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:
Health insurance • Health Insurance Reform • Medicaid • Preventive Care • Medicare • Read More
Why are individuals’ health insurance premiums soaring on ObamaCare exchanges, healthcare.gov?
So far, neither President Obama nor Congress have proposed real fixes for ObamaCare. There is a lot of grandstanding going on while people who've been notified that they will have to find new health insurance plans sit and worry about what will happen after Dec. 31 when their current plans will be cancelled.
I'm pretty well convinced that Obama and HHS Sec. Kathleen Sebelius have the power to rewrite what The Wall Street Journal editorial pages says are changes in eight regulations so that insurers and state insurance commissioners can decide whether current health insurance polices can be renewed. Many states are trying to get insurers to extend the policies that have been cancelled as required by the regulations that were written as far back as 2010 by Sebelius. More states aren't going along with the Obama nonfix.
Putting asside the constitutional questions about the changes in the Sebelius rules, I have some more thoughts and questons:
Health insurance • Community Rating • Health Insurance Reform • Individuals • Preventive Care • Uninsured • Permalink
Until ObamaCare (ACA) law is changed, it can’t be “fixed”
Health insurance • Community Rating • Fraud and Abuse • Health Insurance Reform • Medicaid • Preventive Care • Permalink
9 tips on how to use your new state health insurance exchange
Millions of insured, underinsured and uninsured Americans are being told by President Obama to sign up for very expensive health insurance plans that will be offered on states' health insurance exchanges beginning Oct. 1.
As expected, newspapers, magazines, broadcasters and cable TV networks are trying to win some new readers and viewers by offering advice on how to use the exchanges and how to pick the health insurance plan that will be best for them. Most of them are and will be misleading consumers.
My suggestions, which are based on years of blogging against and about ObamaCare and reading numerous articles and comments about the Affordable Care Act (ACA), follow:
1. Exchanges probably will give more choices of insurers in urban markets than in rural markets where only one insurer may be available. That could make rural insurers more expensive.
2. You will have a choice of deductible plans. Chose a plan that involves deductibles and copays that you can pay off in a year or so at your current income.
3. Many state insurance exchanges won't be fully functional on Oct. 1, and nobody can predict when they will be bug free and give you accurate price quotes on your premiums, copays and deductibles.
4. Health insurance brokers and people certified as "navigators' will be as intimidated by ObamaCare as you are. Don't rush to signup. Give the exchanges, brokers and "navigators" time to learn at the expense of other people.
5. While the government is inviting you to lie on your applications about your income and other variables, remember that sooner or later the IRS will come after you. Violating federal laws is a big deal.
6. Don't believe much of what you see and hear on ABC, NBC, CBS or CNN. They are in the business of selling ObamaCare and making Obama look good. They're serving Obama, not you. The article published recently by WSJ.com shows the same kind of pro-ObamaCare optimism that should be taken with huge grains of salt.
7. Carefully calculate whether you can go wiithout ObamaCare insurance until you have a catastrophic financial loss due to a sickness or accident. Enrollment periods last only six months. That could mean that if you need insurance outside the enrollment period, you won't be able to buy it when you need your free lunch.
8. ObamaCare covers a lot of worthless preventive care and wellness care services for the worried well. The literature warns that such services too often give false positives and result in unnecessary procedures that could do more harm than good. But if you have pre-existing conditions that require wellness or preventive care services, use them. See my previous post.
9. If your health insurance premiums and deductibles seem unaffordable, Obama will be happy to see you stop smoking, skipping your daily Starbucks, canceling your health club and cable TV contracts and keeping your old vehicles for four or five more years than you otherwise would. And you really don't have to buy that new home, appliance, smart phone, computer or mattress.
State insurance exchange blind spots: Unknown risks and unintened consequences, by Seth Kneller. The Health Care Blog.
Will ObamaCare Survive? Nine key questions, by Robert Lazewski. The Health Care Blog.
Health insurance • Buying Insurance • Health Insurance Reform • Individuals • Preventive Care • Mutual Funds • Permalink
Wellness programs are being exposed as big time and money wasters
Al Lewis and Vik Khanna write on The Health Care Blog that corporate wellness programs imposed by clueless CEOs and personell departments have been huge time and money wasters.
The Summer of Wellness's Discontent, by Al Lewis & Vik Khanna, The Health Care Blog.
Preventive care, cancer screenings are costly and can hurt more people than they help, by Donald E. L. Johnson, The Business Word.
Employee Benefits • Health insurance • Health Insurance Reform • Preventive Care • Permalink
10 fixes for ObamaCare; Speaker Boehner has to get real
House Speaker John Boehner (R-OH) should include the 10 fixes for ObamaCare in the bill that he announced he will have the House vote on next week.
If the House bill doesn't include fixes for ObamaCare that are being demanded by both Republicans and Democrats, it's a political fraud.
1. Remove provisions that give DHHS the power to give special treatments to unions and other Obama Democrats, the power to dictate insurance premiums and premium increases and the power to manipulate health insurance benefit designs.
2. Remove provisions that are causing employers to shorten work weeks to less than 30 hours and keep their payrolls under 50 people.
3. Remove mandated benefits that make ObamaCare plans unaffordable for all but those who will be subsidized by the federal government.
4. Remove the "death panels" that will decide without political review what will be covered and what won't be under ObamaCare.
5. Ban state laws that will make it unlawful for small and large companies and unions' Taft Hartley plans to self insure and buy stop loss reinsurance.
6. Remove the corrupt IRS from the role of enforcing ObamaCare rules.
7. Remove all pork that makes ObamaCare a multi-trillion dollar loser. The real positive provisions in ObamaCare can be implemented for less than $20 billions, not trillions.
8. Remove all provisions that fund immoral, unethical and dishonest government promotions of ObamaCare to clueless consumers.
9. Remove funding for worthless wellness and preventive care programs.
10. Remove the 37 new government agencies that are created under ObamaCare.
Health insurance • States' Health Legislation • Health Insurance Reform • Preventive Care • Permalink
Walgreen will send employees to private health exchanges for health insurance
The Wall Street Journal reports that Walgreen will put its 160,000 employes on private health insurance exchanges where they'll be able to shop the offerings of several regional and national health insurers. The Journal reports:
Under Walgreen's new arrangement, to take effect in 2014, the firm will pay a fixed amount for employees to select coverage options in a private insurance exchange run by Aon Hewitt, a consulting unit of Aon PLC. The exchange will offer up to 25 different plans in some states.
Health insurance • Buying Insurance • Preventive Care • Permalink
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.
Health insurance • Medicaid • Preventive Care • Medicare • Healthcare Providers • Taxes • Permalink
Providers are trying to keep health insurance premiums high by protecting expensive mandates
In Colorado, state laws that mandate that health insurers cover services offered by numerous alternative care providers increase the cost of health insurance by some 50%. These mandates generally are backed by the providers who profit from them and by disease-specific advocacy groups that don’t care that they’re making health insurance unaffordable for millions.
The health insurance reforms in the bill before the Senate (HR 3590) would allow
Health insurance • States' Health Legislation • Health Insurance Reform • Preventive Care • Healthcare Providers • Read More
Ritter pushes costly, ineffective wellness, preventive care policies
Governor Bill Ritter continues to allow his senior health policy advisor to sell costly and ineffective wellness and preventive care services. Under ObamaCare (HR 3962), these services would be free. As a result, patients would clog doctors’ offices demanding preventive services, and many would show up weekly just to talk. That’s what’s happened in Britain, where waits last months and years. The goal of the politicians and bureaucrats, of course, is to use the lonely and mentally ill preventive care seekers to block those who need expensive acute care services from seeing their doctors. Ritter doesn’t get it. And, unfortunately, few Republicans do. Links:
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Life expectancy: U.S. health care does very well compared with other countries
A blogger on Reuters writes that the U.S. health care system is really good compared with other countries.
He links to a University of Pennsylvania paper, Low Life Expectancy in the United
States: Is the Health Care System at
Fault?, by Samuel H. Preston and Jessica Y. Ho.
The abstract follows:
Health insurance • Health Insurance Reform • Preventive Care • Quality • Quality Patient Care • Read More
Preventive care increases health care costs 162%
Columnist Charles Krauthammer, M.D., calls the savings from preventive health services touted by President Obama and other Democrats in their efforts to sell health deform a myth.
Think of it this way. Assume that a screening test for disease X costs $500 and finding it early averts $10,000 of costly treatment at a later stage. Are you saving money? Well, if one in 10 of those who are screened tests positive, society is saving $5,000. But if only one in 100 would get that disease, society is shelling out $40,000 more than it would without the preventive care.
That’s a hypothetical case. What’s the real-life actuality? In Obamaworld, as explained by the president in his Tuesday town hall, if we pour money into primary care for diabetics instead of giving surgeons “$30,000, $40,000, $50,000” for a later amputation—a whopper that misrepresents the surgeon’s fee by a factor of at least 30—“that will save us money.” Back on Earth, a rigorous study in the journal Circulation found that for cardiovascular diseases and diabetes, “if all the recommended prevention activities were applied with 100 percent success,” the prevention would cost almost 10 times as much as the savings, increasing the country’s total medical bill by 162 percent. That’s because prevention applied to large populations is very expensive, as shown by another report Elmendorf cites, a definitive review in the New England Journal of Medicine of hundreds of studies that found that more than 80 percent of preventive measures added to medical costs.
Health insurance • Health Insurance Reform • Preventive Care • Permalink
Questions on health insurance reform for Congressional Budget Office
I"ve sent this e-mail to my Senators and Rep. Mike Coffman (R-CO).
Just to get another view of the health options, please ask the CBO for a report that answers these questions:
Estimate the 5, 10 and 15 year costs increases or cost savings for the government if each health insurer were required to community rate all of its insureds by Metropolitan area or state with a minimum enrollment after a set period in business of 50k to 100k per risk pool, assuming that individuals would be required to buy catastrophic policies with no lifetime coverage caps and no or means tested tax incentives?
On Medicare, what would be the savings/costs if benefits covered only financially catastrophic (including chronic) illnesses using community rating, means tested premiums and tax deductions for out-of-pocket expenditures for prescription drugs, medical devices, office visits and wellness care?
On Medicaid, what would happen to state and federal budgets if it were federalized, benefits covered only financially catastrophic illnesses (chronic and long-term) and substantial tax benefits were granted to philanthropists who funded low-cost or free community health clinics for Medicaid enrollees only, not including illegal immigrants?
Assume no government-run health plans for the privately insured. And assume insurers would be required to update their rates and contracts on the Internet daily. Assume insurers could sell policies with no state mandated coverage of preventive, wellness or alternative health care services.
Health insurance • States' Health Legislation • Community Rating • Health Insurance Reform • Medicaid • Preventive Care • Medicare • Permalink
What large employers can do to fix health insurance markets
The Wall Street Journal published a PR piece about how CEOs can fix health care. I think the piece is off base and posted the following reply:
How large employers can help fix health care:
Posted by Donald E. L. Johnson on 07/28/09 at 08:51 PM
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Preventive care, cancer screening are costly and can hurt more people than they help
President Obama, Speaker Pelosi and Democrats who are promising to cut health care costs with preventive care, including cancer screening, are promoting medical services that increase health care costs while doing little to prevent deaths from cancer and other diseases.
That’s the point of Natasha Singer’s NYT article, In Push for Cancer Screening, Limited Benefits.
Dr. Ned Calonge, the chairman of the United States Preventive Services Task Force said, ‚ÄúThere are five things that can happen as a result of screening tests, and four of them are bad.‚Äù His group consists of independent medical experts that Congress has commissioned to make recommendations, based on medical evidence, about what preventive measures actually work.
The one good result of screening, Dr. Calonge said, is identifying a life-threatening form of cancer that actually responds to timely intervention.
The possible bad outcomes, he said, are results that falsely indicate cancer and cause needless anxiety and unnecessary procedures that can lead to complications; that fail to diagnose an existing cancer, which could lull a patient into ignoring real symptoms as the cancer progresses; that detect slow-growing or stable cancers that are not life-threatening and would not otherwise have required treatment; and that detect aggressive life-threatening cancers whose outcome is not changed by early detection.
No one advocates that people eschew tests if they have symptoms or special risk factors. ‚ÄúOnce something bothers you or changes or is unusual, this is no longer routine screening,‚Äù Dr. Calonge said.
But, for otherwise healthy people with no symptoms, he said, only a few routine tests have proven to significantly reduce cancer deaths among certain age groups. The task force recommends pap smears for cervical cancer beginning no later than age 21; regular mammograms to screen for breast cancer in women starting at age 40; and tests for colon cancer starting at age 50. And the task force notes that the evidence supporting the breast cancer screening is not as strong as for cervical and colon cancers.
The National Cancer Institute has a web site that describes the risks and benefits of various cancer screens.
Does preventive care save money? New England Journal of Medicine