| Your Health Care Dollar -- September
2002 Sept. 3 - Individual Insurance: Perils
and Pitfalls?
Sept. 16 - Americans are healthier
than ever, BUT . . .
Sept. 23
- North Valley Hospital-Nursing Home wages
Sept. 30 - Federal budget
cuts pressure healthcare
INDIVIDUAL INSURANCE:
PERILS AND PITFALLS?
INTRO: Most Americans get medical insurance through their jobs. It's part of their
employee benefit package. But some 16 million Americans have to buy their own insurance,
and it's not always easy. Here's Mary Koch with "Your Health Care Dollar."
* * *
MARY: (echo effect) Wow. This is a scary place. Especially when I'm alone. It's
full of pitfalls, traps and perils. The people here don't want me, but they want my money.
What is this terrifying place? According to the magazine "Consumer Reports,"
it's the individual medical insurance marketplace.
(normal) Consumer Reports September issue has an article about the
"perils" of buying your own health insurance. The article says the individual
health insurance consumer is - quote - "one of the unwanted children of the insurance
marketplace." The magazine lists all kinds of traps you can fall into, like no
coverage for existing illnesses, gaps in state laws, under-financed risk pools and gaping
cracks in safety nets.
We reported a few weeks ago that going without insurance makes it more difficult to get
adequate medical care. People who don't have health insurance through their employment may
be self-employed, unemployed – or they work for someone who doesn't provide
insurance. What can they do but wade into the perilous insurance market on their own?
Well, we talked with some insurance brokers who say it's not all that bad. In fact, the
situation for Washington residents has been improving. A couple of years ago, the
individual insurance market all but disappeared in this state.
Omak insurance agent Dennis Carlton says things are turning around.
CARLTON: (50) The insurance environment became so muddied that most of the insurance
companies chose not to do business in the state of Washington. We're starting to get some
of those companies back now.
KOCH: The insurance companies were willing to return after the state relaxed some of
its regulations. As a result, the kind of insurance available to an individual depends,
well, on individual circumstances.
For example, let's start with a rancher. A rancher may feel like he does the work of
three people — and as far as insurance goes, he's considered a group. So are most
self-employed individuals.
CARLTON: (83) They can get insurance, in fact very easily because most of the insurance
we sell is business based. In other words, if a person has a bona fide business and
they're filing a 1040 Schedule C showing that they have legitimate business expenses and
income, then we can issue a group policy down to one person.
KOCH: There are advantages to getting group insurance, even if you are a
"group" of one. For one thing, inidividual premiums are likely to be higher for
smokers than non-smokers. But whether you smoke or not, under group insurance you can't be
disqualified because of medical history or pre-existing conditions. Otherwise, if you're
not on Medicare and you apply for individual insurance, you'll be asked to fill out the
Standard Health Questionnaire. It's very thorough.
CARLTON: (63) An application right now for an individual contains about 300 questions.
KOCH: In the process of answering those questions, you'll learn the names of all kinds
of diseases and conditions you've probably never heard of. You'll also be asked if you
have a history of alcoholism, drug addiction, depression, eating disorders or suicide
attempts.
CARLTON: (64) If a person can't qualify, you know, with that application then they
automatically go into the Washington State Health Insurance Pool, which we've had for a
long, long time . . . Basically what that is is where people can get coverage for their
pre-existing conditions, but they're going to have to pay more premium.
KOCH: There's a different route open to someone who is laid off or leaves a job that
had health insurance benefits. Under federal COBRA rules, those people can continue to
stay on their employer's health insurance policy for 18 months as long as they pay the
premiums themselves. Then, says Spokane insurance broker Mike Otis, they can apply for
individual insurance without having their medical background checked.
OTIS: (53) If someone does exhaust their COBRA, regardless of their health, a carrier
cannot turn them down.
KOCH: Of course, there's a catch. You have to buy whatever insurance your former
employer chooses and pay the full price.
OTIS: (64) If your former employer chooses to have a 100 dollar deductible plan and the
employee rate is 400 dollars a month, then you have to pay that and exhaust it in order to
not have those health questions asked of you. We have had a number of people that we have
told to stay on their group plan regardless of cost, if necessary go out and borrow the
money.
KOCH: Otherwise, says Otis, you may find yourself ineligible for individual insurance.
You'll end up in that very expensive state health pool.
Even though insurance is becoming more available, it's not getting any cheaper for
anyone. It's important that you check out all your options before you change jobs or make
insurance decisions.
Carlton says he encourages his clients to save money by opting for insurance with a
higher deductible. That's the part of the medical bill you pay out of your pocket before
insurance kicks in. That means you'll have a lower monthly premium. Then, advises Carlton,
focus on staying healthy instead of getting your insurance payments back.
I'm Mary Koch, and that's Your Health Care Dollar for this week.
* * *
Click
here to read Consumer Reports: "The perils of buying your own policy.
Click here for the Robert Wood
Johnson Foundation Consumer's Guide to Getting and Keeping Health Insurance in Washington
Americans
are healthier than ever, BUT . . .
Sept. 16, 2002
INTRO: A recent federal study shows that we Americans are healthier than we've ever
been. But the study also shows we're spending more than ever on health care. Here's Mary
Koch with "Your Health Care Dollar" for this week.
* * *
How you feelin'? All those news reports about how we Americans are eating unhealthy
foods, not getting enough exercise, becoming obese! Do they make you feel, well, a little
sick?
OK. Here's some news to make you feel better. The federal government, which keeps track
of such things, says that Americans are dramatically healthier than they were 50 years
ago. Everybody's living longer, and infant mortality is down -- meaning fewer babies are
dying.
The things that used to kill off our grandparents will NOT be a threat to our
grandchildren, says Tommy Thompson, secretary of the Department of Health and Human
Services. Thompson recently released the results of the nation's annual physical check-up.
During the past half-century, death rates among children and young adults were cut in
half. As of the year 2000, men have an average life expectancy of 74 years -- and for
women, it's nearly 80 years. A century ago, Americans were lucky to make it beyond age 50.
Now, if you've made it to age 65, chances are good that you will live beyond age 80.
How have we gotten so healthy? There are lots of reasons.
For one, we're kicking the smoking habit. More than 40 percent of adults smoked in
1965. Now it's 23 percent. Infectious disease rates are declining. Heart disease and
stroke are taking less of a toll on older people.
So, are you feeling better? OK, but don't get too smug. That obesity thing just won't
go away. The federal study shows that three in five adults are overweight. One in four
Americans is considered obese. Almost 40 percent of us are engaging in no physical
activity. Women, by the way, are even more sedentary than men. Ladies, are we going to
lose our edge on that life expectancy thing?
Another thing that's ailing us is the amount of money we're spending to be healthy.
Americans spent 1.3 trillion dollars on health care in the year 2000. That represents 13.2
percent of our gross domestic product, and it's far more than any other nation spends.
So, what's wrong with spending all that money if we're the healthiest folks in the
world? That's the problem. We're not. The World Health Organization says the United
States' health care ranks 37th in the world. The W, H, O says France has the best health
care. That gives a whole new meaning to "viva la France."
So how do we compare with France? Let me throw a couple of numbers at you. I already
said we spend 13.2 percent of our gross domestic product on health care. France spends 9.4
percent.
We spend more than $4,000 per person per year. France spends less than half that. How
do they do it? Just like here, the system in France is a combination of public and
private. But in France, everyone participates. There's no such thing as being uninsured.
In America, millions of people are outside the system -- meaning, they're uninsured. Many
analysts say that's why our health care keeps getting more expensive -- even though we're
healthier. And we -- the taxpayers -- are paying the largest share of that 1.3 trillion
dollar health care bill.
In 1960 health care represented about 3 percent of our federal budget. Now it's more
than 22 percent. Medicare and Medicaid pay 43 percent of all medical bills. Private
insurance pays only about a third.
A lot of attention is given to the cost of prescription drugs -- and that portion of
our medical bill is going up faster than any other. But drugs still account for only about
10 percent of our total costs. The biggest chunk goes to hospitals -- about one-third of
the health care dollars. But here's another curious set of numbers. Even though Americans
spend over 400 billion dollars on hospitals each year, they're spending less time IN
hospitals. Twenty year ago, the average hospital stay was a week. Now it's less than five
days. Twenty years ago, only 16 percent of surgeries were outpatient procedures. Now it's
nearly two-thirds. Now most surgical patients do their recuperating at home.
Well, this report goes on for another 430 pages, but I think that's enough of your
Health Care Dollars for this week -- all 1.3 trillion of them.
Click here to go to the CDC Web site for more
information, including an electronic version of the report that may be downloaded.
INTERVIEW
WITH WARNER BARTLESON
NORTH VALLEY HOSPITAL AND NURSING HOME
INTRO: Staff members at North Valley Hospital and Nursing Home in Tonasket recently
walked the picket lines. They've been working without a contract since March. The
picketing was informational. State law does not allow a strike. Mary Koch has more on the
issues with this week's "Your Health Care Dollar."
* * *I
MARY: When nurses, aides and other staff members at North Valley Hospital and Nursing
Home aired their complaints by picketing recently, sympathetic passersby waved and honked
horns. Just as sympathetic is their boss, administrator Warner Bartleson. Staff members,
who are represented by the United Food and Commercial Workers union, say they're way
underpaid. Bartleson couldn't agree more.
WARNER: (273) The major issue is that our nursing wages are not competitive with other
hospitals even in our area, and the answer is that's absolutely true. And as it stands
right now there is absolutely nothing we can do about it because we don't have the money.
MARY: Bartleson says the primary difficulty is federal reimbursement for nursing home
patients. At the current rate of Medicaid payments, the nursing home loses ten dollars per
day per patient. The hospital subsidizes the nursing home.
In fact, Bartleson says one of the most significant things we could do in this country
to improve long-term care would be to raise the pay of nurses' aides.
WARNER: (008) I think I feel that we ought to increase the pay of nurses aides
somewhere in the area of 20 and 30 percent. And the reason I say that is that I think
first of all it's very hard work and there are a lot of requirements placed on them, and
these are considered entry level positions and they really shouldn't be considered that.
There is a license that's involved. But very importantly it does take a set of skills and
attitudes that make them good at that job, and they have to be very giving people.
MARY: At North Valley, starting wage for a nurse's aide is seven dollars and seven
cents an hour. That is raised to seven-twenty-five once the aide earns certification.
Aides also get a full benefits package – equal to about 15 percent on top of wages.
One of the effects of low wages is high turnover. Nationally, some nursing homes are
reporting turnover for nurses' aides as high as 100 percent or more annually. Bartleson
says turnover at North Valley is not that high, but it's still a serious issue. Higher
pay, he says, would make the nursing home more competitive in the labor market.
WARNER (105): What we would see is that this would be a job worthwhile having on a
regular basis. It isn't something that you find an easier job somewhere, well, I get the
easier job and maybe I get benefits and maybe I get a little more money, so I take it. So
there's a turnover and I think it would really cut turnover down a lot. There's a
significant turnover. This is probably the highest turnover position in health care.
MARY: This is one of the issues that is getting attention all across the country with a
growing concern over quality of care in nursing homes.
WARNER (175): I think on a macro basis, on a national level there's a great deal of
effort being made on how can we improve nursing home quality. And I would say that in our
area, I'm very pleased with our nursing home quality. It's very, very good, and I'd be
willing to match it with just about anybody.
MARY: Bartleson says that the level of care in nursing homes has intensified
dramatically over the past ten years. Part of this is due to the development of assisted
living facilities. Many relatively healthy people who need minimal care now opt for
assisted living instead of a nursing home. As a result, nursing homes are dealing with a
much more seriously ill population.
WARNER (218): Ten years ago we had about 30 percent seriously ill people. Today we have
between 50 and 70.
MARY: Bartleson says another trend that has not helped nursing homes is federal
oversight that has focused on regulations instead of quality of care. He says North Valley
added the equivalent of two-and-a-half registered nurses to its staff, but not to care for
the patients. The nurses are doing paperwork.
WARNER (244): Those two-and-a-half RNs do nothing but paperwork. They don't do any
patient care.
MARY: None of this adds up to easy solutions for the current contract issues at North
Valley. The contract discussion is in mediation. But Bartleson holds out some hope for
long-term solutions.
WARNER (260): There are some new ideas that are bubbling through. I hear less about
nursing homes are no more than warehouses of people, which really angers me when I hear
that. But I know it's thrown around a lot in Washington, D.C., but it's certainly not the
case here. I'm not saying it isn't elsewhere, but I don't think that's happening in our
area at all.
MARY: You've been hearing from Warner Bartleson, administrator at North Valley Hospital
and Nursing Home in Tonasket. This is Mary Koch and that's "Your Health Care
Dollar" for this week.
Click on
this line to read about how one group of nursing homes is improving quality of care and
reducing staff turnover
Federal
budget cuts put
more pressure on healthcare
INTRO: Our nation's economy is not in the best of health, and that's
affecting our health care system. To balance the budget, the Bush administration is
looking at cuts in Medicare spending. Here's more from Mary Koch with "Your Health
Care Dollar."
* * *
It's not getting any easier for senior citizens. They're still waiting for Congress to
pass a Medicare prescription drug bill. Even if seniors ultimately get help buying their
medicine, they're likely to find that the government giveth and the government taketh
away.
Bush administration proposals for budget cuts in health care have been seeping into the
news lately. Critics of those proposals say cuts could affect quality of health care not
only for senior citizens but for their grandchildren in the years to come. The government
is looking especially hard at payments to hospitals for drugs, for outpatient treatments
and for the education of future doctors.
In general, Medicare does not pay for prescription drugs. However, the program long has
covered drugs dispensed in hospitals. Now, the New York Times reports that the
administration's proposed reductions include cancer and arthritis treatments as well as
procedures such as breast biopsies.
There's an irony here. Over the past 10 years, hospitals have cut costs by increasing
the number of out-patient procedures. In these cases, patients recuperate at home instead
of in the hospital. Last year there were more than 110 million Medicare claims for
outpatient services.
The government wants a piece of those savings. The administration claims the government
pays too much for outpatient procedures. Hospitals argue they can't provide the services,
such as chemotherapy, at the proposed, lower rates.
The new rates won't be set until January first, but other proposed cuts have brought
additional protests from hospitals. University of Washington medical school administrators
say Bush's proposed budget for fiscal year 2003 eliminates essential programs to educate
and train health professionals.
Dr. Sidney Nelson, who is dean of the UW Pharmacy School, says proposals include a 72
percent cut in funding for federal health professions and nursing education. In a
commentary published by the Seattle P-I last week, Dr. Nelson says these programs are
especially crucial for areas that are under-served by health care professionals. He says
students educated through the federal programs are three to five times more likely to
practice in minority communities, rural areas and on Indian reservations.
The University of Washington isn't alone in its funding concerns. A national task force
on Academic Health Centers issued a study earlier this year suggesting that health care
education is suffering. Academic Health Centers, or teaching hospitals, are supposed to be
training our nation's physicians as well as taking care of patients, especially the poor.
But the report from the Commonwealth Fund says that education is no longer the primary
activity in teaching hospitals. Faculty now are more concerned with research and patient
care than with education.
Why the change? Follow the money.
Taking care of patients is more expensive in teaching hospitals. A study by Lewin
Associates found that the average cost per case was twice as high in teaching hospitals
than in regular hospitals.
That's because the teaching hospitals used that income from caring for patients to
subsidize education of doctors. But insurance companies and HMOs became less willing to
support the high costs in teaching hospitals. So income from those sources has been
eroding.
Medicare and Medicaid payments have remained steady, but now cuts are looming in those
areas.
On the bright side, substantial funding increases are in store for community health
centers, a program to help struggling rural hospitals. But the UW's Dean Nelson argues
that it won't do much good to keep rural hospitals open if there are no well-trained
professionals to work in them.
This is Mary Koch, and that's Your Health Care Dollar for this week.
Click here
to read about the Commenwealth Task Force report on physician education and training
hospitals
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