The Health Shopper

The “Income, Poverty, and Health Insurance Coverage in the United States: 2006” report released this week by the U.S. Census Bureau shows that, while household income is up and the poverty rate are down, the number of people without health insurance has gone up by .5 percent. It was at 47 million in 2006. As the New York Times put it: "The main reason for the upsurge in uninsured Americans is that employment-based coverage continued to deteriorate. Indeed, the number of full-time workers without health insurance rose from 20.8 million in 2005 to 22.0 million in 2006, presumably because either the employers or the workers or both found it too costly."

But is insurance really unaffordable to the average American? A search of Vimo's database reveals that many insurance plans are available for less than $150 a month for a 30something male living in California. In fact, new affordable health insurance plans are being introduced on a regular basis by the major carriers. Granted, their deductibles are higher, but many of their premiums are low.

As filmmaker Stuart Browning reported in his short film "Uninsured in America," 17 million of the uninsured earn more than $50,000 a year. 9 million earn more than $75,000 a year. 18 million are young people that don't earn much but probably wouldn't have to pay much for insurance because they qualify as "young invincibles" — very healthy people in their 20s.

Individuals can afford health insurance. In fact, services like Vimo have made affordable health insurance just one quick phone call away.

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There have been plenty of articles about the in-store clinic trend lately, including this wire story that plays up the controversies surrounding the clinics. In Georgia, the rise of MinuteClinics even has some government officials calling for similar, state-run clinics for people that can't afford health care.

The New York Times also ran a critical piece about the MinuteClinic trend, focusing mostly on the controvesy that these clinics have generated. New York, New Jersey, Massachusetts and California want to more closely monitor them and some officials are questioning whether or not there is a conflict of interest in pharmacies that run clinics that prescribe drugs.

Ultimately, though, these clinics are providing more choice and greater convenience for health care consumers. Note that the article only cites doctors and government officials expressing concerns about the clinics — not patients.

In the Wall Street Journal this week, Merrill Matthews, director of the Council for Affordable Health Insurance, points out that government controls on health care prices can hurt access. A planned 10 percent cut in Medicare payments to doctors threatens access to care. "A recent AMA survey found that 60% of responding doctors said they would stop accepting new Medicare patients if the 10% cut is imposed. Even if that figure is inflated by currently angry doctors, it could represent a significant decrease in seniors' access to care." As we pointed out in this earlier blog entry, price controls lead to much longer wait times and, in some cases, situations where doctors simply won’t see patients.

With clinics opening up in CVS and Walgreens stores, health care is becoming more consumer friendly and franchise-like by the minute.

Now, corporations are working to make it easier for their employees to see a doctor. Not only can employees buy lunch in the company cafeteria — they can visit a doctor at the company clinic.

One company that opened its own on-site clinic reported lowering its health care costs by 3 percent during fiscal year 2007 versus what they paid in 2004. Compare that to the rest of corporate America which saw employee health care costs rise by 8 percent in 2006.

In advance of the annual open-enrollment period–when millions of people who obtain health care insurance through their employer or through Medicare have the opportunity to switch plans–Consumer Reports National Research Center studied the experiences of 37,000 CR subscribers enrolled in HMO and PPO health plans. Among the higher rated HMOs was Tufts Health Plan (MA, NH, RI), which has made noted progress in the past two years, since CR's last survey in 2004. Kaiser Permanente Northwest (OR, WA), Independent Health (Western NY), Kaiser Permanente Northern California and Capital District Physicians' Health Plan (NY, VT) were also among the top rated. Of the PPOs, which tend to provide a greater range of doctor choices, Anthem Blue Cross Blue Shield of Connecticut, CareFirst Blue Cross Blue Shield (DC, MD, VA), Blue Cross Blue Shield of Alabama, Blue Cross Blue Shield of Illinois, and Mutual of Omaha, which is leaving the PPO industry, were among the top rated.

It looks like a backlog of pending applications is preventing the FDA from approving the growing number of generic drug applications that would help American consumers pay less when they head to the drug store.

Who does this help? Drug companies which stand to benefit from less generics entering the market. Who does it hurt? Anyone that has to foot even a percentage of their pharmaceutical bill.

"The impact of the (FDA) delays is higher costs for consumers," said William Vaughan, a senior health policy expert for Consumers Union.

In this article that appeared a few days ago, another “star” of Michael Moore's "Sicko" questioned the film's assumptions about the Canadian health care system.

I am a new American, but I grew up and worked for many years in Canada. And I know the health-care system of my native country much more intimately than Moore. There's a good reason why my former countrymen with the money to do so either use the services of a booming industry of illegal private clinics, or come to America to take advantage of the health care that Moore denounces.

Government-run health care in Canada inevitably devolves into a dehumanizing system of triage, where the weak and the elderly are hastened to their fates by actuarial calculation. Having fought the Canadian health-care bureaucracy on behalf of my ailing mother just two years ago _ she was too old, and too sick, to merit the highest-quality care in the government's eyes _ I can honestly say that Moore's preferred health-care system is something I wouldn't wish on him.

In 1999, my uncle was diagnosed with non-Hodgkin's lymphoma. If he'd lived in America, the miracle drug Rituxan might have saved him. But Rituxan wasn't approved for use in Canada, and he lost his battle with cancer.

But don't take my word for it: Even the Toronto Star agrees that Moore's endorsement of Canadian health care is overwrought and factually challenged. And the Star is considered a left-wing newspaper, even by Canadian standards.

While government-run care sounds ideal in theory, it often leads to a situation where supply cannot grow and meet demand. The result: long waits and, in some cases, the total absence of service. A Wall Street Journal article last month described a similar situation where a Medicaid patient couldn't find a doctor that would help her deal with a potentially life-threatening illness.

In February, Jada Garrett, a 16-year-old sophomore, developed what seemed at first a mild case of strep throat. Within a couple of weeks her joints ballooned. Many afternoons, her swollen ankles hurt too much to walk.

To get to the bottom of her symptoms, Jada needed to see a rheumatologist. But the local one listed in her Medicaid plan's network wouldn't see her in his office. The wait to get into a clinic was more than three months.

In short, although there have been horror stories associated with private health care, there are plenty of horror stories associated with public health care as well. Public health care also is not "free". As the WSJ also just reported, Wisconsin's new public health care system is going to cost every worker in the state an average of more than $500 a month in new taxes.

Danielle Capezzone, president of the productivity committee of the Italian Chamber of Deputies, published an excellent critique of Europe's health system in Friday's Wall Street Journal. As he points out in "Sicko Europe," innovation has slid in Europe. "About 78% of global biotechnology research funds are spent in the U.S., compared to just 16% in Europe. Americans therefore have better access to modern drugs."

While we complain about health inflation in the U.S., the situation is arguably worse in Europe where spending increases in the wrong places, according to Capezzone. Capping pharmaceutical spending in Italy's government-run system has led to lopsided health care inflation there. "The government has capped spending on pharmaceuticals at 13% of total health-care expenditures while letting expenses for infrastructure and staff skyrocket. From 2001 to 2005, general health expenses in Italy grew by 31% while expenditure on medicines increased a mere 1.7%."

Our health care system in the U.S. is far from perfect, but we have better access to modern drugs, and it shows up in the survival statistics. "One result is that in the U.S., the annual death rate from cancer is 196 per 100,000 people, compared to 235 in Britain, 244 in France, 270 in Italy and 273 in Germany." While there are horror stories about high medical bills in the U.S., you're more likely to survive cancer here than in Europe. We even beat Britain and France, two countries singled out by Michael Moore in "Sicko" as having the best health care in the world.

An interesting news item from Information Week:

The Independent Health Record Trust Act, which was introduced into Congress in mid-July by Rep. Dennis Moore (D-Kan.) and on last count this week has bi-partisan support from 49 House members, aims to create independent health record trusts, or IHRTs, that would manage the electronic medical records of patients upon voluntary participation by consumers signing up for these electronic accounts.

Health records that follow you even after you leave an HMO or PPO would make a trip to any doctor quick and easy because any physician would be able to look at your history. If you were totally unconscious after a car crash, doctors could still find out your prior medical history before treating you — whether or not you had ever been to a doctor in the same network. But many health consumers will likely want the option not to participate in the program if they feel the system infringes on their privacy in any way. Also, we'll see if consumers are comfortable with the idea of doctors being financially rewarded for entering patient data into the system:

On top of that, doctors could also be financially rewarded for submitting authorized patient data to the trust through "sharing" the trust's revenue. The "revenue sharing" with doctors would be non-taxable income for the physicians, another benefit.

A study by the Proceedings of the National Academy of Sciences has found that mice's natural defenses against pre-cancerous cells was boosted by 400% when they were prescribed a combination of caffeinated water and exercise. The mice were given doses of caffeine and ultra-violet radiation associated with skin cancer. But health experts are warning that coffee is not a substitute for skin protection.

Meanwhile, another cancer study out of Britain indicates that red wine may cause cancer. Cancer Research UK studied 500,000 Europeans and found a correlation between drinking two glasses of red wine a day and contracting bowel cancer. In short, it's been a good week and a bad week for news about everyday indulgences and their connection to disease.