Medical gift cards? Why limit where they can spend what you’re giving them?
The card is issued by Visa, so it can be used anywhere Visa is accepted for health-related services. They are not sold in stores and need to be purchased online or over the phone for up to $5,000.
“The peak audience we believe though is women 35-50, the famous sandwich generation,” Bellard said. “So, they’ve got parents that have health needs, and they’ve got a spouse that has health needs, and older children going off to college or living on their own that have health needs.”
How does the card impact medical deductions? The person who uses it gets any eligible write-off.
“Be sure to record how much you spent on that card because that is a legitimate medical expense that you can use when you fill out your taxes,” said Jack Gillis of the Consumer Federation of America.
Still if you insist on buying one then here they are.
This is one of the worst stories I’ve ever heard. A girl goes into liver failure, is sent by her insurer to get evaluated for a transplant. Then develops complications and the insurer denies the transplant despite the organ sharing network having found a match for her. Then just hours after her family has taken her off life support, they learn the insurer has changed their mind.
The case of a Northridge teenager taken off life support just as her insurance company reversed itself and agreed to pay for a liver transplant is highlighting tensions among physicians, patients and insurers over the definition of experimental procedures.
About 4:40 p.m., just as Sarkisyan said the family had decided to remove Nataline from life support, Cigna sent a letter to the family’s attorney approving the transplant.
The letter, faxed to attorney Mark Geragos, is stamped 4:44 p.m. Geragos said his staff tried unsuccessfully to reach the Sarkisyans at the hospital. The family said they didn’t see the letter until after they removed Nataline from life support at 5:20 p.m.
“They took my daughter away from me,” Krikor Sarkisyan, 51, an automotive technician, said at the news conference outside Geragos’ downtown L.A. office.
The trouble was two-fold. First, the procedure was considered ‘experimental’ and the family had not purchased a plan to cover such. Basically it failed to reach some mystery threshold of evidence in the literature, the guidelines for which probably only exist in some dark room at CIGNA HQ. Second, she had a gross 65% survival rate at six months.
Dr. Goran Klintmalm, chief of the Baylor Regional Transplant Institute in Dallas, said the operation that UCLA wanted to perform was a “very high-risk transplant” and “generally speaking, it is on the margins.”
But Klintmalm said he would consider performing the same operation on a 17-year-old and believes the UCLA doctors are among the best in the world.
“The UCLA team is not a cowboy team,” he said. “It’s a team where they have some of the soundest minds in the industry who deliver judgment on appropriateness virtually every day.”
I think the aftermath of this tragedy, by some of the groups who have latched on, is a really lovely demonstration of America’s expectations for health care versus their complaints about cost.
A representative for America’s Health Insurance Plans had the best quote to summarize the voices that should be favored in making health care decisions,
“The transplant was recommended by the medical professionals at the bedside,” [Karen] Idelson said. “They should have been listened to.”
Keeping the bueacrats out of health care decisions costs money. Demanding absolute deference to the physicians in a controversial case like this while also expecting low health care costs or pining for health care hand outs is incompatible. For instance, while certainly not even attempting to make a judgment in this case, the issue of coverage for experimental therapy.
In such a battle of costs versus expectations, the California Nurses Association made a particular ass of themselves,
The California Nurses Assn. publicized Nataline’s case, calling it an illustration of the need to abandon private insurance coverage in favor of a single-payer plan.
The reality is that Natalie would’ve almost certainly been less likely to get a liver transplant under a single payer system. An ‘exponential’ (I use that as hyperbole) increase in rationing is the trade off you make with health care systems with global budgets. Never forget that.
The Field Poll found 64 percent of California voters inclined to support the universal health insurance plan outlined in the bill, compared with 23 percent opposed.
The Field Poll also found 63 percent of voters in favor of the state raising its cigarette tax to support the medical insurance plan, compared with 33 percent against doing so.
The poll only surveyed support for one of the actual final proposed funding mechanisms. That is a cigarette tax as cited above. If you remember (here’s my previous post on California’s plan) the other funding mechanisms are a 4% tax on hospitals and a pay or play deal for employers.
But with media coverage like this, would anyone be surprised if voters just put those two other little new taxes out of their mind or weren’t even aware of them at all (I mean, the majority don’t even read the plain language explanations on the ballot in full) when they vote?
So despite whatever campaigns the California hospitals or the Chambers of Commerce roll out, I would expect the funding mechanisms to fall into place.
This Is A Stick Up! Give Us Your Money!
And despite claims that the bill faces a challenge in the Senate, the actual ballot initiatives are probably the most likely place for this plan to be defeated. That said, there’s a slight glimmer in the Senate as the bill will not even be taken up in that chamber until the new year.
Despite a last-gasp effort in the Assembly last week, the Legislature is about to finish the “year of health care reform” without passing a health care plan.
While that outcome had become expected, what was surprising to many observers was the person responsible for blocking action before the new year: Don Perata, the Senate leader and a liberal Democrat from Oakland who co-authored the bill.
Perata announced he would not allow the Senate to vote on the Assembly-approved bill - not until he knows more about how the $14 billion-plus measure would affect existing health programs and the state’s overall finances.
[…]
[B]y pushing Senate consideration of the bill into next year, some proponents privately fret that Perata may stall its momentum and kill the measure’s already slim chances of being enacted.
At one point last week, the blunt-spoken Perata said in a TV interview that the health plan was “DOA” - a remark his office quickly said that he didn’t mean literally.
[A] risk of waiting may be that by the time the Senate debates it, presumably sometime next month, the political climate will be much more treacherous. Gov. Arnold Schwarzenegger plans to call the Legislature into a special session to grapple with a projected $14 billion deficit, and Perata himself is stoking doubts about whether the sprawling health care proposal would widen that gap.
That said, because the new funding mechanisms for the plan are being put to a vote by the people, and thus the bill doesn’t need a 2/3rds majority in the rooms to either side of the capitol, the bill will likely squeak out of the Senate.
In the end, even Republicans expect Perata will scare up the votes to pass the bill sometime in January. But they have enjoyed hearing the senator talk their talk.
“I love it,” said Assembly Minority Leader Mike Villines, R-Fresno. “I’d love to see it happen throughout the year.”
The Fields Poll certainly seems to emphasis the political capital California politicians have to implement a plan like this. What’s funny is that, according to the poll, the enthusiasm for the plan is tempered under certain circumstances. It shows the absurdism in the growth of society’s greed expectations of hand outs. The circumstantial evidence for this: the plurality oppose the health care plan if it is funded by a 1% increase in sales tax.
Now true, sales taxes are regressive and place a larger burden on the very population this health care bill is trying to “help.” But if you think the average Californian is thinking that deeply when answering this poll question your faith in humanity is, uh, misplaced. We all know that the “more real” it fells like dollars are being taken out of our pockets the less likely we are to support helping our fellow man. Sure the reality is the costs for the program will be passed onto all in some shape or form, but it’s only when it is obvious enough for them to see it, to feel it’s a reality that they pull their support away.
That speaks wonders to society. It also speaks wonders to the growing expectations of the role of government as a teat to suckle at, as welfare provider. Have no doubt that as income disparity grows we will continue to see increasing clamor from the majority for various forms of wealth redistribution (not to sound like Marx and Engels or anything).
That’s a shame. Just because the majority hawk for such handouts doesn’t make it right.
p.s.
Now, I’ve said it numerous times on this blog, but I’ll repeat: I personally believe I have a moral obligation to help the less fortunate. My continuing efforts throughout my career do and will speak for themselves. I just don’t think the government has any place forcing such an “obligation” on others.
I’m not one to hold the past equivocally against someone. That despite the photo above. But it isn’t like Rudy’s past is glowing besides this.
We look upon authority too often and focus over and over again, for 30 or 40 or 50 years, as if there is something wrong with authority. We see only the oppressive side of authority. Maybe it comes out of our history and our background. What we don’t see is that freedom is not a concept in which people can do anything they want, be anything they can be. Freedom is about authority. Freedom is about the willingness of every single human being to cede to lawful authority a great deal of discretion about what you do.
True, there was little chance I was going to vote for Rudy (or Mitt or Mike) in this election, but this quote from a 1994 speech is exceedingly disturbing. Even within context.
*sigh* The widest open race in decades and I still despise my likely options (except for Ron Paul)
The measure, negotiated by Schwarzenegger and Assembly Speaker Fabian Nuñez (D-Los Angeles), would require almost everyone in California to have insurance starting in 2010. It would provide subsidies and tax credits for those who would have trouble paying their share of the premiums.
[D]octors also would have to pay 2% of their gross earnings back to the state to help expand coverage.
But keeping the hospital tax reeks of absurdism. Not that much about the bill is likable if you believe in economic liberty.
There is perhaps some “good” news. Despite the bill’s passage in the Assembly, this plan is far, far from a done deal.
[T]he measure faces a more skeptical reception in the Senate, where Democratic leaders are asking whether it makes sense to adopt such a giant change at a time when California has a projected $14-billion budget gap.
Senate President Pro Tem Don Perata (D-Oakland) did not attend a jubilant news conference with Schwarzenegger and Nuñez, though he is officially a co-sponsor of the bill. He issued a muted statement praising “progress” and saying that he would ask the Legislature’s fiscal experts to determine whether the plan would become a drain on the state’s already depleted coffers.
An even bigger concern may be about asking the citizens to approve the new taxes to fund the proposal. Granted not new personal taxes, but taxes on employers and hospitals which will be passed onto the public in a number of ways.
Nuñez left the financing out of the bill because it would have needed a two-thirds vote to pass, requiring some GOP support. The planned initiative would ask voters to approve taxes: $2.6 billion on employers that don’t provide healthcare, $1.5 billion on tobacco users and $2.3 billion on hospitals.
The initiative is still being drafted. But it almost certainly would have to overcome well-funded opposition from many business groups and the state’s largest insurer, Blue Cross of California.
Tobacco and drug companies might also join the fight, bringing along their substantial financial resources.
The California Chamber of Commerce, which along with the state restaurant association successfully campaigned for the repeal of the last major healthcare measure in 2004, derided the bill passed Monday as “half a proposal.”
As I’ve said over and over, this kind’ve wealth redistribution really doesn’t stand on an ethical base.
Is there a right to property?
Is there a right to…health care?
Without repeating the base on which I’m building this argument (it’s been spelled out numerous times on this blog) I don’t understand how liberals, beyond their emotional reaction to those suffering, are enshrining something as historically evanescent, as ill defined as “health care” into an infallible right. A right more important, more inherent than that of property. Because that is what you’re having to do here to justify a “universal” health care plan like this.
Never forget where this money is coming from. I know income disparity (and perceived commercial greed) immediately entail a gut reaction of unfairness…somehow. But com’n, in the end, by and large these aren’t greedy hospitals and corporations you’re taking from. These are real people. Granted they’re at the top of the income pyramid and sure they can ’spare’ it to fund a “better life” for those at the bottom, but is it really your place to make that determination? You violate it once (just once) and a truly infallible right, like that to property, holds no meaning. That isn’t hyperbole. A political right like that either exists without ex post facto restrictions or it doesn’t exist at all.
I don’t think it is heartless to admit this but I’m disturbed by the emotional rhetoric from those supporting the bill.
Fresno Mayor Alan Autry, gave the most emotional presentation of the [news conference], choking back tears as he recalled how his father, a farm worker, died after receiving substandard medical care that he blamed on a lack of insurance.
“It’s not a political issue,” Autry said. “It’s not an economic issue. It’s a moral issue.”
[…]
“I believe history will show that California was the tipping point in the long-sought dream of an America where every single man, woman and child who works has a choice of secure and affordable and quality healthcare for themselves and their families,” said [SEIU president Andy] Stern…
We see this legislation as a work in progress—a crucial step toward the goal of quality, affordable health coverage for every woman, man, and child in America. The plan is not perfect, but waiting around for the perfect plan is a luxury too many Californians and Americans do not have.
Nay-sayers beware: if meaningful healthcare reform can happen in California, America’s largest and most ethnically, economically, and politically diverse state, it can—and must—happen nationwide.
I’ll say this: there’s no doubt that the California plan will fall short of it’s goals but perhaps that won’t matter, perhaps what it will achieve will still be significant. I know it has provisions to try to avoid such but the plan is going to suffer some of the same pot holes that the Massachusetts plan has.
To remove the threat of a public backlash, the state plans to exempt nearly 20 percent of uninsured adults from the state’s new requirement that everyone have health insurance.
The proposal…is based on calculations that even the lowest-cost insurance would not be affordable for an estimated 60,000 people with low and moderate incomes who do not qualify for state subsidies. Forcing them to buy insurance or pay a penalty could jeopardize the rest of the state’s initiative, officials said. Instead, the state board appears prepared to settle for near universal coverage, all but 1 percent of the state’s population.
Hey Look! I Got One Right…Just Not On My First Try
I’m a big fan of these self quiz resources on the web whether they be derm atlases or radiology cases. Good to find a new one with some breadth and some actual physical exam findings.
A new EU proposal, in it’s current form, would have member states guarantee health care costs no matter where their citizens are in Europe.
The commission was due to announce that that anyone who could not have “appropriate care” for their condition in their own country “without undue delay, will be authorised to go abroad, and any additional costs of treatment will be covered by public funds”.
Basically: think you’re queue to get that hip replaced is too long in the UK? Hope on over to France to have it done, pay for it and when you get home the UK Department of Health would have to write you a check to reimburse you for it.
Not every face is smiling with the proposal.
Anticipating a frosty reception, the commission was expected to propose giving member states prior authorisation of reimbursement for a hospital stay abroad.
For that to happen, a country would have to provide evidence that the number of patients seeking hospital care abroad would affect the planning of their home country’s hospital sector.
[…]
Non-hospital treatment would not require prior agreement.
[The plan] would be pretty radical, and mean that Britain would have to adapt to a much more continental insurance-based system. But there is a potential opt-out.
If a Government can provide evidence that the impact of the law would undermine planning in their health service then they can partially opt out of the scheme.
They would be allowed to insist that patients get the green light from the health service before they travel.
It’s widely thought that this clause has been stuck in to satisfy the British Government.
Indeed, pretty radical and ridiculous (I bet you didn’t see that opinion coming from me). Although I suppose if you’re already guaranteeing health care within your borders, it isn’t a real philosophical jump to guarantee it outside of them.
It does however threaten the entire NHS model, which until the date this is enacted has never had to deal with reimbursement; never had to act as a real payer.
Okay, okay. Sarcasm aside if you’re up at the podium enough, it’s bound to happen that you put your foot in your mouth but Perry’s smirk dismissal of Ron Paul rather than humility in correcting himself is just downright stupid.
I’ve been around the world of politics enough to understand the realities of Ron Paul’s campaign. This is tough to translate into a chance. But he deserves more respect than in this video. Fine, you don’t agree with Dr. Paul, you don’t want to endorse him, then don’t but don’t seemingly scoff at the notion.
The Australian Medical Association has backed a call for laws banning the non-essential circumcision of infant boys.
“There were quite a lot of folk myths around the advantages of circumcision. They’ve almost all been debunked,” Prof Walters said.
“There are some minimal advantages in some circumstances, particularly in some infectious diseases, but they’re overwhelmingly balanced by disadvantages in other areas,” he said.
Granted the both the prevalence and incidence of male circumcision in the Untied States dwarfs that of Australia; so this call for no more circumcisions isn’t too ground breaking. In the United States currently between 55 and 60% of newborn males are circ’d (more that that in the hospital I did my newborn nursery rotation in) while Australia had an incidence of roughly 12% as of fifteen years ago.
[R]esearch, now under consideration for publication in the Medical Journal of Australia, cites an increase in the incidence of circumcision from 10.6 per cent in 1993 to 12.9 per cent for the year to date.
So Long?
Despite calls like this from many health care providers and groups, the medical benefit of circumcision remains a legitimate debate - mainly in nations with HIV epidemics.
Breaking news: Per CQ Today, the Senate Finance Committee has reached an agreement to (once again) hold off on the 10% Medicare fee cuts due Janurary 1st.
Senate Finance Committee leaders have reached a deal to delay for six months a 10 percent cut to Medicare physician pay rates and extend funding for children’s health insurance, a Republican committee aide said Monday.
The legislation, being written now, would stop the Medicare cuts set to take effect Jan. 1, the aide said. Chairman Max Baucus , D-Mont., and ranking Republican Charles E. Grassley , R-Iowa, agree on the package with a few outstanding details to be resolved, according to the aide.
The Senate would take up the package as a standalone bill. “The idea is for the Senate to hotline it and then send to the House,” the Republican aide said.
I guess I should’ve seen that coming, but I had seriously wrote off them postponing the SGR cuts this year. This after we were so close with fixing the SGR once and for all with that first edition of the SCHIP expansion bill. But it looks like, as usual, physicians will get a six month reprieve.
45-59% of physicians actually provide negative uncompensated care
[…]
Compared to all insured, physicians deliver [as little as] -$2.10 in uncompensated care per visit by the uninsured.
How is this possible? Physicians have fees they charge patients for every office visit, every procedure. When third party payers come into the picture they set their own fee schedules. The insurer basically says, we’ll pay you 40% of what you would “normally” charge for an office visit and in return we’ll allow patients on our insurance to visit you. It’s quantity.
But when someone without insurance comes in for a visit or a procedure, they typically get billed the “full” amount (or at least more than what is billed to the insurance company). So even though some large percentage of visits by the uninsured go unpaid (result in no or little compensation), the physicians are charging more than they would get with an insured patient and so physicians actually make more money per patient when you compare the whole of the two populations.
Healthcare Is A Business?
Also of note, most private physician “charity” care doesn’t arise from physicians offering it…but instead by the bills they level onto their uninsured patients not being paid.
[M]ost uncompensated care arises from the uninsured not paying their bills…Only 13% of the uninsured were billed less than the insured; only 7% were billed nothing…on the other hand 87% of the uninsured were billed more than the insured
To be fair, private physicians represent a tiny fraction of the total charity care provided in this country. For instance my county hospital and clinics, staffed largely by salaried physicians (both employees of the county and through contractual arrangement with the medical school), obviously provide the vast, vast, vast majority of charity care in this area. The same is likely true the country over.
Although an interesting study, I think the policy implications for such are limited. Healthcare is a business but there are a lot of physicians out there doing really incredible work for the public good. Don’t draw too many conclusions from this paper.
The public deserves to know about the extent to which every medical journal relies on pharmaceutical advertising revenue to run its business. In 2003, drug companies spent almost half a billion dollars on advertising in medical journals. The two lead general medical journals in the United States—the New England Journal of Medicine and JAMA, the Journal of the American Medical Association—receive about $18 million and $27 million each year, respectively, for display advertisements (as opposed to classified ads placed by individuals seeking jobs or institutions seeking qualified candidates). The display ads represent 10 percent to 21 percent of the journals’ overall revenue, according to one study.
[…]
I have a modest suggestion: In addition to requiring authors to post conflict-of-interest statements when they publish an article, medical journals should tell readers how much revenue they themselves have received in the previous year from the company producing the drug or device under discussion. The total sum should include not just advertising pages purchased, but also the other ways that industry money can slip into journal pockets, by buying reprints and journal supplements. Show us the actual dollar (or euro or pounds sterling) amount. And if a professional society sponsors the journal, tell us about its financial dealings with the drug companies as well.
I couldn’t agree more. I appreciate the “modest” and reasonable suggestion. This isn’t some looney left cry that we eliminate the relationship, but if there is any integrity within the field then they should be more transparent. Let physicians (and the public) come to their own conclusions about the potential conflicts of interests, but at least give them the information to do so.
I did my undergrad work in USC's School of Cinema-Television Cinematic Arts. I have a Bachelors of Fine Arts in Writing for Screen & Television. I loved it, but a future of waiting tables and taking meetings with B-List producers was not for me.
This blog is ostensibly to discuss healthcare policy and maybe educate a few of my fellow medical students. But it will stray into current events, politics, and other science topics when they draw my interest
Other odd notes about me:
I've skied half the resorts on this list (Squaw Valley/Lake Tahoe, Snowbird/Park City, Whistler, Taos, Vail)
I "played" lacrosse in high school and through a club level team in college
Nothing on this website is to be taken as medical advice. I am not a physician. Please consult a physician concerning any health related questions.
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Endorsements
"Please be more precise in your practice of medicine than you are in your blogging!"
- Mark Lanier
