Is there a difference between choosing a primary care provider (family physician) and a specialist to treat you?

Primary care is struggling. Doctors in this field aren’t getting paid from organizations like Medicare and other government-funded entities. And even though many people who have HMO coverage are required to have a primary care physicians, the same HMOs skimp on payouts to the same physicians in their network. No doubt, as a result, patient care is suffering. We can complain and moan all day about underfunding for primary care, but that won’t address the real issue here: Where is that money supposed to come from?

With our economy in the state it is currently in, we can rest assured that additional funds are going to appear out of thin air (or out of other countries’ pockets) to help us solve our health care issues, but wouldn’t it be nice if everything else could stay well funded (though thinking so is laughable), while enough money went to primary care?

One can dream. The Wall Street Journal Health Blog took an informal survey from readers, asking where they thought that extra money for primary care should come from. The most popular answer was this: Lowering reimbursements for care and procedures provided by specialists. Is this a feasible solution? What would Congress do? Are we all just going to have to keep hoping the health care system in this country is going to magically remedy itself? (more…)

Health Reform was a big topic this year.  After all, President Barack Obama stood in front of congress more than once to encourage bipartisan support for the measures.  In the end, the country was deeply divided in their opinions about the bill’s veracity, but few can deny that Health Reform – as described in HR 3590 - will have far-reaching effects for millions of Americans (for better or worse).

This list of the 10 Most Costly Conditions was taken from our consumer guide to Health Reform in 2010.

Among the extensive coverage of health reform (Google shows an astounding 4,100,000 results for the phrase “health reform bill”) there is very little in the way of consumer guides.  MedHealthInsurance.com sought to remedy that shortfall by publishing a consumer guide to health reform in conjunction with the Insurance Research Organization.  We hope this guide will help you better understand your options under the new bill, its timeline, and how it will affect you – no matter which walk of life you hail from.

The Geography of the Congressional Health Care Bill

With a narrow 219 to 212 margin of victory, the landmark health care reform bill (known as the “Health Care and Education Affordability Reconciliation Act”) passed Sunday night. President Obama – along with Vice President Joe Biden – watched the final tally of votes from the White House. Responding, the President said: “We pushed back on the undue influence of special interests. We didn’t give in to mistrust or to cynicism or to fear. Instead, we proved that we are still a people capable of doing big things.”

HR4872 was a revised form of the health care bill passed by Congress on Christmas Eve. It was meant to reconcile some of the reservations that the Senate had with many of the original bill’s provisions. Unfortunately, between Christmas Eve and the vote on Sunday, a spectre of controversy has arisen over the bill, and ultimately, 34 Democrats stood with Republicans to oppose the bill. Representative John Boehner, Republican from Ohio, pledged to vehemently fight the bill: “The American people are angry. This body moves forward against their will. Shame on us,” said Boehner.  Chances are high, however, that the bill will pass the Senate with a simple majority of 51 votes.

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A look at the per capita health costs - U.S. compared to other OECD nations in 2000. Of course, since the year 2000 these costs have ballooned even further.

A poignant article in the respected journal, Health Affairs, put it best when it said that “a cycle of unsustainable spending growth followed by fervent cost containment initiatives has been a regular feature of the health care landscape for the past half-century.” As a result, the journal looked at health care spending per capita for thirty countries in the so-called “industrialized” Organization for Economic Cooperation and Development (OECD) list of countries, all while record numbers of Americans choose to opt out of individual health insurance plans.

In 2002, U.S. citizens spent more than $5,260 per capita for their health care. This represented a 53% premium over any other country in the OECD list. That trend continues to this day, and it is a major catalytic factor in the health care reform movement championed by the Obama administration.

Health Affairs concludes that the two main factors in the high U.S. health care costs are:

• Defensive medicine (which leads to higher diagnostic rates and a hyper-sensitive population of doctors due to the fear of medical malpractice claims), and
• The high rates of emergency care resources vs other industrialized nations. Of course, the article in the journal tends not to oversimplify and cites numerous other potential reasons.

Whatever the case, health care spending has ballooned far beyond that of any other country (as the graph above illustrates). Where the proposed reform will take us from here is anybody’s best guess.

Have you ever pondered what health insurance and healthcare was like throughout your state? Or maybe you and your family are planning a move to another part of the country and want to know what you can expect in terms of health coverage in a state. The Robert Wood Johnson Foundation is making sleuthing like this a whole lot easier for inquiring minds who want to know. They have created a stellar resource website at statecoverage.org, where you can find statistics for all 50 states. Want to compare the coverage provided by employers in Wisconsin versus the coverage provided by employers around the country? Are you curious about the Medicaid coverage in Oregon?

What Makes this Health Insurance Tool Useful

I’m so impressed with this site’s usability and easy of navigation. I’ve always wanted to live in Oregon, as I have a on of family living there and let’s face it: it’s absolutely beautiful there. But let’s say I wanted to truly make a move there and was worried about what type of health coverage would be available me. Once I open the “State Profiles” page, I’m presented with a map of the United States, broken out into states. I clicked on Oregon, and up popped information that can be useful to everyone, despite how you like your information presented. On the Oregon page, I discovered both graphical representation of data (read: bar graphs) and some cold hard numbers.

If you’re looking at a particular state’s data and wondering just where in the heck these statistics came from, the site does a terrific job of citing their sources. Just click on the “Resources” tab for any given state, and you will see listed any source that data was gathered from, including a link to the exact report. For those of you cynics who don’t like to take things at face value, I think this is valuable addition.

Muddling Through the Insurance Jargon

If you’re at the beginning of your insurance journey, you may be looking at terms like Medicaid or SCHIP and scratching your head. Luckily, State Coverage Initiatives has done all of the information gathering for you. Instead of only providing you with facts and figures with no explanation of terms (leaving you opening countless different windows trying to track down what these terms mean), you can click on “Coverage Strategies” at the top of the page and be given in depth definitions of many of the types of coverage you’ll see talked about on other parts of the site. Also impressive is the readability of the definitions-no confusing, misleading trickery here-they lay everything out for you so that it is easy to understand and digest.

Insurance Resources Galore

One fantastic thing about the internet is that there is a wealth of information to be found on just about any subject. It can be difficult to find a reliable and informative site sometimes, and State Coverage Initiatives seems to be one of the good guys. Once you have gotten the specific state information you are looking for, you may be ready to look into purchasing some type of insurance for yourself. There are so many different plans out there, and they vary drastically by carrier and area, so please visit our health insurance by state section arm yourself with even more information to help you with any insurance decisions you’re facing.

President Obama made a lot of promises in his 2008 Presidential campaign, and many of them were around changes he wanted to see happen in America’s health care and insurance system. Unfortunately, many time politicians will talk the talk in order to get voters to punch their ticket a certain way on election day.

Walking the walk as far as campaign promises doesn’t always happen. Just look at the Bush administration…don’t even get me started. It is refreshing to hear Obama say that he is welcoming ideas on how to reform the health care proposal he created during his campaign, and I am all for a system in which many have a say in ideas to find a solution that works for everyone in the current state of the economy.

But the real question is, especially after hearing President Obama’s State of the Union address: What is the buzz around Obama’s statement of “come one, come all” for hearing opinions on health care, and will it work in creating a just and successful health care system for America?

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