Check Up

By Robert Field, a law and public health professor at Drexel University

Imagine owning a $200,000 house and paying $73,000 for homeowners insurance. For anything short of a certified firetrap, most people would consider that a poor deal.

Yet, McDonald's offers its employees something similar for health insurance. For $727.24 a year, you can get individual coverage with a maximum benefit of $2,000.

There are 29,500 participants in what is called "mini-med." Presumably, the emphasis is on "mini." The plan would barely get most patients past the first day of a major hospitalization. And that's with a 30 percent co-pay.

To be fair, "mini-med" has other options that are more generous. For $1,679.60 a year, the plan will cover up to $10,000 in expenses. But that is still a remarkably low payout compared with the typical employer-sponsored health plan. Even this higher coverage limit is only a fraction of the cost of treatment for many major illnesses.

McDonald's is one of several companies that offer mini-med plans. Others include Home Depot, Disney, CVS Caremark, Staples, and Blockbusters. . . . Many of these companies are retailers, and say they can't afford to offer hourly workers more generous plans. That may be true, but the employees' health care needs are no less real.

The single biggest cause of consumer bankruptcy is medical expenses, and a large number of those affected have insurance. The gaps can result from high deductibles and co-pays and from low coverage limits. That is where mini-med would leave most very ill patients.

This is exactly the kind of situation that health reform was designed to address. The new law requires employer plans to meet minimum coverage standards. If they do not, starting in 2014, employees can turn to exchanges, where individual policies that comply with minimum levels of coverage will be available with subsidies for those with low incomes.

McDonald's says the new coverage requirements may force it to drop mini-med because of the added cost, although it is still weighing its options.. . . In response to McDonald's protests, the federal Department of Health and Human Services has granted it and the other employers that offer mini-meds a waiver from the new insurance requirements until 2014. This will allow the plans to continue until the exchanges start. ...

This solves the problem in the short-term. In the long-term, the eventual demise of these plans should not be cause for concern. The only thing worse than not having health insurance is thinking you have coverage and then discovering it does not protect you when you need it.

nolead begins

By Daniel Hoffman, pharmaceutical consultant, Glenmoore, Pa.

At the American Heart Association meeting in Chicago last month, a few pieces of positive news emerged that tickled pharma's marketers. One set of reports related to the Factor 10a inhibitors, the oral blood thinners that can replace warfarin for treating atrial fibrillation and other conditions. That the category may generate $20 billion in annual sales led some to see the new class as a sign of "pharma's new golden age.". . .

Researchers from Johns Hopkins University presented another study that found about half the population appears unlikely to derive benefit from taking anticholesterol statins for primary prevention. Almost half the population has no calcium buildup in their blood vessels and people without such vascular calcification account for just 5 percent of heart attacks and cardiovascular deaths. Even if those people without calcification have high cholesterol, as long as they do not have other risk factors such as obesity, smoking, or a family history of heart problems, a statin wouldn't give them any significant protection....

So what does this back-and-forth mean? Very simply, if someone is not already receiving adequate treatment for a condition and there is no immediate prospect of becoming seriously ill without a new therapy, then as a general rule it is wise to avoid new drugs and drug classes for five to 10 years after they come onto the market. It often takes that long before medical practitioners learn the proper uses and safety issues of drugs. Before that time, published research and the physicians' views reflect the undue influence of marketing disguised as research.