Category Archives: Health Care

Pre-Existing Conditions – Who Should Pay

And the debate rages over health care again.  And the left is going to lie again.

I’m seeing many posts decrying the new health are bill being moved through congress.  Gaining special attention is people’s opinions of the concept of pre-exisiting conditions.

Before I go further, it is my position that government has no role in health care, medical care or health insurance.  None.  It’s also my position that insurance companies treat pre-exisiting conditions within the context of actuarial science.  That is, if an individual has a condition prior to obtaining insurance, either the cost of that insurance is higher or the condition isn’t covered.

That being said, the narrative being trotted out by democrats is absolutely false.  Namely that Trumpcare will do away with the requirement that insurance companies must offer a policy to anyone who applies.  If you had a pre-existing condition during Obamacare and were able to obtain a policy, so too will you be able to obtain a policy under Trumpcare.

So, that being said, who SHOULD pay for such pre-existing conditions?  I found a nice article and they explain it this way:

We have a tendency to use “pre-existing conditions” as a euphemism for “expensive health care needs” but the two aren’t quite the same.  If you and I are both healthy today, and both participating in the same insurance plan, the pricing of our insurance should already factor in the probability that one of us will someday face a health problem requiring expensive treatment – and the plan should be able to handle it when we do.  But a sick person without insurance (or looking to change plans) is in a different situation; their need for health treatment is a certain problem rather than a merely possible one, and hence the average expected cost is much higher.  Technically, what they need is not insurance against a possible, unknown problem, but rather help paying for a certain, known problem.

There’s no way around a simple truth: treating an expensive health condition costs (someone) lots of money.  There are four basic approaches that can be taken to this problem.

1)    Leave sick people to face the costs of their own treatment, whether out of pocket or through high-cost insurance, no matter how ruinous those costs become.

2)    Mandate that other, healthier people overpay for the value of their own health insurance, so that sick people can underpay for the value of theirs.

3)    Spread the costs of paying expensive health bills throughout society, for example by having taxpayers pick up the tab.

4)    Require a targeted group to shoulder the costs.

The aspect that I like about this article is that they take no position on the policy.  Only that there are a limited number of options – options that describe who pays.

An important note – if you are someone that already has insurance, are healthy and then gets sick, you will be covered under that policy.  You will be provided the medical care you require and do not have a pre-existing condition.


Why Capitalism Is Good

Wal MartSo much is said regarding ‘greed’ and ‘corporations’.  Let’s not forget that until the advent of free trade and individual property rights – the common peasant was destined to farm the same land with the same tools as their ancestors.

The benefits of free trade:

NEW YORK (MarketWatch) — Wal-Mart Stores Inc. pushed down prices for some generic prescription drugs to just $4 eight years ago, setting a new industry standard. Now it is trying to do the same for seeing a doctor.

On Friday, a Walmart Care Clinic opened in Dalton, Ga., six months after Walmart U.S., the retailer’s WMT, +0.27%   biggest unit, entered the business of providing primary health care. It now operates a dozen clinics in rural Texas, South Carolina and Georgia and has increased its target for openings this year to 17.

An office visit costs $40, which Walmart U.S. says is about half the industry standard, and just $4 for Walmart U.S. employees and family members with the company’s insurance. A pregnancy test costs just $3, and a cholesterol test $8. A typical retail clinic offers acute care only. But a Walmart Care Clinic also treats chronic conditions such as diabetes. (Walmart U.S. also leases space in its stores to 94 clinics owned by others that set their own pricing.)

“It was very important to us that we establish a retail price in the health-care industry because price leadership matters to us,” said Jennifer LaPerre, a Walmart U.S. senior director responsible for health and wellness, in an interview.

Health Care is just another commodity that, when subjected to the free market, will bend to the advantage of the consumer.

Pino’s Solution To The VA Disaster


Is it just me or is there a simple common sense solution to the Veteran’s Affair disaster?

Consider the 2015 budget:

The President’s 2015 Budget includes $163.9 billion for VA in 2015.

Then use the VA’s number for vets:  Call it 22 million.

Last, the average cost of insurance:

As of February 24, 2014, the average premium for an individual health plan selected through eHealth without a subsidy was $274 per month…

So, do the  math.

$274 a month is $3,288.  Across 22  million vets you get $75,000,000,000.

Double the price of the plan and you STILL are $14 billion to the good.


Free Market Face Palm

Face Palm

This has been in my stack for near 2.5 months now.  The good Dr. Greens writes:

Wow.  Really, really good Washington Post story about how there’s a $50 treatment for a serious eye disease that affects the elderly, but doctors regularly choose the $2000 treatment, bill Medicare, and we all pay.  Ugh.

The story goes something like this:

Two equal treatments, one sells for $50 and the other for $2,000.  Docs prescribe the more expensive one because they make more money.

The complaint?

And another great example of why health care is so much more expensive in the US than the rest of the world.  Other countries simply don’t get lobbied into wasting money on Lucentis when Avastin will do the trick nor are their doctors financially rewarded for doing so.

Right – greed.

Wanna know how to fix it?

Expose the patient to the cost of the treatment.

A Very Predictable Result Of Obamacare


Economic Law Of Gravity

The allocation of scare resources.

That’s economics as defined by Thomas Sowell.

And doctors are scare resources – people that have skills that are in demand.  And the demand results in a cost.  And if that fact is ignored – as is often the case in DC – trouble will ensue.

In this case, the trouble will be that people who have purchased an insurance plan are going too find out that their choice of doctors is limited, sometimes severely:

Some 70% of new plans under the health law offer relatively narrow networks compared with many current plans, according to a recent report by McKinsey & Co. The consulting firm found that plans with smaller choices of hospitals had significantly lower premiums than similar plans offering a broader choice.

And why are we facing this problem?

Because the new law is forcing insurance companies to insure everyone, independent of pre-existing conditions on top of prohibiting them from charging more for demographics that then to have higher medical bills.

Democrats Support Freedom

Statue of Liberty

What Is Freedom – What Is Liberty

According to democrats, freedom is being able to live off the labor of others:

Democrats aren’t buying a Congressional Budget Office report finding that President Obama’s healthcare overhaul could cost the economy millions of jobs over seven years.

The nonpartisan office said the loss of the equivalent of 2.3 million full-time jobs could result from Americans adjusting their hours and employment in response to new healthcare options.

While Republicans said the findings show Obamacare is damaging the economy, Democrats argue any reduction in jobs would reflect the greater freedom the bill gives Americans.

“What we see is that people are leaving their jobs because they are no longer job-locked,” House Minority Leader Nancy Pelosi (D-Calif.) told reporters after House votes Tuesday afternoon. “They are following their aspirations to be a writer; to be self-employed; to start a business. This is the entrepreneurial piece. So it’s not going to cost jobs. It’s going to shift how people make a living and reach their aspirations.”

Pelosi said she hadn’t “fully” seen the report, but, “this was one of the goals. To give people life, a healthy life, liberty to pursue their happiness. And that liberty is to not be job-locked, but to follow their passion.”

Democrats have jumped the shark.

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Obamacare: Incentive To Remain Poor

Carrot and StickLiberal Policies And Noble Intentions

I don’t buy into the notion that liberals are trying to enact policy that effectively enslaves the very people they mean to help – almost to a person the liberals that I know truly have the best interests of humanity in their heart.

They’re wrong – of course.  But they are well intentioned.

However, that doesn’t change the fact that those policies are, at their core, poisonous to the very segment of the population they mean to help.

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Obamacare Woes

Red Tape

This is a common story and is most likely mitigated:

David Miller, of Franklinton, says he has applied, canceled and reapplied for health insurance for his family 14 times. After weeks of technical glitches, he was finally able to select a Blue Cross Blue Shield plan that would cover him, his wife and twin sons. However, he still encountered problems.

“We got to the very last step. We had it all set up, and when we hit the confirm button, then another technical glitch prevented us from being able to complete the process,” Miller said, adding that he has no idea if he and his family are covered. “Every time we think we’re getting close, then there’s another technical glitch, as they call it.”

No one denies that the roll-out of the service was a massive failure.  And, to their credit, the administration seems to have the front end fixed.

But this is the problem left unresolved:

Miller says he called Blue Cross Blue Shield and was told that his application has not been forwarded to them. He says he calls the helpline about every other day and regularly spends two to three hours on the phone waiting for and then talking with service representatives and their supervisors who are unable to tell him his status or how to proceed.

The insurance company doesn’t think that he has coverage.  That’s because the back end website structure isn’t communicating between all organizations.  The billing organizations are collecting money, the insurance companies aren’t receiving data and the consumer isn’t sure if they are getting the right information regarding subsidies or not.

This isn’t close to being over.


Obamacare Score Card

A very nice list of potential problems for Obamacare from Coyote:

  1. Millions complain about their doctor no longer being in-network
  2. Thousands of companies are finding it cheaper to drop coverage and pay Obamacare penalties than continuing to provide health care coverage under new rules
  3. Despite fewer exchange enrollments than expected, total Federal subsidy payments higher than expected
  4. Emergency rooms overflow with new Medicaid patients that no private doctor will take on
  5. Exchange-sold health policies, particularly the unsubsidized ones, were mainly bought by the old and sick
  6. Obama Administration works to bail out health insurers via a number of different avenues
  7. Small to mid-size companies are shocked as Obama Administration finally reveals new record-keeping requirements
  8. After 5 years of 3-4% growth, health care spending skyrockets in 2014
  9. ________ health insurance company dropping coverage in  ____(state)_______
  10. Hackers steal tens of thousands of names and social security numbers from health care exchange computers.

I’m guessing we see 1, 3, 4, 5, 9 and 10 for sure.

Obamacare – The Benefits

Health Care

This past Friday I posted on the problems that Obamacare is facing:

One of those problems is counter-intuitive.  The ACA is going to  force policies to rise.

These prices are only going to continue to rise as Obama’s target market shuns the the law opting for a fine that might not ever be levied – the young and the healthy are fleeing the scene of the crime.  This results in only the older and the sicker enrolling; the most costly of the people covered.  The only result is a rise in policy costs.

In addition to the costs associated with rising policies, there will be rising costs in other places as well.  However, these costs are GOOD costs:

 “The real big surprise was how much out-of-pocket would be required for our family,” said David Winebrenner, 46, a financial adviser in Lebanon, Ky., whose deductible topped $12,000 for a family of six for a silver plan he was considering. The monthly premium: $1,400.

While the health law makes many preventive services free — such as vaccines, blood pressure screening and mammograms — most medical care is paid out of pocket until the deductible level is reached. Some of the new plans offer limited coverage for certain services before a patient has met the annual deductible. These services can include primary care, some prescription drugs and routine care for common chronic conditions such as high blood pressure and diabetes.

We are never, EVER, going  to control the costs of medical care until we expose such care to the market.  Wanna have people spend less on health care?  Ask them to spend their own money.

“But Pino, if we allow the government to negotiate prices for the goods and services, we’ll SAVE money!”

Exhibition A:

Defense SpendingAnother industry where the government is the only player, and we can’t contain it either.

No, the answer isn’t government control of the health care industry – the answer is the exposure of the health care industry to the free market.  And high deductibles is the very best way to do that.