I jumped at the chance. Mental health care can be very demanding and eighteen years of other-focus seemed like my limit.

Then Katrina flooded my Mother’s home. Since September of 2005, she has lived with us and is now 92. I have become her primary caregiver. Although she is able to take care of many of her own needs, as she has aged and become more frail, the time and energy required of me has increased.

Last week I attended a webinar offered by my health insurance carrier. United Healthcare seems pretty intent on offering services that might prevent or mitigate illness. When I got their newsletter announcing the workshop, Take Care of the Caregiver, I signed right up. The information and suggestions they offered will undoubtedly prove valuable for me. My guess is that other insurers offer similar resources.

After attending their seminar, I got to thinking a bit about their ideas and others I have heard. These are a few I have gleaned over time.

  1. Practice mindfulness. Being really ‘present’ in whatever you are doing diminishes the frittering away of time and energy. This can be quite difficult to do when you feel great pressure and the demands of caring for others, but it is very much worth the effort to practice some activity that will assist you in focusing on the things and people for which you are responsible. For some of us, meditation can be helpful. For others, exercise does the job. Whatever method you prefer for increasing your ability to attend well to the persons in your care, use it. Get rid of the excuses and move forward.
  2. Set limits on what you can and will do.You cannot possibly be responsible for everything. Most psychotherapists know this, but it is often difficult not to feel responsible for the entire well-being of clients. Once you have learned to set boundaries as a therapist, it is easier to maintain your energy.The same is true when doing other sorts of caregiving. Know what you are able and willing to do and only do that. This will mean that you may need to find others to provide what you cannot, but that is OK. Just make sure that you know where your abilities and willingness end, that it is perfectly OK to have those end points, and that and your charges will be happier and better off for that clarity.
  3. Let others help you. It is much easier to set limits on what you will do if you let others help you. If you are taking care of children, that means letting their grandparents, aunts and uncles pitch in. If you are taking care of an elder, it may mean involving your siblings or finding programs and assistance in your community. If you are taking care of clients with behavioral health disorders, it may mean delegating tasks to others i1 your organization as well as finding a network of resources in your community that your clients can use.
  4. Take some time for yourself. Give yourself a moment whenever you can. Even brief times can have major impact. Just sit still and breathe for a minute or two. Go for a walk alone. Sit and watch the sun set. Schedule a manicure or a facial or a mini-spa day…or give yourself one. Indulge in a massage. If possible, schedule regular time away from those to whom your provide care. Utilize some of the others in your life so you can schedule an afternoon, a weekend, or a week away. You need vacation time. Take it.
  5. Schedule rest. Do your best to get enough sleep. If adequate continuous sleep is not a possibility, schedule mini-rest breaks into your day. If you always feel exhausted, you are less likely to be the kind of caregiver you would prefer to be. If you are permanently tired, you are more likely to experience suppression of your immune system and susceptibility to illness. Letting others help you may give you the time you need to rest.

I wish I could say I am good at these five things. I am working to be better at them. I’ll let you know when I get there.

I am sure many of you have found ways to take care of yourselves so you can do a better job of taking care of others. Please share some of your secrets. Inquiring minds want to know!

Who’s Making Money from Healthcare Reform?

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Before I get too far into this post, let me be clear about a couple of assumptions.

1. I am an advocate of Healthcare Reform. I was disappointed in the bill that finally passed because I believe it was not a strong enough protection for consumers. Given that, I am glad we have a healthcare reform law on the books.

2. I believe that most consumers would benefit in the greatest possible way from a single payer system. This could be modeled on Medicare or utilize some other possibilities, but I think a single payer system is the only way we will ever get a healthcare system that truly meets the needs of most consumers and costs the least.

Given those assumptions, you will understand my reaction when I read a new article in FierceHealthPayer, a weekly newsletter for healthcare plan executives. If you are involved in the purchase of health insurance for your organization, the title of the article, Insurers Profit from Health Reform, will come as no surprise to you. Of course insurers are the primary ones who will profit from health reform in its current incarnation.

After dropping almost $90 million to oppose the health reform law, repeatedly claiming its provisions would raise costs and disrupt coverage, health insurers actually have benefited the most from the law, according to a Bloomberg Government report released Thursday.

The article goes on to explain that most of the increases in revenue are the result of these companies expanding into government programs. You see, even though Medicaid and Medicare are government programs, they are often administered by private insurance companies. With the expected expansion of the Medicaid program mandated by the Affordable Care Act, there should be even more income growth for insurance companies.

So who’s going to lose money on healthcare reform? Guess what….it’s us again. Those of us who purchase insurance in the private marketplace were subjected to 9% increases on average in 2011…increases aimed at covering the costs of the mandates of the healthcare reform law long before required by the law. That way, we absorb the costs and the insurance companies get to go on paying their executives outrageous salaries and making their profits.

I wonder what it will take for people to finally realize that healthcare and health insurance need not cost so much. I don’t expect it to happen as long as corporations control our government and our lawmakers. I know many folks believe the problem is just the opposite. Government should get out of the middle of the relationship between the healthcare provider and the consumer. Competition and market forces would take care of costs.

What do you think? Who will pay for care for the chronically ill . . . and the chronically mentally ill if we don’t all chip in to do it? Is there enough compassion in the marketplace to assure that children, the poor, and those unable to pay for health insurance because of mental illness will also receive good quality healthcare? Please share your thoughts. I would love some help in understanding how we can assure that we will all get the healthcare we need without spending half our income on health costs.

Health Insurance: How do you feel about yours?

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According to a newsletter aimed at the insurance industry, 70% of comments made about health insurers on social media sites in the past year were negative. FierceHealthPayer reports:

It’s time to face the facts–the American public dislikes health insurance companies. And that’s putting it mildly, considering that 70 percent of all opinions and comments about insurers posted on social media sites in the last year were negative.

(Read more: Insurers should take to social media to combat negativity – FierceHealthPayer http://www.fiercehealthpayer.com/story/insurers-should-take-social-media-combat-negativity/2011-10-07?utm_medium=nl&utm_source=internal#ixzz1aYo3DrmA 
Subscribe: http://www.fiercehealthpayer.com/signup?sourceform=Viral-Tynt-FierceHealthPayer-FierceHealthPayer)

I can understand some of that negativity. This past summer brought major upheaval for me as I searched for affordable health insurance for our employees. I asked our insurance agent early on to get us quotes. I was appalled at what came back from the company who provides our plan. As a small group (only 8 members plus one spouse) we are subject to huge variations in cost and are very limited in benefit choices. Health insurance is our second largest expense.

I interviewed employee leasing companies and other groups that claim to make you part of a larger group so you can benefit from lower pricing structures. Unfortunately, none of them were able to save us enough money to justify the severe limitation in benefits or the cost of membership. We ultimately bought a plan that increases copays and deductibles, but maintains most of the benefits we had….we think. How the insurer will choose to interpret those benefits when one of us actually needs to take advantage of them remains to be seen.

My experience is no surprise. Employers across the nation were faced with a  9% average increase in family premiums in 2011 while many of us were presented double digit increases, in spite of the recession.

The article mentioned above suggests that insurers should get involved in social media to combat their negative perception by the public. They should

Create a social media policy and then get out into the social world and establish a strong, positive presence. Tweet some healthful recipes, post exercise tips on Facebook, make announcements on Google+.

Whatever your specific strategy, though, make sure you monitor all social media sites for comments made about your company and then contact the poster to try and resolve the problem. Even if you can’t fix the particular issue, say because someone is griping about the lack of universal health insurance, you’ll have made an effort to connect with the public, which over time just might change their perception of the industry. – Dina (@HealthPayer)

In other words, they should get their marketing people to work in the social media sphere. Don’t do anything real to correct the negative perceptions of the public, just do your best to appear to care and to look good. Don’t let anybody realize that one of the major reasons the cost of healthcare is so high in the U.S. is because of the part played by the cost of health insurance.

I was rather distressed by that recommendation. Don’t do anything real…just do your best to appear as if you care about these negative perceptions.

I wonder what your experience is with health insurers. Does your organization provide health insurance for your employees? Is everybody satisfied with their plan and the cost of it? Have you ever made a negative comment about your health insurance on Facebook or Twitter? Ever made a positive one?

Please share your comments below.