Archive for the ‘health reform’ Category

Obamacare = Medicaid

Friday, May 8th, 2015

emergency

I have been interested in health care reform for some time and have proposed a plan for reform. It is now too late for such a reform as Obamacare has engaged the political apparatus and sides have been taken. The Obamacare rollout was worse than anticipated and it was hoped that the Supreme Court would have mercy on the country, but that didn’t happen and it has been the law for two years.

What has it accomplished ? Well, the forecast drop in ER visits hasn’t happened. It also didn’t happen in Massachusetts when that plan took effect.

Wasn’t Obamacare supposed to solve the problem of people going to the ER for routine medical problems? We were told that if everyone had “healthcare” — either through the ACA exchanges or through Medicaid expansion — people would be able to go to their family doctors for routine care and emergency rooms would no longer be overrun by individuals who aren’t actually experiencing emergencies.

As it turns out, Medicaid patients can’t get appointments with physicians.

“America has severe primary care physician shortages, and many physicians will not accept Medicaid patients because Medicaid pays so inadequately,” said Michael Gerardi, MD, FAAP, FACEP, president of the ACEP.

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Gruber’s lies.

Wednesday, December 10th, 2014

The left does not do economics. They do politics and elections and lying to get past the “stupid voters” but, when pressed, nothing they do qualifies as numerically or mathematically sound. Social Security worked until everyone found the queue and until Congress raided the trust fund in the 90s.

Obama and the Democrat leaders knew that Hillary made enemies of the insurance companies in 1992. The insurance companies funded devastating TV ads with “Harry and Louise” that cost the Democrats Congress in 1994. Therefore, they had to do what was necessary to get the insurance companies “inside the tent pissing out and not outside the tent pissing in” in Lyndon Johnson’s immortal words.

Insurance companies have considered health insurance a loser for 25 years now. What they prefer is becoming “Administrative Service Organizations” which administer self funded health plans by employers.

Corporate benefits include- organizing/ negotiating health insurance, group dental, STD, LTD, life, etc.

The plan the Democrats came up with, with Gruber’s help, was to make the government the funding entity and pay the insurance companies to run the program. That way everybody is happy, except, of course, the taxpayer. The taxpayer does not like tax increases which would be needed to pay the bills. Therefore the taxpayer has to be fooled.

The excise tax on high-cost health plans was among the many fees and taxes proposed as offsets to help slow the rate of growth of health costs, particularly premium growth, and finance the nationwide expansion of health coverage. When the Affordable Care Act was signed into law in March 2010, its coverage provisions were estimated to cost more than $900 billion over the next decade, from 2010 to 2019, and were to be paid for by fees and taxes on both individuals and businesses. At the time the health reform bill passed, the excise tax on high-cost plans was estimated to raise roughly $32 billion in revenue over the next decade, or by 2019.

Without the taxes to pay the bills, the whole plan collapses. At its base, Obamacare is Medicaid for everyone. The employer mandate has been, contrary to the text of the law, postponed as the flaws in implementation appear. If it were to be enforced, there would be a revolution. The funding from employee plans is called “The Cadillac Tax which is an excise tax on employer plans that exceed the benefits of Medicaid.

As health coverage expands to tens of millions of Americans–through Medicaid expansion in states and the new state health insurance exchanges that will soon begin selling individual health coverage–some Americans with employer-sponsored health coverage are seeing their benefits decrease.

One of the most significant, and controversial, provisions of the Affordable Care Act is the new excise tax on high-cost health plans proposed to both slow the rate of growth of health costs and finance the expansion of health coverage. The provision is often called the “Cadillac” tax because it targets so-called Cadillac health plans that provide workers the most generous level of health benefits. These high-end health plans’ premiums are paid for mostly by employers. They also have low, if any, deductibles and little cost sharing for employees.

If this is ever implemented, the Medicaid-for-all nature of Obamacare will become obvious. That’s why it will not happen. The fundamental premise behind Obamacare is not viable. That is why it will fail and the numbers do not add up.

Gruber can’t say this. All he can do is obfuscate.

Medicaid for All

Saturday, November 1st, 2014

My concept of Obamacare has been that it is a transition period to a single payer that will be Medicaid for everybody. Belmont Club (Richard Fernandez) seems to agree.

One of most fascinating things about the failure of Obamacare is it has occasioned the rise of private exchanges, which are now on track to completely dwarf the public Healthcare.gov exchanges. Obamacare is becoming Medicaid for all. That is where all their expansion is coming from, the metal plans it offers, not so much.

The abolition of employer-provided insurance has led companies to simply give workers money to purchase their own health care on a private exchange. Urgent care clinics are booming because they charge much less than Obamacare network prices when a policy holder has not yet reached his deductible. What is repealing Obamacare is that people are working around it, according to their preference. Vermont, for example, is creating a single payer health care system. The Left approves, but it is a rejection of Obamacare just the same.

Thus, private money offsets legal tender. Private security replaces public safety. Private armies replace the United States Armed Forces. Private exchanges replace public exchanges. In the end, only the poor will be left with the public stuff.

I have been of this opinion since the beginning.

At least 2.9 million Americans who signed up for Medicaid coverage as part of the health care overhaul have not had their applications processed, with some paperwork sitting in queues since last fall, according to a 50-state survey by CQ Roll Call.

Those delays — due to technological snags with enrollment websites, bureaucratic tangles at state Medicaid programs and a surge of applicants — betray Barack Obama’s promise to expand access to health care for some of the nation’s most vulnerable citizens.

As a result, some low-income people are being prevented from accessing benefits they are legally entitled to receive. Those who face delays may instead put off doctors appointments and lose access to their medicines, complicating their medical conditions and increasing the eventual cost to U.S. taxpayers.

Democratic lawmakers who have promoted the law’s historic coverage expansion are wary of acknowledging problems that hand opponents of the Affordable Care Act another rhetorical weapon, said Robert Blendon, a professor at Harvard University School of Public Health and Kennedy School of Government.

That was a year ago.

What now ? The Heritage Foundation has a post about the Medicaid expansion that is Obamacare.

Heritage research shows 40 of 50 states would see increases in costs due the Medicaid expansion. If all states expand, state spending on Medicaid would increase by an estimated $41 billion by 2022.

The costs are being shifted to the states. Will that work ?

Analysis by Heritage shows that by 2022 any projected state savings are dwarfed by costs. Moreover, these projected savings assume states will further reduce payments to hospitals and clinics for uncompensated care. But, as Heritage’s Ed Haislmaier points out, it is more likely that hospitals will lobby state legislatures for more money rather than less.

It all depends on cutting reimbursement to providers. Is that likely to increase access for anyone ?

What it will do is shift those who can afford to pay into a parallel system of cash clinics and practices, Which I have predicted.

There have been other suggestions but it is unlikely that any great reform would be tolerated now after the failure of the Democrats’ attempt.

Instead, I think the Republican Congress should pass legislation to make Obamacare voluntary and let the ,market works things out.

New developments at Mission Hospital

Wednesday, October 15th, 2014

A few months ago, I described the hospital where I used to practice and what was happening there recently.

Now, we have some new developments.

A couple more years went by and I learned that the hospital had laid off the low wage “environmental services” workers who cleaned the operating rooms between cases. Nurses, who made three or four times the hourly wage of the cleaning staff were now expected to clean rooms between cases in addition to their other duties.

That practice continued and now has caused severe problems. Last week, I learned that the Joint Commission on Accreditation of Hospitals had visited the hospital and had withdrawn the accreditation from Surgery, Labor and Delivery and Cardiology services. These are the heart of the acute care hospital. The reason ? Let’s read the paper.

From todays Orange County Register.

All elective surgeries at Mission Hospital, the third-largest hospital in Orange County, are on hold after four patients who underwent orthopedic operations developed infections.

The hospital opted to close its 14 operating rooms in Mission Viejo and Laguna Beach last week after a major accrediting agency, The Joint Commission, intervened and found, among other problems, high temperatures and humidity in some of the rooms, according to Chief Medical Officer Dr. Linda Sieglen.

If those infections were in patients undergoing total joint replacements, they are disasters for those patients. The cost of laying off those room cleaners has finally come home.

The scandal, and that is what it should be, is deeper than that story suggests. Surgeries are being shifted to other hospitals and doctors are going to have to make changes in their practices. Relationships may change permanently.

It is frustrating and infuriating to see the great hospital we built up in the 1970s, reduced to a news story about poor care as the result of ignorant and corrupt administrators.

Medicine is coming to be a government benefit.

Sunday, August 3rd, 2014

Obamacare is having serious trouble as I have discussed. The success stories, like California, are an example of what I have called Medicaid for All.

“It’s a total contradiction in terms to spend your public time castigating Medicaid as something that never should have been expanded for poor people and as a broken, problem-riddled system, and then turn around and complain about the length of time to enroll people,” said Sara Rosenbaum, a member of the Medicaid and CHIP Payment and Access Commission, which advises Congress.

Most of the new enrollees are Medicaid members and those enrolled in “private insurance” learn that they have severely restricted choice of doctor or hospital.

Now we have a new development.

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What next for health reform?

Saturday, July 26th, 2014

It looks to me that the Supreme Court will have little justification for continuing the Obamacare program as it exists. The Halbig decision should kill it off. It is clear that the IRS subsidies to federal exchange subscribers are illegal.

The only statement anyone has found in the legislative history that addresses this point comes from the Act’s lead author, who affirmed that Congress did intend to withhold tax credits in federal Exchanges. During a September 23, 2009, mark-up of his bill, which ultimately became the PPACA, Senate Finance Committee chairman Max Baucus (D-MT) refused to consider a Republican amendment regarding medical malpractice on the grounds it fell outside the Committee’s jurisdiction. Sen. John Ensign (R-NV) protested, asking how Baucus’ bill could do other things that lie outside the Committee’s jurisdiction, like direct states to create Exchanges. Baucus responded the bill creates tax credits, which are within its jurisdiction, and makes eligibility for those tax credits conditional on states creating Exchanges. Conditional necessarily means that Baucus intended to withhold tax credits in states that did not create their own Exchanges.

I just don’t see how the Court can ignore that history. The political left has been on a rant about Congressional intent since the decision was announced.

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An Update on Medical Reform

Monday, July 21st, 2014

Cash medical practice or, in the phrase favored by leftists critics, “Concierge Medicine,” seems to be growing.

Becker is shifting to a new style of practice, sometimes called concierge or retainer medicine. With the help of a company that has been helping physicians make such shifts for over 13 years, he will cease caring for a total of 2,500 patients and instead cut back to about 600. These patients will pay an annual fee of $1,650. In exchange, they will receive a two-hour annual visit with a complete physical exam, same-day appointments, 24-hour physician phone access, and personalized, web-based resources to promote wellness.

The article suggest that all these doctors choosing to drop insurance and Medicare are primary care. Many are but I know orthopedists and even general surgeons who are dropping all insurance.

The concierge model of practice is growing, and it is estimated that more than 4,000 U.S. physicians have adopted some variation of it. Most are general internists, with family practitioners second. It is attractive to physicians because they are relieved of much of the pressure to move patients through quickly, and they can devote more time to prevention and wellness.

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New developments at the hospital where I used to practice.

Friday, June 27th, 2014

When I moved to Orange County in 1972, I joined a friend from my surgery residency in practice at a new hospital that had opened a year before. It was called “Mission Community Hospital,” and was owned by a group of doctors with one of the partners an owner of the new development of Mission Viejo. His name was Richard O’Neill and his family had developed Mission Viejo from part of their huge ranch.

The hospital was small with 110 beds total and the staff was made up of young doctors who had recently finished their training like me. The owners were mostly older doctors and practiced in another area of the county. Some of them we would not have allowed on the staff if they had applied. They largely left us alone and over a period of a few years we developed what we thought was the best hospital in Orange County.

Mission Hospital in 1975.

Mission Hospital in 1975.

This is what the hospital looked like in 1975. The swallows used to nest in that entry area. To the right of the entry, there was a doctors’ parking lot and, for a while, the hospital paid a kid to wash our cars. Tom and I always tipped him extra. The food in the doctors’ dining room was free and good and I got a bit pudgy. The hospital went to considerable trouble to make it friendly to doctors and we responded.

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Medicaid for all.

Thursday, June 5th, 2014

Obamacare has had its problems in implementation but the real problem is the fact that it has severely distorted the health care market by forcing people into narrow high cost markets that do not reflect the real situation in American health care. I have previously expressed my opinion on how to do health reform.

American health care has been distorted by the type of “insurance” that was brought into effect by employer-based insurance. That is prepaid care, not insurance as we know it in every other market.

The history of American health insurance is greatly distorted.

Now we have this latest iteration of the failure of the Obamacare method and the alternatives.

I have believed for some time that what we see is a system of Medicaid for all. The benefits are skewed by politics and the market mechanisms are crippled. Now we see the situation is even worse.

At least 2.9 million Americans who signed up for Medicaid coverage as part of the health care overhaul have not had their applications processed, with some paperwork sitting in queues since last fall, according to a 50-state survey by CQ Roll Call.

Those delays — due to technological snags with enrollment websites, bureaucratic tangles at state Medicaid programs and a surge of applicants — betray Barack Obama’s promise to expand access to health care for some of the nation’s most vulnerable citizens.

As a result, some low-income people are being prevented from accessing benefits they are legally entitled to receive. Those who face delays may instead put off doctors appointments and lose access to their medicines, complicating their medical conditions and increasing the eventual cost to U.S. taxpayers.

Democratic lawmakers who have promoted the law’s historic coverage expansion are wary of acknowledging problems that hand opponents of the Affordable Care Act another rhetorical weapon, said Robert Blendon, a professor at Harvard University School of Public Health and Kennedy School of Government.

What is going on ?

Meanwhile, Republicans usually eager to criticize the Obama administration or states for implementation problems risk looking hypocritical by showcasing the Medicaid waits. Many oppose expanding the program to people with incomes as high as 138 percent of the federal poverty line, as the law allows states to do, and are loath to demand more efficient enrollment to achieve that goal.

“It’s a total contradiction in terms to spend your public time castigating Medicaid as something that never should have been expanded for poor people and as a broken, problem-riddled system, and then turn around and complain about the length of time to enroll people,” said Sara Rosenbaum, a member of the Medicaid and CHIP Payment and Access Commission, which advises Congress.

Oh OK.

Updated numbers provided by Bataille indicate that the total number of people affected remains about the same as reflected in the document. About 1.2 million have discrepancies related to income; 505,000 have issues with immigration data and 461,000 have conflicts related to citizenship information.

Many years ago, I was still interested in health policy research. I had an office at UC, Irvine and Orange County, where I live, was undergoing a transition from fee-for-service Medicaid (MediCal in California) to a new HMO-based program called Cal OPTIMA. This seemed a good opportunity to study the outcomes in two contrasting systems for the same population. No studies had been done to see how the MediCal Population would repond to the different incentives of fee-for-service and HMO. I developed a proposal to study this transition at a time when databases for both systems were available. The data from the fee-for-service program was still current and the new HMO program would provide the opportunity to see how the MediCal patients fared under the new program. I had obtained the cooperation of the UCI statistics department and had had some experience with this sort of study at Dartmouth where I had recently compacted a Masters Degree program in health policy research.

The Orange County Health Department had hired the recent director of HCFA, the Medicare intermediary. Funding was available from a large endowment fund devoted to the study of low income California residents’ health care. The organization was called “The California Endowment” and was funded when Blue Cross became a for-profit entity and was obliged by the state to donate a large sum to charitable causes.

The proposal is here.

All that was needed was the approval of the Cal OPTIMA program to use their data. All the funding was assured.

They refused. I wonder why ?

The Depression may be here.

Tuesday, February 4th, 2014

I have believed for some time that we were entering another Depression. I have previously posted about it.

The Great Depression did not really get going until the Roosevelt Administration got its anti-business agenda enacted after 1932. The 1929 crash was a single event, much like the 2008 panic. It took major errors in economic policy to make matters worse. Some were made by Hoover, who was a “progressive” but they continued under Roosevelt.

I posted that statement elsewhere and it got a rather furious rebuttal. I still believe it. What is more, I am not the only one. Or even only one of two.

The second article preceded the election of 2012 but is still valid.

When employment hit an air pocket in December, most analysts brushed off the dreadful jobs number as an anomaly, or a function of the weather. They chose to believe Ben Bernanke rather than their lying eyes. It’s hard to ignore a second signal that the U.S. economy is dead in the water, though: on Monday the Institute for Supply Management reported the steepest drop in manufacturing orders since December 1980:

fredgraph

In January, only 51% of manufacturers reported a rise in new orders, vs. 64% in December. Not only did the U.S. economy stop hiring in December, with just 74,000 workers added to payrolls; it stopped ordering new equipment. The drop in orders is something that only has occurred during recessions (denoted by the shaded blue portions of the chart). The Commerce Department earlier reported a sharp drop in December orders for durable goods. In current dollars, durable goods orders are unchanged from a year ago, which is to say they are lower after inflation.

So, the economy stopped hiring, even at the poor pace the past five years have seen, but business also stopped buying.

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