Wednesday, December 17, 2008

Editorial: Blue Cross reform should wait until '09

by The Flint Journal
Sunday December 07, 2008, 6:00 AM

All good things in time. If you believe that adage, then you have to believe good legislation on the issue of individual health insurance will require more time than the Legislature has between now and the end of the year.

Blue Cross Blue Shield of Michigan has been pushing hard for lawmakers to approve changes in the way the state regulates health insurance that people have to buy individually because they don't have coverage through an employer.

That attempt is meeting opposition, particularly from state Attorney General Mike Cox, who says the proposed changes would hurt consumers and give Blue Cross an unfair advantage over its competitors.

The battle between Cox and the Blues has gotten a little nasty. That's unfortunate, because this highly complex issue can be resolved only with measured debate, not with the snide attacks that both sides have launched at times.

That aside, Cox is arguing that the lame-duck session doesn't allow enough time or the right climate of deliberation to deal responsibly with the issue. On that much he is right.

The state House erred when it passed a reform package that some lawmakers later admitted didn't get the consideration it needed. The Senate approved a more-thoughtful package, but differences between the two haven't been reconciled.

Blue Cross now wants action. We understand the insurer's desire for reform. It recently announced that in the first nine months of 2008, it lost $111 million on individual policies.

As the number of people seeking them grows, those losses will only mount.
The attorney general argues that Blue Cross remains financially sound, but the insurer faces long-term losses that would jeopardize its financial health in ways Cox isn't acknowledging.

Under state regulations, Blue Cross receives special tax benefits and in turn has a special responsibility to the public. It deserves reasonable reforms, but the attorney general's oversight should be preserved in a meaningful way.

In November, a compromise proposal became public, but we don't see how lawmakers can responsibly review such a complex plan in a short lame-duck session, nor do we think the issue should be decided by 46 House members who are leaving office and don't have to answer to voters for something rushed too quickly through the legislative process.

This issue is too complex, and there's too much at stake.

BCBS of Michigan Could use a little Bailing Out

Michigan’s Largest Health Insurer Sings Financial Blues

Detroit’s auto makers aren’t the only ones in Michigan seeking the government’s helping hand. The beleaguered state’s largest health insurer is looking for financial relief too.

Blue Cross Blue Shield Of Michigan wants state lawmakers to give it more leeway over how much it can charge for health insurance to offset losses the not-for-profit insurer says it has racked up as the state’s insurer of last resort, writes the WSJ this morning.

The proposal hasn’t gone down well with for-profit insurers and consumer groups, who claim BCBS of Michigan is exaggerating its financial problems.

Rival insurers don’t like a provision that would require them to pay a penalty for rejecting sick consumers who wind up with Blue Cross. Blue Cross isn’t taking that criticism lying down. “They don’t want to see Michigan change because they know it’s the last free ride,” Blue Cross’ Hetzel told the paper.

Meanwhile, consumer groups fear any future premiums hikes could boost the ranks of the uninsured.

State lawmakers are hammering out a final version of the bill. A vote could come later this week.

From the Wall Street Journal

BCBS of Michigan Tries to Pry Itself From Under Regulation

From the Kaiser Network:

Blue Cross Blue Shield of Michigan is urging the state Legislature to pass legislation that would give the insurer more flexibility in setting premium rates and reduce government regulation, the Wall Street Journal reports. The insurer said that without the changes, increasing per-member costs will lead to financial troubles. As the state's insurer of last resort, BCBS is exempt from $80 million to $110 million in state and local taxes annually in exchange for providing affordable health coverage to all applicants, including those rejected by private insurers. The firm claims that as more people in the state have lost their jobs or employer-sponsored insurance, the number of BCBS policyholders has doubled in the past two years. It says that because it cannot reject any applicants, its per-member costs are four times those of private insurers. BCBS says the company likely will have a $166.5 million loss on individual products in fiscal year 2008 and a $264 million loss in FY 2009.

In addition, BCBS is asking that other insurers be charged a "cherry-picking" penalty for rejecting applicants who end up with BCBS -- which would go to BCBS to help fund their coverage. A version of the firm's proposal was passed last year by the state House and another -- from which some of the more "dramatic" proposals were removed -- was passed this spring in the Senate, the Journal reports. A vote on a final version could be taken this week.

Other insurers, the Michigan attorney general and consumer groups have spoken out against the requests, saying the legislation would allow BCBS to charge higher premiums to sick customers and shirk its social responsibility. Richard Murdock, executive director of the Michigan Association of Health Plans, said, "This does nothing for Michigan's uninsured population, and it only raises the possibility of the worst-case scenario of higher premiums." State Attorney General Mike Cox (R) said that the firm is exaggerating its problems, noting that its reserves have increased by more than $2.96 billion from 2001 to 2007. He also said the firm has been able to cover its losses on individual products in the first nine months with other income and has recorded $110 million in profit (Fuhrmans/Martinez, Wall Street Journal, 12/4).

CyberKnife Recieves Uneven Coverage from Medicare

Geography Has Role in Medicare Cancer Coverage

Published: December 16, 2008

The medical tool’s catchy name, CyberKnife, evokes digital accuracy. But the way the federal Medicare system treats CyberKnife seems anything but precise.

CyberKnife is a new but fast-growing radiation treatment for prostate cancer, spurred by radio and newspaper ads that stress its convenience and results. The chief selling point is that CyberKnife treatments take five days instead of the eight weeks for conventional prostate cancer radiation, although many experts say they believe that the medical evidence is inconclusive on whether it works as well as those older methods.

Read Entire Article from the NY Times

Tuesday, December 16, 2008

More Info on Medicare Programs

This time from Florida.

Time To Change Medicare Programs

Published: December 1, 2008

This is the annual open window period for either signing up for various Medicare programs or to switch from one to another. If you are confused about which plan you should choose, you can get advice from an impartial person trained to help you decide before Jan. 1 which plan is best for you.
The aid is provided by 400 volunteer counselors throughout the state serving with the SHINE (Serving Health Insurance Needs of Elders) program. You can get assistance by calling, toll free, the Elder Helpline at 1-800-963-5337. They will give you the time and place counseling sessions are available. If you are unable to get to any of those places at those times, your phone number will be taken and a counselor will call you to discuss Medicare eligibility, enrollment and coverage issues; health plan choices; appeal rights; Medigap (Medicare supplemental) policies; Medicare prescription drug (part D) plans; long-term care options; prescription assistance resources; or Medicaid details.
A good way to do your own research and comparison of policies is to get on the Internet and look on the official site at Good explanations of the differences between types of policies and comparisons of their features are to be found there.
More than 1.7 million Floridians (that's one of 10 residents) are caring for a frail elder, reports the state's branch of the AARP. That organization's survey found that 77 percent of adults 35 or older would prefer to receive long-term care at home rather than in a nursing home.
So Lori Parham, state director of the AARP, is bucking to change Florida's status as 41st in the nation in achieving a balance between community-based and nursing home care, where Florida spends 91 percent of Medicaid's long-term care funds.
The average cost of a nursing home stay is about $75,000 a year while care at home costs about $20 an hour.
One Florida business ranked in this year's AARP top 10 list for best employers for 50-year-old or older workers. It is Lee Memorial Health System based in Fort Myers where 38 percent of the 9,204 employees are 50 or older.
Those enrolled in the company's health plan receive free generic medications for treating cardiovascular disease, diabetes and high cholesterol. They also have access to free clinics at all of the system's hospitals and, at a minimum cost, personal trainers, dietitians and nurses' supervision in a weight-loss program.
Thanks to the Mortgage Forgiveness Debt Relief Act, you now have up to two years following your spouse's death to sell your jointly owned house and keep up to $500,000 in profits tax free.
Previously, a widowed homeowner had to sell the house the same year as the spouse's death to qualify for the tax break.
In today's economy, 10 percent of Americans 65 years of age or older have turned for help from families or charities, according to a story by Peter Jaret in a recent edition of the AARP Bulletin. But of those eligible for food stamps, only 34.5 percent of them apply for that aid.
The same issue reported that 1.3 million Medicare beneficiaries are having trouble finding a primary care physician because of a shortage of doctors going into general practice.
Since Medicare and insurance companies establish the fees, primary care doctors are forced to take on more patients and work longer hours to generate revenue. Therefore they spend less time — as little as 15 minutes — with each one, the article quotes a spokesman for the American College of Physicians.
In addition, general practice doctors earn half or less than what many specialists earn. Consequently, only 13 percent of first-year residents in internal medicine in a recent survey indicated an intention to enter a general practice.
Adon Taft is a resident of Brooksville. If you have questions about any issue connected with aging, except medical conditions, please write to Life to the Fullest at Hernando Today, 15299 Cortez Blvd., Brooksville, Fla. 34613, or send e-mail to Please include your name and address.

Spending the Holidays with Aging Parents

Elder Care Expert Has the Prescription for Caregiver Stress

For many families, the problem with the holidays is family. Elder care expert Esther Koch provides insight into how caregivers of aging parents can bring the joy of the holiday season to the elder care experience.

San Mateo, CA (PRWEB) December 2, 2008 -- For many families the stress of the holiday season is family, especially aging parents. Gerontologist and elder care expert Esther Koch, founder of Encore Management, has a simple yet highly effective prescription for holiday stress relief….reframe the experience. "Use the holidays to change the focus from all that you have to do for your parent to all the experiences you can have with your parent", recommends Koch who also was the primary caregiver to her mother for ten years.

"Your holidays will be joyful if you intend them to be", says Koch. "You may have to start with forgiveness - forgive your parents, forgive your siblings and forgive yourself." She emphasizes, "A little forgiveness can eliminate years of regret."

Koch continues, "As a caregiver, you do need to recognize your parent's limits as well as your own." Adjust commitments whenever necessary for health reasons and don't forget to schedule time for yourself. "Most of all, be in the moment and don't take for granted that your parent will always be as physically and mentally able as they are now", she says.

Go to Article at PR Web

Medical society head sees gaps in elder care

Sonja Puzic, Windsor Star

Published: Wednesday, December 03, 2008

As a busy family physician, Dr. Nick Krayacich is all too familiar with the growing challenges facing our health care system.

His patient load of about 2,400 includes many elderly people battling chronic illnesses and adults whose health problems are compounded by job losses and the economic crisis.

Krayacich knows what the community needs -- more health care dollars from the government, better communication among local and provincial agencies and a collaborative, multidisciplinary approach to patient care. As the new president of the Essex County Medical Society, he's got several initiatives in mind.

"We are a very well-respected medical society in the province and one of the most active," said Krayacich, who will be formally installed as ECMS president tonight at the society's dinner gathering. "We need to be vocal and advocate for our membership."

One of the first items on Krayacich's agenda is putting together a medical advisory board to work with the Erie St. Clair Local Health Integration Network, which is responsible for allocating government funding for area health care facilities. The goal is to foster better communication with the LHIN, Krayacich said, "so that they can pick our brains before decisions are made and vice versa."

Krayacich said he will also focus his efforts on "connectedness and inclusion" within the medical community, making sure its members, especially those who were recruited from other parts of the country, feel welcome and get involved.

Krayacich said he is not worried about juggling his day-to-day schedule and new responsibilities as ECMS president. Having served on the medical society's executive, most recently as vice-president, Krayacich said he knows what to expect. He will replace outgoing president Dr. Anthony Glanz, chief of cardiology at Hotel-Dieu Grace Hospital.

Krayacich has been practising medicine in the Windsor area since the early 1990s. He treats many geriatric patients who struggle with various chronic conditions such as heart disease and diabetes. Caring for the aging and ailing population with stretched resources and a persistent shortage of family physicians is a complicated process across the province, Krayacich said.

"We definitely don't have enough nursing homes ... we don't have enough hospital beds," he said. "There are still 40 to 50 thousand people in the Windsor area who don't have a family doctor. We're definitely concerned about that."

The Medicare D shell game

One example of the labyrinth that is Medicare. Like it or not, we are all going to have to pay attention to the devilish details - on an annual basis.

It's a pain for seniors to pick from the myriad drug insurance programs, but it pays to do it - every year.

Kim Andrews had just helped a woman save a couple of hundred dollars on her new Medicare drug plan.

"I asked her about her husband," said Andrews, the Delaware County coordinator for Apprise, the Pennsylvania health insurance counseling service. The woman said " 'Oh, my husband loves his plan. He won't change.' "

"Well, I checked his drugs anyway, and it turns out his plan was no longer going to cover two of his drugs," Andrews said. "I found him another plan that would save him $2,771. That's huge. People are just unaware, it seems."

Read entire 3-page report at the Philadelphia Inquirer.