HEALTHCARE BROKEN? WHO BROKE IT

Orange County Register - Oct. 24: Politicians tell us that health care in America is "broken." The best initial response to that assertion is to ask yourself whether you think that your own health care is broken. And if it is, do you want to turn your decisions about your own health over to politicians who claim they can fix health insurance? Or, if you are generally satisfied with your health care, do you want politicians to take your current care away and replace it with a uniform government system? That is what they want to do, whether you think your own health care is broken or not.

More generally, we all need to ask why politicians assert that American health care is broken, and what agenda does it serve. We should ask, if health care is broken, who broke it, and how did they break it?

Health care was much more affordable in the 1960s. The government paid for less than 10 percent of all health care. Then the federal government created Medicare and Medicaid and wrote 130,000 pages of Medicare regulations. Now the government pays for 50 percent of all health care.

Has that fixed health care, or broken it?

In the same period, state regulation of medical insurance rapidly expanded, adding many coverage mandates that each policy must comply with. In some states you have to buy coverage for electric shock therapy, or in vitro fertilization, or acupuncture, or chiropractic, or hairpieces, a social worker, marriage counselor or a long list of other things, whether or not you want such coverage. And new mandates are added all the time, driving up insurance costs every year.

Moreover, you are not allowed to buy better-priced insurance from a competing provider in another state.

Has that fixed health care, or broken it?

The government could easily make reforms that would reduce the cost of insurance without any additional spending: basic policies without mandates, tax-deductible premiums, competition among insurance companies across state lines.

Why is it, then, that the more government controls health care in order to fix it, the more expensive health care invariably becomes?

Politicians who broke health care and now complain that it is broken do not want people to be able to afford reasonable insurance. They see that as an obstacle in their path to eliminate all private insurance. They are not in favor of fixing anything, but of making us all dependent on the favor of politicians for our health and well-being.

State legislators and members of Congress have destroyed objective law and created a litigation system that is designed not to justly compensate those who have been harmed by medical mistakes but to create a gigantic and perpetual financial bonanza for a relatively small number of trial lawyers.

Liability insurance premiums have exploded and increased the cost of all health care for everyone  as has the "defensive" medicine of unnecessary tests and procedures that physicians have had to adopt to protect themselves from such legal extortion.

Has that fixed health care, or broken it?

When confronted with claims that health care is broken proffered by the politicians who broke it, the last thing we should do is give them additional powers to do further damage. Instead, we need to direct them to reverse the damage they have done, to stop forbidding the options that would make insurance affordable and to start leaving our health care alone.

More Calif. employers offering CDHPs

Business Insurance-Posted On: Dec. 19, 2008 3:05 PM CST Joanne Wojcik

OAKLAND, Calif.—The dominance of managed care in the California market led many benefits experts to doubt if consumer-driven health plans with high deductibles would gain much traction there.

But a recent survey has found that 38% of employers in the nation's most populous state now offer high-deductible health plans to their employees, up from 18% in 2007.

However, only 10% of employers offering HDHPs to their employees also offer a health savings account, while less than 1% offer a health reimbursement arrangement, according to the latest edition of the California Employer Health Benefits Survey, a joint project of the Oakland,Calif.-based California Healthcare Foundation and the National Opinion Research Center.

And even through the percentage of employers offering HDHPs in California surged, the number of employees enrolling in the plans remained unchanged from 2007 at 4%. By contrast, enrollment nationally in the plans doubled from last year to this year to 8%.

More than three-quarters of California workers were given a health maintenance organization option in 2008, according to the survey, compared with just 41% of workers nationally. As such, California workers have been consistently more likely to enroll in HMOs than covered workers nationally, who are more likely to enroll in preferred provider organization plans, the survey noted.

In California, 52% of covered workers were enrolled in HMOs in 2008, while 33% were enrolled in PPOs, 11% in point-of-service plans and 4% in HDHPs. By comparison, 20% of U.S. workers are enrolled in HMOs, while 58% are enrolled in PPOs, 12% in POS plans and 8% in HDHPs.

Among other findings of the survey:

• Employer-based health care premiums rose by an average of 8.3% in 2008, the same as 2007.
• More than half of California employers offered coverage for same-sex domestic partners, more than double the national average. Due to a change in survey wording, the 2008 results could not be compared to prior years.
• Thirty percent of covered workers in California were enrolled in a partly or completely self-insured plan in 2008, compared with 55% nationally. The gap between the state and national figures is associated with California’s high HMO enrollment since HMOs are less likely than other plans to be self-insured, the survey noted.

This year's survey, which was conducted by interview from April to July, included 796 randomly selected participants drawn from the Dun & Bradstreet list of private employers with three or more workers.

For complete results of the survey, visit www.chcf.org.

Survey Shows Consumerism Uptick in Health Benefits

Associated Press Online Tom Murphy - December 11, 2008

Years of rising health care premiums are making U.S. workers less willing to choose plans with higher up-front costs, according a survey by consulting firm Watson Wyatt.

A survey of large company employees shows that workers are significantly less willing to pay higher premiums to keep out-of-pocket expenses like deductibles and copays lower this year compared with 2007.

Only 19 percent of employees surveyed this year were willing to opt for higher premiums, compared with 38 percent last year.

Rising premiums and employers who are shifting more of the health insurance cost burden to their workers have motivated employees to look closely at what they get for their money, said Cathy Tripp, national leader of consumerism for Arlington, Va.-based Watson Wyatt.

"Some employees that have for years overpaid for coverage have now looked at how much they actually consume and realized it's not the right choice," she said.

Other employees are simply choosing the option that leaves the most money in their paychecks. Tripp also noted that benefits companies provide more tools to help workers understand their health care choices and find the right fit for them.

"I think there is an uptick in kind of consumerism in general about awareness around what you're buying," she said.

Watson Wyatt surveyed more than 2,400 workers employed by large U.S. companies last spring and compared their responses for several issues to what they said in 2007.

The study also found that 66 percent of workers took steps to improve their personal care, up from 61 percent in 2007. However, 17 percent skipped a doctor's visit this year to save costs, and an equal percentage failed to fill a prescription or passed on medicine for the same reason.

The survey had a margin of error of 2 percent, Tripp said. Watson Wyatt conducted it in May and June.

Tripp said some of the disparities in responses between this year and last may have widened since spring, with the economy continuing to falter.

"I do think in some ways satisfaction might be higher because I think some employees are just happy to have a job and benefits," she said.

OBAMA HOPES TO AVOID CLINTON HEALTHCARE MISSTEPS

The Associated Press - Dec. 6: Washington - President-elect Barack Obama and his aides are determined not to repeat the mistakes the Clinton

Tom Daschle, Obama's point man on the issue, discussed the early strategy, although details of Obama's proposals won't be finalized for a while.

Already, however, the political and public relations parts are coming into place. The strategy begins with giving people the chance to highlight their concerns and experiences. Daschle invited people around the nation to hold what amounts to house parties from Dec. 15-31.

By asking anybody and everybody to share their health care experiences, Daschle is confronting one of the major criticisms of 15 years ago: that the effort to craft former President Bill Clinton's plan for universal coverage was too secretive.

"We have to make this as inclusive a process as possible," Daschle, the former Senate majority leader from South Dakota, said in a speech in Denver.

It was his first since Democratic officials confirmed last month he was offered the job as health and human services secretary and that he had accepted.

"They are clearly trying to do it differently and help the American public see the case for reform in human terms," said John Rother, public policy director for the advocacy group AARP.

Daschle maintains the efforts to bring about universal health coverage in the first two years of the Clinton presidency took too long. In a book published this year, he urged the next president to act immediately to capitalize on the good will that greets any incoming administration. His speech and recent behind-the-scenes meetings with lawmakers and consumer groups address that point.

"We need to be on the offense," Daschle said. He cited other lessons, too. This time around, lawmakers cannot try to address every detail when it comes to legislation.

"Details kill," Daschle said. "If we get too far into the weeds, if we produce a 1,500- or 1,600-page bill, we're going to get hung up on all the details and we're never going to get to the principles."

Once Congress does take up a health plan, it also can't divert attention to other subjects, he said. "Let's not put it down, let it lie there for months and months and figure out a time when we can get back to it later," Daschle said at a Colorado Health Care Summit organized by Sen. Ken Salazar, D-Colo.

Nevertheless, any overhaul will cost a lot. During the campaign, Obama said he planned to pay for expanding health coverage in part by increasing taxes on the wealthy and requiring larger businesses to provide health coverage or contribute a portion of their payroll to a new public insurance plan. The current recession provides a significant obstacle to both options.

Daschle did not provide any details about how the incoming administration would pay for expanding coverage. Instead, he made the case that not dealing with health care would worsen the economic problems because companies such as General Motors spend more on health care than steel and Starbucks spent more on health care than on coffee.

"Health care is going to destroy many of our manufacturing industries unless we fix the system," he said. He outlined an array of problems with the current system: high costs, lack of access and mediocre quality. He said the myth has long been that the U.S. had the best health care system in the world, but statistics and an increase in medical tourism show that is not the case.

Health insurers put out their own plan this past week and it mirrored some of Obama's proposals, including expanding programs such as Medicaid to help out the poor. But the insurers want to require that people buy insurance, while Obama only supports a coverage mandate for children. They also oppose requiring companies to provide insurance or pay into a pool, referred to as the "play or pay" mandate. administration made 15 years ago in trying to revamp the nation's health care system. That means applying some of the lessons learned moving fast, seizing momentum and not letting it go.

Drug Industry Defends Prices

Pharmaceutical Research and Manufacturers of America (PhRMA) Senior Vice President Ken Johnson blasted a study in the Journal of the American Medical Association on brand-name medicines and generic drugs. “The contention that brand-name medicines drive up the cost of health care is fatally flawed.” The growth of prescription drug costs in the U.S. has been modest, as evidenced by Centers for Medicare and Medicaid Services data showing that drug price growth was 1.4% in 2007. CMS has also reported that in 2006, prescription drug spending grew at its second lowest level in 11 years. In fact, medicines accounted for roughly 10% of total health spending in the U.S. in 2006 – the same proportion as in 1960.

She said that price trends for brand-name medicines are influenced by many factors, including the significant investment required to research and develop and gain regulatory approval of an innovative drug.

It takes an average of 10 to 15 years to develop a new medicine from the earliest stages of discovery through Food and Drug Administration approval. And only two of every 10 drugs that reach the market ever earn back enough money to match or exceed the average R&D cost of getting them to the marketplace.

What’s more, by the time a medicine makes it through the entire development process, a pharmaceutical innovator often has a limited number of years to recoup its investment and generate the funds needed to re-invest in research and development.

In addition, pharmaceutical prices in America today are determined by market transactions and health plans and payors are able to negotiate for discounts. The plans bring powerful tools to their side of the price negotiations, including the fact that they are negotiating on behalf of millions of patients and can decide whether to cover a drug and the extent of the coverage. For more information, visit www.pparx.org.

2009 HSA Contribution Limits Announced

The Internal Revenue Service 2009 maximum contribution levels for health savings accounts and out-of-pocket spending limits for high deductible health plans connected to HSAs, which have been indexed for inflation for federal income tax purposes. For 2009, the agency reports that the maximum annual HSA contribution for an eligible individual with self-only coverage is $3,000. For family coverage, the maximum annual HSA contribution is $5,950. In addition, catch-up contributions for participants who are 55 or older will increase to $1,000 for 2009.

The guidance explains that eligible individuals are allowed the full annual contribution, including a catch-up contribution, if 55 or older by year end, regardless of the number of months the individual was an eligible individual in the year.

"For individuals who are no longer eligible individuals on that date, both the HSA contribution and a catch-up contribution apply pro rata based on the number of months of the year a taxpayer is an eligible individual," the IRS explains.

For 2009, the maximum annual out-of-pocket amounts for HDHP self-coverage jumps to $5,800, and the maximum annual out-of-pocket amount for HDHP family coverage is twice that, $11,600. The minimum deductible for HDHPs increases to $1,150 for self-only coverage and $2,300 for family coverage.

For more information visit the US Treasary Website:

http://www.treasury.gov/offices/public-affairs/hsa/

TARDY MEDICARE REIMBURSEMENTS ARE HURTING DOCTORS IN CALIFORNIA, NEVADA AND HAWAII

Los Angeles Times -

Nov. 8: Doctors across California and in two other Western states are owed millions of dollars in backlogged Medicare reimbursements, leading some physicians to turn away elderly patients and pushing others to the brink of bankruptcy.

In the most extreme cases, doctors have not been paid since February. Others are owed hundreds of thousands of dollars. Doctors who serve high numbers of Medicare patients say they are defaulting on rent, laying off staff and begging drug suppliers not to stop shipments. One cardiologist said she's even resorted to doing the office laundry to cut costs.

Medicare owes Dr. Tim Ganey and his Bay Area practice of oncologists $750,000 in outstanding claims. He sought grace periods from vendors for his drug payments, but now he's running out of time. He won't be able to order more chemotherapy treatments unless he pays his bill.

The holdup is twofold. By May, doctors were supposed to be using a new universal identification number assigned by the Centers for Medicare and Medicaid Services. Without the new number, which is like a Social Security number, doctors can't get reimbursed.

Then, as scores of doctors still waited for those numbers, in September the federal agency switched to a new claim processor for its 90,000 California providers. The move to Palmetto GBA in South Carolina, part of a national effort to reform Medicare contractors, compounded the billing issues and left even doctors who had their universal identification numbers waiting months for reimbursement.

"This is just a complete disaster," said Dr. Dev Gnanadev, medical director and chairman of the Department of Surgery at Arrowhead Regional Medical Center in Colton and president of the California Medical Assn. "I know people who have turned down their office to minimal size. Some are even considering closing temporarily. If you don't get paid, then you're in deep trouble."

Rep. Henry Waxman (D-Beverly Hills), whose office was contacted by at least two dozen doctors, called the transition to the new contractor "marred by missteps."

"I have been hearing from numerous doctors who have been waiting for months for hundreds of thousands of dollars in reimbursements," he said in a statement. "The delay in payments threatens to compromise patient care and provider solvency."

Palmetto has also been the subject of complaints from doctors in Nevada, which switched to the processing firm in August. The state has the fastest-growing Medicare population in the nation.

"If we're still dealing with this in January or February, Medicare patients are going to have serious access problems," said Larry Mathies, executive director of the Nevada State Medical Assn.

So far, Medicare patients have been largely insulated from the reimbursement fight, though they may have difficulty making new appointments. Some doctors, particularly those with specialties that get minimal Medicare reimbursements, say this could be the tipping point that makes them abandon their participation in Medicare altogether.

"There are patients waiting to be seen, and I can't see them," Wong said. "Without completing my enrollments, I can't take Medicare patients."

Mike Barlow, a Palmetto vice president who oversees California, Nevada and Hawaii, said company officials are aware of the issues and have acted to address them. The company has hired and trained more people to field calls. Teams are in place to fast-track the most severe cases. This week, some Palmetto staffers were on site in Reno and Las Vegas trying to process complaints in person.

"We are accelerating to the extent that is humanly possible," Barlow said. Palmetto has taken the brunt of the doctors' ire. The cover of Southern California Physician magazine that hit mailboxes this week features a huge picture of a cockroach, also called a Palmetto bug, with the word "INFESTATION!" stripped across the front. The article opens with one doctor telling Barlow, "I wish I had a tomato," as he stood before an angry crowd at a California Medical Assn. meeting last month.

Critics of the switch say the federal Medicare agency is also to blame for undertaking two major transitions within months of each other. In an effort to cut costs, the agency picked a contractor that was not equipped or prepared to handle California's Medicare providers, they contend.

But federal officials defend the choice. Torris Smith, an associate regional administrator for the agency, said Palmetto has more than 40 years of experience as a Medicare contractor and was selected after a "full and open competition."

Some Employers Are Viewing Consumer-Directed Health Plans as Retiree Savings Vehicles

Reprinted from INSIDE CONSUMER-DIRECTED CARE, By Michael Carbine, Editor, (mcarbine@aispub.com)

The Kaiser/HRET 2008 employee benefits cost survey and a summary of the Towers Perrin 2009 Health Care Cost Survey, both released on Sept. 24, find that companies view CDH plans as a vehicle for managing their costs and continuing to provide their employees with health benefits.

But the Towers Perrin survey of 321 of the nation's largest employers, covering 6.6 million employees, also suggests that large employers view CDH plans as a way to help their employees prepare for medical expenses in retirement. The final version of the report will be released in early January 2009.

Towers Perrin says employers are viewing CDH plans as one solution to their continuing ability to offer affordable health benefits to their employees and, especially, retirees. The survey found that 58% of "high performing companies," defined by Towers Perrin as companies that focus on supporting and improving employee health and rigorously managing their health plans, say their CDH plans are helping them control employee costs. Over half of the companies surveyed say they are offering or will offer a CDH plan in 2009 (up from 46% in 2008), and that most will have an HSA rather than an HRA feature. This, Towers Perrin says, indicates employer interest in providing wealth-accumulation vehicles for retiree medical benefits.

But the Towers Perrin survey also finds that only half of employees participating in HSA-based plans, on average, contribute to the account. Ron Fontanetta, principal in the company's health and welfare practice, says this indicates that while CDH plans deliver lower costs, employers (and employees) "still have work to do to more effectively use these plans to support the wealth accumulation that active employees will need when approaching retirement." Overall, he says, "employers and employees may not yet have developed the mindset required to take full advantage of this new benefit approach."

Analysts caution that this new retiree benefits approach has its limitations, however. An August 2008 report from the Employee Benefits Research Institute concluded that statutory limitations on contributions and other factors make it unlikely that such accounts will play more than a minor part in retiree savings strategies. The report concludes, "The maximum savings that can be accumulated in an HSA will be far from sufficient to fully cover the savings needed in retirement for insurance premiums and out-of-pocket expenses."

The EBRI report was published in the August EBRI Notes and can be viewed at www.ebri.org.

Family Security And Employee Benefits

(NAPSI)-The choices you make in your employer-sponsored group benefits can be much more important than many realize. Having too little life and disability income insurance might have severe, lasting effects on your family if something were to happen to you or your spouse. In a recent survey of 1,000 Americans conducted by Ipsos Public Affairs, 67 percent of survey respondents said that their death or the death of their spouse would be a much greater threat to their family's future financial situation than falling home prices, an economic recession or rising interest rates.

The difference in one group life or group disability income option versus another could add up to hundreds of thousands of dollars in financial stress should you have to rely on the insurance. One reason people often select employer-sponsored life insurance coverage with only a few seconds of thought is that it's seemingly such an easy decision. Many companies provide the equivalent of one times salary automatically, then let the employee add three or four times their salary in additional coverage for a competitive monthly cost. So adding one times salary to their coverage seems like plenty to cover things, but rarely is this the case.

"Premature death and prolonged disability always seem to happen to someone else, not to us, so it's natural for people to underestimate the importance of having solid coverage," said Ivan Gilreath, president of ING Employee Benefits. "Yet, every day, people suffer these losses and the degree of resulting stress often comes down to several dollars in monthly premium deducted from your paycheck--based on a hasty decision you made months before during benefits enrollment."

Gilreath points out that U.S. Department of Labor rules stipulate that most employees are allowed to change group benefit options once each year, generally coinciding with the calendar year. The autumn months are sometimes known as benefits enrollment season, as employers work to finalize plan participation before the beginning of each year, according to Gilreath. ING Employee Benefits' insurers, ReliaStar Life Insurance Company and ReliaStar Life Insurance Company of New York, currently provide group life insurance coverage for about 4.4 million Americans through various employers and affiliate groups.

How Much Insurance Do You Need?

Here are a few factors to consider as you determine how much coverage you may need while looking ahead to your employer's annual benefits enrollment process.

• Your home. Maybe your family wouldn't want to pay off the mortgage if you were to die. But, at the very least, you may want to consider leaving an amount that might serve to pay down the mortgage amount enough to lower monthly payments.

• New debt. Have you taken out a home equity loan in the past year or so? Or increased balances on your credit cards? These numbers may not seem like much, but stretched out over many years, they alone may prompt the decision to add another "one times salary" to your group life coverage.

• Future costs. Do your kids aspire to be scientists, artists or CEOs? While you may not be able to fund everyone's college plans through a group life policy, it makes sense to factor these important goals into your life insurance equation. Don't look at projections of college tuition increases and just throw up your hands. Any money, saved carefully, can help down the road.

Decisions On Group Insurance Benefits

Once you've made your selections, make sure to clearly communicate them to your spouse and share any supplemental materials the insurer might provide. For example, some companies provide a comprehensive package of support services to beneficiaries. These might include special withdrawal accounts for your beneficiaries to help them access their death benefit dollars, toll-free bereavement hotlines to get help with questions and concerns, and booklets and other resources to help them deal with legal and financial issues.

Spend a little time choosing your insurance coverage so you'll be preparing your family well for an uncertain future.

For help in developing a comprehensive benefits package, please contact Ray Ward at Legacy Benefits & Insurance Services.

A PLAN TO IMPROVE HEALTHCARE AND LIMIT COSTS

New York Times - Oct. 20: The issue of health care costs usually comes up for discussion right after the economy as costs for businesses and consumers continue to climb. The Blue Cross Blue Shield Association insures 102 million Americans one in three people and has networks that include 90 percent of the nation's providers and 80 percent of its hospitals.

The association's board just adopted a four-point initiative aimed at containing health care costs and improving care. The goals range from eradicating hospital infections to pushing for health care coverage for everyone. From Chicago, Scott Serota, the association's president and chief executive, recently discussed the new goals:

Q.What was the impetus for adopting a new plan of action, and why now?
A. Much of what is discussed in virtually all forums as health care reform is really health care financing reform. We really have not gotten sufficient national attention on the real underlying issue, which is that the entire health care delivery system needs to be modified. We, the Blues, feel we should try to drive toward a vision for the health care delivery system which we can move collectively forward with our partners.

Q.One of your goals is to cut the prevalence of diabetes in half. Why did you select that?
A. There are 57 million Americans today who are prediabetic. The cost of treating it is $116 billion annually. We treat it pretty well, but there are tangible things we can do in the areas of obesity, weight management, nutrition, fitness and health risk assessment to reduce the incidence of diabetes. We can cut that 57 million number in half and make a dramatic impact not only in the delivery system costs but in people's lives.

Q.Your second point is more affordable health care. How do you translate that sweeping goal into something concrete when costs are steadily mounting for both businesses and individuals?
A. We're not saying the cost of health care will go down. It won't. Our goal is that health care costs rise no faster than any other goods and services. The essential fundamental to getting there is improving the underlying system because 30 percent of care rendered today, according to some studies, is unnecessary, redundant and, in some cases, even harmful. We need to get waste out of the system. That means $700 billion in a $2.4 trillion system.

Q.When you say waste, what do you mean?
A. I'm talking about a whole battery of things like duplicative testing such as two M.R.I.'s instead of one

or hospital-acquired infections. The cornerstone of how we get at this is creating a comparative effectiveness institute to study what treatments really work best for a given condition and letting everyone know what works. There is legislation on this pending in Congress.

Q.Medicare just announced it would stop paying hospitals to treat patients harmed by care, like being given an incompatible blood transfusion. One of your goals addressed that to eradicate so-called 'never events' but is that the cart following the horse?
A. Not paying for them is the end point. If they are no longer getting reimbursed for those costs, institutions will be very aggressive in eliminating those events. There are some Blue plans that are not paying for those events.

Q.Why haven't more Blue plans limited reimbursement for hospital-caused problems?
A. More will. We're trying to figure out mechanisms to help them improve their performance. Then we'll tie reimbursement to performance. These events are a huge problem where we haven't made a lot of progress over the last 10 years. We have to fix it, then adjust the financing.

Q.An ambitious point you have adopted is to ensure that everyone has health care coverage. What specific steps can Blue Cross Blue Shield take to solve something that has remained so elusive?
A. We believe that every American should have coverage, but 45 million don't have it. The reasons are not the same, but if coverage is affordable, more people will be able to buy it. We also need to work with people who are eligible for government programs but are not enrolling. And we need to develop new products like high-deductible plans to attract people like the 'young invincibles' -- who think they will never get sick -- and get them in the habit of buying coverage.

Q.Do you support proposals like the one from the Republican presidential candidate John McCain that move away from the employer-based system?
A. It is essential that we continue to support the employer-based system because 162 million Americans today get their coverage through their employer. We should not disrupt this important piece. Employers provide significant financing and they keep us on our toes.

Q.How do you plan to get others in the health care industry to sign on and help achieve your newly adopted goals?
A. Conversations, dialogue and meeting with trade association leaders. These are goals for all of us. We are insuring one-third of all Americans so we need to step out and provide leadership with real actionable steps.

Q.Do you have any near-term like one-year benchmarks to measure whether the Blues are making progress in meeting each of the new goals?
A. We will have annual benchmarks that we will put out. We believe that what gets measured is what gets done.

Are Healthcare Costs Really Lower in Canada?

A report by the Fraser Institute reveals that healthcare in Canada only appears to cost less than healthcare in the United States because Canadian public health insurance does not cover many advanced medical treatments and technologies; common medical resources are in short supply; and access to healthcare is often severely delayed.

On average, Americans spend more of their incomes on healthcare, but they get better access to superior medical resources.

According to the most recent data, the United States outscores Canada on many key indicators of available healthcare resources, including:

• Number of MRI units per million population in 2006: US 26.5. Canada: 6.2
• Number of MRI exams per million population in 2004/05: U.S.: 83,200. Canada: 25,500
• Number of CT Scanners per million population in 2006: U.S.: 33.9. Canada 12
• Number of CT exams per million population in 2004/05: U.S.: 172,500. Canada 87,300
• Number of inpatient surgical procedures per million population in 2004: U.S.: 89,900. Canada: 44,700.

Even on health insurance coverage, the Canadian system does not perform much better than the U.S. when it comes to actually delivering insured access. The study cites government data showing an estimated 1.7 million Canadians (aged 12 and older) were unable to see a regular family physician in 2007. And it points to other research showing that the actual number of effectively uninsured Americans is less than half of the figure usually reported and that being uninsured is usually only a temporary condition.

Based on these figures, the study estimates that the percentage of the population that was effectively uninsured for non-emergency, necessary medical services at any given time during 2007 was not significantly different between the two countries: 7.9% in the U.S. compared to six percent in Canada.

The study concludes that both Canada and the U.S. should look to countries, such as Switzerland or the Netherlands where the government is not in the business of providing health or drug insurance at all. Instead, people are required by law to purchase comprehensive health insurance in a regulated private-sector market. Access to health insurance for low-income people comes from a publicly funded means-tested subsidy, which varies according to the income and assets of the insured person. For more information, visit http://www.fraserinstitute.org/.

Wellness programs do well among large employers

By Danielle Andrus | Published October 22, 2008 From the October 22, 2008 Issue of Benefits Selling WEEKLY

Wellness programs are increasing among large employers, according to MetLife. The company's Sixth Annual Employee Benefits Trends Study found 57 percent of large employers offer a wellness program, up from 49 percent in 2006. Small employers still aren't convinced about wellness programs; for the past two years, only 16 percent report offering such a program.

About 80 percent of employers offer incentives for using wellness programs, and only 9 percent impose fees on employees who don't meet wellness guidelines.

Employers who offer wellness programs appear to be confident about their benefits programs in general. Sixty-five percent feel their benefits programs are better than their competitors, compared with 42 percent of employers who don't offer wellness programs. Of employers who offer wellness programs, 51 percent feel their benefits program is a big draw when attracting employees to their company, and 70 percent say it is important for employee retention. Only 22 percent of employers without wellness programs say their program is a big part of their company's appeal, and 50 percent say it helps with employee retention.

New IRS Regulation Drives HSA Procedural Change

Legacy Benefits & Insurance Services would like to make you aware of an important announcement which affects both Employees and Employers in the establishment, funding and administration of HSA accounts.

Pay particular attention to the following:

The IRS has clarified when an HSA account is effective: An HSA account must be funded in order to be effective and an account cannot legally exist before the effective date of the HSA qualifying plan coverage.

If HSA paperwork is received after the first day of the month, the HSA account cannot be effective any sooner than the first day of the following month. For example, your client's HSA compatible plan coverage begins on July 1, 2008 and you submit the paperwork to the HSA bank custodian on July 10th. An HSA account can be opened and made effective on August 1st. This means that the accountholder cannot use the HSA funds for any expense incurred prior to the effective date of the HSA bank account. Check with your HSA Bank Custodian to find out their administrative procedure to determine their definition of what constitutes having the HSA account open.

Please note that in the past, HSA Bank Custodians may have been able to retro the HSA account effective date to the start date of the HSA compatible HDHP coverage, but will no longer be able to do this based on these new regulations.

For more information, you can visit the US Treasury website:

http://www.treasury.gov/offices/public-affairs/hsa/

For more information or an free review of your current benefits package, please contact Ray Ward at Legacy Benefits & Insurance Service.

Are You Offering Your Employees Choice?

When you are recruiting or trying to retain the best employees, you are competing with larger employers in your industry. Those employers generally offer their employee a wide variety of benefits to choose from. At Legacy Benefits & Insurance Services, we try to help you design a benefit package that can offer your employees similar choices.

Most smaller employers choose not to offer choice for one of few reasons; they don’t know that they can, they think it will cost them more to offer additional plans, or they are concerned how to communicate the differences in the plans. We can show you that these are issues that we can solve for you.

Can You Offer Choice? - Yes, each carrier is different but there are health and dental carriers that will allow you offer more than one plan with as little as 2 employees. The number of plan designs that you can offer can vary per carrier depending on the number of employees you have. Please note that offering too many plans can be so confusing to the employee that is become more of a burden than a benefit.

Can You Afford Multiple Option Healthcare Plans? - Many companies think that they cannot afford choices health insurance, because some plans are so expensive. The truth is that a carefully constructed benefits may save you money. We have clients that switch to a multiple option benefit package and have saved over 30% of their renewal rates and their employee like the options that they have picked. To learn more, ask to get a copy of our case study.

In addition, voluntary benefits can be offered that are funded by the employees not by the employer. These plans allow the employee to protect themselves and their family in case certain situations arise.

For more information or an free review of your current benefits package, please contact Ray Ward at Legacy Benefits & Insurance Service email:rayward@yourlegacybenefits.com or 916-677-2130 ext. 101.