Wednesday, April 22, 2009

Universal Healthcare already in place is failing

Here is a link to a simple summary of what is being looked at by Congress, and it raises interesting issues.

One point it raises, that is not spoken of often, is the issue of "unhealthy" lifestyles. There are many studies and programs going on that screen employees for alcohol, diet and exercise issues and this video implied how that may need to be managed because of the cost impact on all.

In this day's conversation about Health Care coverage, the people should know how well the existing system, which is being offered as the Universal model for the U. S., is working.

Again - those computer savvy should Google "Medicare issues" and "infections in Veteran's Hospitals" and get up to speed on what certain congressmen want us to live under.

In the interest of full disclosure - once that plan is in place, the exodus of people leaving the Universal plan will rival the exodus out of New Orleans pre- Katrina.

Agents like myself stand to make a nice income providing people with plans that do not limit access or care, and allow the affluent access to better care than that offered in the social programs proposed.

The other factor is it will create a class difference and discrimination between those who are on the social program, and those who can afford "real" care.

Having health care providers bid for the right to provide coverage by offering the lowest price per service has it's own issues. This is part of the structure the VA already uses, with the result that Doctors prescribe medication that is not available to patients in the Pharmacy system.

Witnesses: Sam, Heal Yourself

Published 4/21/2009

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If the federal government really wants to reform health care, it should start by fixing Medicare.

Witnesses from the insurance industry made that case today at a Senate Finance Committee hearing on reforming the U.S. health care delivery system.

Ronald Williams, chairman of Aetna Inc., Hartford, and Dr. Allan Korn, chief medical officer at the Blue Cross and Blue Shield Association, Chicago, appeared on a panel that also included representatives from think tanks such as the Brookings Institute, Washington; employer groups such as the Pacific Business Group on Health, San Francisco; and provider and consumer organizations.

The round table was convened by Sen. Max Baucus, D-Mont., chairman of the Senate Finance Committee, and Sen. Charles Grassley, R-Iowa, the highest-ranking Republican member on the committee.

Baucus and Sen. Edward Kennedy, D-Mass., chairman of the Senate Committee on Health, Education, Labor and Pensions, wrote Monday in a letter to President Obama that they want their committees to move quickly on passing broad health reform legislation.

“Right now, all of the incentives in our system encourage health care providers to deliver more care, not better care,” Baucus said today at the hearing. “Today’s conversation is about how to lower costs and improve quality in the system for the millions of hard-working Americans that are tired of seeing their health care costs rise faster than inflation.”

Panelists talked about creating incentives in the Medicare program to eliminate waste, using health information technology to improve provider communications, and conducting more research on the comparative effectiveness of various treatments.

Panelists also talked about ways to reduce fraud and abuse in federally financed health care programs.

Williams spoke at length about the importance of health IT efforts and wellness efforts.

The United States has the highest per-capita health care spending in the world, but the quality of care delivered by our health care system falls far short of expectations, Williams said.

“Our seat belt laws and anti-smoking efforts have achieved great results, and we need this same type of commitment in the wellness challenges facing us in the areas of obesity and encouraging healthy behaviors,” he said.

Williams also talked about provider compensation.

“Improving our delivery system starts with reforming our payment system to focus on quality and value,” Williams said. “Aetna supports transforming the payment system into one that aligns provider reimbursement incentives with achieving high quality outcomes for patients.”

Reimbursement changes are especially important for the Medicare and Medicare Advantage programs, Williams said.

The programs must be revised so that the focus of health care services “rests on value and quality rather than volume,” Williams said.

Under Medicare’s current fee-for-service payment structure, providers are paid on the basis of volume rather than value, often with suboptimal results, Williams said.

“Moreover, lower payment rates paid by public programs result in cost shifting to those who are privately insured,” he added.

If Congress wants to reduce the cost of Medicare Advantage as compared to Medicare as part of a down payment for financing a health reform program, Congress also must examine Medicare's operational structure and the Medicare Advantage bidding process, Williams said.

“If we decide to follow a pathway to Competitive Bidding in Medicare Advantage, we should look at the development of a viable structure that includes several guiding principles,” Williams said.

Williams said the principles should include generating meaningful cost savings from the Medicare Advantage program; maintaining access for all beneficiaries and minimizing disruption; and providing incentives to improve quality.

Korn also talked about the importance of wellness and prevention programs, comparative effectiveness research, and health IT.

Like Williams, he called for changes in provider compensation arrangements, especially in the Medicare program.

Korn described a “3-tier” Medicare reform strategy that would start with efforts to pay physicians based on quality, build up to promoting wellness and condition management programs, and eventually work up to encouraging providers to combine to form “virtual” care delivery system.

Eventually, Korn said, Medicare should pay the virtual care delivery groups bundled amounts for treating health care “episodes,” rather than paying individual providers separate fees for each type of service delivered.

Korn criticized the Obama administration proposal to create a new, government-run health insurer that would be open to healthy, working-age U.S. residents with above-average incomes.

“Private plans in general and Blue plans in particular, have been active innovating in these priority areas,” Korn testified. “Creating a new government plan that would compete with the private sector would undermine the ability of the health care sector to implement meaningful delivery system reforms. The private sector has led the way in developing innovative programs (e.g., chronic care management, wellness programs, and Centers of Excellence) that would not be possible under a government plan due to enormous political pressure.”

The next financial crisis

all of the government workers have been counting on this.

after all, this was one of the few perks to that low paying government job.

almost 50% of the population is affected by this - since this affects federal, state, city and local government services, including police, teachers, administration, roads and public service workers, etc.

Anyone want to bet $10.00 against me that this will be a bailout inside 10 years?

Before you take that bet - I'd remind you that each member of Congress has a bias to, and vested interest in, voting FOR a bailout - it's their pension plan - it's just like they vote themselves pay raises.

PUBLIC PENSION DEFICIT A CONCERN – What is the deal here? Has everybody been asleep? A current article proclaims that investment losses from the current financial crisis have significantly eroded the funding status of public pension plans, affecting entities from school districts, to local governments, to state governments, and there is growing concern that increasing deficits in public plans will force taxpayers to make up for the shortfall.

The slope gets a little more slippery, and a little steeper

The slope gets a little more slippery, and a little steeper, as a Government agency wants the right to manage private industry, and be able to take it into receivership.

Without oversight from we, the people, a law could be crafted that would allow any private enterprise to be taken by the government.

In property law, that action is called eminent domain. For those of you that are computer search savvy, I invite you to Google "eminent domain issues" and find out how well that has gone.

Then search the history of Cuba, and see how the current Cuban government came about.

Geithner: Expand Our Mission

Published 4/21/2009

Monday, April 20, 2009


And in case this sounds crazy - look up the study that was published in the New England Journal of Medicine. The study was done in England (a country with "universal" health care), and looked at the lifetime health care costs of smokers vs. non smokers.

WHAT THIS COUNTRY NEEDS IS MORE SMOKERS - Smoking takes years off your life and adds dollars to the cost of health care. Yet nonsmokers cost society living longer. House members described huge health care costs associated with smoking as they approved landmark legislation last week giving the Food and Drug Administration authority to regulate tobacco products. No one mentioned the additional costs to society of caring for a nonsmoking population that lives longer. A White House statement supporting the bill, which awaits action in the Senate, echoed the argument by contending that tobacco use "accounts for over a $100 billion annually in financial costs to the economy." However, smokers die some 10 years earlier than nonsmokers, according to the CDC, and those premature deaths provide a savings to Medicare, Social Security, private pensions and other programs. Vanderbilt University studied the net costs of smoking-related spending and savings and found that for every pack of cigarettes smoked, the country reaps a net cost savings of 32 cents. Sell just 10 trillion packs and we can pay for the Obama budget!

Saturday, April 18, 2009


Here it is - the actual numbers for the first half of the year.

The deficit for the first half of 2009 is within a hair of being 4 x the deficit for 2008.

- The U.S. has posted a record budget deficit for the first half of fiscal year 2009 of $956.8 billion, a number inflated by governmental spending on financial and economic programs, and this year's budget shortfall is more than triple 2008's deficit. For March, the government filed a record monthly deficit of $192.27 billion. For the same month last fiscal year, the gap was only $48.21 billion.

so you know - 4 x 48.21 billion is 192.84 billion.

Friday, April 10, 2009

7 signs a health plan might be junk

I offer you this link. It's for those of you who had looked for coverage on line, or those of you that follow health insurance issues, or those who wonder why AARP changed the offered plans.

You can read it below, or click on this link below, or copy and paste it into your browser:

If you want Health Insurance, contact me for coverage options.
John Spek

7 signs a health plan might be junk
AARP Medical Advantage Plan
WATCH THE WORDING “Affordable” health plans, like this one purchased from AARP, may end up costing you much more in the long run.
Do everything in your power to avoid plans with the following features:

Limited benefits

Never buy a product that is labeled “limited benefit” or “not major medical” insurance. In most states those phrases might be your only clue to an inadequate policy.

Low overall coverage limits

Health care is more costly than you might imagine if you’ve never experienced a serious illness. The cost of cancer or a heart attack can easily hit six figures. Policies with coverage limits of $25,000 or even $100,000 are not adequate.

“Affordable” premiums

There’s no free lunch when it comes to insurance. To lower premiums, insurers trim benefits and do what they can to avoid insuring less healthy people. So if your insurance was a bargain, chances are good it doesn’t cover very much. To check how much a comprehensive plan would cost you, go to, enter your location, gender, and age as prompted, and look for the most costly of the plans that pop up. It is probably the most comprehensive.

No coverage for important things

If you don’t see a medical service specifically mentioned in the policy, assume it’s not covered. We reviewed policies that didn’t cover prescription drugs or outpatient chemotherapy but didn’t say so anywhere in the policy document—not even in the section labeled “What is not covered.”

Ceilings on categories of care

A $900-a-day maximum benefit for hospital expenses will hardly make a dent in a $45,000 bill for heart bypass surgery. If you have to accept limits on some services, be sure your plan covers hospital and outpatient medical treatment, doctor visits, drugs, and diagnostic and imaging tests without a dollar limit. Limits on mental-health costs, rehabilitation, and durable medical equipment should be the most generous you can afford.

Limitless out-of-pocket costs

Avoid policies that fail to specify a maximum amount that you’ll have to pay before the insurer will begin covering 100 percent of expenses. And be alert for loopholes. Some policies, for instance, don’t count co-payments for doctor visits or prescription drugs toward the maximum. That can be a catastrophe for seriously ill people who rack up dozens of doctor’s appointments and prescriptions a year.

Random gotchas

The AARP policy that some bought began covering hospital care on the second day. That seems benign enough, except that the first day is almost always the most expensive, because it usually includes charges for surgery and emergency room diagnostic tests and treatments.