In defense of the health insurance industry

Will Ferrell (and celebrity friends) recently created a spoof video speaking out against insurance companies and in support of the public option: http://www.youtube.com/watch?v=B98muhufAGE

It uses sarcasm to portray the insurance industry as the arch enemy of health care reform, claiming that greedy insurance companies make billions of dollars in profit while intentionally taking advantage of those who cannot pay for care. While it's easy to scapegoat insurance companies, it got me thinking that it's important to get the facts. In actuality, for every dollar spent on healthcare in America, 99¢ goes to hospitals, doctors, pharma, other medical services, and other health related spending. Only 1¢ goes to health plan profits. And we need to remember that employees are generally satisfied with their coverage - about 2/3 of employees rated their employer-based insurance coverage as “excellent” or “very good” in a recent survey (National Business Group on Health Employer-based Health Benefits Survey, 2007). Also, the insurance industry has formally supported many of the reform proposals.

Private insurance companies are making profits, but they are certainly slim. Finger-pointing at health plans to portray them as immoral, corrupt, and money-hungry will get us no closer to progress on health reform. I acknowledge there are MANY problems with insurance companies, but I argue that the American system of care is designed to make this the case, not the alleged greed of for-profit insurance CEO's.

Comments? Other opinions?

House, Senate differ sharply on health care reform

http://www.cnn.com/2009/POLITICS/11/09/health.care.congress/

This past weekend marked a major step forward with the House approving a major overhaul of the United States' health care system. There are still major hurdles to overcome, however. The more conservative Senate still has to pass its own version, and this could prove difficult with a smaller Democratic majority and stronger Republican minority. What does everyone think, will the Senate bill contain the public option? Will the employer mandate in the House bill hold up in the Senate? Let me know your thoughts.

Abortion Coverage Debate

This article:

http://www.nytimes.com/2009/11/09/us/politics/09abortion.html?hp

is about the debate on whether federal subsidized insurance plans would cover abortions. I found it helpful because of its information on how abortion is currently covered by health plans.

Some of my takeaways from this article were:

• In 2003, only 13% of abortions were billed directly to insurance.
• About half of employee-sponsored insurance plans currently cover elective abortion.
• A ban on federal-financing of abortions is currently in place. Seventeen state Medicaid programs currently cover abortion by using state funds, the rest do not cover it.
  
• Even if abortion is not covered by federally subsidized health insurance plans, women will be able to buy supplemental insurance coverage for abortions. But it is unlikely that many would, because, as the article puts it, "few [women] plan for unintended pregnancies."

Texting as a Health Tool for Teenagers

Here's a link to a NY Times article that talks about a study in which text messaging was used to help teens with chronic diseases and transplants remember to take their medicines and to come in for regular appointments and lab tests:

http://www.nytimes.com/2009/11/05/health/05chen.html?_r=1&ref=health

There is even talk in the article of a desire for insurance companies to cover some sort of text messaging cell phone plan in the future, as a response to the fact that this technology worked so well in this study until 1/3 of the teens had to drop out because they lost cell phone privileges or could no longer afford to have a cell phone.

Text messaging and other newer technologies (facebook, twitter, email, etc) seem to be coming up more & more as easy & efficient ways to reach the younger part of the population.
In fact, Danielle, Doug, and I were just discussing this today with a few administrative people at Sutter East Bay Medical Foundation. We explained to them why it could be beneficial to get younger patients' email addresses for contacting them, and also revealed an idea of using Twitter for preventive health reminders & information. This just might be a great way for a medical office to show its teen patients that even their doctor has jumped onto the technology wagon :)

Thoughts on new technology? Any other articles that any of you have seen out there on similar topics?

And Speaking of Sugar...

I couldn't help but notice an interesting article about the controversy over American Academy of Family Physicians partnering with the Coca-Cola Company to develop soft drink educational materials. All this reminds me of the debate over tobacco-funded research at Berkeley (the School of Public Health banned tobacco funds in 2004). I take it the the AAFP needs outreach money very desperately, but must it do so in a way that compromises its reputation? We'll just have to see what happens.

http://www.sfgate.com/cgi-bin/article.cgi?f=/n/a/2009/11/04/national/a135617S45.DTL

A spoonful of sugar

Dennis Herrera, SF's City Attorney, just got Kellogg's to stop claiming that Cocoa Krispies boosts children's immune systems. The reporters here, as well as the commentariat, seem to think it's a laughable effort, but I think that if the effort was minimal, it was worth it. It's the kind of intervention we dream up in class exercises, and it's useful to see it pitted against the average citizen's exhausted call for increased focus on more substantive things, like, say, violent crime. Anyway, worth it, I say...

http://www.sfgate.com/cgi-bin/blogs/matierandross/detail?entry_id=50979&tsp=1

The Swine Flu Affair Part II?

Blowing the Shot: What we can learn from the shortage of H1N1 vaccine

As I was reading this article today, I couldn't help but think...this sure sounds like the Swine Flu Affair in its approach to pointing out the shortcomings in the response to H1N1, except that this one is more or less in real time. In the same way that the Swine Flu Affair attempted to bring to light the missteps in the swine flu scare of 1976 in order to learn lessons from the past, this article is quick to point out what lessons there are to learn in our current shortage of H1N1 vaccines.

Here are some of the main criticisms:
* We are using slow and outdated technology to grow these vaccines in hen eggs rather than developing quicker methods culturing the virus in mammalian cells.
* "The Centers for Disease Control and Prevention and the Department of Health and Human Services decided to finish making the seasonal flu vaccine before transitioning to the new vaccine, even as evidence suggested that the new pandemic was going to crowd out the yearly flu."
* "Baxter Pharmaceuticals' H1N1 vaccine Celvapan utilizes the much speedier process of culturing mammalian (monkey) cells rather than hen eggs." This vaccine was tested and determined to be safe, but the FDA was apparently unwilling to take the risk of using a new vaccine technique.

On the policy level, I have not been following H1N1 closely enough to know how valid some of these criticisms are. However, one issue that I found particularly interesting was this repeat issue of seasonal flu vaccine versus swine flu vaccine...which one to focus on. In the swine flu scare of 1976, one of the early issues that the CDC had to decide on was whether to continue to manufacture the Victoria flu vaccine or concentrate all efforts on the swine flu vaccine. They pretty much chose to focus on the swine flu vaccine (making small amounts of the bivalent type). And that was determined later to be the wrong choice. This time around, the focus was put on the seasonal flu. And once again, it is being criticized as the wrong choice because the H1N1 hasn't been following the pattern of the normal "flu season." Well then...it appears that learning from the past may be more difficult than it seems.