Friday, August 31, 2018

Thursday, August 30, 2018

The Association: Cherish is the word

So, lots of pixels being spilled over the newest "shiny thing," Association Health Plans (AHPs). These are a subset of MEWAs (Multiple Employer Welfare Arrangements) with a twist: by creating a new method of forming an AHP, some businesses (and self-employed individuals) may find obtaining coverage easier.

But I want to focus on two pieces that I think are currently flying below the radar:

First, under the new rules, an AHP may form with the express purpose of purchasing insurance.  Previously, groups such as this had to have a primary business purpose. This flies in the face of Insurance 101 that it's against public policy (and hence, the law) to form an association for the sole purpose of obtaining insurance (well, maybe not all "associations"). One wonders how the states (which have ultimate authority on these plans) will handle this.

The National Association of Health Underwriters, provided a helpful presentation on these new rules, including something which seems to have gone unremarked, but seems to me to be very disturbing:

"In applying the nondiscrimination provisions of paragraphs ... the group or association may not treat the employees of different employer members of the group or association as distinct groups of similarly-situated individuals based on a health factor of one or more individuals"

In other words, they can't decline a given member (or employer) based on health or claims.

How do we know this? Well, in examples of association  actions which don't pass "the smell test" we see this:

"As part of the membership application process, Individual D provides certain health information to Association C [and is declined coverage]."

What does this explicitly admit?

That someone at the association is reading and evaluating the Personal Health Information (PHI) of its members. This is a red flag, flares and tornado sirens going off all at once. I know from my ACA training that secure handling of PHI is an absolutely mission critical component of my job; there are significant sanctions imposed for mishandling it.

When I enroll a new group, I always advise employers to have their employees seal their applications in an envelope (with their name on the outside). Or better yet, use an online enrollment service. This way, they know that the employee has competed the paperwork/enrollment process, but no idea what health issues (if any) are disclosed. I do this so that later on, an employee can't say "well, you only fired me because I'm a diabetic." If the employer didn't see the app, he couldn't have known, so no worries.

But here, the employer is handing over his employees' sensitive, personal health information to a total stranger, with no idea how it will be handled. And, of course, this entails an incredible liability on the association's part.

Why isn't this getting more play?

Wednesday, August 29, 2018

About that "free" CanuckCare©

'Nuff said:

Tuesday, August 28, 2018

It really *is* a tax

We've long maintained that the true, over-arching goal of ObamaCare was to usher in single payer; after all, we've heard that directly from its creator's mouth.

But it has, as we've come to learn, another even more obvious purpose. I'll let our friend Rich Weinstein explain:

Thanks, Rich!

Monday, August 27, 2018

Texas & Co win Bigly

In case you missed it, five states that had sued the previous administration over an illicit tax have finally been vindicated, to the tune of almost a billion dollars:

"Texas Attorney General Ken Paxton [led] a five-state coalition that on Thursday won an $839 million judgment against the federal government ... joined by Indiana, Nebraska, Kansas, and Louisiana"

The states had sued because even though ObamaCare explicitly exempted states from this tax, his administration capriciously imposed it. The suit itself took several years to wend its way through the judiciary, and the plaintiffs were duly rewarded for their patience:

"Judge Reed O’Connor ... agreed on the statutory issue (the APA claim), striking down the Obama HHS rule because it violates the plain language of the ACA law."

It's interesting to me because this doesn't seem to have anything to do with the whole Medicaid expansion kerfluffle, which has also been a problem from the outset.

In a related story, "Texas and Wisconsin will argue at a hearing on September 5 that Obamacare, as amended by the recent tax bill, is unconstitutional in its entirety."

That will leave a mark.

Friday, August 24, 2018

Because of course: Pet insurance trends

These are, to be sure, excellent points: After all, fair is fair.

And it's worked so well with people insurance.

Actually, let's take this to its logical conclusion: since pet insurance falls under the category of P&C, not life and health, this same logic would dictate that auto insurers could no longer deny coverage to folks who've just totaled their uninsured cars, or home insurance to those whose houses are currently on fire.

What could possibly go wrong?

How it works

As President Reagan famously observed, "if you want more of something, subsidize it." The result of this, of course, is that it then costs more. We see this every year with increased health insurance costs (which is not to say that the subsidies and risk-corridor payments are the sole causes), and of course we've seen it at work for decades in the world of higher education.

Still there are doubters out there who need more concrete evidence of this (perverse?) relationship, and we're happy to oblige.

Meet The Monied Morticians:

"Predatory funeral homes have been accused of cashing in on Chicago’s relentless crime wave by taking advantage of a taxpayer-funded scheme that pays $7,500 in funeral expenses for homicide victims’ families."

Leaving aside the root cause of this issue, it's hard not to see the direct and obvious correlation: when the government is paying for your groceries, you're going to be eating a lot more steak. And when it's paying for your loved one's funeral, there are going to be a lot of flowers and blinged-up caskets.

And when that government hands out our tax dollars to help pay for health insurance - whether to consumers or carriers - well, you get the idea.

Time to lay it to rest?

Thursday, August 23, 2018

Late Summer Health Wonk Review

Health Wonk Review co-founder Julie Ferguson hosts this month's round-up of health care policy and polity.

This one's a lot "meatier" than some of the more recent versions, lots of great posts.

How Does Medicare Work? How Much Does it Cost?

Medicare premium costs for Part A are "prepaid". Most people have qualified for "free Part A coverage based on past Social Security earnings. Medicare Part B standard premiums in 2018 are $134. If your MAGI is above the threshold you may owe a tax in addition to your Part B Medicare premiums. This tax is an IRMAA tax.

Medicare Premium Costs

In addition to your Medicare premiums, you may incur additional costs for supplemental coverage, prescription drug plan or a Medicare Advantage plan.

Most people pay nothing for Medicare Part A if they have at least 30 quarters of earned income and paid Medicare taxes on those earnings.

Popular Georgia Medicare supplement plan premiums start around $100 per month in 2018. Popular GA Medigap plans limit your out of pocket expenses to the Medicare Part B deductible ($183 in 2018).

Other Premium Costs

Medicare Part D monthly premiums are as low as $12 in 2018.

Many people do not pay a monthly premium for Advantage plans but that does not mean they are "free". If you select an Advantage plan you will need to budget for planned and unplanned out of pocket health care expenses. Outpatient care may incur copay's starting at $10 while some procedures may run $100 or more. Hospital inpatient care imposes a daily copay of several hundred dollars for a specific number of days.

Wednesday, August 22, 2018

And now for some GOOD news

Well, hopefully, anyway:

"Blue Cross and Blue Shield of North Carolina says premiums paid by Affordable Care Act customers in the Triangle will decrease more than 21 percent on average next year because of a new partnership with UNC Health Care."

By teaming up, the health insurance company and the health care provider seem to be blurring the lines between the two health care components, which may actually turn out to be a very good thing:

"We no longer want to be in an adversarial relationship"

A strange take on their current situation; perhaps there's a clue here?

It's basically a modified capitated plan, where Blue Cross pays UNC a set fee per insured, with a mechanism to increase that for folks with more serious (or, perhaps, chronic) conditions, and an emphasis on quality of outcomes versus quantity of care. So far, it's set up as a pilot program available only in a select market of 10 counties, and premiums will be based on the insured's age and county of residence.

Will be interesting to see how this pans out.

[Hat Tip: FoIB Jeff M]

Short Term Medical Plan News

As expected, the sale of Short Term Medical plans is about to be banned in The Golden Sate:

These plans offer reduced premiums (and, of course, benefits) and have proven to be a popular alternative to expensive ObamaPlans, partly because they're partially underwritten and priced according to actual risk.

But the folks in Sacramento think they're a bad deal, and have decided to deprive their citizens of choice in the health insurance marketplace. Of course, it's those citizens who elected these officials, so they really have only themselves to blame (or credit).

The bill awaits Governor Brown's signature, which we presume will be forthcoming shortly, and the law will take effect this coming January.

[Hat Tip: co-blogger Bill H]

Tuesday, August 21, 2018

Hidden Costs of Medicare Part D

Medicare Part D, a prescription drug program for seniors on Medicare, was first suggested by President Clinton in 2000. Under the Bush administration the new drug plan became part of the 2003 Medicare Modernization Act and finally went live in 2006.

One would think a government program 6 years in the making would have worked like a charm.

But not only do gears grind slowly inside the beltway, but most of the big ideas are crafted by attorneys who lack real world experience.

The PDP (prescription drug program) in 2018 is one of the most complex and misunderstood parts of Medicare. Not only is it confusing to the consumer, but many agents can't fully explain it.

The result is, the most popular plan is often the one with the lowest premium and no deductible.

And then there is this . . .

Stable Premiums, Rising OOP Costs

According to a NYT article, 73% of Medicare beneficiaries have a drug plan. Since 2006 premiums have remained mostly flat.

Yet the cost of the drug program has risen by 72% since inception.


While premiums have hardly increased, seniors who participate in the drug plan are paying more and more each year.

If you are a type II diabetic, daily insulin injections are required if you want to live. Yet insulin prices have risen so much that many diabetics routinely pay $600 per month or more for this golden drug.

A version of insulin that carried a list price of $17 a vial in 1997 is priced at $138 today (2016). Another that launched two decades ago with a sticker price of $21 a vial has been increased to $255. - WaPo

That's a lot of money to anyone, but those on a fixed income may find themselves choosing between buying insulin or paying the mortgage.

The Donut Hole

Anytime a product or service goes from CASH to covered by insurance, the price invariably rises considerably. This is especially true for prescription medications.

"between 2010 and 2015, the number of enrollees entering the catastrophic drug cost range grew 50%, from 2.4 million to 3.6 million".

Are people getting sicker or are rising drug prices pushing beneficiaries into the donut hole and beyond?

Is this a bug or a feature, designed to force seniors into bankruptcy? Or possibly hoping they will stop taking their medication and die?

I run about 1,000 drug plan reports for clients, about half of those done in the first few weeks of Medicare open enrollment. Most of my clients pay less than $100 per month in premiums and copay's. But some pay $500 per month or more.

Getting old isn't easy or cheap.

Drug Prices Rise

Some commonly prescribed drugs double in price from one year to the next.

I fill a prescription cream for Eczema flare ups about every 18 months. For years I never paid more than $20 for a small tube. Two years ago the my Part D plan copay was $180.

I refused to pay and found a GoodRx coupon for $27. Almost $150 less for a cash price vs my Part D copay.

Something is terribly wrong here. Most seniors do not understand their drug plan and, by default, use their drug card for everything.

This type of abuse has got to stop!

#MedicarePartD #PBM #DonutHole

Monday, August 20, 2018

Hold the Mayo, Part 2

In Part 1, we reviewed the basic facts of the case of The Gilderhaus Family versus the Mayo Clinic [ed: autoplay warning for that link]. We left off at the concept of “the medical-legal establishment.”

So what is it? Take it away, tsrblke:

"It’s the notion that through a partnership with the state we’ve granted a whole bunch of powers (either directly or indirectly) to medical professionals, and sometimes they actually use them. In this case we see it with the judgement of capacity. Yes, in theory, to have someone declared incompetent you need to go through the courts and show it. Practically speaking, however, judgements of capacity are made all the time by medical professionals and unless someone challenges it (and has the resources to do so) those professionals are usually taken as being correct.

In this particular case we see how that can go horribly awry. Mayo didn’t just say Ms. Gilderhaus lacked capacity: they accused her mother of having a mental illness (even noting there was no formal diagnosis) and used this to send the police after them. (Sadly, disagreeing with doctors is often enough for them to suggest you lack decision-making capacity.) 

Honestly, this case could have ended a lot worse. But it cannot be understated how much control the medical-legal establishment has over you in many situations. Sure, if you’re reasonably healthy (mentally and physically) and somewhere between 20-65 you’re somewhat safe from it. (You’ll note I didn’t start at 18, because as we see in this case, the medical-legal establishment doesn’t respect 18 as the age of majority thing all the time.) But lots of circumstances can change this. Do you have kids? A single call from a pediatrician can totally change your life! Has anything happened at all that may call into question your mental capacity? Well then, best have your power of attorney up to date. Do you care for someone who is disabled? The doctors are watching you.

I don’t have any good answers for you here other than “knowledge is power.” Knowing that the medical-legal establishment exists is the first step. Second is forming a good relationship with your providers. If your providers know you and trust you they’re less likely to jump to conclusions. And should the worst happen you may be able to muster them to your defense. This also means being on the lookout for any potential conflicts right off the bat. I’ve been especially open with my pediatrician both that I am a fan of guns, so I’ll be keeping mine thank you very much, and that I have a healthy distrust of the medical-legal establishment and expect her to help me push back should it turn its sights on me. Have backups in mind, should a provider relationship sour, be ready to jump ship quickly. (Obviously, this may not be possible in all cases.)

Lastly, know your options. Mayo totally screwed up here by not calling in an ethics consult. Facially it doesn’t seem like an ethics issue, but in my experience the vast majority of hospital ethics work is conflict resolution. Most ethics teams have at least one person, often several, trained in mediation precisely to avoid this. Mayo should be chastised for not calling in a 3rd party to mediate the dispute between the providers and patients that could have prevented all of this. If the accounts presented by CNN are accurate, this is an unfortunate and avoidable situation that started when a patient and family felt they weren’t be treated with appropriate dignity (and then, in a self-fulfilling prophecy they weren’t treated with appropriate dignity). In the hustle and bustle of academic medicine, this is all too common. An outside consult with a group who’s entire role is the protection of dignity could have helped

And a heartfelt Thank You to FoIB tsrblke (PhD)!

Friday, August 17, 2018

Hold the Mayo - Part 1

Readers may be aware of a recent story from Minnesota [ed: autoplay warning for that link] involving a young woman with a brain injury, her parents, and the famed Mayo Clinic. The gist is that she and her family were (allegedly) unhappy with her care, and sought to obtain it elsewhere. The Mayo docs put the kibosh on that, so the young lady's parents devised a plan to arrange her "escape."

The folks at Mayo and those at CNN are at odds about what really happened; it seems to me that the latter have more credibility here than the former (yeah, I know).

But the reason for this post is to present a primer on the medical ethics involved in disputes such as this. Regular reader and FoIB tsrblke has a doctorate in this discipline, and offers this explication:

"Out of Minnesota we have an interesting case of a patient who left Mayo Clinic “against medical advice.” Was she kidnapped, or did she run away?

Well that depends on whether you’re the family or the doctors at Mayo. The crucial facts are as follows:

1) 18-year-old patient has a brain aneurysm on Christmas day.
2)  Eventually she makes it to Mayo, after a brief stay at a local hospital, where, against all odds she survives and enters inpatient rehab.
3) The relationship between the hospital and the patient/family breaks down and everything goes to hell.
Sadly, #3 isn’t entirely uncommon, though the escalation here was beyond nuts (we’ll get to that in a second.) It’s not entirely clear what caused the breakdown, but it seems to have started with a disagreement over pain management.

Now one could write an entire essay on pain management problems, and I don’t really want to get caught in what amounts to an aside, because what happened next is where the meat of this particular case is.

Basically, as the relationship between the hospital and family deteriorated beyond repair, the hospital escalated  the situation to the point of, allegedly, trying to have Ms. Gilderhaus declared a ward of the state. I want to emphasize how incredibly extreme this is. Even assuming for argument’s sake that Ms. Gilderhaus lacked mental capacity - that is, that her brain injury interfered with her ability to make decisions (which seems unlikely for reasons we’ll get to in a moment) - there are several possible surrogate decision makers that could be used prior to going to the state. Obviously, there’s the mother. Depending on various legal circumstances the stepfather may be able to fill that role. And there’s the biological father (who’s mentioned briefly in part 2 as being asked, but it’s never explained why they went for state control instead.) Based on the information given, none of these potential surrogates has done anything that would suggest they cannot handle the duties. Indeed, they’ve done everything thus far suggesting they care deeply for their daughter. So what was their great sin in the eyes of Mayo? They didn’t like the care and wanted to transfer her to another facility.

Let’s be clear, based upon the way it’s presented, they didn’t want to just up and leave (until the escalation reached stratospheric levels) they just wanted to go somewhere else. That’s not a crazy idea by any stretch. Nothing indicates she can’t be transferred, and there’s no mention of any reason they couldn’t find another provider. (Admittedly we only have one side of the story, but Mayo is refusing to say much at all despite all the HIPAA waivers, which suggests, to me at least, their defense would be weak.)

Now is a good point to introduce a term I’ve used among my colleagues: the “medical-legal establishment.” What is the medical-legal establishment?

We explore that, and its implications, in Part 2.

Thanks, tsrblke!

Thursday, August 16, 2018

We've got questions

Some may recall the tragic story of a star-crossed love affair that ended tragically on the Hudson River on a Spring afternoon in 2015:

"[Angelika Graswald] pulled the drain plug on Viafore’s kayak while they were paddling on the Hudson River in 2015 and watched him drown."

This seems to have been as cold-blooded a murder as I've ever read of, and compounded by the fact that she and the victim, Vincent Viafore, were actually engaged to be married. He had apparently named her as one of the beneficiaries of his almost half a million dollar life insurance policy.

Okay, we know that criminals aren't allowed to profit from their crimes: arsonists don't get their houses paid off, murderers don't collect on their victim's life insur....

Wait, what's this?

"A woman dubbed the “kayak killer” -- who drowned her fiancé by pulling the plug on the couple's small boat -- was awarded a portion of his $491,000 life insurance payout Monday."

How could this be? I get that the arrangement included her dropping her appeal, and the victim's family dropping their wrongful death lawsuit, but I didn't understand how this deal worked until I got to almost the end of the article:

"The criminal plea did not disqualify our client from taking these funds. They still had to prove that she recklessly or intentionally committed this murder."

Okay, but how would that work? I'm not aware of any law that says "well, if you commit just plain vanilla murder you get the cash, but if it's reckless or intentional you get zip." This seems ... illogical.

So I reached out to FoIB Brian D (a carrier rep of outstanding repute) for insight, and he offered this explanation:

When carriers have a disputed claim (such as a murder or other suspicious circumstance), they will pay it out to the state to be held in escrow until the matter is resolved. Looks like this is what happened with the Kayak Killer case here.

Thanks, Brian!

Wednesday, August 15, 2018

Another CanuckCare© success story

For certain values of "success," of course.

Friend of mine (Canadian ex-pat) just posted this on Twitter*:

"My cousin just called. She was diagnosed with thyroid cancer in March, was put on the urgent list for surgery. It’s mid-August. “Oh well I just have to wait”, she says. Every day untreated means progression of disease. #CanadaWaits #socializedmedicinekills"


"It’s “a good cancer to have”, in that typically they can just cut out the affected organ. But who knows if, in the ensuing time, it’s affection other systems?"

"I am so angry that people are treated like this. Six months almost with no surgery date. In a first-world, technologically advanced country."

From another friend in response:

"I’ve had arguments online w/Canadians about how this kind of thing doesn’t happen & I’m a stupid American & don’t know what I’m talking about. A friend of a friend came to the US for hernia surgery because he was in excruciating pain & the wait was 1.5 years."

And finally, from my ex-pat pal:

"My father’s first oncologist appointment was scheduled for after he died."

But hey: Free.

(*Anonymized to protect her identity)

A Triggering Scenario

Back in July, I posted my skepticism of a claim by Life Settlement industry players that insurers were (surreptitiously?) raising the cost of insurance in viaticated policies:

"Some life settlement companies have responded to universal life cost-of-insurance increases by suing the life insurers  that issued the policies"

Of course, they're free to pursue their own interests, but I suspect that they'll have quite the uphill battle.

Why's that, Henry?

Well, as I noted in that previous post, there's no mechanism for singling out specific policies for increases. For another, policies themselves have specific, stringent definitions on how, why and when these internal costs may be raised. I took the liberty of screencapping the relevant verbiage from one such policy I recently wrote (and which I believe to be fairly typical):

 [click to embiggen]

As one can plainly see, the cost of insurance (COI) is pretty well locked down, and applies to only a few specifically-worded populations, none of which are "life settlement brokers."

The other interesting thing to note is that the other internal costs are left more freely to the carrier's discretion, so it's possible that policyholders could experience those, regardless of the company's mortality experience. But again, there's no singling out of the life settlement folks.

Based on this, I don't see how they'll prevail.

But then, I'm not a lawyer, and I didn't stay in a ...

Tuesday, August 14, 2018

Medicare Open Enrollment

Medicare Open Enrollment. Not to be confused with Obamacare Open Enrollment.

Time to review you Medicare Advantage or Medicare drug plan.

Medicare supplement plans do NOT have annual enrollment periods in most states.

Medicare open enrollment begins October 15 and ends at midnight December 7.

Medicare Open Enrollment Pre-Planning

Before enrolling in Medicare at age 65 for the first time, or planning your next move during Medicare open enrollment, there are things you need to do first.

  • Make a list of all doctors including name, address, phone
  • List all area hospitals, especially the ones you have used
  • Make a list of all medications including dosage, refills, prescribing doctor and pharmacy
  • Be aware of the donut hole and look for ways to avoid that trap
  • Make use of generics and off plan purchases
  • Look for FDA approved generics and ask your doctor before making a change
  • If renewing, get your drug list ID and password date from your last drug plan finder
  • If renewing, study your ANOC for changes
  • Use for reviewing Advantage and drug plan options
  • Avoid using for drug plan comparisons prior to October 25
  • and your state DOI site are essentially useless when comparing Medicare supplement options
  • Most Medigap quote engines only list a handful of options and rarely have plans with the best value
  • Many quoting sites will sell your information to numerous agents; some don't provide instant quotes

Never put anything on auto-renew unless you like unpleasant surprises.

You have questions. We have answers.


Monday, August 13, 2018

Promising Cancer Treatment Breakthrough

In a promising development, a new kind of weapon in the fight against cancer is about to be deployed:

"His oncologists delight in observing that if you saw Rulli on the street, you’d never guess he was sick. At 66, he still is 6-foot-1, still 215 pounds thanks partly to golf-course beer, still an easygoing husband and father of two children, now rejoicing in granddaughters"

In 2013, Bob Rulli was diagnosed with a glioblastoma, a rare but extremely nasty brain tumor. I know, because I lost my baby sister to one a few months ago. These are almost always a death sentence, and difficult to treat; the average life expectancy is about a year and a half.

Now, thanks to some true medical adventurers, there appears to be a real reason for hope, and so far it also appears to have few (if any) side effects):

"On that day in September 2016, for the first treatment, Rulli spent the day at UC with Wise-Draper and Morris keeping vigil for bad reactions. He had none. He felt fine."

Over the next year and a half, Mr Rulli continued to receive the medicine, called BXQ-350, in ever increasing dosages. Repeated MRI's showed that the tumor continued to shrink.

And then there was a glitch...

This is such a great story, I really recommend it. There's no rosy glasses here: there are definitely hurdles left. But so, so promising.

[Hat Tip: FoIB Holly R]

Oh, SNAP! (vs Medicaid)

So, FoIB Michael Bertaut offers 1,000 words on how Medicaid really reimburses providers, and its implication viz both Medicare and commercial health insurance:

[click chart to embiggen]

Money quote:

Friday, August 10, 2018

That was then, and this is now...

On the one hand (nine years ago):

On the other (6 years ago):

On the Gripping Hand (a few days ago, as tipped to us by FoIB Holly R):

Okay, wait a minute, "analysis" is very different from "results." What gives?


"Confounding is a classic problem of selection bias ... But that’s hard to do with a wellness program."

And thus, when accounting for the actual variables being  measured, there "seemed to be no causal effects."

Which is, of course, disappointing to those with an axe to grind, but I'd also point out that there didn't seem to be any evidence, or even any suggestion, that engaging in wellness activities was harmful.

So we've got that going for us, which is nice.

Thursday, August 09, 2018

EBA whiffs it - Again

So the rocket surgeons at EBA (which, ironically, touts "benefits" in its very title) continue to double-down on the stupid:

"Here’s one option advisors can help them explore: health savings accounts. These accounts, which are offered in combination with high-deductible health insurance plans"

First of all, they keep conflating "High Deductible Health Plan" with "HSA-compliant" plan, thereby confusing laypeople (and irritating us pro's). As we pointed out on Monday:

"[U]ntil the age of ObamaCare, HDHP's meant HSA-compliant true Catastrophic coverage, no bells or whistles, just policies that paid for the truly disastrous claims (think cancer or brain surgery, for example)."

And second, they seem oblivious to the fact that HSA contributions are down for a very good reason: with premiums and out-of-pockets continuing to soar, who the heck has extra cash laying around to put in the account?

They even offer proof of this in their article:
[click chart to embiggen]

So, a 1,000 words in self-rebuttal.

Nice job, guys.

CanuckCare© Takes a Shot

So it seems that Britain's Much Vaunted National Health Service© has some competition in the race to the bottom. From our friend The Political Hat:

"Canadian Hospital Pushes Euthanasia on Disabled Patient"

As we've oft-noted, killing off pesky, expensive patients is a sure-fire way to rein in out-of-control health care costs.

(And by the way: have we noticed yet that even nationalized schemes have been unable to keep health care costs in line? Just wondering)

And it seems to be becoming a pretty routine, if final, "solution:"

"Foley tells the man that he’s “always thinking I want to end my life” because of the way he’s being treated at the hospital and because his requests for self-directed care have been denied."

This is far form Dr K's assisted suicide apparatus: no matter what one thinks of that process, at least it was (ostensibly) voluntary. This is full-blown actively pushing for the patient to pull his own plug not for his own betterment, but for the savings to the health "care" system.

Which begs the question: what, they ran out of ice floes?

Wednesday, August 08, 2018

When health care is a "right"

We've long maintained that this notion of health care being a 'right' is fraught with peril:

"The noble-sounding idea that "health care is a right" doesn't even pass the smell test: health care must be delivered by a provider, so if it's a "right" then that person is being forced to provide that care whether or not he or she is remunerated for doing so."

But it goes even further: if health care is a 'right' then, by extension, the government can force health care professionals to provide their service regardless.

Think that's far-fetched?

Well, our Neighbors to the North© are about to put that into practice in real-time:

"Vowing to maintain public dental services in the province, Quebec’s health minister said Thursday he would sign a ministerial decree to block dentists from withdrawing from the public health system amid a bitter standoff over contract negotiations."

Now, I have no idea how much force of law the gentleman can bring to bear on this, or whether he has the ability to actually force these dentists to provide care, but the fact that he believes that he does is chilling, no?

Next up: pediatricians.

Hat Tip to Physics Geek, who notes "Hey, so Canada is kind of cool with forced servitude. Kind of thought slavery was illegal, but whatever."


On BernieCare

Medicare For All (M4A) has been front and center in health care news this past couple of weeks.

Charles Blahous of Mercatus Center performed a study showing that the cost to move to this program would be $32 Trillion over 10 years. In his analysis he used some very favorable assumptions that the law would hit all of its targets - including dramatically reducing payments to health providers, reducing drug prices, and lowering administrative costs.

Senator Sanders countered with a Tweet claiming that the study shows that our country will save $2 Trillion dollars in moving to M4A. He thanks the Koch brothers and Mercatus for "proving" that his plan will work.

So where does the savings and funds to pay for the government program of Bernie's? If you read the media reports it will come from higher taxes, elimination of the insurance industry, and pay cuts to doctors who will accept 40% less at Medicare reimbursement.

On top of the likelihood that M4A will have to double tax rates what is most telling is the last point. For M4A to "show savings" the entire medical world will have to see their average reimbursement cut by 40%. Who all is in the medical world? Well, lets start with a few of those who would see their incomes whacked or in many cases see their jobs eliminated:

Nurse Practitioners
Billing Specialists
Insurance Agents
Speech Pathologists
Insurance Customer Service Representatives
Medical Device Manufacturers
Insurance Underwriters
Occupational Health and Safety Specialists
Dental Hygentists
Physician's Assistants
Pharmacy Technicians
Lab Technicians
Home Health Aides
Certified Nursing Assistants
Medical Transcriptionists
Medical Records Technicians
Research Associates
Pharmaceutical Research Investigators

Maybe Senator Sanders should send out another tweet thanking all of these fine people who work hard to save lives and provide us with care needed to remain healthy. Because if his plan ever comes to fruition they will be the one's paying for it.

Tuesday, August 07, 2018

What to make of *this*?

Hmmm. On the one hand, monetizing my health habits (or lack thereof) is appealing.

OTOH: This smells so much of Big Brother.

On the Gripping Hand: not sure how'd I'd be harmed even if the data were hacked.

What say you, dear readers?

(And would love to hear your thoughts on this in the comments)

Medicare Doesn't Cover Everything

Medicare doesn't cover everything. Here is a partial list of what is not paid by Medicare.

Routine dental care, dentures, crowns, bridges, routine eye exams, eyeglasses, contacts, cosmetic surgery unrelated to illness or injury, OTC vitamins and supplements, hearing exams, hearing aids, long term care, medical treatment outside the country.

Most of these items were not covered by your employer group health plan either. Things like vision, dental and hearing were covered by insurance plans OTHER THAN your major medical. You probably had a separate plan for dental and another for vision care.

Different policy.

Different insurance carrier.

Should You Buy Extra Insurance?

In many cases you can purchase separate insurance coverage for the following.

- dental care
- vision coverage
- hearing exams and hearing aids
- international travel medical
- hospital indemnity
- cancer plans
- critical illness

The list goes on.

But before spending good money on these kinds of insurance, ask yourself if you really need it?

I make an exception for International Travel Medical. That is something you should definitely consider when traveling outside the country. But for the rest of the list . . .

Do you need to spend $40 - $60 per month for a dental plan that limits your annual benefit to $1,000?

Do you need to pay monthly premiums of $50 per month for a plan that pays $600 per day for inpatient care only?

Most people would be better off stuffing that money in a mattress than paying for additional insurance that may never pay off.

Monday, August 06, 2018

They keep using that word....

Tweet from EBA Magazine about Congress' current effort to expand HSA's:
Thing is, folks in the "benefits press" (for lack of a better term) keep referring to ACA-compliant "High Deductible Health Plans" as if this has any actual meaning.

Okay, Henry, what the heck are you going on about?

Well, until the age of ObamaCare, HDHP's meant HSA-compliant true Catastrophic coverage, no bells or whistles, just policies that paid for the truly disastrous claims (think cancer or brain surgery, for example). Not low cost maintenance meds, flu shots or simple primary care. In other words, what insurance should be.

Now comes O'Care, with $6,000+ deductibles and $14,000+ out-of-pockets, but with a panoply of first dollar preventive care "benefits" (well, mostly just for women), and premiums that look like mortgage payments on a mansion.

These are not what we should be calling "HDHP's," confusing non-industry folks who just want to be able to afford their premiums (and to use their plan).


Friday, August 03, 2018

A most cromulent question

From FoIB @dabz:


O frabjous day!

Well, it's that time of year again, when agents must decide whether or not to participate in ObamaCare Open Enrollment (this year: v6.0). For most folks, this year's festivities run from November 1 through December 15 for a January 1, 2019 effective date.

I say "most folks" because DC and Golden State citizens have their own, quirky schedules:

"California has enacted legislation that permanently establishes different enrollment dates within the state, both on and off-exchange. From now on, open enrollment in California will begin on October 15, and end on January 15. So for 2019 coverage, California residents will be able to enroll starting on October 15, 2018, and will have until January 15, 2019 to enroll."

Californians who sign up after December 15 will have February '19 effective dates.

"[O]open enrollment in DC will begin November 1, 2018, and will continue until January 31, 2019. DC residents who enroll between December 16 and January 15 will have coverage effective February 1, while those who enroll in the second half of January will have coverage effective March 1."

Everyone got that?


Adding a little fuel to the fire is the fact that folks in DC will get their own insurance mandate:

"[T]he District of Columbia City Council approved a requirement for all DC residents to purchase health insurance ... The D.C. mandate contains three elements that make it just as bad as, if not worse than, the federal mandate it is intended to replace."


(Click on through for the details)

As for my part? Well, regular readers know that I've long since bailed from actively engaging in the Open Enrollment circus process, but that I continue to do the online training necessary should I change my mind (or, as in recent years, be available to help folks out from the sidelines). This week, I got email from CMS announcing that:

"Marketplace agent and broker registration and training for plan year 2019 is now live!"

I can choose the free (no Continuing Education credit) version from CMS itself, or pay for the training (which includes CE for most folks) from their preferred vendor, AHIP.

Not an AHIP fan, and don't need the CE. So: hard pass.

Thursday, August 02, 2018

Obamacare Rear View Mirror

Way back in 2013 #JohnHawkins had this to say about Obamacare. No one has a crystal ball but he got some things right, and some not so right.

What he got right.

If you like your health care plan, you will be able to keep your health care plan. Period. No one will take it away. No matter what.”
 Well, that promise turned out not to be true and I can tell you that from personal experience. -
Mr. Hawkins was notified he would be losing coverage well before the clock struck midnight ending 2013.

It's difficult to blame my insurance company for that (cancelling his coverage). After all, it's hard for a service to be viable when the government forces consumers who buy it to pay a massive new tax for the privilege


Currently, I pay $191 per month. That will go up to $274. That's nearly $1000 a year more for a service that I already have. In addition, the deductible on my current plan is $200 and that will be going up to $6000.

And that's just for 2014. Wonder what he is paying now?

What he got wrong.

Originally, my health insurance provider told me that my plan wasn't going to be canceled. The agent just said it wouldn't qualify under Obamacare and so, I'd have to pay a tax to keep it.

Grandfathered plans exempted.

Technically his agent was wrong. Can't put all the blame on John.

When you hear about people who are going to be paying an extra $6000 a year out of $47,000 in income 

Those folks SHOULD have qualified for a subsidy. A rob-from-the-rich-give-to-the-poor taxpayer funded subsidy. Depending on many factors, their premium could have been $0.

What a country!

The law couldn't pass today and had Obama told the truth instead of lying shamelessly, even Democrats would have never voted for this law in the first place

Half right. Half wrong.

The law would not pass in 2018. But I do believe the left wing party would still vote for it if given a chance.

Pretty damn scary.

Wednesday, August 01, 2018

Finally, some *good* ACA news

Our Betters in DC© have released their final regs on Short Term Medical plans.

On the only piece that truly matters, they fall short (again):

"Such coverage can now cover an initial period of less than 12 months, and, taking into account any extensions, a maximum duration of no longer than 36 months in total"

The good news is that they've lifted the 3 month max, the bad is that they've left a potentially huge gap in that 365th day.

Still, one should avoid letting the perfect be the enemy of the good, and this is at least a step in the right direction.

As to why they've made this change, well, let's just say that ObamaPlan signups have been ... disappointing:

"[T]he number of people enrolled in the individual market without subsidies declined by an alarming 20 percent nationally in 2017 ... Many state markets experienced far more dramatic declines, with unsubsidized enrollment dropping by more than 40 percent in six states"


Now, it's important to remember that coverage ≠ care, and these plans have their own limitations, including exclusion of pre-existing conditions. But they are generally much more affordable, and offer much lower out-of-pocket options, than ACA-compliant policies.

Will be interesting to see how this plays out, and what impact it has on Open Enrollment v6.

[Hat Tip: HAFA]