Government Experiments on Poor

In an effort to overcome double digit inflation and flowing red ink, the state of Georgia has decided to experiment with their poorest citizens. By forcing those on Medicaid to move to a more structured HMO the state achieved their goal.

But all is not well in the Peach State.

Consumer health advocate Linda Lowe said, "There are widespread reports of children with serious conditions being denied therapies while their medical providers jump through arbitrary authorization hoops."

Widespread reports . . . denied therapies.

Sounds like rationing of services.

The state believed the HMOs "could do a better job managing the care of our members" and save taxpayers money,

The plan worked. In the last fiscal year the state saved the taxpayers of Georgia $78,000,000.

Since the HMO startup, a number of doctors, aggravated by what they call slow and reduced pay from HMOs, have limited the number of patients they will accept from the government programs. Dr. Richard Wagner, a Sandy Springs pediatrician, is one who has cut his Medicaid/PeachCare patient load. The HMO experience, he said, "has been a mess.''

And based on lower fees and more administrative hassles, Dr. Mark Ritz, a Homerville dentist, says he and other dentists are re-evaluating their participation in the government programs.

It would appear that medical providers don't want any part of this program that covers approximately 900,000 Georgians.

What good does it do to have a taxpayer funded program for the poor if they are denied access to services?

A lingering problem involves gaps in the HMOs' doctor networks. Beth Sullivan, a family doctor in Commerce, said a 5-year-old patient had to be driven more than 100 miles to Augusta for an orthopedist willing to treat his broken wrist under his HMO.

That's a two hour drive.

Of course, had it been an emergency care could have been administered closer to home.

At least, that's the theory.

Adding to the chorus of criticism are complaints from many hospitals that say they're losing money on the government programs. "It has been an administrative nightmare," said Tish Towns, vice president of government relations for financially strapped Grady Health System, which operates Grady Memorial Hospital in Atlanta. "I think there's a tremendous amount of work to do to get this right.''

So doctors aren't the only ones threatening to pull out.

"Several rural hospitals have faced near-failure to make payroll, and most rural hospitals are in a cash-flow crisis" because of reimbursement problems

What does this tell us about the future of government managed health care?

Georgia has an estimated 4.6M citizens. About 900,000 of them are on Medicaid. If the state can't do a better job of managing care for 20% of their citizens, then how well would they do if they were to cover 100%?

Right now the state is experimenting on the poor. People who have few, if any choices. If this type program were instituted to cover 100% of our citizens, how many with the means to pay would simply cross state borders, seeking care from private practitioners willing to treat on a cash basis?

Sicko Was Editedo

It seems that "Sicko" was editedo.

Yeah, I find it hard to believe too.

The Main family of Port Charlotte, Florida was supposed to be in Michael Moore's movie but somehow got left out.

Tom Main, a self-employed electrician making about $40,000 a year, had no health insurance and did not qualify for the Florida KidCare state insurance program after moving here from Colorado.

He joined the National Association for the Self-Employed, making him eligible for health coverage. In December 2005, an agent from MEGA Life and Health Insurance Company sold them a family policy at $227 a month.

That's a low price for a family of 4. No one questioned it?

The policy they bought is a limited benefit plan that caps the payout to providers.

Did they read and understand the policy limits?

According to the carrier:

"Mr. Main indicated that he understood the policy and at no point expressed that he had been told anything different about the policy by the agent who sold the policy, or express dissatisfaction with his coverage and benefit selections," Ledbetter said in an e-mail.

Uh-huh.

So Mr. Main clearly understood what he was buying, right?

An ambulance took Kenny to All Children's Hospital in St. Petersburg, where he was diagnosed with acute lymphoblastic leukemia.

When Tom Main handed over his insurance papers to the administration office he was prepared for the $5,000 deductible, but surprised when he was told the policy would not be adequate.

In all fairness, insurance policies can be written in language that might as well be in a foreign tongue to the untrained eye. That is why one should never buy a policy, even from a carrier you know, without first asking a disinterested third party to review the details.

You can start by asking your doctor if they take assignment of benefits from that carrier. If the answer is no, then go no further.

Your next call should be to the business office of your local hospital. Ask them the same question. Better to know up front than after the fact.

If Mr. Main had done this before his child became ill perhaps much of this could be avoided.

This is not casting blame, but when you buy a plan that is designed to provide you with a virtually unlimited line of credit when you need it most, it is better to find out IN ADVANCE is this is the plan you need.

In October, a film crew accompanied Hesper Main and Kenny in the family minivan on the drive to St. Petersburg, filming inside the van, at All Children's and then back at their home, where they treated the family to pizza.

When they were cut from the film, Hesper Main said that the production assistant they had been dealing with felt so bad that she offered to push their story to a companion piece running in "People" magazine.

The family's story made it into the July 23 issue, with Harry Potter on the cover.

This is a situation that even a wizard can't cure.

Do yourself a favor. Stop what you are doing right now and get your policy. Read through it paying particular attention to policy limits. Next call your doc and your local hospital. Ask them what they know about the carrier or the policy you have. It might even be worth your time to buy a cup of coffee for someone in the business office of the hospital.

Better to spend a few bucks now than losing your home later.

Drink up!

Health Wonk Review

HWR is up, this week hosted by Health Care Policy and Marketplace Review. There are 15 entries including a point/counter-point review of the recent Rand study on health insurance prices and willingness to purchase.

The post from Colorado Insurance Insider is a must read! Here is the tease . . ."Dealing with health care providers without the assistance of an insurance company is like dealing with the mafia."

Enjoy!

Cheesy Insurance

It seems the folks who give us great cheese and football now have an idea on how to solve the problem of the uninsured.

This comes in the form of universal, single payor health insurance funded with (what else?) . . . taxpayer dollars.

The Democrats control the cheese state's Senate and are considering bypassing GO and forgetting about the $200 by going directly to a full blown "cover everyone" plan. No baby steps for these folks. Going directly to "free" insurance for everyone.

So how much does "free" cost?

The plan would cost an estimated $15.2 billion, or $3 billion more than the state currently collects in all income, sales and corporate income taxes. It represents an average of $510 a month in higher taxes for every Wisconsin worker.

So, assuming their numbers are correct (and we have a history of politicians UNDER estimating costs) that means doubling the current tax revenue base and then some.

Sweet.

Employees and businesses would pay for the plan by sharing the cost of a new 14.5% employment tax on wages. Wisconsin businesses would have to compete with out-of-state businesses and foreign rivals while shouldering a 29.8% combined federal-state payroll tax, nearly double the 15.3% payroll tax paid by non-Wisconsin firms for Social Security and Medicare combined.


Out of state competition for business? Surely that won't happen!

How dare companies in IL, IA, MI and other neighboring states EXPLOIT the people of the great state of Wisconsin by undercutting prices (since THEY don't have to pay the 14.5% tax) costing jobs for Wisconsinites.

And let's not forget the folks that say guv-ern-mint can do a much better job, more efficiently, for less money.

So where will savings come from? Where they always do in any government plan: Rationing via price controls and, as costs rise, waiting periods and coverage restrictions.

Seems to me the folks need to keep what they do best. Turn out some really good cheese and a good football team.

Wonder what Brett Favre thinks about this?

Cavalcade #31: Submissions Due

Just a reminder that submissions for next week's CoR are due Monday (the 30th). Our host, Jason Shafrin, asks that you PLEASE include:

■ Your blog's url

■ Your post's url

■ The post's trackback URL (if available)

■ A (brief) summary of the post

You can submit them via Blog Carnival or email.

We still have Fall '07 hosting slots available. Hosting is fun, easy, and gets you off the "nag" list. Just drop us a line!

Hole in the Head

Perhaps it is a good thing that Michael Moore gave us Sicko. Otherwise we may never have known as much about the Canadian health care system as we do now.

David Malleau awoke in hospital with a gaping hole in his skull.

The 44-year-old Hamilton truck driver had suffered a devastating car accident in 2004 that forced doctors at Hamilton General Hospital to remove a fist-sized piece of bone from his skull to relieve pressure on his brain.

Once the swelling subsided and he was ready for surgery in March 2005, Malleau was sent home and placed on a waiting list.

Three months passed. Then six. He waited at home, a prisoner unable to leave the house for fear something would hit the exposed side of his brain - for him a potentially fatal incident. In the end, it took nearly a year before he could get skull replacement surgery.

Placed on a waiting list.

My, my, my.

Malleau, after finally getting his skull replacement surgery in January of last year, is paralyzed on his right side and his speech is only now beginning to return.

"I've pretty much had to fight for everything," says his wife Pat, a former bookkeeper.

"We were taxpayers. Owned our own home. We went from having our jobs, being in the middle class, to nothing."

Excuse me. I thought it was only in America where people could lose their home due to the health care system we have.

Mr. Malleau could have avoided the wait by coming to America...as long as he had the ability to pay.

Seems like a Catch 22 situation.

Yanks to the Rescue

With "free" access to health care, why would anyone need to come to the U.S.?

While recognizing that many Canadians believe that we have one of the best health care systems in the world, the founders of Timely Medical Alternatives Inc. also recognize that there are some 875,000 Canadians currently on the waiting list for referrals to specialists or for medical procedures.

Our organization was formed in 2003 to help Canadians from coast to coast, to "Leave the queue" and take personal responsibility for their own private medical services.

An organization to help Canadians with the ability to pay to take charge of their health care.

Interesting concept.

We have helped our clients to regain their mobility, to get relief from chronic pain, to get diagnoses of illnesses and we have, in some cases, helped to save the lives of a number of our fellow Canadians.

Saving lives.

Isn't that what health care is all about?

Few Canadians realize that:

• Surgical waitlists in the US are measured in weeks instead of the years which Canadians are often forced to wait.

• Cutting edge medical procedures and pharmaceuticals which are unavailable in Canada, are readily accessed by American patients.

• People under 65, who are without resources, are guaranteed by federal law, access to emergency care for serious medical conditions.

• Because their access to operating room time is not rationed, an American surgeon 10 years out of medical school, will (all else being equal) be more skilled at his craft than his Canadian counterparts. If a Canadian orthopedic surgeon operates 6 hours per week, he will never achieve the level of practical experience of his America counterpart who might operate 24 hours per week.

No waitlists, cutting edge medical procedures & pharmaceuticals, no rationing of operating room time.

Probably just me, but isn't this a BETTER system?

We believe it is time that Canadians realize that the rest of the developed world is NOT out of step. It is Canada which is out of step with the rest of the world.

And this is interesting as well.

If Canadians choose to go outside the system and pay for care, they can go here and find private fee for service clinics in Canada and the U.S.

With all that "free" care, why would anyone want to come here?

Was Michael Moore wrong?