What health insurance reform should give us: a cheap, high-deductible catastrophic policy.

Which is exactly what none of the current bills would let us have, according to John Stossel:
Consumers could not buy a cheap, high-deductible catastrophic policy [under any of the existing bills currently floating around the House and Senate]
Read the whole thing.

Last week I asked a customer service rep at Maryland's dominant health insurer* if they sell such a policy. She said no, making it sound as if selling catastrophic insurance without the "basic" plan would be an impossibly difficult feat.

At the end, Stossel adds:
Profit is the key to competition. Anyone who claims to favor competition but looks down at profit has no idea what he is talking about.
Well said.

*CareFirst Blue Cross/Blue Shield


Maryland has forced more mandates on health care insurers than any other state

Robert Moffit of the Heritage Foundation, citing a 2001 Blue Cross/Blue Shield study:

Maryland leads the nation with at least 52 mandates on private health insurance . . . Only California, which has 43 mandates, comes close to Maryland.

There seem to be three types of mandates relating to (1) conditions/treatments/services (28 mandates), (2) providers (18 mandates) and (3) patient classes (6 mandates). Here are the mandates relating to conditions, treatments & services:

Alcoholism Treatment
Bone Density Screening
Breast Reconstruction
Cleft Palate
Clinical Trials
Colorectal Screening
Dental Anesthesia
Diabetic Supplies/Edu
Drug Abuse Treatment
Emergency Services
Formula for PKU
Hair Prostheses (Wigs)
Home Health Care
Hospice Care
Invitro Fertilization
Mammography Screening
Mental Health (General)
Mental Health (Parity)
Minimum Mastectomy Stay
Minimum Maternity Stay
Off-Label Drug Use
Prostate Cancer Screening
Rehabilitation Services
Second Med/Surg Opinion
Well-Child Care

A doctor told me last week that these mandates have driven up health insurance premiums in Maryland. And contributed to declining number of insurers competing in the Maryland market.


Thoughts on health insurance reform from a small-business owner in Maryland

I heard Mike Vallerie talk on the Kendel & Bob Ehrlich Show this morning. He came across as thoughtful, fair and practical. His four key ideas:
  1. Tort reform modelled on worker's comp.
  2. Roll back the definition of health insurance so that it really is insurance: "A means of indemnity against occurrence of an uncertain event."
  3. Individuals should be responsibe for taking care of themselves (i.e. paying for expected, forseeable expenses), and
  4. Level the playing field so that small businesses get a fair shake compared to big business.
His website is MikesPlan.net.


Finally! Some thoughts on health care reform that are clear, simple, honest, and to-the-point

Charles Hugh Smith gets to the root of the problem:
The corporate-America or union/government employee who goes to the doctor pays a few dollars for a visit and drugs; the “real cost” is of no concern.
The link between the “consumer” of healthcare and the provider has been broken for decades. There is no “free market” in healthcare–there isn’t any market at all. We live in a Kafka-esque nightmare system in which “some are more equal than others” and hundreds of thousands of dollars are lavished on worthless tests, procedures and medications ...
And more:
So-called “defensive medicine” in which worthless tests are administered to stave off random (sometimes valid, sometimes nuisance) malpractice lawsuits.
I'll have more to say later about my recent experiences with defensive medicine.

And what does Smith recommend?:
There is a solution so simple and so radical that it is “impossible” . . . : shut down insurance and all government entitlements, and make everyone paid cash for healthcare.
How can we break the cycle of frivolous lawsuits, defensive medicine, and spiraling costs for both procedures and malpractice insurance?:
The solution to malpractice is information, not lawsuits.
What about poor people?:
Well right now they have to stand in line at emergency rooms–the most wasteful, inefficient system possible. Even “poor people” can afford a few dollars–there’s endless excuses provided yet how many “poor people” have cell phones, eat costly fast food, do costly illegal drugs, etc. etc.
Sounds about right to me.

Mr. Smith, I hope you go to Washington. We could use more people like you down there.

via Ron Smith's website


Well said, Mr. Palmer

Parker Palmer--from a December 2008 interview on spirituality and the economic downturn--strikes a chord:
We're at a time where self-interest and idealism converge.
The interviewer is Krista Tippett. Her show, Speaking of Faith, airs in Baltimore on Sunday mornings at 7:00 AM on WYPR.



Sen. Cardin Town Hall on health care: Monday 8/10/09 @ Towson U.

The details are on his website:
Health Care Town Halls

In August, I will hold town hall meetings in Hagerstown and in Towson. For planning purposes, because o the large number of people who are interested in attending, please RSVP. Space is limited at both venues so we cannot guarantee admittance. In accordance with fire regulations, when the venues are full, there will be no standing room available.

Monday, August 10th - 7 p.m.
Towson University Center for the Arts
Harold J. Kaplan Concert Hall
Corner of Cross Campus and Osler Drives
Towson, MD 21204

Parking is available across the street from the Center for the Arts on Auburn Drive off Osler Drive on Lot 13.

RSVP - sean_mckew@cardin.senate.gov.


Wilmer Eye, Part 2: my original complaint

[For background, see Part 1.]

Here's the email I sent to Dr. Peter McDonnell under the subject heading "Wilmer Eye Institute: an unhappy customer":
Dear Dr. McDonnell -- here's my story (see link below) . . . I thought you'd like to get some feedback about people's reactions to the services provided by the Wilmer Eye Institute.

By the way, [patient] is fine now and back to normal, and we are relieved and very happy about that. I just wanted to vent, and am not asking anything from you other than to be aware of the weaknesses of your organization and do your best to fix the shortcomings.


Dave Greene



Wilmer Eye Institute flunks customer service test (Part 1)

[or . . . "How not to respond to an unhappy customer" . . .]

In response to a complaint that I emailed to Wilmer's director--the email had a link to this post--I received this letter from an executive at Wilmer, Dr. J:
Mr. Greene:

My chairman, Dr. Peter McDonnell, has brought to my attention your discontent with the care that [patient] received from Dr. [B] at the Wilmer Eye Institute at Green Spring Station on [date].
I have read your blog, discussed the visit with Dr. [B], and reviewed the medical record.

It looks to me that Dr. [B] did everything from an ophthalmological standpoint to rule out any serious eye disease.

Evidently, [patient] was eventually diagnosed with Lyme disease, but I am not sure that the diagnosis of Lyme disease would have occurred to any ophthalmologist on the basis of [patient's] symptoms. I personally performed an internet search to see if I could find instances of Lyme disease presenting solely with pain in one eye upon movement, but could not find such an association.

From your blog, it seems that Dr. [B]'s style was not to your liking. Doctors are human and have personalities like everyone else, and not all doctor's styles suit every patient. I sometimes wonder how many patients leave my office upset with something that I may have said, and never let me know. All physicians recognize this and will facilitate a smooth transition to another physician when they are made aware of the concerns. We would be happy to do that in [patient]'s case if you wish and will let us know.

At Wilmer and Johns Hopkins, we are committed to improving the care that we provide, and so value the feedback that people like you give to us. Your comments will become part of our departmental Performance Improvement Program. I pledge that we will try harder to make the diagnoses, think "outside" the box when appropriate, and suggest consultation with other physicians when needed.

Sincerely yours,

Dr. [J]

cc: Peter McDonnell, Chairman, Wilmer Eye Institute ,
[Ms. X], Wilmer Patient Representative
This letter is unsatisfying and wrong-headed in so many ways, I think I'll write about it in some detail. More to come.


"Cash for Clunkers" program hurts poorest car owners

Michael Barone, who recently moved from US News to the Washington Examiner, explains how:
The dealers are required to destroy the clunkers, which will reduce the supply and increase the price of spare parts for those low-income folks who can't afford to trade their clunkers in even with a $4,500 subsidy. So much for helping the poor.
blog it


How much does a colonoscopy cost? Here's one answer

If we want to contain healthcare costs, one of the first obvious steps is to make sure that patients receive real prices before they have a procedure.

So, from time to time as I run across real-world healthcare prices, I'll pass them on here.

A family member recently had a colonoscopy in December 2008. Beforehand, we googled around a little to get a handle on the cost, but didn't find much. At one point just before the procedure, the patient asked one of the nurses at Greenspring Station Endoscopy how much the total cost would be. She gave a mechanic's shrug, "I don't know."

Everything went smoothly. Our patient liked the staff, was pleased with the experience, and thought Greenspring was a well-run place.

But, as with all doctors and healtcare providers, it would be a great improvement if they would publish prices (or ranges of prices) for prospective patients. In particular they should publish both the "sticker" price and the actual price.

For the nurse's benefit, and for anyone else out there who wants to know, the actual total price was $2,068. This amount, of course, becomes known only after the patient receives the bill indicating the "reduction of billed charges" negotiated by the insurance company**.

----------------------- LIST -- ACTUAL
ITEM ----------------- PRICE --- PRICE
Initial consultation.. $ 195 -- $ 130
Prep supplies............ 20 ----- 20
Anesthesia nurse........ 760 ---- 294
Endoscopy facility.... 1,500 ---- 726
Colonoscopy doctor.... 2,025 ---- 465
Lab/tissue diagnosis.... 600 ---- 433
............. TOTALS $ 5,100 $ 2,068*

*In this particular case, the procedure included cutting out a small number of benign polyps.

**In this case, CareFirst Blue Cross/Blue Shield