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We've had several good news posts recently on ACA successes now that some of the law's parts are going into effect.

However, over at Physicians for a National Health Program I found this disturbing article :

Posted on: Tuesday, December 6, 2011
List of essential services under U.S. health reforms is ‘skimpy’ and dangerous, say doctors
By Jeanne Lenzer
BMJ, Dec. 5, 2011

In a story reminiscent of the recent allegations that  contractors with conflicts of interests hired to issue reports on the Keystone XL pipeline for the State Department, PNHP docs and others attending a meeting off The Institute of Medicine found rules being formulated by folks with clear conflicts of interest.

I was not familiar with teh IFM.  Wiki:

The Institute for Medicine:

The Institute of Medicine (IOM) is a not-for-profit, non-governmental American organization founded in 1970, under the congressional charter of the National Academy of Sciences.
snip
Its purpose is to provide national advice on issues relating to biomedical science, medicine, and health, and its mission to serve as adviser to the nation to improve health. It works outside the framework of the U.S. federal government to provide independent guidance and analysis and relies on a volunteer workforce of scientists and other experts, operating under a rigorous, formal peer-review system. The Institute provides unbiased, evidence-based, and authoritative information and advice concerning health and science policy to policy-makers, professionals, leaders in every sector of society, and the public at large.

Some PNHP docs and others attended a meeting of the IFM and private security prevented them from passing out leaflets to colleages attending the meeting.  

WTF?  Private security prevented doctors from passing out leaflets?  Guess that's not too surprising given what we have been seeing happening to Occupiers...

Doctors Send Letter to Secretary Sebelius RE: Skimpy Care

Danny McCormick, assistant professor at Harvard Medical School and a former fellow of the institute, distributed leaflets at the meeting.He has signed a protest letter sent to the U.S. secretary of health and human services, Kathleen Sebelius, along with more than 2,400 doctors, nurses, and health advocates, stating that the recommendations for “essential benefits” to be provided under the Affordable Care Act will provide “skimpy” care that would endanger the health of many citizens.

Although the report outlines 10 categories of benefits that insurers must cover, such as costs of hospitalization, preventive care, and ambulance transport, it does not prohibit insurers from shifting costs to patients through premiums, co-payments, deductibles, and cost sharing. In the event of a catastrophic illness or injury, patients could be hundreds of thousands of dollars in debt.

Dr. McCormick said that a serious pitfall of the recommended essential benefits is that they would give patients the illusion that they have “real insurance.”He said, “Most patients, no matter how well informed, have no idea what their insurance policy covers. It’s only when some catastrophic event occurs that they find out that they are not fully covered.”

Regardless of where one stands on the ACA, we should all be able to come together and work for preventing the weakening of   beneficial outcomes the bill might have, and prevent insurers from providing crap coverage.

###

Other groups are also pushing back on the proposed essential services, and have launched a campaign described in the following excerpt from their press release:

Patient Advocate Groups to Launch Essential Benefits Campaign on Wednesday, December 7 at 10:00am

WASHINGTON, Dec. 5 -- AIDS Institute issued the following news release:

A group of patient advocates today launched the "I am Essential" campaign, dedicated to making the voice of the patient heard in the essential health benefits debate and ensuring that all Americans receive proper benefits and health coverage. On Wednesday, December 7 at 10:00AM, members of the campaign - including representatives from The AIDS Institute, the National Minority Quality Forum, the National Alliance on Mental Illness, and the American Autoimmune Related Diseases Association - will make the case that an essential benefits package drawn too narrowly will risk not adequately covering patient needs, and that access to affordable, high quality care saves lives and lowers health care costs in the long run.

In conjunction with the launch, the campaign is joining with other patient advocacy groups to send a letter to HHS and members of Congress, urging the government to ensure the nation's Essential Health Benefits package provides for all American health care consumers, particularly those who have chronic health conditions.

The Affordable Care Act (ACA) established and took the first steps in defining a set of core health services, or "Essential Benefits," that all health insurance plans sold through state exchanges must cover. The ACA requires the Secretary of Health and Human Services to define the parameters of Essential Benefits with respect to covered treatments, items and services and approximate the scope of benefits provided under the typical employer plan.

Have heard from other kossacks that Secretary Sebelius is a tough cookie, and not likely to let  Big Insurance tactics slip by.  

Photobucket

Contact info here:

http://www.hhs.gov/...

 

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Comment Preferences

  •  We are retired teachers with junk retiree (7+ / 0-)

    insurance benefit administered by Aetna.  Its just the kind of policy these medical professionals warn about.

    Provides some care, but we realize we are one extended illness or operation away from bankruptcy.

    Hope we can stop this from happening to others under ACA.

  •  Money quote from the article (4+ / 0-)
    Although the report outlines 10 categories of benefits that insurers must cover, such as costs of hospitalization, preventive care, and ambulance transport, it does not prohibit insurers from shifting costs to patients through premiums, co-payments, deductibles, and cost sharing. In the event of a catastrophic illness or injury, patients could be hundreds of thousands of dollars in debt.
  •  I fail to see why (7+ / 0-)

    an industry that does nothing but make health care unaffordable has to be at the center of our national health care system. It is another case of privatization. I realize am a purist about this but it just seems like every solution that comes out of DC ends up having profit for some damn too big at it's heart. Other countries have health care that is not controlled by the for profits. I like the French system. It's a hybrid.  Their insurance is public.

    The French health care system is one of universal health care largely financed by government national health insurance. In its 2000 assessment of world health care systems, the World Health Organization found that France provided the "best overall health care" in the world. In 2005, France spent 11.2% of GDP on health care, or US$3,926 per capita, a figure much higher than the average spent by countries in Europe but less than in the US. Approximately 77% of health expenditures are covered by government funded agencies.

    Most general physicians are in private practice but draw their income from the public insurance funds. These funds, unlike their German counterparts, have never gained self-management responsibility. Instead, the government has taken responsibility for the financial and operational management of health insurance (by setting premium levels related to income and determining the prices of goods and services refunded). The French National Health Service generally refunds patients 70% of most health care costs, and 100% in case of costly or long-term ailments. Supplemental coverage may be bought from private insurers, most of them nonprofit, mutual insurers. Until recently, coverage was restricted to those who contributed to social security (generally, workers or retirees), excluding some poor segments of the population; the government of Lionel Jospin put into place "universal health coverage" and extended the coverage to all those legally resident in France. Only about 3.7% of hospital treatment costs are reimbursed through private insurance, but a much higher share of the cost of spectacles and prostheses (21.9%), drugs (18.6%) and dental care (35.9%) (Figures from the year 2000). There are public hospitals, non-profit independent hospitals (which are linked to the public system), as well as private for-profit hospitals.

    •  Thats very interesting, shaharazade, did not (4+ / 0-)

      know how the French system worked.

      We have our work cut out for us. Glad the docs and the Aids Institute are working on this. We should as well.

      •  Thank you for (3+ / 0-)
        Recommended by:
        divineorder, ocular sinister, JanL

        this dairy. It is good to hear that health care professionals are out there working towards a decent system. The frustrating part is that in reality the majority of people are/were in favor of some form of public health care. One of my son's is a 'conservative' and even he is in agreement with the concept of real universal public health care. His insurance was declared a Cadillac plan and his rates went up and his coverage with 3 kids went down.

        Everyone I know whether insured or not ends up in the ER with kids in tow for what should be day to day medical help. It's a nightmare  People say to me there are clinic's that will help. I sure as hell can't find them other then Zoom care which is private and good for infections or stitches, minor medical needs but were all screwed insured or not by this system. The ER is just freakin inhumane and punitive, and expensive and yet what choice do most of us have?    

        •  PNHP agrees (4+ / 0-)
          About PNHP

          Physicians for a National Health Program is a single issue organization advocating a universal, comprehensive single-payer national health program. PNHP has more than 18,000 members and chapters across the United States.

          Since 1987, we've advocated for reform in the U.S. health care system. We educate physicians and other health professionals about the benefits of a single-payer system--including fewer administrative costs and affording health insurance for the 50 million Americans who have none.

          Our members and physician activists work toward a single-payer national health program in their communities. PNHP performs ground breaking research on the health crisis and the need for fundamental reform, coordinates speakers and forums, participates in town hall meetings and debates, contributes scholarly articles to peer-reviewed medical journals, and appears regularly on national television and news programs advocating for a single-payer system.

          PNHP is the only national physician organization in the United States dedicated exclusively to implementing a single-payer national health program.

          http://www.pnhp.org/...

    •  We know why. ;) (0+ / 0-)

      Dedicated to the GOP debates: When the going gets weird, the weird turn pro. Hunter Thompson

      by NyteByrd1954 on Thu Dec 08, 2011 at 04:27:36 AM PST

      [ Parent ]

  •  For example (1+ / 0-)
    Recommended by:
    divineorder
    Although the report outlines 10 categories of benefits that insurers must cover, such as costs of hospitalization, preventive care, and ambulance transport, it does not prohibit insurers from shifting costs to patients through premiums, co-payments, deductibles, and cost sharing. In the event of a catastrophic illness or injury, patients could be hundreds of thousands of dollars in debt.

    Colonoscopies must now be a covered preventive service.  

    However, the medication needed pre-test is a prescription.  If a person does not have prescription coverage, they're on the hook for $25-$75 dollars.  

    While the colonoscopy is covered 100%, if a growth needs to be removed, as is common with a colonoscopy, the colonoscopy becomes surgery.  Insurance companies are then allowed to charge deductibles and pay "usual and customary" costs.  

    Patients can then incur thousands if not tens of thousands of dollars in costs.  

    Bingo:  The Obama administration giveth and then taketh away to protect the insurance companies.  

    And that is just one example.  

    Dedicated to the GOP debates: When the going gets weird, the weird turn pro. Hunter Thompson

    by NyteByrd1954 on Thu Dec 08, 2011 at 04:27:08 AM PST

    •  NyteByrd1954, this is sickening to me. What can be (1+ / 0-)
      Recommended by:
      NyteByrd1954

      done?

      •  At this point? Nothing (0+ / 0-)

        Obviously, pressuring this administration gets one nowhere.  The same with pressuring Congress.  

        Unless, of course, banks require a few 1 trillion more or so of the taxpayer's money.  Then, no problem.  Coming up, ASAP.  

        If I may add, I'm still waiting for all the tweaks and changes that were suppose happen to HCR after the bill's passage.  For many, that was inherent in their support for the bill:  It's flawed, but it will be fixed.  

        What can be done?  Vote in a real liberal administration who will do more than pay lip service or dust off their old campaign scripts.  

        For the last several days, I've been on the road for business.  I've listened to all sorts of talk radio from the liberal to the conservative to the bat shit crazy.  

        It is interesting to note, conservative Republicans are being fed the same BS pablum by their political establishment as we liberals.  Namely, a conservative, or in our case, a liberal cannot be elected.  Only moderates can be elected.  

        I call bullshit.  

        However, on our side, we have one advantage.  Many of the liberal positions are actually mainstream.  Apparently "mainstream" does not mean "moderate" to the Democratic hierarchy.  So we get triangulation and splitting the difference.  

        Until we stop that process dead, we will be left with a flawed HCR bill that does contain some good.  

        Dedicated to the GOP debates: When the going gets weird, the weird turn pro. Hunter Thompson

        by NyteByrd1954 on Fri Dec 09, 2011 at 07:37:05 AM PST

        [ Parent ]

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