Thu
Mar 20 2014
02:40 pm
Ownby: As A Fiscal Conservative, I Want To Drive Up Your Health Care Costs
By: reform4

Consideration of a Resolution of the Commission of Knox County, Tennessee expressing support of the Amendment to SB 435/HB 264 to require the majority of individual and group health insurance policies to provide coverage for proton therapy for the treatment of cancer. (TO BE ADDED)
(Commissioner Ownby)

First, this shouldn't be a Commission issue.

Second, it's hypocritical for conservatives, who have railed against mandatory coverage in the Affordable Care Act, now want to tell insurance companies what treatments they have to pay for, specifically a therapy that lacks any scientific trials to show it is any more effective than traditional radiation or gamma knife.

Third, such a law would drive up health care costs for everyone in Tennessee to, as noted before, perhaps no benefit whatsoever.

I wonder if Terry Douglass will show up in campaign finance disclosures for Ownby and Ryan Hanes.....

Topics:
reform4's picture

I'm sorry, there was ONE scientific trial:

Submitted by reform4 on Thu, 2014/03/20 - 2:43pm.

Dec 2012: In a finding likely to add fuel to the debate over treatments for prostate cancer, proton-beam therapy provided no long-term benefit over traditional radiation despite far higher costs, according to a study of 30,000 Medicare beneficiaries published Thursday in the Journal of the National Cancer Institute.

What we're seeing here is that Medicare got roped into paying for this for certain cancers, and now that it's in use, private companies are seeing higher cost, no efficacy, and saying "No."

So now conservatives want to interfere with the free market. Hilarious, or it would be, if we didn't have to foot the bill.

politicalleverage's picture

can we get medical marijuana added to this bill?

Submitted by politicalleverage on Thu, 2014/03/20 - 3:11pm.

Seriously, you know what, I hope someone has the guts on County Commission to literally add marijuana for medicinal purposes as a friendly amendment to this bill...Heck if we are going to support alternative, unproven, medical research, let's start with something that is free!

Wait, Amy Broyles has her meeting...in 57 minutes..I am there...

Please note, this opinion is mine and mine only. While I normally don't comment on this board but love reading it everyday, as a person with Parkinson's I find it moronic that people in other states are able to take controlled usage of marijuana to sleep, to calm their nerves, and to help them eat better...yet our politicians will bend over backwards to help a possible therapy with a ton of lobbyists...but let people ravaged by horrendous diseases die in pain, misery, and without compassion. The same lawmakers that cut back TennCare are the ones that saw "you can get a prescription..." No you can't! When you spend all your money on Chemo and you don't have a job cause your too sick to work guess what you don't have money for the prescription...Seriously...

Again, this is my opinion and my opinion only!

Seriously,

B Harmon's picture

proton therapy

Submitted by B Harmon on Thu, 2014/03/20 - 4:29pm.

This bill specifically excludes state employees and those on TennCare. Why? If it is so special, why are not letting all those people at UT (and Tenncare) get it paid for by their insurance?

Will they also dictate at what level the insurance is to pay? Total billed charges compensated at 100%?

Will the insurance companies be allowed to set their own medical necessity criteria or will they 'just have to pay up'?

I really don't think our legislature is this smart, but I began to wonder if they found this expensive procedure they can tack onto private insurance so the rates will go up so they can blame that increase on the ACA....

This may be a good treatment option, I really don't know. But I doubt our legislature is pushing this because the "will of the people" but rather someone is closely tied with the doctor that forked out millions of his own money to get the machine.

Why does Ownby want waste County Commission time on a meaningless resolution?

And that other rant... For those complaining that the ACA has maternity benefits that a man would have pay for in his plan or benefits for children that a childless person pays for, why should I have to pay for someones proton therapy?

Mello's picture

where is the amendment?

Submitted by Mello on Fri, 2014/03/21 - 6:44pm.
(in reply to B Harmon)

(link...)

Mello's picture

$48 a year increase

Submitted by Mello on Tue, 2014/04/01 - 8:12am.
(in reply to B Harmon)

The new fiscal note for the amendment states an estimate of $48 per year policy price increase if private carriers are required to pay for this specific therapy. (link...)

Rachel's picture

Why does Ownby want waste

Submitted by Rachel on Thu, 2014/03/20 - 5:26pm.

Why does Ownby want waste County Commission time on a meaningless resolution?

Commission has been wasting their time on meaningless resolutions for as long as I've been paying attention. Why stop now?

Mello's picture

Some state has to be the first-

Submitted by Mello on Thu, 2014/03/20 - 6:12pm.

Don't forget this is also about economic development so those machines can be built in Blount County.

Will the carriers also be required to pay for the hotel rooms?
(link...)

Our 'good' policy got us in the door at the Mayo and paid for what we expected but it did not pay for the required hotel room for the week we had to stay for all the follow up stuff. Do these proposed bills move this treatment to in-patient?

KC's picture

Current cancer

Submitted by KC on Thu, 2014/03/20 - 9:47pm.

Current cancer treatment/therapy is a huge moneymaker with many stakeholders.

And, unfortunately, for many, current cancer treatments yield questionable results for effectiveness.

Factchecker's picture

Proton therapy

Submitted by Factchecker on Thu, 2014/03/20 - 11:06pm.

It's the new CT scan. Everybody will need treatment just to "put skin in the game" to pay for their costs.

reform4's picture

Not Exactly

Submitted by reform4 on Fri, 2014/03/21 - 10:21am.
(in reply to Factchecker)

CT scans and PET scans are diagnostic tools, to see what's inside.

PT is a therapeutic tool to deliver radiations to tumors to kill them.

Their "secret sauce" is the ability to adjust the energy level in the accelerator do the radiation is delivered over a range of distances from the beam origination point (vs radiation energy delivered all along the beam path). Using a ordinance analogy, trad radiation is a bullet damaging everything in its path. PT is more like a little explosive bullet.

It does a little less damage going in, almost none past the tumor, but the narrower control means that the positioning of the patient has to be more precise (and you hope the target organ doesn't shift) or you can miss the tumor. Traditional radiation allows more room for error, but more side effects (radiation burning).

.

Factchecker's picture

You're right, but so am I

Submitted by Factchecker on Fri, 2014/03/21 - 10:59pm.
(in reply to reform4)

I actually knew all of that, even if I didn't know it down to that level of detail. Where my mind slipped was in the analogy that everyone would be given PT. Of course it would only be those diagnosed with a cancer. But the analogy still stands. An expensive procedure that has not been proven any more effective than cheaper ones will be incentivized* by the enormous capital costs heaped into the system needlessly. And everyone's healthcare costs will continues to rise because of that without improved outcomes.

I do understand the theory of PT. It seems sound and an advance. Yet I also understand the outcomes data do not confirm the theory, at least not yet. If there are any new studies that argue to the contrary, I'd love to hear about them.

We're still stuck with a corollary of the Hippocratic Oath. First, don't add costs without commensurate benefits.

*(sorry for that dreadful word)

reform4's picture

Agreed!

Submitted by reform4 on Sat, 2014/03/22 - 10:25am.
(in reply to Factchecker)

And I see what you were getting at with the comparison. Thanks!

Brian Hornback's picture

The correct spelling for the Representative

Submitted by Brian Hornback on Fri, 2014/03/21 - 6:25am.

Is Haynes.

Average Guy's picture

Yes, the underwear is Hanes.

Submitted by Average Guy on Fri, 2014/03/21 - 10:54am.
(in reply to Brian Hornback)

Speaking of, it looked from the video like the Representative needed to change his in a hurry.

Brian Hornback's picture

Ain't you just special?

Submitted by Brian Hornback on Sun, 2014/03/23 - 9:37pm.
(in reply to metulj)

Bless your heart!

Brian Hornback's picture

NO

Submitted by Brian Hornback on Mon, 2014/03/24 - 5:22am.
(in reply to metulj)

NO

Brian Hornback's picture

You are a witty one, you say.

Submitted by Brian Hornback on Tue, 2014/03/25 - 5:37am.
(in reply to metulj)

You are a witty one, you say.

Mello's picture

More confusion- amounts paid to health care providers

Submitted by Mello on Fri, 2014/03/21 - 6:26pm.

AG Opinion (link...) on this bill
(link...)

We have talked about insurers/carriers not covering cancer and talk of changing the law to cover other types of therapies.
Now, this bills points to a problem with insurers/carriers changing the amount that is paid per service. I assume this is only in regards to PPO type contracted amounts. What is really going on with these changes/proposed changes?

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