Ow! Ow! (This Sceptered Isle Part CCLXXI)

Here is a disturbing story from the London Daily Mail.

It's even more disturbing when you consider that - on average - citizens in the U.K. have but one ovary and one testicle to begin with.  But perhaps the most disturbing of all is this statement:

“The NHS normally pays out around £20,000 if the wrong testicle has been removed.”

Uhhh . . . normally?  Normally??

Oh well, surely no price is too large to pay for the security of a national single-payer medical insurance plan.  

Your (Examination) Table is Ready...

We've been writing about the coming wave of "concierge" medicine for over six years, so this is nothing new to our readers:

"New data from a national survey of nearly 14,000 physicians ... found that 9.6 percent of “practice owners” were planning to convert to concierge practices in the next one to three years."

That's nearly 1 in 10 practitioners, which is pretty significant. The usual suspects are cited: low Medicare and private reimbursement rates, which are only getting worse under the ObamaTax. And the so-called "Doc Fix" continues to hang as an albatross around the future's neck.

What's even more frightening, though, is that the phenomenon seems to be specialty-independent; that is, it's not just primary care, but surgeons and oncologists and, well, the list goes on. Which makes sense: health care is (pretty much) health care, and someone has to pay for it.

Which brings us to the uptick in concierge-style medicine. Some 20 percent of docs already restrict "the number of Medicare patients in their practice and one in three primary care doctors – the providers on the front lines of keeping the cost of seniors’ care low – are restricting Medicare patients." So if you can't get into your primary care doc, good luck getting a referral to that cardio guy you need to see.

Concierge-style medicine seeks to get around that problem by having patients contract directly with the provider. Of course, this will work better for some practice areas than others, primary care being the most obvious. How - or even if - this would work with, say, surgeons or radiologists seems unclear at this point. On the other hand, it was essentially the premise (and "promise") of HMO's. On the other hand, we've seen how those have worked out over the past decades.

The biggest problem right now is the threat that HHS Secretary Shecantbeserious will pull another mandate out of her...um... pocket and render the whole point moot.

ObamaCare...pushing & pulling and going nowhere

There has been a movement to repeal the Health Insurance Tax (HIT) on fully-insured premiums, and now comes a new bi-partisan effort in Congress. An effort last year failed.

The part that confuses me is why you would tax premiums in the first place. Besides the current tax write off, in 2014 most premiums would be subsidized. So the government wrote a bill to subsidize premiums and then will tax those same premiums on the back end. Why not just do nothing; or if that doesn't generate enough subsidy, just reduce the subsidy by the amount of the HIT tax?

Besides creating more work for CPAs and greater opportunity for fraud, the subsidy/tax combination accomplishes nothing. Giving someone a dollar then taxing them a dollar is just wasting time.

PPACA Identity Theft to cost $? Billion per year

I don't think many of us will be surprised to find out the drafters of PPACA either didn't see this coming or weren't smart enough to do something about it.

Start with the fraud we know is happening;

"Using stolen names and Social Security numbers, criminals are filing phony electronic tax forms to claim refunds, exploiting a slow-moving federal bureaucracy to collect the money before victims, or the Internal Revenue Service, discover the fraud. 

Parton was a victim of what officials say has ballooned into a massive, and dangerous, illegal industry that could cost the nation $21 billion over the next five years, according to the U.S. Treasury Department."

I have seen higher estimates from CNN

"Last year, the IRS reported 938,664 fraudulent returns related to identity theft, totaling $6.5 billion, Treasury Inspector General for Tax Administration J. Russell George told a House subcommittee this month."

This fraud is so easy and so rampant because it is done online with no face to face contact or verification.

Now lets look forward to PPACA subsidy and verification. 474 pages of rules can be found here.

The exchanges are suppose to mainly be websites where someone can go online and purchase insurance. Again no face to face contact or method to verify identity.

Employers will be notified if one of their employees received a subsidy after the fact.  They can appeal, which would mean hours dealing with the IRS or some similar agency trying to convince them you don't owe a penalty. Anyone that has had tax issues can attest as to how efficient and cost effective this is. In most cases it would probably be cheaper to just pay the $2,000 penalty.

Individual applicants will certify what they are eligible for, with minor verification. Read any of the annual Medicaid reports to see how rampant with fraud and errors that already is. It is key to remember that no one has a vested interest in keeping people off Medicaid, it is never their money. They get paid to process paper. not protect the financial interest of the plan. The same problems exist here, it is much easier to just approve a subsidy and let someone else appeal than to question it. I deal with this all the time with unemployment; every employee I fire was let go - according to them - for lack of hours. I spend a few hours dealing with paperwork showing it was for cause, and the majority of the time they don't collect. The rest of the time Ohio Jobs and Family tells me I didn't properly fire someone and awards them unemployment anyway. Never for lack of hours but no one is EVER held accountable for lying on their unemployment insurance claim form.

Illegals, on a daily basis and with ease, already steal SSNs to work, how much harder is it going to be to apply for insurance with a Subsidy?

How do you recover stolen HealthCare?

It is problem enough when the government, through lax enforcement, watches $6 billion a year in refunds walk out the door. As an employer, I will someday pay a share off that. Of immediate concern is a system that allows systemic fraud for which I am immediately liable; $2,000 to $3,000 a year for a couple employees plus hours and hours of my time trying to fix it is something I can't afford.

All of this raises one final question: is this a bug in the system or intended?

No means...."No"

Since North Carolina has officially put the kibosh on both a state-run ObamaExchange and Medicaid expansion, some folks are wondering "why?"

Something that gets short-shrift in the media is that, in addition to forfeiting tax-payer subsidies, states with Federally-run Exchanges also get to avoid the employer mandates.

But it gets better:

"Justice John Roberts deemed the taxes levied for noncompliance to be too low to constitute a real mandate. They are simply taxes – and in many cases they apply only when employees are eligible for federal tax credits"

But Henry, we already know this; so what?

Here's what:

"If tax credits are disallowed under federal exchanges, such taxes are no longer applicable. Oklahoma and other states are currently suing the federal government to enforce these terms of the Affordable Care Act."

North Carolina Gov McCrory seems to be playing a game of poker here: if Oklahoma's lawsuit is successful, his state can piggyback onto that. If not, well, there's little downside for his state's employers, and economy. And, of course, he can always revisit the idea of setting up a state-run Exchange.

Win-win-win.

[Hat Tip: FoIB Jeff M]

From the P&C Files: Malpractice makes Malperfect?

My favorite EconBlogger, Jason Shafrin, has an interesting post up on the cost of medical malpractice (aka medmal) coverage for various specialties.

Can you guess which one has the highest rates?

Click on over to Jason's place for the answer.

Buyer's Remorse?

Heh:

"According to backers of [The ObamaTax], enrollment faces big obstacles as polls and focus groups suggest a majority of uninsured people aren’t aware of the new coverage options or the availability of subsidies toward the cost of health insurance premium ..."

One wonders if folks are beginning to wake up to the cold, hard facts.

Ah:

"It might seem odd that the law’s supporters should need to convince Americans to purchase a plan, given that those who don’t will be taxed. But the tax will be less expensive than the cost of coverage."

Asked and answered.

We've been saying this for quite a while (although, to be fair, so has everyone else with an IQ above double digits). There are so many ways to game the system - and of course, folks in states with Federally-run Exchanges get no subsidies, making compliance even more expensive - that it's hard to see why any of the PrObamaTax hordes will bother to participate.

Which won't stop them whining, of course, about the unfairness of it all. Oh, bother.

Cavalcade of Risk #177: Call for submissions

Anisha Sekar hosts next week's Cav. Entries are due by Monday (the 18th).

To submit your risk-related post, just click here to email it.

You'll need to provide:

■ Your post's url and title
■ Your blog's url and name
■ Your name and email
■ A (brief) summary of the post

PLEASE remember: ONLY posts that relate to risk (not personal finance tips and the like). And please only submit if you are willing to link back to the carnival if your submission is accepted.

Runs on the ObamaExchange

Tomorrow's the deadline for states which have yet to make their pitch to Secretary Shecantbeserious regarding how they want to handle those Exchanges.

Here's a quick run-down as of this afternoon:

■ Mississippi is sticking with its game of chicken: they've officially turned down Mme Secretary's offer of a Fed-State partnership. Assuming they don't reach some other arrangement, The Magnolia State will default to a Federally-run model.

■ FoIB Patrick P reports that Illinois has been conditionally-approved to set up its State-Fed Partnership type Exchange. Patrick asks, with 16 carriers offering over 260 plans, "think Navigators will be able to handle explaining this?"

Exit question: It's clear that states choosing a Federally-run Exchange forfeit tax-payer subsidies. What's not so clear is what happens if it's a Partnership operation?

■ And FoIB Jeff M, checking in from The Tar Heel State, sends along the news that North Carolina will not be setting up its own Exchange, putting further pressure on Ms Shecatbeserious and her all-star band of technowizards to design and implement yet another Federally-run version.

■ And, finally, via email from UHC, we learn that, nationally, "the deadline for employers to notify employees of the availability of Health Benefit Exchanges has been delayed from March 1, 2013 to late summer or fall of 2013." Oh goody. Because nothing says "success" like pushing back crucial deadlines as the clock ticks down....

And this just in: "The U.S. Department of Health and Human Services (HHS) hopes to take bids from insurers that want to participate in the federal health insurance exchange programs from March 28 to April 30." Yes, one whole month to submit your bids - you hear that Anthem, UHC and the rest?

It'll be interesting to see which carriers take the bait.

Gorillas in the Mist?

On the one hand, medical technology continues its amazing advance. On the other, the "human interface" continues to be an obstacle to that progress.

Case in point:

"A new psychological study from Brigham and Women's Hospital has demonstrated how 83 percent of radiologists fail to spot the [foreign object] that is in the image below - despite running their eyes over it four times on average."

Do you see it?

If so, then you may have a future as a top-notch radiologist. Sleep tight!

Principles vs Politics in regards to Medicaid Expansion

I read in today's USA Today, only paper at the hotel, that Governors in Wisconsin and Indiana have passed on expanding Medicaid in their State. A rare display of standing on Principle. How are we to end the welfare state and entitlement problem if we continue to expand these programs that reduce and eliminate the need and incentive to work?

The easy math is free money from the Federal Government can't be passed up.

The correct math is there is no such thing as free money. A few thousand dollars in Federal crack to cover someone's Medicaid expenses doesn't begin to cover the cost of someone spending a lifetime working part time or entry level jobs and living off the taxpayor. Compounding the problem is the fact that it doesn't stop when that worker retires: kids raised under that lack of a work ethic are more likely to grow up and also live off the tax payor. Medicaid expansion is just one more step to creating a permanent welfare class. Everyone works 29 hours a week and gets by on Food Stamps, Medicaid, and Section 8 housing.  And then they and the media decry the income gap between these part timers and people working 70 hours a week to support them.

Also of interest is Indiana's request for an exemption; they had a very effective HSA Medicaid model that was being cancelled for not being ideologically consistent with ObamaCare. We'll see what HHS deems more important: a successful and proven program to deliver better benefits at a lower cost, or expansion of the Government Welfare model.

Health Wonk Review: Cupid edition

Peggy Salvatore presents this week's very sweet collection of wonky blogposts. It's really well done - there's no question that she read each entry, and adds helpful context to each one.

Kudos!

Mississippi Burning (The ObamaTax)

In a post yesterday, we reported on the travails of The Magnolia State's ObamaTax Exchange efforts. HHS Secretary Shecantbeserious had denied their request to install a state-run program, citing lack of inter-agency coordination, and had countered with an offer to set up a joint Fed-State operation.

As Mike pointed out, this seemed odd: "And yet, the federales tell Missippi that there's every possibility of coordinating with the same state agencies, under the same governor,  in a fed-state partnership Exchange."

I posed this dilemna to Elizabeth Festa of the National Underwriter (she wrote the original story which prompted my post). After a few emails back and forth, she came back with the Feds' final "answer" to this apparent contradiction: "Don't worry your pretty little heads about it."

Okay, that's a paraphrase; their actual reply was "a  partnership marketplace can still be set up without help from the governor's office because HHS has such a heavy role."

I'm pretty sure that my version would have gone over better.

The problem, of course, is that this is a non-answer. As I pointed out to Ms Festa (who seems like a very well-meaning and industrious person), "the HHS folks are being deliberately obtuse. Cohen (HHS) says "With ... no formal commitment to coordinate with other State agencies, we do not see a feasible pathway"

[As I explained to Ms Festa, I omitted the issue of the Governor's apparent recalcitrance because it's largely a distraction from the key issue]

I continued:

"But if MS agrees to a (Fed-State) Partnership, there's still not going to be any coordination. And if the HHS answer to that is "a  partnership marketplace can still be set up without help from the governor's office because HHS has such a heavy role," then Chaney's right when he says that "[t]he feds call the shots and we do all the work." And in that case, the lack of agency coordination becomes even more intensified."

One supposes that this could still end amicably, but at this point, it seems less likely. Ms Shecantbeserious has a pretty critical timing problem here: if they can't reach an agreement, then it automatically defaults to a Federally-run Exchange.

So what's the problem with that, Henry?

Well, there's (at least) two:

First, that countdown clock keeps on tickin', and HHS will have one more Exchange to set up (and how swimmingly is that effort going, Madame Secretary?). And second, it means that Magnolia State residents will forfeit any potential premium subsidies.

Nice.

Another Hidden ObamaTax

Hadn't thought of this before (my bad), but there's another little gem implicit in The ObamaTax:

Currently many (most?) working folks get their health insurance through employer-sponsored plans. And many of these folks pay their portion of the premium pre-tax, via Section 125 (or "cafeteria") plans.

Since many (most?) group plans will be going away over the next few years, employees dumped onto the Exchanges will lose that feature, and will have no alternative but to pay all their premiums with after-tax dollars. Adding insult to injury, a lot of these folks will be making too much money to qualify for any subsidies. And, of course, those in states with Federally-run Exchanges will get none.

But remember,The ObamaTax will lower your health insurance costs by 3000%.

[Hat Tip: Ace of Spades]

Tuesday Health Notes

■ First up, some great Food Pyramid news:

"Researchers ... in Spain have found that beer can help the body rehydrate better after a workout than water or Gatorade."

Apparently, the carbonation is a key factor, and the carbs help out, too.

■ Next, some good news for stroke survivors:

"A single injection, then a five-minute wait ... Now they're walking more steadily, reading more easily, concentrating better, speaking more clearly and regaining use of once-rigid limbs"

The secret? A 25mg shot of etanercept (an anti-inflammatory med). And the results?

"Of the total studied, more than 80 percent saw improvements in their ability to walk; more than 80 percent had less spasticity; and more than 85 percent exhibited improved motor function."

So if you (or someone you love) had a stroke, this may be just what the doctor orders.

■ Finally, the feel-good story of the week (or more), an early (and amazing) Valentine's Day gift. Forget flowers, candy and PJ's, here's a gift that truly keeps on giving:

"Three days before Valentine’s Day, a Florida woman gave her husband the most special gift of all ... Melissa DeGeso-Jones had her kidney transplanted at Florida Hospital in Orlando to her husband, James Jones, who has been suffering from renal failure."

His next major challenge? How does he top that?

Warning signs...

Earlier this week, we noted that the problems which the Much Vaunted National Health System© is experiencing at Stafford and other facilities is nothing new or even particularly obscure. What we didn't know at the time, though, is that they were warned about these problems by none other than  Sir Donald of Berwick (well-known to regular readers of InsureBlog):

"Its 84-page report ... warned ministers that the [MVNHS©] did not pay enough attention to quality of care because it was too focused on targets. It concluded that hospitals were “hitting the target and missing the point”.

Ouch!

Pretty sad when one of the architects of The ObamaTax finds your system critically flawed.

Missing Mississippi

Y'know, for an agency facing a quickly-approaching deadline, the folks at HHS seem to have an attitude problem:

"[Secretary Shecantbeserious] rejected approval of the Mississippi insurance commissioner’s state-based exchange application ... To be successfully approved and to even work as a marketplace, a state-based exchange would need working relationships with other state agencies ... there was no possibility of coordinating strategy with other agencies under his authority"

Which is all well and good, but fails to address the Magnolia State's main problem with the premise, to wit:

"[T]he health insurance exchanges mandated by [The ObamaTax] are not free-market exchanges. Instead, they are a portal to a massive and unaffordable new federal entitlement program. They trigger new taxes on businesses and will ultimately drive more people onto Medicaid rolls"

Please, Gov Bryant, tell us what you really think.

Underscoring the divide is the inherent conflict between what Madame Secretary wants and that pesky 10th Amendment. It seems reasonable to predict that this issue will also head to SCOTUS in the near future. How that plays out will be interesting to watch.

ADDENDUM: In the comments, Mike points out the fallacy of Ms Kathy's contention that that there's "no possibility of coordinating strategy with other agencies under his authority." In his link, a local paper reports that (as Mike puts it) "the federales tell Mississippi that there's every possibility of coordinating with the same state agencies, under the same governor,  in a fed-state partnership Exchange."

So which is it, Madame Secretary?

Draft Dodging

As Bob noted last week, some of the 58 states have begun to take a serious look at how their Exchanges (if any) will be run. A key issue is the role of agents/advisors, and how they're to be qualified and compensated.

Now comes word that HHS Secretary Shecantbeserious is planning to "start registering agents and brokers around July 1."

Okay, when you're through laughing, we can continue.

Have you noticed the little countdown timer in our sidebar? That's the countdown to the day the Exchanges are to go "live." The date? October 1st. Now, keeping this in mind, wrap your head around this:

"The federal exchange managers want to promote the agents by publishing lists of individual exchange producers starting in August and lists of the producers registered to sell Small Business Health Options Program (SHOP) exchange coverage starting in September." [emphasis added]

Now, given the institutional efficiency for which the HHS is so widely admired, what are the odds of this actually working out?

Yeah, that's what I think, too.

Anther question we might be asking ourselves is whether or not any sane insurance agent wants to participate. After all, under a state-regulated system, worst case scenario is generally a fine and/or loss of license. But these are (presumably) going to be subject to Federal laws, so the down-side must surely be more serious, no?

Which is not to say that it won't happen (I'm still on the fence, for example), but it does give one pause. And since that clock is clicking down at a pretty good clip, this may end up being a rather high-stakes game of chicken with Ms Kathy.

The Social Problem of Medicaid Expansion

Avik Roy has done a good job explaining some of the financial misconceptions our Governor has used in proposing Medicaid Expansion in Ohio.


Not discussed are the common sense social problems with expanding it. Simply: why bother working? When I was younger and wanted money, I got a job. When that wasn't enough, or I wanted a new car or paid myself to go to school, I got a second job. There have been a couple times in my life I held had three jobs. 70 to 80 hour work weeks were not uncommon; even now, with one job, 70 hours is not uncommon.

Our present-day welfare state, on the other hand, discourages work. Work just a little, be sure to show less than $15,000 in income on paper, and you can qualify for all sorts of benefits:

·Free Health Insurance under Medicaid Expansion
·Free food and spending cash with your EBT card
·Housing assistance
·Utility Assistance
·Education Assistance

Why get a second job or work more hours and lose all the free benefits? I see McDonald's and other fast food companies that are looking for workers. How can we have this level of unemployment and demand for assistance but unfilled entry level jobs?  That is a sure sign government assistance has supplanted the need to work.

We might have a Republican Governor in Ohio but we need a Conservative to replace him.

TPAs to pay for Birth Control

Apparently I am going to be spending a fortune on birth control, sadly I don't expect I will have time to use any of it.

"The preamble to the proposed rule suggests several ways in which this could be done, but the basic idea is that the TPA would take responsibility for providing coverage, and in turn contract with an insurer in the individual market to provide the coverage.  The insurer would in turn pass the cost of the coverage (which now will be a real cost since the insurer has no responsibility for covering maternity or any other health care costs) on to a federally facilitated exchange (FFE), which would offset the cost through a reduction in user fees — in other words, the insurer would receive a reduction in the user fee it otherwise owes to the FFE to cover both its costs and any administrative costs incurred by the TPA."

That's just the summary. Where to begin....

I have never seen a contraception-only policy before; are they even legal to sell?

I need to find a carrier, send them eligibility on a regular basis, and not get paid for any of it?

I am going to be really pissed if some carrier has a data breach and exposes PHI or Red Flag Data and I have to deal with the cost for services I didn't get paid for; I haven't seen any mention of immunity.

Will MLR apply to these policies? I foresee a lot of work to provide a small dollar benefit. In fact, I could see the administrative cost being higher then the cost of the drugs.

And who gets the rebates?

"Insurers providing contraceptive coverage would be responsible for notifying plan participants and beneficiaries of the availability of the coverage using language found in the proposed regulation.  The notice would be provided separately from any other plan information, generally on an annual basis."

There starts the excessive administrative fee.  Apparently single males would also need to be offered this policy and notice?

Fraud potential in this is huge: I don't see where anyone is asking the TPA to verify who these policies are being purchased for.

Old Dominion vs The ObamaTax

Well, well, well. So it's not just universities and businesses cutting employees' hours to avoid some of the more pernicious elements of The ObamaTax. Now, states are getting in on the act, too:

"Virginia ... is about to limit part-time employees to 29 hours per week in order to avoid triggering Obamacare’s requirement that employers provide health insurance to those working 30 hours per week or more."

That's because the state can ill-afford the estimated $100 million+ cost of implementing the train-wreck. Look for at least a few more of the other 57 states to follow suit.

Feature or Bug?

The other day, we reported on the latest scandal plaguing (heh) the Much Vaunted National Health System©.  And despite the fact that, as Mike pointed out, we covered this very same facility (among others) over three years  ago (!), little has changed, and nothing has improved.

Now comes British Health Secretary Jeremy Hunt (the MVNHS© version of HHS Secretary Shecantbeserious), openly calling for a police investigation into the affair, opining publicly that it's "absolutely disgraceful” that no doctors, nurses or managers have been held to account for the substandard care which led to the deaths of up to 1,200 patients."

Which begs the question:

If, after (at least) three years of ongoing and documented “abuse on such a wide scale,” isn't it fair to ask whether this might actually be by design, and not happenstance? After all, none of this is "news;" indeed, it's been common knowledge for some time. And yet, it's only after a British newspaper reported the abuse in detail that a high government official thinks it's time to ditch the famous stiff upper lip, and get cracking. 

But wait, it gets worse:

"[Secretary Hunt] admits he is not sure which hospitals are doing a good job ... I think it’s absolutely outrageous that potentially more than a thousand people lost their lives because of poor care and not a single person has been brought to book."

A suggestion, Mr Hunt? Try a mirror.

War is peace. Freedom is slavery. Ignorance is strength.

California seems to be getting jittery that when Obamacare takes hold next January, there won't be enough doctors in the state to treat the expected number of new insured patients.

“Some lawmakers want to fill the gap by redefining who can provide healthcare.  They are working on proposals that would allow physician assistants to treat more patients and nurse practitioners to set up independent practices. Pharmacists and optometrists could act as primary care providers, diagnosing and managing some chronic illnesses, such as diabetes and high blood pressure.”

[via Instapundit]

In this case, California may be awakening to the false promises of Obamacare.  Because in the real world, it has become increasingly apparent that Obamacare can’t be installed as written; that Fed regulations are impediments to its effective management; that the result will more likely be increased, rather than reduced, cost of medical delivery; and that therefore Obamacare is more likely to raise rather than lower everyone’s medical and insurance costs.

What to do?  It now occurs to California that maybe it could REDEFINE “medical care”.

So the California legislature will consider whether you really need a doctor if you are a diabetic. Or whether you can get perfectly fine medical attention from a nurse practitioner’s independent practice.  In California, anyway.

The public needs to know much more about this  - and I’m sure we will.  But right now, the legislature is sorta asking Californians to believe that this here Smartcar is actually a fine modern automobile.

We get mail!

A reader sends along this link to Avik Roy's take on the ObamaTax Medicaid expansion, and asks:

"What was that again [about] how medical costs cause premium hikes?"

Of course, we always welcome feedback, and appreciate the opportunity to reinforce our long-stated (and well-proven) positions.

I replied:

"Interesting article - Thanks!

Still don't see how that contradicts our position: increasing medical costs cause higher insurance costs. And of course other things also cause increased insurance costs. But the reverse is not true: increasing insurance costs don't cause higher health care costs.

Again, nothing in that article contradicts this very basic, very obvious observation."

Mike had a slightly different take:

"I think your correspondent is just being obtuse.

Of course increasing enrollment increases overall insurance expense.  Doesn't it always?  Specifically, ACA will cause Medicaid enrollment to increase.  This means the overall medical cost for the Medicaid population will be greater than its overall medical cost is today.  Why would it be otherwise?

[Avik] Roy makes the point that ACA - by increasing the Medicaid population - will increase the cost shift to private insurance, so private insurance premiums will experience higher trend and therefore private insurance premiums will be higher.

In other words, higher private sector insurance cost result directly from the Medicaid medical costs shifted to the private sector.

And so, it's medical cost that drives insurance cost.  Exactly what we have been saying for years and years.

The difference here - which your correspondent does not recognize - is that additional Medicaid medical cost will be shifted to private insurance.  That means the private insurance premiums will bear the impact.  Clearly that doesn't prove medical costs don't drive medical premiums.  Instead, it illustrates that very point.  And it reveals once again the ongoing failure of government meddling to accomplish anything constructive about overall medical costs in the first place."

Bob also weighs in:

"About that cost shifting ...

Medicaid = lower reimbursement = cost shift to private patients = higher insurance premiums

Of course we all (should) know this, but Medicaid is a Catch 22:

If the government doesn't provide health insurance for those people, they still get sick and those unpaid bills are shifted to private pay. With Medicaid, only a portion of the bills are shifted to private pay with the rest picked up by taxpayers.

Rearranging the deck chairs.

The issue with Medicaid expansion is, even though DC will print magic money to fund the expansion for 5 years (or whatever the time frame is) after that point the burden falls on the states their "fair share."

As I said, I have the best co-bloggers.

Belated Blogiversary!

Can't believe I missed this, but - about a week or so ago - InsureBlog turned eight.

5,600+ posts and countless comments in, and still going strong.

My hearty and heartfelt thanks to the best co-bloggers in the 'sphere: Bob, Mike, Nate, Kelley and Bill, y'all are terrific, and I'm honored to share pixels with you.

And, of course, to our many, many readers: Thank You!

The MVNHS© and The Obamatax

Here's a cautionary tale of what happens when you put the government in charge of health care:

"Britain was rocked this week by one of the biggest scandals in the recent history of its health system ... The report, which examined conditions…over a 50-month period ... cites example after example of horrific treatment: patients left unbathed and lying in their own urine and excrement; patients left so thirsty that they drank water from vases; patients denied medication, pain relief and food by callous and overworked staff members"

And the list goes on (and on).

It's all about - what else? - cost control. As regular readers know, the Much Vaunted National Health System© (and its ilk) are simply no better at controlling spiraling health care costs than our own soon-to-be-dismantled system. Which doesn't stop unelected and unaccountable bureauweenies from playing God, of course:

"It’s a textbook case of how structural incentives in government-dominated health care systems can lead to terrible outcomes."

Coming soon to hospitals near you.

HealthTech Update

Even as the ObamaTax takes a bite out of medical R&D, some folks continue to develop cutting edge health care solutions. Cases in point:

■ We're all familiar with those MedicAlert bracelets (and even tattoos!). Now, ScanMed QR has come out with a smart-phone app that promises to digitize this often vital info. It's pretty remarkable, especially since one can "dynamically enter, edit and change information." The company plans to market the app's associated devices through pharmacies and other retail outlets.

■ FoIB Holly R tips us to this somewhat creepy new technology:

"Autodesk is developing CAD tools that can design new blood vessels, liver tissue and other replacement parts for the human body in collaboration with 3-D bioprinter company Organovo"

The idea is that, someday, we can actually print out organs in real-time. The tech is still in its infancy (heh!), but seems promising.

On the other hand, imagine the cost of replacing those printer cartridges.

■ Finally, one more smart phone-related item:

"[W]ould you want to know in under 10 seconds if your daughter, wife, mother or other loved one was in danger and needed assistance?"

Well, Clandestine Development has, er, developed a personal safety application for iPhones and Androids (sadly, my brand new 2007 tech phone isn't on the list). It touts the product as "the only app that utilizes patent-pending IntelliTouchTM technology, which activates upon natural, human reaction and responds instantaneously without requiring the users interaction to emergency situations."

But don't just take our word for it:

Medicaid Sleight-of-Hand?

Here in the Buckeye State, our (Republican) Governor has opted to buy into the ObamaTax Medicaid expansion program, to the consternation of many conservatives and/or fellow Republicans. Likewise Jan Brewer in The Grand Canyon State, and several others. Since we're not a political blog, we generally leave it to others to dissect the "behind the scenes" for us, and today Josh Archambault, co-blogger at Avik Roy's Apothecary blog at Forbes, does a masterful job:

"Governors are not the sole policymakers in their respective states ... The other state trying to experiment with reforming Medicaid in a meaningful manner is Florida. HHS granted approval earlier this week for a waiver to allow more long term  care patients into managed care. However, the state is still waiting for a federal decision on a second Medicaid waiver that would allow Florida to move the bulk of its other Medicaid recipients into a statewide managed care program"

As usual, Avik cuts through a lot of the rhetoric (on all sides) to get at the kernel(s) of truth.

Read the whole thing.

ObamaTax Ka-Ching!

It seems that every day brings a new ObamaCost. Whether it's birth control convenience items, or our groceries or sky-rocketing premiums, it's the gift that keeps on taking.

So here are three more vignettes, tied together by a common theme; see if you can guess what that is:

■ "The Congressional Budget Office's just-released economic forecast for 2013 is dispiriting ... ObamaCare will cost 7 million their health insurance."

What's so interesting to me is that the various factors they cite - reduced GDP, higher unemployment and so many folks losing their health insurance - are all symptoms of the same disease, not discrete phenomena.

■ Along those same lines, the (ostensibly non-partisan) Congressional Budget Office has "quietly raised the 10-year cost of [The ObamaTax] insurance subsidies offered via the health law's exchanges by $233 billion." This brings the projected total cost to over $1 trillion over the next 10 years. Given that the initial projections were in the neighborhood of $800 billion (not exactly peanuts to begin with), how long do you think it'll be before that $1 trillion estimate gets left in the dust?

■ And, finally, from the "pass it to learn what's in it" files, comes this gem:

"[HHS Secretary Shecantbeserious] and the Internal Revenue Service (IRS) talk about the gaps in the "universal coverage" requirements in the [ObamaTax] in three batches of proposed PPACA regulations."

Wait, what?

There are "gaps?" What part of "universal" don't they understand?

Oh, right, this is the gang that can't seem to get any of their numbers correct, so why would we expect them to get the underlying requirements right?

The so-called "gaps" center around the Minimum Essential Coverage requirements and exemptions (and why are there "exemptions" in the first place? Oh yeah, it's "universal"), as well as the slight problem that the IRS is essentially toothless when it comes to actually enforcing those requirements.

Sheesh.

The Purging Begins

Somehow, I don't think they really have our best interests at heart:

"[HHS Secretary Shecantbeserious] is proposing to reform existing healthcare regulations and purge unnecessary ones ... We are committed to cutting the red tape for health care facilities"

Oh, I can certainly think of one "unnecessary" healthcare law tax, can't you?

In a fit of uncontrolled irony, Ms Shecantbeserious has released a "114-page proposal cover[ing] a range of medical positions and services"

You really can't make this stuff up.

The problem, of course, is that - with these folks - one must always look for the actual, usually hidden, motivation. That is, nothing they do is ever really for our own good. So although this looks good on (lots and lots of) paper, it's fair to ask "what are they really trying to accomplish?"

In this case, it seems pretty reasonable that they're beginning to understand the incredible provider shortage that they've created, and are now scrambling for a way to somehow mitigate the damage.

Rotsa ruck with that.

Cavalcade of Risk #176: Short and Sweet edition

Dennis Wall hosts this week's collection of risk-related posts. From telecommuting to drug prices, you're sure to find something helpful.

Everyone Counts (except you) . . . A timely reminder about government exercise of power

Via Drudge, we learn this from the London Daily Mail Feb 1:

The British National Health Service (NHS) is launching a program called Everyone Counts.  This program requires family physicians to hand over to NHS their patients’ confidential and personally-identifiable records including drinking habits, waist size, weight, cholesterol, BMI, family health history and pulse rate, and other details.  Physicians are ordered to comply.  Patients cannot opt out.

NHS plans to “analyze” the data.

I’ll just bet they do, too.

NHS officials say the data will be stored in a giant information bank where, they insist, it will be “anonymous and deleted after analysis.”

This raises several questions about the program er, excuse me, programme. 

Will anonymous third-parties be supplied with this patient data for analysis? 

Is the patient data easier to hack when it resides in a “giant information bank” or when it's supplied to an unknown number of anonymous third-parties, or when it remains where it is now, in tens of thousands of physician office files?

How long “after analysis” will NHS delete the data?  A day?  A decade?

Here's a better question  – will a day ever come that is "after" NHS “analysis” ends?

Here's the best question of all – what reasons do the British public have, to believe anything NHS officials say about this new program, er programme?

This seems to me a timely reminder that, when the people agree to give powers to the government, the government will actually, you know, use those powers.  This also seems a timely reminder that sometimes governments will use their powers for purposes the people don’t want - and which the government may strenuously deny it's doing.  Thus, the article quotes an unidentified NHS spokesman: "The NHS constitution makes clear what information can be used for by the NHS and this proposal complies exactly with that."

History teaches that to expect governments to behave otherwise is foolishly naïve. 

Excise tax on Medical equipment costing jobs

The 2.3% excise tax on medical equipment kicked in and has already been blamed for hundreds of layoffs.

Looking back at some larger claims we have paid over the years, this tax could be fairly significant. Seeing $100,000 in equipment charges is not at all uncommon for back surgeries and other procedures. This would appear to be another great reason to go out of country to have these procedures done. $2,300 would cover airfare and accommodations.

"The medical device excise tax applies to manufacturers and importers and generally does not apply to individual consumers."

Those attacking our healthcare system will cheer the $300,000 back Surgery bill  only costing $40,000 in India, Costa Rica, or where ever else. I think the American workers who used to make the equipment and perform these procedures - who are now out of work - might not agree so much.

How long before this loss of revenue has the TSA screening for people wearing untaxed equipment crossing back over the border? Are you bringing any fruits, vegitablles or untaxed medical devices with you today?

Someone who passed economics might have an interesting time rationalizing the impact of $300,000 in domestic spending replaced by $40,000 in foreign spending and its impact on our economy. I have a feeling we don't really "save" $260,000.

Stupid Consumer Tricks

From the same LA Times act of Psuedo Journalism comes this gem of projection;

"The Long Beach woman said she sought treatment in 2009 for a pain in her abdomen. First her doctor ordered a CT scan of her abdomen and pelvis at Liberty Pacific Medical Imaging, an independent facility near Long Beach Memorial.

She got approval from Blue Shield, and she paid the negotiated rate of $660."

"This time, her surgeon referred her to the hospital's imaging center. Snyder said she assumed her bill would be about the same because it was the identical test. Instead, Blue Shield's rate with Long Beach Memorial was $3,497 and the insurer told Snyder she owed $2,336,"

Wow. I would be pissed, too, if I was asked to pay $2,336 for a test I could get down the street for $660. She should go after the hospital or the doctor who referred her to the hospital....right...?

"In a complaint filed last month in Orange County Superior Court, Snyder accused Blue Shield of unfair business practices, breach of good faith and misrepresentation over her medical bills. The suit seeks class-action status on behalf of other Blue Shield customers."

HIPAA would make it hard to find out, but I have to wonder if her chronic case of stupid was pre-existing or not. Sue your health insurance because you assumed a hospital would charge the same as a free-standing imaging center.

What is the Part B late enrollment penalty?

This is not intended to be a trick question.  But in the Fair Kathleen Sebelius' HHS, it appears to have a trick answer.

On page 25 (page 26 in the on-line version) the 2013 Medicare handbook "Medicare and You" states that "Your monthly premium for Part B may go up 10% for each full 12-month period that you could have had Part B, but didn't sign up for it."

That sounds pretty clear - what's the praahblem? 

Well.  Since you ask.

It seems there is a Social Security document called the “Program Operations Manual System.”  This document is essentially the operating instructions and rules for Social Security.

As it happens, a little-known, double-secret codicil in this manual requires that anyone who declines Medicare benefits thereby forfeits their Social Security benefits.

In early 2012, a legal challenge arose - Hall v Sebelius - over this double-secret Social Security rule.  The plaintiff argued that neither the Social Security Act nor the Medicare Act allows administrative agencies to precondition benefits under one program on acceptance of benefits from another.

The district court disagreed and the U.S. Court of Appeals for the D.C. Circuit affirmed the lower court decision. Both decisions were sharply divided.  In January 2013, the Supreme Court declined to hear the case. By its decision, the Supreme Court let stand the lower courts' controversial ruling.

So the "trick answer" is yes, you face a 10% per year premium penalty for failing to enroll in Part B when eligible.  But that is the least of your worries -  your penalty is actually much greater.  You have forfeited your Social Security benefits.

This much greater penalty for non-enrollment is NOT included on page 25 (or 26) of the Medicare and You handbook.  It's still double-secret, you see.  

Are we all clear now?

Left unanswered at this time - "how long does the SS Admin wait after you are eligible for Medicare but don't enroll, to take away your SS benefits?"  One quarter?  One month?  One hour?

LA Times' Pseudo Journalism

I have believed for a long time that one of the major reasons our healthcare system has sunk so far is the public knows so little. They are fed endless misinformation and downright lies by politicians and our so-called journalists,  while the public blames greedy insurance companies with 40% profit margins. The LA Times has dumped the latest pile of journalistic malpractice on us; So many problems with this piece of agenda propaganda, possibly the worst:

"For those patients who have insurance, getting the lower price would typically mean withholding that information from the hospital or clinic. Experts warn that doing so, however, means any payments don't apply to customers' annual insurance limits for out-of-pocket spending."

According to these "Experts" (and why are they never named?), if you pay a medical bill, you can not submit it to your insurance company.  Apparently insurance companies don't have claim forms or mail boxes where members can submit claims.

As usual, hacks like Chad Terhune - who rush in to push a lie - miss the real story: the far bigger problem is people paying cash to get a discount, then submitting to insurance and getting deductible credit for more than they pay. If someone accepted the cash discount then billed their insurance, the insurance company would have no way to know the member paid a discounted rate and would process the deductible credit at the higher allowable. Not exactly the story Chad was trying to sell, is it?

We see this already in Rx: Member co-pay cards circumventing plan designs and allowing members to pay substantially less then their benefit plan calls for.

The error was pointed out to Chad, but don't expect the LA Times to actually correct an article. They don't like facts getting in the way of their agenda.

Did Shecantbeserious Blink?

Perhaps, but any celebration over victory of her usurpation of the 1st Amendment is premature:

"[HHS Secretary Shecantbeserious and/or her minions] on Friday announced a broader opt-out for religious-affiliated groups that want to skirt the so-called contraceptive convenience item mandate ... Businesses like Hobby Lobby ... would probably not be affected by the change ... For those with insured plans, the insurer would be required to provide enrollees with "no-cost contraceptive coverage" through a separate policy."

As usual with these rocket surgeons, there's more exemptions than anything else. So who would likely benefit?

A much smaller list:

"[R]eligious nonprofits that object to the mandated coverage of contraceptives, one that will allow large faith-based hospitals and universities to issue plans that do not directly provide birth control coverage."

But even that's a cop-out, because they'll still be required to provide a "stand-alone, private insurance policy that would provide contraceptive coverage at no cost."

At "no cost" to whom?

Yeah, I know.

By the way, sharp-eyed readers will note that I elided over "self-insured plans, a third-party administrator would work with an insurer to set up no-cost coverage through other policies." Your patience will be rewarded.

Cavalcade of Risk #176: Call for submissions

Dennis Wall hosts next week's Cav. Entries are due by Monday (the 4th).

To submit your risk-related post, just click here to email it.

You'll need to provide:

■ Your post's url and title
■ Your blog's url and name
■ Your name and email
■ A (brief) summary of the post

PLEASE remember: ONLY posts that relate to risk (not personal finance tips and the like). And please only submit if you are willing to link back to the carnival if your submission is accepted.

The New ObamaRate$

Remember this:

"Your health insurance premiums will decrease by 3000%"

Yeah, no:

"[T]he Internal Revenue Service (IRS) assumed that under Obamacare the cheapest health insurance plan available in 2016 for a family will cost $20,000 for the year ... In the examples, the IRS assumes that families of five who are uninsured would need to pay an average of $20,000 per year to purchase a Bronze plan in 2016."

Which is, of course, much higher than any (non-enforceable) penalty tax that might be due.

Adding insult to injury, those expected rate increases will be coming in ahead of schedule. In email this morning from Aetna:

"On January 17th, we sent an email message announcing our decision to discontinue the initial 12-month rate guarantee for new business policies with a January 15, 2013 or later effective date ... To prepare for 2014 when new health care reform changes regarding products and rates will take effect"

As Aetna notes, they are not the only carrier to make this change, and I can't imagine any other carrier sticking with annual rate guarantees from here on out.

Glad we passed it to find out what's in it?