Damn these lazy kids wanting their vaccines. . . .

 

Doctors slash vaccines due to rising costs
Health care providers say insurers don't reimburse them enough for essential vaccinations, so they're not offering them.
By Parija B. Kavilanz, CNNMoney.com senior writer
Last Updated: September 8, 2009: 1:16 PM ET
NEW YORK (CNNMoney.com) --

Parents who bring their kids to Dr. G. Andrew McIntosh for the chicken pox vaccine are out of luck.

The family physician, who has a solo practice in Uniontown, Ohio, doesn't offer that shot because he can't afford it. Most insurers won't sufficiently cover the cost.

"It doesn't do me any good. I am losing money on [them]," he said. The chicken pox vaccine runs about $115, but insurers only cover between $68 to $83 of that.

McIntosh has also cut back on a handful of other critical childhood vaccines for the same reason -- including the measles, mumps and rubella, known as the MMR vaccine.

It costs him about $58 to buy an MMR shot, he said, while insurers pay about about $40.

So McIntosh keeps a lot less of the MMR on hand. If a patient needs the shot and he doesn't have it, he sends them to a nearby public health clinic.

"I'm not happy to do that," he said. "The clinic is far, the service isn't great and my patients aren't happy to go there."

Although he says he "feels compelled" to take care of people, he adds, "I can't save the world and pay for my staff," he said. "As we say, 'no margin, no mission.'"

"I've lost a fair number of kids [at the practice] because I've had to send them elsewhere for their shots," he said.

Alarming numbers
It's not clear exactly how widespread vaccine cutbacks are, but in a recent industry survey, 5% of pediatricians and 11% of physicians indicated that they're seriously considering no longer offering immunizations. Currently there are about 350,000 pediatricians and family physicians in the U.S.

"These are fantastically alarming numbers," said Dr. Richard Lander, a Livingston N.J.-based pediatrician who chairs a committee on administration and practices at the American Academy of Pediatricians. (AAP)

"It's an example of how health care is being driven by managed care in the United States," Lander said.

Doctors have to absorb any costs that insurance doesn't cover because in most states insurance contracts prohibit providers from charging patients the difference.

Dr. Jim King, a family physician in Selmer, Tenn. is another medical professional who is dropping expensive vaccines because of "insufficient" reimbursement from insurers.

"The vaccine for shingles is fairly expensive, about $75 to $150 per vaccine," said King, who is also board chair of the American Academy of Family Physicians.

"The profit margin on it is very small, so we're not giving that. If we lose money on one, we need to administer nine to break even," he said. Like McIntosh, doctors at King's practice are referring patients to public clinics for shots that they no longer administer.

The economics work a little better in the case of influenza vaccines, which can cost between $7 to about $33 per vaccine, according to the Center for Medicare and Medicaid Services. So King is stocking up on the flu vaccine.

The threat to public health
Public health experts are particularly worried about doctors dropping vaccinations.

Dr. Lance Rodewald, head of the Immunization Services Division at the Centers for Disease Control and Prevention, points to the consequences this trend has had on public health in the past.

"Between 1989 to 1991, a number of doctors stopped providing vaccinations to children because of financing issues," he said.

Instead, doctors referred patients to public health clinics for shots like the MMR. But many parents failed to follow up on those shots, Rodewald said, and their toddlers were never immunized.

The result: The situation led to 55,000 cases of measles, 11,000 hospitalizations and 123 toddler deaths.

The CDC found that more than half of the children who had contracted the measles had not been vaccinated, even though many of them had seen a health care provider.

"This is why we are taking attitudes of doctors very seriously when they say they are delaying buying vaccines pending insurance coverage, or that they could stop vaccinating because of declining revenues," Rodewald said.

The CDC maintains that vaccination rates for most child and adolescent vaccines are currently about 80% in the United States.

Hidden costs
Vaccines of all kinds represent the largest operating expense for some doctors, according to the AAP.

The problem: Most insurers pay providers just the base cost of the vaccine. So if it costs $120 to buy a particular vaccine, insurance would pay back $120. But Lander points out that there are a lot more expenses that go into providing a vaccine, including the refrigeration, electricity and insurance required to store the shots. On average, doctors keep $100,000 to $150,000 worth of vaccines on hand each year.

The AAP estimates that the actual cost to providers to acquire vaccines could be 17% to 28% above the price of the vaccine itself.

"This is America. Running a private practice is a business," said Lander. "It's not $120 but closer to $140 for me to break even," said Lander.

The insurance industry acknowledged that "there is always a natural tension between health plans and providers about payment," said Susan Pisano, spokeswoman for America's Health Insurance Plans (AHIP).

Then there's the cost to doctors of the office visit to administer a shot. Lander maintains that a majority of insurers are inadequately paying doctors for this service, too.

"When a patient comes to my practice for shots, a nurse will explain what shots will be given, hand out pamphlets and complete paperwork," he said.

Reimbursements for administration fees range anywhere between 60% to 100% of the cost depending on a doctor's contract with the insurer.

"Managed care had decreased [overall] access to health care because of poor pay to providers," Lander said.

McIntosh agreed. "I enjoy seeing kids. It's joyful to see a baby and watch them grow up healthy," McIntosh said. "But I am giving that up because I can't give them the shots they need."

He said more of his patients now are the elderly. "It makes me sad how the dynamics of my practice have changed," he said.

1 in 5 people in this country have no health insurance. HMO profits and  CEO pay thru the roof. C'mon sing it with me. . . .

O beautiful for spacious skies,
For amber waves of grain,
For purple mountain majesties
Above the fruited plain!
America! America!
God shed his grace on thee
And crown thy good with brotherhood
From sea to shining sea!

As opposed to the greedy health insurance agencies who refuse coverage for anything but a nail fungus?
Riffy, someone is already making life and death decisions on your health care - and they don't give a shit about you.
and the doctors screaming now are the same ones who will not touch a child with a brain tumor if that child has no insurance.
who's playing God here Riff?
At least this bill is predicated on the notion of improving your life, not playing with it.

"KEEP THE FEDERAL GOVERNMENT AS FAR AWAY FROM HEALTH CARE AS POSSIBLE!!!" 
                                            Boy do I agree with this. They'll only Screw it up.

Thank you I'm through!

I catch up on Hannity, Beck and Rush reading this thread.

Riffhard wrote on Sep 9^th, 2009 at 8:16am:


I used to think that some conservatives "had a clue". I lost faith in so many of them because they were  so inexplicably brainwashed by a cult of arrogant stupidity in the White House. They were duped into electing an almost-hilariously incoherent,  room-temperature IQ, vacuous empty suit who had a life-long track record of shirking duty, getting by on his family's name, and abject failure at everything he attempted. And even at this late date, it seems that many "conservatives" (who are no longer anything of the sort - just another word they've choked the meaning out of)  still refuse to see, or acknowledge, the damage that they themselves have done to this country with their "blinders on" vote. It's hilarious, really, that every now and again a self-styled conservative thinks they "get it". Such is the case with Riffy's new-found love of Camille Paglia.

Like any person who makes a living spouting opinions, Camille courts controversy.  Who would read her column otherwise? Her mode of achieving that end seems to be talking out of both sides of her  mouth. Riffy, to no one's surprise, only hears what comes out of the right side. He hears the criticism of the Obama administration, without taking into consideration the fact that it builds upon an underlying support of the President. Her last "controversial column" (tellingly, that's HER description of it) STARTED like this:

Buyer's remorse? Not me. At the North American summit in Guadalajara this week, President Obama resumed the role he is best at -- representing the U.S. with dignity and authority abroad. This is why I, for one, voted for Obama and continue to support him. The damage done to U.S. prestige by the feckless, buffoonish George W. Bush will take years to repair. Obama has barely begun the crucial mission that he was elected to do.

Mr. Riffhard seems to think that he can ignore this side of Paglia's schtick and just go with the Obama-bashing stuff, and this blindered vision allows him to have the utmost respect for this liberal commentator - to hear him sing her praises almost makes one think that he doesn't use "liberal" as a swearword.  Camille's message is that BOTH sides are useless, and I'm not sure why Mr. Riffhard thinks anyone here disagrees with this. I mean, he NEEDS to think it, because he HAS to scream at drones, because that's what all of his role models do.

The thing that Mr. Riffhard keeps forgetting is that we did not, and still don't, have any valid options in the matter.  We have a TWO-party system, one which seems to be completely broken. Mr. Riffhard regularly trumpets the "fact" that President Obama is "destroying" the Democratic party, all the while assuming that that means HIS side is now winning. In fact, his folks "destroyed" their party a few years ago too. What did his heroine Camille say about the only option we had in the last election?

McCain, born before Pearl Harbor, is even older than we are! Why would anyone believe that he holds the key to the future? And why would anyone swallow that preening passel of high-flown rhetoric about "country above all" coming from a seething, short-fused character whose rampant egotism, zigzagging principles, and currying of the gullible press were the distinguishing marks of his senatorial career?


And what does she say about HIS side now, post-election?


What a backbiting mess the GOP is! It lacks even one credible voice of traditional moral values on the national stage and is addicted to sonorous pieties of pharisaical emptiness. Republican politicians sermonize about the sanctity of marriage while racking up divorces and sexual escapades by the truckload. They assail government overreach and yet support interference in women's control of their own bodies. Advanced whack-a-mole is clearly needed for that yammering smarty-pants Newt Gingrich, who is always so very, very pleased with himself but has yet to produce a single enduring thought. The still inexplicably revered George W. Bush ballooned our national deficits like a drunken sailor and clumsily exacerbated the illegal immigration debate. And bizarrely, the hallucinatory Dick Cheney, a fake-testosterone addict who spooked Bush into a pointless war, continues to be lauded as presidential material.

Which brings us to Afghanistan: Let's get the hell out!

Does Mr. Riffhard agree with any of that? Well, he does use the "drunken sailor" line about Bush. Must be in the "Big Book of Punditry Cliches" somewhere. Yet he's getting all wet over Camille because she talks smack about the left.

Hey, whatever. How's this: Nancy Pelosi says stupid stuff all the time and obviously had a facelift. Ted Kennedy was known to have a drink. Barney Frank is GAY! Obama is not completely fulfilling my expectations of making the world shiny and happy overnight. Do you like me now, too?

Amid Ms. Paglia's frothy prose we also find references to some of the most awful musical dreck - the Bob Welch version of Fleetwood Mac? "Different Drum"?? GACKKKK! Maybe that explains Mr. Riffhard's curious remark equating the Eagles with Gram Parsons.  But, musical tastes aside, I, and, I'd wager, most of the so-called drones who bear the brunt of Riffy's sound & fury, also agree with some of Ms. Paglia's thoughts. Like this one:

This is one reason I believe Obama is the right person at the right time for the presidency.  Obama wants to unite and heal. It is a project that all Americans of good will should wish to succeed.

And I'll STILL agree with that, even after Camille called Sarah Palin  "feminism's greatest leap forward since Madonna".

Pssst - Riffy - you DO know that Camille's a lesbian, right? Why is it that she's not Camille PIGlia, to go along with Rachel Mancow?

Huge speech tonight! Best Obama yet!

jostorm wrote on Sep 9^th, 2009 at 1:09pm:




Nice post. Thanks for your perspective on health care.

There are many good things about America, but I see no shame in agreeing we have some big hurdles to overcome also.

Riffhard wrote on Sep 9^th, 2009 at 1:23pm:

Glad to help.  Here's the Condensed Cliff's Notes version:  Riffy gets humiliated again.

I enjoy reading Camille Paglia, but she is not, nor has she ever been a liberal.
and Pdog is right,
it is all about what you can afford....but that leaves alot of people out.

fuman wrote on Sep 9^th, 2009 at 1:26pm:


Thanks. And thank you even more for not ignoring and for not attacking me!  I totally agree that America has fabulous aspects. Any country that invents marihuana dispensers in which the dope is kept fresh at optimum temperature has got my eternal blessing, EVEN if every time I want to enter it I have to fill out a card on the plane declaring I’m not a drug addict/drug dealer/Nazi criminal/Communist.   

I have a stones friend like Riffy....
it's like what he believes is the TRUTH, and the rest of the world is just stupid.