Archive for the ‘Health’ category

Full circle about single-payer health insurance

February 21, 2017

Choose Your Health Insurance

I never understood why there is so much support for a national, single-payer healthcare system – until I started working in a small medical office.

Just last year, I believed that commercial health insurance is good for consumers. It is better for us as patients, in terms of flexibility (choosing the plan that fits you), choice (access to doctors you trust), and price (insurance plans must compete for your business, keeping their premiums reasonable and benefits attractive). It is better for healthcare providers, because they can choose which healthcare plans to accept; insurance companies with unreasonable requirements or low reimbursement rates could be avoided. Theoretically.

For healthcare providers, our current healthcare system can be a nightmare. Each healthcare plan has different copays, different deductibles, and vastly different levels of reimbursements. Some payers reimburse providers promptly; some payers may take months. It’s not fair to providers, who may have to wait a long time before they get compensated for their work. How many of us would go to work if we are not sure how much we will get paid, or when we’ll get a paycheck?

Even a small medical office, with a limited number of healthcare providers and billing codes, generates a lot of paperwork. Electronic billing helps, but there are still pre-authorizations, progress notes, requests for documentation, paper claims for payers who don’t accept electronic billing, and customer service phone calls to find out the status of a claim or why a claim was denied.

I’ve had problems with two insurance companies who each insist that the other is “primary” and should be billed first. I’ve had claims that get lost in the system, and then have to be “escalated” for payment. I’ve learned that military plans are “secondary” payers – except when they are “primary” payers.

For healthcare providers, I see the allure of a single-payer system: one claim form, one customer relations contact, one billing contact. Theoretically.

But the more I learn, the more I realize that a single-payer health insurance could be an even bigger nightmare than our current system. A monopoly on healthcare coverage, authorizations, and payments would not be good for anyone.

Consumers would have a limited choice of plans and providers, and under current law would be forced to buy health insurance that they may not be able to afford. Healthcare providers would have little recourse if the single-payer refuses a claim or underpays a claim.

In a short time, I’ve realized that the government health insurance payers (military, veterans, Medicare, and Medicaid) are the most difficult payers to work with. Government payers often take longer to reimburse providers – sometimes three times as long as commercial insurance companies. Government payers often pay providers less – sometimes 25% less than commercial insurance companies. Government payers often fall short in informing people that they need to have an authorization before they see a healthcare provider – and there is little recourse for appeals.

I was beguiled by the idea of single-payer health insurance, until I realized that the single-payer would be a government payer. I’ve come full circle, skeptical that single-payer health insurance would be an improvement over our current healthcare system.

If you work in the healthcare profession, what has been your experience with medical billing and claims? If you’ve lived in a country with a single-payer health insurance, what has been your experience with medical costs and care?


Clipart courtesy of



Health care blues

January 10, 2017

Health care blues

It seems that there are no cost-savings to being healthy anymore. Last year, we received a health insurance packet with our 2017 monthly premium. It jumped 19% — over $100 per month for our family of three.


Now I’m left singing the “Health Care Blues,” to the tune of Elvis Presley’s “Blue Suede Shoes.”


Well, it’s one for the copay

Two for the nurse

Three for the doctor

Now open your purse


But don’t you

Belittle my health care blues

Well you can pay any fee

But don’t scoff at my health care blues


Well, you can get a shot, take an aspirin

Swallow your medicine with a big grin

Well, do any treatment that you want to do

But uh-uh, Congress, don’t pooh-pooh my blues


And don’t you

Belittle my health care blues

Well, you can pay any fee

But don’t scoff at my health care blues


Let’s go, doc!

Ah, pay the bill


You can take a pill, exercise

Eat all the veggies that you despise

Well, do any treatment that you want to do

But uh-uh, Congress, don’t pooh-pooh my blues


Rock it



Well, it’s one for the copay

Two for the nurse

Three for the doctor

Now open your purse


But don’t you

Belittle my health care blues

Well you can pay any fee

But don’t scoff at my health care blues


Well, it’s blue, blue, health care blues

Blue, blue, health care blues, yeah!

Blue, blue, health care blues, Congress

Blue, blue, health care blues

Well, you can pay any fee

But don’t scoff at my health care blues


Happy belated birthday, Elvis.

Vaccines, voting and vigilance

August 16, 2016

Voter Enthusiasm

On the day of the Hawaii primary election, there were longer lines to get the Hepatitis A vaccine than there was at our neighborhood polling place.

The Honolulu clinic was professional and organized. Hepatitis A vaccines were free. I stood in line, answered three questions, signed my name, and went to one of the stations to receive a shot in the arm and a band-aid.

Our polling place was efficient and orderly. I stood in line, signed my name, received a ballot, went to one of the curtained desks to fill out the ballot, and put the ballot in the ballot machine. Knowing that we may soon switch to mail-in or electronic voting, I wanted to vote at my polling place to feel part of my community.

I decided to get the vaccination because I want to take care of myself and the people around me. The vaccine is supposed to last a lifetime, and I didn’t want to worry every time I bought groceries or ate at a restaurant..

I voted because it is both a duty and a privilege to vote, and to be reasonably informed about candidates and issues. The decisions our elected representatives make could affect us for many years after they are out of office.

As of August 10, 2016, there are 168 confirmed cases of Hepatitis A, according to the Hawaii Department of Health. I don’t know how many people have received the vaccination, but people are vigilant about their health: news reports say that pharmacies are seeing an influx of people seeking vaccinations, and insurance companies are responding to concerns by offering prescriptions or free or low-cost vaccinations.

In the 2016 Hawaii primary election, 252,703 voters (34.8% of registered voters) determined the outcome of US Congress, State Legislature, city mayor, and OHA races, according to the Hawaii Office of Elections. Our health may not be directly affected by elections, but too few Hawaii residents are vigilant about our peace of mind, our quality of living, and our wallets.

Did you vote in the Hawaii primary election? Did you make choices for good candidates or against poor candidates?

Summer reflections: 3 commitments and 4 doors

July 5, 2016

Summer Reflections

Recently, I’ve been over-scheduling myself – taking on more responsibilities at work, while keeping family and friends a priority, and trying to fit in the hobbies I enjoy in the margins. I sometimes take work problems home and family concerns to work. I’ve forgotten to schedule “unscheduled” quiet time when I can relax and revitalize myself.

This summer, let’s take time to reflect on three commitments we can make to help us let go of stress and anxiety, and four doors we can open to live a more meaningful life.

“We have a choice. We can spend our whole life suffering because we can’t relax with how things really are, or we can relax and embrace the open-endedness of the human situation, which is fresh, unfixated, unbiased,” writes American Buddhist nun, teacher, and author Pema Chӧdrӧn.

We can learn how to live with uncertainty and change by following the Three Commitments, explained in “Living Beautifully: With Uncertainty and Change” (2012) by Pema Chӧdrӧn. These teachings were given at Gampo Abbey, a Tibetan Buddhist Monastery in Cape Breton, Nova Scotia, in 2009, and are loosely based on the traditional Buddhist Three Vows. Chӧdrӧn teaches us that pain is neither good nor bad – “It’s our interpretation of it that makes it so” – and that we need to acknowledge our pain and anxiety, giving it our full attention, so that we can let it go.

  1. First Commitment: Committing to not cause harm (Pratimoksha Vow). Refrain from speech and actions that are harmful to ourselves and others. This makes us more aware of what we’re feeling and helps us trust in our basic goodness. It’s like walking down a very narrow corridor – if you lose your awareness, you’ll veer off course and bump into a wall.
  2. Second Commitment: Committing to take care of one another (Bodhisattva Vow). Invite everyone to be your guest, even if it’s just for a day or a week. Then gradually lengthen the invitation. Do what you think will bring the greatest benefit. It’s like being on a sinking ship and vowing to help all the other passengers get off the boat before you do.
  3. Third Commitment: Committing to embrace the world just as it is (Samaya Vow). Surrender to life – engage with and appreciate the unique and precious moments in life. Live in the present and be fully open to whatever is coming along right now. It’s like standing at the center of a mandala – a vast, limitless circle, experienced in short moments again and again.”

“Everyone has problems. It’s how we choose to deal with our problems that matters. Some people choose to be whiners – some choose to be winners,” writes novelist Richard Paul Evans.

As we start to live in the present, we can learn how to live a more joyous and meaningful life from “The Four Doors: A Guide to Joy, Freedom, and a Meaningful Life” (2013) by Richard Paul Evans. The book is a 30-year journey about the principles “to live life joyfully, with freedom, power, and purpose.” Evans teaches us that we have to notice and build on our small daily achievements and successes. “Great things can happen in the margins of your own day and the spare moments of your life.”

  1. PURPOSE. Believe there’s a reason you were born. Sometimes our purpose is given to us, sometimes we find it by following our passion or listening to our inner voice.
  2. IMAGINATION. Free yourself from limitation. Imagine a better life. We have to overcome our negative belief, self-doubt, and fear of failure. We have to take control of our lives (don’t think of yourself as a victim!), learn from adversity, offer forgiveness, and feel gratitude.
  3. VISION. Magnify your life. Have a dream. Ask “what if?” and “why not?” Take risks.
  4. LOVE. Develop a love-centered map. Love that wishes good for someone else is an act of will and a skill to be developed. “Love is the destination and the journey.” The fourth door leads to all others.

Do you experience a lot of stress and anxiety in your life? How do you recharge yourself?

Gambling with our health in 2016

December 8, 2015

Health Care

Last month, I received a renewal letter for our 2016 health insurance coverage, and I was shocked to read that our monthly premium is going up over $200 – an increase of 34%. To be able to afford health insurance, we are downgrading our health care plan even more, with a very high deductible.

We are gambling with our wallets, hoping that we will be healthy in the coming year.

This is not the first time that our health insurance premiums have skyrocketed. In 2010, under the Hawaii Prepaid Health Care Act, we had a very good health care plan with our employer. Over the years, premiums slowly increased for our family of three, but we had time to adjust. Four years later, we felt the jarring impact of the Affordable Care Act: our monthly premium went up over $200 – an over 30% increase. Then, as now, we switched to a lower-benefit plan in order to afford our health insurance.

I know that health care is expensive. I know that the costs of providing health care increase every year. I know that we have access to good health care in Hawaii. And I just learned that Hawaii’s health care premiums are among the lowest in the nation, according to the Centers for Medicare and Medicaid Services.

Now I am apprehensive that next year when premiums increase, there is no other “basic” plan that we can downgrade to in order to keep our premiums affordable.

I thought that adding more people to health insurance plans would result in some economies of scale and cost savings in the long run. But in the case of health care, more demand results in higher costs.

Based on my experiences with health insurance in Hawaii, I have three suggestions:

Suggestion #1: We need to make health care premium increases more gradual. The Hawaii Department of Commerce and Consumer Affairs Insurance Division approved a 2016 rate hike because health care providers say it is necessary. A 20% or 30% increase isn’t affordable for most of us. I’d like to be able to limit the percent increase of health care premiums (and state taxes too). It all comes down to figuring out how we can make drastic rate hikes unnecessary.

What if we could limit annual health care premium increases to a set percentage or dollar amount? This would help us budget our money for the coming year.

Suggestion #2: We need access to up-front, published rates for medical and dental services. I would like to see doctors, dentists, optometrists, specialty-care physicians, clinics, and hospitals tell us the costs for services, labs, and procedures without insurance. This would help us compare rates and levels of service among health care providers, and figure out which level of health insurance works for us.

What if doctors decided to accept “cash only” (cash, checks, and credit cards) for services, and individuals were responsible for getting reimbursed from health care insurers? Would this lower the cost of health care, because doctors could focus on serving patients, instead of billing? Would this make individuals more proactive about preventative care and more cost-conscious about health care?

Suggestion #3: We need to move away from health care through employers. By linking health care with individuals, there’s no loss of coverage if we change jobs and we don’t need to rely on employers to make health care plan decisions for us.

What if we received a Health Care Card in addition to a Social Security Card upon birth or naturalization? We could automatically sign up children for pediatric medical and dental plans at the same time that parents fill out birth certificate forms.

Do you think that the Affordable Care Act has been good for Hawaii? How has the Affordable Care Act affected you?

A hospital ship for Hawaii

August 25, 2015

Hawaii Hospital Ship

In Hawaii, providing timely and affordable healthcare is made even more challenging by our remote location. We are about 2,400 miles away from California, over 3,800 miles away from Japan, and over 4,700 miles away from Australia. It takes more time and more money to import medicine, medical equipment, and supplies. We have to plan ahead for what we need now and in the future. During emergencies, we have to rely on what we have on hand.

Another challenge: because much of Hawaii’s population is centered on Honolulu County, rural and neighbor islands have an even greater difficulty accessing healthcare. The neighbor islands have higher rates of preventable deaths and preventable hospital readmission rates, according to the Hawaii Healthcare Project’s “State of Hawaii Healthcare Innovation Plan” (2014).

There are many ways we could improve healthcare in Hawaii, and I’d like to pitch one more idea: a Hawaii hospital ship. This floating medical facility could carry medical equipment and supplies, rooms for medical and support staff, operating rooms, patient beds, and boat docks. It addresses the problem of Hawaii’s geographic separation, not just from the rest of the world, but from each other.

A Hawaii hospital ship could operate on a regular schedule, stopping at harbors for 1-3 days as needed, and making a circuit of the islands once a month. Hawaii has ten state-managed harbors on six islands, and I would add one on the North Shore of Oahu – Port Allen (Kauai), Nawiliwili (Kauai), Haleiwa (Oahu), Barber’s Point (Oahu), Honolulu (Oahu) for repairs and supplies, Kaunakakai (Molokai), Kaumalapau (Lanai), Kahului (Maui), Hana (Maui), Kawaihae (Hawaii), Hilo (Hawaii), and back again.

Hawaii Harbors Map

Here are 4 ways Hawaii could benefit from a hospital ship:

* Regular medical services to remote areas. A hospital ship could deliver medicines and medical supplies, and perform lab tests. Ship doctors could provide consulting services or second opinions and assist with operations. Being able to “share” medical equipment could lower costs, and it could save money for patients who could not afford to fly to Honolulu.

* Search and rescue support services. A hospital ship could be diverted to aid the survivors of airplane, cruise ship, and boat survivors.

* Emergency services during natural disasters. The regular medical schedule could be suspended to deal with a natural disaster by offering medical aid, delivering supplies, and transporting aid workers and the injured. It’s an important part of crisis-planning for our state.

* Quarantine facilities. A hospital ship could be converted to a quarantine ship in case of an outbreak of disease or illness.

Realistically, I don’t think a hospital ship is affordable. We just don’t have a large enough population to make it a reasonable option now. But we could take the long view and start planning for the future. We need to be able to help each other, because help from outside Hawaii is so far away.

Would a hospital ship solve a problem in healthcare and emergency response? How could we make it work? Why do you think it wouldn’t work for Hawaii?

Sun safe and skin wise

June 23, 2015

Cumulative & Irreversible

Living in Hawaii, it’s hard to avoid the sun. When I was young, I didn’t worry about getting sunburned – aside from my annoying habit to burn and peel. Then my mom told me that damage from the sun is “cumulative and irreversible” – a phrase I remember to this day.

I don’t use sunscreen as often as I should, but I have changed what I do outdoors. I keep to the shade as much as possible. I cut down on beach-time. I try to avoid being outdoors during the hottest parts of the day. It hasn’t saved my skin – probably most of the damage was done when I was younger – but think that I’ve prevented further skin damage.

I’d like to take a few minutes to remind everyone to take sun safety seriously.

Did you know that… skin cancer is the most common form of cancer in the United States? Melanoma is the second most common form of cancer among young adults aged 15-29 years old? One in five Americans will develop skin cancer? Read the Environmental Protection Agency (EPA)’s “Just the Facts:  about Skin Cancer in Hawaii” (April 2014) for more Hawaii-specific facts.

UV Index

According to the National Weather Service, Honolulu is consistently rated an 11 (Extreme) on the Ultraviolet (UV) Index. The UV Index forecasts the amount of skin-damaging UV radiation expected to reach the earth’s surface at the time when the sun is highest in the sky. It can range from 0 (at night) to 15 or 16 (at solar noon in the tropics at high elevations under clear skies). The higher the UV Index, the greater the dose rate of skin damaging (and eye damaging) UV radiation, and the smaller the time it takes before skin damage occurs.

There’s an easy way to remember to protect your skin. The National Council on Skin Cancer Prevention reminds us to “Slip! Slop! Slap! and Wrap” when we’re outdoors. That means slip on a shirt, slop on sunscreen (choose a broad-spectrum sunscreen with SPF 30 or higher every two hours), slap on a wide-brimmed hat, and wrap on sunglasses (with UV protection). Even on overcast days, there’s a risk of sun exposure, so stay in the shade as much as possible, especially between 10 am and 2 pm.

Did you know that polar bears have special eyelids that act like sunglasses? Or that elephants use dirt and hay to protect their skin from the sun? Head to the zoo and teach kids about animals and sun safety at the same time. The EPA has a fun fact sheet about “sunwise” animals, as well as coloring pages that reveal how hippos, pigs, turtles, meerkats, and camels protect themselves from the sun.

Are you taking care of your skin? How do you stay safe in the sun?