Californians' health premiums rise 5 times faster than pay

The Sacremento Bee reports

In California from 2000 to 2007, annual premiums rose from $6,227 to $12,194. During that same period, the median pay went from $25,740 to $30,702.

About 6.6 million are medically uninsured in California.

On average nationally, health premiums rose 78 percent, lower than California's rate, during the seven-year period. However, earnings in California outpaced the rest of the country, which saw wages rise by 14.5 percent.

What is clear is that health care is becoming less and less affordable," said Anthony Wright, executive director of Oakland-based Health Access California

The system is broken and needs to be fixed," said Wright, who called for greater oversight of the insurance industry.

del.icio.us Tags: health premiums,medical inflation,sacramento bee

Knowledge is Power-iNFORMATION ASSYMETRY

Quote of the day:
An ignorant person is one who doesn't know what you have just found out. - Will Rogers

^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^

I want to share an article posted on SERMO by it's creator,

Dan Palestrant M.D. (give this link a moment to load, and then click on the video window...it should open in iTunes it is an iTunes video cast         

 

click to JOIN   LICENSED PHYSICIANS ONLY, all applications are 'vetted'.

 

Please excuse the length of the quote, it is included since SERMO is a protected secure website accessible only to licensed physicians. 

 

Those of you who are physicians should JOIN

The pictures are mine, inserted and are not part of the original posting. (all that plain text gives me nystagmus, and I'm a picture guy.)

 

From The Founder: Knowledge is (Still) Power

I'd like to introduce a concept called information asymmetry.

Exchanges, whether it is swapping ideas in a community like ours, or goods and services in a marketplace, always work best when the information held by both parties is symmetrical.  Both parties need to be on an equal footing for the information exchange to be fair and mutually beneficial.  In economic theory, this is referred to as how "perfect" your information is.  As such, it makes sense that the party that has the "more perfect" information has an advantage. In any business transaction (such as when buying a car) if the seller knows something that the buyer does not, there is an information asymmetry and therefore an intrinsic disadvantage for one of the parties (hence the prevalence of Lemon Laws).

The Rise of Asymmetry in Medicine
As physicians, we combat information asymmetries by sharing insights from one another and benefitting from each other's collective experiences.  However, the shift towards outpatient medicine, where physicians no longer enjoy the collective gathering places of the doctor's lounge, grand rounds, or even the nursing station has left physicians "solo" in operating our practices.  Add to this the increasing time pressures that have caused us to sever other ties, and it is no small wonder that physicians feel a growing sense of loneliness and isolation.  This isolation has compounded the information asymmetry for physicians and we are unable to benefit from each other's insights in advancing the collective good of our profession.  The bottom line is that "hearing" each others' voices is a necessary prerequisite before we can have a collective voice and overcome information asymmetry.
The impact of information Asymmetry on our Earnings
Isolation and information asymmetry have had a dire financial impact on physicians. They have allowed critical changes over the past 25 years to the financial mechanisms that underpin our profession. As our isolation has become more acute, the parties that we must exchange our goods and services through (ie insurance companies) have not stood still. They have benefitted from better organization, better technology and ultimately better information.   This did not happen by accident.

Insurance companies and government agencies have leveraged information that we don't have-around costs for drugs and procedures and treatments for example-to gain advantages over physicians.  Rather than a perpetuating a system where a physician's time, efforts, and skills are rewarded based on market value, payers have incredible advantage because their information is more "perfect".   How is it that demand for physician services is exploding and physician supply is flat to declining (as physicians are retiring earlier and increasingly opting out of primary care) and yet reimbursement and physician earnings continue to plummet? Focus on the asymmetry of information.

Information asymmetries have features that can make them very attractive (if you are on the right side of the asymmetry).  They perpetuate positions of strength or authority (they are also threatened by anything that creates a level playing field or meritocracy), while creating great leverage for the party with the more perfect information.  Knowledge, or in this case "information", is indeed power.
Sermo's Role in Regaining Information Symmetry…and Physician Influence

From the moment it launched, Sermo has been a medium physicians have used to overcome information asymmetry in our practices.  Indeed, the information is perfectly symmetrical among physicians within the Sermo community.  Given a level playing field, new insights, new methods, and new strategies have emerged through Sermo.  Quite to my shock, we are starting to erode that information asymmetry that had appeared so daunting, so destructive, to our profession.  The evidence of this abounds.  New clinical insights that never would have been given their due are routinely discussed in Sermo.  Difficult patient situations, clinical dilemmas, and most certainly some of the most vexing economic questions that face physicians are far less daunting when the collective brainpower of this community can be applied.  The axiom has held true: No one of us is smarter than all of us.
Creating a Healthcare Information Exchange

Very quickly we learned that the knowledge, and consensus of physicians on Sermo also has tremendous value to outside entities.  The Sermo Team has worked to build a business model that enables physicians to project our collective voice on every subject to outside entities.  New modes of exchange like AskRx, Clinical Trials, and Earn HotSpots have created an entirely new paradigm  for Exchange with outsiders that need to understand physician perspective to advance their businesses. The community is proving incredibly adept at engaging outside entities on this community's terms and even at changing the rules and forcing outside entities to reevaluate their practices.  This Exchange mechanism has unlocked the power to regain our influence over the players that control the decisions, investments and policies that shape the healthcare landscape in this country. 

This community has been both consistent and emphatic in making sure its voice is heard outside Sermo,

del.icio.us Tags: health information exchange,transformation,power,assymetry

Health Train Travelling Taxes

Following last night's 3rd and thankfully last presidential debate I am taking a grim view on the possibility for real reform in our health system. 

The reality here is that we have two candidates with diametrically opposed views on health care reform.

Senator McCain advocates that our health non system challenges are limited to the premiums and availablility of health care coverage.. This does not speak to all the other areas in health care that need reform.  His  proposal will be a battle of the payers, and the employers and a new book of IRS tax codes. Insurers have no real interest in providing more payments for more patients, nor hospitalizations.  His proposal is not well thought out, and fails to address most of the fundamental challenges for patients and providers alike. 

Senator Obama takes the short path....to universal payor. Although he has not mentioned it lately and backed off when pressed at the debate, his other statements are otherwise. Senator Obama also wants to use the tax codes ( but in a different manner)

Joe the plumber might as well be you the citizen, lawyer, doctor, small business man or even a large integrated health system.

Senator Obama wants to take some of your income and give it to the "guy behind you".  Senator Obama wants to make life easy for you by giving your decision making and accounting to the U.S. government to decide who should give what and who should take what.

When pressed about mandatory mandates Senator Obama was asked how much a fine would be for the employer or employee who did not provide health insurance. He fumbled a bit and mentioned that was only for the 'rich' ,those businesses that had income greater than 250,000.

Some expert economists point out that even many medium and large enterprises, such as General Motors are having problems paying the rent. This type of health reform will bankrupt some large enterprises as well.

Neither Mr. McCain nor Mr. Obama have much real world experience in running a business, making payroll or having employees they are responsible for. 

I doubt if  McCain or Obama are able to add and subtract numbers with less than nine zeroes...That is apparent since Obama sees the divide at 250,000 dollars. If you are above that figure..you are rich, if you are below that, then you are eligible for whatever grandiose federal programs he imagines.

It seems that Obama actually overtly and covertly sees our country still in terms of class warfare facing both sides off against one another.

My fundamental analysis  is that tax codes should not be the determining factor how we finance and deliver health care. The fundamental flaws must be dealt with by providers and patients.

del.icio.us Tags: health care,health care premiums,health taxes,health fines,mandates,health insurance,universal payer,joe the plumber,class warfare,tax credits

Health Train Express, Number Six on the List of Most Important Voter Issues

Graph from The Health Care Blog article by Chris Weaver.

Media coverage of two issues - health care and taxes - nearly doubled. Health care stories increased across all media from 256 stories to 439. Tax stories rose from just over 400 for the week to nearly 800 between the weeks ending Sept. 29 and Oct. 6, according to stories polled for the LexisNexis Analytics dashboard.    This spike in incidence is not unrelated. Tax stories are hot as voters stare at a growing deficit and watch their 401k's plunge, but tax talk has also become a predictable symptom of health care reform stories.  

An excerpt from a New York Times article states,  (link)

"It is health care, advisers said, that they believe resonates more than other issues for Americans who are worried about their economic condition," they wrote. "It is a less threatening way to talk about the economy - showing pictures of shuttered banks, for example, could create more worry - that aides said tested well across demographic groups, but particularly among older voters who have been slower to warm to Mr. Obama."

Of course, this construction fails to appreciate the other important issues under the umbrella of health policy - id est the health part.

Rising to the occasion, the conservative Washington Times reminded us Tuesday that millions of uninsured people have a tough time finding treatment, and in a worst case scenario, camp out for days, waiting to see doctors at a Wise County, Va., health fair. It's not all about the taxes after all.

No physician has to be told this observation by pundits of what is wrong about the American HealthCare non-system.

The portions of the debate on health care seemed to be 'muddle' on both sides.  Mr Obama appears to have backed off on his plan for UNIVERSAL PAYOR.  Mr. McCain's proposals regarding tax advantages for his program at times seemed conflicting, confusing and very unclear...and it does nothing for helping the "uninsured"...He use "Joe, the plumber" at several points attempting to relate "spreading the wealth" as a for socialism. The he used Joe' s   plumbing business as an example for small business as an example for capital, loans, and his tax bracket.  Poor Joe is a busy guy..

Neither candidate demonstrated understanding the root causes of the problem for providers.....increasing costs and fixed overhead for delivering care.  The root causes are increasing baby boomer usage,  and the internal bureaucracy of evaluating, regulating, and paying for health care. 

Health IT and data mining are forecast to evaluate outcomes, and the efficiency and accuracy of treatment.  It will take many years to develop statistically valid data on preferred patterns, and evidence based medicine...By the time this occurs, it is likely that treatment paradigms will have shifted, due to technology, and drug advances.  Don't get me wrong I am all for studying our outcomes, but a billion or so dollars down the line I doubt if we will truly save one nickel. ( hearsay, and highly biased prospective prediction) (shoot the messenger)

On a more positive note, Elizabeth Edwards and HEALTH CARE NOW seem to be on 'our side' in regard to health insurers.

Other items in today's blogs

Wall Street Journal  Hospital closes in Chicago

Medinnovation blog  Geeks, formulas, and algorithms

Trusted MDTrusted MD  Health 2.0  busted??

Guarranteed Health Care  Treatment delayed for months, policy cancelled when payment one day late.

Fresh MD  New perspectives on American Health Care, why are we bitching  ??

That's it for today....it's time for my medications.

GML

Who will Rule Gotham?

Will it be McCain, or Obama?  or  perhaps there is a 'spoiler lurking in the shadows...

Tune in tonight.

Try this link

Or this one

Or this one

If those don't work,

CLICK HERE TO GO TO HOFSTRA UNIVERSITY DIRECTLY

THE LINKS WILL OPEN IN A SEPARATE WINDOW

Ding,Ding Health Train Express on Track 134

"Arriving on track 134, the Health Train Express bound for Everywhere, USA. Stand back please, and have your boarding pass ready.   This train is a local and will stop at HMO haven,DRG depot, P4P pitstop, JCAH junction, Copay Circle, H&P Place, EMR Exit,  and points beyond!"

The train is late, and overloaded, standing room only and passengers hanging out the windows, on the roof, and swinging from the doors.  The engine speeds by the platform and the cars smoothly glide  to a halt.

Track 134 is a new 'high speed" mag-lev train,

with very limited service, since the infrastructure of new technology, magnetic lev cars and rails are not yet put into place.  America has talked about this new technology for over 25 years, and there has been little  progress.

502 km/h on Japanese Maglev Train
by KumagayaRocks

You board this special health train on your way to work, and have a seat, awaiting your destination......as you work on your laptop, fiddle with your PDA and/or take SMS and phone calls on your IPOD, or new G1 phone, the train leaves the station gliding smoothly on a cushion of air.

As you pick up speed and pass by roads, overpasses, crossings, and small towns now vacant from migration to city centers, suddenly, you are distracted by:

Ding, Ding..... go the strings of my heart

Dr. Wes began this scenario for me in his blog today

* Ding Ding * You get a best practice alert!
Have a patient without an mammogram in the last year?
*Ding Ding* You get a best practice alert!
Haven't had your colostomy and over age 50?
*Ding Ding* You get a best practice alert!
Haven't counselled you patient about their smoking each year?
* Ding Ding * You get a best practice alert!
Haven't had your cholesterol checked?
* Ding Ding * You get a best practice alert!
Didn't screen your patient over 18 for depression?
* Ding Ding * You get a best practice alert!
Didn't know that there 134 potential alerts for 2008?
*Ding Ding * You clearly need a best practice alert!

DING DING GO THE STRINGS OF MY HEART  (be patient while this loads (Chuck Berry)

"Best Practice Alerts" are computer algorithms triggered from diagnosis codes.
"Best Practice Alerts" are an Electronic Medical Record's (EMR) means to assure that the "voluntary" Physicians Quality Reporting Initiative is undertaken. Never mind that failing to comply means certain discrimination between physicians. Just remember, it's voluntary! Really.
"Best Practice Alerts" force doctors to cross tacit specialty treatment boundaries and risk alientating referral doctors.
"Best Practice Alerts" drive testing and procedures, and therefore costs, to our health care system.
"Best Practice Alerts" are encouraged by those with a stake in health care.
"Best Practice Alerts" remove judgement from medical care in favor of mandates.
"Best Practice Alerts" are disruptive to doctor-patient interactions, consuming precious clinic time as "why" or "why not" must accompany each alert response.
"Best Practice Alerts" have not been shown to improve patient outcomes over more conventional care.
So how, then, are we to assume such alerts represent "Best Practice?"

image credit:  Google images

Theme Song from Father Knows Best....opens in player, be patient while it downloads. (click on photo)

Well, it's simple: because

Father knows best.
-Wes

Dr Wes......you are brilliant!! And thanks!!

photo credit: Dr Wes blog photo

Free Pass on the Health Train Express.

Sign up for free government programs for EMR. 

Did you know that right now the state and federal government has programs that you may be eligible for.  You do not have to have a disabiity, nor be a member of a special class.  Our operators are waiting to hear from you for these special programs set up by the government.  Don't wait to sign up for these programs.  If you were born between 1900 and 2000 you are elibigle for one of these little known government subsidies. 

“Because you pay your income taxes on time, you have been awarded a free $12,500 government grant! To get your grant, simply give us your checking account information, and we will direct-deposit the grant into your bank account!” Even if you don't pay taxes on time....our program has a waiver for that requirement.

Our program outlines all the monies that have been allotted for you to purchase and EMR for your  medical practice."

Not withstanding the above  "fantasy financing for EMR", the reality is that the situation remains grim for most providers.

Joseph Britto, CEO of Isabel Healthcare writes in The Health Care Blog,

"September 25, 2008, the Certification Commission for Healthcare Information Technology (CCHIT) issued a report that reviewed 90 EMR incentive programs (state, federal, private) with a total funding of $700 million available.

Of course there are some disclaimers.

Many health policy experts believed that “if you subsidize it, they will come.” While that approach has worked in persuading people to take mass transit, it hasn’t lured many physicians into using EMRs. ............................

 Health Industry Insights, a private research firm, reviewing the CCHIT report, estimated that the cost to implement an EMR is roughly $25,000 per physician and that the $700 million currently available would represent only 9% of the expected total national cost  to furnish all physicians in private practice with an EMR. "

With these realistic limitations in mind, it may be time for a new mindset of what the best utiization is for our limited IT resources.

 

"As we endure financially difficult times, we believe it is time for IT leaders at hospitals and medical groups to take second look at a different set of technologies, one which, like EMRs, can align physicians and hospitals in the shared goals of improving patient care and reducing clinical risk. "

"Clinical decision support (CDS) technology is not new, it has been available in various forms since 1986, but as computer hardware has become vastly more powerful, the newer versions of the systems have become faster and more practical for physicians to use. One particular kind of CDS technology, diagnosis decision support (DDS), has been adopted in many hospitals in the past two years, as medical executives realize its value in attracting leading physicians who understand and value medical knowledge tools.  "DDS systems include two key components: a dynamic medical knowledge data base and an inferencing or logic engine to sort and select decision options for clinicians.

There are some skepticism as to the value of CDS, by some physicians

Ira Breite states, "The real reason that internists and other PCPs have been slow to adopt the EHR systems (EMR is sooo 20th century)is that they are not ready for prime time. Data entry is slow to the point of ridiculous, and while "decision support" may work in a hospital where lots of available data can be condensed into an algorithm, its still not real useful for the question of whether to give antibiotics in the case of sinusitis. Yes, I know there is an algorithm for that, but the reality is I don't always follow it and neither do the guys who wrote it (if they actually take care of patients)."

With this in mind.....call 800-FRE-EEMR or run down to the mailbox and send off your application(s) for these  FREE GOVERNMENT GRANTS

Help us Help them

Help us Help them

Don't vote until you see the video

How can we help these people?

Real Stories about Real People

http://www.youtube.com/watch?v=DNHNCScYpX8

Nathan Wilkes

http://www.youtube.com/watch?v=2peGqRrjXek

Cynthia Campbell

http://www.youtube.com/watch?v=McGm00Mvakc

In a stunning turn around, insurance giant CIGNA has capitulated to community demands, and protests that the California Nurses Association/National Nurses Organizing Committee helped to generate, and agreed to a critically needed liver transplant for Nataline Sarkisyan, a 17-year-old girl in the intensive care unit at UCLA Medical Center. Unfortunately, Nataline passed away yesterday just after six o'clock the same day of the massive protest

http://www.youtube.com/watch?v=Wh0mgiwXzGM

Emily Cannon is a young woman in the prime of life, the daughter of a registered nurse, and a former elementary school teacher whose life has ground to a halt since developing a chronic but treatable illness. She is now being denied care she needs to return to the active life she once enjoyed.

http://www.youtube.com/watch?v=K1uXUgTakk4

Watch this compelling video about a mother and daughter living on a fixed income and having to fight their health insurance provider for coverage.

http://www.youtube.com/watch?v=Q4xcV4bULRQ

Retiree Juanita Anderson doesn't just fear the rare disease that attacks her organs and sends her to the ER,she also fears the insurance companies who can change her coverage at any time and destroy her finances.

http://www.youtube.com/watch?v=TqSshZZMHGA

Linda Peeno-Sicko

http://www.youtube.com/watch?v=itKJRq3NU7s

Michael Moore-Sicko

http://www.youtube.com/watch?v=aC7zI7VXcCA

Andy Bales: Rescue Mission

http://www.youtube.com/watch?v=tqmk3ycTmuY

Deborah Burger—RN

Zorses and The Health Train

If you are wondering what a zorse is, check out my other blog

DNA Train & Bill Gates

 

Arthur Caplan, Ph.D.,a bioethicist at Harvard (2005) espoused a

theoretical scenario regarding Bill Gates.

"Who needs Bill Gates? No, I don’t mean who needs a gazillionaire corporate titan, a man whose company, Microsoft, took in billions of dollars last year by controlling nearly all the software used to run nearly every computer on the planet.

No, I mean,  literally, who needs him?  If you could go back in time and stop the birth of the world’s most famous nerd, would you?

You probably answered my question with a "no.".......he is the father of a computer revolution that has brought much good to many people throughout the world. Add to that achievement his current generous philanthropic activities supporting some very worthy causes, such as vaccine research and a center for autism research in Seattle, and the case for having Bill with us becomes pretty persuasive.  What if I told you it’s possible that Gates has a medical condition that accounts, in part, for both his tremendous achievements and for his "nerdiness?" Gates is widely reported to display many personality traits characteristic of a condition known as Asperger’s syndrome.  Asperger’s is a mild version of autism, a more serious condition that renders many children unable to talk, be touched, communicate or socialize. While I certainly do not know if Gates has Asperger’s, his difficulties in social settings are nearly as legendary as his genius, so it's possible.  That said, if you had been Gates' potential mom or dad 50 years ago, what would you have done if you knew about his abilities and flaws before he was born?

Asperger’s is the least disabling form of autism and research is beginning to show that it may also account for the presence of some special capabilities in areas like mathematics, computer science and engineering. But the same genes may also create a person who is socially awkward, easily distracted, very introspective and in many ways withdrawn and solitary.

The reason I ask these questions is that there is a good chance we will soon have a genetic test for detecting the risk of autism in an embryo or fetus. The development of such a screening tool raises the possibility that parents might one day have the option of preventing the birth of a child with even a mild case of the disorder.

 

DNA. or desoxynucleic acid was postulated and proven over forty years ago. At that time it was heralded as the next penicillin of health care.

Millions, and perhaps billions of dollars (now worth much less) have been invested in learning more about the molecules of our primordial basis for reproduction.

Recently several high profile biomedical companies have begun to promote wide screening of individuals who appear to be healthy as a predictor for degenerative and/or chronic diseases. Is this technology ready for 'prime time'? Several question have arisen.  The state of California with a recent "cease and desist order"  decided it is not ready, under the present format proposed by the three companies who stand to make a fortune if this idea catches on with the public. (Affymetrix, Navigenics). Microsoft seeing a chance to capitalize offers "HealthVault" to store the data for future use by patients and health care providers in this prospective study. 

Will this testing be cost effective, and where is the evidence based "medicine" ??  Will health insurance companies reimburse for this lab test?

"The cost of genetic testing can range from under $100 to more than $2,000, depending on the nature and complexity of the test"

Genetic testing has proven it's worth in predictive pre-natal testing for hereditary chromosomal abnormalities such as trisomy 21, trisomy 18, cystic fibrosis, and other tests not related directly to genetic analysis have predictive value. (Tay-Sachs disease, neural tube defects)

 

A consortium of health care, technology and research leaders have joined forces in a first-of-its-kind research study to assess the behavioral impact of personal genetic testing on people who choose to receive such screenings to identify their potential
risk for developing certain diseases.

    Sponsored by Scripps Translational Science Institute (STSI), and the National Institutes of Health, ie, our tax dollars,  the study aims to find out if participating in personal genomic testing will improve health by motivating people to make positive lifestyle changes, such as exercising, eating healthy and quitting smoking, as well as decisions to seek further medical evaluation and preventive strategies. The study will offer genetic scans to up to 10,000  employees, family members and friends of the nonprofit Scripps Health system in San Diego and will assess changes in participants' behaviors over a 20-year period.

    Co-sponsors of the study include Navigenics Inc. of Redwood Shores, Calif.; Affymetrix of Santa Clara, Calif.; and Microsoft Corp. of Redmond, Wash. Study participants age 18 and older can receive a scan of their genome and a detailed analysis of their genetic risk for more than 20 health conditions that may be changed by lifestyle, including diabetes, obesity, heart attack and some forms of cancer. Other companies such as 23andme will offer the range of tests (using a small sample of saliva) for $399.00 through  the internet ( secure)
  

"Genome scans give people considerable information about their DNA and risk of disease, yet questions have been raised if these tests are ready for widespread public use," said Eric J. Topol, M.D., director of STSI and principal investigator of the study. "Our study will prospectively evaluate the effect that state-of-the-art gene scans have on people's lifestyles, behaviors, diets and psyches."

    Affymetrix will scan each participant's genome and Navigenics(TM) will interpret the scan results and offer personalized guidance on steps to lessen the chances of negative health impact. This information will be available to participants on Navigenics' secure Web site. Each participant will be able to enter and store clinical and lifestyle information in an individual Microsoft HealthVault(TM) account, allowing the participant to manage his or her personal health information in one location and share it,
as desired, with health care providers or others they trust to help make more informed health care decisions. (ref: PR Newswire)

It's a brave new world out there!!!

The Train Station

Dr Val  www.getbetterhealth.com

Last night I had a chance to join Dr Anonymous on his world famous Thursday evening show. It was great to hook up with fellow bloggers, Dr A, Dr. Val, Dr Rob and many others in the health train station.

For those of you who have not heard, Dr Val has changed 'networks'. Her new blog, which I call  'soft & fluffy' , address is www.getbetterhealth.com   .

Dr Val  has interview posts from Mike Huckabee, Grant Hill, Maria Menounos, Bob Schieffer,Phylicia Rashad, and Dr.

Richard Carmona.

Here is your chance to learn from "Bones" of Star Trek fame. It seems he had troubles with reimbursements as well.

As usual Dr. Val shows her creative flare....this is going to be a great blog and web site...Watch out Oprah and The View..

Congratulations to Dr. Val!!!!  You are no longer homeless.

Dr. L

Health Train Calclulator

Quote of the day:

Reading is to the mind what exercise is to the body. - Sir Richard Steele

************************************************

Located at number 92 in the list of the most popular Health2.0 blogs is 'Stayin Alive'  Clicking on this link takes you to the blog, and in the posting today (October 9,2008) is a link which takes you to the "Health and Education Calculator" .  The web site is self-explanatory. It's a fun thing to tinker around with.