Category: Health plans

More on MA’s Rx coverage requirement

published date
April 16th, 2007 by

I’m not that happy about the requirement that buyers of health insurance in MA will have to get Rx coverage. Seems like that lines me up pretty squarely in the corner of the health plans. As Massachusetts Association of Health Plans’ Marylou Buyse says:

It is going to take away choice from people. On the other hand, it’s going to force everyone to have what most people consider to be a very desirable benefit, at an increased cost, of course.

Well that about sums it up.

The 98 percent solution

published date
April 12th, 2007 by

Looks like Massachusetts will exempt about 1 or 2 percent of the population from the requirement to buy insurance. Their income is considered too low to be able to afford coverage but too high to receive a subsidy. Business groups generally wanted few or no exemptions while some community activists wanted broader exemptions. According to the Boston Globe

The new proposal adopts some of the recommendations offered by a coalition of advocacy, labor, and medical groups, which had argued that applying the insurance mandate to people who couldn’t afford it would undermine public support. Some had threatened to lead protests against the law.

I can understand their point, but I’d prefer if there were no exemptions. The best thing would be to get universal coverage and then have “public support” to do what’s needed to reform the system in order to keep that coverage. Instead, we may be setting a precedent for further exemptions –after all premiums are likely to continue rising faster than wages.

Still, if we actually achieve 98 or 99 percent coverage, that’s effectively a universal level.

You can’t keep a good drug down

published date
April 11th, 2007 by

With generic Zocor (simvistatin) now on the market, payers are trying to take a chunk out of Lipitor (atorvastatin calcium) sales in the statin market. It’s not working as well as some had hoped. That’s because Lipitor is widely regarded as the best drug in the statin class –further evidence that not all follow-on drugs in a class should be dismissed as “me-too” products.

It’s still worthwhile for payers to push Zocor, even if the results are modest. Statins are a big expense for health plans, so even small share shifts are valuable. Plus even if Lipitor sales hold up, other statins such as Crestor (rosuvastatin calcium) and Vytorin (ezetimibe and simvastatin) may prove more vulnerable.

Are insurance company doctors evil?

published date
March 29th, 2007 by

An article in the Sunday Boston Globe really bothered me. In “Hippocritical” Doctors, an OB attacked physicians who work for health plans. He was unhappy that they didn’t make the health plan pay for all the therapy he wanted for his daughter with cerebral palsy:

This doctor and others like him are making money denying care – and they might as well hang up their white coats. They may believe that their administrative decisions are medically justifiable. However, it often appears that they are hired because their MD degrees lend a patina of legitimacy to administrative decisions that are based on interpretation of a health plan’s policies, not a chart, lab test, or CT scan…

A physician who works for the health insurance industry told me that these doctors view themselves as having “an advocacy role for patient care.” Health plan physicians will argue that without them consumers would have no voice within the company’s walls. But I say let the businesspeople be the ones to withhold care in the name of cost savings and profit margins. Physicians are needed in the clinic and at the bedside, advocating for more care, not less.

The author shrugs off other physicians’ financial relationships with drug companies and banks, because they just damage society, “not… individual patients.”

I think the author is way off base. Remember the earlier days of managed care when doctors complained, sometimes legitimately about “being told how to practice medicine by someone from the HMO with a GED”? Isn’t it better to have a physician to speak with? Meanwhile, contrary to his statement, it doesn’t always make sense for the patient to get “more care.” It can be expensive and wasteful.

I sympathize with the author, who wants what’s best for his daughter, but health plan physicians don’t deserve the abuse he dishes out.

“What are they doing messing with me?”

published date
March 27th, 2007 by

As John McDonough notes on A Healthy Blog, the Globe published a first-rate piece profiling four people affected by the new health insurance mandate. The headlines tell the story:

  • Osmani Rodriguez: Says the state should rethink the insurance options it is offering
  • Annabelle Blake: If she had a choice, she might opt to skip insurance
  • Betty Gitlin-Rich: It’s been a long time since she could afford peace of mind like this
  • James Charles Roy: His family’s longstanding health plan is no longer good enough

The truth is health care is too expensive in Massachusetts. A good feature of mandated coverage is that it will give more people a stake in seeing that health care remains/becomes affordable. My hope is that as universal coverage comes into force there will be pressure for a restructuring of health care financing and delivery in this state that reduces costs and improves service and quality.

Meanwhile, I can definitely relate to Mr. Roy. His current insurance plans lack drug coverage, which is a rational choice on his part as I’ve described before. The new mandate requires Rx coverage and that will cost Mr. Roy an extra $1300 per year. As he says:

“The goal of universal coverage, as I understand it, was to get poor people coverage,” he added. “What are they doing messing with me?”