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Even before insurer Blue Cross and Blue Shield of North Carolina and Moses Cone Health System, Guilford County's dominant health-care provider, resumed talks on a new contract, some readers were taking a pox-on-both-their-houses approach to the dispute. More than one has suggested that the insurance commissioner's office get involved, although that agency does not get involved in contract disputes.

What's your suggestion? What pressure, if any, can the public put on these two health-care entities to speed negotiations? And should they be speeded up if the original Nov. 1 deadline is no longer in play?

UPDATE: Reader Barbara Roth sends this suggestion:

Both sides need an incentive to quickly resolve the dispute and I can't think of a better one than to hurt them both in their pocketbooks while the dispute continues. So I know they plan NOW to keep coverage while discussing their disagreements but my thoughts are that once a hospital system refuses to accept coverage from BCBSNC and BCBSNC does not come to some workable solution with the hospital system that BCBSNC policyholders should be exempt from paying medical bills at the hospital system in question (until the dispute gets settled) AND also to be given coverage by the insurance company but not have to pay their premiums while the dispute continues. That way the consumer is protected and the 2 parties are shafted. I think they both deserve it for leaving their customers and patients twisting in the wind and I think this should be applied to every insurance company and hospital system in the state so they know they will pay for their refusal to get an agreement done.

Blue Cross Blue Shield of North Carolina and the Moses Cone Health System announced this morning that they've agreed on a multi-year contract extension that will let Blue Cross members continue to use the Cone group of hospitals at lower, in-network rates.

So what's your take on this?

After my article this morning on rising Medicare Part D prescription-plan premiums was posted, I heard from Jeff Nelligan of the Centers for Medicare and Medicaid Services in Washington. He offered a link to a Department of Health and Human Services news release that says more than 90 percent of Americans with Part D plans will have access to a less-expensive plan in 2008.

Comparing plans by price alone is a minefield because each plan handles deductibles, copayments, and "gap" coverage differently. The "gap" occurs when prescription drug expenses exceed a certain amount for the year but do not yet approach the level at which catastrophic coverage kicks in.

He also included a news release specifically about Part D in North Carolina, which I'm posting here:

Fast Facts for North Carolina 2008

• 52 Medicare Prescription Drug Plans (PDPs) serve people with Medicare for 2008
• 25 PDPs offering enhanced benefits or services (unchanged from 2007)
• 99.9% of people with Medicare could switch to a PDP with a lower premium in 2008
• 30 PDPs have $0 deductibles
• 1 PDP has a premium under $20
• $14.50 is the lowest monthly premium for a PDP
• $30.00 is the lowest monthly premium for a PDP with generic coverage in the Gap
• 88.8% of people with Medicare in a Medicare Advantage plans with Drug Coverage (MA-PD) will have access to a plan with $0 premium
• 100% of people with Medicare in a MA-PD will have access to a plan with $0 drug deductible
• 348,092 people with Medicare already qualify for extra help with prescription drug costs
• 17 PDPs have a premium amount of $0 for people who qualify for the full extra help.

If you qualify, extra help could pay for almost all of your prescription drug costs. Apply now or get more information by calling Social Security at 1-800-772-1213 (TTY 1-800-325-0778) or visiting http://www.socialsecurity.gov

Nelligan also passed along this news release regarding the Part D program generally:

Medicare Part D Prescription Drug Program

While no program, public or private is perfect, Part D has had extraordinary success in its short, 23-month life. Participation rates, satisfaction rates, savings, and coming in under budget – not what you’d expect from a government program. And to get to the most obvious point – the drug benefit is improving the lives of every single beneficiary enrolled.

1...Satisfaction rates are consistently range above 80 percent:

• Kaiser Family Foundation (June 2006): 80% satisfied
• J.D. Power and Associates (September 2006): 75% satisfied.
• Medicare Rx Education Network (January 2007): 80% satisfied
• Centers for Medicare and Medicaid Services (CMS) tracking survey (January 2007): 75% satisfied
• KRC Research (September 2007): 89% satisfied
• Voter/Consumer Research (October, 2007): 86% satisfied

2. The savings to beneficiaries is $1,200 annually.

3. The average monthly premium monthly is roughly $25, nearly 40 percent lower than when the benefit was established in 2003.

More than 90 percent of beneficiaries in a stand-alone Part D prescription drug plan will have access to at least one plan in 2008 with premiums lower than they are paying this year.

In 2008, beneficiaries in every state will have access to at least one prescription drug plan with premiums of less than $20 a month, and a choice of at least five plans with premiums of less than $25 a month.

Over 90 percent of people with Medicare will have access to a Medicare Advantage plan with Drug Coverage (MA-PD) for a $0 premium and with a $0 drug deductible.

There also are options that cover generic drugs in the coverage gap for as low as $28.70 a month. Nationwide, beneficiaries in any state can obtain a plan with coverage in the gap for generic drugs for under $50 a month.

4. The cost of the program has is $188 billion less (30 percent less), than estimated when the bill was passed. According to the CMS Office of the Actuary, the estimated cost of Part D for the 2004-2013 budget window was $633 billion. That cost is now estimated to be 445 billion.

5. Only 8 percent (of the 24 million) who lacked coverage in the gap had actual spending in the gap in 2006.

6. Generic utilization in Part D s 61.7 percent

7. CMS is making extraordinary efforts to reach out to the Low Income Subsidy (LIS) eligible beneficiaries, those who would receive the benefit for free. We are targeting potential LIS populations by zip code and then focusing outreach efforts in those areas.

The enrollment period for Medicare Part D plans begins today and ends Dec. 31. Follow the links in the "related links" box with my article to find online federal and state help in choosing a plan.

If you're shopping for a Medicare Part D prescription-drug plan, or changing plans, you need to get your paperwork filed by Saturday to be sure that all the changes will be recorded with Medicare and your insurer by Jan. 1, when plan changes take effect.

That's the word from the National Senior Citizens Law Center, which has sent out a news release on the subject.

Although the official deadline for picking a new plan is Dec. 31, the center says, beneficiaries need to make changes by Saturday to ensure that changes are recorded in the Part D plan, Medicare and pharmacy computers by Jan. 1. If that doesn't happen, seniors might not be able to get the drugs they need or might have to pay out of pocket for them.

More information is available at the center's Web site.

On Saturday, I published an article about a report from the nonprofit Families USA estimating that on average, about three working-age people died in North Carolina every day in 2006 because they lacked health insurance. I received a couple of e-mail responses.

One was from Sheryl Dawson, who said that as a health insurance agent, she sees many people turned down for health insurance because of pre-existing medical conditions:

As a licensed health insurance agent, I cannot tell you the number of people what are turned down by insurance companies, and cannot get coverage no matter HOW MUCH they pay. My estimate is that about half of the applications I submit are turned down because of health issues, including diabetes, sleep apnea, hypertension, pregnancy, high cholesterol/triglycerides, heart issues, depression, smoking, cancer and a wide variety of other problems. And don't you think it makes sense that these people -- already with a serious enough disease to warrant exclusion from being insured -- would die more frequently? The ONLY way that these people can be insured is with group health insurance, where the laws force insurance companies to insure everyone in a company, not just the ones whose medical profile they like. Once these individuals lose their job, essentially they're screwed.

Another correspondent sent a link to a Cybercast News Service column taking issue with the original research on which the Families USA report is based. The headline on the column is a little misleading -- it says critics say it's "not true that thousands died for lack of health insurance." What the critics it quotes do say is a little more nuanced -- that there's no way you can know for sure how many people, if any, might be dying for lack of health insurance. (The column also goes into why people might not be insured and whether estimates of the number of uninsured are correct, questions the Families USA report didn't attempt to address.)

"Strap yourself in; this isn't pretty."

So warns Brian Klepper by way of introducing a new report from the Economics Policy Institute called "A Decade of Decline: The Erosion of Employer-Provided Health Care in the United States and California, 1995-2006."

Among Klepper's observations from the report:

• The drop in the percentage of American workers with employer-sponsored health insurance between 2000 and 2006 was bigger than the gain between 1995 and 2000, even though both stretches encompassed times of relative economic prosperity.
• The drop may be fueled by growth in health care costs that, between 2000 and 2006, were four times the increase in workers' earnings and five times the general rate of inflation.
• The drop is hitting all workers: "The burden of these employer cuts is not carried by part-time or marginal workers. Rather, the most dramatic loss is among workers with the strongest connection to the labor force."
• The actual number of American uninsured is probably substantially larger than the commonly cited 48 million.
• The drop has economic implications because of the relationship between health, productivity and competitiveness.
• Even those with insurance have higher costs and lower benefits than in the recent past.

"The market can make care and coverage less expensive and more available," Klepper writes. "But getting to a system that assures appropriate care to everyone within our borders must be facilitated through policy. It will require political will, backed by a national understanding, already firmly in place within our largest corporations, that without secure access to health care, our people cannot be highly productive or continue to lead on the global stage" (emphasis added)

I don't often say, "Go read the whole thing," but: Go read the whole thing.

Public health insurance, such as Medicaid and State Children's Health Insurance Program, results in significantly lower health-care costs compared with private insurance, even when tax subsidies for the latter are thrown in, according to a study published by the journal Health Affairs. (Abstract here; full text here; chart summary of findings here.)

The savings were of particular advantage to consumers, the study found, because much of the savings occurred in consumers' out-of-pocket costs. But the study also found savings in costs paid by public insurers vs. private insurers.

Take a look and tell me what you think.

(Via Health Affairs blog)