Archive for the ‘health insurance companies’ category

When People Think Differently

August 8, 2017

The idea of “universal, single payer” healthcare seems so obvious as both the most efficient and least costly method of delivering a nation’s basic healthcare, it seems incredible that there are so many Americans who do not embrace this notion. Why would that be?

Fewer and fewer Americans remember the time before the wide spread availability of insurance company provided healthcare. Yet the US system of “for profit” healthcare insurers is a relatively recent happening. Following WWII, employers began offering health insurance as an employee benefit designed to retain employees in a period of relatively full employment. Health insurance as a benefit caught on and employers have found it difficult to retain workers without offering health insurance. Hmmm.

Also escaping most Americans knowledge is the cottage industry which is necessary to support the multitudes of healthcare insurers. Healthcare service providers (doctors, hospitals and drug companies for example) must carefully keep track of each patient and how much service that patient has consumers, report those services using each insurers different set of codes on each insurers specific form, and then argue with each of these insurers to insure they receive reimbursement for the services already provided. This entails millions of more healthcare workers who do not themselves provide healthcare. Hmmm.

More than two dozen other modern countries (like Germany, France, England, Japan, and Canada) utilize a single payer, universal healthcare service delivery system. These countries all offer “best in class” healthcare services at about one half the total cost experienced in the US. These countries also report excellent healthcare outcomes and boast longer life expectancies than the US. Oh, and these countries provide this healthcare to all residents. Hmmm.

So, why would anyone not be in favor of universal healthcare?

In the US there are many who decry the idea of universal healthcare. They predict unacceptably long wait times to see a doctor or receive treatments. They ask the question “if healthcare is so good in other countries, why do people from Canada travel to the US for medical care?”, and “Why should we put the government between you and your doctor?”, the ask.

The politics of healthcare is even more fascinating and not easy to understand. Progressives are for a universal system and conservatives are not. Conservatives point to Progressive’s record of entitlements and using taxes to fund the cost. Conservatives see creeping socialism behind the call for universal healthcare and the resulting dependency of Americans to look for government to solve all their problems. And worse, universal healthcare will bloat the government making what is already (in their opinion) too big, even bigger. And even worse, conservatives don’t want their tax dollars going to pay for healthcare for someone else. Hmmm.

Hmmm. What could be simpler. Big government, less choice, poorer quality, and offering out of control cost increases, conservatives claim.

Why do conservatives think that way when there are so many examples around the world that prove otherwise? Why don’t conservatives recognize that some Americans already have “universal healthcare”. These Americans, of course, are over 65 and are enrolled in Medicare.

Is this a subject of “the glass is half empty, or half full”? Do progressives and conservatives see the same problem (basic healthcare available to all Americans) or do they see different solutions to different problems (basic right versus small government with low taxes)?

If Americans see the same problem, conservatives may still view the delivery of basic healthcare too difficult a task for “American thinking” and from their perspective, a universal healthcare system must inevitably end up with poorer healthcare and higher costs. Progressives could, alternatively, see no problem too great for Government to solve and therefore discount totally conservatives’ warnings.

The recent Congressional fight over repeal and replace for Obamacare should make conservatives take notice. The conservative sponsored alternatives largely failed because they offered less coverage for the poor, those with pre-existing conditions, and the elderly.   Voters representing those groups made their views known. Progressives and conservatives would be wise to heed this warning.

Healthcare is not free and does require funding. Most other countries employ a “prevention” oriented healthcare philosophy, inhibitions towards uncontrolled price increases, and utilize a consumption tax (value added tax) to fund healthcare along with modest co-pay requirements.

Obamacare could be a starting point were Republicans to acknowledge that Obamacare was based upon Romneycare (Massachusetts) and that was based on a proposal from the conservative Heritage Foundation think tank.

If conservatives can’t agree with progressives on what the problem really is, voters make make the choice for them. The 2016 Presidential elections was a clear sign that the electorate was dissatisfied with both parties and threw its support to a total outsider.

What will voters do next time?

Take A Breath, And Think This Time

July 29, 2017

“Pause and reflect” might be good advice for Republican Congress members. But it is possible pause and reflect may still miss the foolishness of yesterday’s vote on Obamacare “skinny” repeal. The vote confirmed, with little room for argument, Congress is not fully under the control of the Republican Party. There is no Republican Party and Americans had better wake up to that fact.

Those who claim membership in the party in power are not of one mind other than wanting to get reelected. In other words, GOP membership is about winning elections and profiting personally from those elections as best one can. And with the amount of money floating around Capitol Hill, it would take a pretty dumb Congress Member to not increase their personal worth while in office.

For Congress members, unfortunately, there are strings tied to getting elected. Congress members must surrender their right to vote their conscience and instead march to the drum of the big money that financed their campaign. Besides the Congress members’ integrity, the main casualty is the absence of a functioning body invested in the 21st century problems facing America.

Healthcare is a perfect poster child.

Republicans have called out against the rising costs (premiums and deductables) of the individual market. Instead of offering solutions to this problem, Republicans, in essence, have said, if you think the price is too high for a whole loaf, we will offer you a half a loaf at a lower price. Shameful.

The skinny repeal bill took the Republican position even further into the absurd. Republican Senators were asked to vote for a bill which over turned the Obamacare requirements for individual mandate, employer mandated coverage, and certain taxes on makers of medical devices. The bill makes no sense as it would have destabilized the individual insurance market even more and posed the risk of significantly more Americans losing coverage.

Possibly even worse, the skinny bill was never intended to become law. Imagine, grown up elected officials seeking to pass a bill they believed would never become law. Why would that be necessary? Why not try to pass any bill, regardless of how flawed, that was Republicans true intent?

The Republican mysterious behavior has its roots in what basic principles underfoot healthcare. Is healthcare a right or is it a privilege?

Given the opinion polls and most of the nation’s Governors, Americans are trending towards healthcare is a right. (Now be careful and do not confuse, a right and being free.) Healthcare is expensive and the method of paying for it is not straight forward.
The inevitable end point will be a universal, single payer system, as most modern countries have already adopted.

Like most large social changes, US healthcare may still require more baby steps. But other than disgust with the GOP efforts, the defeat of the skinny bill has not brought us closer to any improvement. That work remains.

IMO, there were many Republican Senators who did see healthcare as a government benefit akin to meeting an individual’s right. Regretably, these Senators caved to special interests pressure. There are other Republicans who deny anyone’s right to healthcare unless they can afford it. They seek the best healthcare money can buy. Hence the fundamental schism.

The brightest face one can attach to the failed GOP effort is “some” Republicans working with Democrats could pass modifications to Obamacare which would stabilize the individual nsurance market and return premium costs to real world levels. A necessary fix, but a fix far short of what’s possible and what is ultimately the goal.

“Skinny” option. Hmmm. What will they think of next?

Healthcare Debate Show Down?

July 10, 2017

Republicans have fought mightily to pass legislation which “repeals and replaces” the Affordable Care Act (Obamacare). Divisions within their own party have prevent Senate ratification of a repeal and replace, and now back from the 4th of July holiday, Republican Senators are back to the grindstone. Will they be successful?

Unlikely, unless one counts failure as success.

Medicaid expansion, thanks to Obamacare, has provided many more Americans with healthcare than before. These voters have made it known that they would not be pleased with Republican Senators were this coverage to disappear. Hmmm.

Pre-existing condition coverage is another “must have” option in voter’s minds. Relatively speaking this is an expensive option and Republican law makers are worrying how they can pay for that option and still provide a tax cut. Hmmm.

And the thinking that no one should be required to have healthcare insurance comes also with the freedom for companies to elect not to offer their employees group insurance plans. This “freedom” might have Americans beginning to wake up to the possibility that although they may have health insurance today, tomorrow they might be laid off or their employer may just choose not to offer coverage. In both cases these Americans will be out of luck.

But what seems to have gotten the GOP’s attention is not the impact poor coverage or no coverage at all will have upon Americans, it is the phasing out of Federal Government funding of the Medicaid expansion and the dawning that States would need to increase their contribution to maintain coverage.

What? States would need to raise taxes or become responsible for dropping State residents from Medicaid rolls.

This line of reasoning reflects a morally bankrupt political party. Public shaming has not worked to date in changing Republican thinking. Maybe the political reality and risk of being voted out of office will have a different result.

Disillusioned And Lost

June 29, 2017

When Senate Leader Mitch McConnell spoke to reporters yesterday announcing there would be no “repeal and replace” vote before the July 4th holiday, the look on his face and the tone of his voice said it all. “How did the Senate get to this point?”

McConnell telegraphed no shame over a bill that gave huge tax cuts for the wealthy, allowed individual healthy Americans to “game” the system by not buying insurance (driving up insurance cost for everyone else), and reduced coverage (via Medicaid) for the most vulnerable Americans. Rather, McConnell was despondent because his Republican majority would not agree to pass the bill.

Several Republican Senators stressed that Medicaid was not being cut but rather would not increase as much as healthcare costs are rising, and about a third of the cost was being transferred to States. In other words, instead of the Federal Government raising taxes from all Americans and distributing this money to those who qualify regardless of where they live, the Republicans are saying, “if your State is willing to raise State taxes, then Medicaid can be offered. It is a State decision to cut Medicaid unless the State agrees to fund.” Hmmm.

There is a legitimate issue around how to fund healthcare (including Medicare and Medicaid). Currently the payroll taxes do not cover the entire amount of Medicare and Medicaid expenditures and the excess is simply added to the national debt.

At the root of this problem is a fundamental disagreement on whether healthcare access is a right or a privilege. There should be no confusion in either case, healthcare must be paid for by someone. The question is what is each persons share and what methods would be used to collect this money.

One party, however, is comfortable with the proposition that you only get as much healthcare coverage as you pay for while the other party is comfortable with everyone getting basic healthcare coverage but it is ok to put the bill on the charge account (Federal Debt).

The greater concern for Republicans seems to be their worry about what voters will do? Rather than looking what other modern countries are choosing for healthcare, Republicans are united only around eliminating the tax aspect of the Affordable Care Act. Republican division arises cruelly on just how many of the ACA benefits should be cut. Hmmm.

Americans are disillusioned and the GOP is lost.

Living Ones Priorities

June 25, 2017

The “repeal and replace” saga, brought to America by the Grand Old Party (GOP) clearly underscores the priorities of Party leaders, and dare I say, the big money interests who make it all happen. So why are Republicans against healthcare?

The answer is Republicans are not against healthcare, healthcare just gets in the way of what they seek.

The Affordable Care Act is only a slight variant of what the US has had for decades. Health insurance companies are the same, hospitals are the same, doctors are the same, and drug companies ditto. ACA changed the individual market’s healthcare delivery model by specifying “essential” healthcare services which must be covered for a healthcare policy to be eligible for government subsidies. (No more catastrophic only policies).

ACA defined what “basic” healthcare might be. For non-group policy holders, these individual consumer could purchase one of three types of policies, each differing only in price and amount of co-pay/deductible.

ACA also added a new route to providing healthcare insurance coverage. ACA expanded the eligibility definition for Medicaid and found millions of Americans who previously could not afford basic healthcare and had not qualified for Medicaid.

What could be so wrong about ACA (Obamacare) to drive Republicans to focus so strongly on repeal and replace efforts?

We hear much about the price of individual policies with year over year huge increases in premiums. But for those who earn more than certain amounts and do not qualify for subsidies, that is a problem. Surely, however, there are other means to convince insurers to set more reasonable rates. (Remember these same insurers who are announcing their withdrawal from certain States’ individual policies market are still quite happy to cover “group” plans in the same States.)

We also hear about returning healthcare to “patient centered” insurance and removing “government” from the place between the patient and their doctor. Hmmm. And what is the difference in substituting a for-profit insurance company as the middle person?

The American Heath Care Act negotiations are illustrative. With control of both the House and the Senate and the White House, Republicans have looked impotent in passing a replacement law. Why?

Well, it turns out that Americans overall have found Obamacare a step forward versus what preceded it. As the debate has unfolded. Americans are learning that Republicans are more intent on sharply reducing Medicaid both as an adjunct to Obamacare and as a stand alone program. It is beginning to dawn on Americans that Medicaid is very important program paying for about half of all births.  I wonder why so many Americans cannot afford healthcare insurance with pregnancy benefits? Medicaid is also critical to treating the Opioid crisis and for nursing home assistance for the elderly. And yet the Republicans are pressing on. Why?

Could it be the GOP is single-mindedly focused upon tax cuts?

Replacing Obamacare comes with a $200 million tax cut for the wealthy. The Trump/GOP’s tax reform (code for tax cuts), a separate piece of legislation, will represent billions in savings for the wealthy. Hmmm.

Back to the current Senate AHCA debate. Most Senators are aware that cuts to benefits (like eliminating pre-existing condition coverage) are very unpopular with constituents. They are now learning that critical health services are tied to Medicaid coverage. So, if AHCA keeps most or all of ACA benefits and ends the individual mandate while eliminating the associated taxes, the AHCA will cost the government more than ACA now does. Hmmm.

At this hour, the Washington soap opera is still underway. There are more than enough “no” votes to preclude Senate passage of AHCA 1.5. No matter how many times President Trump tweets that “it’s a great plan”, “people will love it”, or “AHCA is another campaign pledge kept”, certain facts remain.

Any ACA replacement which includes tax breaks for the wealthy will by budget necessity, also bring Americans less benefits at higher costs and fewer insured. Hmmm.

I guess if you number one priority is tax cuts for wealthy individuals and corporations, healthcare doesn’t really matter.

Healthcare Math

June 22, 2017

News reports quoting prominent Republicans say Republicans are worried, because the healthcare industry makes up about 1/3 of the entire US economy. Rash cuts might kill the golden “jobs creation” goose. Hmmm.

This is a mind boggling statement for Republicans to admit. The GOP ran in the last election on repeal and replace and previously during the Obama Administration tried to hinder the Affordable Care Act when ever and where ever they could. Now suddenly Republicans are waking up to the broader role healthcare plays?

Now for the math. Total healthcare spending in 2016 came in around $3.2 “trillion”. The US population was about 320 million. That means that on average, each American consumed about $10,000 of healthcare (per capita). In actuality, some Americans consumed little or none and others consumed a lot more.

So, a family of five (mom, dad, brother, sister, sister) represent, if they were average, $50,000 a year on healthcare costs. That would represent $4166 per month from this families budget. So even if the household head earned $15 per hour ($31,200 per year), this family can not buy health insurance.

Most people, especially young and healthy Americans do not consume $10,000 a year in healthcare costs. From an insurance company’s perspective, those who consume less help offset those who consume more. In a somewhat complicated process, insurance companies dial in rates (young and healthy pay less, older and sicker pay more) and there you have it, the American healthcare delivery system.

Let’s consider the pending Republican “repeal and replace” healthcare legislation. What math questions arise?

First and foremost, and unfortunately never asked publicly, is $10,000 spending per capita reasonable? Does the US possess a older or sicker population, or are Americans more prone to serious illness than other parts of the world?

In comparison with the rest of the world, especially other modern economies like the US, the US spends almost twice as much as other modern countries. There are no indicators other than over consumption and inefficiency to explain this difference.

So does the Republican plan tackle this spending issue? Regrettably no. One would assume that cutting Medicaid and individual subsidies is intended instead to simply reduce the number of people seeking healthcare coverage, not increasing the number. Since those without insurance seem to consume a lot of healthcare once enabled to get coverage, cutting Medicaid and individual subsidies would help to keep rates from rising too much.  I suppose this could be viewed darkly as a cost control mechanism.

 

Second, the Republican plan shifts the tax burden away from those who can most afford paying to those who can the least. Estimates show an approximate $200 million tax cut for the wealthy while at the same time making it more difficult for lower income Americans to afford healthcare coverage.  This is an unforced error.

 

Third, pre-existing condition bring a bazaar ingredient to healthcare. The Affordable Care Act required insurers to cover all Americans regardless of pre-existing conditions. Republicans have been all over the map with respect to whether pre-existing conditions would be covered, how long, and for how much.

Covering pre-existing conditions, but charging exorbitantly higher premiums is tantamount to not covering those conditions.

 

Fourth, cutting Medicaid enrollment which provides coverage for the sickest and least able to afford insurance is a prescription for increasing the uninsured rolls. Republicans spin this issue by saying States are better able to determine how to deal with the poor.

What?

The nation’s poor are US citizens who just happen to live in a particular State. Some richer States can afford (at the same tax burden) to provide benefits and other States can not. How can healthcare be viewed as a privilege owing to which State one happens to live in?

 

Fifth, value add of insurance companies? The Republican plan doubles down on the existing cadre of healthcare insurance companies. Each healthcare insurance company demands healthcare service providers (hospitals, doctors, and drug companies) to use specific reporting forms for pre-approval and payment. As a consequence, healthcare service providers have increased their operating costs significantly by necessarily adding “non-medical” staff to process paper work.

 

Sixth, fee for service is alive and well. The Republican proposals are silent on changing the basis for paying hospitals, doctors, and drug companies. Republicans claim that the “free market” will magically pit one insurer against another with the average American coming out the winner. This is a delusion.

Summary. There are gaps in the Affordable Care Act coverage (not everyone is covered) and there are anomalies in subsidies such that some Americans still can not afford to purchase subsidized insurance. And, the real healthcare cost drivers are not addressed sufficiently. There exists a pressing need to improve/reform Obamacare.

The Republican proposal does nothing to address Obamacare defects nor does it portend to deal with reigning in the obscene yearly cost increases. What a shame the country is being lead towards third world healthcare delivery standards (best healthcare money can buy) instead of rivaling the best of the best.

Free Market Health Care

June 11, 2017

When President Obama set in motion steps to expand healthcare coverage, in the wealthiest country in the world, for more Americans than ever before, he and his aides made a questionable decision to build the expansion around traditional healthcare insurance companies, like Aetna, Cigna, Anthem, etc. These cowardly chickens are now coming home to roost.

The Obama White House convinced the legacy healthcare insurers that their margins would be protected when they were presented with new enrollees who might not be able to pay for the entire premium. There would be government subsidies in other words.  That promise was enough to get the insurance companies loyalty.

With this promise (and recognition that there would be another 7 years with a President Obama), healthcare insurers signed on citing the importance of new customers and their dedication to improving Americans’ health.

When the Democrats lost control of Congress, the wheels soon began to come off the Affordable Care Act wagon. Republicans tried their best to outright repeal Obamacare and when not possible, the GOP tried to jeopardize the subsidy streams. Any uncertainties about rate coverage was enough to send healthcare insurer CEOs into orbit.

“Oh my, our shareholders simply won’t accept that”, these CEOs moaned.

In quieter moments, healthcare insurers raised rates and cited the “higher than expected” number of “sicker than average” enrollees. Imagine, these big name insurance companies were finding that previously uninsured Americans were devouring healthcare services at amounts greater than the average American?

After thought (and realization that not much more money was coming from the government), these insurance companies proposed a resolution. They would exit the market!

The Aetna’s of this world would no longer sell policies to exchanges and abandon the exchange market to someone else. So, unless the government renewed its pledge to provide adequate subsidies, these newly healthcare covered Americans would join the ranks of the uninsured again.

So much for these insurance companies’ concern about individual healthcare.

One might fantasize that a Government truly interested in its citizens’ healthcare might say to these companies that they might as well withdraw from the rest of the State’s health insurance business. Cheery picking is not in the publics best interest.

Should that hard ball tactic not convince the insurance company to stay, then employing the “public option” might win the day. Expanding Medicare (with its requirement for paying premiums) would be quick and easy to roll out. Insurance companies might then think carefully on whether they needed to become more efficient or face the creeping invasion of “single payer” insurance.

Republicans might jump up and say “how is the government going to fund the public option?  Of course the answer is through taxes combined with individual payments.  And if the Affordable Care Act is repealed or simple succumbs to the death spiral, how is the cost of the 25 million or so Americans without coverage to be covered?

How about taxes and higher doctor and hospital payments?  Which path seems more humane?  Oh, I forgot the Republicans want to cut taxes, not increase them.  Take a hike you 25 million soon to be without insurance Americans.

Hmmm.