Author: bill

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Uncompensated Care Background

 

A recent study by Hadley and others, which used that analytic approach, examined a sample of medical claims for uninsured individuals and projected that they would receive about $28 billion in uncompensated care in 2008. That study also examined reports by doctors and hospitals and derived a higher estimate: Their gross costs of providing uncompensated care would be about $43 billion in 2008, of which $8 billion would come from doctors and $35 billion would come from hospitals. But as the study noted, at least a portion of those costs could be offset by added payments under Medicare and Medicaid to hospitals that treat a disproportionate share of low-income patients (and by similar dedicated payments made under other federal and state programs). Another recent study found that, as a group, office-based physicians roughly "broke even" when treating uninsured patients because some of those patients paid more than the doctors would have received for treating a privately insured patient.

Introduction and Background from the CBO document, Key Issues in Analyzing Major Health Insurance Proposals.

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Alternatives To Mandating Insurance? Maybe : NPR

My actual health care costs outside of health insurance and dental for the last ten years is around $200. For my adult working life, thirty years, the cost is not much more. It stands to reason that I have been a very, very profitable customer for the insurance companies when they could have me. Considering my medical history the logical course of action for me is to seek out the lowest cost health care  plans. The insurance companies benefit because I am a “good” customer. I financially benefit by pocketing the difference. I also benefit by the knowledge that this scheme will work only if I remain healthy. This is what I call being a savvy health consumer. As a cost efficient consumer I am in a very small way lowering the per capita health care spending in America.

The problem I have with the health insurance company position as expressed below is that the underlying health care cost issue they are looking at is unrelated to my group health insurance requirements. They ceased operation as a health insurance company in the traditional sense and are now acting primarily as an agent collecting taxes to be used for unrelated health care services. An odd result of this philosophy is that by removing financial incentives, it turns me into a passive health consumer. What incentive is there for me to question a health care professional over a drug or treatment if my connection with health care costs becomes so remote? On one hand our health care reform wants the people to become more conscious of their health and the corresponding health care costs. On the other hand they are removing one of the few incentives that are out there for active involvement. I am not sure how we are going to reduce costs with passive health consumers.

Another drawback is that the individual mandate does not appear to have lowered health care costs. At least I have not seen lowered health care costs show up when I compare Massachusetts insurance premiums to Ohio premiums.

Mostly, Court says, states could be given more power to ensure that insurance companies can’t impose premium increases that are unjustifiably large.

"The easiest way to get more people into the health insurance pool is to make health insurance more affordable," he says.

The insurance industry says that’s not a good solution because premiums merely reflect underlying health care costs.

Alternatives To Mandating Insurance? Maybe : NPR

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‘If States Could Speak’: The GOP’s ‘Third Front’ Against Obamacare

I was wondering when someone would do something like this. I think many states will opt to not expand state Medicaid programs due to lack of funds. When it comes to laying off police officers or cutting Medicaid, Medicaid loses. The Individual Mandate and the federal mandate to determine what qualifies as an ”˜acceptable’ health-insurance plan are tools for raising costs for healthy people. Basically it makes healthy living a sin tax.

Sens. Lindsey Graham (R., S.C.) and John Barrasso (R., Wyo.) introduced legislation Tuesday that would do considerable damage to the Democratic health-care law by allowing states to ”˜opt out’ of its key provisions.

The State Health Care Choice Act would let state governments choose whether or not to participate in various aspects of Obamacare, including: the individual mandate forcing citizens to purchase health insurance or pay a fine, the employer mandate forcing businesses to provide health insurance or pay a fine, the mandated expansion of state Medicaid programs and the federal mandate determining what qualifies as an ”˜acceptable’ health-insurance plan.

”˜If States Could Speak’: The GOP’s ”˜Third Front’ Against Obamacare – By Andrew Stiles – The Corner – National Review Online

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Things that make me go hmm… Mass media ignores Obama health suit story

Last night my wife and I were discussing the decision by a judge in Florida that the Affordable Care Act was unconstitutional. My wife thought he ruled that only the Individual Mandate was overturned while I maintained that the entire bill was being overturned since there was no severability clause. Since it was dinner time and the news was on the television, we decided to let television news programs decide our debate. We watched the local news, ABC news, and the National Business Report(PBS). No one mentioned the decision. It is an interesting choice by mass media.

Fla. judge in Obama health suit has own med story – Yahoo! News

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Health Care Cost Reform and Minimum Creditable Coverage

If we continue my line of reasoning in “Is the individual mandate necessary for health care reform?” to its logical conclusion, the individual mandate does not have either a positive or negative impact on health care costs. Whether the mandate is at the state or national level, it appears to be a freedom we have sacrificed for no apparent reason. The battle to put cost reduction into health care reform will inevitably center around how to put a little of Adam Smith’s invisible hand into the reform.

A good place to start is make sure the the United State’s “minimum creditable coverage” is flexible enough to allow these plans to be used. I suspect that this provision in Massachusetts is primary culprit causing the healthy people to overpay for their health insurance. Removing these excess funds would probably encourage a healthy re-evaluation of health care spending in Massachusetts. Massachusetts looks like it has a spending problem.

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Is the individual mandate necessary for health care reform?

Most of the recent debate about the individual mandate centers around the constitutionality of the mandate. A more interesting question is whether the mandate works. The answer to this question is different if you are an economist or an average person. The economist or policy maker will be happy if the mandate causes:

to cause the individual insurance market risk pool to become more favorable (include more relatively healthy individuals than it otherwise would).

The average person just wants to know if the individual mandate saves them money. The idea of the individual mandate was that by adding more people to the insurance pool, health costs will go down for everyone and health care will become more efficient. Since everyone would have insurance there would be less emergency room visits and better preventative care. Several logical conclusions should be expected from implementing the individual mandate:

  1. Lower Health Care Costs – Health insurance rates will go down for everyone.
  2. Improved Health Care Efficiency – Health care cost increases should be less than the average for the country.
  3. Improved Health Care Competitiveness – Health care costs in individual mandate states should be less than in other states or countries.

Yesterday I decided to compare the health insurance costs between Ohio and Massachusetts. I entered my demographic data into the Health Connector for Massachusetts, www.mahealthconnector.org, and the lowest Bronze plan available would cost me $1,296 per month. In Ohio I looked up a comparable plans on www.ehealthinsurance.com. This site provides the same features as a Health Connector but does not need a government subsidy. The lowest plan on ehealthinsurance.com would cost me $305 per month. In fact there were 15 plans available for less than $400 and 55 plans for less than $600. Here is the screenshot of my insurance options at the Massachusetts Health Connector.

Massachusetts Health Connector quote

Here is the screenshot of insurance options at eHealthInsurance.com.

eHealthInsurance.com quote

As a healthy person I would pay an extra is $991 per month or $11,892 per year for my health insurance in Massachusetts. If you multiply $12,000 by every  healthy people added to the insurance pool, Massachusetts should not any problem lowering health insurance costs. The lower insurance costs in Massachusetts didn’t happen. The expected cost benefits from reduced emergency room visits and preventative care do not appear on the bottom line either. The Massachusetts insurance prices are so far off we have to conclude that something other than the individual mandate are the dominant drivers for health care costs and those problems are not being addressed. Since Massachusetts health insurance costs are not competitive with Ohio, the logical conclusion for the average person is that the Massachusetts health care system is broken and future health care systems built along the lines of the Massachusetts system are doomed to failure, too. To paraphrase Albert Einstein, replacing a broken health care system with a more expensive, broken health care system and expecting different results, is a sign of insanity.

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TRANSPARENCY: School District Puts Checkbook Online….

Recently I became concerned with our country budgeting process and its possible abuse by county commissioners. In this case the county was planning to buy a shopping mall and lease it at an aggressive rate to encourage a grocery store to move in. There were some obvious questions why was the county jumping into the commercial real estate market and how was this project going to be good for the county. It was obvious that some friends of the county commissioners were going to benefit. Most of the problems centered around Tax Increment Financing(TIF) and whether the only beneficiaries of the project will be the friends of county commissioners. Improved transparency is a possible solution.

TRANSPARENCY: School District Puts Checkbook Online.

TRANSPARENCY: School District Puts Checkbook Online….
Glenn Reynolds
Sat, 08 Jan 2011 15:25:45 GMT

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Holiday Granola | Serious Eats : Recipes

Initially I did not like this granola. Eating this granola by itself did not work for me. So I started adding it to my morning cereal and developed quite a fondness for it. It made my cereal interesting. Every bite was a surprise.

This crunchy, sweet granola is studded with toasted almonds, pumpkin seeds, and dried cranberries and peaches. Feel free to substitute any combination of nuts and fruit, or swap the maple syrup for honey. It makes an ideal holiday gift, and will keep for up to two weeks stored in an airtight container at room temperature.

Ingredients

serves 6 cups

  • 3 cups rolled oats
  • 1 cup shredded unsweetened coconut
  • 1 cup coarsely chopped almonds
  • 1/2 cup green pumpkin seeds
  • 1/3 cup packed dark brown sugar
  • 1/4 teaspoon cinnamon
  • 1/4 teaspoon salt
  • Pinch of allspice (optional)
  • 1/2 cup canola oil
  • 2 tablespoons maple syrup
  • 1 1/2 cups dried cranberries
  • 1 cup diced dried peaches

Procedures

  1. Position the oven rack in bottom third of oven. Preheat oven to 325°. Combine oats, coconut, almonds, pumpkin seeds, brown sugar, cinnamon, salt, and allspice (if using) in large bowl. Add canola oil and maple syrup and stir until all ingredients are well combined.

  2. Spread mixture on baking sheet and bake, stirring often, for 25 minutes. If nuts or coconut are toasting too quickly, turn oven down to 300°.

  3. Remove granola from oven and let cool on pan for 20 minutes. Stir in dried cranberries and dried peaches. Cooled granola will keep for up to 2 weeks in sealed container at room temperature

Holiday Granola | Serious Eats : Recipes

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Rose Bowl preliminary rating down 15 percent – College Football – Rivals.com

 

TCU’s 21-19 win over Wisconsin on Saturday earned an 11.7 overnight rating, down 15 percent from the 13.8 for Ohio State–Oregon on ABC last year. ESPN is available in about 13 percent fewer homes than ABC.

I do not have cable so I was somewhat surprised when I could not find the Rose Bowl on over the air television. It was one of the few bowl games I was interested in seeing. What I didn’t know was that ESPN and the bowl games decided to be shown exclusively on cable. This resulted in a smaller audience and probably smaller advertising revenue. Now this is an interesting business decision.

Rose Bowl preliminary rating down 15 percent – College Football – Rivals.com

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Obamacare: When Obama LIKES Imposing Higher Costs on ‘The Poor’

My biggest complaint with this new restriction on Health Savings Accounts is that it is a blatant attempt to make Health Savings Accounts less desirable by arbitrarily removing benefits. The combination of Health Savings Accounts with a high deductible health insurance represent a low cost competitor to ObamaCare. The primary political objective of ObamaCare was to limit health care alternatives and force everyone into one common but high cost comprehensive health care plan. The key to building support for the high cost health care plan is to hide the costs of the comprehensive plan and make the low cost plans less attractive. The government health plan had to be comprehensive to be acceptable to unions and large corporations. High health care costs have made some businesses uncompetitive and one solution is transfer their health care responsibilities to the government. Under this scenario control of the health care system is the primary objective. Controlling spiraling health care costs is a secondary consideration. Once control of the health care system is attained, then the government could force lower prices at will. It is hoped that the health care czars will be smart, benevolent dictators. The downside is that the proposed health care system could be an inefficient bureaucracy like Medicare or something much worse. Currently this particular scenario has such a dim political future that many large organizations have asked for exemptions from ObamaCare. With this deadly embrace of the status quo, the owners of these luxury health care plans having particularly dim future at controlling their spiraling health care costs and ultimately their product costs. If an individual believes that a low cost plan health plan is better for them, why should they be forced to bail out the high cost plans of unions and big businesses?

Health Savings Accounts and high deductible plans are nasty reminders to the people who wrote ObamaCare that if you have to pay for your health care, a lot of people will choose the basic health care plan over the high cost, comprehensive plans offered by large corporations and unions. Any one who has compared the COBRA health insurance offered  by your former employer with those offered by the major insurance companies would come to the conclusion that corporate health insurance is way overpriced and the first step to control your health costs is to take personal responsibility for your health care and cut out the unnecessary benefits. Under this system your good health results in money in your pocket. This issue exposes some core conflicts within ObamaCare. Who do we trust with our health care decisions, the individual or the government? Will the independent thinker ever be comfortable with the group think of ObamaCare? Can a country as ethnically, culturally diverse as the United States ever adopt the Swedish "homogeneous" view of health care or is this a fool’s errand in the process of creating a health care plan tailored for America?