Newt's Tip #3 of our continuing saga:

• Meet the needs of the chronically ill. Most individuals with chronic diseases want to be in charge of their own care. The mother of an asthmatic child, for example, should have a device at home that measures the child's peak airflow and should be taught when to change his medication, rather than going to the doctor each time.

Having the ability to obtain and manage more health dollars in Health Savings Accounts is a start. A good model for self-management is the Cash and Counseling program for the homebound disabled under Medicaid. Individuals in this program are able to manage their own budgets and hire and fire the people who provide them with custodial services and medical care. Satisfaction rates approach 100%, according to the Robert Wood Johnson Foundation.

We should also encourage health plans to specialize in managing chronic diseases instead of demanding that every plan must be all things to all people. For example, special-needs plans in Medicare Advantage actively compete to enroll and cover the sickest Medicare beneficiaries, and stay in business by meeting their needs. This is the alternative to forcing insurers to take high-cost patients for cut-rate premiums, which guarantees that these patients will be unwanted.

Here's where it all becomes laughable. Let's "meet the needs of the chronically ill." Yeah, isn't that what insurance is for? Isn't that the purpose of insurance? Unfortunately insurances don't have to take anyone who happens to be chronically ill? Have back pain? Sorry, it is a pre-existing condition so not covered. Diabetic? Sorry. Mentally ill (depressed? bipolar?)? Have migraines? How about high blood pressure? Nope. All pre-existing conditions and you won't be eligible for any new plan. Now Obama's bill will change that...IF the Republicans allow passage. A big IF.

Oh, and Newt. Just for your info, patients already have devices to monitor asthma. They're called peak flow meters and the cost about $20. But they're not usually covered under anyone's insurance.

As for HSA's (Health Savings Accounts), I used to think these would be great. As a matter of fact, I thought they were the answer to all our healthcare problems. Not any more. I had one for two years. The theory is that since you control the money, you will shop around and get the best quality care for the least money. The consumer controls the money. Smart huh? Not really. You see once I tried to find out what a doctor would charge, what a hospital would charge. You can't do it. You can't even find out exactly what doctor is going to be charging you for what. It is all a mystery until about a few months later when all the bills start showing up. And then, of course, it is too late. Control the money? Forget about it. The system is rigged and you aren't going to be able to do a thing about it.

Now for the kicker: Newt writes of somehow tweaking insurance into "special needs" away from the be all things to all people model. Hello? Aren't we talking about insurance here? We need insurance for those illnesses that we already have AND for those we don't already have. That is, for those times we get the the unknown unforeseeable future. Newt then continues the idiocy, writing that this is "forcing insurers to take high-cost patients for cut-rate premiums, which guarantees that these patients will be unwanted."

See? That's the problem: Republicans like Newt see this crisis as an attack on insurance companies and their profits. "These patients will be unwanted." Duh...they're sick. They cost the companies money. Anyone who files a claim with an insurance company is by definition "unwanted." That is the problem with having a "system" maintained by for-profit businesses. Get it?


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