ObamaCare in the Granite State

 

The only exchange option afforded to consumers comes from Anthem Blue Cross and Blue Shield, a unit of WellPoint. The insurer built a narrow network that lowered premiums by 25% or 30% while still complying with ObamaCare’s other mandates…

…Of the 26 in-state acute care hospitals, 10 were booted from Anthem’s network (not counting emergency services). Even the state capital of Concord was shut out, and the coverage gaps are wider because so many primary care and specialist practices are now owned by health systems.

The Granite State didn’t lack for insurers before. Anthem dominated with 40.7% of all private policies, but strong rivals included Harvard Pilgrim (20.4%), Cigna (18.7%) and Aetna (7.8%). Anthem did have a 76% share of the individual market, but aren’t the exchanges supposed to increase competition? (WSJ)

Are We Winning the War Against Diabetes?

 

Federal researchers on Wednesday reported the first broad national picture of progress against some of the most devastating complications of diabetes, which affects millions of Americans, finding that rates of heart attacks, strokes, kidney failure and amputations fell sharply over the past two decades.

The biggest declines were in the rates of heart attacks and deaths from high blood sugar, which dropped by more than 60 percent from 1990 to 2010…

Beyond the declines in the rates of heart attacks and deaths from high blood sugar, the study found that the rates of strokes and lower extremity amputations — including upper and lower legs, ankles, feet, and toes — fell by about half. Rates for end-stage kidney failure dropped by about 30 percent.

Unfortunately, diagnoses continue to increase: “The number of Americans with diabetes more than tripled over the period of the study and is now nearly 26 million.”

(Sabrina Tavernise & Denise Grady, New York Times)

Why We Spend So Much on Drugs

 

The editors at Bloomberg explain:

prescription-bottleHere’s how the system works: When a doctor administers a drug in his or her office, Medicare pays 106 percent of its average selling price. The doctor keeps the extra as compensation for administering the injection.

What has this got to do with eye doctors? The drug Lucentis, used to treat macular degeneration, cost Medicare almost $2,000 a shot in 2012. Another drug, Avastin, which works just as well, costs about $50. If you were the doctor, faced with a system that pays you 6 percent of the drug’s cost, which would you choose? That Medicare spent a total of about $1 billion on Lucentis in 2012 suggests most ophthalmologists went with the more expensive one.

It gets worse:

This problem goes beyond a single drug. Of the $20 billion Medicare spent on drugs administered by doctors in 2010, 85 percent went to the 55 most expensive ones. In what seems unlikely to be a coincidence, 42 of those drugs also showed an increase in use from 2008 to 2010.

Tax Preparers Earned Bounties to Sign People Up For ObamaCare

 

ObamaCare’s open enrollment was supposed to close on March 31. Then it was extended to April 15 — Tax Day. The Administration chose that date for a deliberate purpose: Tax preparers were paid to enroll people in ObamaCare. The Administration has a number of ways to pay people who are not licensed insurance agents or brokers to recruit ObamaCare applicants. A self-employed tax preparer of my acquaintance told me that his tax-preparation software vendor offered him $50 “per scalp” that he enrolled in ObamaCare. (Here’s the vendor’s website offering “referral fees“.)

Twofer: Ryan’s Medicare Plan Saves Taxpayers $20 Billion and Reduces Seniors’ Premiums

 

Paul Ryan keeps making his Medicare reform proposal more politically palatable, while still saving money all around:

08Ryan’s plan has gone through several versions, but all of them have been based on the old bipartisan idea of “premium support.” The idea was that instead of paying for senior citizens’ medical services directly, the federal government would help them purchase private coverage plans.

The CBO still projects savings for the federal government — $15 billion — but it shows that beneficiaries will pay less, too.

(Ramesh Ponnuru, Bloomberg View)

Hits and Misses

 

Woman Using Exercise MachineIs the motivation to exercise in your genes?

Does marijuana wreck your brain? Or was the study so much hype?

Readmissions: They may not be the hospital’s fault.

After years of failed attempts, researchers have finally generated stem cells from adults using the same cloning technique that produced Dolly the sheep in 1996.

About 16% of people who die in traffic crashes in the U.S. are bikers or pedestrians. Phoenix and Fresno are the worse cities for bikers. Detroit and Miami are the worse for pedestrians.

Politicizing the Census: In 2009, Obama’s Nominee for Commerce Secretary Quit Because of This

 

WSJ‘s James Taranto has dug into the Washington Post‘s archive to discover that Obama’s 2009 nominee for Commerce Secretary bailed out because of this:

Sen. Judd Gregg said today that his decision to withdraw from consideration for commerce secretary was due in part to his concern with the Obama administration’s decision to have the next Census director report to senior White House staffers as well as the commerce secretary.

In a statement announcing his withdrawal, Gregg cited the administration’s Census decision as one of two “irresolvable conflicts for me” that he said were not adequately discussed before he accepted Obama’s nomination.

Good News for the Uninsured

 

Uninsured patients who seek trauma care at a Healthcare Corporation of America hospital will no longer be charged a special trauma fee, which sometimes added as much as $30,000 to their bills…

“Even so, waiving the trauma fees for uninsured HCA patients might have little impact. Hospitals generally collect only a portion of what they bill patients. And the amount collected from uninsured patients — compared to those covered by auto or health insurance policies — can be tiny.”

HCA told the newspaper that their hospitals collect $300 on average from uninsured patients. (More)

To Be Governed

 

elderly-man-worriedA long list of services do qualify as preventive care under the Affordable Care Act, including vaccinations and screenings for diabetes, depression, high blood pressure, high cholesterol and several cancers. Most insurers will cover one such preventive visit per year with no charge to the patient.

But care related to existing health problems, or new issues, is considered “evaluation and monitoring,” not preventive…

Some offices now ask patients to schedule separate annual visits — one for preventive care (with no out-of-pocket cost) and one to discuss problems (with the usual deductible and copay). Medicare also encourages preventive care with its annual free “wellness” visits. But when elderly patients learn they can’t bring up ongoing health issues at such a visit without being charged, many don’t bother, doctors say. (WSJ)

Why ObamaCare is Never Likely to be Popular

 

Jonathan Bernstein at Bloomberg View:

Caduceus with First-aid KitFor most of us, ObamaCare isn’t that visible, and the benefits often are the least visible part. The biggest winners are probably those on expanded Medicaid, and I’m confident many of them don’t know they were helped by ObamaCare. Don’t expect it to get better; it’s going to be less and less likely that people will identify the benefits they are receiving with “ObamaCare.” In five years, plenty of those in the exchanges won’t realize that under the old system they would have had a pre-existing condition that would have barred them from being insured. Even if they realize that such a restriction once existed, they almost certainly won’t realize that their minor medical condition would have qualified.

Given all that, once Republican opposition guaranteed that the ACA would be controversial it was likely that it would poll badly, even if it worked well — and even if it worked so well it couldn’t be repealed.