My insurance premium for January 2015 will be $479. This is up 18% from my 2014 insurance premium of $407 and up 54% from my 2011 premium of $311. Your mileage may vary but this is the good news! If I was foolish enough to purchase health insurance from the exchange in 2015 the lowest cost bronze plan will cost $923 and my potential out of pocket costs zoomed up from $5,000 to $12,000. For a person who has not made a claim against my health insurance since the mid 1990s, the idea of paying $479 a month is revolting. The idea of paying $923 a month is beyond comprehension. I was the perfect health insurance customer. I was happy even though I was arguably getting ripped off. My existing health insurance plan was being paid by my employer and even though this was not the perfect situation, my employer was happy and my family was happy. In those days my life was simple. I could spend my waking hours on the important things in life. Not surprisingly this situation was not that different from 1976 when health insurance was simple, transparent, and well understood. Boy, have we screwed up a good thing! In those day health insurance was the ultimate no-brainer and everyone signed up. Now we ponder to what happened to the Do No Harm philosophy to health insurance? Today I feel that I have been drug into a fight I never supposed to be fighting. Courtesy of the Affordable Care Act my employer cannot use the Health Reimbursement Act to pay for my health insurance with pre-tax money. It is just another one of those unintended ACA consequences. My employer is trying to be compassionate in a difficult business environment and will give me a bonus in 2014 to try to overcome the dysfunctionality of the Affordable Care Act. Recently I was reminded by Professor Gruber that Affordable Care Act supporters have always been negotiating in bad faith with the healthy people who were supporting the health care system. Quite succinctly he reminded us that the Affordable Care Act was never about health care reform, it was about politics. Six years later and 21,000 pages later we are still trying to figure out how to bend the health care cost curve. If increased federalism cannot reduce health care costs in six years, we have to conclude it will never reduce health care costs. Now the healthy crowd is stuck with a “fool me one, shame on me” mentality. If repeating the same old thing over and over again and expecting a different result is a sign of insanity, what can we do to reform the Affordable Care Act except to let it suffer through a slow, miserable death? Are we doomed to re-live the TennCare debacle all over again. Our health care system was better six years ago and even better 30 years ago. We are going in the wrong direction. I can see a trend and the Affordable Care Act is fundamentally evil.
healthcare
Making Health Care Less Affordable and Harder to Get One Policy At A Time
Today my boss informed me that our Health Reimbursement Account(HRA) would end on December 14, 2014, so I better schedule my remaining health expenses to a date before the 14th. To help with the increased after-tax health costs they will be increasing my paycheck in 2015. Although it is not as nice as the Health Reimbursement Account they recommended that I set up a Health Savings Account. Awhile back I wrote a post, Affordable Care Act Loser #7 – Health Reimbursement Account, that explained that the Affordable Care Act and the Department of Labor had effectively outlawed the HRA. Their decision is a sad reminder that “common sense” and Affordable Care Act do not belong in the same sentence. Although my company is making a best effort attempt to overcome the Affordable Care Act dysfunctionality, the bottom line is that I will be paying a larger part of my health insurance costs than if I had a HRA. So while I will receive a pay increase, the net result after paying for health care with after-tax money is that I just took a pay cut. Anybody wonder why the nine most terrifying words in the English language are, “I’m from the government and I’m here to help.” I keep wondering how we reform health care when the HHS is at war with the healthy people. It looks like a strategy that was born to fail. It is as if the Health and Human Services mission statement should say, “Making Health Care Less Affordable and Harder to Get One Policy At A Time”.
Hospitals’ Struggles To Beat Back Familiar Infections Began Before Ebola Arrived
Last week I wrote the post, What Scares Me About Ebola Is How We Have Handled Sepsis, and Kaiser Health News and NPR has followed up with an article expressing the same concern, Hospitals’ Struggles To Beat Back Familiar Infections Began Before Ebola Arrived. The Ebola infections by health care workers in the United States reminds us that infection control is a serious, unresolved health care problem for both health care workers and patients. The article is well researched and worth the read. My favorite quote is,
Nationally, about one in every 25 hospitalized patients gets an infection, and 75,000 people die each year from them—more than from car crashes and gun shots combined.
What Scares Me About Ebola Is How We Have Handled Sepsis
I was looking at this AP photo on the Wonkblog last week of two hospital workers in a room. The worker on right looks like he or she was dressed up to handle Ebola and the person on the left is not. Our hospitals have a severe problem with infection control. The NIH factsheet on sepsis says that the “Agency for Healthcare Research and Quality lists sepsis as the most expensive condition treated in U.S. hospitals, costing more than $20 billion in 20115.” I personally know three people who think they caught MRSA in a hospital or clinic. If you wonder how we can spread Ebola just take a look of the guy on the left. I know the photo is an innocent, staged photo but considering the industry record on sepsis you have to wonder how many hospital workers will have to die before hospitals get their act together. Infection control is only as good as the weakest link.
My confidence in science is not crumbling but it is shaken!
I was reading a post over at Fabius Maximus and could not resist myself. Here was my comment.
My confidence in science is not crumbling but it is shaken. I do not remember whether I was science skeptic before college but I definitely was a skeptic after getting my engineering degree. You had to be very, very careful to get the right answer in lab experiments. It was hard, tedious work. As a result I do not have the high and lows being experienced by some other people. I have seen how easy it is to be wrong despite your best efforts. I believe what you are seeing in crumbling confidence in science is that bad science is being penalized for being wrong and that is a good thing!
Climate science is interesting example of science going off the rails. I find it amazing that even after all of these years I still remember enough of a thermodynamics class I took 30 years ago to question the approach being used by climate scientists to solving what I would call a heat transfer problem. I was not surprised to see climate scientists struggle to explain global warming with temperature graphs. If thermodynamics is settled science, why did the scientists choose this alternate approach?
I think the scientists noticed that they could not unambiguously prove whether we are experiencing warming or cooling so they went with the political group with the most passion and money. There was a fifty-fifty chance they might get the science right without actually doing any science. All they needed was for Mother Nature to continue to do what she had been doing for a few more years. Unfortunately their prayers to Mother Nature went unanswered and the warming stopped. Now these researchers have to explain how they got it wrong. I think the worship of pagan goddesses took a real tumble when the climate scientists went back to doing real science again.
I hate to be picky but vaccinations, global warming, and economic “science” are not even close to what I see as the most serious confidence problems in science. Frankly, I am not surprised that most people get economics wrong. I still hold to the belief that economics is not a science but a conspiracy to make weathermen look smart. In my mind I have been able to write off the climate science problems as problems to be solved by my son’s generation. Unfortunately my generation gets to deal with the false positive problems in health care. Getting this right is a matter of life and death for healthy people like me. The false positive problem in prostate and mammogram testing is severe enough that one part of the medical profession is recommending less testing. At the same time another part of the medical profession thinks it is better to be safe than sorry so the over-diagnosis of prostate and breast cancer is a necessary evil. My inner engineer keeps wondering why doctors are advocating less testing rather than improving their testing? When did reducing false positives cease to be a noble scientific objective? So what is an otherwise healthy person to think in this environment? When I ask my doctor he shrugs his shoulders.
I think the fundamental problems affecting my confidence in health care can be best explained with the ulcer example. Just two months ago I learned via the TodayIFoundOut podcast that ulcers should be treated with antibiotics. I am old enough to remember when the standard diagnosis for ulcers was that it was caused by stress and could only be solved by surgery. This was settled science so it is not surprising that hospitals were the biggest force that prevented ulcers from being treated with antibiotics. Ulcer surgery was a money maker for many doctors and hospitals regardless of its efficacy. From 1984 to the early 1990s Dr. Marshall and his long-time collaborator, Robin Warren, were thought to be quacks. Finally in 1994 the National Institutes of Health (NIH) held a two day summit to discuss his research and the rest is history. In 2005 Dr. Marshall received the Nobel prize for Medicine for his discovery of the bacteria that leads to peptic ulcers. From settled science to a different settled science in 21 years. Doctors were absolutely, positively sure of their diagnosis and treatment until they changed their mind to a completely different treatment. It sounds like a House script. Does anyone wonder why so many people have become born again science skeptics?
So here is the bottom line if you are looking at prostrate and mammogram testing. You are damned if you do, damned if you don’t, and hospitals make money on either outcome. Even if you opt for the safe rather than sorry route, the hospital still has a chance to collect on the daily double. My father went into the hospital after a fall and got an infection. He never left the hospital alive. I am guessing that Tricare/Medicare paid a quarter of million dollars for this mishap. Sepsis is America’s dirty little secret. The NIH factsheet on sepsis says that the “Agency for Healthcare Research and Quality lists sepsis as the most expensive condition treated in U.S. hospitals, costing more than $20 billion in 20115.” It is the mistakes in health care that shakes my confidence in science.
Affordable Health Care Is Getting Harder Every Day
It wasn’t supposed to be this way but affordable health care is getting harder every day thanks to the Affordable Care Act. The likelihood that I will start 2015 without health insurance is growing every day. Today I was talking to my boss about a HRA replacement and he said that Zane’s HRP idea will not work for us. Both my boss and I have grandfathered plans that are probably not eligible to be used in a HRP arrangement.
A couple of hours later Tom was commenting on my post, Affordable Care Act Loser #7 – Health Reimbursement Account, and provided a link to to a discouraging article called, Guidelines For Using Reimbursement Arrangements Under The Affordable Care Act. Although I cannot find a date for the article the author plainly makes the point that "because employer dollars (i.e., employer contributions/reimbursements) are being used to pay for health care (i.e., the individual market plan), a Section 105 Medical Reimbursement Plan is by definition a “group health plan” under the Code". Yea, that sucks! Even though I like my health care plan and the HRA reimbursement arrangement, I cannot keep either of them. I sure wish the Affordable Care Act supporters would stop trying to help me. With friends like that who needs enemies!
Fixing The Affordable Care Act
One of the major problems I have with fixing the Affordable Care Act is that we are being led by a bunch of morons. Bob Laszewski said “about everybody believed about all of the states would establish their own exchanges” and what do most of the states do? We go from every state wants to set up an exchange to almost no state wants to set up their exchange. Doesn’t anyone see this as a major problem with making health care simpler, better, and more cost efficient? So these same folks have now focused their attention to preserving subsidies rather than making our health care system work better. Unfortunately preserving subsidies turned healthcare.gov into an unnecessarily complex, cost shifting system that requires an unknown number of IRS minions to enforce. Okay, we screwed up. Now is the time to fix it before we turn our health care system into a VA system on steroids. What would it take to make state exchanges work? State exchanges would require a simpler system that minimized development and ongoing costs. Fortunately for us states have limited budgets so complicated systems that do not add value to the customer is not an option. Streamlining or replacing the subsidy system with a simpler cost shifting system that could be implemented in a state exchange without much difficulty would be the first priority. It sounds simple. Instead we seem to be locked into a complex national health exchange we did not want and will most likely fail.
My own observation, having closely watched the original Obamacare Congressional debate, is that this issue never came up because about everybody believed about all of the states would establish their own exchange. I think it is fair to say about everyone also believed a few states would not establish their own exchanges. Smaller states, for example, might opt out because they just didn’t have the scale needed to make the program work. I don’t recall a single member of Congress, Republican or Democrat, who believed that if this happened those states would lose their subsidies.
Can We Start Talking About Gutting The Affordable Care Act?
Until the Progressives are willing to perform a seppuku on the Affordable Care Act, health care reform will be stuck on stupid. I hate to be brutally honest but there is not much left to gut when you look at all of parts of the Affordable Care Act that have been delayed. Since the Democrats wrote the bill by themselves, they own the Affordable Care Act problems and gutting the bill is preferable over a long prolonged death. When the smarter half of the Democratic party drew that imaginary line in the sand, they were of the opinion that health care reform cannot not succeed unless we get a majority of the states to set up health exchanges. For both political and governing reasons this form of co-operative federalism depends on states being willing participants. Without a majority of the states participating via state exchanges the backup plan of a federal exchange would transform the law into a plain old federal power grab built on the shifting sands of administrative law rulings. This smarter half probably viewed the federal exchange scenario as a recipe for political and governmental disaster and extremely hazardous to their re-election. Unfortunately they were proven right. The healthcare.gov roll-out was a grim reminder that our federal bureaucrats are not as competent as we thought and if you want to create a really big problem, the first step is to make it a federal program. The problem we are faced with now is that we are ignoring our past mistakes. Ms. Greenhouse in her article, “By Any Means Necessary”, seems to think that we can safely ignore the legal problems and the lack of political consensus. In a way she is advocating the idea that laws do not matter if it impedes the society’s greater goal, health care reform. This is what I call the “even a blind squirrel finds a nut once in a while” management style or otherwise known as management by accident. This is the evil twin of the more successful management style employed by businesses called management by objective. The management by accident approach is based on the hope that if we have enough people stumbling around trying to fix things they think might be wrong then we will eventually fix all of the Affordable Care problems regardless of how badly the law was written or administered. All we need is money, people, and lots of patience with government failures. This might be an acceptable solution in the federal bureaucratic universe but it reminds me why the healthcare.gov roll-out was such a miserable failure and why my insurance premium continues to go up despite promises otherwise. It should be amusing to see who gets the blame if the number of uninsured returns to historical norms this Fall. This is the Progressive’s proudest Affordable Care Act achievement. Will we be reminded once again that the Affordable Care Act was a health reform in name only? If this is the Progressive idea of health care reform then would someone “wake me when it’s over.”
The Creation Of The Affordable Care Act
In the Beginning was The Plan
And then came the Assumptions
And the Assumptions were without form
And the Plan was completely without substance
And the darkness was upon the face of the Congressional Staff Workers
And the Staff Workers spoke amongst themselves,
"It is a crock of shit, and it stinketh."
And the Staff Workers went unto their Supervisors and sayeth,
"It is a pail of dung and none may abide the odor thereof."
And the Supervisors went unto their Senators and Representatives
and sayeth unto them,
"It is a container of excrement and it is very strong, such that none may abide by it."
And the Senators and Representatives went unto the Speaker of the House
and Senate Majority Leader and sayeth,
"It is a vessel of fertilizer, and none may abide its strength."
And the Speaker of the House and Senate Majority Leader spoke among themselves,
saying one to another,
"It contains that which aids plant growth, and it is very strong."
And the Speaker of the House and Senate Majority Leader went unto the Vice President
and sayeth unto them,
"It promotes growth and is very powerful."
And the Vice President went unto the President and sayeth unto him,
"This new Plan will actively promote the growth and Efficiency of this Country,
and in this Area in particular."
And the President looked upon The Plan,
And saw that it was good,
and The Affordable Care Act became Policy.
And this is how Shit Happens.
The Federal Health Insurance Exchange Is A Lousy Tool To Fix These Health Care Problems
I was reading John Graham’s post, What is To Be Done with Health Insurance Exchanges, Post-Obamacare?, and could not resist saying the federal health insurance exchange is a lousy tool to fix these health care problems. Here are my reasons.
1. The cost of health care for people with high cost, pre-existing conditions is being spread across a fairly small group of people buying their health insurance via the exchanges. If health care for people with pre-existing conditions is society’s responsibility than the cost should be spread over a much larger group of people. Until we solve the problem with paying for pre-existing condition health care in a more equitable manner, health insurance exchanges will be plagued with high risk premiums and are likely to fail.
2. Health exchanges in general are a lousy way to subsidize health insurance for people earning less than 400% FPL if you want to control health care costs. This is the same problem faced by expanding Medicaid. The Oregon Medicaid experiment leads us to speculate that this group of people will consume more health care services without an improvement in health care outcomes. A health insurance credit is probably a step in the right direction of simplifying the subsidy system while providing subsidies and cost control incentives.
3. With the market distortions from pre-existing conditions and subsidies and overall incompetence in the roll-out, it is hard to imagine health insurance exchanges as an adequate substitute for the fair, unbiased health insurance market place we expected in 2013. As a person who has purchased health insurance from eHealthinsurance.com in the past, I have to assign blame for the overall incompetence of healthcare.gov to politics. The ACA made purchasing health insurance unnecessarily complicated. When you combine the public’s unfavorable view of the federal health exchange with its history of being a political football, this would be a good time to look at a replacement that involves less federal government and political partisanship. The original ACA plan relied on state exchanges and we should go back there in a modified form. My personal favorite idea is to simplify the enrollment process and replace the federal exchange with state exchanges run in cooperation with insurance companies and insurance marketers. eHealthinsurance.com and other companies like them already had the infrastructure in place. You can call this the Halbig solution with adults in the room. If we cannot get rid of the amateurs in the federal government we should at least minimize their damage.