America Doesn't Need A 'Health Care Czar'

"The concept of a health czar follows naturally from the welfare statists' premise that government should guarantee health care to all Americans. Whenever the government attempts to guarantee universal medical care, it must also control its costs. Hence, someone must determine how health care dollars may be spent.

The Obama administration would control costs by creating a new Federal Coordinating Council for Comparative Effectiveness Research to determine which treatments are deemed most effective and thus eligible to be paid for by government. These decisions would be based on statistical averages that cannot take into account specific facts of individual patients.

Yet good physicians must consider precisely these specifics when treating their patients. If you are suffering from abdominal pain due to gallstones, who should decide whether medication or surgery would be more effective for you?

The doctor who has felt your abdomen, listened to your heartbeat, and knows your drug allergies? Or the bureaucrat who got his job by telling the right joke to the right person at the right Washington cocktail party?"

Excerpt from an Op-Ed column in the DC Examiner by Paul Hsieh, MD

An Example Of Universal Healthcare - Italy

The following is a summary of an article which looks at health care systems around the world. It was written by the Director of Health and Welfare Studies at the Cato Institute. This summary (without commentary) focuses on Italy's health care system, rated second in the world by the World Health Alliance.

• Similar to the British National Health Service, but with more decentralization.
• Government sets goals on how much money should be spent, monitors the overall health of the nation, and negotiates labor contracts of medical staffs. The government sets the "essential levels of care" in the country.
• Financing comes from payroll taxes and general revenues. Payroll taxes are regressive and start at 10.6% for the first $27,000 of income (roughly) and drop to 4.6% of income between $27,000 and $100,000 (roughly). The remaining funding comes from both federal and regional taxation.
• Even with all of the funding sources, most of the regional health authorities have significant deficits, which total over 1.8% of GDP.
• Italians have limited choice of physicians. They must register with a general practitioner (GP). With the exception of emergency care, ALL care must be referred by the GP - including diagnostic services, hospitalizations, and care by a specialist.
• Expenditures on health care have been rising rapidly and have consistently exceeded government forecasts. To control costs, the government has taken several steps to reduce costs, including reducing reimbursement rates, increasing co-payments, reducing capital expenditures, and limiting prescription drugs. Protests are not unusual and doctor strikes have occurred.
• Average wait time for a mammogram is 70 days, 74 days for an endoscopy, and 23 days for a sonogram.
• They have less access to modern technology, having half the number of MRI machines per capita when compared to the US.
• There is a strict drug formulary and price controls which has successfully reduced spending in this area - but at a price. Many of the newest drugs are not available.
• Public (as opposed to private) hospitals are considered substandard, lacking modern technology and basic goods and services. Overcrowding is wide spread and conditions are frequently unsanitary.
• Private health care is available but only purchased by about 10% of the population. Even without private health insurance, many Italians access the private system and pay out of pocket.
• Dissatisfaction is high, with 84% of Italians expressing a desire for health care reform.

When To Go Where

Emergency Room? Urgent Care? Primary Care? Or the new 'Convenience Care' facilities popping up at retailers? How do you know where you should go? It can be confusing. One of the carriers has a brochure they give out at open enrollment meetings that we thought would be good to summarize here.

Here is a look at some of the options available to you.

Primary Care Physician - When possible, go to your primary care physician. They know your medical history and have access to your medical records. It is also usually the lowest out-of-pocket expense available to you.

Convenience Centers - This category includes the new centers typically available at malls and some retail centers like Wal-Mart, CVS, Walgreens, and others. They are typically a walk-in only facility (no appointments) and have a lower out-of-pocket cost than urgent centers or emergency rooms. Typical conditions that may be treated at a Convenience Care Center include:

• common infections (ear, sinus, pink eye)
• minor skin conditions,
• flu shots
• pregnancy tests
• camp physicals
• certain screenings (cholesterol, diabetes, and hypertension)

They are limited in what they can do, so it might be a good idea to call them before you go there. A brief phone call may save you a trip to find out they cannot see you for the potential condition you have. The list is not all-inclusive and services vary by location.

Urgent Care Centers - Great option for those after-hours illnesses/accidents and for those not quite severe enough for an ER visit. Typical conditions that may be treated at an urgent care facility include:

• sprains,
• small cuts,
• rashes,
• minor infections,
• sore throats

The list is not all-inclusive and services vary by location. If your primary care physician cannot see you immediately, this may be a good option.

Emergency Room - If you think you or a loved one is experiencing a serious medical condition, go to the nearest emergency room or call 911. If your plan does not have all hospitals in their network, don't worry about going to an in-network facility. Do not drive by an out-of-network hospital to get to an in-network facility. We have never seen a visit to an emergency room treated as out-of-network when it was a serious medical condition, or had the symptoms of a serious medical condition. Some examples of medical conditions for which an emergency room would be appropriate include:

• heavy bleeding
• large open wounds
• sudden change in vision
• chest pain
• sudden weakness or trouble walking
• major burn
• spinal injuries
• severe head injuries
• difficulty breathing

NOTE: Let us reiterate, if you believe you or a loved one is experiencing a serious medical condition, go to the nearest emergency room or call 911.

7 Ways To Save Money On Your Health Care

We recently came across a flyer from one of the health carriers that listed some ways to save money on your health insurance. These are not earth shattering ideas, but we feel they need to be reviewed. In the course of our day-to-day lives we don't always think about this stuff. And when events come up, we don’t always think through our actions.


Keep up with preventive care – This includes physical exams, flu shots, and recommended cancer screenings. Some plans cover these procedures 100% or for a very small co-pay. Healthy lifestyles, coupled with preventive care and screenings, can help reduce illness and identify conditions early. This may prevent more costly care later on. The investment is small but the returns can be life-saving.


Choose network providers - Common sense, right? But sometimes we fail to check to make sure a physician or facility is in-network. Just because you are told to go to a certain specialist or a certain lab, it does not mean they are in network. Physicians cannot keep track of every plan and their respective network. Ultimately, it is up to the patient to make sure they stay in-network. The differences can be huge. Negotiated network discounts can be significant. If you go out-of-network, you do not have those discounts available to you, and you are responsible for the entire bill.


Emergency rooms are for emergencies - Understanding when to go to an emergency room or an urgent care facility can mean the difference between a $35-50 bill, or a bill for 10-20 times that amount. In a later post, we will give you some guidelines to help you decide when to go where.


Use your plan's prescription mail-order service when it makes sense - Depending on the plan, there can be significant savings when you take advantage of the mail-order service available to you from you carrier. This is especially true when you have to purchase more expensive drugs. Most plans now have a co-insurance component for more expensive prescription drugs. This form of cost-sharing puts more of the cost burden on the member, and may make it worthwhile to investigate if your mail-order program can you save you money.

Ask about generic drugs - Take a few minutes to become more involved in your medical care and talk to your doctor about alternative medicines and treatments. Ask them if they have a reason for prescribing the brand name drug over the generic. If your doctor feels the generic formula is right for you, you could save hundreds of dollars over the course of the year. To get more information about generic drugs, including if there is a generic drug available for your prescription, go to this Food and Drug Administration website.

Know your benefits - Take the time to read your benefits summary and understand what you plan covers - and does not cover. If you have questions, call the member services number on the back of your ID card.


Know the discounts available to you - Most plans offer discounts for gym memberships, weight loss programs, alternative treatments, massages, and a host of other programs. These may not be any better than what you can get if you do some shopping around, but it is one more way to save money.

21st Century Lassie

We received this cartoon in an email and thought it was worthy of a post. (Click on the picture for a larger version)

An Example Of Universal Healthcare

The following is a summary of an article which looks at health care systems around the world. It was written by the Director of Health and Welfare Studies at the Cato Institute. This summary (without commentary) focuses on Italy's health care system, rated second in the world by the World Health Alliance.

• Similar to the British national Health Service, but with more decentralization.
• Government sets goals on how much money should be spent, monitors the overall health of the nation, and negotiates labor contracts of medical staffs. The government sets the "essential levels of care" in the country.
• Financing comes from payroll taxes and general revenues. Payroll taxes are regressive and start at 10.6% for the first $27,000 of income (roughly) and drop to 4.6% of income between $27,000 and $100,000 (roughly). The remaining funding comes from both federal and regional taxation.
  
• Even with all of the funding sources, most of the regional health authorities have significant deficits, which total over 1.8% of GDP.
• Italians have limited choice of physicians. They must register with a general practitioner (GP). With the exception of emergency care, ALL care must be referred by the GP - including diagnostic services, hospitalizations, and care by a specialist.
• Expenditure on health care have been rising rapidly and have consistently exceeded government forecasts. To control costs, the government has taken several steps to reduce costs, including reducing reimbursement rates, increasing co-payments, reducing capital expenditures, and limiting prescription drugs. Protests are not unusual and doctor strikes have occurred.
• Average wait time for a mammogram is 70 days, 74 days for an endoscopy, and 23 days for a sonogram.
• They have less access to modern technology, having half the number of MRI machines per capita when compared to the US.
• There is a strict drug formulary and price controls which has successfully reduced spending in this area - but at a price. Many of the newest drugs are not available.
• Public (as opposed to private) hospitals are considered substandard, lacking modern technology and basic goods and services. Overcrowding is wide spread and conditions are frequently unsanitary.
• Private health care is available but only purchased by about 10% of the population. Even without private health insurance, many Italians access the private system and pay out of pocket.
  
• Dissatisfaction is high, with 84% of Italians expressing a desire for health care reform.