Medicine on Call – The Latest

 

The latest episode of Medicine on Call is here. 

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Medicine on Call with Dr. Elaina George

Dr Elaina George gives you the medical advice that other doctors won’t give.

 

 

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Why Black Folks Should Fight for Healthcare Reform

By Julianne Malveaux

Congress seems to be putting the final touches on health care reform legislation, arranging to provide health care, especially, for the uninsured. Anyone who has made the summer rounds of civil rights conventions understand that African American policy makers care about this issue. Still there seems to be no passion in advocacy for heath care reform.

Our presence in this debate is much needed - we have a dog in this fight. African

Americans are more likely than others to be uninsured, so the many ways our new legislation will make insurance available is important. And even when we are insured, the way that health problems hit us are most different. According to the Centers for Disease Control, African Americans and Hispanics "bear a disproportionate burden of disease, injury, and disability." African Americans, in particular, are more likely to be killed or to die of HIV than others are.

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How to Play the Insurance Game and Win

 

Dr. Elaina George, Medical Correspondent – YourBlackWorld.com 

For Americans, receiving heath care is like going to a casino, but here the typical rules don’t apply. In the healthcare casino, the medical insurance industry, Big Pharmaceutical Companies and hospitals make the rules to insure that the house wins every time. Over the years they have increased your stakes by increasing premiums, drug costs and hospital costs, while raking in windfall profits. The medical insurance industry has grown larger and more powerful by systematically fleecing patients and doctors. To hide the fact that they are playing with people’s health; they have been masters of distraction. The ever changing rules for patients and doctors have made it impossible to learn what you need to know. Moreover, it has placed doctors, who are the face of medicine, in a position where the patient has begun to question their motives. This has eroded the doctor patient relationship and has damaged the foundation of excellent medical care.

Over the next several weeks, we will examine how the game has been rigged so that you can finally understand the rules. Each week we will expose what you need to know to take back your power and put the odds back in your favor so you can win! This week we will examine the medical insurance industry.

Basic facts about the medical insurance industry:

· The Players - Top Medical Insurance CEOs

· Most of the insurance companies are for profit corporations

· Doctors do not receive money for ordering tests

· Insurance companies use pre-authorization to control what tests a doctor is allowed to order

· When insurance companies set a doctor’s fee of “usual and customary” it is an arbitrary fee devised by the insurance company. It is not based on the doctor’s actual cost of doing business and

· Insurance reimbursement rates are based on Medicare rates

· Premiums have risen to pay for the insurance industry’s cost of doing business (including shareholders and CEO salaries), while reimbursements for doctors have dropped by about 60-70% over the last 10 years

· Although approval for a patient’s care may be approved by the insurance company, there is no guarantee that the insurance company will pay the claim

· Insurance companies have subsidiaries that work with pharmaceutical companies in order to make money by selecting what drugs your doctor is allowed to prescribe to you.

· Insurance companies invade patient privacy by buying lists from pharmacy clearing houses that document what prescriptions you have ever gotten. They use this information to deny coverage to new and existing members based on a ‘pre-existing condition’ even if you had only filled a prescription once.

What you can do to protect yourself:

· Read your insurance contract and if you don’t understand it contact your insurance company or human resources and ask questions

· Choose coverage that fits your medical needs as well as your budget. If you have chronic medical problems make sure that you choose an insurance company with a large network of doctors so that you have choice.

· If you currently have a physician and you are happy with their care, ask them what insurance company they belong to and ask them about access – specifically, if the insurance mandates pre-certification for services.

· Before you go to your doctor know your benefits, don’t depend on the doctor’s office to do it. For example, if you have recently seen a doctor or had medical care, that information may not be updated. Therefore, the status of your deductibles or co-insurance may not be current and that can affect what you have to pay.

· If you have been denied medical care by your insurance company and you have exhausted their appeals process, but still feel that you have been unfairly denied, you should contact the insurance commissioner in your state. The insurance commissioner is the main regulatory authority that can change a decision that has been made unfairly.

· Open your insurance bill (also known as an explanation of benefits), it will detail what was done by the doctor or hospital, the amount the insurance company paid and the amount you have to pay. If you have questions about what was done call the doctor’s office or hospital and ask them to clarify what was done and why. Honest mistakes can be made and rectified in a timely way when you are proactive.

Next week, we will take a detailed look at the pharmaceutical industry. If you have any questions please send them to drgeorge@tmo.blackberry.net or http://www.twitter.com/medicineoncall.

Dr Elaina George is a prominent Board certified Otolaryngologist who practices in Atlanta. She started her practice Peachtree ENT Center with a mission to practice state of the art medicine that is available to everyone, and has come to be known as, the patients’ advocate. Dr. George graduated from Princeton University with a degree in Biology. She received her Masters degree in Medical Microbiology at Long Island University, and received her medical degree from Mount Sinai School of Medicine in New York. She completed her residency at Manhattan, Eye Ear & Throat Hospital. Her training included general surgery at Lenox Hill Hospital, pediatric ENT at The NY-Presbyterian Hospital, and head and neck oncology at Memorial Sloan-Kettering Cancer Center. She has published in several scientific journals and presented her research at national meetings. You can listen to her radio show Medicine on Call, and read her blogs as a medical correspondent for Your Black World .

To have Dr. George as a speaker, please reach out to information@yourblackpublicity.com or call S. Prewitt at (901) 413-0203.

Science Must Determine if Athlete is a Woman or Not

No 1: Caster Semenya celebrates as she wins gold in Berlin Photo: AP

Semenya crowned a spectacular season by triumphing in 1min 55.45sec while Britain's Jenny Meadows produced a lifetime best of 1min 57.93sec to take the bronze - Britain's third medal of the championship. Fellow Briton Marilyn Okoro was eighth.

But instead of being able to celebrate her victory, Semenya found herself facing uncomfortable questions about whether she should really have been lining up in today's first-round heats of the men's 800m.

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Are Doctors to Blame for the High Cost of Healthcare?

Dr. Elaina George, a prominent family practice physician in Atlanta, has a bone to pick with President Obama. During various healthcare town hall meetings and press conferences, the president has villified doctors as the cause of the high cost of healthcare. But Dr. George doesn't agree.

As one of the few black doctors in America who is taking the time to speak out in the current healthcare debate, Dr. George says that the culprits in the high cost of healthcare are The American Medical Association, hospitals, big pharmaceutical companies and insurance companies. Here is how she breaks it down.

1) Our country has gotten away from preventing illness and is instead engaged in the high cost of managing disease. Dr. George explains in the interview below that rather than actually curing illnesses or preventing them, we simply try to manage them. Her argument, as with many others in the healthcare profession, is that this attitude is driven by the fact that pharmaceutical and insurance companies only maximize profits when people stay sick. Symptoms tend to be treated instead of the underlying cause of the illness, making problems worse in the long-term.

2) According to some physicians, the public option on healthcare may not be as great as it sounds. When it comes to the public option (which is being heavily debated right now), Dr. George argues that while the option may provide health coverage for many Americans who don't have it, it may not cause insurance companies to pay their fair share of the cost of healthcare reform. "The argument that the public option will drive down costs is disingenuous," says Dr. George. "How can a program designed to cover about 10 million people (as per the Congressional Budget Office) really exert any pressure on the health insurance industry when a company like Blue Cross and Blue Shield has over 30 million members and United Healthcare is even larger?"

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Dr. Elaina George Speaks on the Healthcare Debate – Where are We Now?

 

by Dr. Elaina George

The debate on healthcare reform is in full swing, but no one is paying attention to the long term effects.

I am for universal healthcare in theory. As a physician, I believe that it is a fundamental right. Unfortunately, the way the debate and pending legislation has been crafted, the outcome will result in unintended consequences.

As a physician in solo practice, I am in a unique position to see the outcome if we continue on the path that Congress is proposing in HR 3200.

1. A single payer system that pays the same rate as Medicare or as the bill stipulates (5% above Medicare) will lead to LESS choice. People are overlooking the fact that most private physicians are currently NOT accepting new Medicare patients because they can’t afford to do so and stay open. There will be no reason for this to change if the reimbursement scale is adopted.

Unintended consequence: The network of private physicians would be smaller and more patients will be placed in a system of fewer physicians, less choice and longer waiting times to be seen. This would have the opposite effect – what is the point of universal healthcare if you don’t have quality physicians to provide it?

2. The proposed healthcare bill sets up a bureaucracy run by a National health insurance commissioner and sets up an insurance “self regulatory agency” – made up of national insurers, national agencies, and insurance producers. There are no physicians or patient advocates.

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Healthcare Reform 101

Walter Gaines Jr., left, who supports health care reform, confronts a man who opposes health care reform in Alhambra, Calif. (AP Photo/Jae C. Hong)

 

Dr Tyeese Gaines Reid – TheGrio.com.

 

With the bombardment of speeches, commentaries and rowdy town forums, many Americans are struggling to decipher the current state of health care reform. Understanding the ins and outs of over 1,600 pages of proposed law is daunting. Unfortunately, there is no politician or any crystal ball that can predict either plan's success at this stage.

To date, two bills have been proposed - the 1,017-page House bill (H.R. 3200) and the 615-page Senate Health Committee bill. A third bipartisan bill is said to be in the works from the Senate Finance Committee. Until September, when Congress reconvenes, we will continue to wait and debate on the limited information we do have.

Here is a summary of those bills, commonly-raised concerns and the debate as it now stands.

1) Problem: The Uninsured
Millions are uninsured and falling ill without insurance can be financially catastrophic. Many of these are working people, or recently unemployed, who can't afford to buy insurance plans. Others are self-employed or small business owners who also can't afford insurance. Some are between the ages of 55 (retirement age) and 65 (Medicare-eligible age), and thus have no coverage. In 2008, the Kaiser Commission reported that 41 million were uninsured, while another 35.8 million people had no insurance during part of the year.

Proposed Solution: "Health care for all." Both bills have outlined strategies to include all Americans in some form of a health insurance plan - whether Medicaid, Medicare, the private or the public/community option.

2) Problem: Pre-existing conditions
People with any history of medical problems ("pre-existing conditions") can be denied coverage by certain insurance plans because their condition makes them too high-risk.

Proposed Solution: Ban the pre-existing condition clause for all health insurance companies, including those in the private option. The hope is that as more young and healthy Americans have insurance and pay their premiums, that money will offset the costs of taking care of the sicker Americans.

3) Problem: The under insured
Some people with health insurance have plans that don't cover all basic health care needs (the "under-insured").

Proposed Solution: All health insurance plans will cover hospitalizations, outpatient hospital and clinic care, physician fees, equipment, prescription drugs, rehabilitation, maternity care, child care, preventive care, mental health, and marriage and family therapy. The addition of coverage for mental health and counseling is an added benefit not often covered currently.

 

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News: President Obama’s New Healthcare Commercial

President Obama just bought a great deal of ad time to push his healthcare reform bill.  What do you think?

Click to watch the ad.

BET Puts on a Conference for Black Female Health

BET Foundation officials believe if anyone has the power to help family members get healthier, it's the woman in the house.

That's why the organization is bringing the BET Foundation Women's Health Symposium, Remembering Our Health, to Detroit for the first time Saturday.

"Our women's health symposium was designed to educate African-American women on how to better care for themselves because we've realized when it comes to health disparities, the leading person that can influence health disparities is the African-American female," says Debra Kilpatrick, director of women's health programs for the Washington, D.C.-based BET Foundation Inc.

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The event, which is free but requires registration, runs from 8 a.m. to 4 p.m. Saturday at the Wayne State University Community Arts Auditorium and Student Center. It features Grammy-winning gospel great Vickie Winans as emcee and a special performance by R&B songstress Deborah Cox during the 3 p.m. plenary session.

 

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