EDITORIAL NOTE: This sabbatical/hiatus was planned to last two weeks which means I should have been back on Monday, but it will go on a a little longer. I will return on Thursday this week.
Some good friends, all met through blogging, are filling in for me while I take a two-week sabbatical from Time Goes By. Today’s guest blogger is AQ who blogs at Always Question.
He is a grandfather, a retired Navy Corpsman and a Red Cross Disaster Services Volunteer. “Otherwise,” says AQ, “I’m just a guy.”
I came across an article recently which served to remind me that, as the Obama administration moves to address health care reform, the insurance and health care industry lobbies are going to be formidable influences on the finished product. I think it is critically important that we as consumers become aware of what is at stake and make our voices heard.
At the risk of sounding like another whacked-out conspiracy theorist, it occurs to me that the media may be playing for the other team on this issue, and by other team I mean the insurance industry.
Insurance companies have nothing to do with health care. They take money from us and they pay it to providers unless they can find of a way to keep it. Meanwhile, as corporate media outlets lose readership or viewers, the revenue from advertisers becomes increasingly important to their bottom line.
This headline from Reuters, More Suffering From Chronic Illnesses, and other pieces trumpeting the spiraling cost of health care could lead one to believe that universal health care is unsustainable and/or unaffordable. But we're not necessarily getting the whole story. As we speak, the health care industry and the insurance industry (they are not the same) are stacking the numbers.
I don't think anyone would dispute an increase in type 2 diabetes. Our appetite for processed carbohydrates is well documented by now. Our unhealthy lifestyles are probably also responsible to a great extent for an increase in high blood pressure and high cholesterol.
At the same time, the industry has also been lowering the diagnostic bar on some of these conditions. Cholesterol used to be high at 250, then 200 and now there is movement to treat people with a low density lipid level over 100. The same has been happening with blood pressure with an upper number above 120 now being called "prehypertension."
In 2004, the Centers for Medicare and Medicaid Services (CMS) began taking the risk out of Medicare risk contracts with payments adjusted for risk through a model called Hierarchical Conditions Coding. The purpose of this scheme was to "appropriately" reimburse insurance companies for the necessary care of Medicare enrollees. (My question then is, why are the taxpayers paying for a Medicare Advantage Plan at all? If they bear no risk then they are superfluous cost centers.)
The upshot has been coding classes held throughout the health care industry to learn to combine diagnosis codes for maximum reimbursement from CMS.
For instance, I have high blood pressure and high cholesterol (and history of cancer and I'm fat, etc.). As a commercial patient, my doctor gets paid to refill my blood pressure meds and/or my cholesterol pills. When I become Medicare eligible, if I choose to join a Medicare HMO, the insurance company will be reimbursed for every condition I've ever had so long as they can document that I've had it (and they're pushing for universal electronic medical records).
If I never show another cancer cell, the American taxpayer will still pay for my cancer. The example they typically use in class is diabetes, and with correct coding they can quadruple the monthly payment from CMS.
There are going to be challenges in implementing universal health care. One heart/lung transplant can fund a prenatal program for a small town for a year or more, and we will need to talk about those things.
I'm just saying that when I see a report that ends with a comment on how hard it's going to be for us to implement universal health care with the world's most expensive health care system, it makes me wonder. Reuters never does cite the specific reports they're getting this "information" from.
[The story bin at The Elder Storytelling Place is empty so until some new ones arrive, let's revisit some from the archive. Today, Gilbert Lake from Joy Des Jardins. All elders, 50 and older, are welcome to submit stories for this blog. Instructions are here.]