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Articles by Donald E. L. Johnson

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Today is Wednesday, July 30, 2014

Medicaid


Why liars for ObamaCare will be in trouble in 2016

Politico.com's lead story at the moment is about how 2016 presidential candidates will lie for ObamaCare or spin their wheels promising to repeal it, which will be impossible because it may have imploded by then and Democrats will always have enough political power to block a total repeal. Here's why I think Obama/Clinton Democrats will have a tough time defending ObamaCare in 2016 and maybe even this year:

Posted by Donald E. L. Johnson on 04/26/14 at 08:36 AM
Health insuranceHealth Insurance ReformMedicaid • (0) CommentsRead More

Journalists who accept Obama’s claim that 7.1 million signed up for ObamaCare can’t be trusted

The Wall Street Journal's headline writers and most of the media proved that they can't be trusted when they promoted President Obama's blatant lie that 7.1 million people have signed up and enrolled in ObamaCare. Everyone knows that huge percentages of those who signup never pay their ObamaCare health insurance premiums to insurers. Indeed, one insurer says that only 53% of previously uninsured signups pay their premiums. How many will continue to pay their premiums after insurers pay for their initial claims, which will be huge, remains to be seen. The ObamaCare numbers released by Obama so far are pretty meaningless. ObamaCare will never be repealed in full, but Obama already has used his executive orders to unlawfully change the law. Here are a few of the law's big problems as I see them:

Posted by Donald E. L. Johnson on 04/05/14 at 03:45 PM
EthicsTrustHealth insuranceHealth Insurance ReformMedicaidMedia • (0) CommentsRead More

Poverty traps: Medicaid, food stamps, unemployment compensation, Social Security disability benefits

ObamaCare is what Rep. Paul Ryan (D-Wis.) accurately calls a "Poverty Trap".


15 questions Republicans are asking gubernatorial candidates

The audience at the North Suburban Republican Forum had about 15 questions last Saturday for the three candidates for the GOP’s nomination to challenge Gov. John Hickenlooper next November. These same questions probably are being asked around the state as the candidates work to visit all 64 counties even though only about 12 counties have most of the votes.


Real fixes for ObamaCare (Affordable Care Act)

Congress and pundits are proposing shallow, ineffective fixes for ObamaCare, which is the nickname for the Affordable Care Act. Of course, ObamaCare is just as unaffordable as expected by those who read at least parts of the act and wrote about it in 2009 and 2010. I've written several times about how I think ObamaCare should and could be fixed if only Obama wanted to fix it. Here's my latest version, which I posted in the comments section of http://www.nationaljournal.com below an article: Why ObamaCare isn't so easily fixed, by Sam Baker:


Until ObamaCare (ACA) law is changed, it can’t be “fixed”
"Glitches" aren't #ObamaCare's biggest problems. 
 
The biggest problem is that the law is unworkable, mandates worthless preventive care and wellness benefits, offers free primary care to the lonely well, and implements community rating instantly rather than over an acceptable transition period of several years. 
 
Make deductibles workable and affordable for the low income people who ObamaCare supposedly is intended to help. Create payment plans so that the deductibles can be paid off over three to five years. As now structured, the high deductibles, which I support for those who can afford them, will force more medical bankruptcies, not fewer.
 
Make it very difficult and expensive to defraud ObamaCare, Medicare and Medicaid. Think jail, huge fines. Maybe we need a special court and prosecutors/public defenders for health care fraudsters.
 
Breakup healthcare provider and insurer monopolies and oligopolies so that consumers will have real choices on the exchanges. Let private enterprises other than insurers or insurance brokers create, run and profit from health care exchanges. Get the incompetent, politically driven bureaucrats and politicians out of the health care exchange business.
 
Fix the law so that it will work for consumers and so that it can be sold on the Web. If you're not willing to admit mistakes and keep doing the same dumb things over and over, you're insane.

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.


How to make a fiscal cliff deal on Medicare, Medicaid and Social Security

Democrats and Republicans are deeply divided within each party as well as between parties on how to avert putting the country over the "fiscal cliff," which really is a slope, not a cliff. As a Small Government Republican Medicare beneficiary who's benefited from the free gift of Part D, cheap Medicare premiums, tax credits on home mortgages and coverage of primary care services that I should be paying for out of pocket, here's the deal I would like to see:

1. Make Medicare and Medicaid catastrophic programs only. Drop all the wellness and primary care nonsense that enriches providers and often hurts patients with false positives and harmful procedures.

2. Take all Congressionally imposed mandated benefits out of M/M.

3. Take all payments for teaching and medical research out of M/M. Fund them in separate bills and programs.

4. Breakup regional and metro hospital systems, medical groups and national health insurers.

5. Free seniors to buy non Medicare health insurance plans that cover primary care, wellness care and alternative care services without any Medicare subsidies for those premiums.

6. Raise premiums on all parts of Medicare. They're ridiculously low. 

7. Raise co-pays for all primary/preventive care and lower co/pays on catastrophically expensive cases.

8. Make Medicare Advantage enrollees pay the full premiums for the expanded coverage. 

9. Use money saved by eliminating coverage of provider-enriching preventive and wellness services to cover long-term care expenses that become catastrophically expensive as a percentage of the beneficiary's wealth, including the value of a a home or other investments. If someone is worth, say, $5 million, and long-term care costs, say, $80,000 to $100,000 a year, let that person pay for that care. If the person is worth $500,000 or less, Medicare could pay. That's the Moocher Nation way, of course.

10. Eliminate the death tax. Keep taxes on capital gains and dividends at 15%. No tax increases on the rich unless everyone gets income tax increases. Shrink the number of people who don't pay income taxes, get food stamps and are fraudulently filing disability claims.

11. Keep SS/Medicare enrollments at current ages. Change CPI calculations to reflect real inflation, which is a lot higher than the CPI shows today.


How to cut Medicare, Medicaid entitlement costs, expenditures

Congress and the Obama administration are fighting over how to fix entitlements, especially Medicare and Medicaid. Even Democrats disagree among themselves, according to today's Wall Street Journal. Some Democrats want no cuts, others want cosmetic cuts. Republicans want real reforms, but good luck with that.

Here are some ideas for fixing Medicare and Medicaid that I've made over the years and are even more relevant today: 

1. Take free physician office visits out of ObamCare. They waste physicians' time and create tremendous wait times for sick Medicare/Medicaid beneficiaries, which increases costs.

2. Require patients with minor symptoms to see nurse practitioners and other allied providers before wasting the time of the shrinking number of primary care physicians.

3. Eliminate coverage of the most wasteful primary care and allied providers.

http://www.businessword.com="">

4. Get hospitals out of the doctor business. Their overhead is too high, and they demotivate physicians with all of their rules, red tape, etc.

5. Breakup so called integrated health care systems that are local monopolies and horribly distort local provider and health insurance markets.

6. Eliminated incentives for physicians/hospitals to practice very expensive defensive medicine.

7. Raise premiums for Medicare beneficiaries by 25% on coverage of primary care and drugs, and allow them to spend what they want on the kind of supplementary care they want.

8. Repeal the laws that keep Medicare beneficiaries from opting out of Medicare, especially the primary care coverage, which is a waste of money most of the time.

9. Invest in real fraud and abuse law enforcement.

10. Hire private insurers whose administrative costs per patient, not per enrollee, are 20% to 30% of the administrative costs of Medicare and Medicaid.

None of these reforms will be attempted because AARP, health workers' unions, HCA, the American Hospital Assn., the Catholic Health Assn. and the Federation of American Hospitals will fight them.

LINKS:

13 ways to cut Medicare costs, by Donald E. L. Johnson, 8. 3.2011

Cutting physicians’ incomes wrong way to cut Medicare costs and expenditures, By Donald E. L. Johnson 8.2.2011

Posted by Donald E. L. Johnson on 11/20/12 at 05:50 AM
Health insuranceFraud and AbuseMedicaidMedicarePermalink

13 ways to cut Medicare costs

Over the last 35 years, there have been a lot of attempts to slow the growth in Medicare expenditures, which have continued to soar unabated because of poor policy making by both parties. 

Although the Budget Control Act of 2011 (S. 365) says the Joint Budget Committee that will try to agree on the next round of budget cuts won't be allowed to change Medicare's benefits, I think it should.

Here are some ideas for changing Medicare that would give consumers and providers strong financial incentives to increase access to care and higher quality care at lower costs per patient and per enrollee:


Cutting physicians’ incomes wrong way to cut Medicare costs and expenditures

The Budget Control Act signed by President Obama today creates a Joint Committee of a dozen members of Congress. It's job is to cut the budget by Thanksgiving.

Everyone expects that the committee, which will be comprised of six members of the Senate and six members of the House with six from each party, will target Medicare, Medicaid and other health services for savings.

This is a slightly revised piece I'm posting on comments sections and on Facebook:


What I would like to hear from Tim Pawlenty and Mitt Romney

What I want GOP candidates to promise:


What Mitt Romney should but won’t say about RomneyCare and health care reform

On Thursday, Mitt Romney, a yet-to-be-announced presidential candidate, will try to get the RomneyCare Massachusetts health insurance disaster off his back. 

Romney experimented with health insurance markets in Massachusetts, and his stab at increasing access to health services while containing costs has failed big time. Health insurance is more expensive and health care is harder to get in Massachusetts under Romney care. And 100,000 still are uninsured.

 
In his speech, he needs to spell out the failures in RomneyCare and explain what he has learned from those failures. He should not play the blame game.
 
Then he should propose a new experiment for the country and the states. I think putting the health insurance and health care reform burden on uninformed, self-interested and gullible state legislators and governors would be a huge mistake. Even more than members of Congress, state legislators are over influenced by the experiences that they, their families, their friends and their biggest contributors have had and are having with specific illnesses, medical procedures, drugs, medical devices and providers.
 
Indeed, I think Medicaid should be federalized and standardized rather than continue with the state involvement that we have today. It's just to complicated for state politicians and bureaucrats to manage cost effectively and for patients. And I'm a libertarian Republican who is against socialized medicine and centralized planning. But I've also been covering health policy since 1976, and I think Medicaid is broken because both members of Congress and members of state legislators have voted for their personal power, not for patients nor taxpayers.
 
Private health insurance markets should be re-regulated to give consumers and insurers the freedom to buy and offer products that meet the needs of consumers at a profit for insurers.
 
Both consumers and insurers need financial incentives to buy right and create cost-effective products. The key is to make sure that consumers know what they are buying and have the freedom to buy as much or as little coverage as they want so long as they end up paying for all of their health care without tax credits or government subsidies unless they truly need subsidies. No one who needs subsidies pays taxes, which means those who don't pay income taxes should not get tax credits of any kind. No one should be allowed to declare bankruptcy so they can avoid paying the uninsured portions of their medical and health care bills. 
 
People should have strong financial incentives to buy the insurance that would cover the catastrophic losses that they could not afford to put on their credit cards. People who under insure should be required to sell their homes, cars and any other assets to raise the money to pay their medical bills, and they should be put on payment plans that hurt until they get their bills paid.
 
High deductible insurance is what you should buy to avoid the pain of paying catastrophic medical bills and the cost of fixing cars when they are wrecked. If you don't buy the insurance, you should suffer the consequences, not taxpayers nor people who do buy insurance and pay their bills.
 
Take all employers out of the health benefits business. Employers buy what's good and affordable for them, not what's good and affordable for their workers. Employers game the system, the tax codes and their workers on health benefits. After politicians, employers are the most dishonest players in health care.
 
Thus, there should be no tax credits for anyone who buys health insurance. It should be an after tax expense for everyone. Tax incentives are for the favored few, which, amazingly in this case, are those who make enough money to pay income taxes. 
 
And tax incentives promote wasteful spending on low deductible policies that pay insurers to hold insureds' money until they need to buy preventive care and routine medications that should be paid for out of their pockets. We don't use insurers to pay for oil changes in our cars or for the maintenance of our homes, and we should not pay insurers to hold our money until we needed it for preventive and routine health care services and products. We don't pay banks to hold our savings until we need our money.
 
Further, tax incentives redistribute incomes in ways that increase government spending, increase financial incentives for politicians to pander to the favored few and kill jobs.
 
Health insurers should be regulated to ensure that they create and sell products that consumers with 4th and 5th grade educations can understand and evaluate. They should be required to spend the time and money needed to make sure that every customer understands insurance, health care and how their health plans will work and what they will cost.
 
Insurance is complex, and if insurers offer too many options, no one will know what to do. Part D Medicare's drug benefit plans have taught even those of us who believe in consumer choice and free markets that insurers can make decision making very difficult. Indeed, the politicians who write the laws and regulations force insurers to confuse consumers, imho. New health laws and regulations should be easy to understand, comply with and enforce.
 
Even though Romney knows all this, I doubt that he'll take this approach.
 
Like all politicians, he'll pander to special interests in health care and government as well as in the insurance business. He'll suck up to the moocher nation because most Americans believe in free lunches---tax credits, government subsidies, government programs and no deductible health insurance policies.
 
Sadly, few Americans want to pay their own way, which is why we have a huge budget deficit and  totally dysfunctional health insurance and health care markets.

Judge rules ObamaCare (PL 111-148)  may force Colorado and other states to spend more on Medicaid

A Florida Federal District Judge who today ruled ObamaCare (PL 111-148) is unconstitutional because it mandates that all Americans must buy government-approved health insurance also ruled that the law's provisions that force states to spend more on Medicaid is constitutional according to case law. The only thing that will save the states on the Medicaid issue is the judge's ruling that the unconstitutionality of the mandates makes the whole law unconstitutional. Links:  Decision on Florida v. DHHS. Scholars, politicians discuss the ruling here.

Posted by Donald E. L. Johnson on 01/31/11 at 02:13 PM
Health insuranceHealth Insurance ReformMedicaidPermalink

Mike Fallon, M.D., is a politician who knows how to explain why ObamaCare adds $500 billion to debt

Mike Fallon, M.D., Wednesday gave the one best talks on health care economics and policy that I've heard since 1976 when I started covering health care deform. He certainly showed that he knows more about health economics and policy than any Republican who's in the U.S. House of Representatives today. More with links after the jump:

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