Mass Health

Massachusetts is often at the leading edge of healthcare reform because of the high quality of its medical facilities, and therefore, the high cost of medical services and insurance in the state. Harvard Business School senior lecturer and Brookings Institution senior fellow, Robert Pozen, has articulated some good ideas in today's Boston Globe.

HSAs Are Going Through Changes

And they're not good ones. This was emailed to me by a Unitedhealthcare South Florida account executive -

As expected, the IRS recently released that there are not going to be any changes on HSA limits in 201l.  These limits include:

Maximum Contribution:

     $3,050 Individual

     $6,150 Family

HDHP Maximum Out-of-Pocket:

     $5,950 Individual

     $11,900 Family

HDHP Minimum Deductible:

     $1,200 Individual

     $2,400 Family

An additional catch-up contribution of $1,000 is available to account holders ages 55 and older.

There are also 2 provisions of the Patient Protection and Affordable Care Act that are scheduled to take effect in 2011, unless Congress changes them:

1) The tax penalty on HSA withdrawals not used for qualified medical expenses will be increased from the current 10% penalty to 20%.

2) Expenses for OTC medications (other than insulin) will not be eligible for payment or reimbursement from HSAs or other types of consumer-directed health accounts, unless they are obtained with a prescription.

For additional details, please refer to the IRS document at http://www.irs.gov/pub/irs-drop/rp-10-22.pdf

The 2nd provision is a real shame. It was really easy to pay for something at the drug store that was eligible to be paid with HSA dollars. All you had to do was use your card like you would any other debit or credit card. Drugstores had even begun noting on the receipt which of your purchases were covered.

Haw Haw Haw, Zere Eez Prohblem Een Zee Fronce

As the healthcare debate rages on in the U.S., the Sarkozy administration is attempting to make some cost-saving changes to the universal system in France. As an American, it is really funny to hear some of the stories from other countries where so much is provided by the government and taken for granted. It's not free though, smart guys. It has to come from somewhere.

This is my favorite -

"Yet even the smallest budget moves are proving controversial. Local residents are up in arms over a cost-cutting measure that makes patients pay €1.10 an hour to park at the hospital. 'It's a scandal,' says retired local Communist politician Gérard Eude. 'It goes against the very idea of universal health care.'"

Read the article on WSJ.com.

Healthcare Debate

The people who are attempting to upend our nation's healthcare system think this way -

"Health care does more than save lives: it also reduces pain and suffering. How can we compare saving a person’s life with, say, making it possible for someone who was confined to bed to return to an active life? We can elicit people’s values on that too. One common method is to describe medical conditions to people — let’s say being a quadriplegic — and tell them that they can choose between 10 years in that condition or some smaller number of years without it. If most would prefer, say, 10 years as a quadriplegic to 4 years of nondisabled life, but would choose 6 years of nondisabled life over 10 with quadriplegia, but have difficulty deciding between 5 years of nondisabled life or 10 years with quadriplegia, then they are, in effect, assessing life with quadriplegia as half as good as nondisabled life. (These are hypothetical figures, chosen to keep the math simple, and not based on any actual surveys.) If that judgment represents a rough average across the population, we might conclude that restoring to nondisabled life two people who would otherwise be quadriplegics is equivalent in value to saving the life of one person, provided the life expectancies of all involved are similar."

Those are the words of Princeton "bioethics" professor Peter Singer in his recent "Why We Must Ration Health Care" piece in the New York Times.

President Obama comes from a similar school of thought -



I don't mean to say that these are easy decisions, but I certainly don't want bureaucrats making them.

There's Some Good News and There's Some Bad News

Well, the good news is that I had a delicious sandwich for lunch. The bad news is that there was bacon on that sandwich, and if someday that contributes to my having a heart attack, I'm not too encouraged by the trends in emergency room care.

Emergency room waiting times are up to an average 30 minutes! And up to 25% of heart attack patients wait 50 minutes or more. Less than 20% of visitors to emergency rooms are thought to be in need of immediate care, by the way. Wow, people sure are stupid!

It turns out that ERs are closing as usage is rising. There just isn't room for patients. Resources and time are used moving patients around when they are needed treating sick people.

Dr. Art Kellermann, a spokesman for the American College of Emergency Physicians, uses the analogy of an airport having planes parked all over the runway, but it's more like airports having planes parked all over their runways as airports are shutting down across the country.

So, if you think about how terrible it is to fly now, just remember that it'll be like that if you need emergency care, but it's like an airport where people go and clog up the lines and have keys and change in their pockets when they go through the metal detector and they sit in the seats at the terminal and they stand in the way as you try to board the plane, and they even fly sometimes, even if they weren't really going anywhere. Plus people who are flying to Hawaii pay the same as those flying to the next state over. AND you're pants are open in the back so everyone can see your butt.

Read the depressing article in Forbes, if you really want to.

Don't Mess Up!

Hey all you doctors, nurses and other hospital staff, listen up. Medicare is no longer going to pay for mistakes (like sponges left inside of patients after surgery). Read about it here in the New York Times.

Private insurers are going to monitor the new policy to see if they can implement something just like it -

"Susan M. Pisano, a spokeswoman for America’s Health Insurance Plans, a trade group, said, 'Private insurers will take a close look at what Medicare is doing, with an eye to adopting similar policies.'"

"The Bush administration estimates the new policy will save Medicare $20 million a year. But other experts say the savings could be substantially greater."

$20 million might as well be 20 cents when you're talking about government spending. It sounds like this will result in a lot of finger pointing and tons of spending by hospitals, but I suppose time will tell. The statistics for rates of infection and accidents will be released sometime in the future, and we'll see if this initiative has given medical care providers the right incentive to give better, more efficient care.