Wednesday, October 17, 2018

Price Transparency

Some people make a big deal about price transparency in health care.

Others don't.

It seems the US may be bending to the will of the people and will move towards some kind of drug transparency, price regulation, or both.

The federal government said Monday that it wants to force drugmakers to disclose prices for prescription medicines in their TV commercials.

The drug industry's main trade group said drug companies are only willing to disclose the prices on their websites, not in commercials, and they'll start doing that next spring. - KYW

Almost every time DC tries to "help" they make things worse.

Less competition.

Higher prices.

Fewer choices.

The most feared words in the English language, "I am from the government and I am here to help you".

Regarding drug price transparency, Medicare prescription drug pricing has full disclosure. Cost reports for the Part D coverage illustrate the full retail price as well as the copay.

Drugs on the formulary are priced to the consumer at a discount.

Those not on the formulary are not.

I have a client that uses Xarelto and refills in 90 day increments. The retail cost is listed at $1200 for 90 pills. The medication is on most plan formulary's.

For the first 2 refills she has a $0 copay. By the time she get's to her third refill she is entering the donut hole and will pay $130. Her last refill for the year is $380.

Yesterday she complained about having to "pay so much" later in the year and wanted a better plan. She completely ignored the fact she is getting $5,000 worth of medication for less than $500 per year.

Price transparency.

And yet, she still complains.


Tuesday, October 16, 2018

How to succeed at Obamacare Without, Well...

So I did my Marketplace re-certification this morning, enabling me to sell ObamaPlans in the upcoming Open Enrollment v6.0. I anticipate that comp will continue to be less than generous, but at least we have some choices this year. As part of the re-cert curriculum, I learned that CMS has a Circle of Champions" award package, which includes "a letter, badge, and access to a certificate" presumably suitable for framing. All for selling (IIRC) 20 or more plans during this Open Enrollment season.

But seems like someone may have found a short-cut. Thanks to co-blogger Bob V, we learn about this enterprising family:

"A father and son from California have pleaded guilty for their roles in a scheme that defrauded more than $27 million from Affordable Care Act programs in at least 12 states ...  the Whites fraudulently enrolled people in ACA plans in states where those people did not live."

They then signed these folks up for (expensive?) substance abuse programs and pocketed the reimbursement fees.

One wonders if they signed up enough folks to earn that sweet CMS swag.

2,000 Words

First, from FoIB Jeff M:



[click to embiggen]


Second, from Google:


Monday, October 15, 2018

Singer Quits, Medical Tourism Wins

Longtime entertainer and 4-time Grammy Award winner Michael Buble, whose hits include "Haven't Met You Yet" and "It's a Beautiful Day" has put his career on hold to care for his liver cancer-stricken son, Noah:

"Going through this with Noah, I didn’t question who I was, I just questioned everything else. Why are we here? 'Is this all there is? Because if this is all there is, there has to be something bigger."

A selfless act by a successful musician. Yasher koach, and may Noah experience a full recovery.

Which is all very noble, Henry, but what the heck does it have to do with insurance, let alone medical tourism?"

Well, as regular readers know, we have pointed out many times over the years that CanuckCare
© may be free, but that doesn't mean it's terribly good. And how do we know this? Because folks with the resources to do so choose American health care when lives are at stake:

"Both he and Luisana put their careers on hold to be there for their son - they jetted to the US so Noah could undergo treatment for hepatoblastoma." [emphasis added]

Of course, with a $46 million a year income, he and his family can afford to do so. But what about average Joe Poutine?

Gives one pause, no?

[Hat Tip: FoIB Michael Bertaut]

Making Strides Against Breast Cancer: v2018

Once again, I'm raising money with my team: Love, Hope and Faith. Our walk is coming up so quickly - this coming Saturday, October 20th - and I'd really like to break the $1,800 mark.

Will you please help out by making a donation - Any amount helps.


Thank You!!

Friday, October 12, 2018

CanuckCare©/Medicare4All: A study

Shot:

Chaser:

"On a Slippery Slope, Canadian Hospital Unveils Physician-Assisted Suicide Plan for ‘Sick Kids’"

Hat Tip: FoIB The Political Hat

If it's too good to be true....

There's an old retailer's trick where one marks up the merchandise 75% (or more!), then announces a 50% off sale. It's tried and true, and coming to an ObamaPlan for you. From our friend Holly R:

"Obamacare premiums are going down for first time"

Oh frabjous day!

That's right, standard-bearer Silver level plans are set to go down a bit when Open Enrollment v6.0 takes off next month.

By about 1.5%. Which is nice, but then comes the not-so-fine print:

"[T]he decline comes after a 37% spike for this year's benchmark silver plan."

Which means that average $6 per month savings pales in comparison to the $1,200+ increase they ate last year, and will continue to pay even now.

Such a deal!

Thursday, October 11, 2018

Something new

So, we've discussed Direct Primary Care (DPC) for quite a while here at IB; some pro, some con. On balance, I think the idea has a lot of merit, and certainly potential.

But as Yoda says, "there is another:"

I've been reading a lot about Virtual Primary Care (VPC). Like DPC, it's usually a subscription-based model, offering direct access to a (presumably qualified) physician who can diagnose what ails ye, and even prescribe meds. One advantage to VPC is that, unlike your friendly neighborhood Direct Primary Care doc, it's available 24/7. Of course, you give up the inherent advantage of actual person-to-person direct access, but how often is that actually necessary?

The other appeal to VPC is its low price, often much lower than DPC (caveat: be mindful of "you get what you pay for"). It seems to me that these plans would work well with so-called "high-deductible plans" (scare quotes because true "cat plans" are illegal under ObamaCare), especially those with limited or no office visit co-pays.

We've arranged to offer one such plan to IB readers - the subscription fee is a modest $20 a month (regardless of whether it's just you, or a family). You can get all the gory details in the "Teledoc [NEW]" link in the side-bar.

Wednesday, October 10, 2018

The cost of compliance

First off, I realize that anecdote ≠ evidence, but this seems like a really simple, effective and meaningful way to describe the impact of full ACA-compliance on small group plans:

Both Employers A and B are insured with the same carrier, are about the same size and with similar plan designs, and boast a January 1 renewal date. Employer A's plan is Grandmothered (doesn't fully comply with all ObamaCare requirements), Employer B's is not.

Yesterday, I received both renewals.

Company A's premium actually decreased (by pennies, but still...). I haven't seen that for many, many years.

Company B's premium increased by about 17%. Now, I've seen worse, but it's not as if they can now just go out and raise their service rates by almost 20% to cover that difference. And that 17% is, basically, the cost of ACA compliance.

The more you know...

Tuesday, October 09, 2018

What happened?

How could this be?
'Tis a poser.