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Covid-19 and U.S.A. health insurance

10/4/2020

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The number of cases of Covid-19 spreading around the world and increasing even more so in the United States of America.  




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​Just one of U.S. President Donald Trump’s lies about Covid-19. The one that worries me the most.  


When: Wednesday, March 11
The claim: In an Oval Office address, Trump said that private-health-insurance companies had “agreed to waive all co-payments for coronavirus treatments, extend insurance coverage to these treatments, and to prevent surprise medical billing.”
The truth: Insurers agreed only to absorb the cost of coronavirus testing—waiving co-pays and deductibles for getting the test. The Families First Coronavirus Response Act, the second coronavirus-relief bill passed by Congress, later mandated that COVID-19 testing be made free. The federal government has not required insurance companies to cover follow-up treatments, though some providers announced in late March that they will pay for treatments. The costs of other non-coronavirus testing or treatment incurred by patients who have COVID-19 or are trying to get a diagnosis aren’t waived either. And as for surprise medical billing? Mitigating it would require the cooperation of insurers, doctors, and hospitals. 
https://www.theatlantic.com/politics/archive/2020/04/trumps-lies-about-coronavirus/608647/


The number of American citizens who do not have access to, even affordable, healthcare is staggering. As the  information below shows the United States does not have a full funded health care system that is available to all citizens.  With the number of people who simply can not afford adequate health insurance I believe many will simply not apply to be tested and even some will not even seek medical attention if they do fully develop the disease.  These people will then continue to infect others further exacerbating the pandemic.


The United States stands out from many other countries in not offering universal health insurance coverage. In 2010, 50 million people (16 percent of the U.S. population) were uninsured (DeNavas-Walt et al., 2011). Access to health care services, particularly in rural and frontier communities or disadvantaged urban centers, is often limited. The United States has a relatively weak foundation for primary care and a shortage of family physicians (American Academy of Family Physicians, 2009; Grumbach et al., 2009; Macinko et al., 2007; Sandy et al., 2009). Many Americans rely on emergency departments for acute, chronic, and even preventive care (Institute of Medicine, 2007a; Schoen et al., 2009b, 2011). Cost sharing is common in the United States, and high out-of-pocket expenses make health care services, pharmaceuticals, and medical supplies increasingly unaffordable (Commonwealth Fund Commission on a High Performance System, 2011; Karaca-Mandic et al., 2012). In 2011, one-third of American households reported problems paying medical bills (Cohen et al., 2012), a problem that seems to have worsened in recent years (Himmelstein et al., 2009). Health insurance premiums are consuming an increasing proportion of U.S. household income (Commonwealth Fund Commission on a High Performance System, 2011). (https://www.ncbi.nlm.nih.gov/books/NBK154484/)


An item from before The Affordable Care Act (ACA)
About 44 million people in this country have no health insurance, and another 38 million have inadequate health insurance. This means that nearly one-third of Americans face each day without the security of knowing that, if and when they need it, medical care is available to them and their families.


And then in 2019
Lack of health coverage has been a persistent problem in the U.S. The Affordable Care Act (ACA) sought to address gaps in the health coverage system and led to historic gains in health insurance coverage by extending Medicaid coverage to many low-income individuals and providing Marketplace subsidies for individuals below 400% of poverty. The number of uninsured non-elderly Americans decreased from over 46.5 million in 2010 (the year the ACA was enacted) to just below 27 million in 2016. However, for the second year in a row, the number of uninsured people increased from 2017 to 2018 by nearly 500,000 people. This issue brief describes how coverage has changed in recent years, examines the characteristics of the uninsured population, and summarizes the access and financial implications of not having coverage. (https://www.kff.org/uninsured/issue-brief/key-facts-about-the-uninsured-population/ Published: Dec 13, 2019)


The number of Americans without health insurance climbed to 27.5 million in 2018, according to federal data that show the first year-to-year increase in a decade, before the Affordable Care Act began reducing the ranks of the uninsured. (https://www.wsj.com/articles/number-of-americans-without-insurance-shows-first-increase-since2008-11568128381 April 10, 2020)


Health care seems to be such a problem in the U.S. that it is even counted on their annual census report.
 In 2018, 8.5 percent of people, or 27.5 million, did not have health insurance at any point during the year. The uninsured rate and number of uninsured increased from 2017 (7.9 percent or 25.6 million). 
• The percentage of uninsured children under the age of 19 increased by 0.6 percentage points between 2017 and 2018, to 5.5 percent.
• Between 2017 and 2018, the percentage of people without health insurance coverage at the time of interview decreased in three states and increased in eight states.


Not even all types of health care are covered:
In 2018, private health insurance coverage continued to be more prevalent than public coverage, covering 67.3 percent of the population and 34.4 percent of the population, respectively. Of the subtypes of health insurance coverage, employer-based insurance remained the most common, covering 55.1 percent of the population for all or part of the calendar year
(https://www.census.gov/library/publications/2019/demo/p60-267.html)


Insured persons from 2018Number of persons under age 65 uninsured at the time of interview: 30.1 million
Percent of persons under age 65 uninsured at the time of interview: 11.1%
Percent of children under age 18 uninsured at the time of interview: 5.2%
Percent of adults aged 18-64 uninsured at the time of interview: 13.3%
Percent of persons under age 65 with private insurance at time of interview: 65.1%
Percent of children under age 18 with private insurance at time of interview: 54.7%
Percent of adults aged 18-64 with private insurance at time of interview: 68.9%
Percent of persons under age 65 with public insurance at time of interview: 25.5%
Percent of children under age 18 with public insurance at time of interview: 41.8%
Percent of adults aged 18-64 with public insurance at time of interview: 19.4%
(Three tables from https://www.cdc.gov/nchs/fastats/health-insurance.htm)

Canada's health care system

"About Medicare
Medicare is a term that refers to Canada's publicly funded health care system. Instead of having a single national plan, we have 13 provincial and territorial health care insurance plans. Under this system, all Canadian residents have reasonable access to medically necessary hospital and physician services without paying out-of-pocket. 
Roles and responsibilities for health care services are shared between provincial and territorial governments and the federal government. 
The provincial and territorial governments are responsible for the management, organization and delivery of health care services for their residents.


Comprehensiveness The provincial and territorial plans must insure all medically necessary services provided by: 
hospitals
physicians
dentists, when the service must be performed in a hospital Medically necessary services are not defined in the Canada Health Act. The provincial and territorial health care insurance plans consult with their respective physician colleges or groups. Together, they decide which services are medically necessary for health care insurance purposes. 
If a service is considered medically necessary, the full cost must be covered by the public health care insurance plan. 
Universality The provincial and territorial plans must cover all residents.
PortabilityThe provincial and territorial plans must cover all residents when they travel within Canada. Limited coverage is also required for travel outside the country. 
When a resident moves to another province, they can continue to use their original health care insurance card for 3 months. This gives them enough time to register for the new plan and receive their new health insurance card."
(https://www.canada.ca/en/health-canada/services/canada-health-care-system.html)

In Ontario our health care insurance is provided by ​The Ontario Health Insurance Plan
"What services does OHIP cover?
The Ontario Health Insurance Plan (OHIP) pays for a wide range of health care services. It pays for most basic medical and emergency services. It can pay for all or part of the cost. 
There are some services that OHIP does not pay for such as cosmetic surgery (dental or physical), dental services or chiropractic services. 
For some treatments, OHIP pays part of the cost. For example: 
Some services from your doctor, and podiatrists
Physiotherapy treatments 
Dental services in hospitals 
Eye tests 
Travel costs: if you live in northern Ontario and must travel long distances for specialty medical care, OHIP may pay some travel costs.
What is covered under OHIP+?
OHIP+ covers many prescription medications for youths 24-years-old and under. You can find out if your medicines are covered through the online search tool. OHIP+ starts January 1, 2018."
(https://settlement.org/ontario/health/ohip-and-health-insurance/ontario-health-insurance-plan-ohip/what-services-does-ohip-cover/)

More comprehensive information can be found at:
(http://www.health.gov.on.ca/en/common/system/default.aspx)

Yes, I also have private insurance which is provided by Government Service Medical Insurance Plan (GSMIP) through payroll, now pension deduction.  When I was working for the government I was required to have this. While in Canada I was only required to have the minimum coverage (Level II) which would provide for some services not covered by OHIP.  When I was posted overseas where my Provincial plan would not cover any medical expenses I was required to increase the coverage to Level III.  This was coverage covered all expenses which occurred overseas, including doctor, hospital, and any other costs such as hotels and meals.  Upon return to Canada I had the option of reverting back to Level II or maintaining the Level III coverage.  In Canada the added coverage provides for a semi-private hospital room and added prescription coverage.
While we say that our provincial health coverage is free it really isn't.  After all nothing is free in this world.  Different Provinces have different ways of collecting the funds not provided by the Federal Government.  In Ontario it is now an employers responsibly to pay the monthly OHIP fee.  In other Provinces it may be through added sales tax, or a specific tax on gasoline, or user pay through payroll deductions.  No matter how the fee is collected it appears as if we do not directly pay, consequently the general idea is free because when we walk out of the doctor's office or hospital we do not have to reach into our pocket before we leave or dread a bill demanding payment.



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April 08th, 2020

8/4/2020

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I suppose it is about time that I added a little more to this little story.  It seems as if something gets in the way of getting at it.  No real excuse just a bit busy doing other minor little things.  
Most of the first set of seeds that I planted early in March have sprouted and I topped up the ones that didn’t.  Have been doing more planting and trying a few ‘experiments’.  A couple of the experiments are trying to pre-start carrots and beets and transplant once it is safe to do that.  I started them in egg cartons.  Because each of the cells is the correct distant apart after thinning I so should be able to just put the whole thing in the ground.
Have been moving all the sprouted seedlings into the greenhouse and then back into the house at night.  Most nights the temperature dips to near zero and a couple of nights below.  I am tending to be a little cautious which is probably the safest thing to do.
This Covid-19 virus certainly has the world in an uproar.  So many restrictions to try and keep the populations safe.  Here in Ontario and Ottawa we are all supposed to self-isolate, all nonessential stores and services are closed, which includes parks and the community gardens.  Although we are allowed to go for walks, runs, and other outdoor exercises we are not supposed to be in groups larger than two and to maintain a 1 metre distance (6 foot).  When shopping only a limited number of people are allowed in the store.  Line up before entering maintaining the 1 metre distance and as one person exits one is allowed in.  Yes only one person in a family - no more family outings to the grocery or department stores.
People over 70 are encouraged to abide by all the rules and limit any outdoor activity, especially shopping, to the minimum.  Heather is adamant that Wendy and I abide by those rules and either she or Hareth does the grocery shopping.  If Heather does the shopping Wendy stays in the car with the baby.
The Ontario government has now set up on-line teaching so the children don’t miss to much school.  There are set amounts of time that different grades are supposed to do each week.
All of this could really be a bit of a downer and I strongly suspect that it is having negative effects on some people.  So far we are coping with it and not finding it stressful.  I think the most stressful part is knowing that you are not supposed to allowed to do certain things.  Not doing them on your own is one thing but not being allowed to do them is another.
The May weekend running events have been cancelled and still no word on what is going to be done to take their place.  I shouldn’t complain to much because my training certainly has taken a down turn.  I was out on Monday for a bit of a run and at the start kind of twisted my ankle a little bit.  Yesterday it was really sore and painful to walk.  Today it isn’t as bad but still a little sore.  Just another excuse to not go running today.  We are supposed to get snow or rain sometime tonight and tomorrow so that is another day of no running.  Lots of excuses…  Now I really do need excuses to get my bum back in gear and get at it.

COVID-19
08 APRIL 2020  15:35   08 April 2020

                          CASES                 ACTIVE           DEATHS
WORLD       1,486,851                1,082,034          87,341
CANADA           18,855                      13,895               427
ONTARIO           5,276                        3,300               174
USA                   414,867                    378,134          14,141

Ottawa at 17:00 07 April
                                403                                                      6
Note: these statistics are constantly being updated.

President Trump of the USofA is still not taking any responsibility of his delay in recognizing the depth of this pandemic.  He has also tried to halt export of essential personal protection equipment (PPE) to other countries.  This has brought much condemnation to his policies.  While maintaining his "America First" election promise it has backfired even in the US.  The man just does not understand how the whole world works and how intertwined manufacturing is.  Some of the major broadcasters are no longer airing his speeches because of the number of falsehoods and outright mis-information they contain.  Often times the complete opposite of what his experts and science are saying. 
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