Tuesday, October 22, 2013

The UK thinks WHAT about American healthcare?!?!?!?

Holy shit.

I was just told that UK bureaucrats look to the US as an exemplar of privatized health insurance. We have a guest staying with us from across the pond who told me a bit about how to the power players in the British government are systematically cutting health benefits to the disabled and piecing apart the revered (in my mind at least) NHS to sell off to their cronies.

WHAT?!?!? Have they not been listening to a thing I have said?

Here's what is going on, as far as I can surmise from the press, but be warned that the spin on this seems to be excellent:
  • The UK has hired a French company, Atos, to review disability benefits in hopes of dropping a half million recipients of disability benefits--such as Personal Independence Payments, Disability Living Allowance, 
  • Mobility services will be cut -- leaving disabled folks without a reasonable and affordable means to get around, including to and from work
  •  More than a half million disabled people will be reassessed, and some 330,000 of them can expect to see benefits cuts or reduced
What's amazingly ironic is that Fox News looks to what the UK is doing as an exemplar for the US system. Ha! When discussing the topic, one Fox host notes that the UK hired a French firm to reevaluate disability claims. He asks, "Did it work?"

"It worked, in that it exposed a huge scam," the guest responds. Scam, you say? Let's talk about this "scam."

(This article from the Guardian is a great analysis on what's happening.)

Work and pensions secretary, Iain Duncan Smith, also claims that there was a huge scam under the surface-- claiming that a 30% increase in those on disability benefits over the past few decades is due to fraud and abuse. 

The Department of Work and Pensions' own estimates put fraud at 0.5%, so where is this scam? Also, one can think of plenty of reasons--just off the top of one's head--why disability claims would go up 30% over the years. 
  1. Rise in obesity (thanks, America, for leading the pack on this one)
  2. People living longer (the UK allowed for people to continue receiving disability claims past retirement age in 1992, causing a sharp rise in disability claims)
  3. There has been broader (and better) recognition of conditions 
Our guest thinks that while these officials in the UK government are doing what they think is best for the country, they are operating from a fundamental belief that disabled people are really just lazy, don't want to work, and/or want a free ride. SOUNDS FAMILIAR (ahem, Fox News/Tea Party).

One report shows a rise in verbal abuse towards disabled people. Yes, because that's what they need. People yelling at them. In addition to the disability that makes everyday life difficult at best. And now a French company is coming in and making really BAD assessments about who is fit for work.

"The work capability assessment, outsourced to Atos, a private healthcare organisation, has made it harder to qualify for the benefit, but the assessment process has been highly erratic, with thousands of patients with chronic, lifelong disabilities being wrongly found fit for work." 

A lot of these decisions -- claiming that disabled people are fit for work -- have been appealed and overturned. 

As the article points out, a lot of these people receiving Disability Living Allowance (often used to help get to and from work) are already living in poverty. Removing this allowance will plummet them further into poverty. 

Here's my commentary:
This issue isn't black and white. Nobody can claim that it is. Some conditions are the result of unhealthy lifestyles, and some disabilities can happen to anyone at anytime. If we want to really cut down on the number of folks on disability claims, then let's promote healthy lifestyles. Hey, let's start with an assessment of the food industry--that dirty, irresponsible gang of unfeeling thugs. Let's reform health insurance to reward healthy choices. 
What we shouldn't be doing is this: Cutting back on services that allow disabled people some ease and convenience in basic, everyday conveniences that the "abled" population takes for granted. Like getting around. Like being able to work. How can you claim that someone is "fit for work" when they have to spend 6 hours a day soaking and wrapping their feet because of complications of type 2 diabetes?

Instead of antagonizing this already vulnerable, yet incredibly resilient population, let's put this level of effort to eradicating obesity. There's your decrease in disability claims: help obese people get to a healthy weight range. Give them the tools to do so. Give them the support to do so. What if, instead of paying out a small pittance of disability living allowance throughout their lifetime, there is a focused effort on health education, support programs, assistance with making healthy choices, FREE EXERCISE? 

Crazy, I know, but it would work. Free Herbalife shakes for all.




Wednesday, October 9, 2013

Insurance co. forced to be a good puppy by big, bad university

I post far too much about insurance companies sucking (in case you haven't noticed, it's my Carthusian). So I've decided to celebrate something my lovely insurance company did unprompted. See, I got married in June, changed my last name, and took a permanent position in late August at the university and went from my partner's plan to my own.

So, I went in for something on Sept. 16, two weeks after switching to my own plan. The provider (U-M health system) billed my old plan. I got an explanation of benefits that showed that I was responsible for the full amount because the claim was denied (duh, because my husband dropped me when I got my own plan).

S#*! Now I have another big medical bill--$1640 this time. I called in to the provider to explain the situation and to ask them to resubmit the claim under my new member number.

"It's already been taken care of," she told me. "We figured it out when the claim came back unpaid. You're all set."

Wow. Impressive. If only Edgepark Medical (grrrrrrrrr!!!) could learn a lesson from this.

Now, here's what's really going on and why it works: the University employs a large number of people (plus they cover grad students). They therefore have a lot of bargaining power and they have really good intentions -- to both reduce costs as much as is reasonable and to provide a high level of healthcare for its faculty and staff. Additionally, they run the best hospital (and 2nd biggest) in the state. Furreal. There have actually been a number of impressive benefits offerings out of the U: they have bargained a grace period for medical flexible spending, they are starting to offer all employees a base level disability insurance at no cost. The dental offerings aren't too shabby.

Here's an idea: if you have a large pool of people, and a well intentioned organization going to bat for them against the money-grubbing insurance companies, then, well, you might actually have a shot at getting good care for a reasonable price wheee the insurance company doesn't try to weasel it's way out of paying every little claim.

I'll add that Blue Cross in Michigan is a not-for-profit organization.

Large pool of folks + single payer system where the payer actually wants a healthy (read: productive) population + non-profit insurance company (incidentally, they only use 9% of premiums to cover overhead) = really happy Laura







Monday, October 7, 2013

What is it they say about sausages and laws?

They say you don't want to see how either one is made. Well, I'd like to add insurance policies, and well, pretty much insurance anything to the list.

I've been on a really great plan for the past 10 months -- thanks University of Michigan (and the gays! who paved the way for significant others to be covered on their non-spouse partner's plan). Each time a claim is processed, the insured member gets a copy of the Explanation of Benefits (EoB), which outlines the services rendered and if they were covered (and for how much). I'm the type of person to carefully go over each and every EoB; this is pretty much the only way to figure out what was charged, how much, and what was paid.

In looking over my EoBs, I noticed two things--one of which should be illegal, and the other is just really sneaky.

  1. The discrepancy between what the provider attempts to charge and the price the insurance company actually pays is criminal. Case-in-point: Lancets (the little plastic pokey things that go in the lancet device in a blood glucose meter kit) are charged at $75. That's how much an uninsured person is charged. The insurance company has negotiated (strong-armed?) this price down to $5. The real cost of lancets remains obscure, but is probably somewhere around $10 if I had to guess. 
  2. The insurance company uses the amount is was charged as the "amount covered." Remember, they didn't pay this amount; it's just what they were charged. Ie: "Amount covered: $75" when really they paid $5 for the thing. Disgusting.
While I think this is very sneaky of the insurance company, I don't think it's such a huge deal, unless they use this amount to calculate toward maximum yearly or lifetime benefits. When I was in graduate school at Brandeis, I had an insurance plan (boo Harvard Pilgrim, you sucky, sucky insurance company) that had a maximum yearly payout of $2,000 toward prescription benefits (then the plan reclassified all kinds of items that are traditionally under Durable Medical Equipment and called them prescriptions). If they used the amount charged--rather than the amount paid--as a way to calculate that maximum amount, then I have a HUGE problem with that.

Let's look at an example, using real amounts, of what this would mean:

Amount charged (and amount paid):
  • Lancets: $75 (paid $5)
  • Sensors: $1500 (paid $1100)
  • Insulin: $768 (paid $485)
Total amount "covered" = $2,343 (leaving me with $343 to pay in addition to the copays for each Rx)
Total amount actually paid = $1590 (leaving me with $0 to pay, except for copays, and some cushion room for other prescriptions, should I need them)

Just to get political for a minute: Is this what Republicans envision for our free market healthcare system? One in which insurance companies and healthcare providers continue to obscure and confound pricing? One in which the uninsured is completely taken advantage of?

When you look at the inflated prices that the uninsured are paying, does requiring people to get health insurance seem so bad? Perhaps when all are insured, these criminal practices will go away.

Done.