Archive for the ‘Health Care / Medical Insurance’ Category

The UK’s “new normal” in healthcare…

January 19, 2023

“Private pay” to the (partial) rescue.
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Recently, a friend’s family member — a UK citizen, living in London — needed open heart surgery.

Rather than waiting in the months (or years) long National Health Service queue, he understandably opted to “private pay” for surgery at the Cleveland Clinic in London.

As the Cleveland Clinic – London promotes on it’s web site:

Some medical issues just can’t wait, especially when they’re affecting your quality of life.

At Cleveland Clinic London, you have the freedom to self-pay or pay through private medical insurance or a sponsorship.

This gives you access to prompt care when you need it the most.

With that case top-of-mind, a WSJ Editorial caught my eye: Britain’s National Health Service Meltdown.

Here’s an excerpt from the editorial…

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The Situation:

The UK is in the midst of another winter of healthcare misery.

The National Health Service’s winter crisis has become an annual tradition, but this year’s troubles for the free-at-point-of-service system are significantly worse.

The “new normal” winter wave of flu, Covid and other respiratory ailments is swamping hospitals and doctors’ offices already coping with a backlog of patients awaiting tests and treatments deferred by Covid lockdowns.

Waiting times for ambulances for the most serious calls are getting longer, with the average response time — targeted at 7 minutes — reaching over 10 minutes.

Once patients reach the emergency room, 35% now face waits above four hours between a decision to admit and transfer to an appropriate bed for treatment, the worst performance since 2010.

Some 7.2 million non-emergency patients are waiting prescribed treatment to start.

Of those, over 40% (2.9 million) have been waiting more than 18 weeks.

The NHS considers itself a success if it starts treatment within that four-month window.

By some estimates, NHS delays may be contributing to the 1,000 weekly excess deaths in recent weeks —deaths above the normal average level.

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The (partial) remedy

One sign of the severity of this year’s crisis is the rise of private and semi-private healthcare.

An increasing number of Britons who can afford it buy private health insurance, which generally requires them to use the NHS for routine matters but lets them skip queues for specialist care, physical therapy and the like.

Some NHS hospitals are even offering patients the option to pay out-of-pocket for diagnostics or treatments to skip NHS queues.

Some NHS hospitals with record waiting lists are promoting “quick and easy” private healthcare services at their own hospitals, offering patients the chance to jump year-long queues … for an additional private pay fee.

For example, the Guardian cites the case of a woman who was told that she’d have to wait two years for surgery via the NHS or can see the same surgeon in the same hospital and be treated in two weeks for £1,200.

Hospitals are offering hip replacements from £10,000, cataract surgery for £2,200 and hernia repairs for £2,500. MRI scans are offered for between £300 and £400.

One lady who paid £350 for an MRI scan reported that “There were posters on the walls stating times for the return of results: three days for private, three weeks for NHS.”

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The WSJ’s conclusion

“The U.S. suffers a chronic problem of healthcare financing but not of health-care delivery.

Britain shows that with single-payer you end up with both.”

I agree with the latter conclusion, but based on some recent experiences, I’m not so sure that I agree with the latter.

These days, almost everybody I know (myself included) is  now or has recently been sick.

And, with only a few exceptions, most have been frustrated by the long leads required to see their primary care doctor … or, god forbid, specialists.

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More to come on that subject…

Ouch: Employer health plans now cost over $20,000 per family.

September 30, 2019

How long until employers jump on the Medicare-for-All bandwagon?

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According to a Kaiser Foundation survey reported in the WSJ, annual health insurance premiums rose 5% in 2019 to hit $20,576 for an employer-provided family plan.

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Drilling down on the increase….

(more…)

What’s the biggest middle class tax break?

August 8, 2019

Hint: Medicare For All would eliminate it and nobody seems to be talking about it.

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Anybody remember the Simpson-Bowles Report?

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It was commissioned by President Obama shortly after he was first elected … reported out in 2010 …  and trash-canned shortly thereafter … since it predictably recommended spending cuts and  tax increases.

According to Simpson-Bowles, the “biggest“Federal tax break” is ….

(more…)

Did the Dem candidates jump the shark with this one?

July 2, 2019

They dropped a couple of doozies during last weeks debate…

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I went cool turkey (<= that’s not quite “cold turkey”, but pretty close) away from cable news while at the beach.

On return, I jumped off the wagon by watching parts of the Democratic debates.

I was expecting entertainment value … and I wasn’t disappointed.

Reminded me of the old Happy Days tv series that – among other things – coined the the phrase “jumping the shark”.

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Ratings were slipping, so they had Fonzie (Henry Winkler) jump a shark while water skiing … hoping (but failing) to generate some ratings-boosting buzz.

So now, according to Wikipedia:

Jumping the shark is the moment when something that was once popular that no longer warrants the attention it previously received makes an attempt at publicity, which only serves to highlight its irrelevance..

How does that apply to the Dem debates?

(more…)

The (personal) economics of Medicare premiums

March 6, 2019

After paying Medicare taxes for years, weren’t the benefits supposed to be free?
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Yesterday, we argued that Medicare’s payroll taxes can thought of as prepaid premiums … that amortize to the equivalent of $10,000 per year over a retiree’s post-65 life span.

See Ouch: The (personal) economics of Medicare payroll taxes

And, we pointed out that the prepaid premiums are just the tip of the iceberg.

Once retired, the Feds collects additional annual Medicare premiums.

This may surprise pre-retirement folks who think that they pay in during their working years, but then get “free” healthcare insurance when they retire.

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Today, let’s take a look at Medicare premiums…

 

(more…)

Has ObamaCare provided more healthcare?

November 3, 2018

Not really: it just covered more people with health insurance?

Since Dems are making ObamaCare an election issue, let’s flashback to a prior post and inject some facts…

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In my consulting / problem-solving class, I emphasize asking the right question before starting to gather data, doing analyses, drawing conclusions and making recommendations.

Makes sense, doesn’t it?

Then, would someone please explain to me why the politcos (on both sides) obsess over health insurance coverage (how many people are covered) and largely ignore the quantity & quality healthcare that Americans are getting?

 

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Source: AAMC

My conclusion: More Americans now have health insurance, but healthcare hasn’t increased … it has just been re-distributed.

(more…)

Remember how healthcare costs were going to drop by $2,500 for every family?

November 2, 2018

Since Dems are making ObamaCare a midterm’s election issue, let’s flashback to a prior post and inject some facts.

In 2016 (Obama’s last year in office), employees paid $11,000 out-of-pocket for healthcare … up $2,500 since 2012.

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Milliman – a well-regarded actuarial consulting” firm – has published an annual recap of healthcare spending since 2001.

The Milliman Medical Index tracks the total costs of providing health care to an average family of four covered by an employer-sponsored “preferred provider plan” … that’s about 155 million employees and their dependents.

The total includes the health insurance premiums paid by both the employer and the employee, as well as the actual expenditures for health care paid by the insurance plan and out of pocket by the insured family.

The big news: In 2016, the average healthcare costs for a family of 4 surpassed $25,000 for the first time … the $25,826 is triple the cost to provide health care for the same family in 2001 … and up about $5,000 since 2012.

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The bad(est) news is the increased proportion of the healthcare costs being shouldered by individual employees …

(more…)

One way to alleviate the shortage of doctors…

April 4, 2018

Grant med school grads provisional licenses.

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Very interesting idea reported by the Heritage Foundation

It widely accepted that the U.S. has a current shortage of doctors that is expected to balloon as the demand increases (aging population, expanded Medicaid, etc.).

Current estimates put the 2030 shortage between 40,000 and 105,000.

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Each year, US med schools crank out about 18,000 medical degrees. Source

Dictated by the AMA, before getting licensed, these grads need to go through formal residency programs at teaching hospitals.

Here’s the rub.

The residency programs are largely government funded, and there are spending caps.

Spending caps translate to enrollment caps.

So, each year, about 5,000 of the med school grads — more than 25%) — don’t get a residency slot.

No residency, no license.

Reportedly, these non-residentially certified med school grads either land in non-patient treating medical jobs (think “pharma”) or leave healthcare all together.

The usual response: just throw more tax dollars at the problem.

But, there are other options…

Addressing the problem, a few states have implemented a program that Heritage is now touting: provisional licenses.

(more…)

More part-timers finding full-time jobs …

February 15, 2018

One of the benefits of the current low unemployment rate is that many people who were previously working part-time “for economic reasons” (i.e. had their hours reduced to part-time status or couldn’t find a full-time job) are now employed full-time.

By the numbers …

Approximately 127 million workers are now employed full-time …. that’s an all-time high … up 16 million from the financial crisis low point …  and up 5 million from the pre-crisis high.

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Here’s the interesting part …

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What’s the biggest tax loophole ?

December 1, 2017

… and, why isn’t it part of the tax reform conversation?

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I’ve been scratching my head over what the Senate & Congress are going after under the “tax reform” umbrella … and, what are being treated as sacred cows.

For example, the deductions for mortgage interest and state & local taxes are on the chopping block … but the biggest “Federal tax break” according to Simpson-Bowles and the Pew Foundation is the tax-free status of employer-paid health insurance.

Real tax reform would put employer-paid health insurance under a microscope: it’s clearly compensation that should be recorded on W-2s and taxed at ordinary income tax rates, right?

And, the loophole creates a severely unlevel playing field.

Think of the small business owner (or his employees).

They have to buy their health insurance with after-tax dollars …

That’s not fair, is it?

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Before you hit me with the “healthcare is different (and untouchable)” argument, consider this:

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How much does “healthcare” really matter?

October 16, 2017

For a long time I’ve railed that politicos and pundits confuse “healthcare” with “health insurance” – trying to fix health insurance (by throwing money at it) … rather than getting to the efficacy and efficiency roots of healthcare delivery.

Here’s another twist to the story.

I stumbled on a report from the Kaiser Foundation: Beyond Health Care: The Role of Social Determinants.

It’s punch line:

“Though health care is essential to health, research demonstrates that it is a relatively weak health determinant.”

More specifically, Kaiser concludes that healthcare has only about a 10% impact on the risk of premature death … dwarfed by genetics (30%) and individual behavior (40%).

Said differently, health behaviors, such as smoking and diet and exercise, are the most important determinants of premature death

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And, as the title of the article’s title suggest, there’s a social component (20%) that’s double the impact of healthcare per se …

(more…)

Who’s paying for the Medicaid expansion?

August 14, 2017

It’s a microcosm of a messy system.

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Let’s pit the question in context with a budget recap from the WSJ

As ObamaCare came on stream in 2014, spending on Medicaid in exploded.

Annual federal Medicaid outlays rose from $265 billion in 2013 to an estimated $378 billion this year, and they are expected to keep climbing to $439 billion on current trend by 2020.

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But, the projections above are premised “on the current trend.”

The CBO underestimated the “power of free” and enrollments continue to soar way past initial projections.

Further, the Medicaid blowout is likely to accelerate, as states that have so far refused the federal freebie accept that the expansion is here to stay and sign on.

So, who picks up the bill?

(more…)

How many medical schools are there?

August 8, 2017

… and how many medical degrees are granted each year?

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Let’s start with the last question first…

Currently, U.S. medical schools graduate almost 19,000 students each year.

Most healthcare pundits agree that – while the number has been increasing over recent years – too few are being graduated to forestall an anticipated doctor shortage.

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Note that since 1960, there have been 3 distinct periods: growth from 1960 to 1982, flatline from 1982 and resumed growth from 2006.

Here’s a short history of medical school openings and admissions …

(more…)

How many doctors are women?

August 4, 2017

…. and, how old is the pool of active doctors?

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Even though Congress is punting on healthcare (or maybe because Congress is punting on healthcare), I decided to to get better informed on the topic.

Of course, I like to start with the numbers.

Where better to start, than with the “ 2016 Census of Actively Licensed Physicians in the United States”

Note: Unless noted to the contrary, all data reported below is from this census .

Today, let’s look at physician demographics ….

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An aging pool of doctors

The average age Active Licensed Physicians is just a bit over 50 years old.

Older doctors (over 60 years old) are the biggest age group … and their percentage of the overall mix has been increasing.

Bottom line: the pool of doctors is aging as baby boomer doctors “mature”.

 

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How do the numbers break out by gender?

(more…)

How many doctors are there in the U.S.?

August 2, 2017

… and how many got their degrees from U.S. schools?

========

Even though Congress is punting on healthcare (or maybe because Congress is punting on healthcare), I decided to to get better informed on the topic.

Of course, I like to start with the numbers.

Where better to start, than with the “ 2016 Census of Actively Licensed Physicians in the United States”

Note: Unless noted to the contrary, all data reported below is from this census.

Here are some of my takeaways ….

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There are about 950,000 active licensed physicians (ALPs) in the U.S.

Doing the arithmetic, that works out to about 350 people per doctor … or, reversing the stat, about 295 doctors per 100,000 of population.

The number of doctors per 100,000 of population is relative even across states, with one glaring exception … that might explain our crack Congress is content dragging their heels on real healthcare reform.


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Let’s dig a little deeper into the numbers ….

 

(more…)

Pareto is alive and well … and haunting the U.S. healthcare system.

July 25, 2017

According to the National Health Care Management Association analysis of  2008 healthcare spending:

  • The top 1 percent of the population was responsible for 20.2 percent of spending.
  • The top 5 percent of the population accounted for almost half (47.5 percent) of all health care spending.
  • ABout 60% of the top 5 percent (and top 1 percent) are 55 and older; about 40% is 65 and over
  • The top 10 percent of the population accounted for 63.6 percent of all spending.
  • 15.6 percent of the civilian, non-institutionalized population had no health care spending at all in 2008
  • The half of the population with the lowest spending accounted for only 3.1 percent of all expenditures.

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>> Latest Posts

Has ObamaCare provided more healthcare?

June 28, 2017

Not really: it just covered more people with health insurance?

=========

In my consulting / problem-solving class, I emphasize asking the right question before starting to gather data, doing analyses, drawing conclusions and making recommendations.

Makes sense, doesn’t it?

Then, would someone please explain to me why the politcos (on both sides) obsess over health insurance coverage (how many people are covered) and largely ignore the quantity & quality healthcare that Americans are getting?

 

image

Source: AAMC

My conclusion: More Americans now have health insurance, but healthcare hasn’t increased … it has just been re-distributed.

(more…)

One way to alleviate the shortage of doctors…

June 27, 2017

Grant med school grads provisional licenses.

========

Very interesting idea reported by the Heritage Foundation

It widely accepted that the U.S. has a current shortage of doctors that is expected to balloon as the demand increases (aging population, expanded Medicaid, etc.).

Current estimates put the 2030 shortage between 40,000 and 105,000.

clip_image002

=========

Each year, US med schools crank out about 18,000 medical degrees. Source

Dictated by the AMA, before getting licensed, these grads need to go through formal residency programs at teaching hospitals.

Here’s the rub.

The residency programs are largely government funded, and there are spending caps.

Spending caps translate to enrollment caps.

So, each year, about 5,000 of the med school grads — more than 25%) — don’t get a residency slot.

No residency, no license.

Reportedly, these non-residentially certified med school grads either land in non-patient treating medical jobs (think “pharma”) or leave healthcare all together.

The usual response: just throw more tax dollars at the problem.

But, there are other options…

Addressing the problem, a few states have implemented a program that Heritage is now touting: provisional licenses.

(more…)

Pareto is alive and well … and haunting the U.S. healthcare system.

May 3, 2017

Here are some numbers that put healthcare spending in perspective …

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According to a National Health Care Management Association analysis of healthcare spending:

  • The top 1 percent of the population is responsible for 20.2 percent of spending.
  • The top 5 percent of the population accounts for almost half (47.5 percent) of all health care spending.
  • ABout 60% of the top 5 percent (and top 1 percent) are 55 and older; about 40% are 65 and over
  • The top 10 percent of the population accounts for 63.6 percent of all spending.
  • 15.6 percent of the civilian, non-institutionalized population account for no health care spending at all.
  • The half of the population with the lowest spending accounted for only 3.1 percent of all expenditures.

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>> Latest Posts

Did ObamaCare exacerbate a shortage of doctors?

May 1, 2017

Answer: Of course it did … it’s simple arithmetic.

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In yesterday’s post, I concluded that ObamaCare increased the demand for healthcare by providing health insurance to 20 million previously uninsured Americans … but that ObamaCare didn’t increased the aggregate amount of healthcare that Americans are getting.

Since the supply of healthcare is constrained by too few doctors, the amount of healthcare is just being redistributed

It’s a zero sum game …  previously uninsured people are getting more healthcare … previously insured people are getting less healthcare … and total healthcare delivered is staying about the same.

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I got a few questions about the incremental doctor shortage created by ObamaCare, so I pulled together a quick & dirty  estimate.

(more…)

Has ObamaCare provided more healthcare?

April 27, 2017

Or, has it just covered more people with health insurance?

=========

In my consulting / problem-solving class, I emphasize asking the right question before starting to gather data, doing analyses, drawing conclusions and making recommendations.

Makes sense, doesn’t it?

Then, would someone please explain to me why the politcos (on both sides) obsess over health insurance coverage (how many people are covered) and largely ignore the quantity & quality healthcare that Americans are getting?

 

image

Source: AAMC

My conclusion: More Americans now have health insurance, but healthcare hasn’t increased … it has just been re-distributed.

(more…)

“Just because you have insurance doesn’t mean there’s a physician who can (or will) see you.”

April 13, 2017

Remember Romney Care?

To refresh memories, the former Massachusetts governor  enacted something very similar to the Obama health plan.

It’s still largely in place.

And, it still  isn’t working well:  Costs are up, folks are gaming the system, and people with insurance can’t get in to see doctors.

Uh-oh.

Here’s a flashback to further refresh memories.

* * * * *

Excerpted from WSJ: The Failure of RomneyCare

The Bay State is suffering from what the Massachusetts Medical Society calls a “critical shortage” of primary-care physicians.

As one would expect, expanded insurance has caused an increase in demand for medical services. But there hasn’t been a corresponding increase in the number of doctors.

As a result, many patients are insured in name only: They have health coverage but can’t find a doctor.

Fifty-six percent of Massachusetts internal medicine physicians no longer are accepting new patients.

For new patients who do get an appointment with a primary-care doctor, the average waiting time to see a doctor is 44 days.

As Dr. Sandra Schneider, the vice president of the American College of Emergency Physicians, told the Boston Globe last April, “Just because you have insurance doesn’t mean there’s a [primary care] physician who can see you.”

The difficulties in getting primary care have led to an increasing number of patients who rely on emergency rooms for basic medical services. Emergency room visits jumped 7% between 2005 and 2007.

Officials have determined that half of those added ER visits didn’t actually require immediate treatment and could have been dealt with at a doctor’s office — if patients could have found one.

* * * **

The promise that getting everyone covered would force costs down also is far from being realized.

One third of state residents say that their health costs had gone up as a result of the 2006 reforms.

A typical family of four today faces total annual health costs of nearly $13,788, the highest in the country. Per capita spending is 27% higher than the national average.

Insurance companies are required to sell “just-in-time” policies even if people wait until they are sick to buy coverage. That’s just like the Obama plan.

There is growing evidence that many people are gaming the system by purchasing health insurance when they need surgery or other expensive medical care, then dropping it a few months later.

Some Massachusetts safety-net hospitals that treat a disproportionate number of lower-income and uninsured patients are threatening bankruptcy.

They still are treating a large number of people without health insurance, but the payments they receive for uncompensated care have been cut under the reform deal.

Oops

 

What percentage of babies are born on Medicaid?

April 3, 2017

Make your guess before peeking ….

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Medicaid took center stage during the repeal & replace drama … so, I’ve been more alert to Medicaid news.

Let’s put today’s question in context.

According to MSN:

Over the past five decades, Medicaid has surpassed Medicare in the number of Americans it covers.

It has grown gradually into a behemoth that provides for the medical needs of one in five Americans — 74 million people.

For comparison … about half are on employer-based plans and “only” 14% are on Medicare.

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Here’s the geographic spread, according to the Kaufman Family Foundation:

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Note the heavy Medicaid density in the West … and the relatively light density in the Heartland.

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OK, you have your frame of reference: about 20% of Americans on Medicaid.

So, what percentage of babies are born on Medicaid?

(more…)

A hidden cost of ObamaCare: Docs getting stiffed.

March 14, 2017

ObamaCare’s high deductible plans pushing up bad debts.

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Chatting with a doctor-friend recently.

His is a very specialized 1-doctor practice (supported by a handful of well-trained techs).

Patients who are referred to him usually have a very serious condition needing sophisticated diagnostics.

My friend casually mentioned to me that – in the past couple of years — he has had to write-off more than $2 million in bad debts.

Way more than in prior years.

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Here’s what’s going on …

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Don’t faint: I agree with ObamaCare on this one …

March 9, 2017

For the record, I think that ObamaCare is an expensive, amateurish travesty that should be repealed and rebuilt from the ground up by professionals.  Keep the high risk pools for pre-exiting conditions, keep the subsidies for the poor … but lose the  micro-narrow provider networks and the junk mandated into policies (e.g. my favorite: universally free birth control for law schoolers).

And, I think that Dr. Dr. Ezekiel Emanuel – Rahm’s brother and one of the ObamaCare architects – is a complete butt.

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That said, I was on Zeke’s side when he sparred with O’Reilly  …

(more…)

Remember how healthcare costs were going to drop by $2,500 for every family?

March 7, 2017

In 2016, employees paid $11,000 out-of-pocket … up $2,500 since 2012.

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Milliman – a well-regarded actuarial consulting” firm – has published an annual recap of healthcare spending since 2001.

The Milliman Medical Index tracks the total costs of providing health care to an average family of four covered by an employer-sponsored “preferred provider plan” … that’s about 155 million employees and their dependents.

The total includes the health insurance premiums paid by both the employer and the employee, as well as the actual expenditures for health care paid by the insurance plan and out of pocket by the insured family.

The big news: In 2016, the average healthcare costs for a family of 4 surpassed $25,000 for the first time … the $25,826 is triple the cost to provide health care for the same family in 2001 … and up about $5,000 since 2012.

clip_image002

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The bad(est) news is the increased proportion of the healthcare costs being shouldered by individual employees …

(more…)

Should a family of 5 have to pay more at a restaurant than a family of 3?

January 23, 2017

The answer is obvious, right?

They take up more seats, require more server time, and eat more food.

Why do I ask?

As the GOP moves to Repeal & Replace ObamaCare, a constant refrain is ‘everybody agrees that two popular parts of ObamaCare should be saved: insurability for pre-existing conditions and allowable coverage of ‘adult- children’ on their parents’ policies until they are 26”.

I agree that there needs to be a way to cover pre-existing conditions, but … except for special needs situations, I respectfully disagree re: adult-children.

First, the term “adult-children” gives me the creeps. But, that’s beside the point.

More on point, I don’t care if insurance companies have to carry 26 year olds on their parents’ policies, but I don’t understand why they should “fly free” and that you & I should have to pay for it … not the adult-children’s parents.

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Let me explain …

Now, practically all employer-sponsored  health insurance plans charge premiums in tiers: employee only, employee plus spouse, employee plus children, and employee plus spouse and children. Note: it doesn’t matter if the employee has 1 child or a dozen children … same premium.

Say what?

For example, the United Healthcare plan through Georgetown — which is probably pretty typical — charges:

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Let’s dive a little deeper into those numbers …

(more…)

There are 3 Americas (not 2) … thanks to Obamacare.

January 11, 2017

ObamaCare is front & center on the legislative agenda again, so …

Last week, we reported that — according to Gallup — ObamaCare is under water by 7 points (51% to 44%) … and that 29% think their families have been hurt by ObamaCare versus 18% who think that their families have been helped).

obamacare-jan-2017

In other words, the disapproval is grounded in the program’s fundamentals.

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Cutting to the chase, an article in the WSJ quoted David Cutler, a Harvard health-care economist:

Obamacare may be “a story of three Americas.”

One group, the rich, can afford health care easily.

The poor can access public assistance.

But for lower middle- to middle-income Americans, “the income struggles and the health-care struggles together are a really potent issue.”

No kidding, Dr. Cutler …

HomaFiles was all over this one back in June:

Remember how healthcare costs were going to drop by $2,500 for every family?

We concluded that in 2016, employees will pay $11,000 out-of-pocket … up $2,500 since 2012.

“Employees” … you know the working class … the middle class.

Here’s the essence of our original post …. worth re-reading …. glad others are catching up to it.

========

Milliman – a well-regarded actuarial consulting” firm – has published an annual recap of healthcare spending since 2001.

The Milliman Medical Index tracks the total costs of providing health care to an average family of four covered by an employer-sponsored “preferred provider plan” … that’s about 155 million employees and their dependents.

The total includes the health insurance premiums paid by both the employer and the employee, as well as the actual expenditures for health care paid by the insurance plan and out of pocket by the insured family.

The big news: In 2016, the average healthcare costs for a family of 4 surpassed $25,000 for the first time … the $25,826 is triple the cost to provide health care for the same family in 2001 … and up about $5,000 since 2012.

clip_image002

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The bad(est) news is the increased proportion of the healthcare costs being shouldered by individual employees …

(more…)

ObamaCare has bent the cost curve …

October 20, 2016

Unfortunately, it has bent it up, not down.

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Hillary’s lucky that the MSM is burying ObamaCare coverage, so she can continue to tout it as a resounding success.

Remember how ObamaCare was going to save each family $2,500?

Well, turns out to be just the opposite.

According to Federal Reserve data, once the full program kicked in, real personal healthcare expenditures — the “net total” of insurance premiums, deductibles and other out-of pocket spending, adjusted for inflation — has turned up, not down.

obamacare-bending-the-cost-curve-up

Her are some details …

(more…)

There are 3 Americas (not 2) … thanks to Obamacare.

September 1, 2016

Article in yesterdays WSJ quoted David Cutler, a Harvard health-care economist:

Obamacare may be “a story of three Americas.”

One group, the rich, can afford health care easily.

The poor can access public assistance.

But for lower middle- to middle-income Americans, “the income struggles and the health-care struggles together are a really potent issue.”

No kidding, Dr. Cutler …

HomaFiles was all over this one back in June:

Remember how healthcare costs were going to drop by $2,500 for every family?

We concluded that in 2016, employees will pay $11,000 out-of-pocket … up $2,500 since 2012.

“Employees” … you know the working class … the middle class.

Here’s our original post …. worth re-reading …. glad others are catching up to it.

========

Milliman – a well-regarded actuarial consulting” firm – has published an annual recap of healthcare spending since 2001.

The Milliman Medical Index tracks the total costs of providing health care to an average family of four covered by an employer-sponsored “preferred provider plan” … that’s about 155 million employees and their dependents.

The total includes the health insurance premiums paid by both the employer and the employee, as well as the actual expenditures for health care paid by the insurance plan and out of pocket by the insured family.

The big news: In 2016, the average healthcare costs for a family of 4 surpassed $25,000 for the first time … the $25,826 is triple the cost to provide health care for the same family in 2001 … and up about $5,000 since 2012.

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The bad(est) news is the increased proportion of the healthcare costs being shouldered by individual employees …

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Remember how healthcare costs were going to drop by $2,500 for every family?

June 1, 2016

In 2016, employees will pay $11,000 out-of-pocket … up $2,500 since 2012.

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Milliman – a well-regarded actuarial consulting” firm – has published an annual recap of healthcare spending since 2001.

The Milliman Medical Index tracks the total costs of providing health care to an average family of four covered by an employer-sponsored “preferred provider plan” … that’s about 155 million employees and their dependents.

The total includes the health insurance premiums paid by both the employer and the employee, as well as the actual expenditures for health care paid by the insurance plan and out of pocket by the insured family.

The big news: In 2016, the average healthcare costs for a family of 4 surpassed $25,000 for the first time … the $25,826 is triple the cost to provide health care for the same family in 2001 … and up about $5,000 since 2012.

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The bad(est) news is the increased proportion of the healthcare costs being shouldered by individual employees …

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Would your boss fire you if your project underperformed plan by 50% ?

October 20, 2015

Answer: Apparently not if your boss is President Obama …  and your project was ObamaCare.

In a conference call with reporters last week, HHS Secretary Sylvia Burwell said “We believe 10 million is a strong and realistic goal” for 2016 enrollment in ObamaCare Exchanges.  That represents an increase not significantly different from zero.

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Let’s put that number in context … and show how performance against plan is even worse than it initially appears.

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ACA: More Americans insured, but vast majority are less insured …

September 3, 2015

I’ve  been wrestling with a conundrum ..…

Mainstream media continues to tout the success of ObamaCare … always focusing on the number of previously uninsured folks who now have insurance.

Most recent CBO numbers say that about 19 million previously uninsureds now have insurance – mostly from Medicaid and subsidized ACA Exchange policies.

Now, about 80% of the non-elderly population is covered … but, about 36 million are still uninsured.

Said differently, over half of the previously uninsureds are still uninsured.

Huh?image

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Let’s look at the cost …

ObamaCare added about $100 billion in annual government spending .

So, the cost per newly insured person is roughly $5,000 per newly insured person per year.

That sounds about right since an average individual health insurance policy is about $5,000 per year.

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OK, so what’s the rub?

Some simple arithmetic suggests that the aggregate monetary amount of insurance provided to the full population of non-elderly citizens has actually declined.

Here’s my logic …

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Stiffing Docs: High deductible plans pushing up bad debts … thanks, ACA

September 2, 2015

Chatting with a doctor-friend recently.

His is a very specialized 1-doctor practice (supported by a handful of well-trained techs).

Patients who are referred to him usually have a very serious condition needing sophisticated diagnostics.

My friend casually mentioned to me that – in the past couple of years — he has had to write-off more than $2 million in bad debts.

Way more than in prior years.

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Here’s what’s going on …

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Remember how your healthcare costs were going to go down by $2,500 per family?

August 18, 2015

Recently, a friend casually mentioned to me that his family finances were being strained by healthcare costs.

Why?

His family’s annual deductible had gone up from $2,500 to $12,500.

What?

Think about that for a moment … a 10-grand bump in out-of-pocket healthcare costs before the insurance even kicked in (with co-pays, of course).

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The discussion piqued my curiosity, and I did some digging to put my friend’s predicament in perspective … what I found was surprising (and certainly under-reported in the main stream media)

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Should a family of 5 have to pay more at a restaurant than a family of 3?

January 20, 2015

The answer is obvious, right?

They take up more seats, require more server time, and eat more food.

Family of 5

Why do I ask?

Since ObamaCare premiums have been back in the news, we have to ask the question.

Virtually all articles re: ObamaCare are saying “at least save the popular parts like allowing adult children on their parents’ policies until they are 26”.

First, the term “adult-children” gives me the creeps. But, that’s beside the point.

I don’t care if insurance companies have to carry 26 year olds on their parents’ policies, but I don’t understand why you & I have to pay for it … not the adult-children’s parents.

Now, practically all employer-sponsored  health insurance plans charge premiums in tiers: employee only, employee plus spouse, employee plus children, and employee plus spouse and children. Note: it doesn’t matter if the employee has 1 child or a dozen children … same premium.

Say what? Let’s take a look at the nums …

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Bitter pill: Harvard faculty thought ObamaCare didn’t apply to them … oops.

January 7, 2015

According to the NY Times , the Harvard faculty is throwing a collective hizzy fit.

What’s their beef?

In a touch of irony, the same folks who cheer-led the passage of ObamaCare now feel aggrieved because they’re being forced to shoulder some of the costs.

To quote my grandson Ryne, “Oh me oh my.”

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Here’s the scoop … with some priceless snippets from the Times’ article

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Have you even looked at YOUR health insurance premiums?

November 17, 2014

This headline in the NY Times caught my eye:

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The article leads with:

The Obama administration on Friday unveiled data showing that many Americans with health insurance bought under the Affordable Care Act could face substantial price increases next year — in some cases as much as 20 percent.

Now, those are exchange premiums so they don’t apply to me.

Still, the headline was shocking enough to make me take a serious look at the premiums that I pay.

What I discovered is very interesting …

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I’ve seen the future of healthcare … and it’s not pretty.

October 10, 2014

Before I start grousing,  let me be clear about a couple of things.

First, the medical team at Georgetown Hospital is totally awesome.

Second, I like my doctor and I got to keep my doctor … mostly because I’m still working.

But, I’ve discovered that insurance and access aren’t synonymous …. and that appointment slots are getting scarcer and scarcer.

 

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In the past couple of weeks I’ve had personal experiences that have me a bit worried …

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Surviving a post-med school residency …

August 20, 2014

We’ve been spending a lot of time at Georgetown Hospital recently.

In the process, we’ve developed a deep respect for some of the key cogs in the system: nurses, nurse practitioners and doctor-residents.

In casual conversation, our surgeon mentioned how she had managed to “survive her surgical residency”.

That got me wondering, about the life of a resident.

 

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Here’s what I found …

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POTUS says: “When veterans do get into the system, they get great healthcare” … oh, really?

June 5, 2014

When Obama finally commented on the VA scandal, he gave the usual “outraged, will investigate and hold accountable” … then asserted that “when veterans do get into the system, they get great healthcare”.

No questions from the media.  Not much follow-up.

Must be true since the President said it, right?

Of course, my BS detector started screeching.

Fortunately, the WSJ started to dig and found “significantly higher rates of mortality and dangerous infections at some VA hospitals compared with others” … and compared to private hospitals.

For example, the Boston area VA hospital is rated 5-stars … the embattled Phoenix VA draws a single star.

 

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The WSJ concluded that the Phoenix VA doesn’t appear to be an outlier.   

Here’s where things get interesting …

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More: The doctor will see you … eventually

June 4, 2014

Last year, I needed to see an eye surgeon, when I called, I was given an appointment within 2 weeks.

This year, I called the same doctor and was told the the first open slot was in 8 weeks.

Hmmm.

Can’t project off one observation, right?

 

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Last week, the VA waiting times were revealed to be 115 days … almost 4 months.

That got me to wondering: What are waiting times in some other countries often cited as ObamaCare models .

Here’s a sampling …

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The doctor will see you … eventually

May 29, 2014

Yesterday, VA Hospitals’ Inspector General released an interim investigative report on patient wait times.

 

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Here are the headline findings …

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Boomerang Effect: Bending the cost curve … the wrong direction.

May 14, 2014

Two related articles caught my eye ….

First, Business Insider reported that “spending on healthcare grew an astounding 9.9% in Q1 … the biggest percent change in healthcare spending since 1980”

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The article goes on to say: “Analysts said it’s primarily due to a consumption boost from the implementation of the Affordable Care Act.”

That makes sense.

Some folks rushed to their docs in the last quarter of 2013 to beat the jump in their deductibles and to jump the line ahead those becoming newly insured.

Nonetheless, the fact remains that, adjusted for inflation, America is spending more on healthcare than ever before..

Here’s the big takeaway … (more…)

Boomerang Effect: Bending the cost curve … the wrong direction.

May 8, 2014

Two related articles caught my eye ….

First, Business Insider reported that “spending on healthcare grew an astounding 9.9% in Q1 … the biggest percent change in healthcare spending since 1980”

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The article goes on to say: “Analysts said it’s primarily due to a consumption boost from the implementation of the Affordable Care Act.”

That makes sense.

Some folks rushed to their docs in the last quarter of 2013 to beat the jump in their deductibles and to jump the line ahead those becoming newly insured.

Nonetheless, the fact remains that, adjusted for inflation, America is spending more on healthcare than ever before..

Here’s the big takeaway … (more…)

What happens when you cut doctors’ reimbursement rates?

April 24, 2014

Here’s a shocker …

They spend less time seeing patients.

Medscape does an annual hours and pay survey.

For 2013, the Medscape survey said that the average doctor was face-to-face with patients about 41 hours …. with about 2/3s of them in the 40 to 50 hours cluster.

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How does the 41 hours compare to historical rates?

 

 

According to Medscape:

A 2010 study in JAMA found that after no significant change between 1977 and 1997 in the hours per week that physicians spend with patients’

Patient hours decreased steadily from 54.6 to 51.0 between 1997 and 2007.

The study authors attributed the decrease to a parallel 25% inflation-adjusted decline in fees between 1996 and 2006.

Shocker, right? 54.6 to 51 to 41 …

Pay somebody less and they’re less incentivized to bust their humps.

Think about that each time you hear about the Feds and insurance companies ratchet down the reimbursement rates to “fix” the healthcare system,

I’m betting the under on that one.

#HomaFiles

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Should a family of 5 have to pay more at a restaurant than a family of 3?

March 28, 2014

The answer is obvious, right?

They take up more seats, require more server time, and eat more food.

Why do I ask?

Virtually all articles re: ObamaCare are saying “at least save the popular parts like allowing adult children on their parents’ policies until they are 26”.

First, the term “adult-children” gives me the creeps. But, that’s beside the point.

I don’t care if insurance companies have to carry 26 year olds on their parents’ policies, but I don’t understand why you & I have to pay for it … not the adult-children’s parents.

Now, practically all employer-sponsored  health insurance plans charge premiums in tiers: employee only, employee plus spouse, employee plus children, and employee plus spouse and children. Note: it doesn’t matter if the employee has 1 child or a dozen children … same premium.

Say what?

For example, the United Healthcare plan through Georgetown — which is probably pretty typical — charges:

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Note that it costs  $7,346 to tack a spouse (or equivalent) — presumably an adult — onto an employee’s policy.

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Don’t faint: I agree with ObamaCare on this one …

March 6, 2014

For the record, I think that ObamaCare is an expensive, amateurish travesty that should be repealed and rebuilt from the ground up by professionals.  Keep the high risk pools for pre-exiting conditions, keep the subsidies for the poor … but lose the  micro-narrow provider networks and the junk mandated into policies (e.g. my favorite: universally free birth control for law schoolers).

And, I think that Dr. Dr. Ezekiel Emanuel – Rahm’s brother and one of the ObamaCare architects – is a complete butt.

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That said, I was on Zeke’s side when he sparred with O’Reilly this week …

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More about those young folks that ObamaCare is targeting …

November 14, 2013

Conventional wisdom, summarized by the WSJ, is that”ObamaCare’s financing won’t work unless “young healthies”  … pay through the nose for coverage  … via the individual mandate.”

The Obama administration estimates that 2.7 million people between the ages of 18 and 30 need to buy health insurance through the federal and state marketplaces to offset the health care needs of older, less healthy Americans.

The 18-26 age group is the lowest user of care.

For example, the average male sees a physician only six times between the ages of 21 and 35.

But, ObamaCare now limits insurers to charging the sickest seniors no more than three times the amount they charge their youngest customers.

Since an average 64-year-old uses six times as much health care as 19-year-olds, young healthy enrollees have to pay considerably more than the cost of their own care.

So, the Administration is pulling out all stops to get young healthies enrolled.

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But, there are some flies in the ObamaCare ointment …

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Adverse selection: Will “adult children” destroy ObamaCare economics?

October 22, 2013

I’ve railed for awhile re: one of ObamaCare’s most popular benefits … forcing insurance companies to allow “adult-children” to be appended to their parents’ health insurance policies.

I wouldn’t mind if they – or more accurately, their parents – were paying for the coverage … but they typically aren’t

All other folks are being forced to pay higher premiums to cover the added costs.

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Let me explain the economics and tie it to another likely ObamaCare “glitch” …

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