One of the great ironies of the insurance system is that when you’re sick and need the protection of health insurance the most, you can expect to pay a lot more for your premiums. It’s practically one of the certainties of life, like death and taxes, that are invariably true for everyone. But is that about to change?

Health Plan Companies Consider Removing Pre-existing Condition Penalties

For the first time, the health insurance industry has been talking about the possibility of ceasing its practice of charging much higher premiums for health insurance applicants with pre-existing medical conditions or a history of medical problems.

The offer comes from America’s Health Insurance Plans and the Blue Cross and Blue Shield Association, and – make no mistake – this is a big deal.

In the wake of the Obama administration’s plans to reform America’s health care system to provide coverage for the estimated 48 million who are currently uninsured, these insurance industry groups have stated their willingness to make a start at charging fair premiums for all Americans.

In their letter to key senators, the two organizations spoke of their willingness to “phase out the practice of varying premiums based on health status in the individual market” if health coverage becomes mandatory for all Americans.

Why is this so important? Because it means these organizations are willing to move away from the risk-assessment factor of insurance premiums – meaning that people who have a history of medical problems won’t be penalized when it comes to getting health insurance.

It’s not all sunshine and roses, however. Insurance companies will still charge different premiums based on other factors such as sex, age, and location. And certain groups, such as small business owners, have been left out in the cold. Small business owners are often hit hard by risk-assessment, because if just one worker becomes seriously ill premiums can sky-rocket the following year.

Financial Motives of Changing the Pre-existing Condition Health Insurance Policy

And, of course, the motive for all of this is purely financial. Insurers are simply trying to gain political support in an attempt to stall the creation of a government insurance plan that would necessarily compete with private insurers.

But whatever the motive, the outcomes could certainly be positive. The insurance industry has already discussed support of a national goal to prevent insurance costs rising, and, in its bid to fend off the competition, has also offered to end its practice of outright denying health coverage to people with pre-existing conditions.

photo credit: SavaTheAggie

Fibromyalgia is a devastating disease that causes chronic pain and other symptoms for those who are affected – but it’s a disease with no known cause and no standard treatment. Many people haven’t even heard of the condition, but if that’s the case it’s not because the drug industry isn’t trying hard enough.

Drug Companies’ Hundreds of Millions Help Raise Awareness of Fibromyalgia

Last year, drug industry giants Pfizer and Eli Lilly spent hundreds of millions of dollars in advertising to “raise awareness” of fibromyalgia. The companies donated more than six million dollars to non-profit organizations for educational campaigns and medical conferences, too.

That’s more than the companies donated for Alzheimer’s, and diabetes. And only donations made for cancer, depression, and AIDS were higher than the donations made to further the cause of fibromyalgia.

Why all this trouble for a disease nobody’s heard of, that some doctors don’t even believe exists? Simple. Pfizer and Eli Lilly are using their money and influence to “raise awareness” and get doctors prescribing fibromyalgia drugs for people with the disease.

Is Fibromyalgia Real? Why the Sudden Drug Company Interest?

Fibromyalgia is a real disease, especially to those people who are affected by it. But there’s no standard treatment – just a couple of drugs more commonly used to treat other conditions which improve symptoms for some people with fibromyalgia.

Pfizer markets a drug called Lyrica, which originally received FDA approval for the treatment of epileptic seizers. Eli Lilly’s drug, Cymbalta, was originally approved for depression. Both have now been FDA-approved to treat fibromyalgia symptoms and will probably soon be appearing on the formulary lists of prescription drug plans, if they haven’t already.

Sales of the Fibromyalgia Prescriptions since Big-pharma’s Campaign

Since the companies began marketing “awareness” for fibromyalgia, sales increased from $395 million to $702 million for Lyrica, and from $442 million to $721 million for Cymbalta, between 2007 and 2008. Each company spent just over $125 million in advertising its drugs in the first nine months of 2008.

Now this might not necessarily be a bad thing. After all, people with this chronic, painful condition are getting treatment that they need.

The problem, however, is that the underlying purpose for Eli Lilly and Pfizer is simply selling drugs, and some healthcare professionals are concerned that undue influence from the pharmaceutical industry will pressure doctors into diagnosing fibromyalgia more often, even if it might not be appropriate.

In addition, some doctors believe that fibromyalgia, while a real condition, isn’t necessarily physical – that there may also be a psychological or neurological component in the development of the disease. If that’s the case, the drugs that Pfizer and Eli Lilly are pushing may not be the best solution for people with fibromyalgia.

photo credit: ccox888

Japan’s overcrowded, understaffed hospitals are in danger – and so are the people who rely on those hospitals when they need emergency medical care. An elderly Japanese man who sustained head injuries after being struck by a motorcycle waited ninety minutes in an ambulance – while paramedics phoned fourteen different Tokyo hospitals, trying to find a hospital that would accept the man for treatment. All the hospitals refused to admit the injured man, saying they lacked the equipment and staff needed to treat him. The paramedics arrived at the accident site just a few minutes after the 69-year-old man was injured, but ninety minutes and fourteen hospitals later, the man died just a short time after paramedics finally located a hospital that would accept him for treatment. The man died from the shock caused by the loss of a large amount of blood – a condition which the man might have survived if he had received treatment earlier.

Stretching the Health Care System

This incident is only the latest in a list of recent cases occurring in Japan, where the emergency healthcare system is stretched thin due to staff shortages and the medical needs of an aging population. According to Japanese Health Minister Yoichi Masuzoe, the rapidly increasing number of elderly patients is a large part of the problem, with hospitals so full that there just isn’t room for emergency patients. While this particular incident clearly highlights the problems for Japan’s overburdened healthcare system, it is by no means an isolated occurrence. In 2007, more than fourteen thousand emergency patients were rejected three or more times by overcrowded hospitals before finally receiving treatment. The worst case so far was that of a woman who was rejected 49 times before finally receiving emergency treatment for breathing difficulties. Another high profile case, that of a pregnant woman who died eight days after being refused admission by nineteen different hospitals, finally prompted the government to establish a panel to investigate the issue.

What Tokyo is Doing to Change Things

Following the most recent incident, the city of Tokyo issued a directive that requires paramedics to coordinate with emergency call centers so that emergency patients can be accepted to a hospital within fifteen minutes. However, this doesn’t solve the most pressing problem of hospital overcrowding. Health Minister Yoichi Masuzoe has urged that the government develop a community support system to reduce the burden placed on hospitals. The Japanese government has also announced plans to improve coordination between hospitals and the emergency support system, and to increase doctor numbers in understaffed hospitals.

photo credit: udono