Insurance Articles and Commentary

Lack of Insurance, High Medical Costs Put More in a Bind

Free-Market Medicine

Health insurance disinformation

McCain's health insurance plan: More radical than Democrats'?

The Real Truth about Drug Companies

Lifetime Insurance Caps

Here's a good article on lifetime insurance caps.

As medical costs have risen these cap limits have remained stagnant and they need to change.

But just as important we, as consumers of medical care, need to demand transparency in medical costs. Everything; doctors visits, procedures, tests, examination gloves, alcohol swabs, everything. There are countless instances of a provider having two prices; one charged to an insurance company, and one to the guy paying out of pocket. This cycle of provider charging insurer, charging employer, charging employee with higher premiums and higher deductibles has got to stop. It's a rigged system where costs are hidden and choices are narrowed. Like the three gas stations down the street at the corner that compete for my fuel money it's time for the medical industry to join the rest of the market system and compete my health care dollars. Let the consumer be the judge of what's best for them considering services, prices, location and everything else.

I know, I know. Universal health care. I don't buy it. Costs will continue to rise, choices will diminish as will the number of docs and other health care professionals leading to a reduction in quality of care.

McCain's Health-Care Vision

Republican presidential hopeful, Sen. John McCain had an opinion piece Thursday at National Review Online outlining his vision for the future of the American Health-Care System.

“The problem is not that Americans don’t have fine doctors, medical technology, and treatments. American medicine is the envy of the world. The problem is not that most Americans lack adequate health insurance. The vast majority of Americans have private insurance, and our government spends many billions each year to provide even more. The biggest problem with the American health-care system is one of cost and access, and as a result tens of millions of individuals have no insurance.”

From my standpoint it hit the right notes:

Control of health care choices in the hands of the individuals.

“American families know quality when they see it, so their dollars should be in their hands. When families are informed about medical choices, they are more capable of making their own decisions, less likely to choose the most expensive and often unnecessary options, and are more satisfied with their choices.”

More choices in finding an insurance provider.

“Americans also need new choices beyond those offered in employment-based coverage. They want a reformed system so that wherever you go and wherever you work, your health plan goes with you.

… another option would be available: Every year, they would receive a tax credit directly, with the same cash value of the credits for employees in big companies, in a small business, or self-employed. You simply choose the insurance provider that suits you best.

Increased competition in the marketplace for your insurance business.

“Millions of Americans would be making their own health-care choices again. Insurance companies could no longer take your business for granted, offering narrow plans with escalating costs. It would help change the whole dynamic of the current system, putting individuals and families back in charge, and forcing companies to respond with better service at lower cost."

Competition through reform in the maddening array of states health-insurance rules.

“Right now, there is a different health-insurance market for every state. Each one has its own rules and restrictions, and often guarantees inadequate competition among insurance companies. Often these circumstances prevent the best companies, with the best plans and lowest prices, from making their product available to any American who wants it. We need to break down these barriers to competition, innovation and excellence, with the goal of establishing a national market to make the best practices and lowest prices available to every person in every state.”

Extremely important for the bleeding disorders community provisions to insure preexisting conditions within the marketplace framework.

“But we also need to ensure that those without prior group coverage and with preexisting conditions, who have the most difficulty in the individual market, have access to the high-quality coverage they need.”

“I will consult with the governors to solicit their ideas about a best practice model that states can follow — a Guaranteed Access Plan or GAP — and work with Congress, the governors, and industry to make sure that it is funded adequately and has the right incentives to reduce costs such as disease management, individual case management, and health and wellness programs.”

I don’t agree with Sen. McCain on all issues. But this is a sensible, workable approach to addressing the nation’s health-care needs without the leviathan of government run universal coverage. Universal coverage is well intentioned and admirable in principle but in practical terms would be a disaster for this country. The cost of health-care is already outpacing the ability of Americans to pay it. Involve the federal government (more than it already is) and can we seriously envision those costs going down. On a list of bloated, inefficient government programs health-care would be the biggest colossus of bloat and inefficiency. Rather than sending huge premium checks to insurers the American public would instead send their health-care dollars to the federal government in the form of vastly higher taxes.

One major aspect missing from the senator's proposals is some strong steps toward transparency of medical costs. How can the American public be savvy medical consumers if they can't compare costs because those costs are hidden? How hard is it to get the price of a unit of hemophilic factor out of a specialty pharmacy (negotiated contract price with your insurance carrier be damned).

Senator McCain’s proposal may need work and revisions but it is a sensible, responsible and comprehensive start.

Focus on Health Insurance Lifetime Caps

This Washington Post article does a nice job putting some flesh on the lifetime cap issue. Some key graphs:

Statistics on how many people exceed the lifetime caps are hard to come by, but advocates note that the amount of many caps hasn't changed in decades, or at least has not kept up with health-care inflation and the sky-high cost of lifesaving new therapies, making it more likely that people will reach the limit.

and,

Three of Kerry and Chuck Fatula's four boys have hemophilia, a rare inherited bleeding disorder that prevents their blood from clotting normally. All three punched through the $1 million lifetime cap in the Pittsburgh area family's private insurance policy within a few months of one another in 2004, their mother said.

The clotting factor they take to prevent and control bleeding costs about $150,000 a month, and at various times each has been hospitalized for internal bleeding or to treat infections of the ports that allow them to take medication intravenously, Kerry Fatula said. For now, Medicaid pays medical bills for all three. But the eldest, Paul, a senior in high school who physically can do "90 percent" of what his healthy peers can, recently turned 18 and must qualify as a disabled adult to retain federal assistance, she said.

I had some personal reflections on the lifetime cap issue in a previous post here.

Study shows extended half-life of recombinant FVIIa feasible

A study by CSL Behring shows that the half life of rFVIIa can be prolonged by fusing it with human albumin.

CSL Behring today announced the results of a pre-clinical study that show for the first time it is feasible to genetically fuse Factor VIIa (FVIIa) to human albumin, prolonging the half- life of this therapeutic protein while retaining its biologic activity. In the study, which was presented at the American Society of Hematology 49th Annual Meeting and Exposition, the half-life of recombinant VIIa-albumin fusion protein (rVIIa-FP) was shown to be extended 6-to-9 fold (emphasis mine) compared to wild type rFVIIa.

Greater half life of rFVIIa would be welcome news indeed. Bottom-line, NovoSeven is expensive. We're glad to have it don't get me wrong. When dealing with inhibitors being able to treat bleeds with a recombinant product is extremely valuable. But it is costly.

When Jack was around 13 months he developed an inhibitor. This was in the middle of the factor shortage for recombinant FVIII (rFVIII) products. Because of the shortage immune tolerance (IT) was delayed for over a year. During which time we treated bleeds on-demand with NovoSeven. We used Novo to treat bleeds for an additional year during IT until it was successful and rFVIII once again had some meaningful efficacy.

For 2 1/2 years we used NovoSeven to treat bleeds from when Jack was around 13 months to 3 1/2 years-old. By the time Jack was four we came very close to the $2 million lifetime cap on the PPO insurance option through my work (and this was with a 5-month period before IT started during which Jack did not have a bleeding episode). Not all of that expense could be attributed to rFVIIa but certainly the lion's share.

Had we had a longer lasting rFVIIa that hit toward the lifetime cap would have been much less. Treating some bleeds every 2-3 hours for 24-36 hours to keep on top of the bleed just ate up a huge amount of insurance. (We've been very fortunate to have a HMO option with no lifetime cap, less choice - but no cap)

So I think there's definitely room for optimism. Noted in some of my previous posts here, here, here, here and here there's a lot of activity in the anti-hemophilic industry. And this is good. Market forces at work. Competition fueling innovation which produces better products and therapies for our community.

Employers offer health benefits - for pets !?!?

The cost of health care in America continues to rise. The national dialogue on health care has polarized into a free-market vs. universal single-payer debate. Yet more employers are expanding health care options, for pets that is.

This article from the Puget Sound Business Journal tells of this growing trend

"Though pet insurance is just a small market now, industry experts say it could grow substantially. Of an estimated 69 million pet-owning households in the U.S, less than 2 percent own pet insurance, according to the American Society for the Prevention of Cruelty to Animals. The organization expects the market for pet insurance to grow 25 percent next year. "

If more employers offer and pay for pet insurance it will surely grow. As will the cost of pet health care and in turn pet insurance itself. Just like the human version; if someone else is paying for it why not have a few extra tests and that previously out of the question procedure?

At a time when employers are sharing more and more of the price increases with employees by way of higher deductibles and higher co-pays some misguided companies are willing to go down this slippery slope for pets, for property.

Its really calls into question priorities.