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Articles by Donald E. L. Johnson

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Today is Friday, April 18, 2014


What people who don’t buy ObamaCare (ACA) can do to manage self insurance risks

Smart young people who don't have pre-existing medical conditions are deciding to self insure rather than enroll in hugely expensive insurance plans sold on ObamaCare (ACA) health exchanges. If they self insure, I think they should understand their risks and know how to deal with a huge medical bill if they are hurt in an accident or are stricken by an expensive illness. Some ideas:


Who do we blame for ObamaCare, the unAffordable Care Act? Big Government corrupts

Who do we blame for soaring health insurance premiums?

You can blame AARP, health insurers, doctors and hospitals and the politicians that they paid with campaign contributions to distort the health insurance and health care markets.

And you can blame uninformed, unorganized and powerless voters for letting the Henry Waxmans of Congress and every president since JFK for making it all go wrong.

Health care is big money and big government.

Big government spends big money.

Big money in the hands of Big Government corrupts. 

Big government corrupts politicians, campaign contributors, drug companies, hospital administrators, physicians and regulators who have anything to do with distorting our health insurance and health care markets.

That's why America's huge government is and looks so corrupt. We're a third world country now.

Keep health care providers out of the health insurance business

The Wall Street Journal reports that some health care systems are getting into the health insurance business.

Gosh, how history repeats itself. Back in the 80s and 90s, several so-called "integrated" health systems got burned in the health insurance business. They didn't have insurance expertise, financial resources, market clout or credibility with individuals, employers or regulators. So most failed.

Hospitals and docs created Blue Cross and Blue Shield back in the 30s to make sure that they got paid the way they wanted to be paid, patients and payers be damned. That scam worked for decades until Medicare/Medicaid and smarter employers came along and forced the Blues to work for the payers instead of the providers.

If hospital systems try to compete with national health insurers, they'll lose the price wars even if they are the providers. This is because the national insurers have the financial and political resources and the market share that will allow them to crush the providers' plans whenever they decide to do that.

Over the last 35 to 40 years, too many hospital administrators have gotten their institutions into businesses that they knew little about, and they cost those institutions millions. Or, I should say, they ran up huge losses that they recovered by over-charging insurers and self-insured patients.

Most health care administrators are too smart to get into the insurance business. But their medical staffs get frustrated with insurers and demand that the hospital systems go into the health insurance, medical supply, group purchasing or whatever business the docs think will help them become richer.

Any board of directors that lets its CEO take it into what will be a money-losing, over-regulated business such as health insurance strikes me as being either incompetent, manipulated, self serving and/or all of the above.

State and federal legislators and regulators should not only outlaw health care providers from getting into the health insurance business, they also should enact anti-trust laws that break up the big regional and national health care chains and insurers.

People who are smart about money won’t buy health insurance until they become sick

ObamaCare will give working Americans who are smart about money strong financial incentives to become and stay uninsured until they need catastrophically expensive health care. If they recover and no longer need insurance, they’ll drop it until the next time. The number of people who can afford to buy health insurance today but don’t is about 15 million. In five years, it could be several multiples of that.

Economists are just figuring it out here and here. Even liberal bloggers are getting it.

What this means:

What does defensive medicine cost? It depends on your agenda

Democrats who depend on malpractice lawyers for huge campaign contributions do everything they can to down play the cost of defensive medicine. Republicans who don’t get money from trial lawyers do everything they can to show that the threats of malpractice suits cause physicians to increase the cost of health care by 30% to 50% by practicing defensive medicine. When physicians practice defensive medicine, they order more tests and procedures and drugs than they should in an effort to reduce their risks of being sued. Trial lawyers win. Medical supply companies and medical device companies win. Physicians and hospitals win. Patients and taxpayers lose.

A new Gallup poll of physician finds that 25% of procedures ordered by physicians are unnecessary. Jackson Healthcare uses that number to estimate that $650 billion of the $2.5 trillion spent on health services is spent on unnecessary tests and treatments. Click on the hed of this story to see links to several relevant articles.

Posted by Donald E. L. Johnson on 02/28/10 at 01:23 PM
ColoradoPPCHealthcare ProvidersHospitalsPhysiciansQualityRead More

Catholic hospitals, nuns split with bishops over Nelson’s abortion solution in HR 3590

Catholic hospitals and a group of nuns are splitting with their bishops over Sen. Ben Nelson’s (D-Neb) abortion compromise in the health bill (HR 3590) that the Senate passed on Chistmas eve.

The hospitals are “cooperating with evil” because 

Obama, Pelosi HMO gets new life but not there yet

President Obama, Speaker Pelosi and Senate Majority Leader Reid are doing all they can to force working Americans and their families into a Medicare for all HMO/PPO that would sharply cut payments to providers and limit patients’ access to advanced medical technology and quality care. The Wall Street Journal is the only news organization covering this scandal in depth, and it explains in an editorial what the hard left Democrats are plotting. Other media are willingly being sucked in by clever White House distractions designed to hide what’s going on in Congress.


The Public Option Comeback The secret to its budget ‘savings’? Medicare price controls. [Read comments after the editorial.]

Rep. Mike Coffman’s town hall: won’t support HR 3200; wants Congress to deal with jobs, economy

Rep. Mike Coffman (R-CO, CD-6) met in Conifer with more than 30 constituents. His summary of the most pressing issues before Congress and questions and answers that followed are below. Click on the headline.


How Obama uses misleading uncompensated care statistics to promote health care reform

Is President Obama lying about ObamaCare or just being given bad information like President Bush got from the intelligence community when he warned about Iraq’s weapons of mass distruction?

This articleby Thomas P. Miller at the American Enterprise Institute shows how the argument that hospitals’ uncompensated care costs are shifted to the privately insured is inflated by a magnitude of about seven. Instead of costing the privately insured $57 billion a year, think about $8 billion.

Hospitals, of course have been misleading the public and policy makers about uncompensated care costs for decades. They’ve inflated their uncompensated care costs to show how they provided “community benefits” that justify their highly inflated list prices, or charges, and what they charge private insurers.

The actuary and health consulting firm, Milliman & Assoc.and its client, Family USA, come off looking terrible in this article because Milliman produced the hugely inflated number used by the president.

Waxman’s attack on Obama’s deal with drug makers depresses pharma and hospital stocks

Rep. Henry Waxman (D-CA) helped depress most drug and hospital stocks Thursday with his warning that the Obama administration doesn’t feel bound by its deal with pharmaceutical companies and that Congress isn’t bound by that deal.

The markets obviously didn’t believe the White House denial that anyone working there said President Obama isn’t bound by the deal he made with drug makers, which made a vague promise to help the government save some $80 billion on drug purchases over the next 10 years.

This sent most drug stocks and health exchange traded funds lower Thursday. Daily charts for drug and medical device makers are here.

If the drug companies can’t depend on Obama and Congress to uphold their ends of the deal they thought they had with the politicians, then the drug makers appear to be more vulnerable to health reformers’ efforts to legalize reimportation of exported drugs, shorten the lives of patents on new biologic drugs and make the companies pay for advertising to consumers with after tax dollars.

Hospital stocks also fell because the industry’s $155 billion deal announced with President Obama and the Senate also is worthless, if it ever was worth anything. That deal supposedly protected hospitals against a variety of attacks under consideration in Congress, but it is being opposed by several state hospital associations that say the deal provides for costly cuts in Medicare payments that hospitals can’t afford.

Congress also is considering making tax-exempt private hospitals taxable. But that would only help publicly-owned hospital companies, because they could grow by snapping up not-for-profit hospitals after Congress made them for profit businesses. This assumes, however, that consolidators could get anyone to finance their acquisitions of more hospitals.

Hospital stocks also are down because speculators think that if health insurance market reforms die in Congress, hospitals won’t get any relief from the cost of serving the 6 million to 8 million uninsured Americans who can’t afford health insurance and aren’t qualified for existing government programs. And they would continue to be obligated to treat some 9 million to 15 million illegal immigrants without getting paid.

Daily charts for major acute care hospital chains are here.

With the major media reporting new splits over health care reform proposals in Democratic Party Congressional ranks daily, this hasn’t been a good week for health care reform or health insurance reform.

Health care reform may not be dead, but it’s in big trouble. In the long run, the death of all of the health reform schemes being considered in Congress would be good for most health stocks.

Daily charts for health insurers’ stocks, which were mixed Thursday, are here.

Disclosure: I own BDX.

Health insurers drop on health care reform’s stall; providers are mixed; health ETFs up

The future of health care reform seems to be so uncertain that speculators in the stocks of health insurers, health care providers, medical device makers and exchange traded funds that track health stock indexes aren’t sure which way to turn.

On Wednesday, as expected, health insurers’ stocks lost part of the gains they made Tuesday when it looked like insurers wouldn’t face competition from President Obama’s government-run public option health plan, or government HMO. Late Tuesday, Obama reasserted his support for a public option, which is why insurers’ stocks fell Wednesday.

But the correction didn’t take away all of Tuesday’s gains. The reason is pretty simple. Chances that a health insurance reform bill won’t make it through either house of Congress by Obama’s August 1 deadline are growing despite what Congressional leaders are promising. Congressional Democrats are so divided on health insurance reform and financing the new health spending bill that they have a lot of work to do before they can agree on anything. That the bill might be delayed through August increases the probability that a bill that means anything won’t pass this year or next.

While insurers’ stocks dropped Wednesday, three ETFs that track health stocks rose a bit even though the stocks of hospitals, drug makers and medical device makers were mixed.

Insurers’ health ETFs’ charts are here. Medical device makers’ and pharmas’ charts are here. Hospitals and other providers are here and here.

Why the mixed returns?

There are several possible answers. If the Government HMO is back on the table, demand for medical devices and some supplies may slip. Members of Congress are again talking about more cuts for Medicare and Medicaid providers, which would hurt providers and their suppliers. That some hospital chains were up could be because speculators recognize that the industry’s deal to take $155 billion in Medicare payment increase cuts over the next 10 years can be and probably will be reversed by a future Congress.

And speculators who are paying attention know that the Democrats again are talking about taxing people making over $250,000 to raise funds for the health spending bill that’s being touted as a health care reform bill. That, of course, would work against a near-term economic recovery. It would be bad for all stocks, including health stocks, which seems to be okay with Obama and most Democrats in Congress.

So, now, all investors have to watch the health care reform circus in Washington, not just patients, workers, employers and speculators in the various health stocks.

Hospital stocks drop on talk of cuts in Medicare payments; states’ Medicaid budget problems hurt

The nine leading hospital company stocks are looking pretty bearish on their daily charts.

Reports and rumors in Washington late last week that the three large hospital associations are about to agree to give Congress and the Obama administration $150 billion in cost concessions over the next 10 years obviously have not been good for the hospital companies.

In addition, Sen. Max Baucus (D-MT) is looking for cuts in Medicare payments to hospitals and physicians.

And how many hospitals can run on California’s IOUs? Not only California, but most states are having budget problems because of Medicaid.

Then there are the confusing signals coming out of Washington about the prospects for the health insurance market reform legislation that’s going through Congress or is not going anywhere.

While last week it looked like the Democrats’ public option health plan, which I call a Government HMO (GHMO), was dead on arrival. Over the weekend, a couple of prominent Democrats promised that it is alive and kicking. I’ve seen talk that the public option would get only 38 votes in the Senate, but who knows?

The GHMO would solve hospital companies’ problems with uncompensated care and the 6 million to 8 million uninsured American citizens who aren’t eligible for existing government programs and can’t afford to buy any kind of health insurance because they’re permanently unemployable and chronically ill.  But it wouldn’t solve the hospitals’ problems with 12 to 15 million uninsured illegal immigrants because they still would have to give them care without getting paid.

That unemployment rose last month to 9.5%, a 26-year high, also hurt hospital stocks, which almost always suffer during recessions.

On these charts, CYH, HMA, LPNT, THC and UHS are showing bearish signals.

On these charts, HLS, KND, MDTH and PHC are showing mixed signals. Click on the charts to see galleries of charts.

I don’t have positions in any of these stocks.

Sen. Baucus threatens to make hospitals dirty, unsafe, unfriendly and unavailable

Senator Max Baucus (D-MT), chairman of the Senate Finance Committee, is demanding money from hospitals and insurers so that he can pretend that his health insurance reforms will cost less than $1 trillion over 10 years.

If Baucus, President Obama and Democrats get the concessions from hospitals, look for hospitals to spend less on improving quality and outcomes, on cleaning their facilities, on training staff to treat patients as customers rather than as spoiled meat and on unprofitable “community” services.

Politico reports that Baucus thinks hospitals and insurers are dumb enough to believe that 46 million uninsured folks will become profitable customers under a nationalized health care system.

First, there are only about 6 million to 8 million uninsured people who would become new customers, not 46 million, which is an over hyped and inflated estimate from flawed studies by the highly politicized U.S. Census Bureau.

Second, the uninsured tend to be unhealthy and even chronically ill folks. It’s not clear that they would be profitable new customers for hospitals, physicians or insurers. They’d probably be unprofitable.

The Politico story concludes:

The next big deal is expected to be negotiated with hospitals. Lawmakers are looking to the industry to offer up $150 billion to $220 billion in savings, according to five health care insiders.

The deal could be a make-or-break moment for the legislation.

Hospitals are important community institutions in congressional districts nationwide, and lawmakers need their support. And since hospitals are viewed as major players in the industry, many other groups — from nurses to medical device manufacturers — will feel the ripple effects.

“Whenever they feel pain, we feel pain,” said a health industry source.

Call your member of Congress. The Democrats are intent on destroying your health care. Someday you’ll need it.

Colorado House passes sick tax

Democrats in the Colorado House passed a tax on hospitals that will tax the sick.

The tax on hospitals will be passed on to the sick patients and to workers who buy health insurance either individually or through their employers. However the sick tax is collected, it will be passed on to consumers.

This will further reduce consumers’ disposable income, increase their debt and prolong the recession.

I discussed this bill in greater depth here.

“Bed tax boondoggle” at Rocky Mountain Right.

Colorado legislature wants to rob its taxpayers and hospital patients to cover the ‘uninsured’

Colorado’s legislature wants to increase the cost of hospitalization for patients and their families by imposing a $600 million tax on hospitals, which would pass the tax on to their customers one way or another.

The Colorado politicians reason that

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