not as cranky as he pretends to be….

Some cool catastrophic health insurance images:

catastrophic health insurance
not as cranky as he pretends to be….
J.D. Kleinke – disappointed but still hopeful idealist on health care.

As J.D.Kleinke points out, “Over the past few decades, the steady expansion of the health insurance enterprise to pay for almost all our routine care has created de facto buyers’ clubs – large, bureaucratic, breathtakingly inefficient, and often hostile-to-their-members buyers’ clubs – that take 20 percent off the top in transaction and other administrative costs without adding much in the way of real value.” Kleinke believes it would make more sense to pay for routine care in a way that encourages direct consumer involvement and price/performance discrimination, while catastrophic care is more appropriately a matter for insurance. Among other things, it often involves situations where individuals simply can’t be well-informed, empowered buyers. . For almost everyone but the seriously ill, though, the insurers are not the right ones to be in charge. As Kleinke says, “Most people will take paternalism from their doctors, but they won’t take it from an insurance company!”

The challenge is that some people want to control their own health care, and others don’t. But a critical mass of empowered individuals is likely to change the system for everyone over the long run.

So how do those individuals get empowered? Right now, they are underinformed and have little market clout. But employers can help – and have an incentive to do so. Kleinke’s betting on that among other developments at Omnimedix Institute, the non-profit organization he founded in 2004 to research, test and disseminate ways for consumers to manage their own medical data, with a focus on personal health records (PHRs) as a key mechanism. Omnimedix is working with a group of large employers (led by Intel Corporation) to develop and roll out a free, portable, public-utility-type PHR designed to break up what he calls “the classic health-care IT logjam.”

“There are hundreds of commercial PHR vendors,” Kleinke says, “all hamstrung by the absence of a viable business model. None of them is near the critical mass necessary to force open the health care institutions’ legacy information systems – such as they are – the way Quicken opened up the banking institutions. We think we can be most effective working with a group of large employers to promote the use of a single, open, private, portable system among their workforces and communities. The infrastructure we are building with these employers will allow millions of consumers to create, get, store, edit, amend and transport all of their own medical data using a common networked system. This is a significant departure from the paternalism and proprietary lock-in inherent in the institutional relationships and IT vendor models that dominate the U.S. health care system. And our status as an independent non-profit reduces the mistrust inherent in other employer-sponsored approaches to PHR deployment.”

As Vice Chairman of Health Grades, a publicly traded health-care ratings company, Kleinke has watched the business slowly transform over the past few years from one that developed and marketed its information exclusively to hospitals, health plans and other institutions, to one that sees its biggest growth opportunity coming from selling the exact same information to consumers. “A decade ago, when we were creating the commercial health-care informatics business at HCIA [now Solucient, where Kleinke worked as vp of corporate development], there was no consumer business,” he says. “There was no Internet to distribute the small bits of industrial-strength information that an individual patient needed. There was no IOM report,” Kleinke says, referring to the 1998 report by the Institute of Medicine that quantified the nearly 100,000 deaths each year attributable to medical errors in hospitals. “And most importantly, until recently, patients had nevnever confronted high deductibles, large co-payments and other new economic mechanisms that have jarred them from complacency born of paternalism."

catastrophic health insurance
Carolyn Comeau On The Impact Of Health Insurance Reform
This afternoon at a press conference in the Capitol, Carolyn Comeau talked about how she will benefit from much-needed health insurance reform:

I’m Carolyn Comeau. I live in Ashville, North Carolina. I was diagnosed with breast cancer three years ago at age 45. I got the diagnosis call as my husband was on an important job interview for a position that would allow us to have good, high-quality benefits. Thank heaven he got those benefits in that job. However, seven months later, he was laid off. He works in the construction industry, which was hard hit in our state — and laid off in the middle of my treatment. We had no choice but to get — then get benefits through COBRA and that was ,058 a month for 18 months. We looked to the individual market for private-insurance, we did not qualify for Medicaid, and had a disastrous meeting with a representative from a company who quoted us ,000-plus a month for me only. You feel, in a sense, tainted. Being a woman should not be a pre-existing condition.

It’s hard to describe the stress of going through a catastrophic illness and the side-effects of the treatment that you receive and worrying about the insurance mess at the same time and how you are going to make it through as a family. The light on the horizon that we thought we had was the North Carolina high-risk pool. I currently pay into that 0 a month. I have a ,000 deductible. However, my oncologist’s office does — is not a member, is not affiliated with that program. And the latest update is that I just got word that there is an exclusionary policy with the high-risk pool for the genetic testing that my doctors want me to have, which would possibly impact my treatment and my future course as well as the futures of my children.

And the final highlight is that recently my husband and I did our taxes. And as we sat down and saw everything in black and white, we saw that very nearly half our income went to health-related costs. And that is just for me. My children are on the North Carolina CHIP program and my husband is uninsured.

So, the bottom line is — the reality: if you’re healthy, you get insurance. If you get sick, there’s no option — you then have a pre-existing condition, there is no place to turn. Insurance should help everyone, including those who need it. There’s no real option in a private market for people with pre-existing conditions. So I urge and urge strongly that Congress make the humane choice for our country and pass this health care reform bill. Plain and simple: It’s a broken system and it continues to leave a trail of families whose finances have been decimated by the system.