by

TheHealthSherpa and the HMO Debate

Kudos to a couple of programmers who decided to create a demonstration site of the shopping functions that should have been included in  www.healthcare.gov. I have a minor quibble with the article since I believe that this demonstrates management failure rather than an architecture failure since the shopping function could have been completed by an independent team. It is the old project management tactic, divide and conqueror.

Three San Francisco programmers in their 20s proved just how inept HealthCare.gov’s architects were, taking just a few nights to design a simplified version of the glitch-ridden contraption.

Michael Wasser, Ning Liang and George Kalogeropoulos, who share office space with other Bay-area techies, built an alternative website,TheHealthSherpa.com, that resolves HealthCare.gov users’ main complaint ”“ easy access to plan descriptions, according to CBS News. And it didn’t take them $600 million to do it.

“They got it completely backwards in terms of what people want up front,” Liang said. “They want prices and benefits, so that they could make the decision.”

Unfortunately as I research the health insurance issue further I am still struggling to find the details on the plans. TheHealthSherpa.com does not help in this area. This weekend I did some research into copays after some comments by Juan Williams last week and into the decision health insurance customers will have to face between HMO and PPO insurance plans. Copays are unlikely to save me any money but customers who have a lot of doctor’s appointments and drugs might find a benefit depending on their premiums. Depending on your point of view the HMO style of health care was made famous or infamous  in the 1990’s HMO debate.  This sounds like déjà vu all other again. The HMO option is the lowest cost plan for me and the lowest cost PPO plan is more expensive even when I include the subsidy than my current plan. I am tentatively planning on writing a future post that explores the value of the Affordable Care Act plans compared to my current insurance. I will have to remind myself to make sure I am comparing PPO plans or I will be comparing apples to oranges.

by

The Nuclear Option and What It Means to Fixing the Problems with the Affordable Care Act in 2014

One of my many complaints about the Affordable Care Act is that it is primarily a political achievement and the heavy lifting of health care reform was left as a future exercise. Although there have been some political achievements that were translated into good government policy by our bureaucrats, this piece of legislation needed some opposition views to help detour them from changing things that are not broke. This is most evident in the policy that resulted in the cancellation of existing insurance plans. The plans seemed to be working okay and the customers were happy. There was never a good argument put forth why these people had to be the first in line for health care reform. It seems that the Affordable Care Act supporters deliberately went out of their way to make enemies and then had the nerve to gloat about it as “progress”. President Obama’s comment to the GOP sums up the Affordable Care Act supporter’s attitude.

I Won. Get Over It

This attitude leads to a political strategy that reduces good will, trust, and consensus making among our legislators at just the moment these legislators needed to back off from the partisan Kool-Aid and start fixing their mistakes. Instead the Senate embraced the nuclear option and kicked off the 2014 election debate with a bang. The congenial Senate has become more like the House and passing laws to help fix the more egregious problems with the Affordable Care Act in 2014 is one of the many losers. One of the lessons I learned in over thirty years of marriage is that being right is overrated. The Senate has set themselves up for a bitter custody battle and we, the people, have lost hope for a more perfect union.

by

Things that make me go hmm… Up to 40 percent of the technology needed to run the new Obamacare health insurance marketplace has not yet been built

Since I previously voiced my skepticism of management’s competence in administering the www.healthcare.gov project, I am not be surprised that there was an assortment of uncompleted work. However the magnitude of Mr. Chao’s claim astounds me. Here is his quote:

Up to 40 percent of the technology needed to run the new Obamacare health insurance marketplace has not yet been built and will not be ready when insurance companies start sending in bills when coverage begins January 1, the project manager of HealthCare.gov told the U.S. Congress on Tuesday.

 

Uh, what was the management team doing over the last three years when the developers were falling behind and why is this management team suddenly so confident that they can build and test these missing business functions in sixty days? The missing business functions sound like management reports that would have been essential to managing a successful implementation and integration of the insurance marketplace and to answer all of those pesky questions from Congress and the media!

by

Can We Improve Health Care The Next Time Around?

One of my biggest regrets about the Affordable Care Act is that it really does not improve health care. The Affordable Care Act made some changes to the way we pay for health insurance but we are still stuck with the inconvenient truth that health insurance does not heal people. Hospitals, pharmaceutical, and medical device companies do not heal people either. If we distill health care down to its bare essentials, it is the health care professionals who heal people and I remain unconvinced their job got easier or more effective with the Affordable Care Act.  It might seem obvious but if we are going to improve health care and reform the cost structure then it would make sense that we should focus on the health care professional/patient relationship. The Affordable Care Act took a different tack and seems to be inordinately focused on expanding a flawed third party payer system. From this viewpoint we can see that as much the Affordable Care Act was a political success, it has been a health reform failure. When I started working in the 1970s the third party payer system was still a pretty effective to pay for health care. Forty years later it has declined to the point where it is viewed as one of the major problems impeding health care reform and I am once again thinking self-insurance is a feasible plan. Even when the Affordable Care Act supporters reluctantly admit to the third party payer system failures they cling to the belief that expanding the system is a price they are willing to pay if it expands access to health insurance to the poor.  I do not see a good future for health care reform with an expanded third party payer system. To those people who had their health insurance plans canceled and replaced with higher cost plans, the Act has increased their financial burden. They are the designated Affordable Care Act “losers”. To the poor who were not paying for their health care, it is much ado about nothing. It does not matter to them if the emergency room accepts Medicaid. The financial burden of hospital care was never going to be their problem. The only potential winners are the people whose subsidized insurance is less than their current plans. This dependence on subsidized insurance keeps reminding me of the insurance subsidies in the Farm bill. As I was pondering alternatives to the Affordable Care Act subsidized insurance I ran across the TriHealth pricing page and was surprised with the discounts they offer based on family size and income level. The biggest attraction of the Affordable Care Act exchanges was already being offered by a local hospital. Here is the table from their page.

100% Discount 80% Discount 60% Discount 45% Discount
Family Size: 1 $0 – $11,170 $11,171 – $22,340 $22,341 – $33,510 $33,511 – $44,680
Family Size: 2 $0 – $15,130 $15,131 – $30,260 $30,261- $45,390 $45,391- $60,520
Family Size: 3 $0 – $19,090 $19,091 – $38,180 $38,181 – $57,270 $57,271 – $76,360
Family Size: 4 $0 – $23,050 $23,051 – $46,100 $46,101 – $69,150 $69,151 – $92,200
Family Size: 5 $0 – $27,010 $27,011 – $54,020 $54,021 – $81,030 $81,031 – $108,040
Family Size: 6 $0 – $30,970 $30,971 – $61,940 $61,941 – $92,910 $92,911 – $123,880
Family Size: 7 $0 – $34,930 $34,931 – $69,860 $69,861 – $104,790 $104,791 – $139,720
Family Size: 8 $0 – $38,890 $38,891 – $77,780 $77,781 – $116,670 $116,671 – $155,560

I am left to ponder one final question. If we have an example of a direct financial subsidy system that does not require the Individual or employer mandate, why did we choose the Affordable Care Act option with its inefficient scheme of subsidized insurance?

by

More Parsing the Insurance Cancellation Debate

Yesterday I pointed out an interesting oddity in the Insurance cancellation debate and today I read a more extensive post by Adrianna McIntyre on The Incidental Economist about the Administration’s plan to “help” the people whose health insurance policies are being canceled. Like all policy changes there are winners and losers. Here is my comment.

In a narrow sense some insurance companies may benefit from this ruling. As an example my policy with Aetna in Ohio is grandfathered since I acquired the policy before March 23, 2010. According to Aetna, policy holders who acquired the policy after that date are not grandfathered and are being canceled even though the policy will continue for people like me in 2014. Since Aetna is not participating in the exchange it would make business sense for them to un-cancel those policies acquired after March 23, 2010, which are just like existing grandfathered polices because they could hold on to existing customers.They become the hero. This a much bigger dilemma for companies participating in the exchanges like Anthem since they are going to get a lot more money by pushing their customers into the exchange. Any way you slice it, they become the goat.  Once again we are reminded that no good deed goes unpunished.

by

Things that make me go hmm… Parsing the Insurance Cancellation Debate

Yesterday I got some good news. Aetna confirmed that I could continue to keep my grandfathered health insurance plan in 2014.  Here is the letter.

2013-11-14_06-44-51-Aetna 

It is kind of sad but all of the chaos surrounding health insurance cancellations heightened my fears. Despite the President making that conservative argument that if I like my insurance plan I could keep it, it became very important that I figure out what factors allowed me to keep my insurance plan beyond 2013. My trust that the President said what he meant and meant what he said is about zilch. I think the key factor can be found in the second paragraph. I had purchased my plan before March 23, 2010.

Coincidentally I received an email from www.ehealthinsurance.com that covered some of the factors that kept some people from keeping their insurance plans. Here is what they said. Once again the key factor appears to be when you purchased the plan.

AARP® Essential Premier Health Insurance Plan, insured by Aetna
For Non-Grandfathered members in: Alaska, Arizona, Connecticut, Washington D.C., Delaware, Florida, Georgia, Illinois, Michigan, Missouri*, North Carolina, Nevada, Ohio, Oklahoma, Pennsylvania, South Carolina*, Tennessee, Texas, or Virginia –

Effective January 1, 2014, your current AARP® Essential Premier Health Insurance Plan, insured by Aetna will no longer be available. As a result of the many health coverage options and policies available under the Affordable Care Act (ACA), AARP will not be co-branding a 50-64 health insurance product in the 2014 Exchange marketplace.

Because your current co-branded plan was purchased after the passage of the ACA on March 23, 2010, it does not meet all the new standards required in 2014. As a result, you will need to select another plan with an effective date no later than January 1, 2014. You should have received more details from Aetna, including information about a December 1, 2013 option for an Aetna Individual Plan.

If you do not make a new plan selection by November 25, 2013, Aetna will automatically move you to an Affordable Care Act (ACA) qualified health plan (where available) so you have continuous coverage. You must continue to pay premiums on your current coverage through December 31, 2013. This change will go into effect on January 1, 2014.

Please note: There aren’t any Aetna 2014 ACA options available in Missouri and South Carolina. There is only an Aetna December 1, 2013 option.

For more information, please visit http://HealthInsurance.Aetna.com. Should you need help with enrollment, you can call Aetna directly at 888-352-1047, Monday ”“ Friday from 8:00 a.m. – 9:30 p.m. ET.

*There are no Aetna 2014 ACA options in Missouri and South Carolina only an Aetna December 1, 2013 option

Hmm… are the really saying if a person purchased AARP® Essential Premier Health Insurance Plan after March 23, 2010, their plan is being canceled even though the exact same plan exists for other people in the state.

by

Things that make me go hmm… Fixing www.healthcare.gov by the End of November

I have been critical of www.healthcare.gov since I first used the web site in 2010. It sure looked like I was the only person who had tried to use it and I can say that it did not improve with age. Two weeks ago I had to chuckle when Mr. Zients announced that “by the end of November, HealthCare.gov will work smoothly for the vast majority of users.” Since his claim violates much of my personal experience and knowledge of software design and development,  I was skeptical that they could fix www.healthcare.gov by November 30th. When a project like www.healthcare.gov makes the transition from development mode to maintenance mode, fixing problems on the fly while customers are using the system is difficult and risky. I am not saying the healthcare.gov folks cannot do this but experienced IT guys will remind anyone still listening that they have been there, done that, and have the cuts and bruises to show for it. I hate to say I told you so but CBS is reporting in “Memo warned of "limitless" security risks for HealthCare.gov” that:

Chao said he was unaware of a Sept. 3 government memo written by another senior official at CMS. It found two high-risk issues, which are redacted for security reasons. The memo said "the threat and risk potential (to the system) is limitless." The memo shows CMS gave deadlines of mid-2014 and early 2015 to address them.

I can think of only one reason that Mr. Chao was unaware of the memo, somebody did not want Mr. Chao to know the extent and gravity of the problems. Management failure is a dish best served cold. Good luck, Mr. Zients!

by

Changing of the Guard

We have a new senior pastor at church so it is time to reflect on servant evangelism again. It has been our thing for the last twenty years. So as we embark on this journey of saying we are changing but not really changing, here are some words from Donald Sensing to keep in mind as we try to reinvigorate our passion for servant evangelism. If Jesus is King then is servant evangelism the crown prince?

Jesus was selfish (?)

By Donald Sensing

But the trick is discerning what it is that actually helps the poor. Too often we wind up treating them like pets rather than people who are, and should be related to, as responsible moral agents on their own.

And unfortunately, churches are frequently targets of what I call the "professional poor," people who make most of their actual living in scamming charitable givers. In fact, the actual majority (by far) of the supplicants who come to my church are that category.

It’s no wonder that many people are tapped out and suffer from compassion fatigue.

In the biblical model of helping the poor, the primary responsibility always rested with blood kin, then with the clan, then with the synagogue (later, church), but was never seen as the responsibility of the government. We have utterly reversed that today so that most people see primary responsibility for assistance resting with faceless government agencies.

But whenever someone wants to lower government spending to leave more money in the hands of private citizens, with which they could then increase personal assistance to the needy, well then then we are told we hate the poor and have no compassion.

So Colbert’s cute quote wears a little thin. Paying taxes does not equal Christian compassion.

by

RE: Anecdotes ain’t our thing. Stop asking.

Aaron wrote a post, “Anecdotes ain’t our thing. Stop asking.” in which he said it was important to him to “see the system work at a population level”. Okay, that got me thinking. Here is my comment.

I am curious what “see the system work at a population level” will mean? I am also curious when the Affordable Care Act will transform itself from a primarily political achievement into a policy driven achievement. Until then I would be suspicious of any population level data coming from the http://www.healthcare.gov. On one hand I agree with you that a steady diet of anecdotal stories is hazardous to your mental health. On the other hand I found that when I tried to explain differences between anecdotal information and some “population level” data sets found on healthcare.gov and coming from HHS, I found serious problems in either the data or the application used to access that data. As long as http://www.healthcare.gov is a politics driven web site it would be wise to remember the old saying, caveat emptor!

  1. As an example the insurance finder on healthcare.gov is an example of a population level data application that is seriously misleading for some people. Was it intentional or another silly healthcare.gov mistake?
  2. For the last month the Kaiser subsidy estimator was incorrect for me. It looks like the source of their problem was bad data from healthcare.gov(GIGO).
  3. I am still trying to figure out the burst of reports in September 2013 that showed that the 2014 Ohio rates will show a reduction compared to 2013 when all of my simple price checks are showing a 100% increase in rates? Maybe it is a coincidence but something has got to give. It is way past time that policy statements should start matching up with price checks.
by

Adventures in Fermentation

yeast starter for california steam kit I typically buy two beer kits at a time because I am comfortable with brewing on consecutive weekends and it saves on shipping costs. This time I let my second brew date slip. Although I refrigerate my yeast when I receive it, the best used by date on the yeast  vial had come and gone. So I bought a yeast starter kit to see if I could give the yeast a fighting chance. I use a yeast starter when I make bread called a sponge so this should be pretty easy. I followed the instructions and after a day it looked like the yeast was active. So I brewed the California Steam Lager and pitched the yeast. For the first 36 hours there were no bubbles. Finally on Tuesday morning there were bubbles coming out. Today when I left for work it was still bubbling. Whew! I almost made a big mistake.

 

Last Saturday I got a kick out of watching a new show on Esquire channel called Brew Dogs. Esquire was showing all of the episodes back to back so I sat through the first two episodes before I realized I was past my bed time. The guys and the show format was entertaining even if you are not a craft beer geek. I was fascinated with their ability to pick out flavors in the beers and how they paired beers and foods. Their pursuit of “craft beer virgins” was funny as was some of the exotic ingredients craft brewers are experimenting with. In the second episode the guys went to San Francisco and Anchor Steam Brewing. The show reminded me that the first time I drank an Anchor Steam Lager was back in the 1970s when it claimed to be the smallest brewery in the United States. For many years I told people that my favorite beer was Anchor Steam Lager. It was ironic that I was going to brew an imitation of the Anchor Steam lager the very next day.