There has been a lot of recent discussion about insurance companies’ sudden entrance into the health care debate. The Washington Post referred to the health insurers as Obama’s “top foe” last week, mainly as a response to actions taken by America’s Health Insurance Plans (AHIP), industry trade group, including an advertising campaign opposing health care reform and a controversial PricewaterhouseCoopers report commissioned by AHIP analyzing the recent Senate Finance Committee proposal.

Many others have criticized AHIP’s actions, claiming that AHIP is scared and attempting to block health insurance reform as a last ditch resort. Well, of course. The health insurance industry is reacting because the public option will put them out of business. Although they are not saints, the health insurers simply pay claims and charge premiums. In the end they make a 3% profit out of doing so. They also subsidize Medicaid and, to a lesser extent, Medicare-by paying doctors, hospitals, and more. The payment difference is not by choice-rather, free (and oligopolistic) market forces at work.

The idea that a public option will make health care more affordable can only happen in 2 ways: (1) pay doctors, hospitals, and others less. This may be a good idea, but there are consequences of monopolistic, heavy handed pricing tactics; (2) we can have taxpayers subsidize the public option.

The idea that the public option will save on administrative costs is not realistic. What does Medicare do for administrative costs? It contracts with Blue Cross and other insurance companies! If you still don’t believe it, go visit any major health insurer headquarters in CT (Anthem, Aetna, Cigna…). The places are half empty, having massively reduced costs over the last 5 years. “Profiteering” may be considered bad, but these insurers are very lean.

We don’t like HMOs, because they are too restrictive. We don’t like limited benefits so we pile on mandated benefits each year. We don’t like high deductibles, but we do like high tech cures. There is no ceiling and our solution? A public option? If our appetites are insatiable, NO option can solve the problem.

You know the debate has really moved in the last few months when the headline of every major paper praises the congressional budget office scoring of the latest senate health bill, suggesting an 829 billion dollar cost over a decade (See the Wall Street Journal and the New York Times)! It is not clear if the positive review of the 829 billion dollar price tag includes the $444 billion cuts to Medicare and the $221 billion excise tax on health plans and the tens of billions of dollars of fees levied on insurance companies, medicare device makers and pharmaceutical companies. Note to Max Baucus: insurance companies and pharmaceutical companies don’t pay taxes: they merely pass costs onto consumers.

We started the health care debate to reduce the unsustainable medical trend or to “bend the curve” and to reduce the number of uninsured. It is not clear that with a trillion and a half dollars of new spending taxes and cuts to Medicare we’ll really have accomplished anything. The only cost cutting measure in this bill of significance is cutting fees to physicians, hospitals, and others- which does very little to affect the trend of increasing medical costs and, in fact, is a one times savings.

I wonder what constitutes an unattractive alternative.

The American population remains highly divided in its opinion of President Obama’s proposed health reform plans. A national telephone survey recently found that 50% of U.S. voters at least somewhat favor the Democratic health care reform proposed by Obama, whereas 45% are at least somewhat opposed. Interestingly enough, more people have stronger opinions that oppose the plan than favor it. Only 24% strongly favor the plan, while 34% are strongly opposed to it.

Obama’s plan includes a new government-run health insurance plan that would allow Americans to choose their own doctors, although the capability to do that may diminish or be totally eliminated in the future. The government plan Obama proposes would compete with private insurers as a method of keeping healthcare costs down. However, many people believe this could lead to the destruction of private insurance companies.

These recent statistics exemplify the uncertainty surrounding healthcare reform. In fact, just 12% of people believe health care coverage will improve if the plan is passes while 37% believe coverage will worsen and 37% expect their coverage to stay about the same. Many people are also questioning whether now the time for health care reform is now given America’s current economic status. Surveys show that 44% of Americans think Obama should wait on health care reform until the economy improves and only 43% say reform should happen now.

Investigators found yesterday that two-thirds of the health insurance industry in the United States uses a faulty database that charges patients more for seeing out of network doctors. The database, operated by Ingenix, kept rates low in order to underpay doctors which then drove up costs for patients.

Ingenix is a subsidiary of UnitedHealth Group which is also used by nearly 20 regional and national health insurers. Ingenix agreed last January to pay $350 million in order to settle allegation that it kept its rate low to underpay doctors.  Other health insurers include Aetna, CIGNA, and Wellpoint.

Health insurers submit information to Ingenix to determine the costs for care received out of network. Health insurance companies often skew data to underestimate the costs of medical services so that patients would have to pay more in out of pocket costs.

“The result of this practice is that American consumers have paid billions of dollars for health care services that their insurance companies should have paid,” states the Senate Commerce Committee’s investigative staff.

“Insurers know that policyholders are so baffled by those notices they usually just ignore them or throw them away,” said Wendell Potter, a former insurance executive at CIGNA. “And that’s exactly the point. If they were more understandable, more consumers might realize that they are being ripped off.”

To see the full report, go to http://www.google.com/hostednews/ap/article/ALeqM5g4s2×4w7hv-cWoKaCbdWmE1sQecAD991BJOO0.

President Obama has made clear his goal for universal health care for all Americans. When he addressed the American Medical Association on Monday, he called for an elimination of insurers’ practice of denying those with pre-exisiting health conditions, which got him a huge applause. “This is personal for me. I will never forget watching my own mother, as she fought cancer in her final days, worrying about whether her insurer would claim her illness was a preexisting condition so it could get out of providing coverage. Changing the current approach to preexisting conditions is the least we can do – for my mother and every other mother, father, son, and daughter, who has suffered under this practice.” While Obama does have support on this idea from the AMA, insurance companies are very hesitant to change many of their practices. Rescission has been a fiery issue between Congress and the insurance companies. This practice effectively cancels the coverage of some sick individuals. Rescission is particularly damaging because patients have gotten used to having coverage, and suddenly it is dropped. “No one can defend, and I certainly cannot defend, the practice of canceling coverage after the fact,” Rep. Michael C. Burgess, of Texas , told the Los Angeles Times. “There is no acceptable minimum to denying coverage after the fact.” Insurers claim, however, that the practice needs to stay in place to protect themselves from those who lied or committed fraud to get policies. The practice certainly saves the companies money, as a congressional investigation found that the canceling of 20,000 people in a five year period allowed the companies to avoid paying $300 million in claims. The problem is that not all of these people committed fraud or lied to obtain coverage. Many were simply dismissed because of their costly health conditions. The question over whether or not rescission will be allowed to be practiced by insurance companies will be a great debate for a long time.

As the cost health care services continue to rise in the United States, so does the cost of providing health care coverage. This can be seen in Anthem increasing base premiums for some of its Individual business under-65 plans in Virginia. The base premiums for a Plan like the Lumenos HSA standard increased by 15% while the Keycare Preferred base premium rose 13.5% and the Virginia Standard base premium rose 11%. Factors like any applicable age increase, moving to an area with higher or lower medical costs, changing the number of family members enrolled in a policy, or adding or deleting optional coverage may also affect premiums for customers. Members are required by law to be notified in writing of the increases in premiums, and are advised to to call their agent or Anthem Sales Representative if they have any questions. Anthem offers advice to its customers, some of which includes raising their deductible. They also state they offer other lower-cost plans as alternatives.

Unfortunately for many people in New England, large changes are being made to insurance plans for the upcoming year. Important changes in the way CIGNA HealthCare plans to operate in the states of Massachusetts, Maine and New Hampshire will take effect on January 1st of 2010, the next contract year. CIGNA HealthCare has decided to withdraw from the HMO market and no longer offer the HMO Plans to any sized employers for coverage of any employees and their eligible dependents in those states.

These changes affect the CIGNA HMO and CIGNA HMO Point-of-Service Plans which are currently used by employers with more than 50 eligible employees as well as the stand alone HMO only network use by New Hampshire Small Group employers with 50 or less than 50 employees. In order to help ease the transaction clients can replace their HMO/POS Plans upon renewal with one of the other plans that CIGNA will continue to offer.

Clients and their employees will be notified of this termination in writing starting with mailings scheduled for the week of June 15th.

A recent study done by J.D. Power and Associates ranked the nations best health insurance plans by areas of the United States. The study measured health plans based on seven key factors that drive the members’ overall health plan experience: Provider Choice; Information and Communication; Coverage and Benefits; Claims Processing; Statements; Customer Service; and Approval Processes. Included in the study are 131 health plans in 17 regions in the United States and the results of more that 33,000 health plan member surveys conducted between December of 2008 and January of 2009.

Headlining the results of the study is Health Alliance Plan (HAP), which was rated “Highest in Member Satisfaction among Commercial Health Plans in Michigan.” This is the second year in a row where HAP ranked highest in member satisfaction among Michigan commercial health plans. HAP earned a five star Power Circle Rating which signifies “Among the Best” in four areas: Customer Service, Overall Experience, Coverage and Benefit, and Information and Communication.

Other award recipients include: BlueCross BlueShield of AZ, AL, FL, NE, and IL, HIP Health Plan in New York/New Jersey, Harvard Pilgrim Health Care in New England, and Humana in the South Atlantic and Texas.

One of the more obvious ways to cut healthcare costs and create more saving is to eliminate the large variations in healthcare costs across the country.  This theory, however, hinges on the notion that there is little or no difference in patient care across the country.  In a city like Miami, for instance, the average Medicare costs per patient is $16, 351, nearly triple the amount per patient in a city like La Crosse, Wisconsin, without clear evidence of difference in patient care, the Washington Post reported today.   If there really is no difference in the patient care, then eliminating the variations in healthcare payments would save a lot of money and make a lot of sense.  My one question would be what sort of clear evidence are they looking for to determine a difference in patient care? In other words, how are they sure there is reallyno difference in patient care and overall patient experience between cities like Miami and La Crosse? Surely, eliminating the variation in different regions across the country would not hurt a city like La Crosse but I am not sure the citzens of Miami would feel comfortable losing their quality of care.  The Wall Street journal has reported. It will be interesting to see how drastic the changes in variations in healthcare costs across the country will be.

Everyone nowadays is aware that the Gardasil vaccine administered widely to young girls can protect against four strains of the human papillomavirus, a sexually-transmitted disease which can lead to cervical cancer. But what about older women? A new study argues the vaccine is indeed effective in protecting women ages 24 to 45 from HPV.

About 3 out of 4 sexually active women get HPV at some point in their lives. Though there are more than 100 HPV strains , most are harmless and disappear on their own without treatment. Gardasil protects against four of the strains of the virus that, when untreated, do bear serious medical risks: two which cause genital warts (strains 6 and 11) and two which can lead to cervical cancer (strains 16 and 18). Gardasil is only approved for girls ages 9 to 24, but a rising population of older women (24 to 45) are at risk of HPV infection. This is because more and more women are reentering the dating scene in middle age after a period of monogamy, such as after a divorce.

The ongoing multicenter, parallel, randomized, controlled, double-blind study tested the immunogenicity, safety, and efficacy of the quadrivalent HPV vaccine in 3819 Colombian women ages 24 to 45, none of whom had a history of genital warts or cervical disease. 1911 women received the vaccine, and the other 1908 were given a placebo. The researchers found that among the per protocol population (3222 women), the vaccine had a 90.5% efficacy rate against all strains of the virus. There were only 4 instances of infection in the vaccine group compared with 41 in the control group. The vaccine had an 83.1% efficacy rate against the two most common strains (HPV 16 and 18). Only four cases appeared in the vaccine group versus 23 in the control group. Researchers also looked at the intention-to-treat population, which included women who had not received all 3 installments of the vaccine or who did have a pre-existing HPV infection. When these subjects were included in the calculations, vaccine efficacy against all 4 types of HPV was 31%; against strains 16 and 18 was 24%. Because Gardasil will not protect women who were infected by HPV before they received the vaccine, the lower efficacy in the above mixed population suggests the “public health effect of vaccinating women ages 25 to 45 will be smaller than that recorded after vaccinating susceptible adolescents,” said researchers. Therefore, the maximum effect of vaccinating older women will be seen only in those who were susceptible to infection (engaging actively with new sex partners) and had not been previously exposed to HPV. However, most of the women in the study who were or had been HPV-positive were positive to only one strain of the virus. This means that the quadrivalent HPV vaccine could still be beneficial in protecting older women against the HPV strains they had NOT been infected with.

Though these findings are encouraging, some scientists are not as optimistic that the Gardasil vaccine will be effective in the older female population. They claim the new study is simply too small and that the vaccine’s true efficacy in the study group won’t be seen for several more years; the study has only followed the women for about 2.2 years.

Even if longer-term and larger-scale studies confirm the efficacy of the vaccine for older women, the problem for many women who believe they could be at risk of HPV infection is that the vaccine is currently only approved for girls 9 to 24. This means that right now insurers will not cover vaccination for older women until the shots are proven effective and approved for the older population. The fact that the vaccine’s three shots cost about $375 (not counting fees the doctor may charge for the visits) means that though these study results are encouraging, few older women will pursue vaccination until insurance companies begin covering it for them.

Regardless of whether women at any age receive the Gardasil vaccine, all women should still receive routine Pap smears, which check for cancerous or precancerous changes in cervix cells. Pap smears are almost always covered by private insurance as part of a woman’s routine gynecological exams.