And Now for Something Completely Different . . .

. . . real news for a change about public health around the U.S, posted at the WSJ Healthblog.

The article contains a link to the results of the study; click on any state to see that state's data summarized by county, with comparisons to statewide and national U.S. averages.

One of the commenters brilliantly points out that the report classifies being "uninsured" as a "clinical care" factor, and inquires what the ICD-10 code may be for uninsured.

Any InsureBlog reader happen to know?

Channeling Elvis . . .

Depression and the $17 Diagnosis

Depressed? Are you a senior on Medicare? Are you depressed because you are a senior, or depressed because you are on Medicare or simply depressed because you are a senior on Medicare?

This is an election year. Candidates on both sides use seniors and Medicare as a political football. Each side blames the other as the bad guy (or gal) who, if elected, will cut your Medicare benefits and appoint a death panel to make sure you don't bankrupt Medicare by expecting the taxpayers to fund all your health care bills.

It's enough to get anyone down.

Kaiser Foundation reports that, coming in October, Medicare will begin paying doctors to diagnose depression.

Paying doctors to screen for depression -- Medicare's going rate is $17.36 per person -- may well increase how often they do it, say experts.

Seriously?

A $17 payment will result in more diagnoses?

Seems a bit of a stretch to me.

Most primary-care practices that screen for depression use a tool called the patient health questionnaire. The PHQ-9, as it's called, asks people to describe how frequently during the past two weeks they have felt down or hopeless or taken little interest or pleasure in doing things. It also asks about sleep patterns, appetite and concentration, among other things. Although the test can be taken in just a few minutes, a 2001 study indicated it identifies depression and pinpoints its severity nearly 90 percent of the time.

The good news is, this simple test has a high success rate.

The bad news is, with Medicare low reimbursement rates, how many docs are willing to spend a few more minutes with a patient who may or may not be depressed, in exchange for $17 when there are patients in the waiting room that are more profitable.

SCOTUS vs. Obamacare - April Madness

The Obamacare playoffs during March Madness have spilled over in to April. El Presidente, the former constitutional law professor, has this take on SCOTUS vs. Obamacare.

Obama suggested that the high court would be guilty of “judicial activism” if it overturned the law. He also argued that the justices should uphold the individual mandate, saying it’s a key — and constitutional — piece of the law.

“We are confident that this will be upheld because it should be upheld,”

Well there you go.

He said it, he believes it, that settles it.

Why not just abolish the Supreme Court? This administration (and many members of Congress) have already trampled all over the Constitution. Why not reduce the three branches of government to just two.

Or perhaps, only one.

The Executive branch . . .

“I think it is important and I think the American people understand, and I think the justices should understand that in the absence of an individual mandate, you cannot have a mechanism to insure that people with preexisting conditions can actually get health care,” he said.

At the risk of sounding redundant, pre-existing conditions does not preclude someone from getting health care. If it did, doctors and hospitals would only exist for healthy people.

As for the mandate, citizens in every state have the ability to purchase health INSURANCE absent a mandate so his comment is not only patently false but ignorant as well.

Overturning the law would be “an unprecedented, extraordinary step” since it was passed by a majority of members in the House and Senate,” he said. “I just remind conservative commentators that for years we’ve heard that the biggest problem is judicial activism or a lack of judicial restraint. That a group of people would somehow overturn a duly constituted and passed law. Well, this is a good example. And I’m pretty confident that this court will recognize that and not take that step.”

The law was passed by only one party . . . the Democrats. So the Democrats are right and everyone else is wrong?

Now the Supreme Court is just "a group of people". He just confirmed what many have suspected and vocalized. He has contempt for the Constitution and the Supreme Court (unless they rule in his favor).

Sounds to me like Chairman Obama is living proof of a statement made to Richard Wolfe back in 2008. "You know, I believe my own bullshit".

Yes you do.

Medicare Opt Out

Medicare options at age 65. Automatic enrollment in Medicare? Yes, and no. You have Medicare options but you may not want to exercise them.

The folks at Consumer Reports offer this Q&A on Medicare options.

Q. I’m a candidate for high national office who just turned 65. I’m not signing up for Medicare because of my political convictions. Is there any downside to this?

A. OK, I made up this question, but it’s true that, according to several news sources, Republican presidential candidate Mitt Romney, who turned 65 on March 12, is not enrolling in Medicare but rather continuing to be covered under his current private insurance plan.

Is there, in fact, any downside to not enrolling in Medicare when you turn 65?

Yes, several.

1. You will be penalized later if you change your mind. Your Medicare Part B premium will be 10 percent higher, for life, for every year you could have been in Medicare, but were not. Similarly, your Part D drug plan premium will be 1 percent higher for every month you could have had a plan, but did not. With a reported income in 2011 of nearly $21 million, Romney may not care, but you probably will. (The rules are different for people who have group health insurance through their own or a spouse’s active employment at a job. Here are details if this is your situation. )

2. You may have to give up your Social Security benefits. This startling possibility arose last month when the U.S. Court of Appeals for the District of Columbia Circuit affirmed a lower court ruling that said if you want to get a monthly check from Social Security, you must be enrolled in Medicare Part A. Or, to put it another way, if you want to turn down Medicare, you’ll have to turn down Social Security as well.

3. Your existing individual policy is likely more expensive than, and not as good as, Medicare. Surprisingly, if you have an individual health plan (as opposed to a group plan through your job or a spouse’s job), you can keep it once you turn 65. But it will cost you, especially considering that Part A, the part of Medicare that covers hospital care, is free for anyone who qualifies for Social Security retirement benefits. “Generally what you pay for Part B, Part D, and Medigap is going to be the same or less than what you’re paying for individual coverage, and the benefit package might be better, because a lot of individual plans today have very high deductibles,” says Bonnie Burns, a Medicare expert with California Health Advocates, a nonprofit advocacy group. Also, on Medicare you can see any participating provider, whereas almost all private individual policies restrict you to some type of provider network.

4. You may find it hard or impossible to purchase new individual coverage. Individual coverage becomes increasingly hard to find the older you get, mainly because older adults are more apt to have pre-existing conditions. Moreover, because the overwhelming majority of Americans take Medicare at age 65, “there really isn’t a robust private individual market for individuals that age,” says Mila Kofman, an insurance expert at theGeorgetown University Health Policy Institute.

For instance, Ann Romney, the candidate’s wife, has multiple sclerosis, a serious pre-existing condition that in most states would disqualify her completely from purchasing private insurance. But the Romneys live in Massachusetts, where—thanks to a health reform law that Romney himself signed when he was governor—insurers are not allowed to turn down customers or charge them sky-high rates based on their health histories. A couple with their birth dates, living in their Belmont zip code, can buy a generous comprehensive plan for around $1,500 a month.

Well, not everyone has Romney's wealth, nor do the live in Massachusetts.

Even if you do live in Mass., you will need a big pot of money to buy health insurance. Thanks to RomneyCare, citizens of Massachusetts pay some of the highest health insurance premiums in the country.

And yes, you can expect the same if Obamacare is not overturned by SCOTUS, or repealed following the 2012 election.

Exploring your Medicare options, including enrolling in Medicare at a later date, may not be in your best interest.

Do we really have an affordability crisis?

"Americans spent nearly $1.5 billion for a chance to hit the jackpot, which amounts to a $462 million lump sum"

Where did $1.5 billion come from in 4 days?

We can't afford our healthcare but we can gamble away $1.038 billion in four days?

We don't have an affordability problem we have a priority problem. Until we view it as such we won't have any realistic solutions.

If we eliminated $100 billion in health care spending annually where would that money go? We assume it would lesson the debt, improve education, or go to some other worthy cause. Do we have anything to support that desired outcome?

Washington has never shown any problem spending money if it was available or not.

No matter how much we fund education it gets worse every year.

It is just as likely that any savings would be spent on more foreign imported electronics, maybe houses bigger then our already largest in the world. Maybe we would smoke more or drink top shelf instead of draft. If you look at our spending as a whole we sure don't appear to be suffering from a crimped budget. If we are going to blow the money on something healthcare is better then smoking, drinking, or gambling.

SCOTUS vs. Pelosi

Rep. Pelosi. Constitutional law expert. Rocket surgeon.