Just FYI…What was HMSA’s most popular health plan offered to state and county workers prior to 2009 is back, but many may not realize they only have one more week, until October 21, to decide whether they want to select it.
The Employer-Union Health Benefits Trust Fund, or EUTF, which administers health insurance coverage for public employees and retirees, has set a firm deadline next Friday for any health plan changes.
The HMSA 90-10 PPO, an HMSA “preferred provider” plan in which employees pay only 10% of medical costs, was the most popular choice until 2009 when, in a highly controversial move, EUTF replaced the HMSA plan with one from Summerlin, a small mainland health insurer. EUTF claimed a glitch in its computer system prevented HMSA from continuing to offer its 90-10 plan in competition with Summerlin. Instead, HMSA was left with an 80-20 plan with lower premiums but higher out-of-pocket costs.
[See 11/10/2009: “HMSA plan bumped by limitation (a bug?) in new EUTF computer system,” and 11/27/2009: “HMA/Summerlin to be EUTF “default” plan despite failure in two key mainland markets“]
But Summerlin announced in early 2010 that it was pulling out of the Hawaii insurance market and selling its local business to another small provider, HMAA.
Now HMSA is back offering both 90-10 and 80-20 PPO options.
Public workers who previously selected the Summerlin 90-10 plan will automatically be enrolled in the new HMSA 90-10 plan. But those who stayed chose the 80-20 plan in order to maintain their coverage through HMSA have to file new paperwork to go back to the more popular HMSA 90-10 plan.
The EUTF booklet and other information explaining the different plans is available online from EUTF.
We’ve been surprised by the number of UH faculty who were unaware of the changes and the rapidly approaching deadline. It likely means there are lots of others blissfully unaware of their choices.
And on the subject of health care, here’s a very brief vignette from friends spending time in London.
Hello Ian, as luck would have it we were in this morning for a first visit to our National Health Service office for a flu jab. Their delightful term for a shot.
No need to prove you are a UK citizen, no need to have a health care plan—you live here (in London) now so you are covered. A delightful attitude toward health care.
To get the jab, we did need to be in an “at risk” group which included being over 65. I told the receptionist that this was yet another good thing about being over 65.
Doesn’t that sound un-American?
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What exactly does a 90-10 plan mean when I thought the state is imposing a 50-50 split for insurance costs.
Two different things. the 50-50 split applies to the monthly premium paid to obtain health insurance.
Under the new contract, premium costs are being split 50-50 between the employees and employer.
The 90-10 health plan, once purchased, pays 90% of approved medical charges, leaving 10% to be paid by the employee. I think there’s also a cap on annual out of pocket costs.
A smart health program doesn’t care who you are when immunizing for flu. The more people with “jabs’ the greater the “herd immunity”, making it harder for influenza to rock and roll.
When I was a little kid, I got terribly ill when visiting England, constantly vomiting for days. My parents took me to the hospital finally, where I got a shot of penicillin. I was only five years old, but I remember feeling stunned to find out that my treatment — as a foreigner! — was free. It was a totally new concept. Nothing is free, but this was free.
What I also remember is that the hospital seemed frozen in time at 1943. There was no equipment in the ward, and the beds were really just metal nets that suspended these crude mattresses. When I asked to go to the bathroom, I was instructed to go out the door to a room “across the way”. But when I opened that door I found myself walking barefoot across a lawn. Weird. But it all worked.
Someone I know recently got a stomach operation in England. He was born there, but did not live there, but the system did not research his residency when he claimed that he was now living in Britain. The operation was perfect, but he immediately developed an infection and had to have a second operation. One of the problems was the procedure, in his opinion, which is relatively new albeit widespread, but the other problem was the nurses. The head nurses, like the physicians, were all properly trained and licensed, but the rank and file nurses seemed to be immigrants (Jamaicans, Pakistanis, e.g.) who were not really qualified. He assumed that they were essentially temp workers who lied about their background (as he had) and the system was really just too laid back to check it out.
His take on the British system is that if you have money, the US is a better place for treatment; if not, then not. I think that 85 percent of Americans have health insurance, and although they do want health care reform generally, ‘reform’ for them means lowered costs, not expanded access for the other 15 percent who are have-nots. He was one of the 15 percent, so he had to buy a plane ticket to England to get an operation. That’s a bummer for him, but for most Americans that’s just his problem and everything is just jim dandy, hunky dory and apple-pie perfect.
It’s too bad we have a President who cannot relate to people and does not know much about how Americans think. If he did, we might have health care reform that sticks, and we would not have this Tea Party backlash and anti-tax rhetoric.
Here is the famous New Yorker article by the surgeon Atul Gawande that became required reading within the Obama administration.
http://www.newyorker.com/reporting/2009/06/01/090601fa_fact_gawande?currentPage=all
Gawande goes to McAllen, Texas, which has one of the highest health care cost rates in the United States, although the quality of that care and the coverage are not better than anywhere else (notably when compared to neighboring towns).
The largest cost driver is fees for referral. In the United States, physicians receive a kickback from specialists every time they order a test for a patient. Physicians in the US order twice as many tests as physicians elsewhere in the developed world; consequently, physicians in the US earn twice as much as physicians elsewhere in the developed world. If fees for referrals were eliminated, health care costs in the US would drop, perhaps from 17 percent of the GDP to half of that, which is the level in the rest of the developed world.
By looking at McAllen’s history, Gawande concludes that at a certain point in time, many of the physicians in that town decided that profit, not providing care, was their primary motive. That’s something new. Technically, medicine is not a business, it is a profession with an explicit ethic of public service in which practitioners can be de-licensed for unethical or incompetent behavior by what is essentially a guild (the same is true with the legal profession and, one could argue, with the modern military officer corp). Officially, profits are supposed to be secondary in the medical profession, and according to Gawande, that is exactly how it still is at places like the Mayo Clinic, which he holds up as a model. But it seems like since the 1980s in general in American society, there was a paradigm shift away from the traditional practices toward the notion that profits are primary and the benefits of a profit-driven system will “trickle down” to all of society (this is not true conservatism because it is a big break from tradition). This is a very recent development, but it has become the dominant or even exclusive worldview in the US, I think, and one finds it on Wall Street and in the universities. It’s also really dumb and dysfunctional.
What is also perhaps dumb is creating a legislative bill to deal with this that is about 2000 pages long. It might have been better to just ban fees for referral, or to tax them stiffly, or to provide at the federal level greater malpractice insurance coverage for physicians who have fewer referrals. In this case, there would be no rhetoric of “death panels” or a right-wing backlash. In general, from both a political and policy point of view, it’s supposedly better to provide broad strategy and not micromanage (this is one of the criticisms in Hawaii with the PUC and projects like the Big Wind and biofuels.)
Here is another essential New Yorker article by Atual Gawande, “Getting There from Here: How Should Obama Reform Health Care?”.
http://www.newyorker.com/reporting/2009/01/26/090126fa_fact_gawande
The article compares the British system of nationalized health care to the French system of payroll-tax-funded health care and to the Swiss system of private commercial health-insurance coverage. Basically, each of these societies established their health care systems in the wake of World War II, and basically built on and expanded what they already had.
Gawande points out that the US is unique in that it has no ‘system’ of health care, rather it has at least three multiple systems, each resembling the British, French and Swiss models. (For example, the Veterans Administration is basically just like the British model of nationalized health care.)
Of course, a lot of people — maybe 15 percent of the US population — fall between the cracks of all three systems. In order to broaden coverage, Gawande suggests that all three systems in the US be expanded. There is no need to have the One And Only True System and eliminate all the other systems. In fact, Gawande does not mention this, but this is the ‘high concept’ that lies behind the architecture of the Internet: the ‘Internet’ is actually multiple, disparate systems of computers that have been provided with a few rudimentary common standards to communicate with one another.
The funny thing is, even though Obama made Gawande’s previous article on health care required reading within the White House, Obama himself did not seem to actually read this article that was specifically written for Obama’s consumption. So Obama seems to have gone against Gawande’s advice. That’s … um … “unusual”. Consequently, Obama’s policy is failing.
Now, a couple of notes on the VA, outside of the health care issue. First, the US — in particular, the Republican Party — is cutting back veterans’ benefits. This is bad faith, I think, and it could have bad practical consequences. From a conservative point of view, screwing over veterans makes society cynical and undermines the social order. I mean, governments and traditional elites support marriage and marriage benefits and tightly regulate things like gambling in order to preserve social order and buttress the status quo. In that sense, messing with veterans’ benefits is like breaking a major taboo.
Second, one of the great challenges in coming years will be containing contagion (no, I have not seen the movie yet). The US government has to make that paradigm shift.
For example, there is a consensus now within the US foreign policy establishment that terrorism is not really a threat (the worst terrorists could do is make an American city unlivable for a while; this happened to New Orleans with Hurricane Katrina, and nobody really cared). Rather, a growing China is now seen as a threat to the stability of Asia. The big debate now is on the pace of confronting China (Obama wants to re-orient toward China ASAP, whereas the Pentagon wants to complete a surge in Afghanistan before a drawdown of troops there).
But China is not a threat either, really. The real threat are ducks and pigs in China that harbor influenza. Epidemics could kill millions or billions of people, and disrupt international trade and daily life, and destabilize entire regions. In a serious epidemic in the US, all government workers (at all levels), government contractors and retired and active military personnel will be mobilized. All of these people and their families need to have mandatory schedules of vaccinations, and have their medical histories in a national database. All these people should have VA healthcare, and the VA needs to be upgraded.
This is not an argument for healthcare reform of national healthcare or universal coverage. This is instead an argument for preparedness. International trade inevitably means plagues.