Friday, June 28, 2013
E-Book, on Health Plans, Their Proponents and Their Distractors
The engine that drives enterprise is not Thrift, but Profit.
John Maynard Keynes (1883-1946), a Treatise on Money
I’ve been working on an E-book, chronicling my thoughts on health plans and health reform.
CMS has jsut announced health plans have ssued a $500 million rebate to 8.5 million employers and health plans, That annoucment prompts this book. CMS portrays this rebate as an Obamacare triumph, as nailing those heartless health plan bastards that prey upon innocent citizens or reject their suffering from pre-existing illnesses or other problems over which they have no control.
I am no fan of managed care, or the role health plans play in managed care. But I believe if private health plans did not exist, we would have to invent something like them to cover those not covered by government. CMS now subsidize something like 110 million of 315 million Americans, while health plans insure something like 160 million. This 160 million figure is likely to decline when employers recognize the extent and expense of Obama-qualified and endorsed health plans.
As the following blog post titles suggest, other things are going on at the health plan-Obamacare intersection. Health plans are doing a tremendous amount of data mining, and they are using thise data to set premiums and manage care. In 2003, many major health plans settled with doctors in a Miami courtroom, by agreeing to pay over $100 million to set up a couple of physician foundations, now reduced to one, which is run the Physicians Foundation, a non-profit organization representing over 500,000 physicians in state medical societies. Restrictive managed care have faded , due to delays of physician payments and bundling of fees, and using primary care physicians, as gatekeepers to minimize specialty care and hospitalization, The gatekeeper approach has proven to the unpopular with Americans who reserve the right to go the specialist of their choice. Nevertheless, health plans continue to narrow their providernetworks. In the last five year, a variant of health plans, health savings accounts, has risen to the ascendancy, as employers and workers alike have realized they can save significant premium expenditures,by shopping for care and setting aside tax-free money for retirement.
Another significant development has been concierge practices and cash-only or direct payment practices, wherein physicians escape 3rd party scrutiny and overhead expenses, by asking for payment on delivery of services. Finally, there has been a growing movement of small businesses to self-fund, as most major corporations do, to minimize the expenses entailed in meeting Obamacare provisions.Blog Posts, with dates of entry and titles
1. June 1, 2007, Decline and Fall of Restrictive Managed Care
2. June 22, 2007, The Physician Health Plan Tango
3. September 20, 2007, Employer Driven Reform Hits Connecticut
4. October 13, 2007, Ranking Doctors Using Claims Data
5. Janaury 19, 2008, Physicians and Health Plans – Forecast for Managed Care
6. May 3, 2008, Short Take on Health Plans
7. October 10 , 2008, Managed Care Memoir
8. January 31, 2009, Health Savings Accounts, Skeptics and Believers
9. February 14, 2008, HSAs Tied to High Deductible Plans
10. April 14 2009, Health Plans, The Skunk at the Health Reform Political Party
11, May 1, 2009, Private Health Plans in Trouble
12. May 22, 2009, Managed Care, How Doctors React to Being Managed
13. August 21, 2009, Health Plan Bureaucracies Costs to Doctor
14. September 20, 2009, Beyond Private Health Plan Attacks
15. October 29, 2009, AARP Members Air Doubts about Obamacare
16. March 1, 2010, Savings Achieved Through Health Savings Accounts
17. September 25, 2010, Why Obamacare Attack on Health Plans Isn’t Working
18. March 20, 2011, Some Health Plans Are More Equal Than Others
19. July 17, 2011, Health Savings Accounts, A Return to the Obvious
20, October 27, 2011, Defined Contributions, High Deductible, Vouchers, HSAs, HRSs
21, April 21, 2012, Wisdom of People, Key to Reducing Health Costs
22, June 11,2012, UnitedHealth to Keep Some Health Law Provisions
23. October 12 2012, AARP and UnitedHealth Group
24. February 13, 2013,. HSAs Tied to High Deductibles
25, March 14, 2013, Are Health Savings Accounts Wave of Future?
26. March 28, 2013, Health Reform Endgame
27. April 8, 2013, A Practitioner’s Journey from Solo Practice, to Managed Care , to Obamacare
28. May 9, 2013, Can UnitedHeath Data Fix the System?
Tweet: Health plans insure the majority of Americans. Obamacare portrays these plans as villains in driving up costs which is half the story.