Friday, May 24, 2019

Outcomes vs Costs


Yup.

But: #NarrativeUberAlles

Gentlemen: Start your ... needles?

Courtesy FoB Holly R:

"Some fans attending Sunday's Indianapolis 500 can get measles vaccines at the track's infield medical center."

This comes as the CDC has issued a warning about the increasing incidence of the once-eradicated disease:

"From January 1 to April 26, 2019, 704 individual cases of measles have been confirmed in 22 states including Indiana. This is an increase of 78 cases from the previous week."

At least one fan's not worried though. Local Indy aficionado Mike Dean's theory is "I think if you drink enough beer, it kind of inhibits the measles virus, so that’s been my defense."

Heh.

Thursday, May 23, 2019

Gleaner Life: "Give and Grow" 2019

We've mentioned before how Gleaner Life gives back to its community of policyholders and their families:

"These "Give and Grow Grants" put real dollars directly into the hands of folks who want to help "to improve their communities through volunteer service projects."

Well, they've just announced this year's recipients, all 100 of them (Wow!), will split almost a quarter of a million dollars to help with college (and/or other post-secondary) education expenses.

The competition is available to Gleaner life clients and their families, and:
Applicants are scored individually in six basic areas:

1. Academic record
2. Leadership
3. Quality of activities and community involvement
4. Letters of recommendation
5. Explanation of financial need
6. Overall quality and completion of the application
Sweet!

Wednesday, May 22, 2019

MedicaidForAll: A preview

Shot:
Chaser:

Tuesday, May 21, 2019

GoodRx for Healthcare?

A while back, our Jack Russell-mix puppy had knee surgery, and the doc prescribed 4 (yes, four - I told you she's a Jack Russell-mix) meds for her. Buying them from the vet got expensive pretty quickly, and they recommended the folks at GoodRx. This is a site (and an app) where you can procure coupons for various meds, often saving significant dollars.

This helped a lot with Maddie's meds, and we've since used it for our own. It's easy and efficient, and even better, it's free.

Well, seems like the basic idea is really taking off:

"Discount medical shopping site launches in Kansas City ... has gone live with the test version of sesamecare.com."

We've seen this model before, of course:

"Must See TV featured an interview with Dr. Keith Smith where he outlined the unique practice at the Surgery Center of Oklahoma.The hospital operates on a cash only basis."

The Sesamecare site takes the reduced-fee, cash only model and expands it to include primary care and dental visits, eye exams and MRIs, and other services. According to the site, over 100 providers offer over 600 services, from OB-GYN to dermatology, even cardiology services. Pretty expansive.

And of course, since patients know the price of services upfront, and there's no insurance involved, there's no worry about what they will ultimately cost.

Unlike Direct Primary Care or sharing ministries, these services will generally be HSA-eligible, which also helps to offset the fact that there's not going to be much (if any) insurance reimbursement (depending on whether your plan is a PPO or an HMO).

So far, the service is available only in Kansas City [ed: I've heard that everything's up to date there], but perhaps we'll eventually see it rolled out in other markets.

Kudos!

[Hat Tip: Dr Gina Reghetti]

Monday, May 20, 2019

Thursday, May 16, 2019

Evergreen State Long Term Care

So the great state of Washington has passed legislation implementing what appears to be the first "Social-Insurance Program for Long-Term Care" in the nation.

Cool.

But what, exactly, does that mean?

Well first, let's look at what this plan isn't:

It is not an individually owned, Partnership Compliant long term care insurance plan (it's not, in fact, 'long term care' coverage at all, but we'll circle back to that). That's not to say it's evil, fattening or carcinogenic, just noting its limitations.

On the other hand, it's also not the late, unlamented CLASS Act, so it actually seems to have some decent value, especially relative to cost.

Okay, that's nice, Henry, but what is it?

Pretty simple, really:

"All residents will pay 58 cents on every $100 of income into the state’s trust. After state residents have paid into the fund for ten years—three if they experience a catastrophic disabling event—they’ll be able to tap $100 a day up to a lifetime cap of $36,500 when they need help with daily activities such as eating, bathing, or dressing."

That is, they'll be eligible to receive up to a year of extra help with common tasks (assuming care costs $100 a day, and this amount increases each year). Which is, quite frankly, pretty remarkable. And at a tax rate of about 6/10th's of 1%, quite affordable. Given the state's average income of $70,000, that comes to about $400 a year per taxpayer.

So, is this a good deal?

Depends, no?

I'm ambivalent as to its likely result:

On the one hand, as it relates to encouraging folks to at least discuss the idea of long term care (and insuring it, obviously), raising awareness, I think that can be good.

What I'm afraid of, though, is that it will give folks a false sense of security as to the need to self-insure. I see this quite a bit with folks who think "oh, I don't need LTCi, Medicare will pay for it."

Uh, no, no it won't.

But a lot of folks believe that it does. And I'm concerned that folks will think that this is indeed Long Term Care insurance when it's not even really Short Term Care coverage.

On the gripping hand, it may well be all that many (most?) Washingtonians want, or need, or even qualify for.

Then here's this: proponents say that "[a]ll working people will pay into the fund through a payroll tax and then be able to claim a benefit when they need it."

Oh, really?

Then what happens if I pay into the plan for 20 years, and then decide to retire to Florida?

Time will tell, no?

[Hat Tip: Bill Comfort]

Wednesday, May 15, 2019

From the 'Be Careful What You Wish For' Files




A portent of MedicaidForAll.

#CanuckCareWinning

Tuesday, May 14, 2019

Bond, Dr James Bond

Just saw this report on the latest 007 outing:

"The difficult road to production on the latest James Bond film has hit another hurdle after shooting was reportedly suspended following an injury to star Daniel Craig."

The actor apparently suffered an unspecified leg-related injury during a stunt.

So what's that got to do with insurance?

Well:

"... the actor ... has been flown to the U.S. for X-rays." [emphasis added]

So apparently Her Majesty's Secret Service has no use for her Much Vaunted National Health Service©.

Hunh.

From the P&C Files: Active Shooter Insurance

So as one might imagine, this has become something of a hot topic of late. I knew we should blog on it (for all the obvious reasons), and since it's in the P&C world, I wanted to be sure that I had a firm grasp on as many of the issues as possible.

To that end, I turned to my colleague Teresa S, and we had a nice (long) chat trying to identify those issues (as best we could).

Beyond the obvious (wrongful death and medical and funeral expenses), there's counseling, biohazard cleanup, and destruction of property; in some cases, relocation and rebuilding expenses might also come into play. There's also business interruption and even Public Relations, and let's not forget off-site coverage (if the business or organization needs to rent temporary facilities).
This is not, of course, an exhaustive list.

Who and what, exactly, are being insured is also important: the institution/organization, of course, but also boards of directors, Elders, etc.

And who's eligible for coverage becomes an issue: members or students, of course, but what about guests or employees?

Generally speaking, commercial liability policies will have a list of exclusions; items not on this list are then usually covered. Typical exclusions might include acts of war and/or terror, or even more specifically mass casualty events. Which latter begs the question: what does mass casualty mean?

[ed: Turns out that, much like Tootsie Pops, the magic number is 3]

The folks at World Wide Facilities sent along a very helpful guide to their program, which includes some nice features. One thing that Teresa pointed out was that regardless of whether or not one's current commercial liability insurer even offers this coverage, it may be worth considering this kind of stand-alone plan in addition to or instead of adding coverage to the current plan. 

And, of course, what kinds of establishments might be looking for this coverage (or, maybe more critically, should be considering)? That would include:

Schools                                          Hotels
Religious Organizations                Restaurants and Bars
Hospitals                                       Sports/Recreation/Entertainment venues
Municipalities                                Events and Concerts
Retail  

Whew!

Coverage limits are generally measured in the millions (or even tens of millions). One thing I liked about World Wide's brochure was that the application itself provides a great deal of helpful hints about what to be considering:

■ Is there an on-site security detail?
■ How far away is the nearest police and/or fire department?
■ Is there an emergency preparedness plan in place, and who knows what it is (or even knows that it exists)?
■  Are there regular security drills?

And more.

The bottom line, of course, is that it's a lot easier (and more cost effective) to consider these issues and this coverage before an incident. As usual, we recommend speaking with your own agent to determine what coverage (if any) is already in place, and what's missing.

Monday, May 13, 2019

Options Denied

So got a call the other day from a couple looking for health insurance. Well, Karen was; Carl is on Medicare. Karen's 63, and a cancer survivor (Yay!!). Their current, grandfathered Anthem plan sports a $5,000 deductible, and runs about $540 a month, and that's become something of a budget burden for them. They reached out to me to see if they could get something cheaper.

After determining that they're not eligible for a Special Open Enrollment, I explained that there's not a lot that we can do for them. Yes, there are cheaper alternatives, but they're either underwritten, or exclude pre-existing conditions (or both), or offer much more limited benefits than their current plan.

Out of curiosity, I looked at the 404Care.gov site, and saw that the least expensive offering there featured a $7,900 deductible (almost 60% higher than their current plan), and cost almost $640 (about 20% higher than their current plan). They would almost certainly qualify for a subsidy, but that, too, is a moot point until the Fall.

I felt bad explaining to them that, as frustrating as it is, their current policy is the least bad alternative (at least until the next Open Enrollment period). I truly hate that, but I couldn't in good conscience recommend any other plan.

/sigh

Friday, May 10, 2019

It's a Holly Jolly Linkfest

All links courtesy of FoIB Holly R:

Scientists in Israel have discovered what appears to be a very promising treatment for epilepsy, and it comes from an unexpected source:

"Researchers at Tel Aviv University have discovered that a drug used to treat multiple sclerosis may help epilepsy patients."

Yasher koach!

On the other hand, Israel's universal health insurance system (a hybrid of public and private) isn't faring so well:

"Israel’s health expenditure is way below its OECD peers’. This leaves Startup Nation lacking beds, doctors, nurses, MRIs and CT scanners"

The country has begin a major effort on tech solutions to the problem but, well:

"... if you are in need of hospital care in Israel, you may end up, like 94-year-old Mr. Dabah or Fiasl’s mother, parked for days in a ward corridor, or waiting for hours in an emergency room."

Oy.

As we've noted before, the major benefit to Direct Primary Care (DPC) is that it "guarantees quick access to care." And  that access also means more quality time with the doc.

Which, as it turns out (unsurprisingly), is a very good thing:

"Trojanovich spent more than an hour with patient Andrew Buttrell, who says that time spent with the doctor makes a difference with his health needs."

Hunh.

Bonus Link: When is a clump of dirt *more* than what it seems?

When it holds the key to a life-saving medicine:

"In 2010, when Lilli Holst scraped a lump of soil from the underside of a rotting eggplant, she had no idea that this act would help to save the life of a British teenager, eight years later and 6,000 miles away."

This is a fascinating true medical detective story. Very cool.

Thanks, Holly!

Thursday, May 09, 2019

Don't Bogart That Ointment

So I recently had a life case go south in a weird way:

Did my usual pre-screen, which includes height, weight, any meds, any tobacco use, and the like; based on his answers (including no tobacco use), gentleman seemed to qualify for a preferred non-smoker rate. And so we submitted the application and arranged for the paramed exam. All very cut-and-dry.

Until I got back the approval .... at Preferred Smoker class.

Hunh?

So I thought "oh, he vapes or maybe had a cigar the day before." But when I called, he said no, had quit smoking years ago, but when he gets anxious he sometimes pops some nicotine gum.

Hunh.

So I called the underwriter, who said, based on the lab result, my guy's "popping that gum" a lot; enough, in fact, to kick him into tobacco use territory.

But Henry, you object, he's not using tobacco, he's just chewing some nicotine-laced gum.

Um:

"Nicotiana tabacum, the type of nicotine found in tobacco plants."

Oh.

Thing is, most folks don't make that connection: they (reasonably) believe that nicotine ≠ tobacco, because they're not smoking or chawin' it.

Which brings me forward a few weeks, to CBD oil:

"Cannabidiol (CBD) is one of more than 100 unique “cannabinoid” compounds that are found in the oily resin of the cannabis plant ... To make CBD oil, one must start with CBD-rich plant material."

Are you beginning to see a connection?

This past weekend, I had an interesting conversation with a doc who specializes in pain management and is a big fan of CBD oil and its pain-reducing abilities. He also claimed that taken topically (ointment) or even orally, one would likely not get flagged on a drug test.

I questioned this, in part because of my client's recent tobacco/nicotine experience. One of the questions on life applications is about marijuana (among other drugs) and/or extracts thereof. So I again reached out to my primary carrier's underwriter to see what he had to say, and he graciously replied:

"If the applicant is taking CBD oil, it should be noted on the application as we ask if they are taking any medication, prescribed or not. The drug testing results should be negative if they are using CDB oil.

Our concern certainly is if they have chronic pain and we would rate for this impairment
."

Which, to be fair, I hadn't even considered. So it turns out that my doc friend was right about red flags for the oil itself, but the underlying impetus for its use would be a concern. And, of course, it is a med, so needs to be noted on the application.

Interesting (at least to geeky me).


[Thanks to FoIB Rob P for the assist]

Wednesday, May 08, 2019

That was then...

I'm with Bernie:

[click to embiggen]

[Hat Tip: FoIB Sam B]

The Best/Worst Part

I've noted before that the death claim process marks the final part of the promise I made to my client when I sold him (or, of course, her) a life insurance policy:

"There is really nothing remarkable about this process; after all, everything went as it should ... And yet, there is everything remarkable about it: over the years, George paid in several thousand dollars in premiums, a mere fraction of what his widow will receive ... And in a week or so, I will be the only person in his widow's life who will be giving her money."

This was the culmination of the process, wherein I got to keep my promise to George. It is at once the worst part of my job (losing a client) and the best (bringing a check).

Yesterday, I learned of the recent death of another client: Bob had some medical issues, and was far from a spring chicken, but he was a patient, kind and friendly gent, with a ready smile and a quick wit. When we met back in '15, he said that he wanted to take care of his (much younger) wife should he pass away. His health precluded a "regular" underwritten plan, so we chose a Guaranteed Issue one from the wonderful folks at Gleaner Life. This underwriting process asked only for a pulse and a check, but had very limited death benefits for the first two years.

Since it's now 4 years later, no such restrictions apply, and so Beth will soon be receiving a check for $25,000.

Out of the blue.

Hunh?

Well, it turns out that Bob had chosen not to tell her about his purchase, and she only figured it out going through some of his paperwork and finding the policy and my card. So I was fortunate to provide a substantial, and welcome, surprise.

Feelin' pretty good 'bout that.

Monday, May 06, 2019

DIAM: How much is enough?

May is Disability Insurance Awareness Month, and as usual we'll be featuring posts about this important coverage throughout it. Here, for instance, is an online calculator, courtesy of MassMutual, to help folks try to get a handle on how much coverage they really need:

Online DI Calculator

Friday, May 03, 2019

Friday LinkFest: International Edition

As we see the effort to implement Medicaid For All (M4A) continue ramping up, it may be instructive to see how well the concept works in the real world. Case in point: Singapore. As Ari Armstrong explains:

"Singapore has a mixed system, with both public and private components. But “the government holds the cards” ... the government strictly regulates what technology is available in the country and where."

It's the ultimate exemplar of "who pays the piper calls the tune."

#BeCarefulWhatYouWishFor

Meanwhile, Sally Pipes reports on Our Neighbors To the North, specifically the folks n Nova Scotia:

"A mother in Nova Scotia living with cancer is challenging Premier Stephen McNeil to meet with her after a years-long battle with the province's health-care system."

*This* is the face of government-run health "care:"



Finally, some good news on the health/culinary front, courtesy of FoIB Holly R:

"When restaurants across America put signs in their windows vowing never to use your company's flagship product, you might have a problem."

For many years now, we've been been warned to stay away from MSG.  But that may have been a mistake:

"[X]enophobia, not science, explains the initial anti-MSG push a half-century ago that lingers today despite no definitive evidence that MSG causes sickness in humans."

Bon appetit!

Thursday, May 02, 2019

#Clawback FTW!

One more satisfied ACA victim customer:

Springtime Heads' Up

From our friends at Cincinnati Insurance:

Wednesday, May 01, 2019

Coincidence?

Shot*:
Chaser:

"May is Disability Insurance Awareness Month"

Just sayin'.

*Hat Tip: Erie Insurance

Transparency is the Word


Gotta love this headline in today’s readings: Doctors: Don’t blame me for high healthcare costs.

Lots of factors are at play when it comes to high healthcare costs. But doctors are sure of one thing: They aren’t to blame.

Physicians instead point to pharmaceutical and insurance companies as the source of high costs, according to a new survey from the University of Utah Health.”

This seems counter-intuitive: of course Doctor’s are to blame because that is who the patient pays for medical care. Yes you, the patient, pay the Doctor for your portion of the appointment, but the Insurance Company determines what is the patient’s portion.

There has been much discussion lately about making the cost of health care transparent. Most of that discussion revolves around the physician appointment and the physician charges but very little revolves around the part Insurance Companies play in determining the cost of healthcare.

To understand how vital a role Insurance Companies plays in healthcare costs, one must understand the relationship between the Provider and the Insurance Company. The Provider agrees to see all the patients in the Insurance Company’s Panel for a certain reimbursement for each Procedure Code that is billed. The Insurance Company agrees to list the Provider as an “in network” Provider and promote that Provider to their panel.

The Provider is given a list of select Codes and the reimbursement for each. Usually, the provider does not know what the reimbursement will be until the payment comes in. Since the provider does not know the exact amount he/she will be paid, charges are set high enough to ensure full payment from the various insurance companies with which the Provider is contracted. The standard charge is set at 150% or more of the Medicare Fee Schedule.

So, a Provider sets a charge high enough to get full payment and the Insurance Company pays the Provider, then why doesn’t the Provider know what the patient will pay. There are two factors:1) The reimbursement from the Insurance Company is always less than the charge (this is known as the write off) and 2) In the Insurance Contract between the Insurance Company and the Patient is defined Patient Responsibility of the cost. This includes a Deductible, Co Payment, Co-Insurance, Out of Pocket, Cost Share and a plethora of other terms to break up the Patient’s Responsibility. Based on all these breakouts, it is impossible for the doctor to know what the patient will end up paying.

Tuesday, April 30, 2019

The Much Vaunted National Health Service© Strikes Again

Entirely preventable:

Another Life Insurance Conundrum

We've previously discussed how one is prohibited from collecting life insurance proceeds on folks one has murdered:

"California dad charged with insurance fraud after he drove off cliff, killing autistic sons"

But what about a person who's a beneficiary of a life insurance policy, who then goes on to murder someone else? In other words, two completely different circumstances, connected only by the person in the middle?

The facts:

The mother of the monster responsible for last year's Parkland shootings passed away a few months prior to the tragedy. It then took about a year and a half for her life insurance claim to be processed [ed: it's unclear why the long delay]. After her death, but before the claim was paid, her son murdered his classmates and teachers.

And here's where it gets, well, murky (and we're only going to discuss the life insurance issues here):

The murderer is due approximately $430,000 from his mother's policy, and so he's about to lose access to his public defenders:

"Parkland school shooting suspect['] ...public defenders asked to withdraw from his case on Wednesday because the defendant stands to inherit more than $432,000 through an insurance policy."

Okay, that makes sense, PD's are (ostensibly) for those in poor financial straits. But this raises a few issues, as well:

If he hasn't actually received the money, then how can they withdraw?

And what if he doesn't actually receive it?

How would that work, you ask?

Well, according to the (poorly written and researched) news article:

"A judge could award the money to families of the shooting victims, some of whom have sued [the defendant] in civil court."

Really?

How would that work? These are two completely separate cases and courts: one civil, one criminal. The defendant's mother had no connection to the murders; indeed, he would have received the money before them had the claim been processed more quickly. Would he have then been forced to just hand over the cash in that circumstance? One doubts it, absent a plaintiff's win in civil court.

What would compel the insurance company to write the check to ... well, who knows? This just seems very unlikely.

Or am I missing something obvious?

(And by the way, if the judge did funnel the insurance money directly to ... whomever ... wouldn't that necessarily obviate the PD's recusal request?)

Monday, April 29, 2019

Twitter asks ... I Answer

I am not sure why, but Twitter seems to be filled lately with complaints or comments about service at their Doctor’s. To an outsider, I suppose some of the things that are done in a Doctor’s office seem inappropriate, but there really are reasons for everything that is done. I will try to answer some of the more basic questions.

Twitter Post: “Does anyone else feel like they give a full history every time you go to the doctor? I asked the girl today “maybe try writing some of this shit down.”

Reason: The Government (this will become a recurring theme) has mandated many, many questions that have to be asked once a year to ensure that you as a person are following the rules of society:

Questions such as, “Do you have a gun in the house?” My favorite answer to this one was “What does a gun have to do with a vagina?” Or, “Do you feel safe in your house?” or “Do you have fall risks?”

Sometimes the questions change based on societal changes, such as “Have you traveled to an area that had the zika virus?”

All these answers are entered into the EMR, which is uploaded to Insurances and the Government for tracking purposes.

"Why?" you may ask.

Well, falls account for the majority of Hospital Visits for elderly, costing Medicare money. If a fall can be prevented, then that is money that Medicare does not have to spend. If you do not feel safe in your house, is there a domestic violence issue, which could result in a visit to the ER which costs money? The Government (there it is again) mandates that these questions are asked once a year and then reviewed at appointments as needed.

Twitter Post: Regarding a post in an exam room explaining the difference between a problem visit and preventive visit: “From the “is it bait and switch or just dumbassery” files, this. Posted in exam room. Guarantee billing for two visits, or just some bureaucratic bullshit?”

Reason: The Government (told you this would get old) has mandated through the Center for Medicare and Medicaid Services appropriate billing. Billing is done through a series of codes defined as the Current Procedural Terminology. There are two sets of codes for Office Visits, Preventive Visits and Problem Visits. The Preventive visits are your yearly checkups to ensure you are healthy, i.e. preventive care. These visits cannot be combined with any Problems you may have, such as that rash on your foot that has been there for 6 months but you waited for your preventive visit to talk about it.

The ACA ruled that Preventive visits are paid for at 100% by Insurance companies. Since Insurance companies are paying in full for these visits, they do not want to pay for any Problems that by coding rules are financially the patient’s responsibility.

Thus, these visits are separate and identifiable from one another and must either be done at separate times or if done at the same visit, both codes are billed and you the patient will pay your portion. 

Twitter Post: There is so much turnover at my doctor’s office, new staff every 6 months.

Reason: Good employees are hard to find for any business, but healthcare is even more difficult. The reason is very simple, healthcare is hard work and pay is low. Many staff find that they can make more money in other career fields and get tired of the abuse from patients and doctors, the long hours, and the Government (yep) regulations that they must follow.

Well, that one seems easy to fix, pay the staff more.

There is one problem: Doctor’s make the money in a Medical Office and payments from Insurance Companies have not kept up with the cost of overhead. The fee schedule is based on the Government Medicare Fee Schedule, which has been kept flat since 1996. What this means is that for 20 years, the reimbursement for medical services has not significantly increased to allow for Doctor’s to stay in business. The result of this is Doctor’s selling their practice to large groups or Hospitals and salaries staying flat.

Due to Government Regulations (yep, it is here, too), the average staff to Doctor ratio is 3 staff to every Doctor. So, the Doctor must make enough money to pay his or her staff and the overhead of the medical office, we all like electricity and running water. I know of many, many offices where staff do not get raises or must take on more of the benefits costs themselves, that is if the office can afford to offer benefits.

If you have any burning questions about why your doctor’s office does something feel free to ask.

Friday, April 26, 2019

Ooooh! We get to break *another* "Embargo

Several weeks ago, I mentioned that I would now be routinely breaking so-called "embargoes" foisted upon us by self-important PR flacks:


So here's the second in this presumably on-going series:

"I’m reaching out with the embargoed news that Limelight Health, the most efficient and compelling quoting, underwriting, and proposal platform for the employee benefits industry, is announcing a unique integration with [a] global financial services provider."

Well good for them!

In the unlikely event that readers might be interested, here's the link to Limelight Health.

[Caveat clicker]

Friday FunLinks

Despite the fact that there are currently no true catastrophic health insurance plans available, Health Savings Accounts remain popular:
Very interesting.


Seems like things will have to get worse before (if?) they get better:

#Medicaid4All

Some time ago, we posted on a unique service that helped facilitate end-of-life care decisions:


The Vital Decisions service still provides "counseling services to advanced illness patients near end-of-life." And now, at least one insurance carrier is getting on the bandwagon (of sorts):
Nice.

Thursday, April 25, 2019

(Un?)Intended Consequences #1,483

About eight years ago, we noted that one of RomneyCare's explicit promises was to reduce ER visits. RomneyCare being, of course, a precursor to ObamaCare, and the ER one of the most expensive pieces of the health care pie.

Of course, that's not what happened:

"... according to a report from the Division of Health Care Finance and Policy, expanded coverage may have contributed to the rise in emergency room visits"

Why's that, you ask? Well, because "newly insured residents entered the health care system and could not find a primary care doctor or get a last-minute appointment with their physician."

Hunh.

But that was then, and this is now, and surely the ACA has tamped down on ER (over-)utilization, right?

Right??

Well, you may want to sit down for this:

Surprise!

Wednesday, April 24, 2019

Medicare, Social Security, in Trouble - AGAIN

Here we go again. Another year, another Trustee report, stating Medicare and Social Security will be insolvent in a few more years.

The solution?

Increase Medicare premiums and cut Social Security benefits.

Solving the Medicare Problem

Medicare Part B premiums are paid by Medicare beneficiaries. Most are retired. A few (like me) still work because we enjoy what we do.

But many of those age 65 and older work because they HAVE TO.

There are 160 million people in the U.S. labor force.

Currently 44 million are on Medicare.

Rather than raising premiums and cutting benefits on the 44 million on Medicare, why not RAISE TAXES on those still working?

Just saying . . .

read more - https://www.gamedicarenews.com/2019/04/23/medicare-social-security-unsustainable/

#GAMedicareExpert #GAMedicareNews


Tuesday, April 23, 2019

Tuesday Morning LinkFest

The good news is that we're starting to see real progress in the world of 3-D printed medical items, from prosthetics to tissue to actual working organs. But that latter may pose some interesting (and, perhaps unexpected) concerns. As FoIB Holly R alerts us:

"Within a decade, manufactured hearts could obviate the need for organ donations; ethicists highlight potential pitfalls along the way ... But not everybody is gung-ho about the heart breakthrough, citing ethical implications — like whether it will widen the gap between rich and poor, and whether superhuman hearts or other mutations can also be manufactured."

So far, this is all hypothetical (the 3-D printed heart is not yet functional), but that day may be fast approaching.

After all, just because we can ...

As we've often pointed out, coverage ≠ care, and one of the most significant challenges facing the Medicaid4All folks is the question of just who will provide that care:

"The CMS saw a sharp decrease in the number of providers opting out of Medicare in 2017, after several years where thousands indicated that they did not want to participate in the program."

This is what is known in the nomenclature as a "trend."

See also: "Be careful what you wish for..."

A little over 5 years ago, co-blogger Patrick sounded the alarm about "tier creep" as it relates to Actuarial Value. His thesis was that rate and cost-sharing increases were essentially baked into the ObamaCare cake:

"However, there are a few big secrets they aren't telling you - ones that year after year will negatively impact everyone. They are called actuarial value, cost sharing limits, and indexing."

I highly recommend that folks read the whole thing.

And now, half a decade later, FoIB Greg Fann continues to bang the drum:

Good (if alarming) stuff.

BONUS: Remember when they said that suspending the tax/fine/penalty mandate would result in millions of people losing their insurance?

Funny thing and (you may want to sit down for this), but that didn't actually happen:


Imagine that.

Sunday, April 21, 2019

Holy Week and Notre Dame Cathedral

I doubt there is nary a soul anywhere that is not aware that "Our Lady" of Paris, Notre Dame Cathedral, suffered a terrible tragedy this week. One does not need to be Catholic to feel at least some sense of loss.


Even those who are not religious seem to at least share a sense of loss in this building that has stood for over 800 years.

The Cathedral averages over 30,000 visitors per day. More than even the Eiffel Tower.

While this is a great loss, some view it as a symbol of rebirth for the building, Catholics worldwide and many others with no affiliation with the church.

Donations to rebuild the structure exceed $1 billion in just a few days. Last week fund raising efforts for restoration hovered around $50 million.

Unexpected loss has an unusual impact on people.

"There is something about the brick and mortar stones, placed there by believing people, that can communicate to people. They know they are on holy ground, and it's not because the place is holy, but because it is made holy by the faith of the people there," he said. - The Church News

The fire occurred at the start of Holy Week.

"If there is a moment when Christians should be ready to mourn the death of something, but to believe in the resurrection of something, it's Holy Week," Father McCarthy said.

"It is my belief that something is going to rise from these ashes," he said, noting that even the pagan myth of the phoenix and the ashes can bring hope after the day's events.

When Jesus was on Earth he said "Tear down this Temple and I will rebuild it in three days".

Those who heard him, including his followers, did not understand the true meaning of his words. Some even scoffed and said "It took 46 years to build this Temple. How can you build it in 3 days?".

He was of course referring to his body as the Temple. And he was prophesying about his death, followed by the resurrection three days later.

Notre Dame will not be rebuilt in 3 days or even 3 years. But I have no doubt the Cathedral will one day return and welcome all who come.

Blessings

#NotreDameCathedral

Friday, April 19, 2019

Chag Pesach Sameyach!

This evening marks the beginning of our annual observance of the Exodus, beginning with the lighting of candles. We will recount the story itself, and, as always, I've found some interesting readings to supplement that.

Of course, beyond the ritual and the special foods lies the central theme of liberation and freedom. May we never take either of these for granted.

Thursday, April 18, 2019

An #InconvenientTruth

About that CanuckCare being such a great deal:
Heh.

[Hat Tip: FoIB Michael B]

Wednesday, April 17, 2019

Hungary in line [UPDATED]

[Scroll down for Update]

We often post about these things in England and Canada, maybe Sweden, but this marks the first time we've blogged on the (troubled) Hungarian health care system:


By way of background:


Talk about double-billing.

And for all that, they still can't provide timely care to their citizens, many of whom actually have to wait years for necessary surgery and other services. The truth is that, as with ObamaCare, coverage ≠ care.

#Medicaid4All


UPDATE: Speaking of England (see top of post), here's more devastating info from its Much Vaunted National Health Service©:

"Tens of thousands of elderly people in UK are left struggling to see because of NHS cost-cutting drive that relies on them dying before they can qualify for cataract surgery"

I see.

[Hat Tip: Holly R]