Consumer Directed Healthcare

Leslie Wines, writer for Market Watch, penned this article on President Bush call for a reform of the tax code to create a standard deduction for all Americans with Health Insurance.

“The reform would end a disparity that forces persons who pay for their own insurance to pay more taxes than those who are insured through their jobs, he said.

“Today, the tax code unfairly penalizes people who do not get health insurance through their job,” Bush said in his weekly ratio address. “If you buy health insurance on your own, you pay much more after taxes than if you get it through your job.” Read the address.

“I proposed to end this unfair bias in the tax code by creating a standard tax deduction for every American who has health insurance,” Bush said.

Bush said that, for example, every family that has health insurance could get a $15,000 deduction on their taxes. Such a deduction could also apply to payroll taxes, so that even those who pay no income taxes would benefit.

“Americans deserve a level playing field,” he said.” If you’re self-employed, a farmer, a rancher, or an employee at a small business who buys health insurance on your own, you should get the same tax advantage as those who get their health insurance through their job at a big business.”

The president said that health care costs are rising twice as fast as wages, making it difficult for working families to afford coverage.

“These rising costs also make it harder for small businesses to offer health coverage to their employees,” he said. “We must address these rising costs so that more Americans can afford basic private health insurance.”

“Bush said he has been speaking with citizens about health care reform and next week will visit a Tennessee to speak with people who do not have access to basic affordable health insurance.”

What are we missing here? It sounds good. The uninsured numbers are forcast in the 47 - 50 million range. Would this help the uninsured. Where do we get the dollars to fund this tax deduction? Do we cut Medicare and Medicaid?

Dr. Pat Saber has a great web site, www.peertrainer.com go out and take a look. The following was taking form one of the posting on her site. It is a great read:

The Internet has changed the way we do so many of life’s routine activities. We shop on-line for clothes, food, birthday presents (thank heavens–no more going to the post office), insurance, dates, and new friends. The list of things we can do and get on the net just goes on and on. PEERtrainer (www.peertrainer.com) has joined many other websites as a convenient, fun way to meet people with common interests and goals. It offers peer support and accountability with 24/7 convenience, and if desired, anonymity. And the Internet is changing the face of health care as well. I belong to Kaiser Permanente, an integrated health care system that makes it easy to make appointments on-line as well as to refill and have my medications mailed to me. I can get my lab results via a secure website and I can communicate with my physician via email.

But I never thought I would be able to get health and wellness services on the web. This weekend, I was at a medical conference and learned about an amazing new website: www.keepyoursight.com. A young ophthalmologist, Sean Ianchulev, described how his company, Peristat Group, has developed a way to screen for glaucoma on-line. Now, I guess I am a little out of date. My first thought was, “How are they going to deliver that little puff of air to my eye via the web?” Of course, that is not the only way to screen for glaucoma anymore. Rather, machines that test your peripheral vision have replaced the air puffs in many health care settings. This type of testing is called perimetry. The Peristat Group has figured out how to mimic what on-site perimetry machines do — on-line. That means, anyone can get screened for glaucoma in the privacy of their home anytime they want. It’s a bit complicated and takes some practice, but the site takes you through some simple instructions and then allows you to practice until you get the hang of it. Dr. Ianchulev tells me they built algorithms into the on-line test that help them weed out tests that are not performed properly. He also tells me they are developing an on-line test for macular degeneration, one of the leading causes of blindness in the US. Imagine, as this technology gets better and better and the test-taking gets easier and easier, glaucoma testing, testing for macular degeneration, and who knows what else, will be available to people “On Demand.”

As we move into an age where consumers are being asked to shoulder more and more of the financial burden of health care, I suspect we will see even more innovation in the delivery of services. The FDA recently turned down the request to have statins, very effective cholesterol-lowering drugs, available over-the-counter (OTC). Opponents of OTC statins worried that consumers would not recognize the rare, but serious side effects of these relatively safe medications. However, such dangerous drugs as aspirin and acetaminophen (e.g., Tylenol) have been available OTC for decades. I can’t tell you how many people I treated for overdoses of these benign drugs during the years I practiced emergency medicine. I think the argument of having to protect the public is one that will not hold up in the long run. Combine the use of home testing electronic devices with great interactive web-based programs, OTC availability of cholesterol-lowering drugs and blood pressure-lowering drugs, and on demand lab testing (available in many states) and you now have a way to get treatment of these common conditions to millions of people who are now untreated or undertreated… and for a fraction of the cost.

I think innovations in health care delivery, such as these, are very exciting, but also threatening to the same folks who have been promoting “Consumer Directed Health Plans” as the way to save the disintegrating American health care “system.” But, hey, if I have to pay for it out of my pocket, I am going to get what I want, how I want it and when I want it. If I can get it for free on the net in the middle of the night, I say, bring it on. “Health On Demand,” — now this will usher in the age of real consumer directed health care.

President Bush signed H.R. 6111, the Tax Relief and Health Care Act of 2006 on December 20, 2006. This new tax law expands and creates improvements in the current HSAs laws.

First, it allows HAS users to roll money over from other tax-favored accounts, such as their companies health reimbursement accounts, individual retirement accounts, and flexible spending accounts.

The law also increases HSA annual contributions limits. The existing law stipulated users could make deposits totaling the amount of their health insurance policy deductible over the course of each year. Now, as long as the insurance policy qualifies for HSAs, users may contribute the maximum $2,700 per family for an individual or $5,450 for a family.

Current law requires employers to contribute the same amount to all workers HSAs. Under the new law, employers will be able to contribute more money to the HSAs of lesser-paid employees. The treasury department will publish cost-of-living adjustments for HAS contributions and deductible amounts in March, rather than August.

How popular are HSAs? In late 2004, about 500,000 individuals had them; currently more than 3 million use them. Where are they going form here?? What is there in the market place that will displace the momentum toward consumer directed healthcare? Will tax relief and tax savings be enough to propel the movement forward??

There are scholars that are saying essentially “that over time Americans would have less time and more money to deal with their healthcare (and lives as a whole)….based on the growth of income and wealth of high paid Americans verse the average.” As a result, we begin to see physicians clinics who are converting their practices into concierge services.(www.virginiamason.org) These services are many and varied types. They are focused around Primary care types of services. For example, Virginia Mason in Seattle, has creates a boutique practice where for $3,000 dollars a year, it offers individual subscribers 24 hour access to internists by Mobil phone or e-mail, as well as house calls and office calls by physicians. It has signed up 850 people.

Greenfield systems in Portland Oregon, for a mere $350 dollars per year offers similar services, which includes extended phone call and e-mail consultation plus the promise of an appointment the next day.

As we begin to see more and more providers create self payment systems, what does this say for the Consumer Directed Healthcare movement (HSAs). Will we begin to see a system where the deductible is fully in the control of the Consumer who has the ability to manage their healthcare and the system that delivers such? How will the HMO and managed care plans react to this? Is there a future for “Concierge Medicine”?

The so-called Baby Boomers are aging quickly. The current system—if we have affordable access to it — is extending our lives through more effective (and much more costly) treatments in almost every area. In fact the healthcare industry, particularly the pharmaceuticals, is driven by the enormous profits available from selling drugs that maintain some semblance of youthful performance in the face of aging. (I believe I read quote form Hugh Hefner on his 80^th birthday that with Viagra, “80 is the new 40”). This extension of both length and quality of life for those with wealth diverts resources and talent into those areas, diverting them from health care to the poor—both here and in developing nations.

I’ve read a number of studies that document the rather profound gap between rich and poor in this country on measurements of quality of care and heath outcomes. Much of this is because our healthcare system is based on treating disease in a free enterprise model. Treating the diseases of the affluent aging is the most profitable. We have a very under-developed and under funded Public Health System, and very little infrastructure to implement community health approaches to health care.

Our current system costs about 16% of GDP (2-2 ½ times that of other developed countries with more effective systems overall), in the context of 47 million uninsured and increasing numbers of immigrants placing more pressure on this system.

What can or should we do about this? What is the relationship between healthcare and justice? What would it take to move toward public health models that are more just, given that the multi-trillion dollar health care industry is based on the treatment of disease for those who can afford it?