10 Essential Benefits for the Affordable Care Act

Here it comes whether we are ready, trained, or able to talk in complete sentences.  The Affordable Care Act is a reality, so we should at least know what we are going to buy.  I say we because although I will be selling it as an agent, I will also be purchasing it as a consumer.

So let’s get started.  What are the “TEN ESSENTIAL BENEFITS”, that are required for a plan to be considered a “Qualified Plan”, and be sold on the “Exchange”?

1) Ambulatory Patient Services
– Care received outside of a Hospital, Dr.’s office, walk-in clinic, same day surgery.

2) Emergency Care
– Care for conditions that if not treated immediately could lead to serious health conditions and possible death.

3) Hospitalization
– Care in a hospital (including but not limited to surgery, drugs, room and board, tests and such).

4) Maternity and Newborn Care

5) Mental Health and Substance Abuse Disorder Services
– This includes behavioral treatment.  This is for evaluation, diagnosis and treatment of mental health and substance abuse.

6) Prescription Drugs
– Drugs for ongoing treatment as well as acute illness that require a doctor’s prescription.

7) Rehabilitative and Habilitative Services and Devices
– This is for rehab to relearn skills, e.g. talking, walking, feeding oneself, or motor skills, and rebuilding strength and flexibility.  Habilitative services are for keeping and learning age appropriate skill and increased functioning.  Unfortunately this is a very broad definition and leaves some gray area for consideration.

8) Lab services
– Testing to diagnose a medical condition or to monitor an ongoing treatment.

9) Preventative and Wellness services
–  Including chronic disease management, routine physicals screening and immunizations. Chronic disease management is an integrated approach to manage ongoing chronic conditions.

10) Pediatric service for children under 19
These services also include dental services for children under 19, preventative and restorative care as well as vision care and prescription eye glasses for children.

The key to all of this is these are broad sweeping benefit definitions.  The insurance companies can submit programs that fit into the various metal levels (bronze, silver, gold etc) for actuarial coverage.

With that said we will have more and better information to your e-mail as soon as we know,  until then please be patient and tell a friend about our services, the more people that know, the more people we can help walk through this maze of information.

-John Coulson
Castell Insurance

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Affordable Care Act Employer Mandate Update

Wow, can you believe the news that the employer mandate portion of the ACA has been delayed for 12 months until 2015?

Let me start with explaining what the employer mandate is, and then follow up with the ramifications of such a move.

The employer mandate was to affect those companies with more than 50 full time employees. If they did not offer their employees coverage, they were to face a penalty starting in 2014. This has now been delayed to 2015.

This in itself was only a minor portion of the overall ACA and would have affected only between 1-4% of the population. The figures vary depending upon the source. Most large employers already offer health benefits to their employees. That is why the number of folks affected is relatively small.

However, the ramifications of this could be far reaching and we will have to see what the unintended consequences of such a move might be.

Some commentators see this as the first major sign that the entire ACA program will collapse in the first few years. I personally do not see it that way. I believe the ACA will be a huge success as long as the government subsidizes the premiums with tax dollars. When they start to scale back the flow of Federal dollars into the program at that time we shall have to wait and see where the program will head.

Here on the Peninsula I do not see this affecting many people, as I had mentioned earlier, most companies with that many employee’s already offer coverage.

One of the unintended consequences of this delay could be to provide companies with an opportunity to drop employer coverage for at least a one year time period and thereby force their employees into Exchange programs. Let me give you an example. If you were a large fast food company where the vast majority of your employees were younger, under age 30, earned next to minimum wage, why would you offer company sponsored insurance. If your employees went into an Exchange program based upon their young age, and low earnings they would receive premium supports to where their monthly costs would be quite low.

For example on the Washington Exchange web-site at www.waplanfinder.org a 28 year old earning $20,000 per year would have a monthly premium of $85 for a “silver” level plan. In addition they could have even lower premiums if they went to a bronze level plan or even a catastrophic plan. Catastrophic plans will only be available to people under 30 years of age.

Now, I took the $20,000 per year as the income for someone working full time at $10 per hour. Many of these stores will only hire part time, and many workers may be single parents. So, if we keep the income at $20,000 but add a child as a dependent then the $85 monthly premium disappears as they are now eligible for the greatly expanded Medicaid program.

I hope that most large employers have a social conscience and also that the competitive nature of hiring and retaining good employees will make the above scenario unlikely to materialize. This is one we shall have to wait and see.

ACA Updates

As promised I will be giving a monthly update on the Affordable Care Act which is now less than 3 months away from accepting applications.

Last month I gave an update of the various plans submitted to the State for approval. The Office of the Insurance Commissioner (OIC) web-site has been updated (www.insurance.wa.gov) and several companies have submitted plans since last month. These companies are Time Insurance; which does most of it’s business under the Assurant brand name, Molina Healthcare which specializes in Medicaid and low income plans, Coordinated Care Corporation which is the new carrier to the state and is an HMO that likewise specializes in the Medicaid and low income arena and finally MODA which is part of Oregon Dental Group.

In reviewing the filings, the one that caught my attention was the filing from MODA. The entire filing was only a scant 28 pages in length which is miniscule when compared to the 373 pages in the Time Insurance filing. MODA has filed the same premium rate for the entire state, whereas most carriers have dissected the state into 6 different rating areas. In addition the MODA Plan will charge smokers and non-smokers the same premiums.

MODA is not planning on being a major player in the Washington market as they are only anticipating a total of 2,000 members for the year, and their plan will be available both in and out of network. My assumption is, that as a part of the Oregon Dental Group, most of the PPO providers will be in the Vancouver area in Southwest Washington.

The following companies were previously “not approved” by the OIC but have all refiled their products and are now in the “under review” status.

Time Insurance – will be only offering plans outside of the Exchange, and they are anticipating annualized premiums of around $21 million which roughly translates to about 5,000 clients statewide.

Molina – has filed an Exchange only offering, for only three counties in the state which are King, Pierce and Spokane, and are anticipating an enrollment of just under 27,000 members.

Coordinated Care Corporation – This one surprised me for two reasons; it is an HMO and I was under the impression that the OIC was not going to approve any additional provider networks this year. But the greater surprise is that it is only anticipating member premiums of $2 million, which would mean about 500 members. It seems like an awful lot of regulatory filings and paperwork to build a network and then only anticipate enrolling 500 members. Breaking news…This plan was once again showing as “not approved” as of July 7th, and it remains to be seen if they will refile.

So, the bottom line is as far as Clallam County is concerned nothing has changed since last months column.

That column is still available for your review on the Sequim Gazette web-site under the columnists tab, www.sequimgazette.com/castell

Where do we go from here? More and more of the operational details are being worked out on an ongoing basis and next month I will answer a number of questions that have been posed to me.

During the month of September I will be making a number of presentations to various groups in the community If you would like to be kept informed as to the schedule, please shoot me an email and I will keep you updated.

And finally for those loyal readers who are on Medicare we are not anticipating many drastic changes for 2013. Medicare Supplement premiums appear to be relatively stable. Advantage plans have had an increase in funding from CMS of over 4%, so that also bodes well for premium stability. I have heard of another carrier possibly going to offer an Advantage plan for 2014 in Clallam County. The prescription drug plans offerings change annually and I do not anticipate any less changes for 2014. We already know that Aetna has purchased Coventry Health which offered the popular First Health Part D plans. We shall have to wait and see if Aetna will rebrand that plan under it’s own name or continue with the First Health name.

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OBAMA CARE FOR SMALL BUSINESS BY THE NUMBERS

As we stagger towards the start of the Affordable Care Act or Obamacare, the decibel level of horror stories, false statements and general fear mongering will increase. It is our goal here at Castell Insurance to try and give you a non-biased explanation of what is happening. So for today’s topic, let’s look at the statement that has been circulated by every opponent of Obamacare, “Obamacare will kill small business”. (Jose Pagliery @Jose_Pagliery NEW YORK (CNNMoney)

First, the individual mandate which forces firms to provide health care to employees only applies to companies with 50 full time workers. 97% of small businesses have less than 50 full time workers. This means that 97% of small businesses will not have to provide insurance for their employee. If they do that is great, they are a good employer and they strive to provide for their employees. Will they benefit from Obamacare? Will it save them any money? We do not know but we do know that they are not FORCED by the individual mandate to provide health care benefits.

Second, 96% of the small businesses that have 50 or more employees already provide health insurance benefits. Of those 96%, 99% of those work sponsored plans have insurance that meets most of the Obamacare’s standards. (University of Chicago National Opinion Research Center) http://www.healthaffairs.org/

So to sum up all the numbers; of the country’s 6.5 million workplaces, only 1% must actually start providing NEW HEALTHCARE BENEFITS next year. Is this going to kill small business in America? I think not……

So whatever happens as we move forward in this ground breaking implementation, please keep in mind that a healthy dose of common sense, applied to everything that you hear from the left and the right, will go a long way in keeping your stress at a manageable level.

If you are interested in more information about the opportunities for small businesses to cover their employees or if you currently cover your employees and are looking for answers, please feel free to contact us at www.Castellinsurance.com or call 360-683-9284.

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Clallam County Affordable Care Act Update

Welcome to the first in a series of postings on the fast approaching implementation of the Affordable Care Act. We are only 3 ½ months away from the start of the enrollment period.

You are receiving this because you are either already a policyholder of our office who will be affected, or a person who has expressed an interest in receiving periodic updates on this subject.

Please feel free to share this with others who may be similarly affected, and while this information is geared towards folks in Clallam County we will be able to assist people throughout the entire State of Washington.

To say that things are changing daily is an understatement, as we frequently receive more than one update or point of clarification each day.

We receive information from a number of sources including direct from the Washington Office of the Insurance Commissioner, the insurance companies who will be participating, trade journals and yes even the newspapers.

This whole process is almost like rediscovering “the law of unintended consequences”, each and every day as this Associated Press article from the June 14th edition of the Peninsula Daily News will show.

Coverage may be unaffordable for low-wage workers

WASHINGTON (AP) — It’s called the Affordable Care Act, but President Barack Obama’s health care law may turn out to be unaffordable for many low-wage workers, including employees at big chain restaurants, retail stores and hotels.

That might seem strange since the law requires medium-sized and large employers to offer “affordable” coverage or face fines.

But what’s reasonable? Because of a wrinkle in the law, companies can meet their legal obligations by offering policies that would be too expensive for many low-wage workers. For the employee, it’s like a mirage — attractive but out of reach.

The company can get off the hook, say corporate consultants and policy experts, but the employee could still face a federal requirement to get health insurance.

Many are expected to remain uninsured, possibly risking fines. That’s due to another provision: the law says workers with an offer of “affordable” workplace coverage aren’t entitled to new tax credits for private insurance, which could be a better deal for those on the lower rungs of the middle class.

Some supporters of the law are disappointed. It smacks of today’s Catch-22 insurance rules.

“Some people may not gain the benefit of affordable employer coverage,” acknowledged Ron Pollack, president of Families USA, a liberal advocacy group leading efforts to get uninsured people signed up for coverage next year.

“It is an imperfection in the new law,” Pollack added. “The new law is a big step in the right direction, but it is not perfect, and it will require future improvements.”

Andy Stern, former president of the Service Employees International Union, the 2-million-member service-sector labor union, called the provision “an avoidance opportunity” for big business. SEIU provided grass-roots support during Obama’s long struggle to push the bill through Congress.

The law is complicated, but essentially companies with 50 or more full-time workers are required to offer coverage that meets certain basic standards and costs no more than 9.5 percent of an employee’s income. Failure to do so means fines for the employer. (Full-time work is defined as 30 or more hours a week, on average.)

But do the math from the worker’s side: For an employee making $21,000 a year, 9.5 percent of their income could mean premiums as high as $1,995 and the insurance would still be considered affordable.

Even a premium of $1,000 — close to the current average for employee-only coverage — could be unaffordable for someone stretching earnings in the low $20,000’s.

With such a small income, “there is just not any left over for health insurance,” said Shannon Demaree, head of actuarial services for the Lockton Benefit Group. “What the government is requiring employers to do isn’t really something their low-paid employees want.”

Based in Kansas City, Mo., Lockton is an insurance broker and benefits consultant that caters to many medium-sized businesses affected by the health care law. Actuaries like Demaree specialize in cost estimates.

Another thing to keep in mind: premiums wouldn’t be the only expense for employees. For a basic plan, they could also face an annual deductible amounting to $3,000 or so, before insurance starts paying.

“If you make $20,000, are you really going to buy that?” asked Tracy Watts, health care reform leader at Mercer, a major benefits consulting firm.

And low-wage workers making more than about $15,900 won’t be eligible for the law’s Medicaid expansion, shutting down another possibility for getting covered.

Now here is the basic background on the ACA and where we are today.

The following is a very brief primer on the Affordable Care Act (ACA) which will be accepting 2014 enrollments in less than four months’ time, on Oct. 1.

This is directed toward those who are not on Medicare and are covered by an individual health plan or currently do not have coverage.

All insurance companies wishing to offer plans under the ACA for 2014 had to file their plan details, including premiums, with the State Office of the Insurance Commissioner (OIC) by May 1.

The filings for 2014 are readily available for public review and comments on the OICwebsite at http://www.insurance.wa.gov.

I shall summarize my observations and also share with you some thoughts and opinions.

The Players

I had heard that some large out-of-state insurers were considering entering the state and offering health plans. Names that were thought to be considering such a move included Aetna, United HealthCare and Humana. Of the 14 plans that have filed for 2014 there was only one from a company not already offering individual health insurance in the state.

That company was called Coordinated Care Corporation, which is an HMO from the Midwest. Its plan has been “Not Approved” by the OIC. I heard secondhand that the OIC was not going to be approving any additional physician networks for 2014 and as the Coordinated Care plan was an HMO, it was a non-starter for 2014.

Of the 13 other companies that filed, offerings from Molina and Time Insurance (Assurant) have likewise been “Not Approved” by the OIC. I would think that these plans possibly could be amended and refiled if the carriers chose to do so.

The 11 other plans are offered by the following companies and their affiliates; Regence Blue Shield, Premera, Group Health Co-operative, Kaiser Foundation, Community Health and Time Insurance.

Health Insurance Exchanges

Before I expand on the carriers and their filed plans, I would like to take a moment to explain in very simple terms the concept of the Health Insurance Exchanges as envisioned by the government.

Insurance companies will be free to offer plans either within the Exchange or outside of the Exchange. However, and this point is very important, ONLY plans purchased through the Exchange will be eligible for subsidies or premium support if you qualify based upon income levels.

The Health Insurance Exchange will be an online marketplace where people can review plans benefits and premiums and then apply for coverage directly from the company on one central website.

The income levels to be eligible for premium subsidies are quite generously capped at 400 percent of the federal poverty level. This equates to $45,000 for a single person to over $94,000 for a family of four.

Needless to say, the lower your income level, the lower the premium you will have to pay.

The Washington Health Benefit Exchange website can be found at http://www.waplanfinder.org and it includes a great tool to help estimate premiums and subsidies. I would strongly urge everyone to take a few minutes to explore this site.

While it does not include plan details at this point as they have not yet been approved, it does provide a wealth of information. When the site is live with real information I shall keep you informed.

At this point my thought is that everyone should consider a plan through the Exchange if they would receive a subsidy and only look outside of the Exchange if they were not eligible for a subsidy.

Pending Plans

Now back to plans filed but not yet approved by the OIC.

Regence BlueShield and affiliates have filed four plans. Regence BlueCross BlueShield of Oregon will offer plans in the Vancouver, Wash., area; Regence BlueShield or Asuris is available in most counties throughout the state. Bridgespan Health is a new Regence company and is the company through which all the Regence Exchange policies will be offered.

Regence announced that it only will be offering Exchange plans in six counties in Western Washington and one county in Eastern Washington. These are as follows: Skagit, Snohomish, King, Pierce, Thurston and Kitsap in Western Washington and Spokane County in Eastern Washington.

Group Health Co-operative only will be offering Exchange plans in the current counties where they offer their HMO plans and Clallam is not in that category. GHC’s reasoning for this was that in those areas it already had built a network of preferred providers and those counties accounted for 70 percent of its subscribers.

Kaiser Foundation only will be offering its plans in Southwest Washington from Vancouver up to the Kelso/Longview area.

Premera and Lifewise have filed for both Exchange plans and non-Exchange plans in all counties.

Community Health will be offering plans only within the Exchange, but its OIC filing did not include Clallam County as one of the counties it will serve.

Time Insurance has filed to only offer its individual products outside of the Exchange.

Clallam Plans

So, there you have it folks. In Clallam County we will have plans available from the Exchange and they will be offered by both Premera BlueCross and Lifewise. When I spoke with Premera officials, they told me plan benefits and premiums will be basically the same for both companies.

When I asked why they would use both companies, the answer I received was that many current clients are familiar with the name Lifewise, whereas non-clients probably would be more familiar with a Blue Cross-branded product.

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Phew, is it over yet? (Obama’s Affordable Care Act)

The long-awaited decision by the Supreme Court on the constitutionality of President Obama’s Affordable Care Act was announced this past Thursday.

As anticipated, it was a very close decision and could have been decided in either direction. In the end the vast majority of the provisions were upheld by the highest court in the land. So does that mean the arguments are over? Unfortunately, not quite.

The bill was debated and voted on by the House of Representatives, and the U.S. Senate; it passed both Houses and was signed into law over two years ago. It was then challenged by various groups and states all the way to the Supreme Court, where it was upheld.

But with this being an election year it has turned into the largest focal point by both parties. The Democrats are rejoicing in its survival and the Republicans are vowing to overturn it if they gain the presidency as well as majorities in both houses.

Most people are in favor of many of the provisions of the act. For instance, we as a country are already reaping the benefits.

• We have greater prescription drug coverage for folks on Medicare who hit the coverage gap.

• Individual policies may no longer have a lifetime maximum on benefits paid.

• Children can be kept on parents’ plans until age 26. Children cannot be denied coverage based upon their health.

• Preventive care is covered without any copays and deductibles.

The main point of contention is what has been called “the individual mandate.”

This is the provision that states that a person will have an additional tax to pay if he or she chooses not to purchase insurance.

Dollars and sense

The Government can’t force you to purchase health insurance, but they can charge you a tax if you fail to do so. So people can still have a choice whether to purchase insurance or not, but they face higher taxes if they choose not to.

The tax in 2014 will be $95 but will increase and could be up to 1 percent of a person’s income by 2016.

That is the global view of the ruling, but let’s takes a closer look at how it will affect people locally.

Medicare recipients will find few changes at this point. They are already receiving greater preventive screenings as well as enhanced drug coverage.

For people covered under employer coverage, likewise minimal changes.

Employers with more than 50 employees will have to offer health insurance starting in 2014 or face penalties.

Individuals without health insurance will have a guaranteed right to purchase insurance if they choose. We already have that right in Washington, albeit at a higher premium than standard rates.

Millions of people around the country and potentially thousands here in Clallam County will be eligible for premium assistance through an expansion of the Medicaid program.
Pros and cons

For local providers the implementation of the Affordable Care Act could be a mixed blessing. Eric Lewis, the CEO of Olympic Medical Center, has stated that it should reduce the amount of unreimbursed care the organization provides but could also reduce the reimbursement rates from Medicare and Medicaid. Hopefully the overall result will be positive.

Greater usage of preventive services and primary care could mean longer wait times for primary service appointments, but shorter wait times in emergency rooms.

The states will have to create Health Care Exchanges, which are designed to be online shopping sites where people can compare and enroll in plans.

It is anticipated that this will lead to greater competition in Washington as many insurers have avoided the state since the early 1990s. Insurance Commissioner Mike Kriedler has stated that a number of companies have expressed an interest in entering the individual marketplace under the new rules and provisions.

The one thing this bill does not address in any meaningful way is the rising cost of health insurance. Insurance premiums are based upon cost of services provided and as we are all-too-aware, medical expenses continue to increase at rates that are higher than inflation.

It will be interesting to see how everything plays out, but we are now less than 15 months away from, Oct. 1, 2013, when the Health Care Exchanges are to be up and running and accepting applications for January 2014.

When I first started writing about 2014, that date seemed so far away. It now appears to be imminent, so please stay tuned and as things progress I will do my best to explain how it might affect you.

Lifewise

I will close on a different subject. Lifewise Health Plan of Washington is changing most of its plans that have included a prescription drug benefit.

If you receive any letters from Lifewise, take the time to review and act in a timely manner as any decisions have to be made by July 31. If you require any assistance, feel free to contact those great folks at SHIBA, your existing Lifewise agent, or my office. It is not as complicated as it may appear and can easily be explained either in person or over the phone.

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KPS Pulls Individual Coverage

There aren’t many Washington State based insurance companies offering individual health insurance policies and that number is shrinking by one in the months ahead.

The company that is leaving the market is KPS Health Plans and it will affect approximately 2,900 residents of the state.  That is not a huge number, but it is very important if you or someone you know will be affected. This decision only affects those holding Individual policies. This does not affect any other plans the company offers including Medicare, large employer or Federal Employee plans.

Formerly known as Kitsap Physicians Service (KPS) is a Bremerton based nonprofit health care service contractor that was founded in 1946 by the physicians of the Kitsap County Medical Society.  Over the years many similar county based organizations consolidated into what is known as Regence Blue Shield.

KPS retained it’s independence until late 2005 when it became a wholly owned subsidiary of Group Health Cooperative (GHC) the large Seattle based HMO or managed care organization.

Ms. Cathie Valentine-McKinney who is the Director of Public Relations and Communications for KPS stated that the two companies are acting as totally separate entities and each enjoy an independent board of directors.

One aspect of the Affordable Care Act (ACA) that took effect in 2011 was the removal of lifetime maximums. Previously most individual plans had a lifetime maximum of $1 million, now with the cap removed it can have serious consequences for smaller companies. For example a company with a small number of individual members means a few very large claims can have an adverse affect to the whole group.

The cost of cancer and other serious conditions can easily exceed $1 million and with no limits on expenses this poses a potential problem for smaller insurance companies without a large pool of consumers to spread the risk over.

This could be an unintended consequence of the ACA that may be repeated across the country in the future.

Common sense would say that if you are losing your coverage you just go out and buy another plan. Unfortunately it is not that simple.

In Washington state, you have to complete the Standard Health Questionnaire a 26 page form with 220 questions, unless you qualify for one of the ten exceptions.

Having you insurance company cancel your coverage is not currently one of the listed exceptions.

Each of the 220 questions is assigned a point value and if you score over a total of 325 points you are not eligible for an individual plan. But would qualify for the high risk Washington State Health Insurance Pool program whose premiums are designed to be approximately 50% higher than an individual plan.

But wait that’s not all.  Other potential problems that might arise include, pre-existing conditions not being covered for 9 months, children under age 19, deductibles and out of pocket maximums carry over.

The State Legislature is well aware of these potential problems and are attempting to rectify them via House Bill 2739 and Senate Bill 6412.  The details can be found at the following web-site.  http://apps.leg.wa.gov/billinfo/summary.aspx?bill=6412

I am sure something will work itself out prior to the July 1st termination date. However, Ms. Valentine-McKinney of KPS is highly recommending those families with children under the age of 19 review their options during the State mandated Open Enrollment Period which runs from March 16th through April 30th.

KPS states  “failure to apply during this time frame may exclude your under age 19 applicants from coverage until the next OEP, which does not occur until September 16th to October 31st 2012.”

As I have stated in previous columns the health insurance industry will be facing unprecedented changes in the coming years that will potentially affect everyone of us.

If this change affects anyone you know please make sure they fully understand their options. Advice is available from your friendly local insurance agent or the great folks at SHIBA.

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Phil’s Insurance Opinions

As you are probably aware I am from the UK and grew up under the National Health Service (NHS).  I left the UK at 18 years of age and had not had any real experience with the NHS prior to that time, other than terrible experiences with an NHS dentist before my parents decided to pay for a private dentist. But maybe I will save those details for another day.

However in the past few years I have heard anecdotally from family and friends lot’s of experiences of the NHS in the UK and also in Canada.

For the most part if a person has an emergent situation or a life threatening condition the service is adequate.  For example, when my Mom was diagnosed with cancer she received fairly prompt attention.  They lived in rural Scotland and for some of the tests she went to three different locations all within a 50 mile radius, between Dumfries, Glasgow and Edinburgh.  Dumfries as that was her local hospital 20 miles away and then Glasgow and Edinburgh for different specialist tests and equipment.

In the US we have far greater accessibility to technology where that amount of travel would be unusual. Look at little ‘ol Sequim where we now have a pretty amazing new cancer center with state of the art technology. Amazing.

A few years ago it was reported that Washington State with a population of around 5 million at that time had more MRI machines than did the whole of Canada with a population five times larger.

So, once your condition is diagnosed the treatment is somewhat comparable to the US, with frequently different results.  By that I truly believe that if a person is proactive about their health, conditions will be diagnosed sooner in the US than in the UK and that will lead to a better outcome.  For example, my father is 78 and to my knowledge he has never had his prostrate checked.

That is just but one example. The following comments are from the NHS web-site on Prostate screening and I find them utterly amazing

“It is in some ways a lifestyle choice,” says Dr Parker. “If you want to do everything to maximise your chances of living to a great age, and are willing to risk the side effects of treatment, then PSA testing makes sense.

“If, on the other hand, you are more accepting of your ‘allotted span’, and are keen to preserve normal sexual and urinary function, then you may decide not to have the test.”

Can you believe on the government run web-site they make it sound bad that you want to maximise your chances of a long life, and they then continue to talk about your “allotted span”.

According to the NHS web-site over 1.6 million women a year have a mammogram.  This is for a country of something over 60 million people.  It is available only to those women between ages 50 and 70, and even then only every three years.  Here is a link from the NHS web-site.  http://www.nhs.uk/Conditions/Cancer-of-the-breast-female/Pages/Screeningbreastcancer(female).aspx

I believe the same can be said for Canada.  We have a cousin whose daughter needed a heart transplant as an infant 10 years ago.  That surgery had to be performed in Toronto as that was the only place in the whole country capable of performing such a complex operation at that time.  The cousin became a bit of a crusader and activist and now 10 years later then are very close to having the capabilities for similar surgeries here in Vancouver as opposed to the other side of the country.

The area that I believe both Canada and the UK are lacking is in the treatment of non emergency conditions such as back surgery or hip replacement. The anecdotal reports of extreme waiting periods do have a basis in fact. The NHS has a handbook that outlines what are to be considered acceptable wait times.  The major one is 18 weeks to see a specialist, or 62 days if it is suspected you have cancer.

I don’t know about you but I don’t want to wait 2 months if the doctor’s think I may have cancer, do you???

I sincerely think that the UK system does a certain amount of rationing of services and testing based upon age etc, and this does possibly lead to what has been called “the death panels” in ObamaCare.  From a cynic’s point of view if the government can delay and postpone services it will lead to higher mortality, and if the same government saves money via either social security benefits or in the UK pensions, they have a financial interest and what I believe is a direct conflict of interest in your wellbeing.

My next email will be my opinions on The Patient Protection and Affordable Care Act or what the press call ObamaCare.

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