The Politics of Health Care

[ccp]

There will be a crush of middle players finding ways to ring money out of this.   Will this save us money?  Short answer:  no.   While I am not totally against this as IMHO there is some reasonable aspects to this, I won't like how it will be "sold" to the public.  It will be sold as "all in the  interests of patient  care".  The real driver is costs. 

****IMPROVING PATIENT CARE
 
Engaging Public Health in End-of-Life Issues: It Is Time to Step Up to the Plate
 
Jaya K. Rao, MD, MHS, Deputy Editor

The Doctor: For Life and at the End of Life

Ann Intern Med.  2015;162(3):230-231. doi:10.7326/M14-2479

This article was published online first at www.annals.org on 9 December 2014.

 

In September 2014, the Institute of Medicine (IOM) released its fifth full report on end-of-life issues, “Dying in America: Improving Quality and Honoring Individual Preferences Near the End of Life” (1). Acknowledging the substantial progress made since its first report on these issues was published in 1997 (2), this report identifies recommendations within 5 domains. It is particularly encouraging to see the following recommendation for public education and engagement in the report: “Civic leaders, public health and other governmental agencies ... should engage their constituents and provide fact based information about care of people with advanced serious illness to encourage advance care planning and informed choice based on the needs and values of individuals.” Because I was one of the first authors to articulate a role for public health with respect to end-of-life issues (3) while I was working at the Centers for Disease Control and Prevention (CDC), it is noteworthy that this is the first IOM report to explicitly mention that public health has a role in this arena. By describing the work on end-of-life issues done by the public health community during the past decade, I hope that policymakers, members of the IOM Committee, and health professionals can use and build on these efforts.

Although end-of-life issues have long been considered a societal problem that needs to be improved, the field of public health has only begun to embrace end-of-life as a health concern. Because public health's primary focus is to prevent illness and premature death due to chronic disease and other health threats, public health professionals' reluctance to acknowledge death or its circumstances may be understandable. However—whether we wish to admit it or not—prevention has its limits, and everyone will die eventually. Some public health professionals may also believe that end-of-life issues are a health system problem rather than a priority to be addressed through population health efforts. Public health priorities tend to have at least one of the following characteristics: a large population burden, a major effect in terms of health and other consequences, and the potential for prevention.
 
In 2002, a literature review that I coauthored (3) clearly showed that end-of-life issues met the criteria of a public health priority. This review was designed as a primer to document the relevance and importance of these issues to the public health community. Given that public health is a key partner of the health care system for many health issues, we proposed that public health could disseminate culturally appropriate materials about advance care planning to the public, thus reaching persons before they were faced with making end-of-life decisions. In addition, we made a case for considering advance care planning as a critical part of chronic disease management programs.
 
Working closely with the CDC, chronic disease partners in state health departments identified priority end-of-life actions for public health (4). More than 200 public health stakeholders were engaged in this effort and made 103 recommendations for end-of-life activities across a range of topics (for example, public education, professional education, and research and evaluation). Of note, 3 of the 5 initial priorities identified as public health end-of-life actions are consistent with the spirit of the IOM's recommendation to educate and engage the public: to educate the public about hospice and palliative care and the importance of having an advance directive or health care proxy and to collect, analyze, and share data about the end of life through state surveys.

One of these actions has resulted in the development of online information on advance care planning for the public and public health and aging services professionals. For example, the CDC's Healthy Aging Web site (www.cdc.gov/aging/advancecareplanning/index.htm) presents materials for the public on advance care planning, including links to decision aids, state-specific advance directive forms, legal guides, and other end-of-life resources (such as hospice and palliative care organizations and information for caregivers). An online modular training course on advance care planning also was developed for public health and aging services professionals. Since then, more than 1000 health professionals have completed the course (Anderson L. Personal communication.), which is available for free and offers continuing education credits (www.cdc.gov/aging/advancecareplanning/care-planning-course.htm).

In addition to providing educational materials to the public, the 2014 IOM report suggests that government agencies undertake and share behavioral research aimed at assessing public perceptions and actions with respect to end-of-life care. Although national polls in the United States have provided periodic insights into public perspectives on end-of-life issues, ongoing population-based national surveys currently do not include questions about the end of life (5). Recently, end-of-life surveillance items were administered to a nationally representative sample of U.S. consumers to assess factors associated with completion of advance directives. This survey found that 26.3% of respondents had an advance directive and nearly 70.0% had concerns about end-of-life care, such as the costs of care, the pain that they might have, or their comfort and dignity during this period (6). Black or Hispanic persons or those who lack the knowledge to have concerns about the end of life were less likely to have advance directives; these groups may represent potential targets for intervention.

Although a PubMed search for “public health” and “end of life” still yields few articles addressing a population approach to end-of-life issues (most of which are presented here), the broader public health community has recently begun to acknowledge this issue. Several states (5, 7) and communities included palliative care questions as state-added items to the Behavioral Risk Factor Surveillance System. Other authors have declared end of life as a public health crisis ( and the dying as a vulnerable population that should be a concern of public health (9). More recently, the American Public Health Association adopted a policy statement in 2013 on the role of public health in addressing unmet needs in serious illness and at the end of life (10). Such steps represent incremental progress.
 
In making its recommendations, the IOM appropriately considered the end of life as an issue that requires the involvement of sectors beyond the health care system. Hopefully, public health will heed the IOM's call for action and continue to build on the recommendations of the IOM and key public health stakeholders with respect to end-of-life issues. And, when the IOM writes its next end-of-life report, perhaps public health can influence the next set of recommendations.

[ccp]

I really don't want to be a government employee but this is where it is going.   I no of no significant scientific evidence that sex is a decent form or aerobic exercise unless one is being whipped while running on a treadmill.  This is just patently ridiculous:

*****British Doctors Told to Prescribe Sex as Exercise

by A.B. Sanderson13 Feb 201586

Medical experts have recommended that exercise is something which GPs should be prescribing more often, describing it as “a wonder drug” which is important in the prevention of many common diseases.

The report from the Academy of Medical Royal Colleges says that physical activity plays a significant role in the management of long term conditions but its impact is so positive that it needs to take a greater role in the daily routine of children and adults, the Daily Mail reports.

There is, it says, a direct correlation between the increasingly sedentary lifestyle and conditions such as diabetes and obesity.

And worryingly, over 40 per cent of adults do not reach the minimum recommended level of 30 minutes of moderately intense exercise five times per week.

Regular exercise can prevent dementia, type 2 diabetes, some cancers, depression, heart disease and other common serious conditions – reducing the risk of each by at least 30% – better than many drugs.

But rather than simply telling doctors to send their patients down the gym or pounding the streets in lycra, the authors suggest there are a huge number of ways to raise the heart rate which fit into a person’s schedule.

The report says that fun activities are more likely to be sustained, suggesting many activities can be promoted including dog walking, dancing and even having sex. ‘Basing activities in communities leads to sustained acceptance’ it says, although the report offers no comment on whether this applies to the latter activity.

And it is not just the health of patients which will improve with more adults taking part in community dance classes or training for charity events: The costs of physical inactivity to the UK, the NHS and other public bodies are estimated to be in excess of £15bn.

There are also other costs which are less simple to quantify, including the effects of bad health on families and communities. Lack of physical activity is, is says, acknowledged as one of the top four factors responsible for premature deaths and long term diseases.

Chairman of the Academy of Medical Royal Colleges Professor Dame Sue Bailey sailed:

“This is about people and their doctors believing that the small effort involved is worth it because they are worth it.

“There really is a miracle cure staring us in the face, one which too many patients and doctors have quite simply forgotten about.

“This is about people and their doctors believing that the small effort involved is worth it because they are worth it. This needs to work across the life-course, from children to the very elderly.”

But the advice was not welcomed everywhere, with Joyce Robins of Patient Concern saying, “It’s none of GPs’ business to be talking about patients’ sex lives. I would take amiss at that and I’m sure many others would too.

“This is particularly true as nowadays most patients don’t even know their family doctor.”*****

[Crafty_Dog]

http://www.newsweek.com/obamacare-picture-health-305471

[ccp]

The speaker I heard today could answer this.   The numbers and stats above are probably all distortions.  The Affordable Health Care Act has done little if anything to reduce costs.  The administrative costs could be as high as 30%.  The only ones who did well are the same ones who havce done well in the rest of the economy - big companies who have the resources to squeeze out all competition and soak the system.   Without the input of tax dollars to supplement these companies they would go out of business.  We are supplementing them with tax money.

I ask everyone who reads this board:

How much less are you paying for your insurance and is your plan better than last year or the year before that?

I know the answer.

The speaker I heard advocates for single payer.   He made a strong case and almost has me convinced he may be right.

If I can find the website he recommended I'll post but I lost the site when I left a piece of paper somewhere while answering a page.


Based on what his presentation concluded based on a lot of statistics and sources the Newsweek piece is exactly what one would expect from a veiled Democrat outlet - pure propaganda.

[ccp]

This is one article from the organization the speaker (I noted in the previous post) was promoting.  I am not a member and would not. 

A rather socialistic group.  Yet they are right about pointing out the large layer of administrative costs.   

He thinks the AHA is going to fail in a few years.   One could argue it is designed to fail in the march to single payer.  I don't know.

http://www.pnhp.org/news/2015/march/health-care-law-did-not-end-discrimination-against-those-with-pre-existing-condition

[Crafty_Dog]

POTH

WASHINGTON — In 2012, the Supreme Court declared that Congress had put “a gun to the head” of states by pressuring them to expand Medicaid, and it said that such “economic dragooning” of the states violated federalism principles embedded in the Constitution.

Now, in a separate case, comments by several justices indicate that they could uphold a pillar of the Affordable Care Act — insurance subsidies for millions of lower-income people — by invoking those same principles.

In 2012, the court said it would be unconstitutional for Congress to cut off all Medicaid payments to states that refused to expand eligibility, and this ruling instantly transformed the expansion of Medicaid into a state option.

That precedent echoed through oral arguments last week before the court; justices again expressed respect for federalism and state sovereignty.

   

Under the health care law, Congress gave states a choice: They could establish and operate their own competitive insurance marketplaces, or they could rely on one established by the federal government. It was, several justices said, inconceivable that Congress would then punish states that used the federal exchange by denying insurance subsidies to their residents.

Justice Anthony M. Kennedy suggested that such a choice could coerce states in a potentially unconstitutional way. Under the theory favored by critics of the health care law, Justice Kennedy said last week, “the states are being told either create your own exchange, or we’ll send your insurance market into a death spiral,” and “the cost of insurance will be sky high.”

Mark H. Gallant, a health lawyer at Cozen O’Connor in Philadelphia, said: “Justice Kennedy’s take on this case was a brilliant touch. He used the plaintiffs’ own argument against them to suggest that it would be unconstitutionally coercive if Congress made the subsidies depend on a state’s decision to establish an exchange.”

Plaintiffs in the case, King v. Burwell, say the Affordable Care Act authorizes subsidies only in states that created their own insurance exchanges.

Justice Antonin Scalia said it was “gobbledygook” for the Obama administration to suggest that an exchange set up by the federal government “qualifies as an exchange established by the state.” When the language of the law is clear and unambiguous, he said, the court cannot twist the words to avoid “untoward consequences.”

And Justice Samuel A. Alito Jr. said the court could delay the impact of its ruling if the consequences were as disruptive as the administration said.

But the Obama administration argues that the subsidies are available in all states, including more than 30 that refused to establish exchanges and rely on the federal marketplace. Without the subsidies, it says, many people would be unable to afford insurance, and healthier consumers would go without coverage, leaving insurers with a sicker, more expensive pool of customers.

The Affordable Care Act has begun reducing the number of uninsured in two main ways: by expanding Medicaid and by providing tax credits to subsidize private insurance purchased through the public exchanges. The court, which focused on Medicaid three years ago, is now examining the subsidies.
Continue reading the main story Continue reading the main story
Continue reading the main story

Justice Sonia Sotomayor told the plaintiffs’ lawyer, Michael A. Carvin, that if the court accepted his argument, it would be “intruding on the federal-state relationship, because then the states are going to be coerced into establishing their own exchanges.”

And Justice Elena Kagan said Congress had not warned states of the consequences if they chose to use the federal exchange. In interpreting statutes, Justice Kagan said, the court presumes that “Congress does not mean to impose heavy burdens and draconian choices on states unless it says so awfully clearly.”

For decades, more conservative justices have emphasized respect for state sovereignty. The court often uses “basic principles of federalism embodied in the Constitution to resolve ambiguity in a federal statute,” Chief Justice John G. Roberts Jr. said in his opinion for the court in an unrelated case nine months ago.

The oral arguments also showed how the court, in the digital age, could be influenced by a flood of research, analysis and commentary from bloggers, scholars and advocates forecasting dire consequences if insurance subsidies end. More than 20 legal briefs have conveyed those concerns to the court, citing studies by groups like the Commonwealth Fund, the Urban Institute, the Kaiser Family Foundation, the RAND Corporation and Families USA.

“In the last six weeks,” said Abbe R. Gluck, a law professor at Yale, “people finally woke up and became aware of the drastic real-world consequences.”

A typical study, from the Urban Institute, based on a computer model of the health care system, was titled: “Implications of a Supreme Court Finding for the Plaintiff in King v. Burwell: 8.2 Million More Uninsured and 35 Percent Higher Premiums.”

When ruling on appeals, judges typically make decisions by closely reading the law and applying it to the facts of a case, as revealed in a trial court. But in the subsidies case, supporters of the health care law found a way to bring their predictions to the Supreme Court justices’ attention.

The government argued that Congress could not have imposed such drastic consequences on states without discussing the impact and without giving clear, explicit notice to the states.

“If that was really the plan, then the consequence for the states would be in neon lights in this statute,” said Solicitor General Donald B. Verrilli Jr.

Justice Kennedy has long been a protector of the states. They need clear notice of the conditions attached to federal funds so they can “guard against excessive federal intrusion into state affairs and be vigilant in policing the boundaries of federal power,” he wrote in 1999.

The Affordable Care Act expanded federal power, but preserved a large role for states.

Mr. Carvin, the plaintiffs’ lawyer, said the law had offered an irresistible incentive — “billions of free federal dollars” in subsidies — as an inducement for states to set up exchanges.

“That’s hardly invading state sovereignty,” Mr. Carvin said.

[Crafty_Dog]

What say we?
======================

 Future Obamacare Costs Keep Falling
By Nick Timiraos and Stephanie Armour
    CONNECT

    Floridians sign up for the Affordable Care Act in February. The nonpartisan Congressional Budget Office projects the law will cost the government 11% less than their forecast six weeks ago.
  

Nearly five years after President Barack Obama signed the Affordable Care Act into law, federal budget scorekeepers have sharply revised down the projected costs of the signature bill.

In the latest projection, published by the nonpartisan Congressional Budget Office on Monday, the major provisions of the law will cost the government 11% less than they forecast six weeks ago, or $142 billion over the coming decade.

Overall, the health-care law will now cost 29% less for the 2015-19 period than was first forecast by the CBO when the law was signed in March 2010. Back then, the CBO and the congressional Joint Committee on Taxation estimated that for the last five years of their 10-year projection, Obamacare would cost $710 billion. Now, they expect it will cost $506 billion for the same period.

In 2019, for example, the agencies project  Obamacare will cost $116 billion, which is down 33% from the initial forecast for the same year made in 2010.

Monday’s report illustrates two dynamics at play. First, health-care costs are rising more slowly than previous forecasts assumed. And slightly fewer people than anticipated are signing up for health insurance through federal exchanges.

The CBO estimates the government will spend 20% less on subsidies provided to individuals who purchase health insurance through the federal health exchange, or around $209 billion in lower-than-projected costs over the coming 10 years.

The government won’t see all of that savings, however, because the CBO also estimates that the government will collect less money from taxes on certain high-premium insurance plans. The latest forecast now projects taxes on those so-called “Cadillac” plans will bring in 41% less money, or $62 billion in reduced revenues. The CBO forecast shows that in 2022, the tax will bring 71% less than projected in 2012.

The decrease in government spending on the health-exchange subsidies is linked in part to projections of slower growth in health care spending. The growth in private health insurance spending per enrollee over the 2006-2013 period averaged 1.8% per year, compared with an average rate of 5% per year during the 1998-2005 period, according to the report.

In the past, the CBO had assumed that the recent slowdown in health-care inflation was temporary and would quickly reverse. The latest projections assume that health-care inflation will rise more modestly.

The slower growth in health care spending is attributed in part to the slow economic recovery and more insurance cost-sharing requirements like deductibles, which have prompted consumers to rein in their own spending on medical care. Medicare spending growth has also slowed.

The CBO report also decreased its estimate of the number of people who will be without health insurance to around 25 million, from its prior forecast of 27 million.

The report also reflects lower-than-expected enrollment in federal and state exchanges set up under the Affordable Care Act. The Obama administration said about 11.4 million people signed up for private insurance through the health law’s exchanges so far this year.

The CBO earlier estimated that 13 million people would enroll in private health plans in 2015 but has since lowered that projection.




 

[ccp]

The Ugly Civil War in American Medicine

By Kurt Eichenwald   3/10/15 at 12:04 PM

A group of doctors is charging that the American Board of Internal Medicine has forced them to do meaningless work to fatten the board’s bloated coffers. Blend Images/Alamy

Are physicians in the United States getting dumber? That is what one of the most powerful medical boards is suggesting, according to its critics. And, depending on the answer, tens of millions of dollars funneled annually to this non-profit organization are at stake.

The provocative question is a rhetorical weapon in bizarre war, one that could transform medicine for years. On one side is the American Board of Internal Medicine (ABIM), which certifies that doctors have met nationally recognized standards, and has been advocating for more testing of physicians. On the other side are tens of thousands of internists, cardiologists, anesthesiologists and the like who say the ABIM has forced them to do busywork that serves no purpose other than to fatten the board’s bloated coffers.

“We don’t want to do meaningless work and we don’t want to pay fees that are unreasonable and we don’t want to line the pockets of administrators,’’ says Dr. Paul Teirstein, a nationally-prominent physician who is chief of cardiology at Scripps Clinic and who is now leading the doctor revolt.

 Try Newsweek for only $1.25 per week 

The physicians lining up with Teirstein are not a bunch of stumblebums afraid of a few tests. They include some of this nation’s best-known medical practitioners and academicians, from institutions like the Mayo Clinic, Harvard Medical School, Columbia Medical School and other powerhouses in the field.

This spat is hardly academic, though. Some doctors are leaving medicine because they believe the ABIM is abusing its monopoly for money, forcing physicians to unnecessarily sacrifice time with their patients and time for their personal lives.

A little history: For decades, doctors took one exam, usually just after finishing training, to prove they had absorbed enough medical knowledge to treat patients. Internists—best known as primary care physicians—would take one test while those who chose subspecialties of internal medicine—cardiovascular disease, critical care, infectious disease, rheumatology—sat for additional exams. Doctors maintained their certification status by participating in programs known as “continuing medical education,” which, when done right, keep physicians up on developments in their field.

The value to a doctor of being certified can scarcely be overstated. Many organizations will not hire uncertified doctors. And, without that stamp of approval, even doctors who open their own practices rarely receive permission from hospital boards to treat their patients in hospitals. It was a sensible way to make sure doctors stayed on top of their game and weed out incompetent clinicians.

Someone, of course, had to pay for the testing and continuing education, and it was usually the doctors. So physicians shelled out money to the ABIM to take the tests, and then ponied up more cash to attend conferences and other programs for continuing medical education. Few objected—it was worth the money to keep up the profession’s standards.

But then ABIM decided that rather than just having doctors take one certification test, maybe they should take two. Or three. Or more. Under this new rule adopted in the early 1990s, internists and subspecialists recertify every 10 years with new tests. In other words, a doctor certified at the age of 30 could look forward to taking an ABIM exam at least three more times before retirement. This was not cheap—doctors spend thousands of dollars not only for the tests, but for review sessions, for time away from their practices. And with each new test, the ABIM made more money.

Physicians sheepishly went along with the process, assuming their good old pal the ABIM was working hard to make sure medical practitioners were fully qualified.

Then, something strange happened, doctors say. The tests started including questions about medical problems that had nothing to do with how doctors did their jobs. For example, anesthesiologists who worked exclusively with adults were required to answer questions about pediatric anesthesiology. To the layman, those might not sound like a big difference,  but it completely ignores how medicine is practiced. For the anesthesiologist, for example, the measurements, methods and almost every other element of putting a child to sleep for surgery is completely different than for an adult (what is the perfect measurement for an adult in a particular scenario could kill the child). And these aren’t calculations that are pulled off a chart; they involve very technical analysis that adult anesthesiologists don’t even know how to do, because they never use them. So the doctors have to spend hours reviewing issues they hadn’t seen since medical school to learn how to do something they have never—and will never—do. Then there are the internists, who are forced to learn details of a subspecialty that they would never use because, in the real world, the first thing they would do is call a subspecialist colleague for a consult—so again, the doctors have to spend time re-learning information that has nothing to do with the actual practice of medicine.

Videos and study sessions sold to help doctors prepare for re-certification exams often featured instructors saying physicians would never see a particular condition or use a certain diagnostic technique, but they needed to review it because it would be on the test. “Exam questions often are not relevant to physicians’ practice,” Teirstein says. “The questions are often out-dated. Most of the studying is done to learn the best answer for the test, which is very often not the current best practice.”

The result? According to the ABIM’S figures, the percentage of doctors passing the recertification test started dropping steadily. In 2010, some 88 percent of internists taking the maintenance of certification exams passed; by 2014, that had fallen to 80 percent. Hematologists dropped from 91% to 82%. Interventional cardiologists went from 94% to 88%. Kidney specialists, 95% to 84%. Lung experts, 90% to 79%.

Wow. Was it Obamacare? Ebola? A sign of the end times? What was turning so many American doctors so stupid all of sudden? Not to worry, the ABIM declares—the board could help doctors keep their certification. All they had to do was pay to take the tests again. Making doctors appear ignorant became big business, worth millions of dollars, and the ABIM went from being a genial organization celebrated by the medical profession to something more akin to a protection racket.

The ABIM disputes that characterization. Lorie B. Slass, a spokesperson for the ABIM, says “there have been and always will be” fluctuations in test results, since different groups of doctors are taking the exam each year. But in each of the categories cited above, there are no statistically significant fluctuations—the passing rate keeps going down. So the point remains: Either doctors are getting dumber each year, or the test that helps determine who gets to practice medicine has less and less to do with the actual practice of  medicine.

Slass says the suggestion that the ABIM is “purposefully failing candidates on their exams to generate more revenue is flat-out wrong.” Maybe so, but according to the Form 990s filed with the Internal Revenue Service, in 2001—just as the earliest round of new-test standard was kicking in, the ABIM brought in $16 million in revenue. Its total compensation for all of its top officers and directors was $1.3 million. The highest paid officer received about $230,000 a year. Two others made about $200,000, and the starting salary below that was less than $150,000. Printing was its largest contractor expense. That was followed by legal fees of $106,000.

Twelve years later? ABIM is showering cash on its top executives—including some officers earning more than $400,000 a year. In the tax period ending June 2013—the latest data available—ABIM brought in $55 million in revenue. Its highest paid officer made more than $800,000 a year from ABIM and related ventures. The total pay for ABIM’s top officers quadrupled. Its largest contractor expense went to the same law firm it was using a decade earlier, but the amounts charged were 20 times more.

And there is another organization called the ABIM Foundation that does...well, it’s not quite clear what it does. Its website reads like a lot of mumbo-jumbo. The Foundation conducts surveys on how “organizational leaders have advanced professionalism among practicing physicians.” And it is very proud of its “Choosing Wisely” program, an initiative “to help providers and patients engage in conversations to reduce overuse of tests and procedures,” with pamphlets, videos and other means.

Doesn’t sound like much, until you crack open the 990s. This organization is loaded. In the tax year ended 2013, it brought in $20 million—not from contributions, not from selling a product, not for providing a service. No, the foundation earned $20 million on the $74 million in assets it holds.

The foundation racked up $5.2 million in expenses, which—other than $245,000 it gave to the ABIM—was divided into two categories: compensation and “other.” Who is getting all this compensation? The very same people who are top earners at the ABIM. Deep in the filings, it says the foundation spends $1.9 million in “program and project expenses,” with no explanation what the programs and projects are.

There are some expenditures, though, that are easy to understand: The foundation spends $153,439 a year on at least one condominium. And it picks up the tab so the spouse of the top-officer can fly along on business trips for free.

The ABIM is not what it was. Its original mission was to make sure doctors provide patients with the best care. When condominiums and lavish salaries and free trips and making money off of physicians failing tests became a priority, the evidence suggests the organization lost its way.

But that may not matter soon. In January 2014, when the ABIM issued a series of new requirements for maintaining certification—that would have generated all new fees—Teirstein and his colleagues declared “enough.” They recently formed a new recertification organization called the “National Board of Physicians and Surgeons.” It will only consider doctors for recertification who have passed the initial certification exam that has been required for decades. Doctors must also log a set number of hours with programs that qualify under guidelines as continuing medical education. The group’s fees are much, much lower than those charged by the ABIM. And its board and management—all top names in medicine—work for free.

This new board is not just about breaking the ABIM monopoly, Teirstein says, but is also part of an effort to put the right people in charge of the profession’s future. Medicine has been “controlled by individuals who are not involved with the day to day care of patients,” he says. “It is time for practicing physicians to take back the leadership.”

[Crafty_Dog]

http://www.ifyouonlynews.com/weird-news/conservative-forbes-admits-obamacare-is-adding-jobs-and-helping-the-economy/

[DougMacG]

http://www.ifyouonlynews.com/weird-news/conservative-forbes-admits-obamacare-is-adding-jobs-and-helping-the-economy/

Lol.  Not exactly Forbes the conservative, but a writer found a sentence regarding jobs in the health sector that didn't mention the anti-job effect of two dozen tax increases within Obamacare, the loss of full time jobs elsewhere, the shift from full time to part time work, the stampede of working age adults leaving the work force, the permanent loss of trillions of dollars of GDP or the epidemic of people going on food stamps and permanent disability.  The article admits the oddity of finding a sentence in a report like not also pointing out the economic damages of Obamacare and other Obama policies.

84% of Obamacare enrollees are on government subsidy.  We already had free healthcare for the poor.  Obamacare is a welfare dependency program for people who were once self sufficient and middle class. As Elizabeth Warren would say, good for them.  (Really it isn't.)  Shifting of resources was bound to occur in a trillion dollar program but no jobs and no wealth is created by robbing Peter to pay Paul.

From the article:  The health care industry added 22,000 jobs last month, which was about on par with February totals for health services jobs, according to the jobs report issued Friday by the U.S. Department of Labor’s Bureau of Labor Statistics.

That statistic counts part time workers at minimum wage with no benefits on an equal footing with doctors leaving their practices.  Some economic measure!

This was in Forbes too:  Worst recovery since WWII.  " ...total of about 10 million missing jobs."
http://www.forbes.com/sites/peterferrara/2013/06/02/economically-could-obama-be-americas-worst-president/

The unemployment rate today is 9.8% calculated at the workforce participation rate we had when Barack Obama was first inaugurated.  The median wage is up by zero and income inequality is widening.  The growth rate for all of last year was a miserable 2.2% and Q1 2015 was even worse.  You have to be a blindfolded liberal or First Trust economist to see any of this as positive economic news for Main Street America.

[Crafty_Dog]

http://www.nytimes.com/2015/04/11/us/texas-medical-panel-votes-to-limit-telemedicine-practices-in-state.html?emc=edit_th_20150411&nl=todaysheadlines&nlid=49641193

[ccp]

The million dollar question:

"But Mr. Chicotel of the California advocacy group said the Kaiser example pointed to a broader tension within the quickly changing health care world: At what point does a desire to keep costs low trump concerns for quality?"

---------------------

As Nursing Homes Chase Lucrative Patients, Quality of Care Is Said to Lag


****The New York TimesThe New York Times   
The New York Times

By KATIE THOMAS8 hrs ago

A USS Arizona survivor salutes the remembrance wall of the USS Arizona during a memorial service for the 73rd anniversary of the attack on the US naval base at Pearl harbor, on December 7, 2014, in Pearl Harbor, Hawaii

  Dr. Lois Johnson-Hamerman, a retired neonatologist, entered a Philadelphia nursing facility for short-term rehabilitation of an injured foot. She later required hospitalization for an infected bedsore.   © Jessica Kourkounis for The New York Times Dr. Lois Johnson-Hamerman, a retired neonatologist, entered a Philadelphia nursing facility for short-term rehabilitation of an injured foot. She later required hospitalization for an infected bedsore. 
Promises of “decadent” hot baths on demand, putting greens and gurgling waterfalls to calm the mind: These luxurious touches rarely conjure images of a stay in a nursing home.

But in a cutthroat race for Medicare dollars, nursing homes are turning to amenities like those to lure patients who are leaving a hospital and need short-term rehabilitation after an injury or illness, rather than long-term care at the end of life.

Even as nursing homes are busily investing in luxury living quarters, however, the quality of care is strikingly uneven. And it is clear that many of the homes are not up to the challenge of providing the intensive medical care that rehabilitation requires. Many are often short on nurses and aides and do not have doctors on staff.

A report released in 2014 by the Department of Health and Human Services’ Office of the Inspector General found that 22 percent of Medicare patients who stayed in a nursing facility for 35 days or less experienced harm as a result of their medical care. An additional 11 percent suffered temporary injury. The report estimated that Medicare spent $2.8 billion on hospital treatment in 2011 because of harm experienced in nursing facilities.

“These nursing homes were not built for this purpose,” said Dr. Arif Nazir, an associate professor of clinical medicine at Indiana University who studies geriatrics. He said many patients leave hospitals with acute medical needs, before infections have been fully treated, or as they adjust to new medications.

“These patients are leaving the hospital half-cooked, and believe me, the latter part of the cooking is the hardest part,” he said.

Competition for these patients has become intense because Medicare, the health insurance program for older adults, pays 84 percent more for short-term patients than nursing homes typically get from Medicaid, the health insurance program for the poor, for long-term residents.

At the same time, hospitals are trying to cut costs by pushing some patients out early — like those who have had hip replacement or heart surgery, for example. Not quite ready to go home, they need continuing care somewhere. And for older adults, Medicare usually pays the bill.

The combination of factors has created a bull market in the once-struggling industry as investors clamor to snatch up homes with the most potential to bring in short-term patients. Sale prices of nursing homes averaged $76,500 per bed last year — the second consecutive year of record-breaking prices, according to Irving Levin Associates, which analyzes the senior housing market.

So lucrative are Medicare payments that some homes have decided not to take lower-paying Medicaid patients at all.

The shifting landscape, some say, marginalizes poor long-term residents with extensive medical needs. “This focus on Medicare, Medicare, Medicare has pushed out people in the custodial care world,” said Anthony Chicotel, a staff lawyer at California Advocates for Nursing Home Reform, who says he fields calls at least once a week from residents who are being evicted because their Medicare coverage, which lasts 100 days, is expiring and the residents will transition to lower-paying Medicaid insurance. “They’re being pushed out, and they don’t have anywhere to go, really, that can take care of them.”

Representatives of nursing homes acknowledge that the challenges are substantial, but they are optimistic about the progress they are making.

“It’s uneven, but I think, that said, we’re trending in the right direction,” said Dr. David Gifford, the senior vice president of quality and regulatory affairs at the American Health Care Association, an industry trade group. “I think you’re seeing a much greater linking of quality, and an emphasis on it,” he added.

Dr. Gifford and others say they are paying close attention to quality — not only because it is the right thing to do, but because hospitals and large health systems are beginning to demand it. Under the new health care law, hospitals may be penalized if too many of their patients are readmitted within a certain time.

“Hospitals are starting to get really worried, and when hospitals are worried, skilled nursing facilities are worried, because they are their sources of patients,” said David Grabowski, a professor of health care policy at the Harvard Medical School.

Promises of Care

Dr. Lois Johnson-Hamerman, a retired neonatologist, said she thought she had done her homework when she checked into the Watermark at Logan Square, a nursing facility in Philadelphia.

The home had a reputation for quality and got high marks from the federal government. Until a recent revision, its website promised “top-notch health care” with amenities including a staff willing to administer a “decadent hot bath” at any hour of the day.

But just one month after arriving at Watermark for short-term rehabilitation of an injured foot in 2012, Dr. Johnson-Hamerman ended up in the emergency room with a severe bedsore that had become dangerously infected. Far from the service she said she had been promised, she said the workers never gave her a full bath or shower, were slow to respond to her requests to have her diaper changed and did not turn her every few hours, a crucial step in preventing bedsores.

She said she left the facility only after friends, including doctors and nurses, became so horrified by her care that they insisted that she be taken to a hospital.

Geriatric researchers call this disconnect the “chandelier effect.” Attractive lobbies and enticing amenities do not always mean that a home provides good medical care.

In reality, said Dr. Steven Handler, a geriatrician and assistant professor at the University of Pittsburgh School of Medicine, many nursing homes are struggling to provide consistent, quality care despite genuine efforts. “The nursing homes are kind of stuck in an older model that is based on a very small operating margin, low-staffing model and low physician presence,” he said.

Dr. Johnson-Hamerman, who is 87, is suing Watermark over what she describes as negligent care.

“At least I’m still here,” she said recently at her home. “But where would I be if I didn’t have the friends and resources to do something about it?”

C. Jill Hofer, a spokeswoman for Watermark, said that the home was committed to providing quality care and that it denied the allegations in the lawsuit.

Bull Market for Short-Term Homes

The nursing home industry has long argued that it relies on higher Medicare payments to offset the rates it receives from Medicaid, which usually pays for the care of long-term residents.

And indeed, even though facilities earned a 2 percent overall profit in 2013, they lost about 2 percent on non-Medicare patients, according to the Medicare Payment Advisory Commission, or Medpac, an agency of Congress.

But in recent years, that focus on Medicare patients has intensified as many long-term residents have moved to assisted-living facilities and hospitals have sought to discharge patients earlier. On a typical day in 2000, about 9 percent of residents in an average nursing home were covered by Medicare, according to federal data. By 2014, that had risen to 15 percent.

Some companies are now eliminating Medicaid payments entirely by building homes solely for the more lucrative short-term patients.

Santé Partners, a developer in Arizona, recently opened four nursing homes that do not accept any long-term residents. A fifth is set to break ground this summer.

The buildings resemble hotels, with high-quality restaurants and private rooms that have kitchenettes. Developers say their singular focus allows them to provide better care.

“I think pretty much every company now is going in this direction,” said C. Mark Hansen, the president and chief executive of Santé Partners.

Some for-profit chains have aggressively increased their numbers of Medicare patients. In California, the share of Medicare patients at several large chains has far outpaced the state average, according to an analysis of state nursing home data by The New York Times.

On a typical day in 2012, about 11 percent of beds in California nursing homes were occupied by Medicare patients, The Times’s analysis showed.

But at HCR ManorCare, one of the nation’s largest chains, 32 percent were Medicare patients at its California nursing homes. At the Ensign Group, a large chain based in California, Medicare covered 20 percent of patients on a typical day in 2012.

HCR ManorCare said that it had invested in treating patients with complex medical needs and that that helped explain why its percentage of Medicare patients was higher than the state average. A spokeswoman for Ensign declined to comment.

Ensign is one of several chains that has recently paid federal fines to settle charges that they exaggerated the therapy needs of patients to increase Medicare payments. The company paid $48 million in 2013 to settle such claims. In October, a large Canadian company, Extendicare Health Services, paid $38 million in a similar case.

Even homes with a history of poor care are marketing their high-end amenities. The Medford Multicare Center for Living on Long Island recently opened a wing intended for short-term care known as “The Lux at Medford.” Guests have access to a putting green, a model apartment and a parked PT Cruiser to teach them how to resume their day-to-day activities.

The New York State attorney general sued the facility last year over issues of quality, and seven employees were indicted on a range of charges related to the death of Aurelia Rios, a patient in the facility’s ventilator unit. Federal officials recently placed the home on a watch list of the nation’s poorest-performing facilities.

Jason Newman, a spokesman for the home, says the owners of Medford dispute the charges. “The owners of this facility care very, very much about this place,” he said.

Claims of Lapses, and Death

Deaths attributed to lapses in care are not uncommon. In 2010, Mary Dwyer checked into Harborview Healthcare Center in Jersey City to recuperate after dislocating her shoulder in a fall.

Ms. Dwyer, who was 87, planned to return home, but her condition deteriorated rapidly because of what her family described as negligent care. Staff members were so overworked that Ms. Dwyer was not fed properly and not repositioned frequently in her bed, according to a lawsuit the family later filed in New Jersey state court alleging negligence and wrongful death.

In a month, Ms. Dwyer lost 20 pounds and developed a bedsore so severe that it exposed her bone.

She was treated at a hospital for her injury, and she died about a month later. Last year, a jury awarded her family more than $13 million.

The amount has since been reduced to $4.75 million and the case is being appealed by the nursing home. A spokeswoman for Harborview said the company denied the charges and maintained an outstanding record for quality.

“Nobody really took responsibility,” Ms. Dwyer’s daughter, Henrietta Dwyer, said recently. “It seemed nobody was accountable for anything.”

Industry specialists say that competition is so intense that eventually quality will prevail, as hospitals and insurers, who cover some Medicare patients, will balk at sending patients to homes that perform poorly.
Siblings Georgette Dwyer, left, Henrietta Dwyer and James Dwyer. Within a month of checking into a nursing home after dislocating her shoulder, their mother lost 20 pounds and developed a severe bedsore. She died a month later.   © Bryan Anselm for The New York Times Siblings Georgette Dwyer, left, Henrietta Dwyer and James Dwyer. Within a month of checking into a nursing home after dislocating her shoulder, their mother lost 20 pounds and developed a severe bedsore…
Hospitals now pay penalties if too many patients are readmitted.

And under new payment models, health systems are beginning to coordinate the care of patients even after they leave the hospital. They are rewarded for keeping costs low, but they also must prove that certain quality goals are met.
The Medford Multicare Center for Living on Long Island has a wing for short-term care known as “The Lux at Medford.” It includes a parked car so residents can practice getting in and out.   © Kirsten Luce for The New York Times The Medford Multicare Center for Living on Long Island has a wing for short-term care known as “The Lux at Medford.” It includes a parked car so residents can practice getting in and out. 
“It’s happening at a head-spinning rate,” said Dr. Nazir of Indiana University. “It has been a very positive thing.”

Dr. Gifford of the industry trade group said his group’s members had reduced re-hospitalization rates by 14 percent. And the group has supported other measures to improve quality, he said, including one passed by Congress last year that will withhold a percentage of Medicare payments from facilities, who can then earn back some of the money if they meet certain standards.

Mr. Hansen, the chief executive of Santé Partners, said his facilities did not bring in high profits because the company invests heavily in quality. That investment pays off, he said, because he can demonstrate that his facilities provide good care at a lower cost than, say, a hospital.

“It’s bringing down the total cost of the health care spend,” Mr. Hansen said.

Still, some insurers and hospitals continue to send patients to homes with poor records.

Kaiser Permanente, which combines a nonprofit insurance plan with its own hospitals and clinics, sends patients to a network of outside nursing homes in Maryland and Virginia that the organization says meet its “high standards of care.” However, of the 12 so-called core nursing homes in Kaiser’s network, four held a one-star rating for their health inspection. One was ranked five stars, the highest score.

After The New York Times contacted Kaiser, a spokesman said it would end its association with one of the poorly rated homes, Commonwealth Health & Rehab Center in Fairfax, Va.

The spokesman said that the company sends Kaiser doctors and staff members to the facilities to treat its patients, and that most of them are placed in homes with the higher ratings. He said Kaiser was working with the low-rated homes to improve their conditions.

“The care and safety of our members and patients are our top priorities,” said the spokesman, Marc Brown.

But Mr. Chicotel of the California advocacy group said the Kaiser example pointed to a broader tension within the quickly changing health care world: At what point does a desire to keep costs low trump concerns for quality?

“I think a lot of the time when it comes to managed care, it’s a race to the
bottom"

[Crafty_Dog]

U.S. Emergency-Room Visits Keep Climbing
By Stephanie Armour
May 4, 2015 12:01 a.m. ET

Emergency-room visits continued to climb in the second year of the Affordable Care Act, contradicting the law’s supporters who had predicted a decline in traffic as more people gained access to doctors and other health-care providers.

A survey of 2,098 emergency-room doctors conducted in March showed about three-quarters said visits had risen since January 2014. That was a significant uptick from a year earlier, when less than half of doctors surveyed reported an increase. The survey by the American College of Emergency Physicians is scheduled to be published Monday.

Medicaid recipients newly insured under the health law are struggling to get appointments or find doctors who will accept their coverage, and consequently wind up in the ER, ACEP said. Volume might also be increasing due to hospital and emergency-department closures—a long-standing trend.

“There was a grand theory the law would reduce ER visits,” said Dr. Howard Mell, a spokesman for ACEP. “Well, guess what, it hasn’t happened. Visits are going up despite the ACA, and in a lot of cases because of it.”

The health law’s impact on emergency departments has been closely watched because it has significant implications for the public. ER crowding has been linked to longer wait times and higher mortality rates.


More than half of providers listed in Medicaid managed-care plans couldn’t schedule appointments for enrollees, according to a December report by the Health and Human Services Office of the Inspector General. Among providers who could offer appointments, the median wait time was two weeks, but more than a quarter of doctors had wait times of more than a month for an appointment.

Many doctors don’t accept Medicaid patients because the state-federal coverage provides lower reimbursement rates than many private health-insurance plans. The waits for primary and specialty care by participating doctors appear to be leaving some Medicaid patients with the ER as the only option, according to ACEP.

“We’re seeing a huge backlog in the ER because the volume has increased,” said Ryan Stanton, an emergency-room doctor at Baptist Health Lexington in Kentucky. “This year we already have had to board people in the ER because of the sheer volumes,” he said, referring to a practice of keeping patients in the ER until a hospital room becomes available.

Dr. Stanton said ER volume rose about 10% in 2014 from 2013, and was up almost 20% in the first few months of this year.

The ACEP survey also found that ERs are seeing sicker patients: About 90% of the doctors polled said the severity of illness has stayed the same or gotten worse. That might be explained in part by an aging population, newly insured people with multiple maladies, and people delaying care because they have high-deductible insurance plans.

Nicholas Vasquez, a medical director for an emergency department in Mesa, Ariz., said volume rose 5% in a year, representing about 10 more patients a day. The stress from bigger caseloads prompted some nurses to resign, he said. “Physicians are working more shifts—that pushes them a lot,” Dr. Vasquez said. “If they work too much, they get burnt out. For patients, it means longer waits.”

Some states have been trying to curb ER use by Medicaid recipients by requiring higher copayments for visits deemed nonurgent. Critics have denounced that practice as punitive, and warn that it will dissuade low-income patients from seeking care that may be necessary.

A 2013 study by Truven Health Analytics that examined insurance claims for more than 6.5 million ER visits by commercially insured people under age 65 found just 29% of patients required immediate attention. Twenty-four percent didn’t require immediate attention, 41% received care that could have been provided in a primary-care setting, and 6% got care that would have been preventable or avoidable with proper primary care.

More than 40% of emergency physicians said they expect emergency-room visits to increase if the Supreme Court rules that subsidies provided to people who obtain insurance on the federal exchange are invalid. The court is expected to rule by late June.

Write to Stephanie Armour at stephanie.armour@wsj.com

[Crafty_Dog]

http://www.newyorker.com/magazine/2015/05/11/overkill-atul-gawande

[Crafty_Dog]

http://www.wsj.com/articles/health-insurers-seek-hefty-rate-boosts-1432244042

[Crafty_Dog]

http://www.smashwords.com/books/view/428864

[Crafty_Dog]

http://www.nytimes.com/2015/05/26/health/rural-nebraska-offers-stark-view-of-nursing-autonomy-debate.html?emc=edit_th_20150526&nl=todaysheadlines&nlid=49641193

[Crafty_Dog]

If the SCOTUS decision goes our way, how does this measure up?


http://www.capoliticalreview.com/capoliticalnewsandviews/contrary-to-media-gop-has-plan-to-replace-obamacare-with-real-health-care-reform/

[DougMacG]

If the SCOTUS decision goes our way, how does this measure up?
http://www.capoliticalreview.com/capoliticalnewsandviews/contrary-to-media-gop-has-plan-to-replace-obamacare-with-real-health-care-reform/

Great question.  I will look into it, and want to also know what Crafty and others think.  The Republicans need a plan.  This is the plan.  Just saying no government or federal involvement isn't going to cut it.  Does this move us in the right direction and solve enough politically to allow us to win and privatize healthcare further in the future?  We know this issue is going to get demogogued as soon as the Republicans take action.  I guess we also know Obama will veto anything they pass.  It better be their best effort, one they can hold firm on as while an insincere jerk makes straw arguments back against them from the bully pulpit.

(More likely Republicans will fear Obama, fold and give him everything he demands.)

From the link:

“Highlights of the bill include removing any subsidy assistance, increasing tax benefits, expanding federal funding for state “high-risk pools,” allowing Americans to purchase policies across state lines, reforming medical liability laws, and investing in research for the most common causes of death in the United States.”

[Crafty_Dog]

"allowing Americans to purchase policies across state lines"

I've pushed this one here for a while now.  This is the only one I see that is likely to gather positive notice.

"reforming medical liability laws"

Good idea but not a particularly potent idea.  Question-- Isn't this a matter of State laws?

"removing any subsidy assistance"

Politically this will be a BIG negative.   Something potent will be needed to offset this and then some.

"increasing tax benefits"

In that the rich are the ones paying taxes, this will be portrayed as subsidizing the rich while ending subsidies for the poor.

"expanding federal funding for state “high-risk pools,”"

probably a good idea to answer the pre-existing condition issue.

"and investing in research for the most common causes of death in the United States.”

Pork to placate; I doubt it will serve that function very well.

[DougMacG]

"allowing Americans to purchase policies across state lines"

I've pushed this one here for a while now.  This is the only one I see that is likely to gather positive notice.

"reforming medical liability laws"

Good idea but not a particularly potent idea.  Question-- Isn't this a matter of State laws?

"removing any subsidy assistance"

Politically this will be a BIG negative.   Something potent will be needed to offset this and then some.

"increasing tax benefits"

In that the rich are the ones paying taxes, this will be portrayed as subsidizing the rich while ending subsidies for the poor.

"expanding federal funding for state “high-risk pools,”"

probably a good idea to answer the pre-existing condition issue.

"and investing in research for the most common causes of death in the United States.”

Pork to placate; I doubt it will serve that function very well.

Good work answering this.

1.  Agree, open up commerce across state lines. 

2.  'Isn't medical malpractice/liability a matter of state law?'  By their standard, nothing is a state matter.  This affects interstate commerce, right?

3. "removing any subsidy assistance"   Agree, this is the landmine they left behind.  84% of Obamacare enrollees are subsidized.  Republicans / reformers have to deal with this economically and politically or they have walked into the trap.  I don't have the answer for how to replace socialism with socialis, or to have people who left work for subsidy suddenly become self sufficient.

4.  "increasing tax benefits"  Agree with you, playing with fire here.

5. "expanding federal funding for state “high-risk pools,”  Agree again with you, a program for dealing with pre-existing conditions is a political must.  This was a point Republicans already agreed to before Obamacare.  This should be a shrinking pool if more and more now have coverage, unless people are losing their coverage.  It seems to me the govt enters into a contract with the individual similar to what was done with welfare reform.  If we subsidize, you have to maintain payment on your portion of the coverage to remain eligible.

6. "investing in research"  Right.  Don't we already do that?  Another socialist answer to a private sector challenge?

None of these, it seems to me, addresses the underlying problem that our healthcare system is overly bureaucratic and inefficient and therefore overpriced by several-fold.  There will be short term and long term agenda items.  If/when the Supreme Court strikes down federal subsidies to individuals in states with no exchange, we need to some plug in that hole.  That will require positive legislation from a Repulican congress to a signature from the President.  I don't know the specifics, but we should agree to the short term fix only if he/they agree to a long term fix which must necessarily include a pathway to giving consumers more power and responsibility.  The proposed reforms don't get us there other than ending subsidies, which is a political disaster.  We know negotiating with the President is a losing proposition.  The plan has to be good enough to take to the people and win.  We could use some real leadership here.  Maybe one of our 19 candidates can step forward and do that prior to being elected.

[Crafty_Dog]

"2.  'Isn't medical malpractice/liability a matter of state law?'  By their standard, nothing is a state matter.  This affects interstate commerce, right?"

But this is supposed to be OUR offering!!!

Anyway, what to do, what to do , , ,

As I have stated here previously, the sound bite gist of it is this:

"Insurance is for unexpected and potentially catastrophic events-- flood, fire, earthquake, tornado, big accidents, serious disease.   Insurance is NOT for overflowing toilets, burnt bacon in the kitchen, a lamp falling over during a tremor, or the boo boos and sniffles that you may have.   If insurance is used in that way, then everyone is spending the insurance company's money and not their own and the discipline of the market on prices is vitiated. 

Therefore day to day stuff is out of pocket.   Towards that end, PRICES MUST BE KNOWN; THEY MUST BE READILY AVAILABLE TO ALL POTENTIAL PATIENTS.

This approach will dramatically lower premium costs and restore market driven price behaviors to the health care market.

 

[DougMacG]

"Therefore day to day stuff is out of pocket.   Towards that end, PRICES MUST BE KNOWN; THEY MUST BE READILY AVAILABLE TO ALL POTENTIAL PATIENTS."

Agreed.  That is exactly the focus we need.

[ccp]

Perhaps this shouldn't be under the "politics" of health care thread but I post this article because it shows 4 things.

1)  How studies are misleading.   First a drug with a suspected 28% increase risk of heart failure turns out not to be true at all - not surprising. 

2) That this article is in an investment magazine, Forbes,  tells us how literally interwoven Wall Street is with our health system.  There could have been more investor analysts at a recent cancer conference looking for an insider edge than there were oncologists.

3)  The fact that it reports DDP 4 inhibitors may not decrease risk of stroke or heart attack.  So the "f" what.  Does that suggest the drug is no good or we shouldn't worry about lowering elevated blood glucose?  NO!!

4)  The lesson to take away is question the MOTIVES as well as the reported results of all research today.  I can vouch first hand how money corrupts many in the health field just like everyone else.

http://www.forbes.com/sites/matthewherper/2015/06/08/giant-study-boosts-januvia-mercks-6-billion-drug/2/

 
 

[DougMacG]

It's now called SCOTUScare.

[ccp]

The American College of Physicians represents me about as much as the Republican party.  Actually they are s0cialists like the Democratic party.   Here is their predictable response to the SCOTUS decision.

***Reaction by Internal Medicine Physicians to Supreme Court Opinion
American College of Physicians (ACP) Applauds SCOTUS for Upholding Subsidies

(Washington, June 25, 2015) The American College of Physicians – the nation’s largest medical specialty society and second largest physician group – applauds today’s opinion of the Supreme Court of the United States in the King versus Burwell case.

In an opinion issued today, the Supreme Court ruled that the premium subsidies created by the Affordable Care Act (ACA), which are essential to making coverage affordable to millions, will continue to be available in states where the federal government manages their health insurance marketplaces.

ACP President Dr. Wayne J. Riley, MPH, MBA,MACP said, “we are thrilled and gratified by the Court’s ruling, which affirms that the citizens of all 50 states will have the opportunity to access either a state or federal exchange to obtain subsidies to purchase health insurance policies which benefits themselves, their families and loved ones.”

In March, the College joined with other health advocacy organizations in an amicus brief urging the court to uphold the subsidies, because of the grave danger a ruling against them would pose for patient care and the health and well-being of all Americans.

Dr. Riley further added that “the Patient Protection & Affordable Care Act of 2010 is now more than ever, the law of the land and we urge the Congress to work with this and future administrations to improve it in the years ahead.”

To illustrate, had the Supreme Court ruled with the petitioners in King versus Burwell and overturned the subsidies, the Kaiser Family Foundation estimates 6.4 million people would have been in immediate danger of losing their premium tax credits, and subsidized enrollees would have seen a 287 percent average premium increase. The Urban Institute/Robert Wood Johnson Foundation estimates the number of uninsured would have increased by 8.2 million.

For many years, ACP has advocated for every American to have access to affordable coverage, knowing that uninsured people live sicker and die younger than those with insurance. By upholding the ACA’s premium subsidies in all states, the Supreme Court decision will ensure continued coverage for many millions of Americans—and as a result, better health for them.

###

The American College of Physicians is the largest medical specialty organization and the second-largest physician group in the United States. ACP members include 141,000 internal medicine physicians (internists), related subspecialists, and medical students. Internal medicine physicians are specialists who apply scientific knowledge and clinical expertise to the diagnosis, treatment, and compassionate care of adults across the spectrum from health to complex illness. Follow ACP on Twitter and Facebook.

Contact:   David Kinsman, (202) 26****

[ccp]

"attract a new type of student" 

"Test takers will now have to define terms like "institutional racism" and "social constructionism," 

Political correctness has no bounds:

****Medical School Hopefuls Grapple With Overhauled Entrance Exam
JUNE 29, 2015 3:50 PM ET

It's T minus four days until exam day, and Travis Driscoll is practically living at his desk.

"Each day, I'm easily here for five hours," he says. "I haven't done much of anything else but studying for the last two months."

Driscoll is one of 13,000 medical school applicants across the U.S. taking the new Medical College Admissions Test, or MCAT. He's got stacks of science books on his desk to help him prepare and a rainbow of biochemistry charts pasted to the walls: glycolysis, citric acid cycle, electron transport chain, mitosis, meiosis and DNA replication.

He also has a thick prep book on psychology and sociology — new ground for this year's MCAT takers.

The test has been thoroughly revamped and is now three hours longer. It takes 7 1/2 hours to complete, including breaks, and covers four new subjects, including a combined section on psychology and sociology that account for a quarter of the overall score.

Dr. David Muller, dean of medical education at Mount Sinai, believes that including in each medical school class some students who have a strong background in the humanities makes traditional science students better doctors, too.
SHOTS - HEALTH NEWS
A Top Medical School Revamps Requirements To Lure English Majors
Test takers will now have to define terms like "institutional racism" and "social constructionism," and answer applied questions about how race and class affect health.

Driscoll, who works in a San Francisco theater, focused on biomedical engineering in college. So for him, the new psychology/sociology section is the one he's most nervous about.

"It's at the end of the test, which makes it more difficult because you're pretty tired by then," he says. "And it's the thing I had the least experience with."

Bringing Test Up To Date

The Association of American Medical Colleges, which administers the MCAT, wants to make sure the doctors of tomorrow are better prepared to care for an increasingly diverse patient population in a rapidly changing health care system. Administrators say the exam changes are necessary to bring it up to date with how medicine is practiced, and with all the scientific discoveries that have been made since the test was last revised, more than 20 years ago.

Research on genetics and the social factors that affect health, in particular, have advanced significantly.

"Whether or not someone becomes ill has a lot to do with the society in which they live," says Catherine Lucey, vice dean of education at University of California, San Francisco School of Medicine and a member of the committee that will assess the new MCAT.

For example, she says, we now know a lot more about what happens to children who are exposed to violence before they turn 5.

"If they live in a violent neighborhood, if they hear gunshots all the time, if they themselves are the victims of interpersonal violence or child abuse," Lucey says, "they are much more likely to develop diabetes, high blood pressure, obesity, and many other chronic conditions, because of their social environment."

How those conditions are treated has also evolved. Doctors know how to treat acute infection now. But managing chronic disease has become a much bigger part of medical care, and doctors need to develop different skills and a different kind of relationship with the patient. Doctors need to build trust, Lucey says, to understand how patients think and make decisions, in order to convince them to exercise more and change their diet.

"My ability as a physician to affect that patient's health is not only dependent on medical knowledge, in terms of what drug should I give this individual, but on my ability to support this patient in the decisions they're making on a daily basis," she says.

Attracting A New Type Of Students

While the test prep industry adapted quickly to the new MCAT, enrollment in prep courses at the Princeton Review and Kaplan is only starting to pick up.

The real rush was last fall, when students flocked to take the old test, says Krissi Taylor Leslie, tutoring director at the Princeton Review in Northern California.

There was a recognition among students "that was my chance at the 'easier' test and now I'm up against this beast," Leslie says.

She says the new social sciences section is already attracting a different kind of student to consider med school.

"It entices certain students to come in and consider this test when they might not have otherwise," she says. "For instance, an increase in the number of English majors, of psychology majors."

And philosophy majors, like Ari Fischer. He started thinking about a career in medicine the summer after his junior year, when his grandfather was diagnosed with cancer.

"And that's when I was first shown, hands on, what physicians do every day," he says.

He started taking medical ethics classes — one was called "Life and Death" — where he read works about immortality, the meaning of death and the meaning of life in the face of death.

Fischer says he can imagine drawing on this knowledge one day if he has a patient facing tough end-of-life decisions.

"There's always a scientific view, then there's the theological views, or philosophical views. Knowing what other disciplines believe is going on at the same time, I think that could really help me in a daily practice of medicine," Fischer says. "What a cool way to take my degree in philosophy and turn it into a helpful, practical skill."

Fischer took the MCAT on the first testing date for the new exam in April, and just got his full score back on Tuesday. He did best on the social sciences section and the verbal, analytic reasoning. Overall, he landed in the 87th percentile.

"Perhaps Harvard will think I'm lacking in my MCAT score," he says. "For myself, I did well enough."

Altogether, he's applying to 38 schools. He says he's willing to go anywhere that will take a humanities major like him.

"All I've ever wanted out of the MCAT really is a score that's good enough to not get me kicked out of the pile when it comes to admissions decisions," he says. "Any school that gives me a shot, I'm going to be thrilled."**

[DougMacG]

Yes, we will soon have Gender Studies majors and cultural sensitivity experts replace Biology majors in our medical schools - to improve health care.

Speaking of MCAT and Medical Schools limiting the supply of doctors, when will the cartel get opened up?

[ccp]

"Speaking of MCAT and Medical Schools limiting the supply of doctors, when will the cartel get opened up?"

I am not aware that the supply of doctors is limited.  What cartel?  One just needs good grades to get in.

Probably half of doctors now are trained in foreign countries.

Still not enough?

[Crafty_Dog]

This source frequently hyperventilates, so read with care; however the larger point remains

http://www.capoliticalreview.com/capoliticalnewsandviews/hepatitis-drug-could-cost-california-taxpayers-5-billion-a-year-not-a-typo/

[Crafty_Dog]

ObamaCare’s Prices Will Keep Surging
After this year’s spike, the average family plan will go up another 11.2% in 2016.
ENLARGE
Photo: Getty Images
By Stephen T. Parente
July 16, 2015 6:54 p.m. ET
42 COMMENTS

Americans who purchase health insurance on the Affordable Care Act’s exchanges should buckle up. Within the month, state regulators will begin approving premium hikes for plans sold in every state. The Centers for Medicare and Medicaid Services (CMS) has already released the premium increases that health insurers have requested for their 2016 plans. By law, insurers must receive regulatory approval for any increase more than 10%—and more than 10% is what many of them want.

The numbers are staggering. According to the rate requests posted on Healthcare.gov, nearly every state has multiple plans that are facing a more than 10% premium increase. Many plans—including some offered by state-market leaders—could see hikes of more than 30%, 40% or even 50%. Though most of these requests have not been approved, nor have all of the rate hikes that are less than 10% been unveiled, it is undeniable that millions of Americans are facing double-digit premium increases for health insurance next year.

For the first time since the law went into effect three years ago, insurers are basing their rate-hike requests on more than a year of data. For 2014 plans, they had to make educated guesses on how to price their never-before-sold ACA-compliant plans. For 2015 estimates, insurers had about six months of information to work with, and the final average premium increase was 5.4%. Now that insurers have a more complete picture, it is clear that costs are increasing much faster than anticipated.

It’s only going to get worse after 2016, as I’ve written in these pages, when two de facto bailouts for insurance companies expire. Through “risk corridors,” taxpayers are on the hook for patients who spend more on health care than insurers predicted. Through “reinsurance,” taxpayers are heavily subsidizing the most-expensive patients—those who make more than $70,000 in claims in 2015. Thanks to these two programs, insurance companies are able to artificially lower their premiums for consumers—by between 10%-15% in 2014, according to CMS—while charging the taxpayer for their losses. Reinsurance alone cost taxpayers $7.9 billion in 2014.

But consumers will pick up that tab once these programs disappear at the end of 2016. Health insurers are aware of this fact, and it’s in their interest to avoid the negative attention—and angry customers—that dramatic premium increases will cause. They thus have an incentive to spread out the coming hikes over both 2016 and 2017, rather than confine them to next year.

Using the latest health-insurance-exchange enrollment data and a microsimulation model funded in part by the Health and Human Services Department, I estimated the premium increases that could occur as a result of the expiration of risk corridors and reinsurance. My model also assumes that 2017’s big premium increases will be spread out over both 2016 and 2017 rates.

My research shows that the average 2016 family plan could experience premium increases of 11.2%, compared with 8% hikes for individual plans. The relatively cheap bronze plans, which cover 60% of a consumer’s health-care costs, could see the highest jumps—16.6% and 11.5%, respectively. Individual silver plans could see a relatively low increase—3.1%—but families won’t be so lucky, potentially paying 8.4% more.

That won’t stay the same in 2017, however, when individual silver-plan premiums could rise by an average of 12.1%, surpassing a 9.2% increase for families. Across every type of health-care plan—bronze, silver, gold, platinum and catastrophic—families could be looking at average increases of 7.3%, compared with 11% premium hikes for individual plan holders.

To put these numbers in context: For consumers with silver plans, which account for about two-thirds of the ACA market, the average individual could see annual premiums rise to $3,700 over the next year and a half from $3,200. A family could expect an increase to $15,400 from $13,000 over the same period.

After 2017, most ACA-compliant plans will likely fall into a pattern of annual premium increases of between 3%-6%, which will persist for the next decade and likely beyond. By 2023, I estimate that the average family plan could be 61% more expensive than it is in 2015, with individual plans only one or two percentage points behind. These increases are so high that direct taxpayer subsidies to consumers are unlikely to keep up. So the cost, both financially and politically, will become increasingly intolerable.

Policy makers should keep this in mind in the wake of the Supreme Court’s decision upholding federal subsidies in King v. Burwell . Despite the court’s decision, and the president’s claims to the contrary, the Affordable Care Act remains unaffordable for too many Americans—and that will only get worse in the coming years.

Mr. Parente, a professor of health finance, is an associate dean at the Carlson School of Management at the University of Minnesota.

[Crafty_Dog]

When a Doctor Is Always a Phone Call Away
Many of the 136 million ER visits in 2011 could have been replaced with a $50 telemedicine consultation.
By
Richard Boxer
Aug. 2, 2015 5:30 p.m. ET
42 COMMENTS

A 39-year-old truck driver was hauling through the Midwest in the middle of the night in 2011 when he began to feel a bit of indigestion. Then a lot of indigestion. He pulled over, recalling that his company had recently signed on with Teladoc, for which I was then the chief medical officer. The service allowed him to get a doctor on the phone within 15 minutes. He called and described his symptoms: nausea, chest pain, a little numbness in his left arm. He was having a heart attack, and his GPS guided him to the nearest emergency room.

Getting that doctor on the phone saved his life, and potentially the lives of whoever his 10-ton rig might have plowed into had he keeled over behind the wheel. If efficient and affordable quality treatment is the goal, telemedicine should be the future of health care.

When it comes to health care, “efficient” is a word that frightens people, calling to mind a soulless bureaucracy with an eye on the company’s bottom line. But it is inefficiency that is overburdening the medical system. Consider a woman with a urinary-tract infection who has to leave work to obtain a prescription from a doctor for a drug she already knows she needs. Or a man with a fever and hacking cough who has good health insurance, but who goes to the emergency room because his doctor’s office is closed.

Americans are struggling to obtain affordable, convenient care, and 103 million people in the U.S. live in areas with a shortage of primary health-care providers, according to the Health Resources and Services Administration. Yet the country is dependent on expensive, brick-and-mortar facilities that require time-consuming travel.

Primary-care doctors tend to cluster in urban areas. If you get sick in rural Wyoming, even during the workweek, your only choice might be the emergency room. In 2011, the Centers for Disease Control and Prevention reports, 136 million people were seen in an ER; many of those visits could have been replaced with a $50 telemedicine consultation. Researchers at the University of Rochester found that 28% of the visits at one pediatric emergency room involved ailments such as ear infections or sore throats that could be diagnosed over the phone.

These problems are exacerbated by the increase in the elderly population, coupled with tens of millions of patients newly insured by the Affordable Care Act. A study in the Annals of Medicine projects that the U.S. will need 52,000 more primary-care doctors by 2025. Those positions aren’t filled easily. It takes 12 years and hundreds of thousands of public dollars to educate one primary-care doctor.

But there is an untapped resource: the many doctors leaving their practices, fed up with the regulations and other hassles, but who love their patients, and the older physicians eyeing retirement because they no longer want to maintain an office. Why not let these doctors offer their expertise to patients by smartphone?

Doctors who contract with a telemedicine company can opt for a specific block of time when they are “on call” to patients, picking up the phone and answering questions in 10- to 15-minute intervals. The doctor is paid and the patient gets a prompt and inexpensive answer to a concern.

Home care of individuals with major chronic conditions would also substantially benefit from telemedicine. Millions of houses have cable and satellite connections that can be used to monitor patients wearing wireless devices, allowing health professionals to intercede at the first sign of trouble. This can reduce rates of hospitalization by half or more, some studies suggest.

While there is worry about the quality of these interactions, telemedicine companies assess their doctors routinely and maintain strong quality-assurance programs. Every doctor is taught in medical school that 80% of diagnoses are obtained through a medical history and symptoms, and not by what a doctor sees, touches or tests.

Telemedicine will never completely supplant face-to-face visits, and most doctors naturally would prefer to treat a patient in person. The American Medical Association, for instance, has encouraged restriction of telemedicine to patients who have an established relationship with a doctor, and some state medical boards try to enforce that view.

But the perfect cannot be the enemy of the good—and by continuing to practice medicine as usual, we are making it so. Millions of Americans live in areas that are short of primary-care doctors, and millions more go to the emergency room when they have a sore throat. Entrepreneurs have responded by creating methods of connecting patients to doctors remotely, which reduces costs and satisfies patients.

There is no scenario for sustaining or improving health care in America without telemedicine. State and federal governments, as well as the medical establishment, should embrace the technology. For one thing, they should change Medicare and Medicaid to allow reimbursement for telemedicine consultations, most of which are currently not covered. Ask that truck driver if he thinks talking to a doctor over the phone has value: He is still alive and trucking.

Dr. Boxer is the chief telehealth officer of Pager and chief medical officer of Well Via.

[Crafty_Dog]

"My expectation is that [rate increases] come in significantly lower than what's being requested," Barack Obama told a Nashville audience last month. After all, he promised ObamaCare would bend the cost curve down, right? And that it would save the typical family $2,500 a year in premiums, right? Wrong. So much for that. According to The Wall Street Journal, Tennessee Insurance Commissioner Julie Mix McPeak "answered [that question] on Friday by greenlighting the full 36.3% increase sought by the biggest health plan in the state, BlueCross BlueShield of Tennessee. She said the insurer demonstrated the hefty increase for 2016 was needed to cover higher-than-expected claims from sick people who signed up for individual policies in the first two years of the Affordable Care Act." So, Madam Commissioner, you're telling us the Affordable Care Act isn't exactly, uh, Affordable? So far, Tennessee's rate increase is the highest approved this year, but two other states — North Carolina and Maryland — exceeded 30%, and half a dozen more were in double digits. Others, like Minnesota (seeking a whopping 54% hike), are yet to be determined. And lest anyone think higher premiums were paying for better coverage, most insurance carriers are also increasing deductibles and copays. Our own plan here in our humble shop now offers this wonderful trifecta of higher premiums, higher deductibles and higher copays. So we pay more up front, we pay more before we can receive care, and then we pay more when insurance finally does kick in. Remind us again how great ObamaCare is...

[Crafty_Dog]

Largest ObamaCare Co-Op Admits Failure, Starts Closing Shop

Joining three other ObamaCare health care co-ops that already found themselves unable to operate in the current health care landscape, Health Republic, the co-op servicing the State of New York, started closing down its operation Friday, Sept. 25. "[A]fter coordinating with state and federal regulators, Health Republic will begin winding down operations in an orderly manner starting today," CEO of Health Republic Debra Friedman wrote to the co-op's members. "While we are deeply disappointed with this outcome, we believe it is in the best interests of our members. Starting a new insurance company is a daunting task in any environment, but the systemic challenges placed on us by the structure of the CO-OP program were simply too difficult to overcome." In other words, ObamaCare's worst enemy in this case was its own regulations. As The Daily Signal reported, the government loaned out $265 million to get the co-op off the ground. You shall know the program by its fruits: In this case, an effort by ObamaCare to provide more solutions and health care "competition" yielded government waste and failure.

Surprise!

[G M]

Largest ObamaCare Co-Op Admits Failure, Starts Closing Shop

Joining three other ObamaCare health care co-ops that already found themselves unable to operate in the current health care landscape, Health Republic, the co-op servicing the State of New York, started closing down its operation Friday, Sept. 25. "[A]fter coordinating with state and federal regulators, Health Republic will begin winding down operations in an orderly manner starting today," CEO of Health Republic Debra Friedman wrote to the co-op's members. "While we are deeply disappointed with this outcome, we believe it is in the best interests of our members. Starting a new insurance company is a daunting task in any environment, but the systemic challenges placed on us by the structure of the CO-OP program were simply too difficult to overcome." In other words, ObamaCare's worst enemy in this case was its own regulations. As The Daily Signal reported, the government loaned out $265 million to get the co-op off the ground. You shall know the program by its fruits: In this case, an effort by ObamaCare to provide more solutions and health care "competition" yielded government waste and failure.

Surprise!

Shocking!

[Crafty_Dog]

I have made this point about pricing more than once before.  IMHO this may be the single biggest and most effective thing we can do-- make prices knowable, in advance!

https://reason.com/archives/2015/10/05/the-maddening-world-of-hospital-pricing

[objectivist1]

The Republican candidates need to talk about this in the upcoming debate:

Anybody Checked on Obamacare Lately?

October 19, 2015 

Obamacare, That Big Issue Barely Mentioned in the Debates… Hey, remember Healthcare.gov? You know, the $2 billion web site that didn’t work at first and now works “for the most part”? The construction of healthcare.gov involved 60 companies, supervised by employees of the Centers for Medicare and Medicaid Services instead of a lead contractor, according to the inspector general at the Health and Human Services Department. The project was marked by infighting among the contractors, CMS officials and top officials at HHS, the Cabinet-level department that oversees CMS, according to e-mails released Sept. 17 by the House Oversight and Government Reform Committee.

Or maybe it costs $2.5 billion by now. It’s hard for the federal government to keep track of the money it spends, apparently: The Medicare agency and independent auditors have had trouble tracking the costs of Affordable Care Act programs. The Government Accountability Office, a congressional agency, said in a Sept. 22 report that it was “difficult and time consuming” to obtain financial information for the Center for Consumer Information and Insurance Oversight, the CMS office that manages many ACA programs, and that it “could not determine the reliability of most of the amounts” CMS provided.

A mere three years after the launch, the web site is now including the ability to search for a doctor and what plans they accept.

President Obama keeps going around the country, insisting everything’s working fine; the numbers indicate the administration and the Democratic Congress had no idea how difficult this would be when they passed the law: The effort to ease the consumer experience is driven by the administration’s push to reach the 10.5 million people who Sylvia Mathews Burwell, the secretary of Health and Human Services, says are still uninsured but eligible for marketplace coverage. While 9.9 million people have received health insurance through the exchanges as of June 30, the law has far to go to reach the 21 million people the Congressional Budget Office estimated in March would be enrolled next year.

Federal health officials say that target is too optimistic, but they have yet to announce their own numerical goal.

Meanwhile, out in Oregon: Health Republic Insurance, one of two nonprofit insurers created in Oregon under President Obama’s health care law, announced Friday that it is shutting down. Health Republic will continue to pay claims through the rest of the year but won’t sell policies for 2016, the company said. The 15,000 individuals and 800 small businesses that get insurance through Health Republic will have to turn to another insurer. The company blamed a reduction in federal payments that are supposed to help insurers smooth out the risk of taking on newly insured patients under the Affordable Care Act. CEO Dawn Bonder said the company assumed it would get those payments when it set premiums, but due to a change made last year by Congress, insurers are receiving less than 13 percent of the money they’d expected. For Health Republic, that represented a hit of $20 million for 2014 and 2015. Co-ops like Health Republic were created as part of a compromise in the Affordable Care Act to compete with for-profit insurance companies.

But that’s just Oregon. Surely things are better in New York… Regulators will shut down Health Republic Insurance of New York, the largest of the nonprofit cooperatives created under the Affordable Care Act, in the latest sign of the financial pressures facing many insurers that participated in the law’s new marketplaces. The insurer lost about $52.7 million in the first six months of this year, on top of a $77.5 million loss in 2014, according to regulatory filings.

…or Kentucky! Democrats are always pointing to the success in Kentucky… Kentucky Health Cooperative, a nonprofit insurer known as a co-op, explained that it could not stay financially afloat after learning of a low payment from an ObamaCare program called “risk corridors.” That program was intended to protect insurers from heavy losses in the early years of the health law by taking money from better-performing insurers and giving it to worse-performing ones.  However, the Obama administration announced on Oct. 1 that the program would pay out far less than requested, because the payments coming in were not enough to match what insurers requested to be paid. Therefore, insurers only will receive 12.6 percent of the $2.87 billion they requested. 

Okay, how about Colorado? Colorado’s biggest nonprofit health insurer announced its closure Friday, forcing nearly 83,000 Coloradans to find a new insurer for 2016. Colorado HealthOP announced Friday that the state Division of Insurance has said it can’t keep selling health insurance. That’s because the cooperative relied on federal support, and federal authorities announced last month they wouldn’t be able to pay most of what they owed to a program designed to help health insurance co-ops get established.

Okay, but in Tennessee, things are bet-oh, wait, never mind. Community Health Alliance will no longer offer insurance coverage next year, forcing about 27,000 enrollees to find new health insurance plans. The Knoxville-based health insurance cooperative, created under the Affordable Care Act, will continue to pay out existing claims but will wind down its coverage by not taking on new customers.

You would think a sentence like this one would be spurring a national discussion: “Nearly a third of the innovative health insurance plans created under the Affordable Care Act will be out of business at the end of 2015.”

Read more at: http://www.nationalreview.com/corner/425760/anybody-checked-obamacare-lately-jim-geraghty?laEe6PhO29kLW8Hp.01

[Crafty_Dog]

Updated Oct. 25, 2015 9:52 p.m. ET
863 COMMENTS

ObamaCare’s image of invincibility is increasingly being exposed as a political illusion, at least for those with permission to be honest about the evidence. Witness the heretofore unknown phenomenon of a “free” entitlement that its beneficiaries can’t afford or don’t want.

This month the Health and Human Services Department dramatically discounted its internal estimate of how many people will join the state insurance exchanges in 2016. There are about 9.1 million enrollees today, and the consensus estimate—by the Congressional Budget Office, the Medicare actuary and independent analysts like Rand Corp.—was that participation would surge to some 20 million. But HHS now expects enrollment to grow to between merely 9.4 million and 11.4 million.
Opinion Journal Video
Editorial Board Member Joe Rago explains why the president’s signature healthcare law is failing to meet its enrollment projections. Photo credit: Getty Images.

Recruitment for 2015 is roughly 70% of the original projection, but ObamaCare will be running at less than half its goal in 2016. HHS believes some 19 million Americans earn too much for Medicaid but qualify for ObamaCare subsidies and haven’t signed up. Some 8.5 million of that 19 million purchase off-exchange private coverage with their own money, while the other 10.5 million are still uninsured. In other words, for every person who’s allowed to join and has, two people haven’t.

Among this population of the uninsured, HHS reports that half are between the ages of 18 and 34 and nearly two-thirds are in excellent or very good health. The exchanges won’t survive actuarially unless they attract this prime demographic: ObamaCare’s individual mandate penalty and social-justice redistribution are supposed to force these low-cost consumers to buy overpriced policies to cross-subsidize everybody else. No wonder HHS Secretary Sylvia Mathews Burwell said meeting even the downgraded target is “probably pretty challenging.”

The HHS survey shows three of four ObamaCare-eligible uninsured people think having coverage is important—but four of five say they couldn’t fit their share of the premiums into their budgets even after the subsidies. They’re not poor; they tend to have jobs in industries like construction, retail and hospitality but feel insecure financially; and they prioritize items like paying down debt, car repairs or saving to buy a home over insurance.

The law’s failure to appeal to the young and rising middle class is already cascading through the insurance markets. Researchers at the Robert Wood Johnson Foundation and Urban Institute recently published a remarkable study of the industry barometer called medical loss ratios, or MLRs, and the pressure is building fast.

MLRs measure the share of premium revenue that flows to reimbursing medical claims. ObamaCare sets an MLR floor of 80% for patient care, with one-fifth left over for overhead like administration and profits, and the pre-ObamaCare 2010-13 historical trend for the individual market ranged from 79% to 86%.

The researchers found that in 2014—the first full year of claims experience in ObamaCare—average MLRs across all health plans sold on 16 state exchanges roamed from 90% to 99%. Average MLRs in 11 states climbed to 100% or more, reaching as high as 121% in Massachusetts. A business can’t stay solvent for long spending $1.21 for every $1 that comes in.

The 2014 MLRs are used to set rates for 2016 premiums, which are still under regulatory review. But the researchers estimate that to rebound to an MLR of 85%, premiums in the 11 money-losing states need to rise by 10% to 36% in the best estimate and 23% to 52% in the worst scenario. The familiar danger is that as rates rise, more people drop out, and thus rates must rise still higher, as the states that attempted ObamaCare-like regulatory schemes in the 1980s and 1990s discovered.

ObamaCare liberals pose as what-works-and-what-doesn’t technocrats. So perhaps they’d care to explain what it says about their creation that so many rational adults are willing to pay a fine of $695 or 2.5% of their earnings, whichever is higher, for the privilege of not buying an ObamaCare-compliant health plan.
***

ObamaCare will almost inevitably be reopened in 2017, whoever wins the election. The good news is the emerging consensus among Republican candidates about a credible, pragmatic and optimistic alternative. Jeb Bush was the latest to release a plan two weeks ago—and this is a debate that has always deserved to be litigated at the presidential level to create a mandate for reform.

The basic approach is to deregulate insurance and medical practice while replacing ObamaCare’s complex subsidy schedule with a refundable tax credit for individuals who lack job-based coverage. Unchained from benefit and redistribution mandates, insurance products and prices would come to reflect what consumers want. The credit would be sufficient to buy at least coverage for catastrophic expenses if people get sick, and the trade-offs of such skinnier plans might look better to voters priced out of ObamaCare.

GOP reformers also recognize that the Cadillac tax on high-cost employer-sponsored health plans is a heat shield that might let them solve some of the problems of the pre-2010 health finance status quo. Substituting a cap on the tax-code subsidy that helps drive medical inflation is more politically plausible with the Cadillac tax in place than without.

Mr. Bush was shrewd to frame his proposal with the vocabulary of innovation and aspiration. ObamaCare is built on a 20th-century chassis that is ever less relevant to modern medicine and consumer finance. If the law continues to underperform, voters may be open to a new model that puts their choices and needs ahead of the political class’s.

[G M]

http://hotair.com/archives/2015/10/28/obamacare-premiums-soar-60-in-mississippi/

Cost curve accidentally bent in wrong direction...

[DougMacG]

Orange County Register:
http://www.ocregister.com/articles/obamacare-691964-government-insurance.html

Obamacare at 5: Sick and getting worse
Nov. 14, 2015
By MARK LANDSBAUM

Big government’s health care solution is imploding. Soon it will be undeniable to even its most ardent champions that Obamacare is the unmitigated disaster critics predicted when, literally, only Democrats voted it into law, most without reading it.

Despite innumerable warnings that it was an unworkable, extremely costly Rube Goldberg contraption doomed to fail, those advancing it didn’t care. When it finally implodes, they knew, it will create the opportunity to rush to the rescue by doubling down on the bad bet.

Obamacare always was intended to pave the way for full-blown nationalized health care, as is so common in Europe. That’s why it wasn’t important to know the details. They knew the destination.

As with every Big Government program, failure becomes the excuse to do more of the same, rather than to kill the contrivance and get government out of the equation. In the face of mounting deficits, escalating costs and failed bureaucracies, Big Government champions from Bismarck to Obama always insist failures happen because they just didn’t have enough time, enough money and enough control. The day nears when Obamacare’s failure will prompt demands for more time, more of your money and more control over your life.

Let’s not lose sight of how this scheme was born. Obamacare’s failure was set in motion not by one-party dominance in Congress, and not even by FDR’s trailblazing socialism. The real seed of this evil may not be immediately obvious. But the root of this malevolency is taxes. Explanation to follow.

First, let’s review how catastrophic the Obamacare adventure has become in five short years.

Instead of people shopping for insurance or health care they can afford, making tradeoffs as they would with a car purchase or restaurant meal, they have been told what to buy and how much to spend, even if they don’t want what’s being sold. Instead of providers competing by offering varieties of services at fluctuating prices, allowing demand to ebb and flow, insurance companies, doctors and hospitals are dictated to from D.C. Those with more clout have the scheme rigged to their advantage. Those with less clout, less so.

In 2009, starry-eyed Big Government worshippers swallowed Barack Obama’s promise that Obamacare would lower a typical family’s premiums by $2,500 a year. Instead, premiums increased about an equal amount. In 2016, people who don’t qualify for taxpayer-financed subsidies will see a very expensive market “become even more expensive,” according to an insurance comparison website. Of course, you also were promised to be able to keep your doctor and health plan, and that the whole rigmarole wouldn’t increase the deficit.

Hundreds of New York cancer patients are losing hospital coverage because they signed up with Obamacare insurance co-ops, reports the New York Post. Indeed, more than half the nonprofit co-ops formed through Obamacare have left the market, the Washington Post reports. Nearly half a million Americans are left searching for health care.

Two days into the new enrollment season, Michigan’s Consumers Mutual Insurance announced it won’t sell coverage for 2016, becoming the 12th plan to fail in the past year, leaving only 11 operational.

Harbingers of bad news continue. A key Obamacare program to protect insurers from high costs faces massive cash shortages, Standard and Poor’s reports. The risk pool holds only $1 to cover every $10 in claims, the Hill reports. Simultaneously, people who don’t receive subsidies paid by taxpayers and who buy the cheapest Obamacare health plans, “face the largest increases for premiums and out-of-pocket costs in 2016,” CNBC.com reports. A new study by McKinsey & Co. found insurance companies lost $2.5 billion in 2014 and “will have to charge higher premiums or quit.”

Yet, even in failure there are those who profit, big time. Executives who ran failed co-ops were paid as much as $414,000 a year, and averaged $245,000, for steering their government-created contraptions essentially into bankruptcy. For perspective, median family income in 2014 was $53,657.

If profiteering from the rigged system is bad, how much worse is it that the government itself reported twice since July that basic information to determine enrollment and subsidy eligibility was not verified by the federal Health Insurance Marketplace or insurance exchanges examined in California and Kentucky? To test the system, investigators submitted 10 fictitious applications. All 10 were approved. One study concluded the government “could not verify” $2.8 billion in financial assistance payments through April 2014.

Central planners never can include enough protections and contingencies to thwart self-interested human behavior. Neither can Washington foresee how markets will behave by artificially limiting and directing responses.

How was such a beast born? Taxes.

Taxes feed mammoth government. Taxes pay bureaucrats to control you. Taxes reward political cronies at taxpayers’ expense. You can’t persuade people who already have your money that they shouldn’t spend it. You must deny them the money. Follow the money to see who’s in control. It’s not you.

[Crafty_Dog]

http://mobile.nytimes.com/2015/11/15/us/politics/many-say-high-deductibles-make-their-health-law-insurance-all-but-useless.html?ref=health&_r=1&referer=http%3A%2F%2Fpjmedia.com%2Finstapundit%2F

[Crafty_Dog]

http://www.dickmorris.com/category/lunchtime-videos/

[Crafty_Dog]

The ObamaCare-Immigration Collision
Keeping millions of illegal immigrants in the U.S. and virtually ensuring that they will cost American jobs.
ENLARGE
Photo: Getty Images/Imagezoo
By Andy Puzder
Dec. 3, 2015 7:10 p.m. ET
52 COMMENTS

The Justice Department last month asked the Supreme Court to review a preliminary injunction blocking the Obama administration from implementing the president’s immigration executive order, which would defer deportations for up to five million undocumented immigrants.

When President Obama announced his executive action, he acknowledged in his televised speech the concern that such immigrants “would take our jobs” and “stick it to the middle class.” He assured us that this is “not what these steps would do.” But he didn’t consider how this new edict would interact with his other legal inventions, namely ObamaCare.

The government’s petition says that the executive action intended to provide “work authorizations” so that undocumented immigrants could find jobs in the U.S. without working illegally for less than market wages, which might harm American workers. But wait: Employers aren’t required to offer ObamaCare coverage or subsidies to these immigrants. The statutory language in the Affordable Care Act says that only “lawful residents” are eligible, and the government’s petition specifically notes that the immigration action does not “confer any form of legal status in this country.”
Opinion Journal Video
Business World Columnist Holman Jenkins Jr. on why the president’s signature health care law may soon collapse. Photo credit: Getty Images.

In short, companies will be encouraged to hire these immigrants over U.S. citizens. ObamaCare requires employers to offer all full-time employees health insurance that meets the law’s standards. For businesses that offer health-insurance coverage, the government enforces this rule by imposing a penalty of up to $3,000 a year for each full-time employee who receives a federal subsidy, a proxy for each full-time employee who doesn’t receive compliant coverage. The penalty is triggered if a single full-time employee purchases coverage on the marketplace and receives a subsidy.

But none of this matters if your employees are immigrants freed up by Mr. Obama’s executive order. Companies could save $3,000 in penalties or the cost of insurance—about $3,300—for every one of these immigrants they employ over a U.S. citizen or lawful resident.

Suppose businesses subject to ObamaCare employ only 40%, or two million, of the up to five million immigrants covered by the president’s executive action. At $3,000 an employee, businesses would save about $6 billion a year. Companies already dealing with the added expense of operating in the Obama economy—burdened by regulations, high taxes and other barnacles—would find those savings hard to pass up.

The administration may yet find some justification for granting ObamaCare benefits to immigrants covered by the president’s executive action. The law’s 2,407 pages of text, backed up by more than 20,000 pages of regulations, are full of ambiguities and inconsistencies, leaving ample room for invention. Fixing this discrepancy may be the administration’s next tweak to ObamaCare.

But that would conflict with the president’s statement that he was not offering these individuals “the same benefits that citizens receive,” not to mention ObamaCare’s text. And it is hard to argue that Congress intended to grant ObamaCare benefits to a group of people who weren’t legally in the U.S. when Congress passed the law.

Exempting employers who hire these immigrants from the law’s penalties gives the immigrants a distinct market advantage over U.S. citizens. That flies in the face of the president’s statement that his executive action would not “stick it to the middle class” by allowing these individuals to “take our jobs.” It is also contrary to the government’s statement that the executive action would make it less likely that these undocumented immigrants hurt American workers by “illegally” working “for below market rates.” They could still work at below-market rates, only it would be legal.

All of this was inevitable. The root problem with ObamaCare is that one party rammed it through Congress without a single Republican vote, while the law’s supporters didn’t even read it, let alone vet it through congressional committees. As a result, ObamaCare as written was unworkable, and the administration has had to repeatedly amend it by constitutionally dubious executive fiat.

Now this flawed law is clashing with yet another constitutionally dubious executive action that the administration couldn’t be bothered to pass through the legislature. That’s one reason the Supreme Court should allow the existing injunction to stand and avoid the conflict.

But the immigration-ObamaCare nexus is only the latest example of how untenable and incomprehensible the Affordable Care Act is. The only real solution is to scrap the law and replace it with something that works. Republican candidates— Jeb Bush and Marco Rubio, for instance—have proposed just such market-based plans. Let’s hope one of those plans gets a chance to work.

Mr. Puzder is the chief executive officer of CKE Restaurants.

[ccp]

I don't recall physician organizations that are fronts for every major liberal policy agenda before but here is another one.

From climate change, to guns, to fracking, to planned parenthood.  You name it:

http://npalliance.org/blog/2015/10/04/upcoming-amsa-npa-webinar-physician-gag-laws-surrounding-fracking-industry/

[Crafty_Dog]

http://www.nationalreview.com/article/428475/single-payer-health-care-model-lawyers 

[ccp]

Yup.

[DougMacG]

I bought my healthcare plan when I went self employed for $40/month.  That policy was canceled by Obamacare and replaced with a worse one.  I received notice from MN Blue Cross Blue SHield this month that my new premium is $800 / mo. for one person, high deductible, no real coverage, so I have decided to cancel it as and go on the official state site as they want me to and become a ward of the state or whatever you call a person who can't to pay their own basic living expenses.

The site being unworkable I looked up an official "healthcare navigator".  For people having trouble with their internet, that is as easy as downloading a 111 page pdf, unsorted and finding out they don't have one anywhere near where I live.  So I drove this morning to the nearest public 'navigator' where my phone directions program put me in endless u-turns on a state highway until I took it offline and drive some frontage roads, found the building, rode the elevator to the top floor and discovered no one there would see me without an appointment and that no appointments are available until well into the new year even though I need coverage to start on the first or else I will have the hated lapse in coverage which seems to bother only me.

So I called another agency in St. Paul they referred me to who was also unable to help; they have their Hennepin County office closed on the busiest week of the year, and then I called MNSure directly.  After 40 minutes on hold, sitting in a cold car with my phone battery depleting I reached a somewhat helpful worker who led me through how to navigate the confusing state website for myself, though also told me I wouldn't be able to get coverage to start until February 1st - the state apparently doesn't care if I go without even though I am will to spend days trying and willing to pay whatever it costs.

So I went the state website, divulged all my most personal information again for the 4th or 5th time, through a public wifi connection and received the following error message instead of healthcare coverage:

Online service problems

One of our internal services has failed. We apologize for the inconvenience. Please come back later and try to create your account again.

Error Code: M002

Now I am wondering what else the government might be able to help me with...  

That government-involved Life of Julia is looking a little depressing about now.

Update:  I called the number for MN Gov Mark Dayton.  Someone from the Lt Gov office answered on the first. Told him the above.  He took my info and said he would call the HHS commissioner.

So I've got that going for me.

[ccp]

These guys really thought offering people chump change was going to have them lose 15% of their weight for a year?   Lets see.  If you deny yourself what you crave to eat will pay you $550 bucks.  That will work.  Well Dr. Patel got his name in the paper I guess.   I don't know why these pencil pushing data crunching faux pax researchers are taken seriously.  Thanks Bamster care.

http://www.npr.org/sections/health-shots/2016/01/08/462380096/why-employers-incentives-for-weight-loss-fall-flat-with-workers

[Crafty_Dog]

http://freedompartners.org/latest-news/2016-obamacare-premium-increases/?utm_source=jolt&utm_medium=email&utm_campaign=Jolt01112015&utm_term=Jolt

[DDF]

At last.... the chickens are coming home to roost.

http://www.bloombergview.com/articles/2016-01-14/gaming-of-obamacare-poses-a-fatal-threat?cmpid=yhoo.headline