The Politics of Health Care

[Crafty_Dog]

Medicaid Or Education?
By DICK MORRIS
Published on TheHill.com on February 11, 2014

In state capitals throughout America, a drama will play out this coming year and in every subsequent year for at least a decade.

Legislators and governors will find themselves unable to provide decently for education without cutting back on the ambitious Medicaid expansion built into ObamaCare. Even in those states that opted not to participate in raising the eligibility levels for Medicaid -- and took the out Chief Justice John Roberts gave them -- the Medicaid rolls will rise as more of those previously eligible sign up through the well-publicized federal exchanges.

The explosion in Medicaid cost and enrollment represents a dire threat to educational quality in all 50 states. Simply put, improving our failing schools will have to wait, as ObamaCare drives up state healthcare spending.

Last year, according to usgovernmentspending.com, education ate up $286 billion of the $1.5 trillion in state spending -- about 19 percent. But Medicaid gobbled up $478 billion -- or 32 percent.

But this is just the beginning. Due to lower medical inflation, Medicaid spending has grown only at about 2 percent a year during the past two budget cycles. However, due to ObamaCare's increased Medicaid enrollment, Medicaid spending is projected to rise 12.2 percent in 2014, 7.9 percent in 2015 and 2016, and 6.6 percent per year thereafter. Meanwhile, state total spending is projected to hold fairly steady at $1.5 trillion.

The left is going to have to choose between Medicaid and education. We cannot afford both. Of course, states can still raise taxes and join jurisdictions like Detroit into their slow spiral to oblivion.

Is the Medicaid spending worth it? Is it a good trade to swap our children's future for a perceived increase in healthcare quality for today's poor? Does increasing Medicaid help to improve the health of the new recipients? The seminal study says: Not much.

The study came about when Oregon expanded its Medicaid program in 2008, using a lottery to determine who would benefit from the limited expansion. Amy Finkelstein, an economics professor at MIT, and Katherine Baicker from the Harvard School of Public Health, analyzed the results in what came to be called the Oregon Health Insurance Experiment.

The researchers found "no measurable health benefits in the Medicaid group for several chronic conditions, including hypertension, high cholesterol and diabetes."

They did find that expanding Medicaid coverage caused the newly enrolled to throng emergency rooms. Finkelstein said: "Medicaid coverage increases emergency department use, both overall and for a broad range of types of visits, conditions, and subpopulations, including visits for conditions that may be most readily treatable in primary care settings." In fact, she reported a 40 percent hike in ER visits among the newly enrolled.

The control population and the Medicaid population in the study differed only in "the fact that some have insurance and some don't."

So is the Medicaid expansion worth it? Is it an effective way to use state resources to tell an entire generation of children that they will have to wait for good schools until the Medicaid expansion experiment has run its course? Or will it be too late for them then?

In view of the lack of evidence showing the benefit to providing poor adults under the age of 65 with free medical care, are we justified in diverting funds that would likely otherwise go to schools, better teachers and enriched curriculums? With students throughout the nation no longer able to study such subjects as science, social studies and foreign languages due to financial limitations, are we right to make Medicaid the sole object of our generosity?

Ask the kids.

[G M]

[G M]

http://hotair.com/archives/2014/02/12/how-many-obamacare-enrollees-have-paid-for-coverage/

How many ObamaCare enrollees have paid for coverage?


posted at 3:21 pm on February 12, 2014 by Ed Morrissey






The White House and its supporters have begun bragging that the ObamaCare system has started to function as planned, with sign-ups increasing as the deadlines approach for the individual mandate deadline. But how many of those sign-ups turned into actual enrollments through the payment of the premium? As it turns out, not nearly as many as the top-line numbers suggest:
 

While the number of states reporting this information is small, they actually make up a good chunk of Obamacare’s currently accepted 3 million nationwide enrollment total. According to the Obama administration’s most recent detailed report on enrollment data, these five states — New York, California, Washington state, Nevada and Rhode Island — account for a third.
 
California’s exchange last reported that three-fourths of its reported enrollees had paid their first premiums, according to California Healthline; Washington’s totals released Tuesday indicate that only 51 percent have purchased their plans.
 
New York’s numbers are fuzzier, since the exchange itself doesn’t separate applications for Medicaid and private plans. It counts 412,221 enrollments for public and private coverage (just 251,000 are private plans), but notes that another 697,000 customers have completed applications on the exchange website. If the entire 421,221 have paid (or accepted the low- to no-cost Medicaid coverage), New York’s payment rate is only 59 percent.
 
Nevada’s payment rate is just 66 percent — 14,999 out of 22,597 so far — and Rhode Island has by far the best total, with 14,086 paid customers out of 16,512, for a payment rate of 85 percent.
 
Those numbers aren’t much improved from a month ago, when industry expert Bob Laszewski estimated the payment figure at 50%. The federal system’s back end for dealing with those issues is still missing in action, too, which means it’s going to be even more problematic. We’re about a month out from the big deadline for the April 1 cutoff for enforcement, and at the very best, we can say that the signup-to-paid ratio isn’t improving by much, if at all.
 
That may be a surprise to Laszewski, who predicted an 80% clearance rate by this time, which only Rhode Island appears to be achieving. He also noted a multitude of issues in the federal system still awaiting resolution:
 

Last fall I said that I thought it would be late January or early February before Healthcare.gov would generally be fixed.
 
Boy, was I wrong.
 
The to-do list still includes:
 Problems with the government sending enrollment transactions to the carriers––the 834s––that are still having error rates much too high for high volume processing.
 The inability of the government to do an automated enrollment reconciliation with the carriers––to be able to sort out who really is covered and who is not––because that system still hasn’t been built.
 The inability of the government to pay carriers because that system hasn’t been built––carriers are sending estimated bills to the feds.
 The inability of the government to add and delete people from the system for things like a newborn or a divorce because that system hasn’t been built yet.
 The inability of the government to handle appeals when people think their eligibility or subsidy calculation is wrong because that system hasn’t been built yet.
 The inability of the government to cancel people off of Healthcare.gov because they never built that functionality. As a result, I expect they will be reporting bloated enrollment numbers for some time.
 
At least two carriers have told me that because the government can’t cancel people off the system, it the person shows up next month they can’t reenroll on Healthcare.gov because the government can’t get the old enrollment off the system.
 
What kind of progress is being made in Minnesota, where the MNSure administrator ended up getting fired over its launch failures? Investors Business Daily offers a look, and it’s not pretty:
 

Minnesota’s exchange enrollment goal of 67,000 seemed within reach on Jan. 4, when signups stood at 25,860.
 
But after surging by more than 4,000 per week in the prior five weeks, signups collapsed back to November’s pace of less than 700 per week. …
 
Only 21% of signups were in the key 18-34 demographic vs. 35% ages 55 to 64. Minnesota officials have been taken by surprise at the share of people signing up for ObamaCare’s richest “platinum” coverage, which reimburses 90% of the covered group’s qualifying expenses.
 
Fully 29% have signed up for low-deductible platinum policies — compared to a projection of 5%. Such policies would tend to be favored by people who want to guard against high medical expenses, while someone expecting minimal costs might go for a high-deductible bronze plan.
 
In fact, the shortfall of sign-ups — let alone actual enrollments — threatens to create a budget crisis:
 












Enrollment is currently at 92,000, which is still way short of their goals by for enrollment prior to March 31. The worry is if they don’t have enough people paying into MNsure, it won’t be sustainable and they’ll have to ask the legislature for more money.
 
Minnesota lawmakers have warned leaders of MNsure that they must figure out budget needs soon as insurance enrollment trends point to a 2015 deficit. MNsure must give lawmakers a proposed 2015 budget by March 15.
 
The 92,000 figure includes the Medicaid enrollments through the system, too.  The problem is in the lack of private-insurance enrollments, and it’s going to be a huge problem for the state legislature, which is already strapped for funds as it is.
 
Guy Benson hits the numbers:
 

This portends two separate risk pool problems. First, not enough young and healthy people are signing up — a trend that has been well established for some time. Minnesota’s 21 percent figure is nearly identical to what health insurer Humana is reporting in its nationwide risk pool so far — and roughly half of the administration’s initial goal within this demographic. Second, a surprisingly high number of enrollees are selecting “platinum” plans, indicating that they anticipate incurring high levels of annual medical expenses and are looking to minimize out-of-pocket costs. Add these two together, and you’re staring at an adverse selection problem, which may result in larger taxpayer bailouts of on-the-hook insurers.

Also take note of the paltry payment rate of “enrollees” in Washington State so far … Washington has a payment rate of just 50 percent, with Nevada sitting at 66 percent. Both states are far off pace to hit their 2014 targets, even counting unpaid “enrollments.”
 
Be sure to read it all.

[DougMacG]

When did we know he wasn't the best person to stop Obamacare?

"Frustration with the broken Massachusetts Health Connector website and the paperwork backlog was evident Thursday, when Jean Yang, the agency’s executive director, wept as she told the [Health] Connector board how demoralized her staff is.

“These people came here to lead and innovate, and instead they’re doing manual workarounds,” Yang said. “And they are embarrassed to tell friends and family that they work for the Health Connector,” once considered a national model."

http://www.bostonglobe.com/metro/2014/02/14/health-connector-has-backlog-paper-insurance-applications/n8IEAFGvEnlQPvd4NzsYlJ/story.html

Boston Globe: 50,000 filings for health coverage in limbo
State may need months to process paper applications
By Michael Levenson    February 14, 2014

“The market cannot wait and people need help,” said Health Connector head Jean Yang.

About 50,000 health insurance applications, many filed by low-income Massachusetts residents, have yet to be processed by the state’s troubled insurance marketplace, officials disclosed Thursday, and it may take months to get all these people enrolled in subsidized plans.

For several months, residents have been encouraged to file old-fashioned paper applications because the state’s insurance website has been hobbled by error messages and has crashed frequently since it was revamped in October to comply with the more complex requirements of the federal health care law.

Frustration with the broken Massachusetts Health Connector website and the paperwork backlog was evident Thursday, when Jean Yang, the agency’s executive director, wept as she told the Connector board how demoralized her staff is.

“These people came here to lead and innovate, and instead they’re doing manual workarounds,” Yang said. “And they are embarrassed to tell friends and family that they work for the Health Connector,” once considered a national model.

She made clear that she was not looking for sympathy.

“We have to work harder,” she said. “That means I need to tell the staff members they’re not doing a good enough job, and I’m telling them that, even though they have been doing this tirelessly for months and they’re exhausted.”

Sarah Iselin, a health insurance executive whom Governor Deval Patrick last week put in charge of fixing the website, said the state is bringing in 300 people from Optum, a private contractor, to process the applications. The state is also working to develop a faster data-entry system, though that task alone could take three weeks, she said.

Currently, it takes two hours to enter each application into a computer database. Each application may represent a family or an individual.

“We’ve got to catch up,” Iselin said at the Connector board meeting. “That’s priority number one.”

The website was working smoothly until it was overhauled by the tech firm CGI in a botched attempt to comply with the federal Affordable Care Act. Since then, the state has resorted to off-line workarounds and has put many people into temporary health plans. But an unknown number of other people may be uninsured because their applications have sat untouched.

Yang’s unusual display of emotion at a meeting normally focused on dry policy discussions came a day after she, Iselin, and other state health insurance officials were grilled by angry legislators who complained bitterly that many of their constituents have been unable to find coverage.

Yang said those concerns have been driving her and her staff to lose sleep. “The market cannot wait, and people need help,” she said. “That’s what keeps me up at night.”

Dolores L. Mitchell, a Connector board member, thanked Yang.

“A shaky voice every now and then sends a powerful message about how much you care,” Mitchell told her. “You’re going to get it right. I know you are.”

Despite the many problems, officials said they had received some encouraging news: On Wednesday night, federal officials granted a three-month extension for 124,000 people with subsidized health insurance who were set to lose their coverage on March 31 because it did not comply with the federal law.

The state had requested a six-month extension, but Iselin said the three months will give the state extra time to enroll those people in plans of their choosing.

Iselin said another 32,000 people with insurance that is not subsidized and whose coverage expires March 31 are being mailed paper forms that will allow them to “sign, pay, and enroll” in plans that comply with the federal law, without having to use the faulty website.

The state has also opened a command center in Quincy where state Medicaid officials and Connector staff are working with CGI and Optum, which was hired to make fixes. Iselin said staff are there around the clock, although she could not say when the website will be operating properly.

Optum is being paid $9.8 million for the first month of services, but is expected to work through the end of the year.

“There’s clearly been a failure of the actual coding of this beast,” said Jonathan Gruber, a Connector board member and MIT economist.

Board members floated the idea of hiring a “dream team” of computer programmers to help Optum, with the promise that they would be showered with praise for their work.

Connector staff said they would explore the idea, which is based on last year’s “tech surge,” when the Obama administration enlisted engineers from Google and other firms to help Optum repair the troubled HealthCare.gov website.

In the meantime, the Connector is operating a call center with 270 staff members fielding questions about insurance coverage from anxious residents, up from 65 several weeks ago.

“We know we’re not where we need to be,” Iselin said. “We’re disappointed to be in this position. And we are determined and committed to fixing it.”

[Crafty_Dog]

One of the biggest of claims of Obamacare was that of coverage pre-existing conditions.  Whoops!  The coverage does not include drugs that keep people alive.

http://capoliticalnews.com/2014/02/16/another-obama-lie-exposed-obamacare-denying-meds-from-people-with-serious-pre-existing-diseases/

[Crafty_Dog]

second post

http://www.nytimes.com/2014/02/17/us/politics/on-health-act-democrats-run-to-mend-what-gop-aims-to-end.html?nl=todaysheadlines&emc=edit_th_20140217&_r=0

[DougMacG]

At this point, what difference does it make?

http://www.realclearpolitics.com/video/2014/02/20/minnesota_dems_hesitate_to_answer_obamacare_question_at_town_hall.html

Minnesota Dems Hesitate To Answer Obamacare Question At Town Hall - Video at link

U.S. Sen. Amy Klobuchar with Congressmen Tim Walz and Collin Peterson (all D-MN) faced a question about Obamacare at a town hall meeting.

"I thought the Affordable Care Act would save $2500 per family," a resident asked. "What happened?"

After a pause, Peterson grabbed the microphone and said, "I voted 'no,' so I'll let these guys handle that."

(Peterson is chair of the House Ag. committee, one of very few Dems who voted no.)

The expressions, blank stares, and laughter is priceless.  Klobuchar smiles and throws her hands up in the air.

Too bad Sen. Klobuchar didn't face a serious challenge to reelection last year.  We'll see what Sen. Franken's excuse is soon.

[ccp]

Economist article explains why health "tourism" has not taken off as expected:

http://www.economist.com/news/international/21596563-why-health-care-has-failed-globalise-m-decine-avec-fronti-res

[Crafty_Dog]

They are insisting that I accept cookies, blah blah.  May I ask you to share it here?

[DougMacG]

They are insisting that I accept cookies, blah blah.  May I ask you to share it here?

Medical tourism
Médecine avec frontières
Why health care has failed to globalise
Feb 15th 2014 | From the print edition

CLARE MORRIS hardly noticed when she tore the meniscus in her knee while dancing. The pain started only when she heard that repairing the damage at a hospital in South Carolina, where she lives, would cost $15,000. With limited insurance, she would have had to pay much of that herself. But after shopping around she found that she could have her knee repaired at a good hospital in Costa Rica for $7,400—and take a holiday, too.

Just a decade ago, stories like hers seemed to point to the future of health care. If a person could save thousands by shopping in the global health market, the reasoning went, insurers and governments could save billions. A knee replacement costs $34,000 in America, but just $19,200 in Singapore, $11,500 in Thailand and $9,500 in Costa Rica, according to Patients Beyond Borders, a consultancy. Even within Europe savings are to be found: a hip replacement is $4,000 cheaper in Spain than in Britain.

In the mid-2000s American insurers set out to find these savings by touring foreign private hospitals. They found that many were as good as their rich-world counterparts, and far cheaper. A big shake-up seemed likely. In 2008 Deloitte predicted an “explosive” boom in medical tourism, saying that the number of Americans going abroad for health care would grow more than tenfold by 2012.

It did not happen. Poor data were part of the problem: whereas Deloitte counted 750,000 American medical tourists in 2007, McKinsey, another consultancy, found at most 10,000 a year later. It is generally agreed that the number of medical tourists has grown since then—Thailand’s Bumrungrad hospital, which is popular with foreign patients, reports “steady growth”. But the data are still fuzzy. Patients Beyond Borders estimates that as many as 12m people globally now travel for care, perhaps 1m of them Americans. Industry insiders admit that growth has not matched the initial heady expectations.

Patient interest also turned out to be lower than predicted. Though some patients in the rich world seek out deals, most receive adequate health care at a manageable price and would prefer to stay at home. Potential savings are often insufficient to trump concerns about quality and the lack of recourse if something goes wrong. In 2008 Hannaford, an American supermarket chain, offered to pay the full cost of hip and knee replacements for its employees, including travel and patients’ usual share—provided they would go to Singapore. None took up the offer.

The predicted growth depended on medical tourism evolving from an individual pursuit to a cost-saving measure embraced by insurers and governments. But without reliable projections, insurers were reluctant to invest in the idea, says Ruben Toral, a health-care consultant. And cooler measures of the size of the opportunity dimmed their ardour. In 2009 Arnold Milstein of Stanford University estimated that less than 2% of spending by American insurers went on the kind of non-urgent procedures that might be moved abroad.

The legwork required also turned out to be formidable. Insurers had to choose foreign hospitals, negotiate contracts and malpractice insurance, and arrange follow-up care with American providers. They also risked upsetting the locals who would continue to take most of their custom. By the time the battle over Obamacare distracted them from contemplating transnational forays, most seemed to have concluded that they would not be worthwhile anyway. Companion Global Health Care, a subsidiary of Blue Cross Blue Shield, is the only big medical-tourism offshoot of an American insurer.

Governments have shown a similar lack of enthusiasm, perhaps because state promotion of medical tourism is usually seen as an admission of policy failure. In 2002 Britain allowed patients facing long waits to seek treatment elsewhere in Europe. Liam Fox, the shadow health secretary at the time, called the decision “humiliating” and criticised the government for not spending more at home. In Germany patient advocates blame government stinginess for the fact that some retired people choose, for reasons of cost, to live in eastern European care homes. Overall, only 1% of public health-care spending in Europe now crosses borders.

But the mere possibility of medical tourism is starting to change health care in unexpected ways. The biggest gains have gone not to patients, insurers or governments, but to hospitals, which have calculated that they could win more business by reversing the trend and going abroad to find patients. America’s Cleveland Clinic will open a branch in Abu Dhabi next year. (It already manages Sheikh Khalifa Medical City, a 750-bed hospital in Abu Dhabi.) Singapore’s Parkway Health has set up hospitals across Asia. India’s Apollo Hospitals, a chain of private hospitals, has a branch in Mauritius.

And though American firms and insurers have mostly stopped scouring the globe for bargains, some have negotiated bulk rates with top-notch hospitals at home. Lowes, a home-improvement firm, offers workers all around the country in need of cardiac care the option of going to the Cleveland Clinic in Ohio. PepsiCo, a food giant, made a deal with Johns Hopkins in Maryland. Other firms are said to be working on similar schemes. The future of medical tourism may be domestic rather than long-haul.

[ccp]

AMA Calls For ICD-10 Delay

The costs to medical practices for implementing the International Classification of Diseases-10th Revision (ICD-10) coding system have been grossly underestimated, according to a recent study by Nachimson Advisors for the American Medical Association (AMA).

The association is calling for a delay in the October 1, 2014, ICD-10 go-live date in order to give practices more time to prepare for the financial and administrative requirements.

Small practices can expect to spend between $56,639 and $226,105 and medium-size practices can spend between $213,364 and $824,735 to implement ICD-10. Expected costs include up to $100,000 in payment disruption for small practices, and up to $166,000 in productivity losses for medium-size practices.

Large practices can expect to spend between $2 million and $8 million to implement the new coding system, according to the study. The study estimated that two-thirds of physicians will pay the upper range of cost estimates. In 2008, the AMA estimated that it would cost a small practice $83,290 to implement ICD-10.
 
“The markedly higher implementation costs for ICD-10 place a crushing burden on physicians, straining vital resources needed to invest in new health care delivery models and well-developed technology that promotes care coordination with real value to patients,” AMA President Ardis Dee Hoven, M.D. said in a press release. “Continuing to compel physicians to adopt this new coding structure threatens to disrupt innovations by diverting resources away from areas that are expected to help lower costs and improve the quality of care.”

The AMA sent a letter to the Kathleen Sebelius, secretary of the U.S. Department of Health and Human Services, outlining the hardships physicians are facing in implementing ICD-10. The letter calls for Medicare to offer “true end-to-end testing” of ICD-10 coding to ensure practices and payers will be able to communicate.

“While it will allow a physician to know whether his or her claim was received or not, it does not give any indication as to whether it will be paid, how much it will be paid, whether they have used the correct ICD-10 code, or whether Medicare believes more information is needed to adjudicate the claim,” James L. Madara, MD, AMA’s assistant director of federal affairs said in the letter. “To draw a simple analogy, this is like receiving a package on your doorstep that you can only view from your window. While it is helpful to know the package has arrived, you have no idea what is inside until you are able to open it.”

Other suggestions include expanding advance payment options and offering free Medicare billing software for practices facing financial hardships. The AMA also requests that the Centers for Medicare and Medicaid Services allow for a two-year implementation period where miscoded claims are not denied, but are returned to physicians with feedback on how to correct them.

According to a February survey by the Medical Group Management Association, 79% of physicians report that they haven’t begun ICD-10 implementation, or were “somewhat ready.”

——————————————————
Thank you for everything - Brock. 

[Crafty_Dog]

http://www.theblaze.com/stories/2014/02/26/alaska-family-living-in-nightmare-after-son-declared-ward-of-state-following-hospital-visit/

In a related vein:  http://www.theblaze.com/stories/2014/02/25/a-national-outrage-father-of-15-year-old-at-center-of-boston-childrens-controversy-says-were-fighting-evil/

[ccp]

With regard to the first case in Boston there sounds like there is disagreement as to the diagnosis.  One group thinks it is some rare mitochondrial disorder and the other thinks it is psychiatric.

I can tell you there occasionally are cases like this which are extraordinarily difficult.

I wonder if the parents of the child cannot accept a psychiatric diagnosis and hence are making the situation worse by insisting on it being the other.

Look at autism and vaccines.  There are parents who will insist to their dying days it is the vaccine that caused the autism.  Despite evidence to the contrary.  Just some thoughts.

It is interesting that there is a gag order in effect.  Judges are from what I have seen rarely willing not to give a family the benefit of the doubt.

[Crafty_Dog]

http://www.washingtontimes.com/news/2014/feb/28/weber-obamacares-punch-to-home-health-care/

[Crafty_Dog]

Impossible to Cancel Plans

A Florida man found out the hard way that he's keeping his insurance plan --
whether he likes it or not. When Andrew Robinson signed up for coverage under
ObamaCare but then realized he couldn't afford it, he quickly signed up for a
different plan and called Florida Blue to cancel the first one. WFTV Orlando
reports (http://youtu.be/lNEsaalrC0Y), "But he quickly learned canceling
Obamacare is no easy task. ... More than six weeks later after spending 50 to
60 hours on the phone his policy is still not canceled and he is still waiting
for the payment Florida Blue withdrew from his account to be refunded." But
not to worry; Harry Reid says the horror stories aren't true
(http://patriotpost.us/posts/23645).

[Crafty_Dog]

I happened to sit on a long flight next to a stuffy snooty very smart doctor who was a prof at a med school (I forget which).  We got to talking and it turns out he was also on the AMA's advisory board for Obamacare.  He was quite emphatic that the ACOs described in this article will be a good thing.

http://www.newrepublic.com/article/116752/ezekiel-emanuel-book-excerpt-end-health-insurance-companies

[G M]

I happened to sit on a long flight next to a stuffy snooty very smart doctor who was a prof at a med school (I forget which).  We got to talking and it turns out he was also on the AMA's advisory board for Obamacare.  He was quite emphatic that the ACOs described in this article will be a good thing.

http://www.newrepublic.com/article/116752/ezekiel-emanuel-book-excerpt-end-health-insurance-companies

Of course. There are lots of books filled with dreamy plans for eutopia. Funny how those tend to work out.

[ccp]

I guess this is what Rush was referring to when he noted ZEEK said something to the effect that the plan of Obamacare was to put insurance companies out of business.  Some providers have had integrated systems.  I know I worked for one 25 years ago.  It was called managed care.  The ACO concept is just a variation.  The providers take the "full risk" not the third party insurance company or "middle man" as ZEEK calls them.  Guidelines are just that.  They are guidelines.  If anyone thinks insurance companies are rough just wait till the providers have big stakes on restricting services. 

But I digress.  Rush is not accurate if this is what he was talking about.  This just means replacing insurance companies with ACOs and hospital systems.  Some will be run by doctor groups.  Most and the largest and the most powerful will simply be run by large business hospital or other conglomerate chains. 

****Obamacare Architect: ‘Be Prepared to Kiss Your Insurance Company Good-Bye Forever’
 
Mar. 3, 2014 7:29pm   Jason Howerton   

Ezekiel Emanuel, one of the architects behind Obamacare, is now claiming that “insurance companies as we know them are about to die.” Critics of President Barack Obama’s signature health care law have long alleged that one of the real goals of the law was to put private insurance companies out of business.

“The good news is you won’t have insurance companies to kick around much longer. The system is changing,” Emanuel writes in an op-ed on New Republic. “As a result, insurance companies as they are now will be going away. Indeed, they are already evolving. For the next few years insurance companies will both continue to provide services to employers and, increasingly, compete against each other in the health insurance exchanges.”

Due to Obamacare, “new actors will force insurance companies to evolve or become extinct,” he continues. Instead, new groups called “accountable care organizations” (ACOs) must start competing directly in the health care exchanges for exclusive contracts with employers.

In this March 11, 2009 photo, Dr. Ezekiel J. Emanuel, special advisor for health care at the Office of Management and Budget, speaks at the American Medical Association's annual conference at the Grand Hyatt Hotel in Washington, Ezekiel J. Emanuel values intelligence, but don't accuse him of Harvard-itis. He'll tell you an Ivy League degree doesn't prove anyone's worth. (AP Photo/J. Scott Applewhite)
In this March 11, 2009 photo, Dr. Ezekiel J. Emanuel, special advisor for health care at the Office of Management and Budget, speaks at the American Medical Association’s annual conference at the Grand Hyatt Hotel in Washington, Ezekiel J. Emanuel values intelligence, but don’t accuse him of Harvard-itis. He’ll tell you an Ivy League degree doesn’t prove anyone’s worth. (AP Photo/J. Scott Applewhite)

The ACOs will have “standardized, guideline-driven care plans for most major conditions and procedures to increase efficiency,” says Emanuel, the brother of Obama’s former chief of staff and current Chicago Mayor Rahm Emanuel.

“They will have figured out how to harness their electronic medical records to better identify patients who will become sick and how to intervene early as well as how to care for the well-identified chronically ill so as to reduce costs,” he notes.

The key skill these ACOs and hospital systems lack—the skill insurance companies specialize in—is the actuarial capacity to predict and manage financial risk. But over the next decade this is something they will develop—or purchase. After all, actuarial science is not rocket science, even if it involves a lot of mathematical equations. And with that skill, ACOs and hospital systems will become integrated delivery systems like Kaiser or Group Health of Puget Sound. Then they will cut out the insurance company middle man—and keep the insurance company profits for themselves. Therefore, increasingly these ACOs and hospital systems will transform themselves into integrated delivery systems, entering insurance exchanges and negotiating with employers, in direct competition with insurance companies.
 As the ACOs become more established, Emanuel claims contracts between the health systems and employers will become more common, thus “cutting out the insurance companies.”

Once the health systems “make the jump to offering coverage in the exchanges, the health insurance companies will only have a few options if they want to survive, according to Emanuel.

“First, they can refuse to change, in which case they will eventually go out of business,” he writes. “Second, they can shift their business to focus on offering services they have expertise in, particularly analytics, actuarial modeling, risk management, and other management services.”

Finally, the “third evolutionary path is that health insurance companies may transform themselves into integrated delivery systems.”

“So be prepared to kiss your insurance company good-bye forever,” Emanuel concludes.

Read the entire article here.

–
Programming note: Is this the end of health insurance as we know it? Glenn Beck and his producers debated the impact of this story in Tuesday’s morning editorial meeting. Watch it tonight at 5pm ET on TheBlaze TV.

[ccp]

Hillary Rodham Clinton: Let evidence lead the healthcare reform fight
HIMSS keynote speaker calls on physicians, health IT, policymakers to face challenges of access, delivery, and technology

Publish date: FEB 28, 2014
Print


By: Daniel R. Verdon
Hillary Rodham Clinton HIMSS 2014Former Secretary of State Hillary Rodham Clinton gave the keynote address at the HIMSS 2014 conference in Orlando, FL. (Photo courtesy of HIMSS)The “hyper-politicized debate” about healthcare reform needs to shift to a thoughtful dialogue about evidence and data, according to former Secretary of State Hillary Rodham Clinton.

In addressing thousands of health information technology professionals at the recently concluded HIMSS 2014 conference in Orlando, Florida, Clinton called on healthcare thought leaders to let evidence guide decisions and development to improve quality and reduce cost of the American healthcare system.

“I am a believer that good data helps to make good decisions,” Clinton says. “It’s true in medicine; it’s true in business; it’s true in government, and it’s true in life…. Unfortunately, the hyper-politicized debate about the Affordable Care Act (ACA) has been often more about ideology than data.”

Clinton called on policymakers and healthcare professionals to debate ways to improve the U.S. healthcare system.

“I want us to have a healthcare debate where our differences are fully aired," Clinton says. "We don’t have a one-size-fits all; our country is quite diverse. What works in New York City is not necessarily going to work in Harrison, Arkansas or Albuquerque. We do need to have people who are looking for ways to use evidence but leave their blaming, their gaming, their shaming, their point scoring at the door.”

There are many reform provisions in the ACA that attempt to improve the system, Clinton says. Some examples include:

•measuring outcomes,
•covering preventive care,
•shifting from fee-for-service to rewarding quality and value,
•building pricing transparency,
•using comparative effectiveness research,
•opening up access to healthcare coverage to millions of Americans who were previously uninsured,
•allowing children to stay on their parents’ coverage until they are 26,
•“liberating employees” from staying in jobs solely to access health insurance because a family member has a pre-existing or chronic health condition.

[ccp]

Hillary Rodham Clinton: Let evidence lead the healthcare reform fight
HIMSS keynote speaker calls on physicians, health IT, policymakers to face challenges of access, delivery, and technology

Publish date: FEB 28, 2014
Print


By: Daniel R. Verdon
  
“There are many provisions embedded in this act that most Americans, if asked, would support,” Clinton contends. And there are just as many challenges facing the system.

“What happens when us Baby Boomers double the number of Medicare beneficiaries from 40 million to 80 million people?" Clinton asks. "How do we prepare for that dramatic increase? How could we improve coordination and communication among all healthcare providers responsible for a patients’ well-being? Will advances in technology combined with comparative effectiveness research continue providing patients and providers with more and better information about what works and what doesn’t in ways that will reduce cost and improve outcomes? How might we replace, once and for all, our fee-for-service model (with a system) that provides provider-led, community-wide care?”

The case for electronic health records

The challenges facing healthcare are also calling for its modernization through technology, Clinton says.

The need for digitizing medical records was clearly evident following the devastation of Hurricane Katrina in 2005, which decimated parts of New Orleans and other areas on the Gulf Coast.

Millions of pages of medical records were lost during that storm.

“I saw firsthand when I went to meet with survivors and refugees from Katrina. People were just totally bewildered. Elderly people didn’t know what medicine they were taking. They couldn’t explain what that little blue pill was they took 3 times a day. We know how important this is. When you are in the middle of a medical emergency, accessing information can literally make the difference between life and death,” Clinton says.

Squeezing healthcare costs

Technology will ultimately lower healthcare costs to Americans, Clinton says. And this country has made some progress. “Healthcare costs are growing at the slowest rate in 50 years, just around 4%. That has significant implications for our economy going forward.”

“There is a lot of misinformation and a lot of anxiety (about healthcare reform),” she says. “(People) are worried about what they might lose. We need to clear the smoke, and figure out what is working and what isn’t. It would be a great tragedy, in my opinion, to take away what has now been provided to the millions of people who now have Medicaid or a health insurance plan for the first time.”

Clinton was one of four keynote presenters at HIMSS 2014, which drew more than 37,000 healthcare IT professionals. Other presentations were delivered by Mark Bertolini, CEO of Aetna; Marilyn Tavenner, administrator of the Centers for Medicare and Medicaid Services (CMS), and Karen DeSalvo, MD, MPH, Office of the National Coordinator for Health Information Technology.

[Crafty_Dog]

She is slick.  IMHO there are some point in there that everyone agrees with e.g. having records available.

IMHO we need to say "We are glad she agrees with Newt Gingrich on the importance of electronic records."  Indeed this is a "no brainer".  However when she says "We need to clear the smoke, and figure out what is working and what isn’t" she is blowing smoke. she is obscuring the fact that the smoke comes from Obamacare itself.  Winging it and expecting everyone else to come along and wipe up the mess of a system that defies economic literacy is a classic misdirect by a politician who is a master of misdirects.

We need to operate by the common sense fundamentals that we all know work:

*Prices should be known to all,
*There should be one national market for all, not 50 separate markets;
*There should be equal tax treatment of individuals and those who get their insurance through their jobs;
*health savings accounts should have their legal limitations lifted.

etc etc etc

[Crafty_Dog]

ObamaCare's Secret Mandate Exemption
HHS quietly repeals the individual purchase rule for two more years.
March 11, 2014 7:15 p.m. ET

ObamaCare's implementers continue to roam the battlefield and shoot their own wounded, and the latest casualty is the core of the Affordable Care Act—the individual mandate. To wit, last week the Administration quietly excused millions of people from the requirement to purchase health insurance or else pay a tax penalty.

This latest political reconstruction has received zero media notice, and the Health and Human Services Department didn't think the details were worth discussing in a conference call, press materials or fact sheet. Instead, the mandate suspension was buried in an unrelated rule that was meant to preserve some health plans that don't comply with ObamaCare benefit and redistribution mandates. Our sources only noticed the change this week.

That seven-page technical bulletin includes a paragraph and footnote that casually mention that a rule in a separate December 2013 bulletin would be extended for two more years, until 2016. Lo and behold, it turns out this second rule, which was supposed to last for only a year, allows Americans whose coverage was cancelled to opt out of the mandate altogether.

In 2013, HHS decided that ObamaCare's wave of policy terminations qualified as a "hardship" that entitled people to a special type of coverage designed for people under age 30 or a mandate exemption. HHS originally defined and reserved hardship exemptions for the truly down and out such as battered women, the evicted and bankrupts.

Agence France-Presse/Getty Images

But amid the post-rollout political backlash, last week the agency created a new category: Now all you need to do is fill out a form attesting that your plan was cancelled and that you "believe that the plan options available in the [ObamaCare] Marketplace in your area are more expensive than your cancelled health insurance policy" or "you consider other available policies unaffordable."

This lax standard—no formula or hard test beyond a person's belief—at least ostensibly requires proof such as an insurer termination notice. But people can also qualify for hardships for the unspecified nonreason that "you experienced another hardship in obtaining health insurance," which only requires "documentation if possible." And yet another waiver is available to those who say they are merely unable to afford coverage, regardless of their prior insurance. In a word, these shifting legal benchmarks offer an exemption to everyone who conceivably wants one.

Keep in mind that the White House argued at the Supreme Court that the individual mandate to buy insurance was indispensable to the law's success, and President Obama continues to say he'd veto the bipartisan bills that would delay or repeal it. So why are ObamaCare liberals silently gutting their own creation now?

The answers are the implementation fiasco and politics. HHS revealed Tuesday that only 940,000 people signed up for an ObamaCare plan in February, bringing the total to about 4.2 million, well below the original 5.7 million projection. The predicted "surge" of young beneficiaries isn't materializing even as the end-of-March deadline approaches, and enrollment decelerated in February.

Meanwhile, a McKinsey & Company survey reports that a mere 27% of people joining the exchanges were previously uninsured through February. The survey also found that about half of people who shopped for a plan but did not enroll said premiums were too expensive, even though 80% of this group qualify for subsidies. Some substantial share of the people ObamaCare is supposed to help say it is a bad financial value. You might even call it a hardship.

HHS is also trying to pre-empt the inevitable political blowback from the nasty 2015 tax surprise of fining the uninsured for being uninsured, which could help reopen ObamaCare if voters elect a Republican Senate this November. Keeping its mandate waiver secret for now is an attempt get past November and in the meantime sign up as many people as possible for government-subsidized health care. Our sources in the insurance industry are worried the regulatory loophole sets a mandate non-enforcement precedent, and they're probably right. The longer it is not enforced, the less likely any President will enforce it.

The larger point is that there have been so many unilateral executive waivers and delays that ObamaCare must be unrecognizable to its drafters, to the extent they ever knew what the law contained.

[Crafty_Dog]

Obama shut down the government rather than have Obamacare postponed, but the Pravdas seem not to notice that , , , in violation of his oath to enforce the law he blocked the Reps from changing he has postponed the law.  Truly we are in Alice in Wonderland territory , , ,

ObamaCare's Individual Mandate Effectively Postponed -- For 3 Years -- For Policies That Were Cancelled
By DICK MORRIS
Published on DickMorris.com on March 12, 2014

In a policy retreat that is little known and virtually uncovered in media circles (except for the Wall Street Journal), the Obama Administration has effectively postponed, for three years, any requirement that those whose health care policies were cancelled or will be cancelled from having to buy health insurance.

This regulatory decision, coupled with the delays granted to employers large and small in the mandate that they cover their workers, so truncates ObamaCare as to amount to its a virtual repeal.

Specifically, by delaying the individual mandate for three years, Obama has given the GOP everything it sought in its abortive government shutdown in October, 2013.

Now, those whose health care policies were cancelled can opt out of the individual mandate -- and not pay the fine for being uncovered -- simply by checking a box on the form.

Under the new rules, according to the Wall Street Journal, "all you need to do is fill out a form attesting that your plan was cancelled and that you 'believe that the plan options available in the [ObamaCare] Marketplace in your area are more expensive than your cancelled health insurance policy' or 'you consider other available policies unaffordable.'

You can even opt out of the requirement to buy new insurance if "you experienced another hardship in obtaining health insurance."  Documentation?  The regulation only requires that you provide it "if possible."

Effectively, this means that anyone who wants an exemption from ObamaCare who previously had a policy that was cancelled can get one simply by asking for it.  No proof.  No documentation.

The policy retreat is the latest in a series of Administration attempts to backpedal on the law and its requirements as their reality dawns on voters in swing states and on Democratic Senators trying to entice them to back their re-election.

The previous step back was an announcement last week that the one year moratorium on cancellations would be extended to three years, effectively pushing it out past the 2016 elections.

But, that postponement will not affect many of the states where endangered Senate Democrats live.  That is because the original decision to postpone the cancellations was subject to the approval of the state insurance commissioner in each locale.  The blue state commissioners mostly rejected the option and ordered the cancellations to proceed.  As a result, the president's offer of a postponement for two more years of the cancellations will avail little marginal Senate Democratic candidates in Alaska, Arkansas, Colorado, Minnesota, and West Virginia.

Altogether, the retreat of this president from the enforcement of his signature program is breathtaking and can only be summed up as a repeal, or postponement of the bulk of the ObamaCare Law's provisions.

Can Obama repeal and postpone his way to keeping a Senate majority in the fall?  We'll see.

[ccp]

"Can Obama repeal and postpone his way to keeping a Senate majority in the fall?"

And can he lie and distort and conceal along with willing MSM accomplices till then?

My guess is no.   How convenient that he is safely re elected some Dems will speak out against him only to set the stage for their next front person.

Morris said Brock is now doing the same thing Clinton did during Lewinsky by announcing policy programs and changing the subject every day.

Remember when we seem to have had thrust in our faces every single day an adorable announcement by Clinton?  Now we see the Brock doing the same thing to constantly change the subject and announce liberal crap every day.  Raise the min wage.  Raise overtime pay and so on.

[DougMacG]

The whole point of health care reform (and the first name of the act) was (is) affordability.  Affordability has two components, the cost of your healthcare and the size of your income.

To address the affordability 'crisis' we committed maybe a trillion dollars so far to a program that made costs go up, incomes go down, and made affordability much worse.  (The law of holes suggests it is time to stop digging?)

Another approach (looking backward or looking forward) would be to grow personal, household and national incomes to make basic expenses like food, clothing, shelter, transportation, and yes, healthcare, more affordable.

Imagine instead if we had legalized free enterprise, encouraged the productive use of capital, removed burdensome regulations, simplified and lowered tax rates, opened up competition (in all industries), employed idle labor, and massively grown the private sector instead of this 7 year project of super-sizing our federal government.  What would that do or have done to the affordability of health care?

[G M]

Yes, but there are no opportunities for graft and control over the masses if you did that.

The whole point of health care reform (and the first name of the act) was (is) affordability.  Affordability has two components, the cost of your healthcare and the size of your income.

To address the affordability 'crisis' we committed maybe a trillion dollars so far to a program that made costs go up, incomes go down, and made affordability much worse.  (The law of holes suggests it is time to stop digging?)

Another approach (looking backward or looking forward) would be to grow personal, household and national incomes to make basic expenses like food, clothing, shelter, transportation, and yes, healthcare, more affordable.

Imagine instead if we had legalized free enterprise, encouraged the productive use of capital, removed burdensome regulations, simplified and lowered tax rates, opened up competition (in all industries), employed idle labor, and massively grown the private sector instead of this 7 year project of super-sizing our federal government.  What would that do or have done to the affordability of health care?

[G M]

[Crafty_Dog]

http://www.nytimes.com/2014/03/26/opinion/why-im-jealous-of-my-dogs-insurance.html?emc=edit_th_20140326&nl=todaysheadlines&nlid=49641193

[Crafty_Dog]

Let me see if I have this right.

Since the beginning of Obamacare, it has taken weeks or months to get vague, incomplete numbers.  Now, in one day, they declare 7.1 million? 

Six million people had their individual health insurance cancelled, so that leaves a net difference of 1.1 million.  Per insurance company data which shows that 15-20% of "enrollees" have not paid, deduct from the 7.1 million 1.65 million  to 1.42 million.

In short, less people have insurance than when we started.

Yes?

[G M]

Obama would never lie to the American people.

If you think otherwise, you are obviously raaaaaaaaacist!

[G M]

Oh, and crunching numbers is just patriarchal, heteronormative, and an example of white privilege.

Luckily, our professional journalists, like Martha Raddatz wouldn't dream of asking such questions.

[ccp]

I think some competing drugs are on the way:

*****Insurers Are Really Mad at Sovaldi, the $1,000-a-Day Miracle Drug

The Atlantic Wire
By Polly Mosendz 23 hours ago
 
In December 2013, the FDA approved Sovaldi a drug developed by Gilead Sciences that promises to do wonders for patients with hepatitis C. Since then, insurers and the government have grown incredibly angry and frustrated with the company.

Sovaldi is a revolutionary advance that promises to cure 90% of targeted patients. Without this treatment, patients could develop liver cancer or require liver transplants. The FDA has said "it is the first drug that has demonstrated safety and efficacy to treat certain types of HCV infection without the need for co-administration of interferon." It was granted the FDA's coveted Breakthrough Therapy Designation, becoming approved in under a year. Director of the Office of Antimicrobial Products at the FDA's Center of Drug Evaluation and Research, Edward Cox, M.D., believes Sovaldi is life changing: “[Sovaldi's] approval represents a significant shift in the treatment paradigm for some patients with chronic hepatitis C.”

Yet, insurers cannot stand this life saving, revolutionary medication. That's because it runs $1,000 a day and the average patient requires a 12-week treatment of Sovaldi. That's $84,000 for one cycle. For patients with a strain that is more difficult to treat, the regiment is 24 weeks. That comes in at $168,000. It is projected to rake it between $5 billion and $9 billion in profits in the United States this year alone. There are an estimated 4 million Americans with Hepatitis C, and 15,000 are killed each year by untreated chronic infections.

Unfortunately, there is not much insurers can do about the price. A comparable drug is not yet on the market. The most similar medication, Incivek, runs $68,000 for  12-week course, but it is much less effective. Comparatively, Sovaldi is still much cheaper than the next-best alternative: a liver transplant. Transplant surgery runs at least $175,000 per patient, not including complications and other associated costs. Additionally, the risks of surgery are far greater than the drug: the body can reject a transplant, it is major surgery, and the recovery time is much longer. There is also a wait list, and a hepatitis C patient may not be eligible for a liver in time.

Gilead Sciences believes the focus is in all the wrong places. "[Critics] have focused on the per-pill cost or per-bottle cost, but that is really not relevant here. It's how much it costs to cure your patient," said Gregg Alton, Gilead's executive vice president of corporate and medical affairs.

Regardless, insurers are battling to lower the cost of the drug. Molina Healthcare, which is set to see earnings decline by 18 percent if (though more realistically, when) the drug reaches $6 billion in sales, is trying to limit which patients have access to the treatment. Mario J. Molina, chief executive of Molina Healthcare gave this statement: “If you’ve got a patient who is advanced and has liver disease and is about to get a liver transplant, it makes sense to give treatment. [W]hat do we do about everybody else? If everyone in the U.S. with hepatitis C were treated with Sovaldi at its list price, it would cost $227 billion compared with the estimated $260 billion spent a year in the country for all drugs.”

Express Scripts is working with doctors to determine which customers can be put on a wait list until a rival, and presumably less expensive, drug is available.

Representative Henry Waxman has taken direct aim at Gilead Sciences as well. In a public letter sent March, 20th, Waxman questioned the pricing: "Our concern is that a treatment will not cure patients if they cannot afford it. [...] According to a recent Reuters report, 'many doctors are requesting a $150,000 combination of Sovaldi ... and Olysio. These costs are likely to be too high for many patients, both those with public insurance and those with private insurance." ********

[Crafty_Dog]

Interesting. 

For the medical side of things let's post on the Health thread on the SCH forum.

[Crafty_Dog]

second post

Numbers Games

An unpublished RAND Corporation study on ObamaCare enrollment has been kept
under wraps and it's not hard to see why. While the White House trumpeted
meeting its goal of 7.1 million enrollees this week, RAND says the number
actually enrolled -- having paid their premium -- could be as few as 858,000.
Just 23% of enrollees were previously uninsured. Even if the true number is
somewhere in the middle, Democrats running for election in November will rue
the day 7.1 million was mentioned. And how did the administration get its
numbers so fast anyway? A couple of months ago Jay Carney stonewalled, saying,
"I'm not going to cherry-pick numbers," meaning, tell you any. Now he says
they know to the decimal point because "our system has gotten a lot better."
Color us skeptical.

[ccp]

Is she serious?  She claims she does not understand the opposition to the ACA!   Why would anyone be so upset about all the free or cheap benefits it brings she wonders?

Totally absent from her argument is who is paying for this stuff and loss of freedom.  Not one iota mentioned of that.   She completely blocks it all out.   Most people I see have higher deductibles and copays, higher rates, more restricted formularies and other tests.  This aspect is totally ignored by the left.   

******IRRATIONAL HATRED OF OBAMACARE IS HARD TO FATHOM
Cynthia Tucker
By Cynthia Tucker 5 hours ago

My friend Isatou has just received an invoice from Kaiser Permanente, testament to her new coverage through the Affordable Care Act -- usually called "Obamacare." She's thrilled to finally have health insurance so she can get regular checkups, including dental care.

A reasonably healthy middle-aged woman, she knows she needs routine mammograms and screenings for maladies such as hypertension. But before Obamacare, she struggled to pay for those things. She once had to resort to the emergency room, which left her with a bill for nearly $20,000. (She settled the bill for far less, but it still left her deeply in debt.)

She is one of more than 7 million people who have signed up for health insurance through the ACA, stark evidence of the overwhelming market demand. Despite a badly bungled initial roll-out, a multimillion dollar conservative media campaign designed to discourage sign-ups, and a years-long Republican crusade against it (50 votes to change the law), millions got health insurance.

That hardly means Obamacare is a raging success. It's much too early to know how it will affect health outcomes for the previously uninsured. But it's abundantly clear that the ACA has already made great strides in improving access to health care. And that alone is quite an accomplishment.

Now, young adults can stay on their parents' health insurance policies until they are 26 years old -- a boon in an economy where many young folks are struggling to find decent jobs. Now, patients with previously diagnosed illnesses ("pre-existing conditions," in insurance lingo) can't be denied coverage. Now, the chronically ill don't have to worry about hitting a lifetime cap that would deny them essential procedures or pharmaceuticals. Now, working folks who don't get insurance through their employers can purchase affordable policies.

Factoring in the Medicaid expansion, the ACA has extended health care coverage to an additional 9.5 million people, according to the Los Angeles Times, which gathered data from national surveys. Needless to say, millions more would have been covered if so many Republican governors, mostly located in Southern states, had not callously refused to accept the Medicaid expansion despite the fact that it is largely paid through federal government funds.

The GOP's relentless opposition has been puzzling. Republicans have resorted to extreme measures to try to derail Obamacare, including an implicit threat to prevent the National Football League from participating in a marketing campaign to encourage people to sign up.

Oh, did I mention 50 votes to repeal or alter the law?

Even acknowledging that our politics have become bitterly polarized, I don't understand this one. Even taking into account the GOP's irrational hatred for President Obama, I don't get it. Even though I know that Republicans believe in less government, I don't understand their approach to Obamacare.

First off, the ACA adheres to market-based ideas, many of which were first suggested by conservatives. Instead of a single-payer system like, say, Medicare, the ACA relies on private insurance companies. It adopts the individual mandate that was supported by many Republicans, including Newt Gingrich, back in the 1990s and later adopted by Mitt Romney in Massachusetts.

Second, Republicans are free to offer up a health care scheme that is more in keeping with conservative principles. But the "repeal and replace" mantra is rarely heard anymore since it has become increasingly clear that the GOP has no intention of coming up with a plan to replace Obamacare. While there are various counter-proposals floating about, none has garnered the support of a majority of Republicans in Congress.

Is the ACA perfect? Absolutely not. There is much in the law that needs to be worked on, refined, improved. But the GOP doesn't seem interested in that. Instead, its members have taken to engaging in increasingly ridiculous criticisms, including the charge that the White House has made up the number of successful enrollees.

It's strange. Could it be that Republicans are simply furious that millions of Americans like Isatou finally have health insurance?

(Cynthia Tucker, winner of the 2007 Pulitzer Prize for commentary, is a visiting professor at the University of Georgia. She can be reached at cynthia@cynthiatucker.com.)

[DougMacG]

http://online.wsj.com/news/articles/SB10001424052702303603904579495064052562826?mg=reno64-wsj&url=http%3A%2F%2Fonline.wsj.com%2Farticle%2FSB10001424052702303603904579495064052562826.html

Sebelius: The Greatest Hits Collection
It's been quite a year for the outgoing HHS secretary. And now she won't get to keep her health plan.

Kathleen Sebelius, who has presided over the disastrous rollout of the Affordable Care Act, is expected to resign as Secretary of Health and Human Services. The news comes less than two weeks after she told the Huffington Post that she would "absolutely" stay in office through November. A Journal editorial notes that her departure "before the election reckoning" is "best understood as one more attempt to dodge political responsibility."

It's been quite a year for the former Kansas governor. At around this time in 2013 Ms. Sebelius was pressuring private companies she regulates to make "independent" donations to outfits promoting ObamaCare.

But the aggressive sales job could not overcome defects in the product. October brought the failed launch of the healthcare.gov website, which Ms. Sebelius initially characterized as simply the result of surging consumer demand for ObamaCare and a "great problem to have."

December brought more embarrassing news as Ms. Sebelius waived the law's individual mandate to buy insurance by categorizing ObamaCare itself as a hardship worthy of exemption.

This was just one of many on-the-fly rewrites the administration claimed the authority to make under a law passed by Congress and signed by the President. As recently as last month, Ms. Sebelius enacted what a Journal editorial called "ObamaCare Delay Number 38"—an extension of the deadline for individuals to enroll in an insurance plan— just weeks after she told Congress that such a delay would not occur.

Though she is leaving now, her legacy is secure, as her name adorns several of the most consequential federal cases resulting from the law. Halbig v. Sebelius  is testing whether the Obama Administration can continue to subsidize insurance exchanges created by the federal government, even though the law says it cannot. And the cases of Sebelius v. Hobby Lobby and Conestoga Wood Specialties v. Sebelius test whether the Obama Administration can force the owners of private businesses to violate their religious beliefs.

Of course there's a reason that the law isn't called SebeliusCare. She is merely the person charged by the President with imposing the law upon American patients and doctors. Her resignation doesn't change the fact that Democrats will remain politically accountable for a law sold on a fraudulent promise from Mr. Obama.

But this latest news does mean that not even the Secretary of Health and Human Services will get to keep her insurance plan.

[ccp]

By Daniela Drake 16 hours ago The Daily Beast

Why Your Doctor Hates His Job

By the end of this year, it’s estimated that 300 physicians will commit suicide. While depression amongst physicians is not new—a few years back, it was named the second most suicidal occupation—the level of sheer unhappiness amongst physicians is on the rise.

Simply put, being a doctor has become a miserable and humiliating undertaking. Indeed, many doctors feel that America has declared war on physicians—and both physicians and patients are the losers.

Not surprisingly, many doctors want out. Medical students opt for high-paying specialties so they can retire as quickly as possible. Physician MBA programs—that promise doctors a way into management—are flourishing. The website known as the Drop-Out-Club—which hooks doctors up with jobs at hedge funds and venture capital firms—has a solid following. In fact, physicians are so bummed out that 9 out of 10 doctors would discourage anyone from entering the profession.

It’s hard for anyone outside the profession to understand just how rotten the job has become—and what bad news that is for America’s healthcare system. Perhaps that’s why author Malcolm Gladwell recently implied that to fix the healthcare crisis, the public needs to understand what it’s like to be a physician. Imagine, for things to get better for patients, they need to empathize with physicians—that’s a tall order in our noxious and decidedly un-empathetic times.

After all, the public sees ophthalmologists and radiologists making out like bandits and wonder why they should feel anything but scorn for such doctors—especially when Americans haven’t gotten a raise in decades. But being a primary care physician is not like being, say, a plastic surgeon—a profession that garners both respect and retirement savings. Given that primary care doctors do the work that no one else is willing to do, being a primary care physician is more like being a janitor—but without the social status or union protections.

Unfortunately, things are only getting worse for most doctors, especially those who still accept health insurance. Just processing the insurance forms costs $58 dollars for every patient encounter, according to Dr. Stephen Schimpff, an internist and former CEO of University of Maryland Medical Center who is writing a book about the crisis in primary care. To make ends meet, physicians have had to increase the number of patients they see. The end result is that the average face-to-face clinic visit lasts about 12 minutes.

Neither patients nor doctors are happy about that. What worries many doctors, however, is that the Affordable Care Act has codified this broken system into law. While forcing everyone to buy health insurance, ACA might have mandated a uniform or streamlined claims procedure that would have gone a long way to improving access to care. As Malcolm Gladwell noted, “You don’t train someone for all of those years in [medicine]… and then have them run a claims processing operation for insurance companies.”

In fact, difficulty dealing with insurers has caused many physicians to close their practices and become employees. But for patients, seeing an employed doctor doesn’t give them more time with the doctor—since employed physicians also have high patient loads. “A panel size of 2,000 to 2,500 patients is too many,” says Dr. Schimpff. That’s the number of patients primary care doctors typically are forced to carry—and that means seeing 24 or more patients a day, and often these patients have 10 or more medical problems. As any seasoned physician knows, this is do-able, but it’s certainly not optimal.

Most patients have experienced the rushed clinic visit—and that’s where the breakdown in good medical care starts. “Doctors who are in a rush, don’t have the time to listen,” says Dr. Schimpff. “Often, patients get referred to specialists when the problem can be solved in the office visit.” It’s true that specialist referrals are on the rise, but the time crunch also causes doctors to rely on guidelines instead of personally tailoring medical care. Unfortunately, mindlessly following guidelines can result in bad outcomes.

Yet physicians have to go along, constantly trying to improve their “productivity” and patient satisfaction scores—or risk losing their jobs. Industry leaders are fixated on patient satisfaction, despite the fact that high scores are correlated with worse outcomes and higher costs. Indeed, trying to please whatever patient comes along destroys the integrity of our work. It’s a fact that doctors acquiesce to patient demands—for narcotics, x-rays, doctor’s notes—despite what survey advocates claim. And now that Medicare payments will be tied to patient satisfaction—this problem will get worse. Doctors need to have the ability to say no. If not, when patients go to see the doctor, they won’t actually have a physician—they’ll have a hostage.

But the primary care doctor doesn’t have the political power to say no to anything—so the “to-do” list continues to lengthen. A stunning and unmanageable number of forms—often illegible—show up daily on a physician’s desk needing to be signed. Reams of lab results, refill requests, emails, and callbacks pop up continually on the computer screen. Calls to plead with insurance companies are peppered throughout the day. Every decision carries with it an implied threat of malpractice litigation. Failing to attend to these things brings prompt disciplining or patient complaint. And mercilessly, all of these tasks have to be done on the exhausted doctor’s personal time.

Almost comically, the response of medical leadership—their solution— is to call for more physician testing. In fact, the American Board of Internal Medicine (ABIM)—in its own act of hostage-taking—has just decided that doctors should be tested not every ten years, but every two years. If a physician doesn’t comply by the end of this month, the ABIM will strip away the doctor’s board certification status.

In an era when nurse practitioners and physician assistants have shown that they can provide excellent primary care, it’s nonsensical to raise the barriers for physicians to participate. In an era when you can call up guidelines on your smartphone, demanding more physician testing is a ludicrous and self-serving response.

It is tone deaf. It is punitive. It is wrong. And practicing doctors can’t do a damn thing about it. No wonder doctors are suicidal. No wonder young doctors want nothing to do with primary care.

But what is a bit of a wonder is how things got this bad. 

Certainly, the relentlessly negative press coverage of physicians sets the tone. “There’s a media narrative that blames physicians for things the doctor has no control over,” says Kevin Pho, MD, an internist with a popular blog where physicians often vent their frustrations. Indeed, in the popular press recently doctors have been held responsible for everything from the wheelchair-unfriendly furniture to lab fees for pap smears.

The meme is that doctors are getting away with something and need constant training, watching and regulating. With this in mind, it’s almost a reflex for policy makers to pile on the regulations. Regulating the physician is an easy sell because it is a fantasy—a Freudian fever dream—the wish to diminish, punish and control a disappointing parent, give him a report card, and tell him to wash his hands.

To be sure many people with good intentions are working toward solving the healthcare crisis. But the answers they’ve come up with are driving up costs and driving out doctors.  Maybe it’s too much to ask for empathy, and maybe physician lives don’t matter to most people.

But for America’s health to be safeguarded, the wellbeing of America’s caretakers is going to have to start mattering to someone. 



 

[Crafty_Dog]

http://www.thedailybeast.com/articles/2014/04/14/how-being-a-doctor-became-the-most-miserable-profession.html

How Being a Doctor Became the Most Miserable Profession
by Daniela DrakeApr 14, 2014 5:45 am EDT
Nine of 10 doctors discourage others from joining the profession, and 300 physicians commit suicide every year. When did it get this bad?


By the end of this year, it’s estimated that 300 physicians will commit suicide. While depression amongst physicians is not new—a few years back, it was named the second-most suicidal occupation—the level ofsheer unhappiness amongst physicians is on the rise.
 
Simply put, being a doctor has become a miserable and humiliating undertaking. Indeed, many doctors feel that America has declared war on physicians—and both physicians and patients are the losers.

Not surprisingly, many doctors want out. Medical students opt for high-paying specialties so they can retireas quickly as possible. Physician MBA programs—that promise doctors a way into management—areflourishing. The website known as the Drop-Out-Club—which hooks doctors up with jobs at hedge funds and venture capital firms—has a solid following. In fact, physicians are so bummed out that 9 out of 10 doctors would discourage anyone from entering the profession.

It’s hard for anyone outside the profession to understand just how rotten the job has become—and what bad news that is for America’s health care system. Perhaps that’s why author Malcolm Gladwell recently implied that to fix the healthcare crisis, the public needs to understand what it’s like to be a physician.

Imagine, for things to get better for patients, they need to empathize with physicians—that’s a tall order in our noxious and decidedly un-empathetic times.

After all, the public sees ophthalmologists and radiologists making out like bandits and wonder why they should feel anything but scorn for such doctors—especially when Americans haven’t gotten a raise in decades. But being a primary care physician is not like being, say, a plastic surgeon—a profession that garners both respect and retirement savings. Given that primary care doctors do the work that no one else is willing to do, being a primary care physician is more like being a janitor—but without the social status or union protections.

Unfortunately, things are only getting worse for most doctors, especially those who still accept health insurance. Just processing the insurance forms costs $58 for every patient encounter, according to Dr. Stephen Schimpff, an internist and former CEO of University of Maryland Medical Center who is writing a book about the crisis in primary care. To make ends meet, physicians have had to increase the number of patients they see. The end result is that the average face-to-face clinic visit lasts about 12 minutes.

Neither patients nor doctors are happy about that. What worries many doctors, however, is that the Affordable Care Act has codified this broken system into law. While forcing everyone to buy health insurance, ACA might have mandated a uniform or streamlined claims procedure that would have gone a long way to improving access to care. As Malcolm Gladwell noted, “You don’t train someone for all of those years in [medicine]… and then have them run a claims processing operation for insurance companies.”

In fact, difficulty dealing with insurers has caused many physicians to close their practices and become employees. But for patients, seeing an employed doctor doesn’t give them more time with the doctor—since employed physicians also have high patient loads. “A panel size of 2,000 to 2,500 patients is too many,” says Dr. Schimpff. That’s the number of patients primary care doctors typically are forced to carry—and that means seeing 24 or more patients a day, and often these patients have 10 or more medical problems. As any seasoned physician knows, this is do-able, but it’s certainly not optimal.

Most patients have experienced the rushed clinic visit—and that’s where the breakdown in good medical care starts. “Doctors who are in a rush, don’t have the time to listen,” says Dr. Schimpff. “Often, patients get referred to specialists when the problem can be solved in the office visit.” It’s true that specialist referrals areon the rise, but the time crunch also causes doctors to rely on guidelines instead of personally tailoring medical care. Unfortunately, mindlessly following guidelines can result in bad outcomes.

Yet physicians have to go along, constantly trying to improve their “productivity” and patient satisfaction scores—or risk losing their jobs. Industry leaders are fixated on patient satisfaction, despite the fact that high scores are correlated with worse outcomes and higher costs. Indeed, trying to please whatever patient comes along destroys the integrity of our work. It’s a fact that doctors acquiesce to patient demands—for narcotics, X-rays, doctor’s notes—despite what survey advocates claim. And now that Medicare payments will be tied to patient satisfaction—this problem will get worse. Doctors need to have the ability to say no. If not, when patients go to see the doctor, they won’t actually have a physician—they’ll have a hostage.

But the primary care doctor doesn’t have the political power to say no to anything—so the “to-do” list continues to lengthen. A stunning and unmanageable number of forms—often illegible—show up daily on a physician’s desk needing to be signed. Reams of lab results, refill requests, emails, and callbacks pop up continually on the computer screen. Calls to plead with insurance companies are peppered throughout the day. Every decision carries with it an implied threat of malpractice litigation. Failing to attend to these things brings prompt disciplining or patient complaint. And mercilessly, all of these tasks have to be done on the exhausted doctor’s personal time.

Almost comically, the response of medical leadership—their solution— is to call for more physician testing. In fact, the American Board of Internal Medicine (ABIM)—in its own act of hostage-taking—has decided that in addition to being tested every ten years, doctors must comply with new, costly, "two year milestones." For many physicians, if they don't comply be the end of this month, the ABIM will advertise the doctor's "lack of compliance" on their website.

In an era when nurse practitioners and physician assistants have shown that they can provide excellent primary care, it’s nonsensical to raise the barriers for physicians to participate. In an era when you can call up guidelines on your smartphone, demanding more physician testing is a ludicrous and self-serving response.

It is tone deaf. It is punitive. It is wrong. And practicing doctors can’t do a damn thing about it. No wonder doctors are suicidal. No wonder young doctors want nothing to do with primary care.

But what is a bit of a wonder is how things got this bad.

Certainly, the relentlessly negative press coverage of physicians sets the tone. “There’s a media narrative that blames physicians for things the doctor has no control over,” says Kevin Pho, MD, an internist with apopular blog where physicians often vent their frustrations. Indeed, in the popular press recently doctors have been held responsible for everything from the wheelchair-unfriendly furniture to lab fees for pap smears.

The meme is that doctors are getting away with something and need constant training, watching and regulating. With this in mind, it’s almost a reflex for policy makers to pile on the regulations. Regulating the physician is an easy sell because it is a fantasy—a Freudian fever dream—the wish to diminish, punish and control a disappointing parent, give him a report card, and tell him to wash his hands.

To be sure many people with good intentions are working toward solving the healthcare crisis. But the answers they’ve come up with are driving up costs and driving out doctors.  Maybe it’s too much to ask for empathy, and maybe physician lives don’t matter to most people.

But for America’s health to be safeguarded, the wellbeing of America’s caretakers is going to have to start mattering to someone. 

[ccp]

Brace For ObamaCare

By Dick Morris on April 23, 2014
   
Published on TheHill.com on April 22, 2014

ObamaCare has signed up 8 million people. Democrats are breathing a sigh of relief, but their trials have only just begun.

Now a large swath of America will experience firsthand the shortages of doctors, the limited access to hospitals, the high deductibles, the large co-pays, the significant co-insurance requirements and the long delays in care that will accompany Obama-Care’s implementation. These Americans will see, firsthand, what government-run medicine is like. And the rest of the electorate will have a front-row seat from which to watch the debacle.

The fundamental problem facing ObamaCare is the same as it was when the misbegotten program was launched: You cannot expand the number of patients without expanding the number of doctors. If you try, as the Affordable Care Act does, you will have long waits to see doctors, big increases in costs and unsatisfactory patient outcomes.

The increases in cost that we are now seeing in the healthcare sector come, of course, from an increase in demand with no commensurate rise in the supply. These price hikes will trigger the most deeply disturbing — and controversial — of ObamaCare’s provisions, the Independent Payment Advisory Board (IPAB).

Appointed by the president and confirmed by the Senate, this 15-member board will be charged with requiring alterations in Medicare practice to hold down costs sufficiently to cut program spending by $500 billion over the next decade. The formulae it develops will, undoubtedly, be adopted by states seeking to contain Medicaid costs and by private insurance firms.

The IPAB has not yet come into existence because the rate of medical inflation has not required it. But now, with prices rising, it will become central.

Each January, the IPAB will issue a cost-reduction plan. It will proscribe the use of certain high-cost medicines, limit access to diagnostic tests and condition approval of certain surgeries and treatments based on the number of “quality-adjusted life years” left to each patient, all to bring Medicare costs into line.

Congress may override the IPAB recommendations by a three-fifths vote of each House. Otherwise, they automatically take effect by Aug. 15.

Each year, the administration will face a bruising fight over the IPAB recommendations. Patients will protest, and doctors will warn of bad outcomes. Sarah Palin’s “death panel” will begin its reign.

At the local level, cancer patients will find that the nearest and the best hospitals won’t take them. Pharmacies won’t fill their prescriptions. Doctors will turn away patients. As the ObamaCare bureaucracy struggles with the rising costs it caused, it will ration access to medicines, hospitals, surgeries and elective procedures for all in its reach.

Meanwhile, all Americans under the age of 65 who are not on Medicaid — both those on ObamaCare and covered by private plans — will find huge premium increases throughout the remainder of 2014 and during 2015. Deductibles will skyrocket. Stories of the financial hardship of paying the new premiums will abound.

And the cancellations will continue. Small employers will shut down their policies rather than accept the new higher premiums, and their workers will have to fend for themselves in the high-cost ObamaCare market. Those insured by large companies will see big increases in premiums and deductibles. And employees will continue to see a reduction in their weekly work hours as their bosses squirm and maneuver to limit ObamaCare’s universal coverage mandate.

Meanwhile, many of the 8 million enrollees will not pay up, eroding the program, and those who go without health insurance will hate every penny of the fine Obama will impose on them — or, they just won’t pay it.

For those who feel the political damage of ObamaCare is behind them, you ain’t seen nothin’ yet!

View my most recent videos in case you missed them!

[Crafty_Dog]

The Coming Two-Tier Health System
ObamaCare is already creating one class of care for the poor and middle class and another for the affluent.
By Scott W. Atlas
WSJ
April 30, 2014 7:01 p.m. ET

With the unveiling of the Affordable Care Act's website, the public experienced a painful reminder of the consequences of the government's new authority over health care. While millions signed up for insurance, millions of others abruptly lost their existing coverage and access to their doctors because that coverage didn't fit new ObamaCare definitions.

The health-care law was generated by an administration promoting government as the solution to inequality, yet the greatest irony of ObamaCare is what will undoubtedly follow as a long-term, unintended consequence of the law: a decidedly unequal, two-tiered health system. One will be for the poor and middle class, and a separate system will be for those with the money or power to circumvent ObamaCare.

With the Affordable Care Act, the government has dramatically expanded its authority as final arbiter over health insurance and consequently over access to medical care. After the law's Medicaid expansion and with the population aging into Medicare eligibility, the 107 million under Medicaid or Medicare in 2013 will skyrocket to 135 million five years later, growing far faster than the ranks of the privately insured.

Add to that centralization of power the Independent Payment Advisory Board (IPAB), ObamaCare's group of political appointees tasked with reducing payments to doctors and hospitals. Even Howard Dean, former chairman of the Democratic National Committee, warned that "The IPAB is essentially a health-care rationing body. By setting doctor reimbursement rates for Medicare and determining which procedures and drugs will be covered and at what price, the IPAB will be able to stop certain treatments its members do not favor by simply setting rates to levels where no doctor or hospital will perform them."

The hidden truth is just around the corner—those more dependent on public insurance, mostly the poor and middle class, will have limited access to medical care. About one-third of primary-care physicians and one-fourth of specialists have already completely closed their practices to Medicaid patients. Over 52% of physicians have already limited the access that Medicare patients have to their practices, or are planning to, according to a 2012 survey by Merritt Hawkins for the Physicians Foundation. More doctors than ever already refuse Medicaid and Medicare due to inadequate payments for care, and that trend will only accelerate as government lowers reimbursements.

At the same time, ObamaCare is squeezing out the middle class from affordable private insurance that correlates with far better disease outcomes than government insurance. By bloating coverage requirements and minimizing the consideration of risks fundamental to pricing insurance, the law has already increased premiums by 20%-200% in more than 40 states, according to a 2013 analysis by the Manhattan Institute's Avik Roy and others.

Less widely known is that inadequate reimbursement by government insurance to doctors substantially increases private-insurance prices. According to a December 2008 Milliman report presented by Will Fox and John Pickering, a shortfall of more than $88 billion in payments from Medicaid and Medicare beneficiaries added more than $1,500 extra a year in premiums and $1,800 extra in total out-of-pocket costs to every family of four with private insurance. With increasing enrollment into government insurance, private premiums will undoubtedly rise even more.

Even inside Medicare, two-tiered access will occur. Under political pressure in advance of this fall's midterm elections, the administration backed off from the ObamaCare plan to eliminate affordable private drug-coverage options inside Medicare, options that all Medicare beneficiaries enjoyed before the law. These substantial cuts will likely return post-election, limiting those choices to more-affluent seniors.

Despite the government's assertion that the health-care law increases insurance choices, the ObamaCare exchanges do the opposite for those dependent on them and the government subsidies they offer. The average number of plans offered in individual states has decreased from 117 in 2013 to 41 in the new exchanges; consumers in 16 states now suddenly have their choices limited to three or fewer insurers.

ObamaCare is also eliminating access to many of the best specialists and the hospitals for middle-income Americans. To meet the law's requirements, major insurers are declining to participate in the exchanges, or only offering plans that restrict choice of doctors and exclude many of America's best hospitals. McKinsey reported a marked narrowing of hospital networks on the ObamaCare exchanges: In 2013, 33% of individual insurance offerings contained narrow or very narrow networks, but this year under the exchanges 68% of options cover only those limited networks.

For cancer care, the overwhelming majority of America's best hospitals in the National Comprehensive Cancer Network—including MD Anderson Cancer Center of Houston, New York's Memorial Sloan-Kettering, Barnes Hospital in St. Louis, and the Seattle Cancer Care Alliance uniting doctors from Fred Hutchinson Cancer Research Center, UW Medicine and Seattle Children's—are not covered in most of their states' exchange plans.

Meanwhile, concierge practices are increasing rapidly, as patients who can afford it, along with many top doctors, rush to avoid the problems of an increasingly restrictive health system. The American Academy of Private Physicians estimates that there are now about 4,400 concierge physicians, 30% more than last year. In a recent Merritt Hawkins survey, about 7% to 10% of physicians planned to transition to concierge or cash-only practices in the next one to three years. With doctors already spending 22% of their time on nonclinical paperwork, they will find more government intrusion under ObamaCare regulations taking even more time away from patient care.

As America doubles down on government authority over health care, Europeans with the means to do so are increasingly circumventing their own centralized systems. In Britain, even though they're already paying for the National Health Service, six million Brits—two-thirds of citizens earning more than $78,700—now buy private health insurance. Meanwhile, more than 50,000 travel out of the U.K. annually, spending more than $250 million, to receive treatment more readily than they can at home. Even in Sweden, the mother of all welfare nations, half a million Swedes now use private insurance, up from 100,000 a decade ago.

Unless ObamaCare is drastically altered, America's health care will also become even more divided, with rising inequality. Just as in the U.K. and other countries where governments take an outsize role in dictating health-care policy, only the lower and middle classes in America will suffer the full consequences of ObamaCare.

Dr. Atlas is a physician and a senior fellow at Stanford University's Hoover Institution.

[ccp]

"Howard Dean, former chairman of the Democratic National Committee, warned that "The IPAB is essentially a health-care rationing body"

Well of course.  That is also what the whole electronic medical record, the expansion of codes by several times, the reporting of "data" are about.  It is all about control and cutting costs.  Under the guise of better "quality" care of course.

As for the rich being able to get better care - it has and will always be that way.  This is NOT new.  Anyone know of any famous person who could NOT get an organ transplant?

Name one!

[G M]

http://m.washingtonexaminer.com/veterans-affairs-puts-3-on-leave-congress-threatens-subpoena/article/2547983

[Crafty_Dog]

http://media.wix.com/ugd/520423_fa60e0dba4e14293aeaebbe01fd5ed80.pdf

[ccp]

My post from last year.  I pointed out I agreed with Ezekial Emanuel that there IS NO shortage of doctors or at least primary care:

*****Follow up to previous post.  Went to meeting of the New Jersey american college of physicians few weeks ago and listened to Ezekiel's talk.

Basically he starts with a bunch of charts and graphs describing what we all know - health care costs are going up and are unsustainable.

His prescription is basically for provider groups to form and control costs by monitoring what they do "outcomes" and basically what managed care has been doing for decades now.   I guess the difference is really now the politburo types are requiring we do it on industrial scale with industrial level quality control with reems of data, measurements, more data of the data more measurements and every penny counted.  He gave one example from a gourp of several hundred physcians Caremont though I don't remember where they are located and I haven't looked into it - yet.

Supposedly they cut costs while increasing the bottom line.  Thus this is a model for all.

He also explains the cost rising is down form over 2% to around 0.8%.  Of course he is suggesting he and the rest of the politburo are responsible for cost savings - not that the economy is so bad for most people they can't aford their co pays their deductables their premiums and neither can as many employers.

I only had a chance for one question so I asked him about Clay Christiansens theory that Nurse Practitioners will supplant primary care doctors and it is inevitable and no stopping it.  He said PCP's are not replaceabale by nurses and that he doesn't think that would happen - though we are clearly seeing that trend.

He doesn't believe that there is a doctor shortage.  Indeed I agree with him on that.  There probably is a shortage of a few specialties and doctors in some low income urban areas or in the boondocks but certainly not in the north east and probably the West coast.

Indded if any group feels threateneed by the low wages of illegals /legal immigrants no where is this felt more than in health care.

All we see here are doctors born everywhrere else.  The schools of course also like to play the shortage gimmack so they can get more money to churn more graduates out and the nursing programs the same.

Getting back to Emanuel his personality is the same as his brother Rahm.    He ran out after one question after mine.  I guess he had his next speaking engagement.l****

The doctors exist and are being churned out left and right.  Except is some rural areas as always.  If there are going to be longer waits it would be a  result of some doctors refusing to accept patients our of principle or more they refuse to accept the lower pay coverage.   As always follow the money.

http://www.usatoday.com/story/news/nation/2014/05/10/obamacare-surge-primary-care-overload/8894227/

[ccp]

Most employers could shift healthcare coverage to exchanges by 2020, report says
Switch from employer to individual plans could save businesses $3.25 trillion

Publish date: MAY 15, 2014
Print


By: Rachael Zimlich
 
A new report is gaining attention for its prediction that U.S. companies could save trillions of dollars over the next decade by using the Affordable Care Act's (ACA) healthcare exchanges, and eliminating employee health plans.

The report, prepared for the financial services industry by S&P Capital IQ Global Markets Intelligence, predicts that companies could shift 90% of their workers from employer-based healthcare to individual coverage on insurance marketplaces by 2020. If all U.S. companies with 50 or more employees transferred coverage for their employees to the marketplace, they could save $3.25 trillion by 2025, the report predicts. If only Standard & Poor’s (S&P) 500 companies did so, they would save between $690 billion and $800 billion over the same period.

The premise of the ACA is to shift the responsibility for healthcare insurance to employees. This will put corporate America in a position to redefine its role in healthcare, the report states.

S&P 500 companies employ about 138 million people, or 20% of the American workforce. So when S&P companies adopt a practice, it often indicates the start of a new, large-scale trend among employers.

The report predicts that when the switch from employer to individual insurance begins, it won’t take long to complete, with 10% of S&P companies expected to begin transferring coverage to workers by 2016, 30% by 2017, 70% by 2019 and 90% by 2020. Low- and middle-income employees, entry-level workers or new college graduates, and part-time employees will be pushed into individual coverage first and will receive federal subsidies to help afford their new plans. Higher-income workers will follow later, likely with stipends to help cover the cost of their coverage, the report predicts. Those stipends will eventually become part of employee pay, completing the transition to a complete corporate abandonment of providing healthcare coverage.

But with all that money saved, someone is going to have to pay more, whether it is employees or the government. According to the report, employees moved to the exchange would pay nearly $2,800 more for their health benefits in 2016 compared with what they paid under an employer-provided insurance plan, or an increase of about 50%. But many low-wage, and even some middle-wage, employees will be eligible for a government subsidy to offset the cost of their their premiums which will also increase the financial burden of subsidizing healthcare for the federal government, the report predicts.

On the other hand, the more individuals that purchase healthcare coverage through the exchanges, the more affordable and competitive the market will become, the report explains. Purchasing individual coverage also will reduce the stress caused by changing jobs, because coverage won’t change with the employment. Overall, the shift could give employees more control over their healthcare coverage and more stability, but could also result in higher premiums for anyone not eligible for federal subsidies or offered stipends from their employers.

The report predicts that employee costs for healthcare will more than double by 2025, although they will be paying the same percentage—about 26%—of their premiums over that period. Employers’ share of premiums will drop from roughly 70% to 33%, while the government’s share is predicted to jump from less than 4% to about 41%.

 

[DougMacG]

Yes.  And we have already tried the single payer system - over at the Veterans Administration.  That's what people want?!
-------------------------------------------------------------------------------------------------------------------------------------------------------------------------

As an aside, I suggest we first vote to re-name ACA at least one day before repealing it.  Don't give the media the headline that Republicans repealed Affordable Healthcare their first day in power.

[Crafty_Dog]

http://www.tpnn.com/2014/05/28/flashback-new-york-times-praises-va-as-a-model-for-obamacare/

[G M]

http://www.tpnn.com/2014/05/28/flashback-new-york-times-praises-va-as-a-model-for-obamacare/

Wow! Krugman got that right. Although it's really a best case scenario.

[Crafty_Dog]

http://www.washingtonpost.com/blogs/wonkblog/files/2014/05/ParenteAnalysis.pdf

[Crafty_Dog]

http://finance.yahoo.com/news/cbo-quietly-drops-forecast-obamacare-180500918.html