Patients with sickle cell disease struggle with pain and suffering, even when they have good health insurance to fall back on. But a new study finds that an under-reliance on effective generic drugs is making them suffer unnecessarily.

At Kaiser Daily Health, it's reported that while there is an inexpensive, generic medication that can stop severe pain and the need for blood transfusions associated with sickle cell disease, few patients receive the treatment.

Why not? The answer lies in our mangled health care system. The number of sickle cell patients lies somewhere between 50,000 and 120,000 - a huge disparity - and not even the doctors know how many people are suffering from it. Fewer doctors are specializing in sickle cell, and not surprisingly, too many of its sufferers don't have good enough health insurance to warrant the kind of time with doctors that sickle cell patients need.

The result is that too many of those afflicted with the disease aren't properly educated in terms of their disease, and are not offered access to the generic drugs that could be helping them. This is why health insurance is so important; it provides patients with the regular doctor's visits that can ease pain, provide information, and minimize the damages caused by diseases like sickle cell.

In the past most consumers feared discrimination from health insurance agencies based on pre-existing conditions. It was, and still is, a sad fact that if you have an illness before you set out to get coverage, you're not likely to find an insurer who will cover you at an affordable rate.

But today, there seems to be a new way that consumers can be denied coverage based on their health - or their potential health. According to Kaiser's Daily Health Policy Report, physicians say that some patients refuse to take genetic tests that would help them make more informed decisions about their health care "because of the potentially dire economic consequences." They're afraid that if they're genetically inclined towards an illness, their health insurance company might dump them.

And to a degree, they could be right. Recently Blue Cross and Health Net were both censured for rescinding policies when consumers, who had been paying their health insurance for some time, fell sick.

But this week, a new twist in the law might save consumers from further fears. Health Net is expected to pay $9 million dollars to a woman who sued when her coverage was cut short after her diagnosis with breast cancer. Better still, Health Net has decided to end their policy of rescinding health insurance at all until such decisions can be approved by a third party.

Hopefully this means that discrimination based on health will soon be a thing of the past, and all Americans will enjoy the medical insurance coverage they deserve.

In this final debate between them, Democratic presidential hopefuls Hillary Clinton and Barack Obama once again agreed upon a need for more affordable health insurance, and debated the necessity of a mandate that would require all Americans to get coverage.

The Wall Street Journal's health blog reports that "Obama and Clinton both have plans that would change the health insurance landscape in a big (and largely similar) way — most notably, perhaps, by giving everyone the option of buying into Medicare-like insurance. At last night’s debate, Obama said, as he has said before, that his plan and Clinton's plan are 95% similar."

So where do they differ? Mostly in the issue of mandates. Both candidates agree that a lack of affordable health insurance is medically and economically devastating to millions of Americans, but only Clinton wants to make it a law that every American gets coverage. She plans to make coverage more affordable by offering tax incentives and forcing insurance agencies to accept everyone, regardless of pre-existing conditions.

The fundamental question is this: will people purchase coverage if affordable health insurance becomes a reality? Sure, the sick, older Americans, and the more responsible among us would, but would everyone pay into the system?

Obama believes that they would, or at least that they should have the option but not be forced to do so. Clinton doesn't have such faith that the young, reckless, and irresponsible won't just try to save the money and hope for the best.

But one thing remains true; today the vast majority of those who don't have medical coverage don't have it because they can't afford it, a situation that all presidential contenders agree is a serious problem.

According to the article at The Kansas City Star, the leading presidential candidates' proposals on health insurance reform are more detailed - and perhaps more realistic - than those of past elections.

And this could mean that real change is on the horizon for the first time in decades.

In the Democratic presidential primary, Senator Hillary Rodham Clinton of New York and Senator Barack Obama of Illinois have both vowed to make health insurance reform a priority, with the stated goal of providing coverage for everyone.

And Senator John McCain of Arizona, the Republican front-runner, has put forth a detailed proposal that could make health insurance more affordable for a large number of the uninsured.

All of the candidates' proposals include subsidies to help people with modest incomes buy health insurance. And McCain, Clinton and Obama all support a long list of initiatives to make the health care system more efficient, including modernization, more preventative medicine, reforming the medical malpractice system, and requiring hospitals and doctors to disclose information on prices and quality.

Let's hope that Kansascity.com is correct, and that we have a healthy and happy 2009 to look forward to.

Last week California health insurance giant Blue Cross instigated a scandal by sending letters and medical coverage applications to doctors, hoping that doctors would reveal if any patients had unreported previous medical conditions. In the case that they did, and their doctor reported them, that person's health insurance could be rescinded.

Doctors, and the public, were outraged. Not only did this represent a breach of doctor/patient confidentiality, but seemed to prove that health insurance agencies don't really care about people, they care about money.

Blue Cross has since stopped sending the forms and letters, arguing still that this was a standard means of keeping down costs.

But taking things even farther, a California lawmaker has introduced legislation that would require state regulators to sign off before carriers drop policyholders for allegedly failing to disclose preexisting medical conditions.

As it's reported at the Los Angeles Times, Assemblyman Hector De La Torre said his bill was needed because insurance companies "were not intending to abide by the spirit" of a law he wrote last year prohibiting health insurance carriers from refusing to pay medical bills for previously authorized services.

Will the bill pass? It's not yet clear, but this is just one of the latest in a series of legislative, regulatory and legal actions in California in response to aggressive efforts by insurers and health maintenance organizations to drop patients.

And as more legislation crops up designed to protect consumers in today's health insurance market, the public and media attention focused on insurance agencies can only be a good thing

An ongoing audit of the Washington, D.C., Healthcare Alliance has raised suspicions that non-district residents have illegally claimed district rights, and are enrolled in a program that provides Washington health insurance at no-cost care for district residents who cannot afford private insurance, but are not eligible for Medicaid.

At Kaiser's Daily Report it's stated that the audit found a "significantly high occurrence" of people using the same address, multiple case records established for the same client, and payments being made for people no longer enrolled in the program. A review of 344 case records showed that most enrollees used unsubstantiated letters from friends or family members to prove their residency in the district.

And of 63,167 data records reviewed, 16,720 include no Social Security number, which might mean that there are a large number of undocumented immigrants enrolled in this no-cost Washington health insurance program.

An "antiquated automated eligibility program" has been blamed for the fraud, and with changes implemented to the program it won't be long before Washington health insurance will only be applied to those in eligible locations. But, with so many uninsured and under-insured in surrounding areas, the public will continue to pay higher premiums to cover the medical debt accrued by those who can't afford coverage until changes are made to the health care industry as a whole.

Yet another study has been released this week, finding that cancer patients who did not have health insurance were more than one and a half times as likely to die from the disease.

Reported at the Battle Creek Enquirer, the report found that people without insurance are less likely to receive recommended cancer screening tests, are more likely to be diagnosed with a disease in later stages, and have lower survival rates.

In fact, twice as many uninsured women were diagnosed with late stage breast cancer as those with private health insurance.

As part of its mission to save lives and end breast cancer forever, Susan G. Komen For the Cure is committed to helping the uninsured obtain mammograms to screen for breast cancer and obtain treatment for those who have the disease.

But until all women have access to cancer prevention treatments, and by extension, decent, affordable health insurance, Komen For the Cure will have a lot of work to do to end breast cancer forever.

In its struggles to provide affordable medical coverage to all state citizens, Massachusetts may have hit a serious snag. As it's reported by the Kaiser Daily Report, Massachusetts health insurance has been predicted to grow in cost and double in enrollment by 2011, which "would far outstrip the original plans" for the program "largely because state officials underestimated the number of uninsured residents."

The plan was designed for those who don't qualify for subsidized plans like Medicaid, but can't afford medical coverage and don't get offered such coverage by their employer. In the last 15 years, as the costs of health care have exploded, more and more people have fallen into this gap.

Massachusetts health insurance was supposed to help fill this gap, but now it's looking like there won't be enough funding to keep the program running for long. Two unforeseen problems contributed to the funding shortfall: The state had expected to shift money from no-cost care for the uninsured to insurance subsidies, but the decline in charity care has been slower than expected; and the state had expected to collect tens of millions of dollars from the penalty on businesses that do not offer health coverage to workers, but it's really only going to collect about $5 million this year.

What does this mean for Massachusetts health insurance? It's hard to tell right now. Perhaps a scramble to rearrange the state budget can ease some of the burden. But one thing's still certain, state residents need to shop around aggressively for the best plan they can afford, and be ready for anything.

In the wake of the failure of California Governor Arnold Schwarzenegger's much publicized universal health insurance bill, all eyes are turning back to Washington. Will health care become a strictly national argument?

The Washington Post things so. According to the article they ran this week, when Schwarzenegger's plan went down in defeat, "so did hopes that successful reform in such a populous, influential state would bolster efforts elsewhere to cover more of the nation's 47 million uninsured."

All over the country have appeared articles and op-ed pieces that suggest that state level health insurance isn't going to work, that only a national plan will function properly and protect the health of those who can't afford coverage.

But on the other side of the argument, there are those who suggest that universal health insurance itself will never work in any venue, a fact made clear by (once again) the failure of California's bill.

For now, it seems that the pressure is back on Washington. The election primaries are flooded with talk of health care in America, and both Republicans and Democrats seem to have something to say about it. Hopefully this means that 2009 will bring some change to the table. But, in the mean time, those who need medical coverage today need to shop around for a policy that can protect them through the rest of 2008.