Healthy Policy

Goodbye, and, Health Insurance: A Primer

After my Uninsured primer earlier this week, I had a few requests to compile a profile on those with insurance.  This is also my last day blogging, so I figured a round up of my favorite health policy issue is appropriate.

Insurance has seen substantial changes and shifts in the last five years, and these are due to the explosive growth of health spending.  As costs rise ever further, employees are hurting.  The pain is dual -- due to delayed treatment for illness or lost coverage for various procedures, as well as a hole in the pocketbook that's become meteor-sized.

The basic facts:

• The average annual cost for insurance in 2004 was $3,695 for individuals and $9,950 for families.

• Employer-sponsored premiums are growing at an immense rate: 8.2% in 2000, 10.9% in 2001, 12.9% in 2002, 13.9% in 2003.

• The average monthly premium for individuals from 1988 to 2004 has increased from $8 to $47, for families it has increased from $52 to $222.  While that increase seems significant, the percent contribution has hardly gone up : in 1988 the $8 contribution was 11% of the total premium cost; today the $47 is 16% of total premium cost.  And for families the 1988 amount was 28%; the current amount is 29%.  The stats essentially tell us that while the percent employees are contributing has remained steady, the total cost has increased greatly to both the employee and employer. 

• The number of employers providing health insurance has dropped 9% in five years; from 69% in 2000 to 60% in 2005. 

• For those who have to pay them, annual deductible size has greatly increased as well.  For individuals they've increased by 60% in five years to $414, for families they've increased 67% to $861. 

• The dollar amount of co-pays is increasing as well; for HMO participants the number paying at least $20 for office visits has increased from 1% in 1998 to 22% in 2004.

• The major problem with affordable health insurance right now is the total health spending increase, which is making premiums cost more and more every year.  And as health expenditures are estimated to be $2.16 trillion in 2006, and are projected to rise to over $4 trillion in 2015, it's showing no signs of slowing. Per person health spending is $7,110 this year and is projected to increase to $12,320 by 2015.  And unless you predict your wages will double during that time, be prepared to shell out more and more.
 

• Although many policy analysts encourage greater cost sharing in the form of higher deductibles and copays, the average insured person already pays 34% of their health costs out of pocket.  Don't count on greater cost sharing to reign in the expected increase to solve our spending crisis.  Americans can only afford so much more out of pocket without forgoing care altogether, which creates crises in worker productivity and absenteeism.

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So there you have it.  The major driver of higher premiums and employee contributions to health care is the increased cost of care itself.  And while employees are putting ever more money away into their insurance premiums, they're paying no greater proportion of the total cost than they were in 1988.  It's just gotten that much more expensive.  With only 60% of employers now providing health care, we can only expect to see more cost sharing and dropped coverage, because costs are not slowing.  In fact, they're expected to almost double in just nine years. 

And that's why I started on the health policy venture in the first place -- these statistics are frightening.  Health care has become a beast, and the United States is unsure how to restrain it from eating its weight in income every day. 

But as the richest country in the world, surely every one of our citizens deserves comprehensive, affordable, and quality health care.  And while I'm leaving blogging, rest assured I'll be out there working and thinking about the ways to tame the beast, everyday. 

Better pharmaceutical safety

Commenter Martin has started his own blog, and I want to be sure to link to it before I end my tenure here.  He's got an interesting post up about a recent NEJM series debating the various conduits to improved drug safety.  What's clear from his post, and the expert's writings he excerpts, is that there's no easy answer for reforming the FDA.

In my mind, a few things need to happen.  Last year the NIH introduced a strict set of new ethics requirements.  These rules were not extended to the FDA, to its detriment, as former commissioner Lester Crawford proves quite well.

But we do have to think seriously about the question of improving drug safety in practical ways.  Many have called for more extensive/longer clinical trials.  That will delay necessary treatments for years.  A better method of ensuring safety is to simply forbid the pharmaceutical companies from operating their own clinical trials.  Study after study has shown that when corporations run their own trials the drug is much more likely to come out positively. 

These results should be public as well; it's ridiculous that we let these corporations put potentially dangerous products on the market but keep questionable safety information to themselves. 

Teen pregnancy: it's worse than you think

A new survey has found almost a third of sexually active girls aged 15-19 have gotten pregnant. 

That number really shocked me, although my shock is surely exacerbated by my upper-middle class upbringing.  Sure, I have friends who've gotten pregnant, but not many.

I recently heard the story of a girl and her boyfriend who had been having unprotected sex for over two years and she just now got pregnant.  She's 20.  The idiocy it takes to continue to take the risk of pregnancy for over 104 weeks is unthinkable.  But apparently not unheard of!

Although straight stupidity is sometimes to blame for unintended pregnancy, among teenage girls it is not the chief culprit.   Rather inadequate sex education, which often creates the impression that all birth control is faulty.  This kind of information not only prevents teens from learning the correct ways to prevent pregnancy, but it might also make them think that nothing is truly reliable and therefore worth taking the time to purchase. 

But only 11% of boys in the same age group report being involved in a pregnancy -- which alludes to the fact that most of these girls aren't telling their partners.  If more guys knew they'd gotten someone pregnant, or that their friend had, they'd be more likely to use birth control.

Stop lookin over my shoulder!

There are 90,000 drug reps in this country. 

That, and other interesting tidbits in today's New York Times article. 

Good news and bad news: reprise

HPites, it's time for some good news and bad news again.

How about the bad news first?

Sadly, this is the last week that I will be posting to this blog (or any other blog). 

The good news is I have finally secured employment!

It's never a good time to end this really, and trust me I'm sad about it.  But I'm headed to DC to find a place to live next week, so ending this week is as good a time as ever. 

I'll still be in touch via email, ksteadman at gmail dot com, and of course working and thinking about health policy.  Just not in this kind of venue. 

Writing this blog has been an awesome journey, and I wish I didn't have to abandon it.  But I won't have much time to keep it up when I'm working full-time anyhow, and now that I'm off my crutches and moving, it feels like the right chance to move on. 

And of course, how could I have done it without you, my razor sharp readers, whose visits inspired me to keep going, especially on those days I really didn't want to write anything.

I'll be taking the blog down, unfortunately, but if you ever have one of those "I remember this one post Kate wrote..." moments, email me and I'll try to track it down.
 

And of course I'll be writing tomorrow and Friday still.  And maybe a bit over the weekend out of habit. 

Pharmacy vs. pharmacy

Ah Dr. Charles.  Thank you for talking some sense about the big pharmacy business.

I completley concur with his observations on the evils of big chain vs. small pharmacies.  I had a Long's Drugs (is that only a California chain?) actually lose my insurance card, which I must say was supremely helpful when they tried to charge me full price for my medications. 

On top of that, the chain pharmacies are always unbelievably busy -- you have to wait forever for your meds, and their pharmacists seem overworked and stressed.  They don't recognize me either.  Whereas at my local pharmacy two blocks from my house in Kansas City, I ran into one of the women employees (who's at least 80 now) freshly off my crutches and her eyes almost teared up she was so happy to see I'd made progress.

It gets stranger everyday

From now on you may refer to me either as Kate, or Child-Bearing Woman.  Whichever you prefer.

Crawford and The Law -- a match made in heaven

Looks like financial holdings aren't Lester Crawford's only problem.

The former FDA commissioner failed to appear in court yesterday.  He was ordered to appear for a federally-ordered deposition in a lawsuit to press the confirmation of Plan B as an over the counter medication.  Worse, Crawford's lawyer told the press he might invoke his fifth amendment rights to avoid tesitfying. 

That's essentially an admission of guilt, although one that will probably provoke dozens of rounds of inquiry to elucidate whose ass he's covering.  Two top adivsors on the application, FDA Deputy Operations Commissioner Janet Woodcock and Steven Galson, director of FDA's Center for Drug Evaluation and Research testified that Crawford excluded them from the process of deciding on Barr's application.  That admission is extremely troubling as it illuminates the extent to which proper regulations for drug approval have broken down.

And think of the unplanned pregnancies that proceeded while these officials sat on their thumbs and refuse to show up for court.  It's sick.

La Grand Rounds

Grand Rounds is up at Polite Dissent.  Very well organized.

Joe da Man

Check out Joe Paduda's great post on the evils of Association Health Plans, and while you're at it, be sure to submit your posts for Health Wonk Review.

Lester in trouble...

The FDA's crumbling reputation continues as former head Lester Crawford (of the refusal to issue a decision on Plan B fame) is being investigated for financial improprieties.

Apparently Crawford held stock in several biotech companies while acting as head commissioner.  The explanation, namely that his decisions weren't influenced simply because he disclosed investments, isn't cutting it for federal investigators. 

I guess the ethics rules regarding NIH researchers and financial investments don't hold for the head of the FDA.  Common sense rules again over at the administration...

Attention to the Uninsured

It's Cover the Uninsured Week, so I'll be posting something on the uninsured each day.

The Robertwood Johnson Foundation released a new report last week with standardly shocking findings about the uninsured and access to medical care.

So while others will persist with their false claims that the uninsured receive care, and therefore the problem is not immediate, remember this:

• 41% of the uninsured adults reported skipping medical care because of cost last year.  This number doesn't include the 20% of children who lack health insurance. 

• 23% of uninsured adults report their health as "fair" or "poor," compared with 12% of insured adults.

That percentage will tick higher and higher while we distract ourselves from solving this problem with brave new explorations into the world of Health Savings Accounts.  As health costs continue to outpace inflation markedly and wages remain stagnant, fewer and fewer of the uninsured will be able to afford any medical care.  State and hospital funds that currently act as reimbursement for the cost of acute treatment will cover less and less. 

This trend will happen faster than we expect; insurance indicators are ticking away at incredible speed.  Just as the number of employers providing health care decreased by 9% in five years, measures of the uninsured's health status will worsen.

Foray into adulthood continues

Because I'm still fairly young, my gradual progression to Real Adulthood is still comprised of obvious markers: graduating from college, moving into my own place, getting a Real Job (still working on that one -- hopefully in the next few weeks).

Now I'm entering that world that my parents and grandparents (and the British) know all too well: a close financial relationship with your dentist.

I'm part of that generation where fluoridated water  was touted as a cure-all for dental problems.  And it was.  Sure, I still go to the dentist every six months, but I've been able to reap all the benefits of my cohort's shiny, white, natural teeth. 

I only have one filling, and might I add, it was not my fault.  The grooves in my molar were exceedingly deep, and regardless of my brushing intensity, a cavity was inevitable.  Fine -- I can live with one filling; I hardly remember the experience anyway.

Well, it was fine until that molar, my one less-than perfect tooth, cracked in half Saturday night.  Now I feel myself joining my parent's version of adulthood -- my dad confessed to me last night that he probably only has six teeth without crowns or that aren't downright false.  My mom is slightly better, though she's popped a few crowns recently and had a several root canals.  Ouch.

So now I journey to the dentist chair, which goes without saying, is one of my least favorite places to be.  My parents think it will cost $400.  Geez!  Let's hope the rest of my perfect teeth stay that way, and this is as far as I go into that part of adulthood for awhile.