HealthWell Foundation

The HealthWell Foundation® is a 501(c)(3) non-profit organization established in 2003 that is committed to addressing the needs of individuals with insurance who cannot afford their copayments, coinsurance, and premiums for important medical treatments. Their vision is to ensure that no patient goes without health care because they cannot afford it.

As patients are required to pay a larger share of health care costs each year, even many individuals with insurance find health care unaffordable. These patients face challenges affording the treatments they need to fight chronic and life-altering medical conditions. The HealthWell Foundation was established to address and help alleviate this problem.

The Cost of Being Underinsured in America

• 6 out of 10 have skipped or delayed seeking healthcare due to cost
• 3 in 10 did not fill a prescription due to cost
• 2 in 10 cut pills in half or skipped doses due to cost

Learn more about the HealthWell Foundation by visiting: http://healthwellfoundation.org

Online health insurance finder tool

HeathCare.gov now offers an insurance finder tool that can help you get coverage. You can explore your coverage options and search your state for the best health plan that will suit your needs.

Find out which private insurance plans, public programs and community services are available to you. To access this insurance finder tool, visit: http://finder.healthcare.gov/

This tool will help you find the health insurance best suited to your needs, whether it's private insurance for individuals, families, and small businesses, or public programs that may work for you. It was created to help consumers under the health insurance reform law, the Affordable Care Act.

Under the new law, people who have been denied coverage due to a pre-existing condition and who have been uninsured for at least six months may qualify to buy insurance. Learn more about the plan.

Historic health care reform in the USA

We all know that the Senate passed a historic health care reform bill. It's hard for me to imagine $871 billion. According to CNN:

The bill passed in a 60-39 party line vote after months of heated partisan debate. Every member of the Democratic caucus backed the measure; every Republican opposed it.

Will it become law? Probably. Will it raise taxes? Yes. Will it reduce health care costs? No one really knows the answer, but there are many people who don't seem to think so. What do I personally think? I think that it depends on too many unpredictable factors at this point. We know that everyone needs health care, but we don't know how doctors are going to respond to this type of reform. If doctors choose not to accept certain types of health insurance policies, then we'll be stuck in a worse situation than ever before.

It's hard to believe that Medicare and Medicaid was enacted over 40 years ago. Now, we're about to see Medicaid get a massive expansion, but what good will that do if more physicians choose to drop Medicaid coverage? There are so many unanswered questions for practicing physicians in the United States. My personal prediction is that many more physicians will choose to drop Medicare/Medicaid and they will rely more on cash-based practice models. A large number will simply leave clinical practice to pursue other careers. 

Do you bargain with your doctor?

Back in the old days, patients used to pay their physicians with crops, knitted blankets, and animal meat. Of course, we now have supermarkets and Walmart, so physicians are expecting cash for their services. Some patients still bring gifts (like fruit and vegetables from their gardens) to their physicians, but I don't think that most patients are bargaining for their healthcare services (unless they lack health insurance and they're paying with cash).

What if that evolved? As we prepare for healthcare reform, maybe bargaining skills will be one of the main components of reforming healthcare costs. What if more patients start bargaining with their physicians? Some are doing that right now because people would rather get paid something (even if it's less) over nothing. What if physicians start offering sales and specials for certain services? (get two physical exams for the price of one!)

Physicians can only control so much when it comes to price. The prices for labs and other diagnostic tests are generally not controlled by physicians. Maybe we'll start seeing some special deals (20% off your CT scan this month!) in the hospitals.

Shopping for health insurance

Over the long weekend, I had a chance to catch up on some reading. I pulled out the August 3rd edition of Forbes and started reading the "Fact and Comment" section by Steve Forbes, Editor-in-Chief of Forbes magazine. The heading for this column was "Washington: Still Abusing the Economy... and Undermining Health Care." These days, it seems like you can publish just about anything when it comes to politics and health insurance reform.

Forbes suggests some "helpful and constructive measures" that may move our country to a more genuinely "free-enterprise" health care system. One of the points he mentions is this:

• Allow consumers to shop for health insurance across state lines.

I don't know how often people think about health insurance plans in other states. If you move around quite a bit, then perhaps you're aware of the differences that may be present. However, unless you're a student and you have your health insurance through your parents who live in a different state, you won't find many people who have coverage through a different state. You simply can't purchase health insurance from a different state.

When looking to buy insurance, you can save time and money by getting auto insurance quotes or health insurance quotes from reliable insurers. I recently did some insurance shopping for my family and I got quotes from everyone. It helps to use a broker if you're too busy to fill out forms, but you may be surprised to know that much of this can be done online these days. I also used comparison sites like J.D. Powers and Associates to compare different insurance plans.

When we see a public health insurance plan emerge, will this new plan actually cause enough competition that private insurers lower their prices? If it's properly designed, then I'm sure we will. Otherwise, it will flop. I'd like to be optimistic and hope that the government sponsored health insurance plan will be a success. If so, I'd like to see some public insurance options for auto, homeowners, and malpractice insurance.

Making house calls to the uninsured

It's great to see that some doctors out there still care about patients. Watch this brief CNN video of Dr. Jeffrey Katz who makes house calls to see people who don't have health insurance. It's a very inspiring story.

Cancer patients struggling to pay for their healthcare

New cancer drugs are extremely expensive. Many cancer patients are having significant difficulty keeping up with all their healthcare costs. Watch this CNN video describe how a "cancer survivor drowns in debt." Breast cancer survivor Catherine Howard talks about how she got into $100,000 worth of debt buying health insurance.

It's an unfortunate reality, but healthcare costs are too high for many people. If you enroll in a clinical study and meet all the eligibility requirements, then you may end up receiving free medical care. However, many patients don't live near major cancer centers that perform medical research. Others don't like the idea about being enrolled in a clinical trial. Some simply don't meet any eligibility requirements, so they're unable to enroll.

Is a co-op the right model for health insurance?

Are you familiar with the co-op or cooperative model for health insurance? A co-op is a non-profit, member-run system for providing insurance plans. HealthPartners is one of the largest co-ops in the U.S. According to CNN, HealthPartners currently has a network of 70 facilities in Minnesota and Wisconsin and serves more than a million members. I wonder what physician reimbursement looks like in the HealthPartners co-op model. Perhaps it's not very different from billing a commercial health plan. Could it be better?

At the end of the day, we're all looking for affordable healthcare. If you're unemployed and uninsured, you may be looking for a free option as well. So many ideas are being thrown around in the current healthcare debate. As things change, I wonder what this will do to the healthcare co-ops that are out there. You can read more about health insurance co-ops here: CNN Health article titled, " Dissecting a health care co-op"

Public health insurance option: not the essential element

A public health insurance option offered by the U.S. government is not the essential element in this healthcare reform debate. Both President Obama and Health and Human Services Secretary Kathleen Sebelius seem to be on the same page on this issue. However, Former Democratic Party Chairman Howard Dean, a physician and a former presidential candidate, argues that "A public option is the only way to guarantee health care for all Americans and its inclusion is non-negotiable." He has a petition here: http://standwithdrdean.com/

My gut tells me that we will eventually see a public insurance option here in the U.S.A. It's inevitable. I think that a public insurance plan will reflect many of the good and bad elements seen in Medicare and Medicaid. Sadly, I also think that many U.S. physicians will choose not to accept this new government-sponsored public health insurance option. Therefore, its real value may be in hospital admissions, ER visits, etc. I really hope I'm wrong and that most physicians choose to accept the public insurance option so that patients can receive medical care. Otherwise, the "in network" provider list will be awfully short.

If we really have the best health insurance in the world, what good is that fact if so many people don't have access to it? To view the CNN story that covers this issue, click here.

'Arbitrary' health care policies?

Here's a quote from a recent CNN story:

An overhaul of health care policy will protect people with insurance from the "arbitrary" policies of the insurance industry while lowering their health care expenses, President Obama on Saturday told an audience in Grand Junction, Colorado.

How much do we really understand about insurance companies? We know that they frequently deny claims and make it very difficult to prescribe certain medications. It's a sad reality, but healthcare is a business. It's a business to physicians and it's a business to the payers. It's also a business to the government and Obama now wants to get seriously involved. He's quoted as saying: "We're going to ban arbitrary caps on benefits. And we'll place limits on how much you can be charged for out-of-pocket expenses."

Read the entire CNN story here.

Whistle-blower: Health care industry engaging in PR tactics

This is an interesting story on CNN: Whistle-blower: Health care industry engaging in PR tactics

Wendell Potter is a former vice president of corporate communications at Cigna. According to CNN:

He left his post in 2007 after Cigna's controversial handling of an insurance claim made by the family of a California teenager, Nataline Sarkysian. The Sarkysian family made repeated appeals at news conferences for Cigna to approve a liver transplant for the 17-year-old, who had leukemia. Cigna initially declined to cover the operation, then reversed its decision. Sarkysian died hours after the company's reversal.

In early July, Potter testified before the Senate Commerce Committee, telling senators that "I know from personal experience that members of Congress and the public have good reason to question the honesty and trustworthiness of the insurance industry."

Now a senior fellow on health care for the watchdog group Center for Media and Democracy, Potter writes a blog on health care reform. He is focusing on efforts to defeat legislation supporting a government health care plan -- something he supports.

To read the CNN story, click here.
To view Wendell Potter's blog, click here.

Healthcare reform must be tailored

Where are we going with healthcare reform? Do decision makers really understand all the issues at stake? With so many doctors no longer accepting Medicaid or Medicare, what's going to happen if doctors choose not to accept other forms of government insurance?

Pfizer Offers Free Drugs to Unemployed, Uninsured

These are tough economic times and we need better patient assistance programs. Pfizer is coming out with a program to help people who have lost their jobs and health insurance. If you lost your jobs since Jan. 1 and you've been taking a Pfizer drug for three months or more, then probably qualify. These individuals will have access to free prescription Pfizer medications (including common drugs like Lipitor which is used to lower cholesterol and Viagra for the treatment of erectile dysfunction) for up to a year.

• Starting today, patients can call a toll-free number, 866-706-2400, to sign up.
• Starting July 1, patients can also apply through the Web site

So, do you know anyone who could take advantage of this program?

Do We Need More Doctors?

According to this commentary on CNN, the answer seems to be "no." Well, perhaps we should explore this a bit further. This story is written by Clayton Christensen, Dr. Jason Hwang (there's another common Asian name), and Vineeta Vijayaraghavan. Here's a bit of background:

• Clayton M. Christensen is the Robert and Jane Cizik Professor of Business Administration at Harvard Business School, co-founder of Innosight Institute, and the best-selling author of six books.
• Jason Hwang, M.D., M.B.A. is co-founder and executive director of healthcare at Innosight Institute.
• Vineeta Vijayaraghavan, M.B.A. is a Research Fellow at Innosight Institute.
  
• Innosight Institute is a non-profit think tank whose mission is to apply Harvard Business School Professor Clayton Christensen’s theories of disruptive innovation to develop and promote solutions to the most vexing problems in the social sector.
  

One point they make is this: "There is a shortage of health care services being provided, but many of them are not best offered by a doctor."

I agree with that statement. However, I also personally believe that we also have a shortage of physicians, especially when we look at rural and other types of underserved areas of this country. If you live in a major metropolitan area, then you won't have any problems finding a doctor (you may have a challenge finding one who takes your insurance, but that's another story). The authors acknowledge the fact that health care is unevenly distributed around the nation, but then they point out that "Studies of geographical disparities of care have demonstrated that more physicians will likely lead to greater intensity of care -- but not better health outcomes." So where does that lead us? What about all the incentive programs that try to drive physicians to these underserved areas? Are those failing?

The authors also argue that we need to embrace more eHealth solutions. I also agree with this point. Technology is making it easier for patients to receive some basic health services

So what's the solution? The authors propose this: "what the country really needs are policies that pave the way to more avenues of care, which is well within the government's control."

Boutique practices, retainer fees, concierge medicine

People often ask me about these so-called boutique practices (AKA: retainer fees, concierge medicine, patient financed medical care, etc.). I usually refer them to the SIMPD. The Society for Innovative Medical Practice Design (SIMPD) is an organization of physicians promoting a direct financial relationship with their patients. Translated = patients who are willing to pay for personalized health care can have more one-on-one time with their physicians by paying cash and bypassing insurance companies.

I think that's fine for patients who have that type of money. If doctors want to offer personalized services and cater to those who can afford it, so be it. However, in today's world, the leading cause of bankruptcy is healthcare bills. As the population ages, fewer can even keep up with the bills. Fewer patients can afford their medications. And, when people reach 65, they can hardly understand the instructions to sign up for all the appropriate Medicare plans. What does this say about our healthcare system?

Working adults (and non-working adults) face different types of struggles. Insurance premiums are escalating, and many have a difficult time keeping up with these rising costs. Consumer directed health plans (CDHP) are starting to get more popular for healthy patients who don't have any serious problems. Fewer physicians are accepting Medicaid, so those who accept Medicaid are getting all the patients in the area. Patients on Medicaid often can't afford medications, so now you have non-compliant patients all going to a single clinician. That clinician will never excel based on pay-for-performance standards since none of his/her patients are being compliant and reaching goal levels. So who gets punished for accepting Medicaid?

The entire system needs a serious overhaul. I wonder what American's health system will look like in a few years. Will these presidential candidates make a dent in the way healthcare is delivered? I guess we'll have to wait and see...