ObamaCare: Striving to Be Better Than Third-World Care

Wait a minute.  Do you mean that government-monopolized care may not be as good as the citizenry is used to?  As you can see, federal regulators are working hard to make sure our new exchanges offer a luxury, adequate, barely tolerable experience.  

This is the federal official in charge of setting up the Exchanges: 

Chao said that he’d once held high hopes that the exchanges would run smoothly from the beginning, but that those hopes had been dashed. “The time for debating about the size of the text on the screen, or the color, or is it a world-class user experience, that’s what we used to talk about two years ago,” said Chao. “Let’s just make sure it’s not a third-world experience.” Both Chao and Cohen said that it’s likely that some of the state-based exchanges might not be ready on time...

 

Full story:  http://www.forbes.com/sites/aroy/2013/03/22/cms-on-obamacares-health-insurance-exchanges-lets-just-make-sure-its-not-a-third-world-experience/  

Just why do doctors hate Medi-Cal so much?

(Note, under PPACA, California just expanded the number of residents eligible by 35%)  

• In many states, Medicaid pays doctors a fraction of what private insurers pay. In 2008, in California, a doctor made 38 cents on a Medicaid patient for every dollar he made seeing a privately insured one. In New Jersey, a doctor made 33 cents. In New York, 29. And states continue to decrease Medicaid physician fees, because it’s the only lever they have.  Full story.  
• For every person added to Medi-Cal or Medicare, doctors are forced to negotiate higher healthcare prices with the private insurance industry.  Those increase are passed onto you and your employees as increased premium.  PPACA has only exasperated that cost-shift.  

How Much Life Insurance Do You Need?

Here is a helpful summary from Miranda Marquit at Lifehacker: 

One rule of thumb is the 4%, which means that your family lives off the interest from your payout, and assumes that the lump sum earns 4% a year. If you make $45,000 a year, you would need $1.125 million in insurance coverage to generate your salary. Of course, you don't know that your family will be able to net 4% a year, considering market conditions and inflation. The money might run out over time, but this can give you a fairly quick way of determining how much life insurance you might need.

Another approach is to add up the cost of all of the expenses you expect your family to need to cover for a set period of time. You might decide that you want your life insurance policy to pay off debts that you have, as well as your mortgage, so that your family doesn't have to worry about these obligations. If you have a life partner that works, or that can get work, replacing your income doesn't seem as important as providing a way for your family to get financially squared away.

Also, consider how long your partner will have to support your children after you are gone. You can get coverage that will allow your youngest child to reach age 18. So, if your youngest is a baby, you might decide to get a 20-year term life policy (a little extra wiggle room). Then, you can add up what you hope to pay off with a life insurance policy. Your list might look something like this:

• $185,000 mortgage
• $7,000 car loan
• $20,000 student loans
• $6,000 credit cards
• 18 years x $45,000 = $810,000
• $5,000 funeral cost

The total by this reckoning is $1.033 million. Your family can pay off the bills, and then put the remainder into an account to draw on as income replacement. With earned interest, the money should last more than 18 years, although it wouldn't last indefinitely.

If you are confident in your partner's ability to earn a living, you might just decide on a number like $500,000 to cover expenses and pay off debts, and maybe contribute to your children's future education. At the very least, though, you want to buy enough coverage to pay funeral expenses and pay off debt. That way, your family has fewer things to worry about.

This Makes Recruiting for Lower to Middle Income Jobs Exceedingly Difficult

In aggregate, each household in poverty receives $60,000 per year.  The median working family earns just over $50,000.  The below is from Daniel Halper at the Weekly Standard. 

The amount of money spent on welfare programs equals, when converted to cash payments, about "$168 per day for every household in poverty," the minority side of the Senate Budget Committee finds. Here's a chart detailing the committee's findings: 

          

According to the Republican side of the Senate Budget Committee, welfare spending per day per household in poverty is $168, which is higher than the $137 median income per day. When broken down per hour, welfare spending per hour per household in poverty is $30.60, which is higher than the $25.03 median income per hour. 

"Based on data from the Congressional Research Service, cumulative spending on means-tested federal welfare programs, if converted into cash, would equal $167.65 per day per household living below the poverty level," writes the minority side of the Senate Budget Committee. "By comparison, the median household income in 2011 of $50,054 equals $137.13 per day. Additionally, spending on federal welfare benefits, if converted into cash payments, equals enough to provide $30.60 per hour, 40 hours per week, to each household living below poverty. The median household hourly wage is $25.03. After accounting for federal taxes, the median hourly wage drops to between $21.50 and $23.45, depending on a household’s deductions and filing status. State and local taxes further reduce the median household’s hourly earnings. By contrast, welfare benefits are not taxed." 

Some Funny Math at Anthem Blue Cross

Anthem Blue Cross has agreed to lower premium rate hikes for about 630,000 individual policyholders in response to pressure from California insurance regulators, the Los Angeles Times reports (Terhune, Los Angeles Times, 2/15).

Background

On Feb. 1, Anthem Blue Cross enacted premium rates increases that averaged 18% for certain individual policyholders(AP/Sacramento Bee, 2/14).

In a rate filing last fall, Anthem said certain medical costs have increased by nearly 11%, while the price that the insurer actually pays is rising by 13.5% after adjusting for customer deductibles.

According to Anthem, the profit margin on its individual insurance plans in California was less than 1% in 2012. The insurer said it expects to lose money in the individual market in 2013 even with the rate hike (California Healthline, 11/28/12).

The state Department of Insurance deemed the premium hike excessive, saying that the rate request included unsubstantiated estimates of expected medical costs.

While the agency can review rate filings, it does not have the authority to reject them.

Details of New Rate Increase

On Thursday, Insurance Commissioner Dave Jones (D) announced that Anthem has agreed to reduce the average premium increase to 14%. The decision will save consumers an estimated $54 million.

The Times reports that even with the lower rate hike, some individual policyholders still could see their premiums increase by as much as 25%.

Anthem plans to provide refunds or premium credits to policyholders who already paid the higher rates this month (Los Angeles Times, 2/15).

Comments

In a statement, Jones said, "Health insurance has become unaffordable for far too many Californians." He added, "I appreciate that Anthem Blue Cross has agreed to lower these rates."

On Thursday, Darrel Ng -- spokesperson for Anthem -- said that the agreement between Anthem and California regulators still reflects rising health care costs (AP/Sacramento Bee, 2/14).

Source text: http://www.californiahealthline.org/articles/2013/2/15/anthem-agrees-to-reduce-rate-hikes-for-individual-policyholders.aspx#ixzz2L01jkZis

 

ObamaCare Appetizer: RomneyCare Bill Comes Due

Here is an indicator of what we are in for:   

• Health care was 23% of the MA state fisc in 2000
• It was 25% in 2006 (when RomneyCare was passed) 
• But it has climbed to 41% for 2013
• On current trend it will roll past 50% around 2020—and that best case scenario assumes the current Governor's price controls work as planned. (They won't.) 

In real terms the state's annual health-care budget is 15% larger than it was in 2007, while transportation has plunged by 22%, public safety by 17% and education by 7%. 

Today Massachusetts spends less on roads, police and schools after adjusting for inflation than it did in 2007.

Full text: http://online.wsj.com/article/SB10001424127887323968304578249694095831444.html?mod=googlenews_wsj  

Who Won't Pay the ObamaCare Individual Mandate Penalties?

Well, to name a few:    

• Illegal aliens 
• Criminals 
• The half of Americans who don't pay federal income tax, and 
• Anybody else generally deemed too vulnerable    

In fact, only about 2% of Americans actually will have to pay the penalty.  Yes, this is the topic about which the country fought vehemently for two years and ended in a Supreme Court case.  Why did we waste all of that time and money?   

Read more here from Katy Grimes in an article that I was quoted in extensively.  

Facts about America's Health Care Quality that the World Doesn't Know

An oft-cited rationale for the Affordable Care Act is that Americans have poor access to quality health care. In reality, a variety of other factors, such as disease and lifestyle, are the real reasons why Americans have lower life expectancies despite our advanced medical technology, says Scott W. Atlas, the David and Joan Traitel senior fellow at the Hoover Institution.

• Obesity is the epidemic linked to a greater risk of death from heart disease, stroke, diabetes, high blood pressure and cancer.
• More than 33 percent of Americans are considered obese, compared to 17.1 percent of Western Europeans.
• Japan has a very low rate of obesity, only 3.4 percent, and also the greatest longevity.
• The United States also has a very high incidence of cigarette smoking, which negatively affects health outcomes.

Despite these burdens, American cancer patients survive at much higher rates that their European counterparts in the Organization for Economic Cooperation and Development. Indeed, for breast cancer, the mortality rate in Germany is 52 percent higher and in the United Kingdom it is 88 percent higher than in the United States. For prostate cancer, the mortality rates are even worse.

More Americans with heart disease receive medication or are operated on for their condition.

• Americans have twice as many bypass procedures and four times as many angioplasties when compared to 10 Western European nations (Austria, Denmark, France, Germany, Greece, Italy, Netherlands, Spain, Sweden, and Switzerland).
• Evidence suggests that Americans actually benefit from this extra treatment, with a longer five-year survival rate than Canadians who have a nationalized health system.

The United States also has a lower death rate from strokes, most likely due to modern therapy that expanded in America far quicker than it did under nationalized insurance.

• Less than 50 percent of high blood pressure patients go untreated in the United States compared with the 66 percent to 75 percent that go untreated in Canada and Europe, respectively.
• The United States is much more effective at controlling blood pressure through its better hypertension treatment delivery.

Source: Scott W. Atlas, "Facts about America's Health Care Quality that the World Doesn't Know," Fox News, January 15, 2013. 

This is how wellness programs save employers money

Heresy at Health Affairs:

Virtually unheard of thirty years ago, workplace wellness is now embedded in large self-insured companies. These firms pay their workers an average of $460/year to participate in worksite wellness programs. Further, wellness is deeply enough engrained in the public policy consciousness to have earned aprominent place in the Affordable Care Act, which allows large employers to tie a significant percentage of health spending to employee health behavior and provides direct subsidies for small businesses to undertake these workplace wellness programs.

Yet the implausible, disproven, and often mathematically impossible claims of success underlying the “get well quick” programs promoted by the wellness industry raise many questions about the wisdom of these decisions and policies.

So why are we doing this? I proposed an answer in Priceless: wellness programs attract employees who are already healthy and repel those who aren’t. 

via John Goodman's Health Policy Blog by John Goodman on 1/17/13. 

GINA ALLOWS life, LTD and LTC companies to use your genetic data against you

But, hey, it can't be used in medical underwriting.  That is such a beautiful illustration of legislative genius.  

There’s a federal law that’s supposed to protect people from having their own genes used against them, the Genetic Information Nondiscrimination Act, or GINA. Under GINA, it’s illegal for an employer to fire someone based on his genes, and it’s illegal for health insurers to raise rates or to deny coverage because of someone’s genetic code. But the law has a loophole: It only applies to health insurance. It doesn’t say anything about companies that sell life insurance, disability insurance or long-term-care insurance.

Source: NPR.

Colleges roll back faculty hours in response to Obamacare

Look away from this reduction in hours. You don't see a reduction in hours. Everybody is fully employed and happy with ObamaCare. Move along ... 

As employers prepare to implement the Affordable Care Act, it’s not just low-wage fast food workers who are feeling the heat. Adjunct faculty from at least four universities will also see their hours cut as colleges try to reduce the number of full-time employees whose health care they need to cover.

Via: http://tv.msnbc.com/2013/01/14/colleges-roll-back-faculty-hours-in-response-to-obamacare/ 

The Power of Negative Thinking

The Wall Street Journal describes a technique I often use and rarely hear discussed:

Just thinking in sober detail about worst-case scenarios—a technique the Stoics called "the premeditation of evils"—can help to sap the future of its anxiety-producing power. The psychologist Julie Norem estimates that about one-third of Americans instinctively use this strategy, which she terms "defensive pessimism." Positive thinking, by contrast, is the effort to convince yourself that things will turn out fine, which can reinforce the belief that it would be absolutely terrible if they didn't.

Quite simply, once you have prepared yourself to deal with the absolute worse case scenario, everything else is a piece of cake.  

The Power of Negative Thinking | Wall Street Journal