Friday, April 13, 2012

Finally Friday Edition

Long week -- emergency insurance appeal for stem cell transplant, corneal abrasion -- I'm pretty wiped out.  My eye is getting better, but because of the antibiotic ointment I have to put in it, I can't really see out of it, and my other eye is really straining.  So who knows what kind of typos I'm missing!!!  Anyway, here's the news for one last time this week:

Health reform is about real people. It's not just politics.  People with pre-existing conditions are holding their breath waiting for the Supreme Court decision, which threatens to derail the part of the law requiring insurers to cover people with pre-existing conditions.  Meanwhile, the Obama administration says it has no back-up plan in case the Court strikes down the law. 

After 6 years, how is health reform doing in Massachusetts?  There's still work to be done on cost control, and widely divergent views on how to move forward.  But they have nearly universal coverage, so now they are able to focus on cost, trying out various ideas in the search for ways to control cost without sacrificing quality health care.

If you get our newsletter (which you can sign up for here), you know that we've been focused on specialty tier legislation at the state level, trying to keep these medications in reach of the average patient.  So I'm glad to see some national press coverage of the issue.  I'm very concerned to learn that Aetna has launched specialty tiers in Connecticut.  If you're on Remicade, Humira or Cimzia for Crohn's, for example, you'll now pay a percentage coinsurance rather than a prescription drug copay.  It puts medication out of reach for too many patients.  And what gets me the most is that, if people can't get their meds, their disease gets out of control, and so they get sicker and far more expensive for the insurance company.  I don't know why they don't get that. 

Across the country, there are efforts to try to improve care for the most vulnerable -- people who are on Medicare due to disability and Medicaid due to poverty, known as "dual eligibles."  These tend to be the sickest of the sick and, thus, their health care costs -- borne by the government -- are especially high.  Connecticut it trying to work towards a plan that rewards health care providers for "shared savings" without eliminating care or making it unaffordable.  

New York's GOP blocked legislation to create an insurance exchange so Governor Cuomo has issued an executive order directing the state to do so.  

The CEO of Quest Diagnostics -- a huge laboratory operation with offices across the country -- says Americans aren't good consumers of health care.  We don't comparison shop, and price is not aligned with quality, he says. And most of all, since consumers don't want health care, health care consumption is not based on desire, as is consumption of most other services.  Interesting.

Women are less satisfied with their medical care than men. This doesn't shock me.  Women use more health care than men -- and women are taken less seriously by doctors, in my opinion and experience. 

Have you seen this video of a man with dementia in a nursing home who lights up when he's given music?  I love this! 

And that's it for this morning.  Have a great day and a great week-end!  Jennifer

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