Booster Shots

Oddities, musings and news from the health world

Category: Health Insurance

Flight attendants may offer too much slack; same can't be said for Blue Shield

December 16, 2009 |  9:48 am

Sometimes, stringent adherence to the rules can be good for one's health. Sometimes, the effects have more negative repercussions. Here are two examples from today's L.A. Times ...

Staff writer Rong-Gong Lin II writes: "Amid concern about H1N1 and seasonal flu, federal health officials issued guidelines late last month on how to handle obviously sick passengers: Flight attendants should ask the person with the cough to wear a mask and move them at least 6 feet from others. In the air, recent travelers report a different reality."

Read more.

On an unrelated topic, columnist David Lazarus begins:

"Amid a national debate on how to make the healthcare system friendlier and more accessible, and as millions of people grapple with the loss of jobs and homes, what does insurance heavyweight Blue Shield of California do? It decides to take a key benefit away."

Read more.

It seems much depends on who follows, and who makes, the rules.

-- Tami Dennis

Finally, Medicare parts A, B, C, D -- and maybe F -- explained

December 14, 2009 |  9:38 am

Pills Medicare Part D isn't a name chosen at random. Though for all the explanation Americans usually get, it may just as well be.

Here's a quick rundown of Medicare's various parts -- and the program's place in the current healthcare debate -- from today's L.A. Times.

"Medicare is divided into four parts. Parts A and B, often referred to as 'original Medicare,' include coverage for hospital and standard doctor visits. Seniors are automatically enrolled in these programs when they turn 65, and the premiums and co-pays are minimal.

"Part C allows seniors to buy into plans that offer more benefits than are available through original Medicare. Part D allows seniors to buy prescription drug coverage."


And, of course, for detailed information, there's

-- Tami Dennis

Photo: Los Angeles Times

Unemployed, uninsured (no more COBRA subsidy), now what?

December 1, 2009 |  5:45 pm

Pig Remember that health-insurance subsidy granted to millions of the newly unemployed back at the beginning of the year? It's ending.

As Kathy Kristof reported in Monday's Los Angeles Times: "The so-called COBRA subsidy was designed to last no more than nine months for each person who was unemployed. Hundreds of thousands who got this subsidy when it was first made available in March are slated to roll off the program today. The insurance subsidy will also no longer be available for Americans who lose their jobs starting today."

Of course, going without insurance is risky in the short term and, if you have a pre-existing condition, in the long run as well.

Here's a package of stories on how to cut healthcare costs -- and find insurance. First, the introduction: Cut costs, not your care. Then, the nitty-gritty tips: How to trim your health bills.

For more money-saving or find-insurance advice, we offer:

Tips for asthma sufferers to help save on prescriptions

How to save money on diabetes supplies and care

Cancer screenings don't have to be costly

Dental care on a budget

And ... Health insurance options when you are unemployed

Then there's the story of one man who weighed his options, considered the odds -- and decided to forgo health insurance: Choosing to not have medical insurance 

-- Tami Dennis

Illustration credit: Getty Images

Mental-health parity laws require oversight

December 1, 2009 | 10:17 am

Mental Consumers need more information regarding new laws that mandate insurance coverage for mental-health treatment, according to an analysis of the first five years of the mental-health parity law in California. Based on California's experience, the authors suggest that government oversight is needed to monitor not only costs and coverage issues but also access to care and quality of care issues.
The review, published today in the journal Psychiatric Services, describes the experiences of consumers, health plans and doctors in responding to the mental-health parity law in California that went into effect in 2000. Lessons from California's experience could be valuable to the success of the new national parity law that will take effect in January. The Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act will provide mental health services and substance abuse coverage to 113 million Americans.
The study, by researchers at Mathematica Policy Research and the Substance Abuse and Mental Health Services Administration, used data from interviews and focus groups to draw conclusions about the success and failures of the California law from 2000 to 2005. Among the findings:

  • Costs associated with parity were in line with, or even below, the projections.
  • Most health plans responded to the parity law by lifting limits on the annual number of days allowed for inpatient treatments and the number of visits allowed for outpatient treatment.
  • Concerns arose over the use of "medical necessity" clauses to authorize treatments and control costs. Medical necessity is typically defined as the need to supply a service for a condition that could endanger life or cause significant illness, suffering or disability and for which there is no adequate, less costly alternative available.
  • Consumers also complained about being referred to lists of mental-health providers only to find out that providers on the list were not taking new patients.
  • Health insurance providers felt the list of diagnoses covered under the parity law was arbitrary in excluding certain diagnoses.
  • Some doctors reported that they chose a parity diagnosis for a patient in order to ensure insurance coverage although it wasn't the most accurate diagnosis. Some doctors said they had little flexibility to change a client's diagnosis if he or she improved because they believed the health plan would then stop providing coverage for continuing care or care for a lesser diagnosis.
  • Nearly half of Californians polled in focus groups were unaware of the parity law.
    Public education campaigns should accompany the introduction of the federal parity law, the authors of the paper wrote, noting that the effort could yield another benefit. "Enhanced public education may also lead to reduced stigma associated with mental illness."

-- Shari Roan
Photo credit: Tim Teebken / For The Times

Shake off the post-Thanksgiving blahs and get engaged

November 30, 2009 |  9:42 am

DrugsGet engaged in the healthcare debate, that is. (We try to avoid relationship directives.)  That debate is now heating up in a national capitol near you.

The D.C. Now blog reports this morning:

"The Senate's post-Thanksgiving debate over healthcare reform gets underway this week against a backdrop of apparent deep public division and slight disapproval.

"With the Senate poised to take up a healthcare overhaul that the Democrats and independent allies have voted to advance to debate and that the Republicans have voted to block, a Gallup poll today reports that 49% of Americans surveyed say they would advise their member of Congress to vote against a bill and 44% say they would recommend a vote for it."

Read more ...

And don't forget The Times' Healthcare Q and A's -- written with the reader in mind -- from our D.C. bureau.

Here's the latest: Breaking down the bills' projected costs: Readers also ask about the penalties for not buying health insurance; changes that veterans would see; interstate insurance plans; and whether the "public option" would cover mammograms.

-- Tami Dennis

Illustration credit: Karen Bleier / AFP / Getty Images

Plavix advertising indirectly cost taxpayers an extra $207 million over five years*

November 23, 2009 |  5:09 pm

Advertising brand-name prescription medications directly to patients is a uniquely American custom, and a controversial one at that. A study published today in the Archives of Internal Medicine may stir new debate over the practice. In the case of one blockbuster drug, the study found, a major advertising campaign did little to expand the medication's use but brought price hikes that cost taxpayers hundreds of millions over a seven-year period.

Both critics and defenders of direct-to-consumer drug advertising agree on one thing: that the advertising of prescription medications will run up the bill that taxpayers foot to provide healthcare insurance to the elderly, disabled and poor through Medicare and Medicaid. When patients see commercials for a branded drug, they will ask for these medications in greater numbers, and they will get them, the reasoning goes.

But whether that higher price tag buys better healthcare is the point of dispute. Critics charge that advertising allows drug companies to pump up their sales to Medicare and Medicaid patients who might otherwise be treated with safer, cheaper medications. Defenders of the practice argue that drug ads spur more patients to seek treatment for conditions (such as high blood pressure or depression) that are widely under-diagnosed: Sure, it'll cost the taxpayer more, they say, but that's because more Medicare and Medicaid patients will get the treatment they need because they saw an ad.

But what if neither side is right? What if advertising a drug did not spur a rise in a drug's use, just in its price?

That, effectively, is what a pair of Canadians who teamed up with researchers from Harvard University and Kaiser Permanente found when they looked at the cost and use of the drug Plavix,* used to prevent blood clots, from 1999 to 2005. Plavix was on the market for two years, and its use was growing steadily when Bristol-Myers Squibb launched a major advertising campaign for the drug in 2001. Over the next five years, the drug company spent $350 million to promote Plavix in advertisements aimed at consumers.

But according to Michael Law of the University of British Columbia, the advertising campaign did not accelerate the growth in sales of Plavix, which reached $5.9 billion in 2005. While they continued to grow, Plavix sales grew no faster after advertising began than they had before the ads hit the airwaves.

But the cost of the drug certainly accelerated, Law found. Looking at Medicaid expenses in 27 states, Law and his co-authors found that the cost of Plavix shot up from $3.40 per prescription just before advertising began. "Immediately after [advertising] initiation, we found a large, sudden, and statistically significant increase" of 12% in the cost of a Plavix prescription. By the end of 2005, the cost to taxpayers a Plavix prescription filled by a Medicaid patient rose 25% beyond the more modest rate of inflation that would have been expected before advertising began.

Translation: In the Medicaid program alone, just 27 states spent a collective $207 million more on Plavix prescriptions after the big advertising campaign began than would have been expected. If one were to figure in the added cost to Medicare programs and the Medicaid programs of the remaining 23 states, the added cost would look like real money indeed.

Lawmakers in recent years have wrangled over whether and how to rein in drug advertising directed at patients rather than physicians, with no changes made to date. The authors say it's not time to put the debate aside. "Payers and policymakers should appropriately still be concerned about [direct-to-consumer advertising] increasing total drug costs for publicly funded reimbursement programs such as Medicare and Medicaid," they wrote.

--Melissa Healy

* An earlier version of this post incorrectly said that Plavis is a cholesterol drug.

Those medical bills won't just go away; now's the time to get a handle on them

November 12, 2009 | 10:31 am

Blood Medical debt doesn't take care of itself. As with a serious illness, ignoring the symptoms will simply ensure more problems down the road.

So today, Families USA offers up tips on what to do about it. The advice from the organization, whose ultimate mission is affordable healthcare for all Americans, is practical and straightforward. It begins with, "Make sure the charges are correct," and ends with links to organizations that can provide additional services.

Here's the complete guide: Your Medical Bills: A Consumer’s Guide to Coping With Medical Debt.

For a general look at medical debt, from the Washington Post and Kaiser Health News, there's this: Americans ensnared by medical debt.

And here's a recent look specifically at California. This report, from the UCLA Center for Health Policy Research, finds that almost 1 in 7 nonelderly Californians has medical debt of one kind or another. It includes breakdowns by region and county.

And here's some more advice, from an article that first appeared in the L.A. Times' Health section: Negotiating Your Medical Bills.

It begins: "Unless you've been rushed to the hospital in an emergency, the time to start thinking about paying the bill for hospital care comes as soon as your doctor says you need to have a test, procedure or surgery."

-- Tami Dennis

Photo: When it comes to costs, and debt, those medical tests can add up.

Credit: John Moore / Getty Images

Health crimes and punishments: Employers -- and employees -- can decide

November 4, 2009 | 12:18 pm

Turns out, those employer wellness programs are not the benignly helpful initiatives that some Americans might have perceived them to be. Sure, they encourage workers to act in their own best health interests, but they're now also having an impact on those who don't. Ultimately, they could ... well, who knows.

StubsAnd that's the point of today's Los Angeles Times story on healthcare overhaul. It begins:

"Who could object to rewarding people who quit smoking, lose weight or start to exercise? The American Cancer Society and the American Heart Assn., for starters.

"Some companies are charging lower insurance premiums to workers who meet benchmarks for healthy living. The Senate's healthcare overhaul legislation would expand the trend.

"But instead of cheering the proposal, some patient advocacy and health groups are worried that it could mean higher rates for less-fit Americans, possibly pricing them out of their employers' insurance plans."

That story: Insurance discounts for healthy habits spur debate in Washington

But it's open enrollment time, and the debate is more than theoretical. It's personal and now faced by millions of Americans of varying states of health. Another recent L.A. Times story notes that some companies won't let workers sign up for health insurance until they sign up for risk assessments that were once optional. It says:

"If the assessment discovers manageable problems, you may be encouraged to join a fitness or smoking cessation program. Do that and you're likely to get bigger financial incentives -- somewhere in the neighborhood of $100 to $500 annually.

"But if you don't, your employer might restrict your health insurance choices to plans that demand higher deductibles and offer fewer services and benefits, which could cost you hundreds of dollars."

That story: This open enrollment period, expect rewards and penalties

Don't like the approach? You could take a stand. And pay for it, of course.

Not wild about helping to pay, in a roundabout way, for your smoking colleague's medical costs? Here's your chance to get just a little bit even and benefit from your own, perhaps wiser, choices.

Either way, the trend's increasing prominence suggests each of us should ask what such "incentives" might ultimately entail -- for good or ill.

Here's a recent Washington Post look at the issue. And an NPR story on Safeway's incentive programs.

-- Tami Dennis

Photo: Stop smoking -- or you might face limited healthcare choices.

Credit: John MacDougall / AFP / Getty Images

Lack of health insurance played a role in thousands of child deaths, researchers say

October 29, 2009 | 11:18 am

An analysis of 23 million hospital records from 37 states shows that a lack of health insurance likely played a role in the deaths of nearly 17,000 U.S. children over a 17-year period.

Researchers at Johns Hopkins Children's Center examined records from 1988 to 2005. They compared the risk of death in hospitalized children who were covered by health insurance with those who did not, and found that uninsured kids were 60% more likely to die, regardless of their medical condition. This does not mean that the children received less aggressive care at the hospital but that they were probably in poorer health before the arrived, researchers said. Insurance status did not affect how long a child spent in the hospital, according to the study.

The study did not count children who died outside the hospital or after leaving the hospital, which means that deaths among uninsured children are probably even higher. The report will be published Friday in the Journal of Public Health.

"Can we say with absolute certainty that 17,000 children would have been saved if they had health insurance? Of course not," a co-author of the study report, David Chang, said in a news release. "The point here is that a substantial number of children may be saved by health coverage. From a scientific perspective, we are confident in our findings that thousands of children likely did die because they lacked insurance or because of factors directly related to lack of insurance."

As the healthcare reform debate reaches a critical stage in Washington, the study is a reminder of the human cost of healthcare inequality. About 7 million American children are uninsured.

"In a country as wealthy as ours, the need to provide health insurance to the millions of children who lack it is a moral, not an economic issue," Dr. Peter Pronovost, a co-author of the study, said in a news release.

-- Shari Roan

Photo: Healthcare reform advocates protest outside the offices of Cigna Insurance in Los Angeles. Credit: Mark Ralston / AFP/Getty Images

Zombies are evolving; these have an agenda

October 28, 2009 |  5:44 pm

For creatures on the prowl for brains, a growing number of zombies seem especially thoughtful. Or at least less single-minded than usual.

Last weekend, they turned up in Santa Rosa to tout the need for healthcare reform. Here's the Press Democrat story and the YouTube video.

And this Saturday -- yes, yes, Halloween -- they'll be lurching around Silver Lake Reservoir to raise money for brain cancer research. Proceeds from that event, Zombiethon: A Run for Brains, will benefit City of Hope.

Whether you consider the zombie and brain-cancer connection witty or grotesque (here, we didn't agree), find out more at (There's a costume contest too.)

The zombies-with-a-cause appear to be a slightly more evolved offshoot of the pop-culture-fad-of-the-moment-zombies.

But presumably even the less health-conscious versions -- if they make a habit of the white-face-and-bloody-mouth look -- would want to know about the potential problems with the trappings of their pastime.

Here's a U.S. News & World Report story on the topic of face paint. One day of use is unlikely to do harm, says one expert quoted. But those who make themselves up routinely may have makeup side effects, amid other problems.

-- Tami Dennis


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