In the things-to-consider-for-the-sake-of-considering-them category, take a gander at this story from the May 27 edition of The Boston Globe: 

After healthcare reform was made law in Massachusetts in 2006, the number of newly insured patients in the state started to grow, and so did the demand for care. The demand, coupled with a longstanding shortage of primary-care physicians, is creating a real crunch for community clinics, say advocates of healthcare reform as well as area medical professionals.

About 80 percent of the new patients at a community health clinic who are covered under the state’s new health insurance program were formerly uninsured, a clinic supervisor told the newspaper. The result is a lengthy waiting list.

Clinics the newspaper contacted have had difficulty recruiting doctors.

‘What Chapter 58 has done is highlighted the crisis and the problem that we have with the primary-care workforce,’ said Dr. Bruce Auerbach, president of the Massachusetts Medical Society. According to a study conducted in 2006 by the society, 53 percent of patients who had an appointment with a primary-care physician were able to see a doctor within a week of initiating contact. Last year, only 42 percent were able to see a doctor within a week. …

Critics have said healthcare reform should not have been attempted without first addressing the workforce shortages, said John E. McDonough, executive director of Health Care for All, an advocacy group that helped craft the healthcare law. …

Healthcare advocates and providers say that the real problem is that the state underestimated the number of residents without health insurance. …

According to Jon Kingsdale, executive director of the Commonwealth Health Insurance Connector Authority, which administers the new health law, 340,000 people who had been mostly uninsured were covered through the state’s program as of Jan. 1. Of that number, about 110,000 have bought private insurance through Commonwealth Choice. But, he said, the remaining 230,000 people have MassHealth or Commonwealth Care, the state’s subsidized health insurance programs.

One thing that’s unclear is why the formerly uninsured choose the types of clinics mentioned in the story when it looks although they could go to any doctor. Maybe they can’t, or maybe the story didn’t address it.

Either way, the unintended consequences of insuring hundreds of thousands of people are worth considering.

Thoughts? Leave a comment on this blog.

Jeff Raymond, Medical Writer

After taking a hiatus from The Medicine Bag, I have returned … with a question.

Do you think it’s fair and/or accurate to see Oklahoma ranked at or near the bottom of, well, just about every study of health that comes our way? We can’t be worst in everything health-related, can we?

I say this after reading about Wednesday’s report from The Commonwealth Fund. The nonprofit ranked children’s health in states on 13 indicators that included access to and quality of care, outcomes, equity and cost.

Oklahoma pulled up the rear. Fifty-first. Behind the District of Columbia and Mississippi. Leading the rankings were Iowa, Vermont, Maine, Massachusetts and New Hampshire.

Now, I know the devil’s in the details, and I admit I haven’t looked at the methodology of this report. I usually do, however, which is why I ask about the fairness of all this. I imagine this report would pass muster if you agree what it measures accurately sums up the state of children’s health.

Ah, here’s where it gets tricky: Are the measures used fair? Are small differences in rates or percentages blown out of proportion? Is the information current, or as current as possible?

See the state’s “scorecard” for yourself here.

The interesting thing about these reports is they are all largely slicing and dicing the same data. Sometimes it gets hard to tell them apart.

Anyone who honestly assesses the state’s health will find huge problems. But last or near-last every time? Perhaps I’m becoming desensitized, but my reaction is getting to be “C’mon!?!”

What’s yours? Tell me what you think by posting a comment on this blog.

Jeff Raymond, Medical Writer

 Is retirement going to be a luxury for thirty- and forty- something workers? I increasingly think it will be, and a new estimate from investment giant Fidelity does nothing to dispel that.

A 65-year-old-couple retiring this year will need approximately $225K to cover medical costs in retirement, Fidelity estimates. Let’s not lose sight of the fact that this is in addition to the coverage available under Medicare, which may itself not be available when I and others retire.

The hypothetical retirees will still have to have enough money to live, either independently or in long-term care.

Perhaps what’s even more sobering than the estimate is its growth since 2002 — 41 percent.

The roughly 6 percent annual growth in the Fidelity projection about matches the growth of my 401K fund during a slow year. I know that doesn’t take into account contribution matching and interest compounding, but I think it raises a worthwhile point nonetheless.

And health care costs show no signs of flattening or decreasing.

Does paying for retirement terrify you as much as it terrifies me? Leave me a comment at http://blog.newsok.com/health.

Fidelity recommends:

- Creating an individual retirement plan

- Starting early and maximizing opportunities to save

- Assessing health status and becoming a smarter consumer of health care

- Determining details of any employer-sponsored coverage

- Understanding the financial impact of health care costs on Social Security income

Jeff Raymond, Medical Writer

One in four Baby Boomers incorrectly thinks they have coverage for long-term care expenses, according to survey results from American’s Health Insurance Plans.

The survey found that many Baby Boomers have misconceptions about who pays for long-term care services.

If you are still unclear on all this, Medicare does not pay for long-term care. Medicaid does, but only for those who are poor or who have spent down their assets.

“This should be a wake-up call to Baby Boomers. They aren’t factoring expenses for long-term care into their retirement planning and are missing an opportunity to protect themselves,” Karen Ignagni, president and CEO of the insurance group, said in press release.

Spoken like a true insurance industry representative, but she nonetheless makes a good point.

The survey also found:

-Even among Baby Boomers nearing or at age 60, only one in four feels “very familiar” with long-term care insurance.

-Thirty-percent of Baby Boomers think they have coverage for long-term care expenses. Most likely do not.

-Fifty-four percent of Baby Boomers think Medicare will pay for long-term care.

Now, I realize these surveys are often commissioned by insurance companies that have a vested interest in selling policies. I also know firsthand that long-term care insurance is laughably expensive for a person my age — my only point of comparison. Maybe it will be a better value when I near retirement.

Just for the record: I’m not interested in buying insurance. Call me in 30 years or so.

To learn more, visit www.ltcchampions.org or www.ahip.org.

Jeff Raymond, Medical Writer

A recent policy brief from the Kaiser Family Foundation intriguingly dealt with the effects of well-documented medical insurance premium increases and cost sharing on senior citizens and young workers.

“This analysis examines the relative burdens of out-of-pocket spending on seniors and younger adults,” the Kaiser Web site said. “Seniors consistently spent a larger share of their income out of pocket on health care than younger people. Given the persistent differences between young and old, it suggests that even with Medicare’s prescription drug benefit, significantly narrowing the wide gap between seniors and younger adults in their out-of-pocket spending burdens is unlikely.”

Some things the report mentions:

• From 2000-05, average in-network deductibles for PPOs (as opposed to HMOs), almost doubled, while average monthly premiums for family coverage rose by two-thirds.
• During the same time frame, median (the point at which half of all families earn more and half earn less) family income rose by about 10 percent.
• During the same time frame, Medicare Part B premiums rose by 72 percent, while premiums rose by 35 percent for a popular “Medigap” plan.
• In 2003, median per-capita health care expenditures were five times higher for seniors than for others.

“Our findings document a persistent gap in financial burden between young and old which could have important implications for ongoing policy discussions in several areas, including the generosity of coverage for working age adults, rising health care costs, entitlements and more fundamental questions about the appropriateness of shifting more costs onto consumers,” the report states.

The main thing to keep in mind is that this cost growth shows no signs of stopping. Any thoughts? E-mail me below.

Jeff Raymond, Medical Writer

I spoke to Steve Anderson, a research fellow with the Oklahoma Council of Public Affairs, today about Census data released this morning that showed an increase in Oklahoma’s poverty rate.

Part of the American Community Survey, which, to my understanding, replaced the Census ”long form” so many Americans loathed, the “poverty report,” as one Tulsa advocacy group called it, is an annual assessment of cities and states’ income. A related report included statistics on health insurance.

Anyway, if you read Wednesday’s paper, or check the Web, you’ll get all this.

What interested me most about the conversation with Anderson, a certified public accountant with a wide knowledge of state government, was his assertion that the rate of uninsured Oklahomans may not be as accurate as is normally portrayed — either numerically or qualitatively.

Anderson said the Census didn’t count American Indians who receive tribal health care. Nor did it reflect those who choose not to have health insurance — the young and fearless, for example. Or those who just aren’t responsible.

I haven’t been able to research his tribal health care claims, and if I have run across statistics on people shunning health plans they can afford, I have long since lost them. However, the bigger picture is more important: Are we making a public-policy crisis out of a problem? If so, to what end?

I’m not weighing in one way or the other. I just think it’s wise to consider things we repeat and take as truth sometimes have shaky foundations. The more we repeat them, the more ingrained they become.

That many Americans are uninsured is undeniable. That they cost a lot of time, money, efficiency and are less healthy than those with insurance is also, in my opinion, undeniable. What is debatable are the scope of the problem and its solution.

On an unrelated note, if you have ever had trouble managing your cholesterol but tried to make a real effort to do better nonetheless, I’d like to talk to you. Please e-mail me by clicking on my name or call me at (405) 475-3364.

Jeff Raymond

I don’t want to announce victory in the earliest stages of a long fight, but I’m encouraged by the steps taken so far to deal with the uninsured in Oklahoma.

Baby steps, to be sure, but steps nonetheless.

The Oklahoma Department of Insurance is soliciting input from around the state about health care priorities and needs to present to a task force that may draft a core benefits plan for residents.

I know, I know … reports, task forces, blue ribbon committees … shuffle paper here, shuffle paper there, talk a lot and change little — at least that’s how I often perceive them.

 Under the clever name of Oklahoma CHAT (Choosing Healthplans All Together), Insurance Commissioner Kim Holland plans to collect information from 31 communities across the state using the CHAT computer simulation.

“The CHAT program will assess how people prioritize what health benefits are important to them when the resources are insufficient to purchase every type of coverage,” according to a news release.

I imagine the research has already been done to some extent, but the way this appears to be designed looks genuine to me.

Now, maybe I’m uncritically giving up my skepticism. After all, solving the problem of the social and economic toll of the state’s 600,000 uninsured won’t happen over night. But, I figure, from where else  than a state with a glaring, vexing problem will an innovative solution arise?

OK, Massachusetts notwithstanding.

They have beaten us to common-sense health insurance reform, but I consider the South more of a peer group.

I guess I’ve concluded that philosophical differences should not keep us from doing something; that what we do doesn’t have to break the bank and may even save money, again, philosophical differences aside; and that some sort of mandatory enrollment in some sort of plan, while it goes against my libertarian sympathies, will be needed.

Just like with 401K plans, people, even those of adequate means, won’t choose to participate in sufficient numbers for society at large to gain unless at least nudged that way, if not pushed.

At this point, I know the reform movement is more of a Doolittle Raid than an Iwo Jima, but acknowledging something must be done, even if we can’t agree on what, is a step in the right direction. And the sponsors of Holland’s project are an impressive bunch that includes Integris Health, the OU College of Public Health, the Oklahoma Hospital Association, the Oklahoma State Department of Health and The State Chamber of Oklahoma.

Strange bedfellows? Maybe. Or maybe not. It depends how you look it at.

The press conference is Tuesday at 10:30 a.m. in the Governor’s Blue Room at the Capitol.

In March, a group called Health Alliance for the Uninsured bemoaned the number of uninsured who turn to emergency rooms because free clinics were full. Or just turned to emergency rooms for basic care, which is costly in time and money and is hugely wasteful in terms of hospital utilization.

“Our 16 free clinics are overwhelmed and do not have the resources they need,” Dr. Murali Krishna, chairman of the alliance and president of Integris Mental Health, said at the time. “That leaves the uninsured with no choice but to go to the emergency room for routine medical care.”

A study presented then showed 53 percent of emergency room visits in Oklahoma County were for nonemergency symptoms.

Among clinics’ problems are getting specialists to volunteer, finding free- or low-cost drugs and locating radiology services.

Because of its location, St. Anthony Hospital deals with a number of poor, transient patients. As such, it has received assistance to put together a system to find these people a “medical home” so that they visit a general practitioner for routine care rather than the emergency room. For a patient with an HMO policy, this is a given. For the uninsured, it’s innovative, at least for Oklahoma.

I haven’t followed up on the project for some time, but it has intrigued me from the start. Will it work? I aim to find out.

As always, please e-mail me or comment on this blog. If you agree, disagree or think I’ve gone off the deep end, let me know one way or the other.

Jeff Raymond