Monthly Archives

April 2018

Commentary: Canada’s Health Care Is Abysmal. Why Would We Copy It?

By | Health Insurance

By SALLY C. PIPES

April 26, 2018

Americans have come down with single-payer fever. A whole 59% now back a national health plan, according to a March 2018 Kaiser Health Tracking Poll—way up from the 33% reported by the Pew Research Center in summer 2017.

But the American people don’t really understand what supporting a single-payer plan means. For instance, in October 2017, 47% believed they’d be able to keep their current health coverage if a single-payer plan were put into place, according to Kaiser.

They’re sorely mistaken. Bills that would launch a government takeover of the country’s health care sector are meandering through Congress and numerous statehouses across the country. Those measures would outlaw private insurance within a matter of years. If any of them pass, Americans will find themselves paying sky-high taxes for access—not to care but to a waiting list.

Take Sen. Bernie Sanders’s Medicare for All proposal. Over the course of four years, it would systematically pryBernie Sanders people away from their current coverage arrangements—employer-sponsored insurance, individual-market coverage, Medicare, and Medicaid—and dump them all in a government-run plan. Companion legislation spearheaded by Rep. Keith Ellison in the House would do the same.

The Center for American Progress’s recently released Medicare Extra for All plan would nudge people into single-payer more gradually. Medicaid beneficiaries, the uninsured, and people with coverage through Obamacare’s exchanges would be first. Newborns and seniors turning 65 would soon follow suit.

The proposal also claims to allow Americans to keep their employer-sponsored coverage. But it offers employers incentives to move their workers into Medicare Extra. The end result, after a decade or so, would be single-payer.

Earlier this month, Democratic senators introduced the Choose Medicare Act, a bill that would allow individuals and employers to buy into Medicare rather than purchasing coverage from a private insurer.

As long as there’s a Republican in the White House, these proposals have little chance of becoming law; consequently, many state legislators are taking matters into their own hands. The California Senate approved a single-payer bill last June. It has since stalled in the Assembly, thanks in large part to the absence of a plan to pay for it. But progressive activists, led by the California Nurses Association, have continued to pressure the Assembly speaker to act on the bill. The New York Assembly green-lit a single-payer plan last year, but it never made it out of the State Senate.

Rhode Island, Washington state, New Hampshire, and Massachusetts are all in various states of exploring how they might implement single-payer within their borders.

They’ll quickly find that it’s financially impossible. California’s Senate Appropriations Committee estimates that single-payer would cost $400 billion per year—roughly twice the state’s entire budget. New York’s plan would increase state health spending by more than $87 billion in 2019 and require nearly $226 billion in tax increases, according to the Foundation for Research on Equal Opportunity.

Sanders’s Medicare for All plan makes these state initiatives look cheap by comparison. According to the Urban Institute, his reform package would cost $3.2 trillion a year. Proposed financing options include new payroll and individual income taxes of 7.5% and 4%, respectively—all on top of existing taxes.

Single-payer wouldn’t merely harm Americans’ financial well-being—it would jeopardize their physical health.

When patients face no out-of-pocket costs at the doctor’s office or hospitals, they have no incentive to moderate their consumption of care or seek lower-cost providers. The only way for governments to control spending is to ration the supply of care.

Consider how things work north of the border. Canada effectively outlaws private insurance for medically necessary services—just as the Sanders plan would. Patients must wait months for routine procedures—a median of more than 21 weeks for treatment from a specialist after referral from a general practitioner.

These long waits aren’t due to a lack of funding. The cost of health insurance for the average Canadian family jumped 174% over the past two decades—nearly twice as fast as incomes and four times the rate of inflation.

Canadians are fed up with their “free” health care. Three in four believe they should have the right to pay for care privately if the wait they’re facing is longer than clinically recommended.

Sanders and his progressive allies are working toward a revolution in the opposite direction. But it’s odd that they’re looking to mimic Canada’s single-payer model just as a strong majority of Canadians want to end their government’s ban on private insurance and permit more private options for care.

Americans’ burgeoning support for Medicare for All will quickly fade when patients learn that the government will confiscate their current health plans and force them to wait in line for care—and then charge them exorbitantly high taxes for the pleasure.

Sally C. Pipes is the president, CEO, and Thomas W. Smith fellow in health care policy at the Pacific Research Institute. Her latest book is The False Promise of Single-payer Health Care. Follow her on Twitter.

Bring back short-term health insurance plans — it’s only fair

By | Health Insurance

THE VIEWS EXPRESSED BY CONTRIBUTORS ARE THEIR OWN AND NOT THE VIEW OF THE HILL

 

The Million-Dollar Cancer Treatment: Who Will Pay?

By | Health Insurance

So far, few patients have received the new drugs, as commercial health plans and Medicare wrestle with how to cover the treatment.

By
Jonathan D. Rockoff
April 26, 2018 7:00 a.m. ET
495 COMMENTS

The emergence of genetics-based medicines is pushing the cost of treating certain diseases to new levels, forcing hospitals and health insurers to reckon with how to cover total costs per patient approaching a million dollars.

The therapies deliver new genes or genetically altered cells to tackle some of the hardest-to-treat diseases, including in children. They come at a high price: Novartis AG listed its newly approved cell therapy for cancer at $475,000, while Gilead Sciences Inc. priced its rival drug at $373,000.

But the price of the drugs is just the beginning, hospitals and insurers say. Administering these therapies can add hundreds of thousands of dollars to the tab, including lengthy hospital stays and use of other services and medicines.

It isn’t clear how much hospitals will get paid for these new treatments. Current payment systems generally cover infusions of drugs, or episodes of hospital care, but aren’t set up to deal with treatments that combine both. What is clear is that the total cost will be far more than the list price of the drugs themselves.

“It is about systems that don’t work well and aren’t set up for cutting-edge new technologies” says Gary Goldstein, a business manager at Stanford University’s health system, which is offering the new treatments. “And if we don’t get this one right, what about the next one?”

Million-Dollar Treatment

A new wave of gene-based therapies for cancer and other diseases threatens to bring the cost of treatment to a million dollars, because both the drug and related care are expensive. Treatment Costs

So far, few patients have received the new drugs, as commercial health plans and Medicare cover treatment on a case-by-case basis until they can settle on an official payment plan.

Finding a path is important, as the next generation of cell- and gene-based therapies expands. Among drugs in late-stage development, Bluebird Bio ’s gene therapy for sickle-cell disease could involve a hospital stay of as long as six weeks.

One of the first genetics-based treatments was Gilead’s lymphoma drug Yescarta, approved last October for use in patients who have failed other drugs. Yescarta is a form of cell therapy known as CAR-T, for chimeric antigen receptor T-cells. It uses a patient’s own immune cells, which are extracted, modified in a lab and then put back into the patient where they hunt down and attack cancer.

Martin Fries’s recent treatment with Yescarta included a 13-day hospital stay, use of several other drugs and a variety of procedures that he anticipates will cost between $750,000 and $1 million.

The 62-year-old pharmacist from Kissimmee, Fla., first spent a half-day at Moffitt Cancer Center in Tampa hooked up to a so-called apheresis machine. It harvested his immune cells, which were shipped to Gilead to be turned into the drug.

Mr. Fries then received two chemotherapies over three days to prepare his body for the altered cells.

He was admitted to the hospital in December, where the engineered cells were infused and he was monitored for side effects. Monitoring usually costs a few thousand dollars a day, hospitals say. Mr. Fries says he was treated for fever of 104.8 degrees and received a blood-plasma drug and a steroid to combat neurological side effects.

Treatment Costs2

In December Mr. Fries received the CAR-T therapy, which involves harvesting his immune cells, sending them to the drugmaker to be processed, and then infusing him with the therapy. PHOTO: EVE EDELHEIT FOR THE WALL STREET JOURNAL

In January, he got a drug called Neupogen to boost his white blood cells. And he has regular follow-ups to make sure he doesn’t have lasting neurological effects.

“Already hit my total out-of-pocket of $5,000 for this year,” Mr. Fries said in March. He returned to work after scans picked up no signs of cancer.

United Healthcare, Mr. Fries’s insurer, reached a deal with Moffitt for the insurer’s share of treatment, according to hospital officials, who wouldn’t reveal terms. United Healthcare says it doesn’t disclose its payments.

So far, Moffitt has treated more than 15 insured patients. “The financial realities of this have not been what we expected,” says Yvette Tremonti, Moffitt’s chief financial officer. “We’re not losing money, but we are certainly not making money.”

The problem, hospitals and insurers say, is the new treatments don’t fit neatly into the existing framework in which insurers pay hospitals for care.

Traditionally, hospitals get a lump sum for care they give in the hospital, including drugs, or a payment for outpatient infusing of a drug that covers extra costs. But hospitals say

“What is the incentive then for hospitals to provide these therapies, which are complicated and require a large investment of time and resources, if there is not a way to at least recoup costs?” says Aaron Chrisman, director of Stem Cell Transplant and Cellular Therapy Administration at the University of Chicago Medicine.

Insurers don’t question the benefits of the treatments but say they are affordable only if the cost is spread over time. There is currently no payment mechanism to do so.

“We either need to accept we are going to see a bump-up in premiums—which I don’t think we want, honestly–or we have to figure out how to pay for them over time,” says Michael Sherman, chief medical officer of Harvard Pilgrim Health Care Inc.

The federal government’s Centers for Medicare and Medicaid Services hasn’t said whether it will cover the drugs, according to hospitals. The decision is left to contractors around the country that process Medicare claims, only some of which have said Medicare will pay. Hospitals have been lobbying for a reimbursement pathway.

CMS has taken steps toward developing payments to cover CAR-T and is working on more, a spokesman says. On Tuesday, the agency proposed changes for fiscal year 2019 that hospitals say would help cover more of their costs associated with providing the new therapies.

Kathryn VanGilder, a retired teacher from Fairmont, W.Va., who is on Medicare, says she struggled to find a hospital to provide treatment, partly because of uncertain reimbursements.

The James Cancer Center at Ohio State University eventually gave her Yescarta in January, Ms. VanGilder says, after she got U.S. Sen. Joseph Manchin’s help in getting a letter from a Medicare contractor stating it would review payment after treatment. The hospital said it treated Ms. VanGilder even though Medicare won’t cover all of its costs.

“In the six weeks I waited,” says Ms. VanGilder, 66, a small tumor in one lymph node “had spread all through my abdomen and throat.” She says her latest tests showed the cancer was eliminated.

Gilead reported $7 million in sales from Yescarta during the final three months of 2017, while Novartis said Kymriah had $12 million in sales during the first quarter of 2018. Spokesmen for both companies said they are working with government and private insurers to make sure appropriate patients get the new drugs.

Write to Jonathan D. Rockoff at Jonathan.Rockoff@wsj.com

Appeared in the April 27, 2018, print edition as ‘Gene Drugs Inflict Sticker Shock.’

 

How To Get The Best Results On Your ParaMed Exam For Life Insurance

By | Life Insurance

Great! You’re  scheduled for a paramedic exam so you can get the best rates on your new life policy!  Here are some life-insurance-medical-examtime-tested tips to help you ace the exam:

Be well rested-

  • Schedule exam in morning before your breakfast for a natural fast of 9-12 hours without food.
  • Do not drink anything but water before your exam.
  • Do not drink alcohol the night before
  • Make sure to take all medications- on schedule per doctors orders- NO need to hide blood pressure or cholesterol medications.
  • Do NOT perform a vigorous  exercise for at least 24 hours before the exam–
  • Do NOT take ANY type of Protein Supplements for at least 2 days before the exam
  • Of course, it goes without saying to be mindful that you will be tested for drugs that are not of prescription nature, as well as for tobacco- tobacco shows up at least 3 days since last use.
  • In addition, in the rare event that you need an EKG ( heartbeat test) make sure to remove all metallic jewelry.

Men Specific:  Please do not have “relations” or ejaculation for at least 24 hours before your exam –  This raises your PSA level and may provide a false reading.

Woman Specific:  Please do not schedule your exam near your monthly menstruation.  Doing so may cause you to flunk your urinalysis due to blood cells found in urine.

Most important -relax- and remember it is NORMAL for the examiner to take your blood pressure 3 times not just once.

Be well,

Mark

Why you need a Will and Life Insurance that provides a lump sum of cash for Critical & Chronic Illness

By | Life Insurance, Living Benefits

Death and serious illness are two life events that tear families apart…and can leave scars that last for generations.Do you have a will?

We’re going to show you an affordable, trusted way that you can minimize the family devastation that these two inevitable events can cause.

Don’t make the mistake of not making these critical family protection choices: a will and Life Insurance that provides lump sum cash for Critical & Chronic Illness.

First, let’s talk about 12 consequences of dying without a Will (then we’ll talk about becoming critically ill without a Living Will).

Many people put off writing a will because they believe it will be costly or difficult, that it’s unnecessary because their possessions will automatically pass to their spouse or children, or simply to avoid thinking about their own death. Yet writing a Will is critically important for all adults regardless of wealth, marital status, or age (and in many cases the writing of a will is FREE!). Here’s why:

  1. Without a will, someone must be appointed to act as an administrator of your estate (an “executor”). This means added, unnecessary delay, expense, frustration, and even loss.
  2. There’s no opportunity to select guardians. Every parent knows how important it is to make sure that your children are in the hands of someone you trust.
  3. There is no opportunity to provide for burial preferences. It’s a tough topic to discuss so outlining your preferences in your will may be the perfect solution.
  4. Your children may not receive the amount you wanted, when you want them to receive the funds.
  5. The Probate Court is involved in the administration of your children’s share if they are minors. This means the government will decide your child’s financial future. The government will also take a portion of your estate, as their fee.
  6. Certain assets that you may have wanted to be kept for your family’s security or for investment purposes may have to be sold. (Make sure the estate is properly funded with Life Insurance that also provides for your care if you become critically ill – otherwise you may drain your estate, leaving your loved ones with nothing.)
  7. In the event of a common disaster (where your whole immediate family passes away), your estate may go to a relative that you may have never spoken to, or don’t even like.
  8. Common law relationships or same sex relationships may not be recognized by the state. This means that your significant other may not receive anything from your estate upon your death.
  9. You are unable to take advantage of tax savings and save money on lawyers and court costs following your death. We’re amazed the clients can set up a Will for free – by going here – as opposed to how much legal fees can cost when there are problems with an estate.
  10. Do you want your estate to go to your grandchildren if their parents predecease you? Only a will can properly indicate what is to happen in the event a family member dies.
  11. When there is something of significant value like a business, it is so important to plan ahead to avoid potential conflicts.
  12. Ultimately, without a will, you are unable to exclude or include beneficiaries. You must depend on the law and the government to decide the economic fate of your family and loved ones.

Now let’s talk about a living will. This a directive to physicians and other healthcare providers specifying your wishes with regard to specific treatments or procedures to be used in the event of your incapacity. A living will becomes effective only when you are unable to express your wishes.

The purpose of a living will is to make your intentions known, so that your family and your doctors will be able to lawfully act in accordance with your wishes. Once completed, discuss your wishes as reflected in your living will with family members, and be sure they have a signed copy. A living will, or advance directive, is not a part of your Will, and must be completed separately.

The last item is having a Life Insurance policy that includes a lump sum payment in the event of critical or chronic illness.  

In a previous blog we shared a true story of one of our clients – and how Living Benefits Life Insurance protected his family from the financial devastation of a critical illness.

Living benefits term life insurance policies can be purchased with one or more riders, which will pay you money while you’re still alive if:

  • You’re terminally ill. You can receive a portion of your death benefit in advance, for help with medical expenses, one final around-the-world fling, or whatever.
  • You’re chronically ill. Frequently you’re considered chronically ill if you can’t perform several of the six activities of daily living, such as getting out of bed, feeding yourself, bathing, and so forth. You can receive a portion of your death benefit in advance, in situations like this.
  • You’re critically ill. That could mean you’ve been diagnosed with a heart attack, stroke, cancer, end stage renal failure, major organ transplant, or some other pretty grim illness. Again, you can get some or all of your death benefit early – in time to be of some use to you.

To sum up:

Writing a Will doesn’t have to be complicated or expensive. This site provides a free and simple way to compose your own legal Will online in a few easy steps.

While you’re creating your will, let us help you fund your estate with Life Insurance as well as provide you a lump sum of cash for Critical & Chronic Illness through the benefits of a Living Benefit plan.  Contact us today! 1-800-257-1723

 

How to Protect Your Retirement by Making Health Insurance Part of Your Retirement Planning

By | Health Insurance

Health insurance is as important to your retirement security as home and auto insurance. That’s because costs of major health issues, like the cost of a catastrophic accident or losing your homeHealthLifeDental Insurance Retirement Planning to a fire, if not insured, could wipe you our financially.

But unlike home and autos – which can be paid off and considered assets, your health is never paid in full – and estimates forecast that the average 65-year-old couple can expect health care costs of more than $275,000 in their retirement years. Unless your retirement package includes ongoing coverage and guaranteed eligibility for supplemental insurance, many people risk spending the bulk of their retirement savings on the aftermath of a major medical event.

With some careful planning, it’s possible to avoid that dreary future and focus on enjoying retirement rather than the effect of potential claims on a fragile nest egg.

Why Health Insurance Matters In Retirement

Wondering why health insurance should be a part of your retirement planning? Let me explain:

The future of healthcare is uncertain. With the proposed changes to mandated health insurance coverage and programs pulling back from the Affordable Care Act, Americans about to retire find themselves in a gray area for health insurance. Many don’t have coverage and are worried about choosing a provider amid such uncertainty.

Few companies provide health insurance in retirement packages. According to the Kaiser Family Foundation, employer-provided coverage won’t be as much help to retirees as it used to be. Its research indicates that only 25% of large employers even offer retiree health coverage, compared with the 40% of employers who offered it in 1999.

Additionally, the current administration’s intent to amend the ACA is clear, but the details of its plan to change federal insurance laws are not. For anyone nearing retirement, the potential impacts to insurance coverage and costs should be of special concern. For instance, the reintroduction of high-risk pools for pre-existing conditions could lead to declining coverage and higher premiums for many.

Potential tax consequences exist for not having health insurance. While the Republican Party’s most recent attempt to overhaul the American healthcare system failed, the issue still tops the party’s to-do list for 2018. One of the proposed changes the GOP has loudly touted in past health bills is the elimination of the penalty for not having insurance.

While the fine no longer exists, two recent versions of the bill suggested people without insurance for more than 63 days would have to pay a 30% premium penalty or forgo coverage for six months.

Here’s the point: no matter how well-thought-out a retirement plan is, failure to account for insurance needs puts a financially secure retirement at risk.

Preparing For a Healthy Retirement

The clear path to a healthy and full retirement requires considering what you might need in the years to come – and approaching health care insurance knowing that our Healthcare System is, to say the least, full of uncertainty. Use these three strategies to create a thorough plan:

  1. Do your research.

Learn the pros and cons of today’s insurance options. You might qualify for Medicare Part A, but Medicare Part B could cost you an out-of-pocket premium. Keep in mind that out-of-pocket costs for premiums increase without employer supplementation. What was once a $250-per-month premium can quickly skyrocket into a $1,000-plus payment for the same coverage.

When you get serious about planning for retirement, we can work with you to help you predict what your out-of-pocket premiums might be. Based on that we can help you allocate funds between savings and a Living Benefits Health Insurance Policy to insure that you can comfortably meet those predictions.

  1. Know your risks — and make sure they’re covered.

Know your specific health risks, and know which currently available insurance options cover them. This will serve as an excellent guide to planning for healthcare needs in retirement. If you’re in excellent health and have no risk factors or history of life-threatening illnesses, it might seem like a good idea to focus solely on coverage for major medical events. That strategy could cut down expenses, but it also leaves a significant gap in coverage.  As professionals with a long-standing track record for successfully protecting our clients, we can help you with this.

The goal is to cover as many bases as possible. Even something as simple as appendicitis could cost more than $55,000 — Without the right insurance policy, the experience could be catastrophic, both financially and emotionally.

  1. Prepare for the worst.

If you buy life insurance for the worst-case scenario, then why not plan for the aftermath of such a scenario? Medical bills can stack up after a major medical event, and in the worst-case scenarios, those bills are often left to family members. Some people might view the discussion about insurance as taboo. But, practically speaking, it’s worse to avoid the discussion and fail to plan.

Making sure the whole family is prepared for the worst can be difficult, but it’s absolutely necessary, and part of how we help our clients protect their loved ones.

When I speak with professionals who haven’t added their health care needs to their retirement planning, they’re often as surprised as I am that they haven’t considered it. The point of retirement planning is to enjoy your golden years, and you can do that more effectively if you aren’t worrying about how to cover medical expenses.

Call us now at 1-800-257-1723 or click here for an appointment.

 

Based on Daniel Wesley’s recent article in Forbes