insurance

An Embarrassment of (Link) Riches

<div class="separator" style="clear: both; text-align: center;"><a href="http://0.tqn.com/d/beginnersinvest/1/W/p/G/scrooge_mcduck.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" height="112" src="http://0.tqn.com/d/beginnersinvest/1/W/p/G/scrooge_mcduck.jpg" width="140" /></a></div><div style="text-align: justify;">The Inbox is filling up with interesting linkage: many of interest, few really blogworthy on their own. So, in no particular order, some (hopefully) interest-piquing links: ■ "<a href="http://www.lifehealthpro.com/2014/09/02/watchdogs-catalog-hhs-ppaca-exchange-contracts?eNL=540625a1160ba092319537f5&utm_source=HCRW&utm_medium=eNL&utm_campaign=LifeHealthPro_eNLs&_LID=107687085" target="_blank">By February, CMS had spent an average of about $92 per HHS exchange QHP enrollee</a>" That is, they'd spent almost $100 per (successful?) ObamaPlan <strike>victim</strike> enrollee. That may not seem like much, but if the numbers HHS is touting are true [ed: uh-hunh], then we're talking hundreds of millions of IT dollars. ■ Does the ObamaTax actually contain wording that contains the seeds of its own destruction? "<a href="http://www.lifehealthpro.com/2014/08/20/ppaca-contains-possible-ppaca-20-provision?eNL=53f4eded140ba01a235c4524&utm_source=HCRW&utm_medium=eNL&utm_campaign=LifeHealthPro_eNLs&_LID=107687085" target="_blank">The Patient Protection and Affordable Care Act (PPACA) contains a provision — Section 1332 — that states can use to turn it inside outside</a>" The little-known Section 1332 allows state Departments of Insurance the opportunity to solicit waivers for certain plan provisions, including Qualified Health Plan requirements. Something to keep in mind, though: The verbiage in question is actually called "Sec. 1332. Waiver for State innovation," and allows states to "apply to the [HHS] Secretary for the waiver of all or any requirements described in paragraph." But it's not open-ended; rather, it's an opportunity for a given state to experiment a bit, while requiring of the state a "10-year budget plan for such plan that is budget neutral for the Federal Government." Sweet deal for the Feds. ■ As if confirmation was needed that the ObamaTax has lead to provider shortages, and at least a suspicion that rationing is just around the corner (if not already here): "<a href="http://www.lifehealthpro.com/2014/09/05/ppaca-rationing-5-ways-insurers-can-limit-care-acc?eNL=540df54f150ba08e416389be&utm_source=HCRW&utm_medium=eNL&utm_campaign=LifeHealthPro_eNLs&_LID=107687085" target="_blank">5 ways insurers can limit care access in this brave new world ... Insurers are not sitting back with open arms and welcoming all of the poorest, sickest and most costly patients</a>" No kidding. When increased demand (in the form of newly insured, both on ObamaPlans and Medicaid) meets static (or perhaps even <a href="http://insureblog.blogspot.com/2013/03/eh-whats-up-doc-i-quit-thats-what.html" target="_blank">shrinking</a>) supply, something's gotta give.  ■ Here's a new twist on the ol' Three R's: reinsurance, risk corridor and risk-adjustment. These also happen to comprise some underlying reasons why insurers' own financial health may face some challenges. According to Steve Zaharuk, a senior vice president at Moody’s Investors, "<a href="http://www.lifehealthpro.com/2014/09/09/moodys-full-year-ppaca-plan-results-might-be-bad?eNL=540f724d150ba0c50378b411&utm_source=HCRW&utm_medium=eNL&utm_campaign=LifeHealthPro_eNLs&_LID=107687085" target="_blank">although exchange qualified health plan (QHP) enrollment has been strong, insurers have given few details about QHP underwriting results ... At best insurers were predicting a break-even scenario, but most were anticipating losing money on the business for the full year</a>.” Not a great long-term business strategy. Which actually ties in nicely with...  ■ FoIB Jeff M tips us to this news out of The Tarheel State: "<a href="http://www.bizjournals.com/charlotte/blog/health-care/2014/09/carolinas-healthcare-cuts-100-jobs-seeks-to-reduce.html?page=all" target="_blank">Carolinas HealthCare System has eliminated roughly 100 jobs and is looking to cut its 2015 budget by $110 million</a>" Which seems to me to be a combination of the four previous links. One wonders how many more such reductions we'll see as we enter the next Open Enrollment season, and even more folks jump in (or don't).</div>

An Embarrassment of (Link) Riches

The Inbox is filling up with interesting linkage: many of interest, few really blogworthy on their own. So, in no particular order, some (ho...

9:33 AM

MVNHS© vs Cancer

<div class="separator" style="clear: both; text-align: center;"><a href="http://birminghamappraisalblog.com/wp-content/uploads/2010/03/chart.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" height="112" src="http://birminghamappraisalblog.com/wp-content/uploads/2010/03/chart.jpg" width="140" /></a></div><div style="text-align: justify;">Spoiler Alert: Cancer's winning. "<a href="http://www.theguardian.com/society/2014/sep/08/cancer-coalition-nhs-health-service-budgets" target="_blank">[A] report by Cancer Research UK said that ‘cracks are beginning to show’ in NHS cancer diagnostic and treatment services ... Specialists have been struggling to keep up with the rising demand for care at the same time as their budgets have shrunk amid the NHS's £30bn efficiency drive</a>" Once again, we need to point out that nationalized health care regimes are no more successful at reining in costs while maintaining (let alone improving) health care delivery than our previous system. My <a href="http://insureblog.blogspot.com/2011/11/facts-can-set-us-free.html" target="_blank">Project Manager Better Half</a> often speaks of "resource starved" organizations. That is, businesses that, rather than spending the necessary funds to fully staff a given project, instead rely on fewer and fewer personnel to handle the tasks. This creates a strain on both the company and the folks that are left, exacerbating the problem even further. That seems to be the case in Britain, where "[t]he abolition of scores of NHS bodies ... such as the scrapping of the highly regarded National Cancer Action Team and cancer clinical networks, has produced an unhelpful "vacuum" and loss of leadership in cancer delivery." No kidding. Previously, the Much Vaunted National Health System© relied on several key coordinating groups, including "NHS England, NHS Improving Quality and the 211 GP-led local clinical commissioning groups." Not that these folks were any great shakes when it came to, for example, <a href="http://insureblog.blogspot.com/2014/01/mvnhs-vs-seniors.html" target="_blank">caring for elderly cancer patients</a>. Of course, the answer always seems to be "throw more money at it," when, in fact, it's not so much a funding problem as it is a structural one. Of further course, the powers that be don't see it that way. They never do. [Hat Tip: <a href="https://plus.google.com/107944168110103829411/about?rel=author%3E+Bob%20Vineyard" target="_blank">Co-blogger Bob V</a>]</div>

MVNHS© vs Cancer

Spoiler Alert: Cancer's winning. " [A] report by Cancer Research UK said that ‘cracks are beginning to show’ in NHS cancer diagnost...

6:18 AM

In case of Emergency...

<div class="separator" style="clear: both; text-align: center;"><a href="http://www.peoplequiz.com/images/quizzes/emergency.jpg-3791.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" height="83" src="http://www.peoplequiz.com/images/quizzes/emergency.jpg-3791.jpg" width="140" /></a></div><div style="text-align: justify;">Let's head to the Wayback Machine, and set the dial for June of 2011: "<a href="http://insureblog.blogspot.com/2011/06/romneycare-reduces-er-visits.html" target="_blank">Two reports from Boston.com, one in 2010 the other today show ER visits are on the rise, not decline</a>." Boston, one may recall, is in Massachusetts, home of ObamaTax progenitor RomneyCare. Proponents of the latter touted its ability to reduce costly Emergency Room visits, and thus drive down the "cost curve." [ed: Funny how we don't seem to hear much about that "cost curve" thingy any more. Wonder why?] Of course, it did no such thing: "MIT economist Jonathan Gruber, who helped legislators draft the law, said some people who avoided emergency rooms because they were too expensive in the earlier period may be using them more, now that they have coverage" Hold the presses! Jonathan Gruber, you say? <a href="http://insureblog.blogspot.com/2014/07/state-exchanges-vs-subsidies.html" target="_blank">That Jonathan Gruber</a>? Hunh. In the event, we knew well over three years ago that schemes like RomneyCare and ObamaCare do not, in fact, reduce ER visits. Why bring this up now, you ask? Well: "<a href="http://nypost.com/2014/09/08/er-visits-skyrocket-under-obamacare/" target="_blank">More people newly insured by Medicaid under ObamaCare are seeking treatment in hospital emergency rooms — one of the most expensive medical settings, a study released Monday concludes</a>" Deja vu all over again. So we knew - conclusively - over three years ago that increasing access to health insurance would necessarily lead to increased use of "free" services (like the ER). Which are, of course, decidedly not free. As newly-insured folks are finding out. Two years ago, we noted: "<a href="http://insureblog.blogspot.com/2012/10/emergency-cash.html" target="_blank">[A]bout 80,000 emergency room patients at hospitals owned by HCA, the nation's largest for-profit hospital chain, left without treatment after being told they would have to first pay $150 because they did not have a true emergency</a>." ObamaPlan customers may be in for a rude awakening.</div>

In case of Emergency...

Let's head to the Wayback Machine, and set the dial for June of 2011: " Two reports from Boston.com, one in 2010 the other today sh...

11:31 AM

With chemo you get egg roll?

<div class="separator" style="clear: both; text-align: center;"><a href="http://shacabkamedia.com/warka/images/stories/2011/amal1/0405-china-hospital-630x4201.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" height="93" src="http://shacabkamedia.com/warka/images/stories/2011/amal1/0405-china-hospital-630x4201.jpg" width="140" /></a></div><div style="text-align: justify;">Here's an interesting twist on medical tourism: "<a href="http://online.wsj.com/articles/desperate-chinese-seek-medical-care-abroad-1409959941?tesla=y&mg=reno64-wsj&url=http://online.wsj.com/article/SB10001424052970203966604580135471469215454.html" target="_blank">When Lin Tao was diagnosed with a lethal spinal tumor in 2012, doctors in Hangzhou told him he had one option in China—surgery that would replace two sections of his vertebrae and might leave him paralyzed</a>" Not particularly enamored with the prospect of permanent paralysis, Mr Lin did what any reasonably affluent and rational person would do in such circumstances: he "flew to San Francisco and paid $70,000 UCSF Medical Center,  where doctors recommended that Mr. Lin try radiation therapy," instead. This despite the fact that China has its own version of the MVNHS©, guaranteeing "free" health care to its citizens. Of course, that care is often (usually?) substandard - when it's even available. Thus, smart Chinese folks with more than a few yuan to rub together are increasingly turning to other sources: "The Mayo Clinic, in Rochester, Minn., said the number of ts patients from China has more than doubled over the past year." Which, by the way, accepts only <a href="http://dailycaller.com/2014/02/23/hospital-cited-by-obama-as-health-reform-model-for-the-nation-accepts-only-one-kind-of-insurance-plan-under-obamacare/" target="_blank">one kind of ObamaPlan</a>, so if yours isn't a Blue Cross/Shield Silver plan, then you're SOL. Unless, of course, you've got that extra $70 large laying around collecting dust. As it is, hospitals in mainland China aren't exactly models of efficacy: "[They] struggle to make money. Low-paid doctors are paid for each service and commonly receive kickbacks for drug prescriptions, which can lead to exploitation of patients." Talk about <a href="http://insureblog.blogspot.com/2014/06/tuesday-potpourri.html" target="_blank">pay-to-play medicine</a>. And there's this: "China ramped up health-care spending more than 13% last year to 820 billion yuan, or around $133 billion ... But the funding barely scratches the surface for a population increasingly plagued by chronic diseases" That is, another nationalized health care system fails at reining in runaway health care costs. Quelle surprise. Glad we don't have such problems here.</div>

With chemo you get egg roll?

Here's an interesting twist on medical tourism: " When Lin Tao was diagnosed with a lethal spinal tumor in 2012, doctors in Hangzho...