In the first year you have Medicare Part B (outpatient insurance), you can get a Welcome to Medicare preventive visit. During this one-time visit, your doctor will review your medical history with you and help you to map out your preventive care needs over a 5-10 year period. Your doctor may refer you for follow-up services and preventive screenings after this visit. After your first year with Part B, you can see your doctor for an Annual Wellness Visit every year. The Annual Wellness Visit is designed to help your doctor monitor your health and build on the information gathered during your first preventive visit. During your yearly visit, be sure to ask your doctor what screenings or other preventive care you should get in the coming year.

Everyone who has Medicare qualifies to receive certain preventive care benefits. For most preventive care, you’ll usually pay nothing out of pocket (no coinsurance or deductible) if you have Original Medicare and see providers who accept assignment, meaning that they accept Medicare’s approved amount as the full payment for a service.

However, you usually will have to pay a deductible or coinsurance if your doctor needs to do further tests or procedures to treat a problem found during a preventive screening. For example, if a doctor finds and removes a polyp during a screening colonoscopy, that preventive service has become diagnostic and, although Medicare will still cover it, you may have to pay part of the cost.

Medicare covers certain other preventive services at 100 percent only for patients who have certain risk factors for a disease. This applies to services such as diabetes screenings and bone mass measurements.

There are many changes to Medicare coverage of preventive care in 2012. Starting this year, if you’re in a Medicare Advantage plan, your plan can’t charge you for preventive care services that are free for people with Original Medicare as long as you see in-network providers. If you see providers that are not in your plan’s network, charges will typically apply. Medicare also added several new preventive care services in the fall of 2011. These new preventive services include a depression screening to ensure you are mentally healthy, obesity screening and dietary counseling for people who are overweight, a cardiovascular risk reduction visit during which your doctor will give you advice on how to combat heart disease, and an alcohol misuse screening for people who are at risk for alcohol abuse.

If you have questions about these new benefits or are having trouble accessing your preventive care, you can always call the Medicare Rights Center’s national consumer helpline at 800-333-4114.
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While you need some insulin to maintain your blood glucose levels, elevated insulin levels causes chronic inflammation in your body, and inflammation is the hallmark of most chronic diseases. In fact, elevated insulin levels lead to heart disease, which, ironically, is the primary reason for taking a cholesterol-reducing drug in the first place! It can also promote belly fat, high blood pressure, heart attacks, chronic fatigue, thyroid disruption, and diseases like Parkinson’s, Alzheimer’s, and cancer.

Secondly, statins increase your diabetes risk by raising your blood sugar. When you eat a meal that contains starches and sugar, some of the excess sugar goes to your liver, which then stores it away as cholesterol and triglycerides. Statins work by preventing your liver from making cholesterol. As a result, your liver returns the sugar to your bloodstream, which raises your blood sugar levels.

Statins also rob your body of certain valuable nutrients, which can also impact your blood sugar levels. Two nutrients in particular, vitamin D and CoQ10, are both needed to maintain ideal blood glucose levels.

Now, it’s important to realize that drug-induced diabetes and genuine type 2 diabetes are not necessarily identical.

If you’re on a statin drug and find that your blood glucose is elevated, it’s possible that what you have is just hyperglycemia—a side effect, and the result of your medication. Unfortunately, many doctors will at that point mistakenly diagnose you with “type 2 diabetes,” and possibly prescribe another drug, when all you may need to do is simply discontinue the statin in order for your blood glucose levels to revert back to normal. So if friends or loved ones you know are on a statin (and one in four Americans over 45 are) and they are told they have diabetes, please do them a favor and tell them about the information in this article.

There’s overwhelming evidence pointing to the fact that vitamin D deficiency plays a crucial role in cancer development. Researchers within this field have estimated that about 30 percent of cancer deaths — which amounts to 2 million worldwide and 200,000 in the United States — could be prevented each year simply by optimizing the vitamin D levels in the general population.

On a personal level, you can decrease your risk of cancer by MORE THAN HALF simply by optimizing your vitamin D levels with sun exposure. And if you are being treated for cancer it is likely that higher blood levels—probably around 80-90 ng/ml—would be beneficial.

If the notion that sun exposure actually prevents cancer is still new to you, I highly recommend you watch my one-hour vitamin D lecture to clear up any confusion. It’s important to understand that the risk of skin cancer from the sun comes only from excessive

The study also shows that these areas had death rates that were 5 percent lower than areas with fewer primary care doctors. Medical costs were about the same in both areas. Overall, the study shows that living in an area with more primary care doctors is beneficial for older Americans

A woman whose doctor (or other health care professional) is treating her for estrogen-deficiency and is at risk for osteoporosis based on her medical history or other findings
A person with vertebral (spinal) abnormalities as demonstrated by an x-ray
A person getting (or expected to receive) steroid treatments for more than three months
A person with hyperparathyroidism
A person taking an osteoporosis drug
This test is covered as a preventive service once every 24 months if you are at risk. Medicare will also cover follow-up measurements or more frequent screening if your doctor prescribes them and says that they are medically necessary. In this case, Medicare will cover the screenings but you will have to pay a 20 percent coinsurance.
If you are in a Medicare Advantage plan (private health plan) you should check with your plan to find out what costs and rules apply to getting this test.

—Marci

The law forces younger, healthier adults who do not have health care insurance to purchase it (at a higher price than it should be in order to reduce inequity between the prices paid between young consumers and older ones). Knowing human nature, and working with health insurance customers every day, I have no doubt that these coerced consumers will seek medical care much more often than they would have if they were paying out of pocket. People are determined to get what they pay for, especially when they are being forced to pay for it. Even if they are healthy, younger adults will get screenings, tests, and medications they would have gone without if they were paying out of pocket. A well-known patient safety expert foresees a problem with this sudden influx of patients. Rosemary Gibson warns that forced participation in health insurance plans will lead to overuse of the medical system.

Gibson, author of The Treatment Trap: How the Overuse of Medical Care Is Wrecking Your Health, and What You Can Do About It, has devoted the last 16 years of her life to studying and advocating for patient safety. Gibson told Kaiser Health News that Obamacare will expose young, healthy individuals to dangerous, unethical healthcare providers. Gibson explains: “Health insurance used to be about giving patients access to provider. That’s still true, but it is also about giving providers access to patients. The 32 million people estimated to be getting health insurance coverage when the law takes full effect will be exposed to overuse.”

I have argued that removing caps from benefits while limiting the amount health insurers can charge is economically unsustainable. Gibson sees a more subtle problem with unlimited benefits. She writes: “The health reform law also removes annual and lifetime caps. That can be an enormously valuable benefit to those who have a serious illness and need medical care; at the same time, it’s an open invitation for health care providers, device manufacturers, pharmaceutical companies and every other health care business to increase volume and price. It’s like a credit card without a credit limit. It’s as if we have this tsunami, this surge of tests, procedures and medication. With health reform, we will be merely transferring the bankruptcy of individuals to the eventual bankruptcy of the federal government.”

I couldn’t agree more.

Employing a shotgun approach to defending the constitutionality the national health care insurance reform law, attorneys for the U.S. Department of Health And Human Services submitted a brief arguing that the individual mandate is “a valid exercise of Congress’s authority” under the Necessary and Proper Clause of the constitution. Judge Vinson summarized the government’s argument this way:

Oversimplified, the defendants’ argument on this point can be reduced to the following: (i) the Act bans insurers from denying health coverage (guaranteed issue), or charging higher premiums (community rating), to individuals with pre-existing medical conditions (which increases the insurers’ costs); (ii) as a result of these bans, individuals will be incentivized to delay obtaining insurance as they are now guaranteed coverage if they get sick or injured (which decreases the insurers’ revenues); and (iii) as a result of the foregoing, there will be fewer healthy people in the insured pool (which will raise the premiums and costs for everyone). Consequently, it is necessary to require that everyone “get in the pool” so as to protect the private health insurance market from inevitable collapse.

The attorneys defending Obamacare used the principle of shared risk to illustrate that the law without the individual mandate creates incentives for healthy people to not buy health insurance, which will lead to the collapse of the health insurance system. I don’t often agree with proponents of national health insurance reform, but this is precisely what I have been arguing in this space for more than a year and a half. I have gone one step further, however, stating that the individual mandate will not prevent the collapse of private health insurance for the simple fact that the fine is far too small. Risk takers can ignore the law, pay the fine, and still pay less money than they would for health insurance, secure in the fact that they cannot be turned down for coverage should they sustain and injury or become ill.

Using the Necessary and Proper Clause to justify the individual mandate is another case of twisted logic, Justice Vinson wrote:

The defendants’ are essentially admitting that the Act will have serious negative consequences, e.g., encouraging people to forego health insurance until medical services are needed, increasing premiums and costs for everyone, and thereby bankrupting the health insurance industry—unless the individual mandate is imposed. Thus, rather than being used to implement or facilitate enforcement of the Act’s insurance industry reforms, the individual mandate is actually being used as the means to avoid the adverse consequences of the Act itself.

Such an application of the Necessary and Proper Clause would have the perverse effect of enabling Congress to pass ill conceived, or economically disruptive statutes, secure in the knowledge that the more dysfunctional the results of the statute are, the more essential or “necessary” the statutory fix would be. Under such a rationale, the more harm the statute does, the more power Congress could assume for itself under the Necessary and Proper Clause. This result would, of course, expand the Necessary and Proper Clause far beyond its original meaning, and allow Congress to exceed the powers specifically enumerated in Article I. Surely this is not what the Founders anticipated, nor how that Clause should operate.

For that reason, Judge Vinson concluded, “The individual mandate is outside Congress’ Commerce Clause power, and it cannot be otherwise authorized by an assertion of power under the Necessary and Proper Clause. It is not Constitutional.”

My question is this: Why didn’t the media report on the negative consequences of the national health insurance scheme as described by its supporters before it was enacted?

The heart of the case, Judge Vinson reasoned, involved the “individual mandate” that requires residents of the United States—whether citizens or not—to purchase private health care insurance. Lawyers for the federal government contended that the decision not to purchase health insurance constituted an economic activity of the type that Congress could regulate. Judge Vinson ruled that this argument turned the whole notion of “ activity” on its head:

I conclude that the individual mandate seeks to regulate economic inactivity, which is the very opposite of economic activity. And because activity is required under the Commerce Clause, the individual mandate exceeds Congress’ commerce power, as it is understood, defined, and applied in the existing Supreme Court case law.

The lawyers for the Obama administration also argue that Congress had the authority to mandate the purchase of health insurance under the “Necessary and Proper” clause of the constitution. As a health care insurance professional, I was especially interested in how Vinson used basic actuarial theory to show that the Necessary and Proper clause could not be made to apply to the “inaction” of not buying health insurance. I will delve into this in my next post.

In June, Medicare health care insurance payments to doctors were scheduled to be reduced by 21 percent. On December 1, according to the budge-balancing legislation passed in the 1990s, the payments were scheduled to be reduced by 23 percent. Unless Congress takes action this month, payments will be cut  almost 25 percent on January 1, 2011.

The was the eleventh time Congress has blocked such cuts in the last eight years, and the fifth time this year. Congressional leaders said that the short-term action was designed to allow the incoming Congress to create a long-term solution. “This bill is a stopgap measure to make sure that seniors and military families can continue to see their doctors during December while we work on the solution for the next year,” said Frank Pallone, the Republican congressman from New Jersey, who chairs the Energy and Commerce health subcommittee in the House.

Congress keeps re-instating full payment because many doctors say they would stop accepting new Medicare patients and perhaps stop seeing current ones if their payments are cut. However, continuing to pay doctors at the current rate would cost Medicare an additional $300 billion over the next ten years.

If Congress continues to put off cutting doctor payments, the cost of Medicare will continue to rise, offsetting $300 billion of the Medicare cuts used to “pay” for Healthcare Reform and adding billions more to the deficit. This is a particular concern given the report by President Obama’s commission on reducing the deficit. More about that next time.

Reminder: Open enrollment for Medicare ends on December 31, so if you or someone you know wants to change prescription drug plans, now is the time to do it.

When the results were in, John Boehner, the presumptive speaker of the House, was asked if the Republicans planned to follow through with their campaign promises regarding health care insurance. Boehner did not mince words:

The health care bill that was enacted by the current Congress will kill jobs in America, ruin the best health care system in the world, and bankrupt our country. That means that we have to do everything we can to try to repeal this bill and replace it with common-sense reforms that’ll bring down the cost of health insurance.

The Republican picked up seats in the Senate, but did not wrest control from the Democrats. Nonetheless, Senator Mitch McConnell of Kentucky, the Senate minority leader, also pledged to follow through on the promise to repeal the Patient Protection and Affordable Care Act, knowing full well that even if such measures passed, President Obama would veto them. “On health care, that means we can — and should — propose and vote on straight repeal, repeatedly,” said McConnell. “But we can’t expect the president to sign it. We’ll also have to work, in the House, on denying funds for implementation, and, in the Senate, on votes against its most egregious provisions. At the same time, we’ll need to continue educating the public about the ill-effects of this bill on individuals young and old, families, and small businesses.”

President Obama disputed the notion that the electorate was sending a message about the health insurance issue. “I think we’d be misreading the election if we thought that the American people want to see us for the next two years relitigate arguments that we had over the last two years,” said the president.

The president remained convinced that the health insurance reforms offered the right solution for the escalating costs of healthcare. “With respect to the health care law, when I talk to a woman from New Hampshire who doesn’t have to mortgage her house because she got cancer and is seeking treatment but now is able to get health insurance, when I talk to parents who are relieved that their child with a preexisting condition can now stay on their policy until they’re 26 years old and give them time to transition to find a job that will give them health insurance, or the small businesses that are now taking advantage of the tax credits that are provided — then I say to myself, this was the right thing to do.”

Ironically, the very benefits the president touted—unlimited annual and lifetime medical benefits and unlimited access to medical care despite serious pre-existing conditions—are unsustainable. As I have written before, one cannot increase benefits without increasing premiums, and one cannot pay unlimited benefits without unlimited premiums. The Republicans seem to grasp this essential aspect of actuarial science, and they have vowed to educate the public about it. If they do not succeed, private health insurance cannot survive.