Author Archive

Zeke Goes Off the Rails

Ezekiel Emanuel, Rahm’s brother and one of the key ObamaCare advisors, has been on quite a roll lately. Consider some of the headlines just from the past few weeks or so –

  • “Insurance Companies as We Know Them Are About to Die” (New Republic)
  • “In Health Care, Choice is Overrated” (The New York Times)
  • “You Don’t Need a Doctor for Every Part of Your Health Care” (CNSNews write up of a Bill O’Reilly interview)
  • “Inside the Making of ObamaCare” (Wall Street Journal)
  • “Progress with Caveats: At least 12 million have received coverage directly through a provision of the law” (Wall Street Journal)

In every instance his message is that he knows better than you do what is good for you. He knows a better way to do insurance than you do, he knows that you don’t really need a choice of doctor or hospital, he knows that you don’t really need a doctor at all for most services, and he knows that “things are actually going well” for ObamaCare despite the fact that you and most Americans don’t like it.

One has to wonder what is going on with this guy. Why is he so confident in offending so many Americans? Either he is triumphant in the idea that what we think doesn’t matter anymore because Obama is firmly in control of our future, or he knows that ObamaCare is such a disaster that he can finally say any damned thing he wants because none of it will ever happen anyway.

Why Bundled Payments Aren’t Working

The New England Journal of Medicine recently ran an article by Clay Ackerly, MD, and David Grabowski, PhD, calling for “Post-Acute Care Reform.”

They use a (presumably) fictional patient to illustrate the problems with the current payment system:

Mrs. T. is an 88-year-old woman who lives alone, has a history of congestive heart failure and osteoarthritis, and has traditional fee-for-service Medicare coverage. One day, she was found lethargic and sent to the emergency department, where she was discovered to be in renal failure and was admitted to the hospital for fluids and monitoring. Her hospitalist concluded that she had accidentally overdosed on Lasix (furosemide). On hospital day 2, Mrs. T. was having difficulty ambulating, although her cognition and renal function had improved and she felt “back to her old self” and was eager to go home.

What to do?

HIT Apologia

Health Affairs recently announced its top 15 articles for 2013, and has made them available to nonsubscribers.

The top article was by a pair of RAND researchers updating what is known about the health information technology (HIT) roll out from the 2009 HITECH law, appropriating $20 billion to upgrade information technology throughout the health care system.

It doesn’t take long ― like just the abstract ― to figure out that people haven’t learned a blessed thing from flushing $20 billion down the toilet. Here’s the complete abstract with my comments −

A team of RAND Corporation researchers projected in 2005 that rapid adoption of health information technology (IT) could save the United States more than $81 billion annually.

This original “study” was horrendously flawed. They deliberately chose (and said so) to ignore any contra information, basing their projections on a best possible scenario that couldn’t possibly come true in real life. In the latest report:

Seven years later the empirical data on the technology’s impact on health care efficiency and safety are mixed, and annual health care expenditures in the United States have grown by $800 billion.

I’m sorry, so sorry
Please accept my apology

Physician Capacity

A little while ago Scott Gottleib and Zeke Emmanuel co-authored an op-ed in The New York Times pooh-poohing the concern about physician shortages.

So certain are they that conventional wisdom is wrong that the piece is headlined, “No, There Won’t be a Doctor Shortage.” Right, and “if you like your health plan, you can keep your health plan — period”. Somehow such bold assertions have lost a bit of their luster over the past few months.

Now, they acknowledge that an aging population and the prospect of 30 million newly insured people may make it seem like there might be a problem, and the Association of American Medical Colleges says their members aren’t able to train enough physicians to fill the need, but what do they know about physician supply? Gottleib and Emmanuel know better.

As Exhibit 1, they look at Massachusetts. They write –

Take Massachusetts, where ObamaCare-style reforms were implemented beginning in 2006, adding nearly 400,000 people to the insurance rolls. Appointment wait times for family physicians, internists, pediatricians, obstetricians and gynecologists, and even specialists like cardiologists, have bounced around since but have not appreciably increased overall, according to a Massachusetts Medical Society survey.

Help.
I need somebody.
Help.
Not just anybody.

The Next Wave

Employers are already starting to get the same cancellation letters that went to millions of people in the individual market late last year. The Washington Post reports that the big surge should take place in October, but it will happen all through the year as employer plans come up for renewal.

shutterstock_160789127Contrary to many press reports this affects not just the small group market, but all fully-insured health plans. Very few meet the requirements of “essential benefits” of ObamaCare, which include things like pediatric dental coverage.

The Washington Post article tried to minimize the effects, quoting Jonathan Gruber, one of ObamaCare’s archictects –

“We’re ending discrimination [against people who are sick, and as a result] the people who were previously benefiting may now suffer,” Gruber said. “That’s sad for them, but it does not mean we should continue discrimination.”

He concludes that the number of losers will be “very, very small.” Right.

Writing in the New York Post, Betsy McCaughey does a pretty good job of rebutting Mr. Gruber. She estimates the number of people who will lose coverage is 25 million, which is the same estimate I’ve been using for some time now. But even she understates the problem by focusing entirely on the small group market.

Risk Adjustments in ObamaCare

Most of the commentators on the exchange roll out caution against the “death spiral,” in which failing to attract the young and healthy raises overall premiums. This further deters low-cost people from enrolling, resulting in even higher premiums.

This is absolutely true in a normal market. But a new report from the actuarial consulting firm Milliman shows how the Affordable Care Act has turned normal market principles on their head.

Here is the problem. Because health insurers are no longer allowed to ask any questions about an applicant’s health, they have absolutely no way of knowing who they are enrolling in terms of past or present illnesses or health conditions. They might attract a group of pretty healthy people or a group of pretty sick people, but they won’t know until people start filing claims. So it is impossible to accurately set premiums, at least for the first few years.

Another problem is that some insurers may attract a whole lot of very sick people while others attract mostly healthy people. In a particular state BlueCross may be known as the best place to go if you have cancer or heart disease, while Aetna may be famous for its discounts on gym memberships. The healthy people will be drawn to Aetna while the really sick people prefer the Blues. If companies could set premiums to accurately reflect their enrolled population, BlueCross premiums would be outrageously expensive while the Aetna premiums would be cheap.

ObamaCare tries to fix these problems in several ways.

Health Savings Accounts: Ten Years On

On a wintery Monday night in Washington about 70 people gathered at a banquet to celebrate the tenth anniversary of the signing of Health Savings Accounts into law.

HCCS-13NovDec-HSA-featureFittingly, the dinner, organized by the National Center for Policy Analysis (NCPA), was held in the O’Byrne Gallery of the DAR’s Constitution Hall where President Bush signed the law on December 8, 2003.

Represented were many of the people who conceived of the idea in the 1980s, the policy staff and legislators who enacted the first Medical Savings Accounts (MSA) law in 1996, the entrepreneurs and regulators who took the concept and created Health Reimbursement Accounts in 2002, and the companies who have turned the law into the products and services that benefit tens of millions of people today.

NCPA President John Goodman, who is often referred to as “the father of HSAs,” and myself opened the commemoration with a tribute to the late J. Patrick Rooney, Chairman of Golden Rule Insurance, who did more than anyone else to popularize the idea and shepherd it through the legislative hurdles.

Health Sharing Groups Grow

A 2011 survey found 8 out of 10 Christians are unaware of health sharing ― an alternative to health insurance. CCHF has long been talking about health sharing, including on radio interviews and in our new ”Legal Alternatives“ flier, which lists it as one of nine exemptions to the ObamaCare insurance mandate. Interest is growing. Since open enrollment began, Medi-Share had more timthumbthan 23,000 people asking for information in October alone, and 2,108 people joined. Samaritan Ministries, which routinely shares about $6 million in medical needs each month, received 754 new household enrollments in October, which added up to 2,483 individuals. Medical sharing is far less expensive than health insurance and exceedingly more personal. Read our 2010 report on health sharing. See comparison chart for two of the three ministries. Read personal stories.

Schizophrenia about High Deductibles

You may remember that when Health Savings Accounts were introduced there was almost universal outrage among liberals about the horrendous burden cost-sharing places on all but “the healthy and wealthy.” A press release issued by the Center for Budget and Policy Priorities (CBPP) within a week of the Ways and Means committee approving an HSA bill in 2003 said –

This legislation would lead many employers to move away from providing low-deductible comprehensive insurance, noted Edwin Park, a senior health policy analyst at the Center and the report’s lead author. Policies with deductibles of $1,000 or more, higher co-payments for medical services, and coverage for a narrower array of health services could well become the norm for employer-sponsored coverage, with employers expecting their workers to pay uncovered costs out of their tax-favored Health Savings Security Accounts, Park stated.

Low- and moderate-income workers, who would benefit little from the tax breaks that the new accounts would provide, and older and sicker workers, who could face large increases in out-of-pocket health care costs as a result of the loss of comprehensive insurance, could be sharply affected, he added.

How Do We Salvage This Wreck?

While all the analysts and pundits in the Capitol City are calculating the political consequences of the ObamaCare bomb, out here in the country we see things differently.

We care less about who is up and who is down for the November, 2014 elections than the fact that our friends and neighbors are getting cancellation notices for the insurance coverage they have. On January 1, 2014 they will be uninsured, and there is nowhere for them to go. There are some 16 million of these people with individual coverage across the country. Rather than reducing the number of uninsured, ObamaCare will add 16 million from the individual market alone and who knows how many more from employers dropping coverage.

Cartoon-Huge-Train-Wreck-6001These folks have been faithfully paying premiums for years. They have taken responsibility for their own situation. They haven’t gotten handouts and are not looking for any. But ObamaCare suddenly requires insurance contracts to cover a whole bunch of things they have no need for, like pediatric dental services or in vitro fertilization. Plus, the requirements for guaranteed issue and community rating have dramatically raised the cost of coverage. Obama has turned the entire country into New Jersey where similar requirements made even catastrophic coverage cost $1,900 a month for a single male.