Tuesday, January 15, 2019

CanuckCare© Continues Swirling

But hey,it's free:

[Hat Tip: Dr Michael B]

Monday, January 14, 2019

#FakeHealthNews: Burying the Lede

Our friend Holly R tips us to this story currently making the rounds at FB:

[click to embiggen]

"Kentucky Sen. Rand Paul, one of the fiercest political critics of socialized medicine, will travel to Canada later this month to get hernia surgery"

Now why would he do that?

After all, we have many fine surgical centers here in the states, why would he choose a government-run one Up North?

Well, turns out that the opening sentence is rendered completely moot by the third:

He is scheduled to have the outpatient operation at the privately adminstered Shouldice Hernia Hospital in Thornhill, Ontario"


Transparency gone terribly wrong

We've been covering (and advocating for) transparency in health care pricing for a very long time:

"Gov. Rod R. Blagojevich today signed the Illinois Health Care Consumer’s Right-to-Know bill, which makes health care price and performance information for outpatient procedures available to all Illinois consumers."

That was over 13 years ago, and we can see how well that's worked out. Recently, co-blogger Bob V sent me a link to a story that not only indicates that we have a long way to go, but also implicitly explains why we likely will never really see true transparency:

"Her insurer’s price tool estimated less than $1,375 for a breast MRI. Then she got a bill for $3,200."

Ms Smith apparently did everything right: she researched MRI facilities and prices using UHC's online cost estimator [ed: and by the way, this is not an indictment of UHC in particular; I'm confident that that same would hold true with other carriers, as well], and still got socked with a larger-than-expected bill.

But why is that? Why is something so seemingly simple so difficult to obtain? After all, when I order a Big Mac and fries, I know exactly what I;'m going to shell out. Likewise a gallon of gas or an oil change. Why is medical care immune?

Well, there's the obvious challenge that the doc can't be sure that a particular surgery will go exactly as planned, and I get that. But simple things like non-emergency MRI's should be basic, off-the-shelf, easily priced items.

Or so one would think.

But here's the dirty little not-so-secret:

"Health-care costs are difficult to pin down because prices vary widely and are part of confidential agreements between insurers and providers." [emphasis added]

Now, I actually "get" that: UHC doesn't necessarily want Humana to know the specifics of its agreement with Dr Smith. And, of course, coverage will often change depending on one's plan's design. I just don't see how to square the circle.

On the other hand, we have newer models like Direct Primary Care and facilities like the Surgery Center of Oklahoma, which operate on a strictly cash basis, no insurance needed (or, in fact, accepted). So we know that cutting out the middleman (ie insurance and/or the heavy hand of government) is a way around the conundrum.But of course, both of these have their own problems and challenges, not the least of which is the ability of one to come up with the scratch to pay for it.


Friday, January 11, 2019

ObamaCare #Winning!

Thursday, January 10, 2019

Sad news: A client story

Over the weekend, a long-time agency client took his own life. Dan was a retired (and much beloved) pediatrician who had been (recently?) diagnosed with both dementia and Parkinson's. One supposes that, as a physician, he knew what lay ahead, and decided to forego that.

Something that often comes up in these tragedies is the issue of whether or not a life insurance policy would "pay off." As with so much insurance-related "conventional wisdom," it's not actually all that simple.As we wrote back in Aught Nine:

"Until just after the Great Depression, suicide was excluded by life insurance policies. There was, it was thought, a very good reason for this: it would be against the public interest to encourage folks to kill themselves to enrich those left behind. And there's some validity to this: we don't want to make such an outcome attractive to people to leave an inheritance at the cost of one's own life.

But a lot of people who lost everything in the Depression killed themselves anyway; not for the insurance (there wouldn't be any) but out of desperation and despondence. And this left behind a lot of widows and children who lost a parent and a spouse along with their life's savings. This was also against the public interest.

So, how to reconcile these two seemingly irreconcilable principles?

New laws were enacted that required life insurance policies to cover suicide after a "reasonable" period ("reasonable" in this case meaning no more than two years). The premise is that no sane person is going to buy a policy with the intent of waiting two years to jump out a window; that a person would do this was ample demonstration of mental illness, and that would be a covered exposure. This protects the interests of innocent family members, while still discouraging a casual view of suicide

Our condolences to Dr C's family.

Not so great HIX news: SEP edition

So by now, most folks understand that it's quite the challenge to buy ObamaPlans outside the regular Open Enrollment season; that one requires a Special Enrollment Period trigger (losing group coverage, getting married or having a baby, etc) to do so. Well, the process just got a bit more onerous.

From email from our Betters in DC©:

"Special enrollment periods (SEPs) provide an opportunity to consumers who experience certain qualifying events to enroll in or change their health coverage outside of the annual Open Enrollment period.

Beginning in early 2019, Marketplace consumers may need to choose a plan in the same metal tier category (instead of from all available categories) during their SEP window. [emphasis in original]

 This impacts consumers when they:

•Currently have a Marketplace plan,
•Experience most SEP-qualifying life events, and
•Want to change from their current plan.
You can help consumers understand that their plan choices after Open Enrollment will likely be limited later in the year, even if they qualify for an SEP and want to change plans. You can encourage them to choose a plan that will meet their needs and their family’s needs until the next Open Enrollment period."

Oh goody.

Did I mention that I'm aware of precisely zero carriers paying commissions on plans outside of the regularly scheduled Open Enrollment? How come no one seems to care (since they don't reduce the premiums to reflect that fact)?

Wednesday, January 09, 2019

The Overarching Deceit of Medicare4All

Ah, those right whingers at Kaiser strike again:
Wait, what?

Michael also points us to this more graphic illustration of the point:

Math is hard.

Tuesday, January 08, 2019

Once again: Coverage ≠ Care

The Much Vaunted National Health Service© presents the latest case in point:

[Hat Tip: Kishore J]

Monday, January 07, 2019

Cool New Blog

Longtime readers may recognize Dennis Wall, who provided us an interesting guest post about lender-forced insurance plans:

"LFPI [Lender force-placed insurance] is insurance which protects the lender’s interest in the borrower’s collateral. It is “collateral protection insurance” in the sense that it is insurance which protects only the collateral."

Dennis went on to chronicle for us some of the many problems and ethical issues that arose from this.

Well, Dennis has a new blog now
(which we've added to the sidebar), called (appropriately enough) Claims and Issues. It's less focused on insurance claims and issues, and more about just claims issues in general. Do check it out.

Weird Caller Tricks

So I get a phone call this past Friday from "Pam," who's looking for help with "personal health insurance." Turns out her husband's "idiot boss" had neglected to pay the group health insurance premiums, and as a result that plan had lapsed. At which point her "idiot husband" went on the Exchange (during Open Enrollment) and signed them up for a plan with Molina, to the tune of $2,100 per month (you know, 'affordable'). Pam was unhappy with both of these events (no kidding), and wanted to make some changes.

In the meantime, she had signed up for a UHC short term plan that will expire on the 20th.,

It should also be noted that Pam has a pre-existing shoulder injury for which she receives periodic treatment, and her "idiot husband" was recently diagnosed with a (thus far benign) thyroid nodule.


I explained that there really weren't a lot of insurance options here: since we're outside Open Enrollment, and I don't see any Special Open Enrollment triggers in her situation, there's not much we can do with ACA-compliant plans. Nor would another Short Term plan be advisable, since both her shoulder and now her "idiot husband's" thyroid condition would be pre-existing and thus excluded.

I then turned to some non-insurance (but ACA-compliant) options, and asked if she was familiar with Health Care Sharing arrangements; she was not. So I explained to her that, although I don't write these myself, I do know that there are a lot of folks who think they're pretty good (and also a lot who think they're a rip-off, of course). I also asked if she knew about Direct Primary Care (DPC) and, unsurprisingly, she did not. And so I explained how DPC worked, and how to use the DPC Frontier site to see if there's a nearby practice.

I also explained that many folks combine these two plans, and why that is often effective.

Keep in mind that I've now spent about 45 minutes with her answering questions and offering advice, and that since I wouldn't be selling her anything myself, this was completely uncompensated. On the other hand, The Sticker pretty much dictates this course of action.

At the end of the conversation, I asked if she had any other questions, and she said "no, I'm going to call the Exchange number and get my plan changed." And then she hung up.

Gee, Pam, you're quite welcome.

And rotsa ruck with that.