Category Archives: Health Care

Obamacare’s Problems Are Just Beginning

Doctor

Health Care Problems Ahead

When I have criticized the ACA in the past, I’ve done so for different reasons; none of them being a horrible website roll out.  With such issues as fewer doctors, rising premiums and political exemptions – the law is riddled with problems.

ACA Forcing Premiums To Rise

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

In all the discussions regarding the benefits of the new law, including “free” contraceptives, for example, it has never been brought up by the defenders of the law that nothing, of course, is free.  That contraceptive package will have to be paid for by somebody – maybe even you.

And how will that cost be recouped?  Why, by raising the premiums on people, of course:

Based on a Manhattan Institute analysis of the HHS numbers, Obamacare will increase underlying insurance rates for younger men by an average of 97 to 99 percent, and for younger women by an average of 55 to 62 percent.

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.

No – make no mistake, the problems with Obamacare have nothing inherent to a failed and botched website – that’s only gravy in the pursuit in demonstrating that this administration is dangerously inept at management issues.

 

 

Be Careful What You Wish For

ObamacareLook, I want life to work out well for everybody.  But when people are making horrible decisions, and I try and tell them that they are basically hurting themselves, I have little sympathy for them:

Many in New York’s professional and cultural elite have long supported President Obama’s health care plan. But now, to their surprise, thousands of writers, opera singers, music teachers, photographers, doctors, lawyers and others are learning that their health insurance plans are being canceled and they may have to pay more to get comparable coverage, if they can find it.

They are part of an unusual, informal health insurance system that has developed in New York, in which independent practitioners were able to get lower insurance rates through group plans, typically set up by their professional associations or chambers of commerce. That allowed them to avoid the sky-high rates in New York’s individual insurance market, historically among the most expensive in the country.

But under the Affordable Care Act, they will be treated as individuals, responsible for their own insurance policies. For many of them, that is likely to mean they will no longer have access to a wide network of doctors and a range of plans tailored to their needs. And many of them are finding that if they want to keep their premiums from rising, they will have to accept higher deductible and co-pay costs or inferior coverage.

“I couldn’t sleep because of it,” said Barbara Meinwald, a solo practitioner lawyer in Manhattan.

I’m not sayin’, I’m just sayin’

I told you so!

Obamacare’s Impact On Jobs

Job Market

First, I admit to acknowledging the noble intention of looking to insure more Americans.  I get that tug often.  When new employees straight out of college walk through our doors, I try and bring up the subject of insurance and 401ks.  Some listen – others don’t.

So I get it.

However, all the noble intentions in the world is not going to change the fact that people, in general, will tend to make decisions that maximize their best interests.

So when the government passes a law that requires employers to compensate employees in a certain manner – look for those employers to adjust their behavior.  Duke did just that – they looked at employers:

Durham, N.C. — Corporate financial chiefs say they expect to reduce hiring and also move more jobs to part-time status as a result of the Affordable Care Act, according to a new survey from Duke University and CFO Magazine.

Many companies also are considering a reduction in health care benefits for employees.

This is exactly the response that we’ve been predicting since the law was passed.

It’s not surprising.  Iin fact, what would be surprising is that someone was surprised:

“The results were startling to us. This will significantly impact employment,” said Campbell Harvey, a professor of finance at Duke’s Fuqua School of Business. “I think the people who drafted the bill probably never anticipated such a negative effect on employment, especially in a time when we really need employment growth.”

Okay, so Duke School of Business was surprised – but it would be hard to say that folks haven’t been warned.

How bad is it?

Almost half of the 500 companies surveyed are “reluctant” to hire full-time employees, the survey found, and one in 10 may lay off current employees in response to the law.

Some people could see their hours cut below 30 hours a week because the Affordable Care Act requires companies with 50 or more employees to provide health insurance to those working 30 hours or more a week or pay a penalty.

More than 40 percent of CFOs surveyed say their companies will consider switching some full-time jobs to part-time jobs in 2014.

“For the employee, often what that means is you have to get a second job, or you just take a hit in the amount of money you make. So, it is quite disruptive,” Harvey said.

The single best method to reduce costs, increase quality and expand availability is to expose the product to an ever free’er -yet maintaining contract laws- market.  Profit motive and self interests will prevail and the more expensive objects today will become commoditized tomorrow.

So really, the question shouldn’t be, “Do we want to provide health care to everyone?”  The question should be, “What costs are we going to expose our nation to in order to provide this coverage?”

Would you trade 43 hours a week for a 37 hour week for our nation?  Would you trade a single point of unemployment; go from 6.5 to 6.6 perhaps?

How many unemployed people would you be willing to accept in order to realize the gain of insurance for all?

Those are the questions that need to be answered.

How Much To Eat Healthy

Fruit

Some time ago we discussed the cost of eating per month specifically as it pertains to food stamps:

We much more generous than the average as described by the democrats.In fact, an individual can earn up to $14,532 and still qualify for $200 a month.  To be sure, 14k a year isn’t much money at all; rent surely would take most of it.  But, 50 bucks is a bunch more than $31.50.  If I had an extra 20 to spend in my challenge I could almost certainly afford a twelve pack.

Where it gets really interesting, however, is at the 2 household range.  There a person can earn $19,680 a year and still qualify for $367.00 a month.  In fact, if approved, an individual could earn $30,000 and qualify for that amount.

As I mention in the post later on, “not the life of luxury”.

Now, what does it cost to go from a poor diet to a healthy diet?

If you want to eat a more healthful diet, you’re going to have to shell out more cash, right? (After all, Whole Foods didn’t get the nickname “Whole Paycheck” for nothing.)

But until recently, that widely held bit of conventional wisdom hadn’t really been assessed in a rigorous, systematic way, says , a cardiologist and epidemiologist at the Harvard School of Public Health.

So he and his colleagues decided to pore over 27 studies from 10 different developed countries that looked at the retail prices of food grouped by healthfulness. Across these countries, it turns out, the cost difference between eating a healthful and unhealthful diet was pretty much the same: about $1.50 per day. And that price gap held true when they focused their research just on U.S. food prices, the researchers found in their of these studies.

One dollar fifty American.

That’s less than $50 a month – the average amount played on the lottery.  And much MUCH less than the weekly food stamp challenge and certainly dramatically less than the amount allocated by the state currently.

The money line, pardon the pun?

“Just as an excuse to not eat healthy,” he says, “for most Americans, I think price is not an excuse.”

Indeed.

Affordable Care Act Helping The Poor

Poor Artist

Came across this article in the NY Times this morning:

For Mark and Elisabeth Horst, both artists in Albuquerque, the risks of signing up for a bronze plan were outweighed by the prospect of getting it free. The Horsts, who make $24,000 a year between them, qualified for $612 in monthly subsidies, but the cost of a bronze plan was $581 a month.

The Horsts are the couple pictured above.

I object to redistribution in general but have to admit to having sympathy for folks who fit the mental picture of “the poor”.  Struggling factory worker barely getting by.  Single mom who can’t pay rent, electric bill AND the water bill.

But THESE ‘effing people?!?  I have to work my ass off to support these people’s health care?

The article goes on to to quote Mr. Horst as claiming to be in good health, so I’m guessing that they are making 24k is that they CHOOSE to make 24k, not because life has dealt them some shitty hand.  These are people who CAN work, COULD work but are making the choice NOT to work.

And we’re taking care of them like children.

Look, I’d like to wake up every day and draw.  Or color.  Or make clay ashtrays too.  But I don’t; I go to work and bring home the bacon.

And because I do – these people get to color.

Awesome.

In honor of the working poor:

Medical Doctor Alternatives

Doctor

I think that one of the reasons our medical care system is so expensive is that the system is not built to match procedure to appropriate expert.

For example, there are very skilled landscapers in this world capable of designing and building stunning works of art in the natural world.  And then there is the need to have your lawn mowed.  Imagine how expensive it would be to obtain a contractor to mow your lawn if you were required to hire that highly skilled, trained and often time licensed landscape designer.

Another example I came across was during a conversation with my mother-in-law.  We were discussing health care and costs and I mentioned that it’s unfortunate that I need to see an MD to have a finger reset, x-rayed and cast when I’m sure it could be done by a PA at most and perhaps a nurse at worst.

[ there may be cases where this is possible – i was using the specific example to make the larger point ]

She objected claiming that if it was her, and had she the insurance that she indeed has, she would insist on not only a doctor but then an orthopedic specialist.

Why the editorial?  I saw this and was confronted that without allowing price to act as a signal, we may not be getting optimal results:

Midwives, nurse practitioners, physician assistants and other non-doctors do as good a job as MDs in the care they deliver — and patients often like them better, a World Health Organization team reported on Thursday.

These non-physicians are especially effective in delivering babies, taking care of people infected with the AIDS virus, and helping people care for chronic diseases such as diabetes and high blood pressure, the team reported in a WHO bulletin.

The findings extend from the poorest nations to the United States and Europe, they said. While some physician groups have resisted wider use of such professionals, they should embrace them because they are often less expensive to deploy and are far more willing to work in rural areas, the WHO experts said.

“There are some obvious advantages in terms of relying on mid-level health workers,” WHO’s Giorgio Cometto told NBC news in a telephone interview.

“They take less time to be trained. Typically, they cost less to remunerate. In some countries they are more likely to be retained in rural areas.”

David Auerbach, a researcher at the Rand Corp., says other studies have shown the same thing. “There’s really not much difference you can find in the quality,” he said.

But we don’t allow the delivery of medical services be exposed to the market.  And so people are not going to shop their needs on said market.  Additionally, we have special interest groups, read AMA, that lobby to create legislation that make it illegal to see anyone BUT a doctor for such commoditized services.

 

Pino Is Right – Sebelius Blames Claims Obama Kept Promise

Kathleen Sebelius

Last night at about 6:30 I opined on how long it would take the administration to deflect blame on the policy cancellations from Barack Obama to the insurance companies.

It took about 18 hours:

The White House has struggled to defend President Obama’s 2009 claim as thousands of people receive notifications that their insurance companies are dropping their plans.

“Is he keeping his promise?” Rep. Marsha Blackburn (R-Tenn.) asked Sebelius.

“Yes he is,” the Health and Human Services secretary responded.

She repeated the administration’s argument that, if people are losing their plans, it is because of insurance companies and not the new healthcare law.

“If a person had a policy in place in March 2010, liked that plan, and the insurance company made no changes to disadvantage the consumer, those policies are in place, you keep your plan if you like it, and that goes on,” Sebelius told the House Energy and Commerce Committee.

“People though who had a medically underwritten policy, were paying more than their neighbor because they happen to be female … they will have a new day in a very competitive market,” she added.

Many insurers have stopped offering plans that do not comply with regulations issued by the Health and Human Services Department outlining basic levels of coverage. Consumers who have received such notices are often left with more expensive options.

These people simply lied.  It’s not like the traditional campaign speech promising no school on Fridays and a pretty girl for every boy.  They knew that people, by the millions, would lose their coverage and they kept saying that they wouldn’t.

The next sound bite?

“Yes, you DID lose your plan, however, it will be replaced by one that is better.”

Obama Is Losing His Media Advantage

Media

Since before he was elected, Obama has had a strong ally in the press.  This has allowed him to remain personally popular and likeable all while his policies have proven to be UNpopular.

Perhaps such a relationship is seeing its expiration date:

After emerging from the showdown over the Republican-led government shutdown relatively unscathed, the Obama administration finds itself under assault on three fronts: problems surrounding Obamacare, revelations of the U.S. spying on allies, and the 2012 attack on the U.S diplomatic compound in Benghazi, Libya — over which a senator has threatened to hold up all of the administration’s nominations.

The controversies are sure to fuel continued Republican attacks on Obama and his Democratic allies as the nation gears up for midterm elections next year, and the White House has portrayed the attacks as so much partisan chatter.

But to CNN senior political analyst David Gergen, they reflect the relative inexperience of the Obama White House.

“This is an administration that has been very, very good at its politics, but has never been very good at execution of policies from Day One,” he said Monday.

“It’s an administration which has some really smart people in it, and a lot of younger people. It doesn’t have very many heavyweights,” he said.

This isn’t news here and was certainly predicted during the first election cycle that Mr. Obama survived.  And, I have to admit, now that he’s President, the fact that he is largely ineffectual may be my most favorite thing about him.

But this ACA rollout is a disaster.  A disaster the likes of which would get an executive in the private secotr fired.

Obamacare – Accountability

Barack Obama

At some point the man in charge has to be held accountable for the success or failure of the organization.

Right?

So far, Obama has escaped that.  But this is an interesting metric:

Obama Unaware

83,300 results for “Obama Unaware”.

However you feel about the Affordable Healthcare Act, at some point you have to admit that Obama simply has no clue as to what is going on.

Affordable Care Act – Young People

College Kids

The Affordable Care Act is in the “Open Enrollment” phase.  And for many Americans, it’s the first time that they ‘re shopping for insurance.  And as they go through the process, they’re going to have to make some decisions.  And I get that the whole thing might be overwhelming, I have to shake my head at this analysis:

 Young adults could pay relatively little up front for Obamacare, only to pay a lot later.

They may be more likely to buy cheaper plans on the health care exchanges, but they are often less informed about how high out-of-pocket costs, including deductibles, can erase any savings realized from the lower premiums, potentially leaving them with crippling bills, experts told CNBC.com.

“I think the exposure is pretty high. It’s way higher than most people are used to,” said Karen Pollitz, a senior fellow at the Kaiser Family Foundation, the health policy research group. “There will be some people who will, for whatever reason, end up getting high-deductible health plans, and I think some of them may not like it.”

Forget, for a second, what “could pay relatively little up front” means.  The fact is that most likely these young folks face two facts:

  1. They weren’t buying insurance before and would be exposed to the same crippling bills.
  2. They are highly unlikely to ever encounter such eventualities.

As for point 1, while they would be exposed to the same crippling costs, at least now that cost is limited.  Anyway, the point is, that people all over creation are forgetting that we are talking about insurance – the protection against risk.

When I was young, my dad would implore me to purchase just such a catastrophic plan.  And now, as I manage young college graduate entering the corporate work force for the first time, I coach them the same way.

Buy the least expensive high deductible plan you can find.  Then, fund an HSA to the max up to or exceeding that deductible.  For the young, the benefits are two fold.

  1. You are fully protected in the event of a life changing financial occurrence.
  2. You have time on your side to grow that HSA.

One last thing.  The article mentions the cost of such a plan:

“I was looking at Texas earlier today,” Pollitz said. “They had a bronze Blue Cross plan that was $250 a month … for a 40-year-old. The bronze had a $6,000 deductible

The cost before the ACA?

Now, how expensive in insurance for a 30 year man in the same ZIP?

The plan that offers $5,000 – 0% -No charge after deductible?

$62.24

The plan with the lowest deductible that is the cheapest looks like this:

$2,500 – 30% – $40 office visits:

$99.40 a month.

It will be fun to watch this thing as it moves from enrollment to functional plan.