This is Robert Book, writing at the Apothecary:
The Affordable Care Act does not define what it means for a premium increase to be “unreasonable,” but the administration defined it in a regulation issued in May. An increase is defined as “unreasonable” if it is “more than 10%.” (76 FR 29964).
So, if a health insurer increases rates by more than 10%, that’s “unreasonable.” What if costs of the underlying health services they pay for increase by more than 10%? Still unreasonable. What if their patients got sicker, and required more than a 10% increase in services? Still unreasonable. What if they need because regulators made additions the list of preventive services – that must now be covered without copays? Still unreasonable. What if they need the money to pay their share of the new $8 billion tax on health insurers? Well of course that’s unreasonable. What if they use the rate increase to pay for golf tournaments for executives? Well, that’s not treated any differently – it’s reasonable if the increase is 9.8% and unreasonable if it’s 10.2%.
from: http://feedproxy.google.com/~r/TheJohnGoodmanHealthBlog/~3/IraEpEOQut8/
“I’ve been a fighter all my life,” said my new patient, a middle aged man with thinning hair, a worried wife, and a dismal prognosis. He had worked all his life as a plumber with no health insurance. When he was healthy, it was okay. But now he was sick.
I was meeting him for the first time in the community health center where I work as a family physician, tending to all the health needs of a community, from birth to grave. One week earlier, he had gone to the local community hospital when he could no longer swallow. The emergency room doctors admitted him for a complete workup. Inside the hospital they found a tumor in his esophagus, and two in his lungs, one in each lobe of his liver, as well as in his adrenal glands.
Metastatic cancer, spread throughout his body.
Read the rest of The positive effects of palliative care on quality of life on KevinMD.com.
Category: Physician | Tags: Cancer, Hospital, Palliative care | No comment
from: http://feedproxy.google.com/~r/KevinMd-MedicalWeblog/~3/wDhQiHbowCM/positive-effects-palliative-care-quality-life.html
One of the main advantages of Medicare FFS [fee for service] is that beneficiaries do not need a referral for any services and are not limited to certain provider networks. However, Medicare beneficiaries do not pay for these added benefits. In addition, even if HMOs are more efficient than Medicare FFS, Medicare FFS beneficiaries still pay the same Part B premiums.
The authors want beneficiaries to face the true price differentials between the lowest cost plans and less efficient plans, regardless if the plan is Medicare FFS or an MA plan. Thus, beneficiaries would be responsible for any premium differences due to choosing a more expensive plan.
This is from Jason Shafrin’s review of Robert F. Coulam, Roger Feldman and Bryan E. Dowd’s new book, “Bring Market Prices to Medicare: Essential Reform at a Time of Fiscal Crisis” (American Enterprise Institute).
from: http://feedproxy.google.com/~r/TheJohnGoodmanHealthBlog/~3/SLDOvM2a8WA/
