What You CAN Do About Prescription Drug Costs

What American’s Think About Prices and What You Can Do 

                    “Corporations now spend at least $2.6 billion a year lobbying Congress—more than the $2 billion taxpayers spend funding the House and the Senate.”  The Week, July 31, 2015

What American’s think about pharmaceutical costs:

This August The Kaiser Family Foundation (www.kff.org) and its Health Tracking poll component, asked Americans about prescription drug costs. They found: Continue reading

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$10,000 Health Design Contestant Creates Model for Colorado

In 2002, I sponsored a $10,000 contest to build an American health system.  We held the contest then built CodeBlueNow! to assure the public had a voice in reform: www.codebluenow.org. We closed our doors in 2010 with the passage of the Affordable Care Act.

But now–nearly 14 years later—a contestant, Ivan Miller, PhD, has refined his proposal working with Colorado state legislators. They developed a model called: Colorado Cares. Coloradans are in the process of gathering 99,000 signatures to to place the proposal on the 2016 ballot.

Miller is not alone. Although he is primary adviser, Colorado supporters and advocates include former Governor and author Richard Lamm and  the widely respected journalist and author, T.R. Reid, whose thoughtful book, The Healing of America, outlines the ills of our system and the variety of models that successfully exist around the world—some of which are both public and private.

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Women’s Health: A Brief Historical Context of Contraceptives and Adoptions

As an aging woman, I have been following  the furor over women’s health with great interest. There are many issues  young women today don’t know.  To understand where we are and what we have accomplished, it is important to remember where we came from.  I will not do a series on women’s health, but I cannot remain silent.  It is only as recent as 1919 that women gained the right to vote which finally gave women the ability to participate fully as equal citizens under the law. Here are some things I remember  and discovered as a young woman:

  • In the early  1960’s, when I returned to the US from high school in Japan, I was stunned to learn that if you used a tampon, which were relatively new on the market, it meant that you were not a virgin.
  • In the 1990’s pregnancy was considered a pre-existing condition. If you were uninsured and became pregnant, you could not get insurance.  Normal maternity care and delivery costs were $5,000-6,000. Choices, therefore, were:  pay for the care and birth yourself, possibly use a midwife, or have an abortion which became legal in 1973.
  • In the 1990’s when I wrote a series of articles on women’s health for a national health care trade publication (trade journal writers  could showcase programs but not criticize them)I gained inside information, but I could not use it in the story  because the magazine would not have allowed it! I interviewed a health benefits actuary at either Milliman or Mercer, the two leading health benefits consulting firms hired by employers to design health benefit packages for their employees, and he said —this is the direct quote:  “Contraceptives? We don’t need to cover contraceptives. They’re cheap. Women will buy them anyway. They’re like hearing aids and eyeglasses; cheap enough that people will buy them themselves. Not so expensive people will go without.”

Pre-1990 Supreme Court decisions about contraceptive coverage and abortions: Continue reading

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Personal Impacts of Long-term Care; Coming Up–another view of personal aging care–this time for Tribal Elders

Caring for One or More Aging Parents: Some Personal Stories

Taking initiative, a friend who was caring for several parents–some of whom lived out of town and on both coasts- started a blog so caregivers could share their insights, concerns and offer mutual support.

Not all stories  on her FaceBook page deal with the costs of care, but some do.  Here is one such story: http://www.nytimes.com/2015/06/23/health/at-home-many-seniors-are-imprisoned-by-their-independence.html?_r=1

Most stories are personal from caring for parents with Alzheimer’s disease  to caring for  one parent when the other has died. These stories give a personal voice and face to the very personal issues of aging and caregiving.  These stories reflect the strength, needs and challenges facing our elders and our families.

Her FaceBook page is:  https://www.facebook.com/GirlfriendsWithAgingParents?fref=ts

For those who missed the earlier blogs on the two models I discussed they are: community villages: www.vtvnetwork.org  and  one of its local networks in Seattle www.widerhorizonsvillage.org

The other is a new care and financing model: http://altarum.org/research-centers/center-for-elder-care-and-advanced-illness. They also have a blog on the development of these communities: http://www.medicaringcommunities.org

There are other models,, such as the one my mother was in, called PACE: http://www.npaonline.org/website/article.asp?id=12   This program is  primarily for low-income elders, but they do accept private pay patients, such as my mother.

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Coming next: Tribal Care Long-term Care 

In my last blog I talked about the importance of programs that respect personal goals and wishes as we age.   The Urban Indian Health Service connected me with the head of their program.  Their story will be featured next.    http://www.uihi.org/about/ Continue reading

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Changing Aging Care: Personal, not Institutional Care–What Can Be Done and What You Can Do; and my new advisory and board appointments

The Limits Of Medicare

“Medicare is great for medical care, but it simply does not cover the support and personal care services that frail elderly people need. The current system cannot support those needs—the way we pay for care is a medical model, not a community based or individual care model.  Such simple community based programs many people depend on, such as Meals on Wheels, have up to an eight month waiting list in some areas,” stresses Joanne Lynn, MD,MA, MS, Director, Altarum Institute’s Center on Elder Care and Advanced Aging. “Our strictly medical care model must change.”  http://altarum.org/research-centers/center-for-elder-care-and-advanced-illness

“We know from experience that 30-40 percent of elderly Americans have long-term care needs that are not and cannot be met by the family. Elderly people also retain their personal priorities and goals that should be honored,” says Lynn.

She lists some hard facts about American’s aging and long-term care needs:

  • Nearly half of all Americans have no savings at the time they retire.
  • 40 percent have no immediate family to help with their care as they age.
  • Daily, 10,000 baby boomers are turning 65.
  • There are insufficient public funds for long-term care for all who need it.
  • Most people have insufficient personal savings to pay for such care.
  • People who live to 70 will probably live to 80, with increasing care needs. People who are ninety can live to be 100 or more.
  • The best predictor of increasing care needs and costs is aging.

“Without significant changes in how we pay for and deliver long-term care services, there will not be enough support for aging baby boomers.  Few people are immune from some care needs as they age.  Those few who make the headlines as having robust and healthy lives make headlines simply because they are so rare,” Lynn indicates.  “Non-medical supportive care needs are not covered by Medicare even for such simple things as home modifications or Meals on Wheels, and often wheelchairs.   People who think they won’t need such service should think again. Right now nearly 30 to 40% of all Americans have to ‘spend down’ (eliminate) their assets to pay for their aging care. When you spend down you have no assets. Without assets you have few choices,” she stresses.

If you couple American’s lack of retirement savings with the lack of coverage for non-medical care costs, financial and emotional disaster looms large for many people. Community based care systems, such as the Community Villages discussed in the earlier blog, are one step in the right direction but they still don’t cover many supportive care needs for frail elders.  Lynn believes that those needs can be met by changing the way we organize and pay for care.

Lynn’s conviction is based on research that demonstrates the effectiveness of a community based system that covers personal and supportive care and also respects the wishes of the individual.  “MedicaringTMCommunities” is a model founded on solid research. Lynn is not alone in her convictions. The model has attracted seed funding. Four communities have developed plans to  organize such systems and are in the early implementation stage.  The Center is also sponsoring a petition drive and a non-partisan “Party Platform Initiative” is underway to assure supportive services are available in communities around the country.

The Older Americans Act, which assured community based programs such as Meals on Wheels, home modification and homemaker services, was passed by Congress in 1965. This year the Act was continued by the Senate, but has not yet passed the House.  “But even if the Act is renewed again,” Lynn notes, “Funding has not increased since 1994, nor has the number of people served increased—all this while the aging population has doubled. Funds for supportive services are flat while Medicare funds increase for medical care. Financial support for the personal and supportive services people need has remained flat since 1994,” she stresses.

What Can Be Done Continue reading

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Just In! A Practical Toolkit on Long-term Care for Families; and A Guide to Long-term Care Costs

The bi-partisan Alliance for Health Reform just released its toolkit on Long-term Care.  Funded by the Robert Wood Johnson, the toolkit offers facts, organizations and resources about aging and long-term care services.  http://www.allhealth.org/publications/Long-term_care/LTSS-Toolkit_166.pdf

Why you need to pay attention: A brief look at long-term care costs: http://longtermcare.gov/costs-how-to-pay/costs-of-care/

Coming Next: Community based models:  http://www.medicaringcommunities.org

Continue reading

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What You May Not Know About Medicare Could Hurt You

If You Think Medicare Covers All Aging Needs Think again.

Medicare is Medical Care. It covers physician care, hospital care, post-acute care (care after a hospital stay), such as a skilled nursing facility or home health care for rehabilitation. In all cases, however, there are limits.

1)   Hospice is covered and it now appears doctors will be paid for end of life discussions.

2)   Medicare Advantage plans may cover a few more things than traditional Medicare supplemental plans, such as fitness classes and limited eyeglass and dental care. These plans do not cover long term care whether at home or in a facility.

3)  Part D covers pharmaceutical costs up to a point. With the Affordable Care Act the “donut hole” will be closing, but still cancer drugs and other specialty medications can cost up to  $100,000. You are still responsible for co-pays up to your deductible amount. In Medicare you are generally responsible for 20% of the cost.

4)   Medicare covers certain “assistive” devices, including walkers and some types of wheelchairs, but there are many restrictions about what is available. High co-insurance means you also must pay for a substantial portion yourself.

Medicare does not cover long-term care! It did not cover most of the costs associated with my mother’s care as noted in my previous blog. Nor does it cover non-medical care needed by people with dementia or long-term disabilities.

Overall, long-term care insurance coverage is inadequate. It is expensive and typically covers around three or slightly more years of care and not always at full cost. If you need long term care, and have means, you must spend them (called ‘spend down’). If you don’t have means, there is Medicaid for low-income seniors and there are a few programs available in some communities that help.

“Most people don’t realize what they will face, but there are some positive steps people can take to prevent what can often can be an emotional and personal disaster for the person and the family,” explains Denise Klein, Executive Director, Wider Horizons, in Seattle, WA(http://widerhorizonsvillage.org/), former Executive Director of Senior Services in Seattle for 10 years. She has worked in the fields of aging, health, and long-term care for more than 40 years.

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Aging And Your Family: Finding The Systems that Work

Introduction:   As we gather with family and friends on this celebration of our national independence, let’s think on independence and quality of life as we or our family members age.

Despite harping about the flaws of our health care system I have seen a system work. After my father’s death I became my mother’s caregiver.   I was confident I could manage her care. I had worked in and wrote about health care for nearly 30 years.  I started my health care career in aging and long-term care.  I had been a Medicare HMO marketing director.  I knew it all.  I thought.   Here’s what happened to my family until we found a system that worked:

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A New Direction for O’ConnorReport: ACA “Watch Dog” and new Showcases of Success

The Supreme Court’s decision validates the core of the Affordable Care Act.  Still much more remains to assure safety, quality and value (bang for the buck). To date, I have focused on the systems’ ills. What we heard loud and clear when we at CodeBlueNow! asked  people about the system was: “Show us what It Will Look Like.” 

As we create a new more user friendly, engaging and robust website, I want to do two things:  1) be a watchdog on the system and 2) be a ‘scout’ that showcases the good and the possible.  My concerns and interests are:

  • Mergers and consolidations among insurers, hospital systems and ‘multi-vendors’
  • Increase in for-profit providers especially in home health care, senior residences and hospice
  • Meaningful patient surveys
  • Real Community engagement models for quality and needs assessments
  • Successful replicable models of care, quality measures
  • Accountability at all levels—cost, quality, safety and community engagement

Ezekiel Emanuel, one of the ACA’s architects, voices similar concerns about consolidations and anti-trust in Reinventing American Health Care. 

The Supreme Court decision is a major victory, but there are more than a few big battles/issues ahead.  As a friend said about the system after reading my book:  “Too many cooks in the kitchen.”  So we must remain alert.

That said, there are more and more bright lights as we will see next:

Coming next—a look at a long-term care system that actually worked for my mother and me. Plus some models of hope for frail elders as 10,000 baby boomers a day turn 65 into a system that is not prepared for them……..Yet. Continue reading

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Insurers Consolidate and Merge and A Quick History of Health Care Reform: The Good, the Bad and the Ugly

No matter what the Supreme Court Decides

Much remains to be done.  Insurance is regulated at the state level.  Even if subsidies are approved, more fights remain ahead.  http://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/NationalHealthExpendData/NHE-Fact-Sheet.html

Insurance company consolidation:

“Merger activity is heating up now because the insurers have become tremendously cash-rich,” says Fuller, who studied the balance sheets of several companies this week. “While hospital revenue is improving somewhat,” he says, “the balance of power when negotiating with the merged companies will definitely be in favor of the insurers,” Fuller predicts.  317643/MegaMergers-Among-Health-Insurers-Bode-Ill-for-Hospitals

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A short selection from  “A Quick History of Health Care Reform,”  in The Buck Still Stops Nowhere (order now!)   Or, support this independent voice and donate today!  We give you news and tools you won’t find elsewhere! 

A Quick History

Benjamin Franklin starts insurance for fire protection. Insurance
not considered commerce and therefore not subject to federal
regulation
• 1752—Benjamin Franklin founds insurance
industry with Philadelphia Contributionship of
Houses from Loss by Fire.

• 1869—in Paul v. Virginia Supreme Court decides “issuing a policy of insurance is not a transaction of commerce.” States have responsibility for taxation and regulation of insurance.

• 1929—1932—Committee on the Costs of
Medical Care formed. A private national
commission created by AMA to examine
ways to control health care costs and prevent
bankruptcies for American families. Failed.

• 1942—1950’s—Wage-price freeze. War Labor
Board rules wage price controls do not apply
to fringe benefits, such as health care. National
Labor Relations Board rules that employee
benefit plans are subject to collective bargaining.
Health care benefits allowed as compensation
during WWII wage /price freeze. Beginning of
health care as a form of employee compensation.
FDR administration.

• 1944—Supreme Court in U.S. v. South-Eastern Underwriters Association decision declares insurance is commerce and therefore subject to federal regulation and oversight.

• 1945—Congress enacts McCarran-Ferguson

Act and gave states continuing authority to
regulate and tax insurance and declared that
state regulation was in best interest of consumer.
Insurance exempt from federal anti-trust laws.
This act over turned the 1944 Supreme Court
Southeastern Underwriters decision that made
insurance regulation subject to federal regulation.

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