John Lechleiter, CEO of Eli Lilly & Co.

Drug-company executives are not content in simply being witnesses to the overhaul of United States healthcare. Drug companies promise not to have a repeat of their performance in the 1990’s, when they helped defeat President Bill Clinton’s reform efforts from the outside. Executives like Eli Lilly & Co’s CEO John Lechleiter promise an “open” process of pushing for reform. “This is not the 1990s, when the industry was playing defense, we’re playing offense. We’re at the table.” Drug-industry players promise not to use stare tactics in their effort to have their voice be heard, and have already outlined their different goals.
The first point made clear by Lechleiter and others like Astra Zeneca’s CEO David Brennan is that drugs are not are not a significant contributor to the exorbitant health care costs in the US. In other words, drugs are not the problem. “Prescription drugs account for just about 10 percent of health-care spending in the US; that has not changed in 40 years and right now that is going down,” Brennan argued on Wednesday to the Wall Street Journal. Mr. Brennan and other drug-executives claim that cutting back on drug prices is not the answer, rather allowing doctors to prescribe based on drugs’ quality rather than their cost will lead to better preventive care and lower costs.
Drug companies have also made the point on numerous occasions that a public plan would not be effective in the US. CEO of Pfizer Jeffrey Kindler argues: “a public plan would crowd out private insurers” and take the form of “price controls “that fail to reward companies for their expensive and risky investments in drug development.
Finally, drug companies have also maintained that recent price increases in drugs have been necessary. Prices on many drugs have been up by as much as 15% from last quarter, and many have argued that the companies are trying to collect as much money as possible before proposed health reform will drive prices down.

While drug prices are a constant concern for millions of Americans, these companies make a valid point that maybe it is not their prices and industry that needs major reform.

Health insurance is becoming more and more expensive as well as scarce. People are losing their jobs as well as their health insurance and small businesses have been deciding to cut health care coverage totally. But with medical costs rising, health insurance is a necessity. Many people are beginning to look for jobs, are changing jobs, or waiting for their new jobs’ health insurance to check in. The best solution is short term health insurance which is better than no health insurance at all.

Short term health insurance is exactly what it says, short term. Policies can be purchased month to month for periods of 12 to 36 months. Though short term plans aren’t as comprehensive as individual health insurance plans and employer-sponsored health plans, they provide you with preventative measures at a cheap price.

Many short term health insurance plans are less than $100 a month and include coverage for services such as hospitalization, diagnosis, or emergency care. Short term health insurance plans don’t cover preventative care such as annual physicals, doctors’ visits, or prescriptions. Short term plans are used for the meantime while individuals are searching for more permanent plans.

Unfortunately individuals with preexisting conditions cannot get a short term health insurance policy because these policies are underwritten. Short term health insurance plans are generally for healthy individuals.

The common belief that exercise increases metabolism is untrue. Since exercise does not increase the body’s ability to burn fat after a workout, there must be more to weight loss than regular exercise. Caloric intake, taken from food eaten throughout the day holds just as much importance in losing and maintaining a healthy weight as does exercise.

A person who replaces the calories they burn while exercising by eating more is in all truth no better off than someone who did not exercise, at least in regard to weight loss. Exercise does not lead to the burning of excess calories after a workout. However, some experts still suggest that longer and harder workouts combined with a greater variety of exercise can lead to a better post-workout fat burn.

However, the #1 secret to weight loss comes down to simple math: a person has to burn more calories than they intake to loss weight. In order to loss a pound a pound of fat, a person has to lose 3,500 calories, whether by exercise, diet or both. For example, by reducing caloric intake by 500 calories a day through exercise or diet, a person can lose a pound a week. Once weight does come off it is a matter of maintaining a healthy lifestyle by eating well and exercising regularly. Of course, some people may require more exercise than others in order to keep the weight off.

This is the choice more and more small businesses are facing

According to a recent survey by the National Small Business Association, about 10% of small businesses are eliminating health insurance coverage over the next year. It’s either health insurance or jobs.

This isn’t the first decline in health insurance coverage over the past year. Only 38% of small businesses are providing health insurance coverage, down from 61% in 1993. About 19% of small businesses are planning on stopping coverage within the next 5 years.

Sheryl Weldon, owner of Texas-based Commerce Welding & Manufacturing Co. dropped coverage in December after seeing health insurance premiums for her employees increase by more than $600 a month in the last five years. Five years ago, Weldon was paying $200 per employee per month and this year premiums skyrocketed to more than $800. Premiums typically increase 8% to 16% a year for small businesses.

Kelly Reeves, president of KLR Communications, canceled health insurance for her three employees. Reeves said she had to choose between cancelling health insurance coverage and laying off an employee after losing a client that accounted for 50% of revenue.

Due to small businesses canceling health insurance coverage, more and more people are becoming uninsured. According to a report released by Families USA this year, approximately 86.7 million Americans were uninsured between 2007 and 2008. The report also found that nearly 75% of those uninsured were without health insurance for at least 6 months and almost two-thirds were uninsured for more than 9 months.

Government Health- Reform Plan Viewed as “Fallback” Option

The vociferous debate on whether to implement a government-backed health plan to compete against private insurers continues to thrive in Congress. Last week, Senator Olympia Snowe (R-Maine) met privately with several different members of Congress to discuss health care reform legislation. One option that Snowe supports and that continues to gain momentum in the search for a compromise is a “fallback public plan” that would be implemented in the next few years. Essentially, the fallback option gives private health insurers the chance to cut costs and increase accessibility before a government-backed public plan would be put in place. A similar option was included in the legislation that created Medicare Part D prescription drug coverage, but a public plan was never created because private companies were able to meet the legislation’s goals and standards. Snowe has had fruitful discussions with a group of bipartisan senators on the Senate Finance Committee, chaired by Sen. Max Baucus (D-Montana). “Fallback is on the table,” Baucus stated at a Kaiser Family Foundation on May 21. Despite the support of the fallback public plan among many bipartisan members of Congress, many have a very difficult time supporting any kind of government-backed plan. A group of House and Senate Republicans claimed on Tuesday the government-backed plan would have “the compassion of the IRS, the efficiency of the post office, and the incompetence of Katrina assistance efforts.”

Many schools have been closing due to the outbreak of the swine flu in the past month. Many of the school closings have been happening in Queens, New York with a total of 30 closed schools. Parents have been flooding hospitals with their children when any flu like symptom pops up. Officials are trying to exercise caution by shutting down more and more schools.

Swine flu surfaced last month at a Queens school which had 69 confirmed cases. The virus has emerged again since then leading 24 schools to close this week alone. New York City has had approximately 201 confirmed cases since the outbreak of the virus with one confirmed death.

Due to the swine flu outbreak, there have been a 20% increase in emergency room visits by adults and a 50% increase by children. Mayor Bloomberg states that. “While there are an abnormal number of people going to the hospital, who are worried, virtually none, a very tiny percentage of them have any symptoms whatsoever.”

According to a UnitedHealth Group poll, more than half of young adults surveyed lack information about their options for health insurance. The poll surveyed 1,000 young adults between the ages of 18 and 21. The survey found that 67% of the students polled haven’t made any plans for health insurance when they graduate. 69% of those covered by their parent’s health insurance plans are unclear about the details of their coverage as well as 26% having no idea when their coverage will end.

Approximately 87% state that educators should do more to communicate information about obtaining health insurance and the basics of health insurance. Some of the options recent graduates and young adults have include:

• Employer-sponsored health insurance: If you’re lucky to get a job out of college, you will most likely have the option of an employer sponsored group plan. Benefits are usually very comprehensive and your employer pays for a portion of it if not all.

• Short term health insurance: If you are looking for a job and working part time or not at all for the meantime, getting a short term health insurance plan may be beneficial. Plans tend to last up to one year and you can cancel at any time. They are fairly low cost but they will most likely not cover any preexisting conditions.

• COBRA: COBRA, or the Consolidated Omnibus Budget Reconciliation Act of 1986, lets students keep their coverage under their parents for up to 36 months. However, COBRA plans are expensive.

• Individual Health Insurance plan: If the above options don’t seem appealing, an individual health insurance plan is another option. Either going directly to a carrier like Aetna, or a health insurance broker, you can choose a plan that caters to your needs. You can also cancel at any time if you get a job or find another plan that suits you better.

Just remember, health insurance is vital and everyone should have it. If something were to happen, it will cost a lot more to treat you than that couple hundred you pay a month for your coverage.

Health Plan One offers the most competitive prices in the health insurance broker industry. They offer affordable prices to consumers from the most popular plans.

Plans include Aetna’s Managed Choice Open Access 5000 in Connecticut, Anthem Blue Cross of CA’s SmartSense 2500 Deductible plan, and the UnitedHealthOne HSA 100 $2900 deductible plan in Pennsylvania. Other popular plans include the Humana Portrait Share 80 Plus RX Unlimited in Florida, the Aetna PPO 2500 in Ohio, and the CIGNA Open Access 5000 in Texas. Virginia’s top plans include Aetna’s PPO 2500, Anthem’s Essential KeyCare $2500, and Humana’s Autograph Share 80 Plus Rx. Washington’s top plans include Regence’s HSA Health Plan 2500, Lifewise’s WiseEssential 2500, and Group Health’s Balance 1500 Plan.

The above plans have monthly premiums that range from $62 for Virginia’s Anthem Essential KeyCare $2500 to $121 for Florida’s Aetna POS Open Access 5000. Other plans have premiums of $72 for Anthem Blue Cross of CA’s SmartSense 2500 Deductible Plan, $100 for CT’s Aetna Managed Care Open Access 5000, $63.60 for Ohio’s Anthem Lumenos HSA 5000 and $105 for Humana’s Autograph Share 80 Plus Rx in Texas. (All the plans monthly premiums have been calculated for a 25 year old female, non smoker)

Founded in 2005, Health Plan One is a licensed health insurance agency and a leading online health insurance market, offering the broadest selection of health plans to individuals, families and Medicare recipients.  Through its comprehensive Web sites, which include health plan comparison tools and extensive educational information, and its enhanced customer service model, individuals can purchase the best health plans to meet their health care coverage and affordability needs.  For more information, visit Health Plan One’s website.

Dr. John Muney, president of AMG Medical Group in New York, started a flat rate health care program last September to help many of his patients who were losing their jobs and health coverage or could not afford their own or their employers’ health care plans.

Approximately 15% of his patients have registered for Muney’s $79 a month flat rate health plan, or 500 people. The $79 fee includes unlimited preventive visits, minor surgeries, on site medical services, lab work, and gynecological care.

“Our healthcare system lends itself to abuse, fraud and waste,” he said. “With this model, we’re bypassing all that.”

Muney has receive several complains from New York state insurance authorities stating that he must charge for over head costs and a per visit fee of $33. He knows this fee may deter people from signing up for the program.

WellCare was accused for falsely inflating expenditure information submitted to Florida Medicaid between 2002 and 2006. Money that was supposed to be used to provide medical services for Florida health care programs, WellCare kept for itself.

The U.S. Attorney’s office and WellCare Health Plans Inc. came to an agreement this year in order for WellCare to avoid fraud conviction. WellCare agreed to pay $80 million; $40 million in restitution to Florida agencies and $40 million in civil forfeiture. WellCare also accepts full responsibility for their actions, agreed to pay an independent monitor to review its operations, and agreed to fully cooperate with the government’s ongoing investigation.

WellCare has already paid $35.2 million, agrees to pay another $25 million by Sunday, and the remaining $19.8 million by the end of the year. As long as WellCare complies with all health care laws and regulations, the agreement can be cut down to two years from three.

The U.S. Department of Health and Human Services hopes that this agreement will serve as a warning to all committing or thinking of committing Medicaid fraud.

To read the full article, go to http://www.bizjournals.com/orlando/stories/2009/05/04/daily25.html