Most people have never heard of the Medical Loss Ratio (MLR), but that’s about to change.  It’s an insurance company measure of how much of your health insurance premium is spent on actual medical care vs. administration costs.  State insurance regulators already require insurance companies to report and adhere to a standard MLR.  However, it’s about to be re-defined by the recently passed Patient Protection and Affordable Care Act.  Like all government regulations, it is certain to affect you.

The new health care legislation requires that 80-85% of premiums must be spent on medical services with the remaining 15-20%  spent for administrative expenses.  (salaries, overhead, marketing, etc.)   Insurance companies unable to meet these standards must rebate the difference to policy holders or go out of business.  Presumably, this provision is designed to provide more and better health care from your premium dollars.

There are several problems with this, however.  Most basic is the difficulty in determining what is considered a ‘medical’ service and what should be categorized as ‘administrative’ costs.  Many patient benefits aren’t strictly medical services.  Fraud prevention, over-dose monitoring, patient counseling, wellness programs, care-coordination, discharge planning, chronic disease management are a few examples of non-medical services that insurance companies, under various plans, provide.  Will they be allowed to add these to the amount
they’ve spent on medical services?  To deal with the problem, the National Association of Insurance Commissioners (NAIC), the body that represents the states’ insurance regulators,  has been called in to help draft the rules.

Another critical issue concerns how to ‘count’ the role of insurance brokers. Right now, insurance brokers receive a commission for the polices they handle.  Most states don’t factor this into the administration costs when calculating the MLR because of the value brokers offer in customer service to the policy holder and the savings  in administration costs they offer to the insurance company.  If these commissions were to be counted as administration costs, broker services such as counseling people on policy choices and providing insurance
information and advice would be curtailed or disappear.

Here’s another problem: Small insurance companies servicing remote areas and scattered communities have higher administration costs and most probably wouldn’t meet the regulation guidelines.  In addition, the added paperwork would be particularly burdensome to smaller companies.  (An example of the paperwork all insurance companies will be required to submit for each of their plans can be found on the NAIC website.)

One of the most controversial issues involves the treatment of insurance company taxes.  The NAIC recommended that taxes, because they obviously can’t be used to pay for medical services or administration costs, should be subtracted from the MLR calculation.  Incredibly, the chairmen of  the congressional committees involved in drafting the original health care reform bill want the taxes paid to be added to the administrative costs so that, in effect, insurance companies would be taxed on their taxes.

On top of all this, serious studies call into question the use of the Medical Loss Ratio at all.  James C. Robinson, a professor of economics in the School of Public Health, University of California, Berkeley, in the paper, Use and Abuse of the Medical Loss Ratio to Measure Health Plan Performance has determined that the Medical Loss Ratio is a poor measure of health insurance efficiency and health care quality.

Throughout the discussions surrounding the passage of the health care reform bill, insurance companies were accused of excessive profits. These new MLR standards reflect this understanding but the facts say otherwise.   As measured by profit margin, the Insurance Industry is the 86th most profitable industry with an average margin of 3.3%.
(As compared with the top, Beverages, at 25.9% or Drug Manufacturing at 16.5%, or Restaurants at 7%)

Given all the difficulties in calculating a meaningful MLR, it’s hard to believe this new health insurance regulation will result in better or more affordable health care for us.  On the contrary, there’s the fear that this, like so many government requirements, will lead to inefficiencies, frustration, mistrust, and higher costs.

Increased rates for California’s Anthem Blue Cross health insurance were approved last week.  Blue Shields health insurance rate increases are expected to be approved shortly, as well.  The Los Angeles Times, reporting on the increase,  quotes shocked, unhappy people complaining about the increase and wondering why it’s happening.  Why is it happening?

The simple answer is that companies must raise prices when their costs go up.  In any industry, if the cost of doing business goes up, the price must go up or the business goes out of business.  Most people understand this.  If drought hits the Midwest effecting the price of wheat, bakeries must charge more for bread because it costs more to make it.  No one’s surprised.  Why are people surprised when health insurance policy rates go up?  I think the factors relating to heath insurance costs are more complex and less known to the public, making these rate hikes less understandable.

One factor less understood by people is the role government regulations play in higher insurance rates.  As illustrated in Health Insurance 101: Costs, insurance policy costs are determined by what medical care the policy covers and the probability of the people applying for that policy to use that medical care.  In March, the Patient Protection and Affordable Care Act was passed, and as a result, health insurers, starting in September, 2010, must allow dependent children up to age 26 to be covered under their parents’ health polices.  Another new health insurance regulation, called for in the act, eliminates any required Medicare co-payment for preventative services such as pap smears, mammograms, some cancer screenings, and immunizations.  It is certainly a nice thing to eliminate co-payments for necessary treatments; but it changes the cost calculation for the insurance companies.  Someone has to pay for this.  The sad thing about eliminating co-payments, is that everyone’s insurance rates must go up to pay for them.  People who don’t need those treatments must help pay for someone else’s.

But wait, more health insurance regulations are coming by way of the California legislature.  AB1825 mandates all health insurance policies to cover maternity services and AB1600 requires insurers to cover treatment for mental health issues.  These bills would bridge the period from now until 2014 when the Patient Protection and Affordable Care Act makes these regulations permanent.  Once again, people who don’t want or need maternity services or mental health treatments are forced to pay for them.  When the rates go up, the Los Angeles Times will once again quote people who are shocked and angry with their insurance companies.  Just don’t be surprised.

All during the health care reform debates, the raison d’etre most often given for passing the act was the number of people without health insurance.  Proponents of the legislation laid the blame on high insurance costs, labeled insurance companies ‘greedy’, and promised affordable health care for everyone if the bill passed.  The legislation, the Patient Protection and Affordable Care Act, did pass.  Given that so much of it affects our health insurance, it might be worth our time to know more about health insurance, how it works and what factors affect its costs.

Insurance is essentially a mechanism for spreading risk.  We cannot guarantee that disaster won’t happen to us whether it’s a disaster that’s natural, man-made, or health related.  Historically, groups of people have mitigated the financial consequences of such catastrophic events by pooling resources so, if disaster struck, those affected would not be destitute.  As communities grew larger, however, something more formal was called for.

Commercial health insurance came into being in the US in the 1850’s when companies began offering disability insurance which provided funds to families in case of a breadwinner’s accident or death.  Hospital and medical expense policies weren’t introduced until the first half of the 20th century.  However, until World War II, day-to-day medical expenses were paid out-of-pocket by most families.   During the war, with so many men otherwise occupied, wages, and, therefore, prices, were sky-rocketing so the government responded with wage controls.  Companies, competing for workers, then expanded their benefits to include health insurance to lure the best workers.  As a result, most people under the age of 65 today have health insurance coverage through their employer.  The employees’ share of the insurance costs, however, are rising; with individually purchased insurance rates rising even more.  Why is this happening?

Insurance policy costs are determined by what the policy covers and the probability of the people applying for that policy to require medical care.  The policy price is the aggregate of the insurance company’s probable pay-out plus administrative costs divided by the number of contributing people minus any policy deductible.

In this regard, insurance costs whether home, auto, or business are all calculated in the same way.  Health insurance, at the beginning, when it covered just disability, was also the same as the others in that coverage was reserved for rare, unexpected events.  Today, unlike other insurance, it covers routine health maintenance and every-day ailments as well as catastrophic medical conditions.  Car insurance, for example, doesn’t cover broken radiators, gas cap replacements, or headlight misalignments unless these were part of an accident.  The frequency and intensity of health insurance interactions drives health insurance administrative costs higher than other types of insurance.

Another difference between health insurance and other types of insurance is a higher degree of government regulation.  These health insurance regulations, which differ from state to state, include required benefits that not all people need such as alcohol treatments, hair pieces, and in vitro fertilization, among others.  Another common form of regulation, called “community rating”, limits insurance companies’ ability to base pricing on risk, forcing individuals who carry less risk to pay as much as people who bear much more.  “Guaranteed issue”, another form of regulation, requires insurers to accept all applicants regardless of their medical condition.

The result is that the historic formula for calculating insurance is altered with the addition of state regulations, and this has contributed to higher insurance premiums.  As a result, states with the most regulations invariably have the highest insurance rates.  The most pertinent example today is Massachusetts whose health care reform laws include  insurance regulations remarkably similar to the federal bill just passed.  After 4 years in force, Massachusetts residents pay the highest insurance rates in the country.

The Patient Protection and Affordable Care Act legislation calls for various insurance mandates to be rolled out over the next few years.  Right now, officials are considering how to limit what insurers spend on administrative costs in an effort to increase the amount spent for member benefits.  Our next blog entry will explain how that will affect you.

Commercial health insurance

http://en.wikipedia.org/wiki/History_of_insurance

medical expenses

http://en.wikipedia.org/wiki/History_of_insurance

health insurance coverage

http://www.diabetes.org/living-with-diabetes/treatment-and-care/health-insurance-options/currently-insured-through-employer/employer-sponsored-coverage.html

health insurance regulations

http://www.cato.org/pubs/handbook/hb111/hb111-16.pdf

Massachusetts

http://www.californiahealthplans.com/blog/2010/07/given-the-massachusetts-experience-what-is-our-health-care-future/

In the previous entry, Personal Health Records in Your Future, we pointed out the benefits of maintaining your own medical records. The personal health record (PHR) you would put together would be an invaluable compilation of your medical history across all the health providers you interact with.   Once filled out, it would give you and your medical advisors a more complete picture of your physical condition and result in better decisions regarding your welfare.

Recent statistics show that consumers are just beginning to be aware of PHRs and their usefulness. A 2005 study by Health Industry Insights found that consumers survey, 83 % had never used a PHR.  Of those, half had never heard of a PHR.   A more recent study by the California HealthCare Foundation, however, found that 40% of the people they surveyed were interested in starting one.  What keeps more people from adopting this valuable tool?  Perhaps the biggest factor, is the time and effort required to create and maintain it.  But help is on the way.

If you are a Kaiser Permanente member, the integration of your medical records has already been done for you.   More than half of Kaiser members have taken advantage of this by reviewing their records online and adding additional information to their PHR profile. However, if you aren’t a Kaiser member, there are other options available, including internet services and PC/Mac software that will make the process easier and less time consuming.

Two of the most well-known Internet services are Google Health and Microsoft HeathVault.  Both offer forms for entering your health information.  They’ve partnered with leading health care providers to automate integration of your health care data.  In addition, they offer
add-in software to manage weight loss, blood pressure, and track fitness goals.  Both give you password protected access to your health information and offer security and privacy assurances.  Another online resource for recording your Personal Health Record is WebMD It excels in features such as health risk assessments, goal-setting and tools for monitoring progress.  Among the software offerings is HealthMinder.  Another software product, My Life Record, is down-loadable to IPhones and Androids as well as PCs and Macs.

As a service to my readers (and because I think it’ll be quite interesting), I’m going to test drive these Personal Health Record internet services and some of the software available.   I’ll report back with my experiences and opinions.  Stay tuned.

In the previous blogs about medical records, we’ve pointed out that medical providers, by law, are required to replace paper-based patient records with electronic medical records (EMR) by 2015.  This computer-based format will pave the way eventually for a health information exchange (HIE), allowing all health providers to share a patient’s medical records.  This won’t happen anytime soon, however.  In the meantime, we’re left with medical records distributed among our medical providers (our internist, gynecologist, dermatologist, urologist, gastroenterologist, and the hospital we had our babies at), each record reflecting just that medical provider’s interactions with us.  Our health providers are left with only their small piece of our medical puzzle, unaware of all the other medical conditions we might have, prescription drugs we are using, or tests we’ve taken.   We the patients, on the other hand,  rarely see any of these files and wouldn’t know if they were inaccurate or out of date.

Increasingly, health care providers, employers, insurers, the federal government, and others who have a stake in our welfare, think there’s a more immediate answer to this problem.  Their solution calls for you to put together and maintain your own personal health record (PHR) which would make available, in one place, all the medical information  that’s at each of your medical providers offices.  In addition, you can include vital family health facts, allergies, and emergency contact information that’s important but probably not on any of the files now.  Here’s a sample of the medical information your PHR might contain:
·     Blood type
·    Your other medical providers
·    Health insurance information
·    Hospitalizations
·    Immunizations
·    Last physical
·    Results of tests and screenings
·    Major illnesses with dates
·    A list of your prescriptions, dosages and how long you’ve taken them
·    Vitamins taken regularly
·    Surgeries
·    Allergies
·    Any chronic diseases
·    History of illnesses in your family
·    Emergency contact
·    Living wills
·    Organ donor authorization
·    Health habits: smoking
·    Images and X-rays with dates and storage locations

Those you designate to view this record would now have a complete picture of your medical history.  Obviously, in a medical emergency, this information would be invaluable.  In routine medical circumstance, as well, the doctor/patient interactions would be more informed with better decisions made.   Doctor visits would address your health condition in a more holistic fashion instead of going down a narrow problem/symptom/cure track.  Duplicate lab tests can be avoided and a review of previous test results may provide a doctor with clues to your current condition.  In addition, it’s been found that people who use a personal health record are more engaged in their health and medical care.  They’re asking their doctors more questions and taking more responsibility in finding solutions to their health problems.

Some people are betting on a big future for personal health records.  They’ve developed tools to make it easier for us to generate our own PHRs.  We’ll take a look at these in our next blog, Personal Health Record Tools.

In our previous blog about Electronic Medical Record Concerns, we noted that using electronic medical records results in better care and saved lives primarily because the medical information is so easily accessible.  However, this also makes these records accessible to more people and increases the likelihood of misuse.  Consequently,  people are concerned with loss of privacy, and the potential inaccuracy and misuse of their medical records.   Who all have medical information about us?  What is being done to safeguard that information; and
what can we do to protect ourselves?

Where are our health records?  Well, we know that bits and pieces of our medical history are scattered amongst all of our health providers.  In addition, we know our health insurers document the medical services they’ve been billed for.  But who else has medical information about you?  Until recently,  people didn’t realize that if you purchase your own health or life or disability insurance, the medical information entered on the application is posted to a central database,  the Medical Information Bureau (MIB) shared by insurance companies.  If a physical examination or medical tests are required, any significant results from these are also added to your MIB data.  If you smoke or engage in high risk activities, this will also be documented by MIB.

IntelliScript and MedPoint are two other data bases used by insurance companies when consumers are seeking health, life, or disability insurance.  In this case, it is prescription drug purchases you’ve made that are recorded.  In most cases, this information comes from pharmacy benefit managers.  Why is this necessary?  About 10% of  insurance applicants don’t disclose all their relevant medical history; and insurance companies require this to gauge the risk they are taking by issuing the insurance.   However, accuracy is essential for you as
well.  Inaccurate data on IntelliScript and Med Point, as well as MIB, could result in higher than necessary insurance costs or a refusal to cover altogether.

The good news is that the companies responsible for these health-related databases are subject to the federal Fair Credit Reporting Act (FCRA).  In the case of MIB, you are entitled to obtain a free copy once a year of your records to ensure their accuracy.  They can be obtained by calling 866-692-6901, emailing them at infoline@mib.com, or consulting their website, www.mib.com.

People who’ve applied for health, life or disability insurance can view their prescription records once a year as well.  For MedPoint, call 888-206-0335 or write to: MedPoint Compliance, Ingenix, Inc, 2525 Lake Park Blvd., West Valley City, Utah, 84120.  IntelliScript reports are available by calling 877-211-4816.

The electronically stored medical records kept by your health providers are also protected by federal law, the Health Insurance Portability and Accountability Act (HIPAA).  The severe penalties that are called for under this law if  medical records have been misused have encouraged medical providers to be more vigilant about your records.  In addition, HIPAA also requires health providers to give patients their medical records on request.   But HIPAA only applies to medical records maintained by healthcare providers and only if the facility maintains and transmits records in an electronic format.  However, medical privacy laws in California, as well as in many other states, require all medical providers, regardless of how they maintain their patients’ records, to make them available upon request.

Unfortunately,  not all information about our health is protected.  For example, many of us participate in informal, often free health screenings for cholesterol, blood pressure, weight and fitness offered at malls, pharmacies, and health fairs.  The results of these tests as well as any other information you’ve been given can be passed on to direct marketers and businesses.  Many Internet sites offer health related coupons or services in exchange for personal and family health information.  Even our checking account transactions can be made available to bank affiliates who scour these for information about you unless you make the effort to contact them and ‘opt out’ of these data transfers.  Nothing but our own awareness and commonsense can protect us from the misuse of these records.

It’s clear that although laws protect some of our medical information, we need to be responsible for its accuracy and mindful of who we share it with.  In fact, it’s been recommended that we go a step further and maintain our own comprehensive medical history to ensure its completeness and accuracy.  Look for more about this in  Part 4:  Keeping Your Personal Health Record.

Previously, we wrote that, by law, paper-based patient medical records kept by health providers are being replaced by electronic medical records.  All medical facilities must make significant steps in that direction by 2015 or face penalties.  But what about us patients?  How will electronic medical records affect us?

First, a short summary:  Electronic Medical Records, known as EMR represent a digital computer-based record of a persons medical history: reasons for office visits, family medical history, lifestyle (smoking, drinking, etc), test results, medications, medical procedures, results of any genetic testing, & physician observations.   Currently, medical providers each keep their own version of your medical records. (Kaiser Permanente, a notable exception) The ultimate goal of electronic medical record keeping is to have one common comprehensive medical record for each individual sharable by all the medical providers in a region over a Health Information Exchange (HIE).  When available over a network, your medical information is referred to as an Electronic Health Record or EHR by the people involved in these enterprises.

Planners see huge benefits.  Shared medical records would bring down deaths from medical errors.  Dangerous drug interactions would be caught.  A digitized system would facilitate research in medical cause and effect.  Computer access would provide fast response in emergency situations, saving lives and avoiding complications.  But their very accessibility makes these records susceptible to misuse.

Significant numbers of people believe that unless addressed, these risks could slow all this down. In a recent EHR Survey, of the people who had concerns, 79% said security was their main concern and 69% thought misuse of their medical records was a real possibility. New York University Professor Jacob M. Appel, bioethicist and medical historian, gauges the large number of people who’d have access to documents in a system this size alone would make privacy impossible and security breaches inevitable.

One friend of mine,  is concerned that if even her General Practitioner knew about her medically controlled mental disorder, he would treat her health concerns differently.  Her fear grows just thinking about someone posting this information on the internet.  What if her employer knew?  Are such fears exaggerated?

We’ve already heard of workers in a highly respected hospital releasing Farrah Fawcett’s medical records and recent reports of government databases being hacked adds further credence to those concerns.   The possibility of medical record errors also causes apprehension.  One Boston Globe article cites the experience of a man, a kidney cancer survivor,  who requested copies of his medical records. They erroneously stated that cancer had spread to his brain and listed other conditions he never had.  It turned out that, in the course of his
treatment, he had just been tested for these conditions.  The report didn’t include the negative results of the tests.

Most people agree that their primary care physician should have access to their health records.  Of course, insurers have records of health care they’ve covered.  But who else might have information about us?  How can we be sure the information is correct?  What’s being done to protect medical records?  How can we protect our privacy?  Answers follow in Electronic Medical Records Part 3.

Does your doctor walk into the examining room with a folder with your name on the tab,   stuffed with odd bits of paper, hand-written notes, old forms and ragged-edged test results?   If so, he or she has until 2015 to move all that information to an electronic medical record (EMR) or face financial penalties.

EMR is one aspect of President Obama’s health reform plan that’s supported by both political parties and, with some reservations, by most of the public.  This didn’t come out of the recently passed health reform bill, however, The Health Information Technology for Economic and Clinical Health Act (HITECH) was passed as part of the 2009 stimulus package.  It provides $19 billion to encourage health care providers to adopt electronic medical record keeping.  Is EMR really all that important?

All major industries are computerized and electronically record customer and supplier information.  Given it’s size and importance, it’s amazing that a patient’s medical history is kept on bits of paper in bins distributed among several doctors’ offices.  These vital records are impossible to back up, time consuming to keep track of, difficult to make available to other health providers, easy to misplace, susceptible to patient mix-ups, and expensive to store.

In contrast, EMR system software has been developed to store all the patient’s medical data: physiology, current medications, medical history, ongoing conditions, insurance coverage and test results. The information is stored in easy to access standard formats and can be backed up, protected, and stored on tiny disk drives.  Advanced systems can call out dangerous drug interactions and guide medical staff in making proper decisions given the symptoms entered and the patient information on file.

But EMR is just the beginning. The ultimate goal is Health Information Exchanges (HIE), networks that can share a patient’s EMR with all the health providers an individual interacts with.  For this, $700 million dollars is being made available to states to begin development of Regional Health Information Organizations (RHIOs), medical networks, that will enable medical facilities and doctors in a region to have access to the medical records of the patients they jointly care for. With both EMR and RHIOs in operation, medical experts see $77 billion a year in savings as well as improved patient care.  It would seem that going digital would be a no-brainer.

To date, however, only 25% of the nation’s hospitals are operating with electronic health systems and only a small fraction of physicians practices have done the same.  It’s because medical facilities, face major hurdles in converting their paper systems to electronic systems.  HITECH incentives paid over 6 years won’t cover the average cost of $30,000 per physician to implement the system or the $9,000 annual maintenance cost.  Staff must be trained and a period of frustration and inefficiency must be endured. To busy, cost-conscious doctors, the cost and effort are daunting.

Hospitals face similar challenges.  In 2002, Cedars Sinai Hospital in Los Angeles cancelled a $30 million system rollout when it so encumbered the work of doctors and staff, that patients were at risk.  The hospital had to start over.  In stages, they modified the software, trained personnel and adjusted existing procedures.  Today, the new system is operational in just one department with a gradual rollout scheduled for the rest.

Medical experts, nonetheless, feel that the financial incentives offered in the HITECH bill will move EMR forward.  In order to qualify for the funds,  medical providers must prove that they not only have installed the necessary equipment, but that they’ve used it to improve patient care.  The initial list of 20 objectives and measures of what is now known as the ‘meaningful use’  requirements was recently released. It calls for doctors and hospitals to comply with 10 base measures and their pick of an additional 5.

Included in the list of ‘meaningful use‘ requirements are:
- provide patients, upon request, with an electronic copy of their health information
- generate and transmit at least 40% of prescriptions electronically
- implement systems to protect privacy and security of patient data
- provide patients with sum-ups of their office visit within 3 days
- send reminders to patients for preventive and follow-up care
- provide more than 10% of patients with electronic access to their health information (test results, etc.)

So, the next time you’re in your doctor’s office, you might ask him or her about their medical record keeping and how far along they are in implementing the  HITECH imperatives.

In the meantime, check this space for Part 2:  Electronic Medical Records Concerns and Part 3: Protecting Your Medical Records.

Are you aware that we’re in the midst of a serious whooping cough epidemic?  Nearly 1500 cases have been reported in California so far this year, a 5 fold increase from last year; and many more incidents are under investigation. With months of warm, infection conducive weather ahead, we’re on track to have the worst occurrence of this highly contagious disease in 50 years. Whooping cough strikes children, particularly infants, the hardest.  Six infants have, in fact, died this year.  The symptoms resemble a cold accompanied by a persistent cough but the symptoms are more sever and can last for months.

One of my New York cousins, here last week for a visit, admitted that she was wary about coming, having been advised by a travel agent that California was in the midst of an epidemic. I was shocked!  She said it was all over the east coast media.    I learned later that, in the U.S., only South Carolina comes even close to the infection rate we’re having here this year.

Whooping cough, called that by its distinct cough, is Pertussis in medical parlance.  You can actually hear the characteristic ‘whooping’ sound of the cough on the WebMD website. It becomes so persistent that it can cause broken blood vessels in the face, eyes and even the brain.  Infants can suffocate, unable to get enough air between coughing bouts.   Protection from it comes from the DTaP or Tdap vaccine which covers diphtheria, tetanus and acellular pertussis.  (It is not available in a stand-alone form.)

The two areas affected most by the whooping cough epidemic in California are Marin County and the Central Valley.   Given the lower income and education levels of a large immigrant population in the Central Valley, higher incidences there aren’t surprising.  But why Marin County?

California law requires children to be vaccinated for childhood diseases before entering kindergarten.  However, parents can opt out by claiming a ‘personal belief’ exemption.  In recent years, various people and organizations have claimed that vaccines contribute to autism and other diseases.  Enter the words ‘vaccine’ and ‘danger’ in any internet search and a plentitude of web sites will be listed alleging the perils of vaccinations.  Actually, there are inoculation risks, but they are temporary and minor: sore arms or slight fever.   But there’s evidence to believe  young, affluent, well-educated people are most apt to believe vaccinations are dangerous and would opt out of immunizations for their children for that reason.  State officials  attribute this as the reason Marin County has such a high incidence of whooping cough.   Public health experts maintain that an immunization rate of 92 -94% is necessary in any child population to keep the disease from spreading. That’s not happening in Marin County or in the Central Valley or for that matter in many parts of California which is why there is so much concern.

Because of epidemic rates throughout the state and whooping cough’s highly contagious nature, the California Department of Public Health has advised that pregnant women and adults and older children who have regular contact with babies should get vaccinated as well as all infants.  Where can we go for immunization?   Many health insurance plans already cover infant vaccinations.  In addition, many counties have vaccination programs available.  Even without government immunization programs or insurance, the vaccine seems to be affordable for most.  My (Orange County) doctor charges $55 for shots for patients without insurance.  Hopefully, we’ll get this old childhood disease under control again.

In our previous entry,  we stated that the Massachusetts health care plan had the same objectives and strategies as the one recently signed by President Obama.   Given their 3 1/2 year head start, we have a pretty plausible picture of what our health care future might look like.

Among the good results are:
-  more, but not all, people covered by insurance
-  low income people provided with state-subsidized insurance

These, however, are over-shadowed by the not-so-good results:
- the highest per capita health care costs in the country
- struggling health insurance companies
- a frustrated state government threatening price controls
- small businesses dropping their health care benefits, accepting fines, and turning their employees over to the state-subsidized system.
- increasingly crowded hospital emergency rooms
- doctors refusing to accept new patients covered by state-subsidized health insurance
- increasing numbers of people coming under the state-subsidized plan
- hospitals in danger of closing

The picture looks even bleaker for the U.S. when we consider Massachusetts’s higher income, education, and skill levels.  Moreover, while the Massachusetts health care system subsidizes income levels 3 times the federal income level ($66,150 for a family of 4) our national health reform plan will cover people at 4 times the federal income level ($88,200 per family of 4).  This alone greatly increases the cost of the national health care plan.

Massachusetts is less than 4 years into their system and their health care cost is not only higher than the rest of the nation, it is rising faster as well.  They and we need to stop and take stock of the situation.  We can’t just keep throwing money at a problem.  In an article titled: Massachusetts Health Care Reform – Near-Universal Coverage at What Cost?, the respected New England Journal of Medicine suggests that, given the resources we have,  we must balance individuals’ needs for quality health care with the obligation to be socially and fiscally responsible.   To be socially responsible suggests we have an obligation to provide good schools, a vibrant job economy, safe neighborhoods, a clean environment, and a secure country.  Fiscal responsibility calls for us to be able to pay for these obligations without going into heavy debt.

Do we need to help people who, for one reason or another, are kept from decent health care?  Yes.  Can we do it with a system like Massachusetts’?  Assuredly not.  We can’t afford it.  We need ideas that address the reasons health care cost is so high.  We need a market centered approach where people determine what they need not the government.  We need to encourage healthy lifestyles. We need to keep what works and attack only what’s not.  We need to stop calling everyone who’s in the medical business  ‘greedy’.  We need to make smaller changes and call for measured results.  In short, let’s not do what Massachusetts is doing.