Is there a future for private insurance exchanges?

The collapse of most Obamacare exchanges has captured the attention of the media in recent months.  This may explain the lack of news about private exchanges.  Private exchanges have not exactly caught fire, but they have not disappeared either.  The failure of Obamacare exchanges may increase calls for a national medical welfare program.  Ironically that same failure increases the future potential for private exchanges.  So even as Obamacare exchanges continue to collapse, work to develop and market private exchanges continues and the future of those private exchanges remains hazy.  Some factors:

(1)  The Massachusetts insurance reform enacted in 2006 is widely considered the model for Obamacare.  This legislation established a state-run insurance exchange called “the Connector”.  Just this August, The Society of Actuaries released an extensive report on the impact of the Massachusetts legislation on insurance markets, pricing and profitability.  This report finds in part that:

“Despite its success in the subsidized market, the Connector, managed by the Massachusetts Health Insurance Connector Authority, enrolled few insureds in the unsubsidized nongroup and small group markets and was unable to exercise much influence on the merged market.”

https://www.soa.org/.../research-2016-ma-health-insurance-reform.pdf  (Copy & past the link to your browser)

 Apparently a different, more effective tactic is needed to reach the “unsubsidized markets”.  That is consistent with the experience of the failed Obamacare exchanges.  Do privately-run exchanges offer a more effective tactic for the unsubsidized markets?  Perhaps – provided the federales will allow a private-sector solution.    

(2)  National consulting firms such as Mercer, AonHewitt, and Willis Towers Watson are investing in their own private exchanges.

This move appears a good fit with their existing business strategy of expanding admin support to employers – e.g., member service functions, 401(k) administration, annual enrollments, etc.  These firms clearly see a future in private exchanges.

(3) Large insurance companies, e.g., Aetna, United, and Anthem, that initially expressed interest in building their own private exchanges, seem to have become less enthusiastic.   I’m guessing they’ve lost appetite for gearing up to administer multiple other companies’ coverage.  Isn’t it much simpler for the insurer to participate in one or more third-party private exchanges and sell its own individual policies there?  I wonder if they aren’t asking themselves, what’s the point of building a proprietary private exchange?

So questions remain following the Obamacare failures – which, don’t forget, go beyond financial.  Their implementation and operational failures have been painfully documented.  Most states declined to set up their own tax-eating, money-losing, hard-to-run, over-regulated, politicized Obamacare exchanges.  The federales have proved they don’t have the resources to operate exchanges even as they proved ignorant of insurance management and eager to over-regulate.  Can private exchanges ever overcome the Obamacare record, and become attractive for the majority of middle-income Americans? More specifically 

        (a)  Will large employers gravitate toward private exchanges?

        (b)  Will employers that subsidize their employees’ group coverage today, continue to do so in private exchanges?   

            (c)  Will insurers decide to participate in private exchanges?

         (d)  Provided employer subsidies continue, will middle-income employees prefer coverage available thru a private exchange, vs. the choices available to them now?      

         (e)  Will the federales expand Obamacare subsidies to include private exchanges, not just Obamacare exchanges (if any)?

I think the best answer for now is “Reply hazy, ask again later.”

 

More 3000% Rate Decreases

Once more, with gusto:



Just got in another batch of renewals on some of my Grandmothered and Grandfathered plans. Sally, for example, has a $3,000 deductible, HSA-compliant plan with no co-insurance. Her current rate of $384 a month is increasing by 17% to $450. She called to ask what we could do about it, and I told her - unironically - that this was the part of the program where she writes the carrier a Thank You note.

Why is that?

Well, I found two plans that came close:

The first has a $6,550 deductible, then 100%, is also HSA-compliant, and weighs in at a respectable $525 a month. So she can spend an extra $900 a year while enjoying twice as much out-of-pocket.

Her other choice is a plan with her current carrier, with a $4,000 deductible, and a $675 a month price tag.

To put this in perspective:

Under her current plan, she's out $8,400 for the year before the insurance pays dime one (well, except for some preventive care).

Under Option A above, she's out just shy of $13,000 before the plan kicks in (well, she would have "free" birth control convenience items and maternity, which may be of limited value to her 55 year old self).

And under Option B, she'd be paying just over $12,000 for the privilege.

Yay.

If you like your plan, Nebraska style

Cornhusker State insureds (and potential insureds) just lost another opportunity:

"Blue Cross drops out of Nebraska's Obamacare marketplace"

That leaves just two carriers on the state's Exchange, one of which has a substantial Medicaid presence as well. And it leaves some 20,000 erstwhile BX enrollees scrambling for a new carrier in a few weeks.

Curiously, Blue Cross CEO Steve Martin (no, not that Steve Martin) claims that "too often federal officials let people buy insurance just before they are due to receive an expensive health treatment and then drop their coverage immediately afterward."

This particular gaming of the system seems to have become more difficult as HHS, and the carriers themselves, crack down on SEP's. Still, he would know, no? And if true, that's really on the government, not the carriers, who simply follow the rules.

For certain values of "rules."

[Hat Tip: Cynthia Cox]

Back to the Future?

Regular readers will recognize Cornerstone: they've been a great resource for me both professionally and for the blog. Steve Geis, Cornerstone's VP of Employee Benefits, recently penned a really interesting article that was emailed to their agents. It's a great perspective on what he thinks the future holds, and he's graciously granted us permission to excerpt it here:

"From its inception, we wondered if employers would offer group health coverage once the ACA became law ... Would groups even need a broker?

Fast forward to present day 2016. We have a thriving group market with employers offering health benefits to their employees. Though a small percentage of groups disbanded coverage, it wasn’t the high volume expected.

So what happened? I believe there are several reasons employers didn’t end their health plan. Groups want to offer health benefits to stay competitive in the marketplace, attracting and retaining the best talent. They also want to provide benefits because they feel it’s simply the right thing to do.

But what new threats exist on the horizon? The House of Representatives passed H.R. 5447, which is now in the Senate as Bill S.3060, also known as the Small Business Health Care Relief Act ... It states that standalone HRA’s, which are not paired with a health plan and used as a means of tax-advantaged funding, are not permitted for employee reimbursement."

I'm going to stop there, but would be happy to send along a full copy to anyone who's interested; just drop us a line.

What I'd like to do, though, is focus on that last paragraph. For a long time, Health Reimbursement Arrangements (HRAs) were a valuable tool for employers to help their employees fund health care and insurance. Sadly, The ObamaTax largely outlawed the practice (unless coupled with a compliant group health insurance plan), which is ironic, but it it what it is. What SB 3060 seems to do is to put HRAs back in our metaphorical toolbox, allowing employers to once again offer their employees the choice of either staying on the group plan (one-size-fits-a-few) or opting for an individual plan that may more closely reflect their needs and budget.

Steve also points out that this could create a problem regarding Special Open Enrollment:  unilaterally dropping off the group plan isn't a Special Open Enrollment trigger. Something to consider.

Now, how likely is it that this will pass? Who knows, but the folks I spoke (including our friends at FlexBank) with are skeptical. Still, hope springs eternal, and perhaps this is just the first volley.

Health Wonk Review: Mazel Tov to CHII edition

Our good friend Louise Norris, co-proprietor (along with her husband Jay) of the Colorado Health Insurance Insider blog hosts this week's round-up of health care wonkery. And it's extra special because they're celebrating the blog's 10 year anniversary [ed: newbies! 😃].

And Louise does her usual outstanding job with this 'Review, adding helpful context to the links.

Kudos, and Congratulations, Louise!

Lying with Numbers

So the most recent conventional wisdom holds that ObamaCare has reduced the number of uninsured by half:

"Obamacare pushes nation's health uninsured rate to record low 8.6 percent"

Which would be a great start, were it true.

Here's why it's not:

The article's baseline is that, in 2010, 48.6 million (or about 15%) of Americans were uninsured (which was always bogus, of course, but for the sake of argument we'll go with that percentage). That is, there are 21 million fewer "uninsured" folks than there were in 2010. The problem is that 15 million of those folks are not insured, they're on Medicaid, meaning that only about 6 million people (net) are newly insured. By the way, I'm not parsing words when I say that Medicaid isn't insurance: it's income redistribution.

So what proponents are really saying is that almost twice as many people are now on the Medicaid rolls as bought actual health insurance.

#Winning!

[Hat Tip: David Williams]

What's up Doc, DI-style

DI being, of course, disability income insurance. My industry isn't well-known for frequent innovations, so when I saw this in email, my curiosity was piqued:

"Guardian challenges Individual Disability Income Insurance industry with unique features for physicians"

Physicians, like most of us, depend on their wages to pay for things like food and shelter, cars and clothes, and all the rest. And it's not like this niche has gone under-served: along with lawyers and accountants, white collar-focused carriers have long since targeted these typically high-end clients.

So what could Guardian have possibly come up with to merit such a breathless headline?

I looked through the email, and a couple items caught my eye:

■ Enhanced True Own-Occupation Protection means more ways to qualify for benefits

Own-occ has long been the gold standard for high-end DI plans. Briefly, it means the inability to perform the majority of the duties that they one's been trained to perform. Now, this is just a baseline definition, and carriers usually tweak them to make their product more attractive. Any wording that makes it easier to access benefits, as this rider purports to do, has to be a plus.

■ Option to protect student loan debt payments.

This is truly cool, and exclusive to Guardian. I really like programs like this; when carriers think "outside-the-bun" (as with MassMutual's RetireGuard) it makes me smile. Think about it: if your income stream is cut off, how are you paying off your student loan(s)? If you're a doctor or lawyer (for example), you're likely paying off both undergraduate and graduate schools.

There are other interesting provisions, as well, including coverage for hospice care.

Kudos to Guardian.

[Hat Tip: Adrianna Webster]

New York, New Jersey and Your Insurance

On Twitter, a friend of mine asked if damage from bombings such as the one in Chelsea would be covered by one's homeowners or auto insurance. We've blogged before on how commercial (business) insurance policies handle terror-related claims, but this is a very different question.

For example, in this latest incident, condo and car windows were shattered, and it seems possible (likely) that there was damage to nearby residences and vehicles from the tremendous heat and flying debris. So, would these claims be covered?

As I do any time auto or homeowners insurance comes up, I turned to my P&C guru Bill M, who tells me that:

Homeowners and auto policies will include an exclusion for "war or acts of war, declared or undeclared" and the like. But terrorism isn't war, so it's likely covered by both, absent some (unusual) specific exclusion.

Which makes sense. So I asked him if that was something that we'd be seeing soon. Bill doesn't think so, as it would be against public policy, and there's also the question of "frequency of occurrence;" that is, we have a lot more tornadoes and hailstorms (for example) than bona fide terrorist actions [ed: knock wood].

As always, consult your own policy and agent for specific answers about your policy.

[Hat Tip: tsrblke]

Stupid Prospect Tricks

So for several months, I've been following up on a referral. Susie is a friend-of-a-friend, and came to me for some life insurance quotes. We discussed her needs, did a pre-screen, and I got her some quotes. This was by no means a remarkable case - no huge numbers or unusual underwriting challenges - but the outcome illustrates why we have things like Life Insurance Awareness Month.

After sending her a few monthly follow-up nags reminders, I got this in email this morning:

"Thanks for all your follow ups Henry.  We have decided not to get life insurance for me per our financial advisor."

Because I'm terrible at high pressure tactics, and out of respect for my friend (the referrer), I elected not to send this response:

Hi Susie!

Thanks for your reply. I think it's remarkably generous that your Financial Planner has offered to replace your income, pay off your mortgage, and finance your kids' education when you shuffle off this mortal coil.

You did get his signed promise to do so, right?

After all, he has a fiduciary responsibility (even further enhanced by recent DOL reg's) to you, and advising you to self-insure instead of shifting that risk off to an insurance company, it's only right that he accept responsibility for that advice.

Be well.

Tar Heel State Blues: The Saga Continues

So it appears that my prediction that North Carolina's Blue Cross affiliate would skate on that penny-ante huge fine may have been premature. FoIB Jeff M tips us that:

"The N.C. Department of Insurance has levied a record $3.6 million fine against Blue Cross and Blue Shield of North Carolina for widespread problems that led to billing and enrollment errors"

Which seems significant, until we translate it to real-world terminology:

"The N.C. Department of Insurance has levied a record $3.6 million tax on Blue Cross and Blue Shield of North Carolina insureds."

That's because, as long-time readers know, companies don't pay these fines: their policyholders do. Every penny of that fine will now be passed along to the Blues' insureds in the form of higher rates.

Jeff also points out that the carrier will have no problem fronting the cash, "since they've not paid commissions since April, the money is there to pay the fine...and a whole lot more."

Heh.

Oy, Canada (Part 2,740)

It's been a while since we've checked in on the health "care" system of our Neighbors to the North©. It appears that things haven't improved. Take, for instance, the case of Stefan Molyneux:

"Canadians know how awful socialized medicine is, and Canada is plagued with immense wait times and a strained system, which Stefan’s recent experience illustrates."

Here's his story:



"Average wait time for MRI in Canada is 101 days. I got one the next business day."

Coming here soon (the 101 day wait, that is).

Gaming O'Care in the news

Co-blogger Patrick has written quite a bit about the challenges that carriers face regarding the overly generous 90 day grace period enjoyed by folks who buy their ObamaPlans on the Exchange.

Now, some 4 years since they first opened for business on that platform, carriers are beginning to realize just how dangerous that game of chicken has been.

For them:

"They are using [health insurance] until they need it and then when they don't need it, they get rid of it"

That's Patrick, as quoted in this morning's US News online edition, where he and FoIB Louise Norris share some interesting, disturbing insights.

Recommended.

Hey Senator Rubio, Give Credit Where It's Due

Obamacare supporters need to stop giving Marco Rubio credit for the splinter he wedged into Obamacare's fingertip. The splinter is the language Rubio inserted into the 2014 CRomnibus that made Obamacare risk corridor payments budget neutral.

When Obamacare passed, the risk corridor provision - which is a temporary program - was written with very vague language. The program existed but didn't specify where funding was coming from. Theoretically it was going to come from a combination of the profitable insurers and the federal government sending payments to insurers who suffered losses.

Because there was a chance of government funding, the GOP called out risk corridors as a bailout for insurers. To combat the political gamesmanship, the Obama Administration pushed a narrative that the program would pay for itself and pointed to an April 2014 CBO document stating the budget neutrality position.

Based on the CBO numbers, Senator Rubio's risk corridor language shouldn't have been an issue. But like many CBO reports, the actual results are a far cry from their rosy projections. In 2014, risk corridors paid out roughly 13% of what they were supposed to. CMS just released preliminary data for 2015 and have made it clear that they will have another shortfall this year. All of this is resulting in pundits and politicians calling the GOP the devil or heroes.

Unfortunately they've got it all wrong. Marco Rubio inserting language into a budget amendment didn't make the legislation pass. That would come from all of the brains in DC who vote on the bills. It also comes from a Presidential signature making the bill become a law.

In CRomnibus, its not about what Rubio did. It's about the bipartisan approval (57 Democrats in the house and 25 Democrats in the senate) that voted in favor of the bill. And let's not forget President Obama who signed it into law.

These are the elected officials who put risk corridors in jeopardy. They are the ones who should be given credit.

Sorry Marco.

MVNHS© vs Autism

If you, or a loved one, is on the autism scale, you need to be very afraid of ObamaCare's ultimate goal of Single Payer.

Why is that, you ask?

Here's why:

"The euthanasia of Nancy Fitzmaurice, a severely disabled child who was not dying, has made international waves ... Nancy’s mother had requested that her daughter be killed and was granted approval by the British legal system."

As we've mentioned before, "who pays the piper calls the tune." And while this may the most egregious example of that we've seen, even by the standards of the Much Vaunted National Health System©, it's absolutely how Single Payer works, how it has to work. And of course, little Nancy's only advocate was the one who petitioned for this outcome.

When an unelected, unaccountable Star Chamber is given free rein to make these kinds of life-and-death decisions, and when the cost of life becomes the value of it, well, that's what we're headed for here.

Now, some would argue that this isn't about the MVNHS©, per se; that it's about the British legal system. And they'd be right - up to a point. That point is that regardless of the agency which murdered this little girl, it was the state that ordered it done.

Be careful what you wish for.

[Hat Tip: C. C. Pecknold]

Bad News and Good News, Enrollment edition

As we've noted previously, the Marketplace seems to have a problem keeping out the riff-raff:

"[F]ederal watchdog office did set up 10 phony insurance coverage accounts with no pushback from those overseeing the applications."

That was a year ago, and we're happy to report that there's been a 50% improvement in those numbers:

"Investigators got coverage approval for 15 out of 15 fake people this year"

Okay, I suppose that depends on one's definition of "improvement."

The GAO was apparently unable to make premium payments for three of these "people," which I suppose is reason for celebration, although where those funds would have come from (and where they did originate for the 80% of those who successfully ponied up) remains a mystery.

On the gripping hand, I am pleased to report that none of these "insureds" racked up more than $10,000 in medical expenses.

That we're aware of.

Garden State Breaking: Another one bites the dust

Oops:

"The [New Jersey] state Department of Banking and Insurance moved Monday to take over Health Republic — known as a consumer-operated and –oriented, or COOP, plan — because of its “hazardous financial condition.”

As with Ohio's own InHealth, and most of the other Co-Ops, the numbers just didn't add up. and the carrier has been forced to fold.

Just in time for Open Enrollment v4.0.

And the timing couldn't be better (for certain values of "better"): when this happens, policyholders are generally eligible for a Special Open Enrollment. Which means they'll be looking for new plans over the coming weeks, and then new new ones a few weeks later. Oh, and looking at three - yes three - deductibles to be met in a year's time.

Yippee!

If You Like Your Plan: Part #4,287

One of the most pernicious claims made by President Obama (and his surrogates) has been the promise that "if you like your current insurance, you can keep it." No rational person ever actually bought that, but it made a great sound-bite (or 3,000). As we all know, with each passing year we're been offered fewer and fewer choices, and very few people have been able to actually keep their plans.

Folks in the Tar Heel State have even fewer choices coming up in November:

"Most in N.C. will have one Obamacare option in 2017"

And to no one's real surprise, that carrier is ... Blue Cross/Blue Shield. Yes, that Blue Cross:

"The N.C. Department of Insurance announced Monday it will broaden its investigation into Blue Cross and Blue Shield of North Carolina, citing “disagreements” with the insurer."

Looks like that particular endeavor is about to hit the trash bin of history.

[Hat Tip: FoIB Jeff M]

Off Topic: Gamer edition

FoIB (and gaming entrepreneur) Fat Dragon Games has just fired up their latest KickStarter, and it's a doozy:

"The DRAGONLOCK™ terrain system for 3D printers allows you to create modular interlocking buildings of your own design."

Pairing the incredible opportunities of newly-affordable 3d printers (I've been assured that really good ones can be had for less than $400) with over 20 years of terrain design experience means tremendous value, and some really good fun.

Click here to get in on the ground floor.

Read all about it at this week's Health Wonk Review

This week's Health Wonk Review is hosted by David Williams at Health Business Blog.  

Do check it out, no library card required!!  You'll be glad you did.   

Don't Get Too Excited Pinal County

News broke of Blue Cross Blue Shield of Arizona remaining in the marketplace in Pinal County, Arizona late on Wednesday. Obamacare supporters will rejoice with a thunderous round of applause to the insurance company and positive vibes about how tax credits will keep costs low. But the folks in Pinal County have little to get excited about.

In 2016 residents of Pinal County had two insurers to choose from. The previously mentioned BCBS and United Health Care. UHC offered ten insurance options including Gold, Silver, and Bronze plans. All ten were PPO plans that included a more robust provider directory. With UHC exiting the market those are gone.

BCBS offered five plans. Two Silver plans and three Bronze plans. The lowest deductible with their plans is $2750 for single coverage. The two Silver plans were the highest and 3rd highest cost silver options available which should make them less appealing to shoppers. But the limited number of plans isn't the worst of Pinal County's concerns.

Cost is the number one driver for purchasers of insurance, which makes the accompanying statement from BCBS even more concerning. In their announcement to remain in the marketplace, their Senior VP of  sales, strategy and marketing, Jeff Stelnik, said premiums will increase by 51%. 

Obamacare is working for you Pinal County residents. You have an option. You have choices in that option. Be grateful for what you have. Because unless we eliminate this train wreck of a law the next time government talks about "health care reform" it will be for single payer.

Precision Cannon Fire

As we noted a week ago, some Grand Canyon State citizens are going to have a problem this November:

"People in Pinal County are at risk of a health insurance problem that hasn't happened anywhere else in the country: no companies offering marketplace health insurance"

Turns out, Aetna was the sole remaining carrier on that state's Exchange, and they've bailed. That means that, if you live in Pinal County (home of the Boyce Thompson Arboretum) and you want to buy health insurance, you'll have to buy if off the Exchange.

Which also means you get to pay full-freight: no subsidies for off-Exchange plans.

And that most likely means you'll be faced with plans that are unaffordable. No problem: the ObamaTax makes provision for such circumstances, and offers an exemption for folks who can't afford premiums.

Except there's a pretty significant, but under-the-radar, catch: this exemption won't be available to the folks in Pinal County.

Why not?

Well, as FoIB Michael Cannon explains, "[t]he unaffordability exemption applies only if “the annual premium for the lowest cost bronze plan available in the individual market through the Exchange” is unaffordable." But there are **no** plans on the Exchange.

See the problem?

Read the whole thing, you'll be glad (and/or furious) that you did.

Medical Necessity: Here we go again

If you want to understand why your rates keep going up, you can lay a big chunk of the blame on items like this (in email from Medical Mutual this morning):

"To be compliant with the non-discrimination rule outlined in the Affordable Care Act (section 1557), we will remove broad exclusions for gender transition treatment"

Let's dial back a bit, and talk about why this is so stupid. In the earliest days of this blog, we participated in a discussion with other bloggers about medical necessity and In Vitro Fertilization (IVF). We averred that:

"[A]ccording to the standard industry definition, “medical necessity refers to treatment which is required to treat or care for symptoms of an illness or injury or to diagnose an illness or condition that is harmful to life or health.” Thus, we see that IVF fails to meet the threshold of “medical necessity,” ergo it should not be covered by insurance."

That is, no one has ever died because they couldn't/didn't get pregnant. Likewise, there is no evidence that anyone has ever died because they didn't get their personal bits chopped and/or replaced (excluding obviously medical issues like cervical or breast cancer and the like). There is, however, ample evidence that these folks are at much higher risk for attempting suicide (which would then require medical treatment in the most expensive part of the hospital).

So when insurers are forced to pay for non-medically necessary procedures, that cost is going to be passed along in the form of higher insurance premiums. Now, am I blaming Medical Mutual for this change? Of course not, they're simply following directives sent down from Our Betters in DC©.

What choice do they (or any other carrier) have?

It's not rocket surgery, after all.

More 3000% rate decreases

This never gets old:



So two more individual medical renewals hit my desk this morning. Both are with the same carrier, both are HSA-compliant with $3000 per person deductibles then 100%, both are grandmothered (meaning they're only partially ObamaCare-compliant, but still "kosher") [ed: for now]:

Sally and her family of four currently pay about $930 a month; their rates are going up 15%, to $1,065 per month. This means that the family will spend just shy of $13,000 before the plan pays bupkes.

Still, that's a bargain: a comparable fully compliant plan will set them back about $1200 a month, and that's with a $6500 per person deductible. So they'd have the privilege of more than doubling their medical expense out-of-pocket while paying only 20% more in premiums.

Such a deal!

Terry's increase is 17%, from $295 a month to about $350. That's also still a bargain: a comparable new plan goes for $480 a month and also comes with a $6500 deductible. This means that Terry would be out almost $11,000 before the plan paid a dime. Well, except for pap smears, mammograms and birth control convenience items. Oh, did I mention that Terry's a 53 year old guy?

And they're the lucky ones.

Insurance working properly, Wellmark-style

They say that "the exception proves the rule," and I think that FoIB Allison Bell has found the exemplar:

"Wellmark Blue Cross Blue Shield of Iowa says it spent $18 million on medical bills for just one patient in 2015."

And that's just from July forward. The patient suffers from a ""severe genetic disorder," and is racking up about $1 million a month in claims. In fact, this one insured accounts for some 10% of the almost 43% rate hike Wellmark's seeking for 2017. As this is a fully compliant ObamaPlan, there's no end in sight, since there's no cap (aka "lifetime maximum").

So why do I call this "insurance working properly?"

Well, because insurance should be about spreading the risk (and the pain). And this certainly qualifies: no average person could afford this kind of health care spending on his own. And since it's a genetic disorder, I don't feel any moral qualms as I would for someone with a lifestyle-related condition. This is simply the hand that this person was dealt.

And yes, it's a lot of money, and money means resources, being spent on one person. My faith requires me to "choose life," and that's the over-arching sentiment here. It's not for birth control convenience items or routine expenses, it's for a catastrophic claim, what health insurance should be about.

May this poor soul find a path to healing.

Mid-Week Linkage Roundup

■ From the "Everything Old is New Again" Department: My late mother had Post-Polio Syndrome, a result of childhood exposure, but (thankfully) she never had the full-blown version of the dread disease. A common treatment for those that did was the so-called "iron-lung." Fortunately, we've long since eradicated polio, but FoIB Allison Bell warns that we may have to dig those old machines out of mothballs:

"Zika May Be Polio All Over Again ... the CDC concluded, “after careful review of existing evidence,” that “Zika virus is a cause of microcephaly and other severe fetal brain defects” in newborn infants."

Heads' up.

■ Co-Blogger Mike thinks that Belgium might be catching up to Sweden in the Bizzaro World medical tourism race:

"Euthanasia tourists are flocking to Brussels to get a lethal dose. Doctors at hospitals and clinics at Belgium’s capital are seeing an increase in number of euthanasia tourists who are travelling from across the world"

Supply and demand.

■ FoIB Jeff M first alerted us to troubles brewing for North Carolina's Blue Cross franchise back in May. Today he shares this update in the continuing saga:

"The N.C. Department of Insurance announced Monday it will broaden its investigation into Blue Cross and Blue Shield of North Carolina, citing “disagreements” with the insurer."

At issue are continuing IT and claims processing issues.

Gotta love the tech.

■ And finally, via FoIB Holly R, this sad (and highly unusual) case from Great Britain (and for once, it's not about the MVNHS©):

"[A] 61-year-old British bagpipe player who developed a dry cough and breathlessness that worsened over a period of seven years ... He died several weeks after entering the hospital"

Turns out, several different - and deadly - fungi had taken up residence in his bagpipe, which he had neglected to clean. Truly sad, but perhaps a helpful warning to fellow pipers.

Death by Amazing Grace?

Tick-Tock: Welcome to the Walmart Marketplace

As we noted earlier this month, agents have the opportunity to sell ObamaPlans at Walmart stores around the country. But the window for signing up to do so is closing.

From email:

"Tomorrow (August 31) is the last opportunity for agents and brokers to sign up to enroll consumers in Marketplace plans in Walmart stores.

In order to participate in this Walmart event, you must hold a valid state license and be trained and registered to participate in the Marketplace for 2017."

Interested? Then click here to get started. And any readers that do choose to participate are encouraged to let us know what you think of the experience.

MVNHS© circling the drain?

Earlier this month, we noted the financial difficulties facing the Much Vaunted National Health Service©, and observed that if you're a government-run health care system and you're going broke, that's a problem. But it's not the only problem - lack of self-awareness is also strong:

"Yet oddly, rationing is not entirely dead. It is alive and well and making a comeback in our “precious” National Health Service." [emphasis added]

Just now noticing that, Jeremy? Had you been a regular IB reader, you'd have seen examples for years. Better late than never, one supposes. And he does, in fact, make an extraordinarily brilliant point:

"In a tax-funded health care system, the normal, self-limiting rules of supply and demand don’t apply."

Which is exactly right, and we're already seeing signs of it here, with only a partially government run health care scheme:

"A majority of new enrollees are considered high risk, meaning insurers will have to spend more money on people in poor health and requiring expensive  care."

Mr Warner goes on to point out three "new elements" that have entered the picture: mass communication, an aging society, and ever-growing, ever-changing tech. Notice the elephant in the room that he doesn't mention?

[Hat Tip: FoIB Peter K]

History Can Be Fun

Shortly after ACA was enacted into law in 2010, Senate Finance Chairman Max Baucus, whose Committee wrote most of it, "tried to calm an angry Montana voter by saying this: “Mark my words, several years from now, you’re going to look back and say, “Well that wasn't so bad after all”. 

Senator, we did mark your words.
 
It’s now been several years. 

It's pretty clear the average person today would NOT say: “Well, that wasn’t so bad after all”.  

In fact, a great many Americans are still looking for a good reason to calm down about Obamacare.

I think perspectives like these help explain why history can be fun.

Now in fairness to Senator Baucus, he had begun to change his opinion of Obamacare, in fact had become a critic, within a couple years of its passage.  Not necessarily because he disagreed with Obamacare's goals; more likely because the Administration's fumbling, bumbling, and rumbling threatened to prevent the law from accomplishing its goals.

The Washington Post reported Senator Baucus' changing opinion during 2013.   Early that year,  the Senator told HHS Secretary Kathleen Sebelius, “I just see huge train wreck coming down. You and I have discussed this many times and I don't see any results yet.” Later that year, the Post reported Senator Baucus commented (about the health-care exchanges and the government enrollment Web site) "Let's just see how much of this can be put together, how much Humpty Dumpty can be fixed, in the next month."

Well, hmmm.  Mmmaybe it WAS so bad, after all?  Even my Magic 8-Ball replied "It is decidedly so".  

I suspect Senator Baucus' deteriorating confidence in the success of Obamacare may have been a factor in his decision to retire from the Senate at the end of his term in 2014.  I also wonder if Senator Baucus' public criticism of Obamacare, especially his use of the descriptions "train wreck" and "Humpty-Dumpty," was a factor in prompting Mr. Obama to name him an Ambassador in 2014 and get him out of the country.  China, to be exact.

I think questions like these also help explain why history can be fun.

EpiPen: The EpiLogue

The other day, I linked to David Williams' insightful post countering the conventional EpiPen narrative. Turns out there's even more fallout:

"Mylan, said that the generic EpiPen would be available in several weeks and be identical to the existing product, which is used to treat severe allergic reactions. But it would have a wholesale list price of $300 for a pack of two, compared with just above $600 for the existing product."

As a friend noted today on Twitter, it's unclear on how they're going to compete with themselves and still come out ahead.

Not my monkeys, not my circus.

[Hat Tip: Co-Blogger Bob V]

Healthcare is Different. Real Different.

Modern Healthcare has released its list of the top 100 most influential people in healthcare.  It's an annual list.

It's worth your time to scan the whole list.  As you do, don't overlook the fact that not one of the top 25 is a physician.

Not one.

Plenty of politicians, lawyers, MBA's, and accountants. Couple of nurses. A phys Ed. Major. Not one physician.

President Obama is #1. (Modern  Healthcare doesn't really say whether it distinguished between positive or negative "influence" assembling their list.). You'll also notice Loretta Lynch, Paul Ryan, John Roberts, even Bernie Sanders.  But not one physician.

Can anyone imagine the automotive industry's 25 most influential people not including even one senior mechanical engineer?  Or the 25 most influential construction executives not including even one experienced building contractor?  Or the 25 most influential American military figures not including even one general or flag rank officer?

But it's all good, because, you know, "Healthcare is different".