Thursday, October 31, 2013

Health Care and Your Private Affairs Are Personal
The personal life of every individual is based on secrecy, and perhaps it is partly for that reason that civilized society is so nervously anxious that person privacy should be respected.
Anton Chechov (1860-1904), The Lady  with the Dog
Every American knows health care and your private life are  personal matters.  
That is why most people want a personal physician, not necessarily a health care team; why many are wary about, which asks for your personal data,  including your social security number; why they want their health care information kept confidential, between them and their doctor; why people are leery about the National Security Agency’s surveillance system collecting personal information from Google and Yahoo data streams; why people are upset that asks for personal  information before allowing you to scan and compare health plans on the exchanges; why people are so upset that their personal health plans are being cancelled, when it was promised that they could keep their plans if they liked them; why governmental personal health  information gathering is regarded as an intrusion into personal freedom.
Suddenly It’s Not about Politics, It’s about Me
Suddenly,   it’s not the politics, it’s the intrusion into my personal affairs. my personal decision making,  and my personal right to choose. Suddenly, it is not a question of Democrats versus Republicans,  single payer versus market-driven care,  government compassion versus cold hearted business practices,  liberals versus conservatives, President Obama versus his critics. It’s about me.
It’s Personal and About Other Things
It’s personal. It’s about losing my health plan, which I like and which I chose.   It’s about the health security of myself and my children.  It’s about what I can afford..  It’s about spending hours and even days and weeks  plowing through a website that doesn’t work and  don’t understand and scratching my head over policies the government can’t seem to explain.  It’s about  misleading promises and deceptive  caveats. 
It’s about unexpectedly cancelled policies, disappearing doctors,  and rebooted promises.  It’s about a sick economy, absent jobs, and  doubling and tripling of government dependency programs. It’s about government policies, which federal officials understood  in 2010,  but did not explain, that might  cause 93 million Americans to lose their health plans.   It’s about the big glitch that failed .  It’s about cramming down government policies that crimp my freedom to choose.
It’s about personal expectations,  being able to see my doctor in a timely fashion,  to choose my own plan on my terms,  to have access to the latest treatments and procedures.
It’s about the unfairness of Congress and government officials being spared from Obamacare.  It’s about politics becoming personal, affecting me and my family in the concrete rather than the abstract.  It’s about what Abraham Lincoln said of politicians, “Politicians are a set of men  who have interests aside from the interests of the people, and who, to say the most of them, are, taken as a mass, at least one long step removed from honest men. I sau  this with the greater freedom, because, being a politician myself, you can regard it as personal.”

When it comes to infringing upon your health care and your personal affairs, and to slow economic growth, lack of jobs, and cancelled health plans,  to paraphrase Lincoln, you may fool all of the people of the time; you can even fool some of the people all of the time, but you can't fool  all of the people all of the time.  You can't infinitely delay the day of reckoning.
Tweet:    Your health and your private life are personal; government asking for your health data  and cancelling personal policies are off limits.

1;  Daniel Henninger, “Progressive Government Fails:Obama's Ideology Is the Politics of the Personal Cram down. Wall Street Journal, October 31, 2013

2. Avik Roy, Obama Official in 2010: 93 Million Americans, Will Be Unable to Keep Their Plans, Forbes, October 31, 2013

‘Substandard” Health Plans

“If you had one of these substandard plans before the Affordable Care Act became law, and you really liked that what  we said, under the law,  you have got to replace them with quality, comprehensive coverage.”

President Barack Obama,  Boston Political Rally, October 30, 2013

In Boston yesterday,   President Obama blasted health insurer “bad apples” by saying these insurers were offering “substandard” plans.  By “substandard,”  he meant those 19  million existing health plans that did not contain the 10 “essential benefits” his administration considered “standard”.

These “benefits” include:

1.    Outpatient care—the kind you get without being admitted to a hospital

2.    Trips to the emergency room

3.    Treatment in the hospital for inpatient care

4.    Care before and after your baby is born

5.    Mental health and substance use disorder services: This includes behavioral health treatment, counseling, and psychotherapy

6.    Your prescription drugs

7.    Services and devices to help you recover if you are injured, or have a disability or chronic condition. This includes physical and occupational therapy, speech-language pathology, psychiatric rehabilitation, and more.

8.    Your lab tests

9.    Preventive services including counseling, screenings, and vaccines to keep you healthy and care for managing a chronic disease.

10.  Pediatric services: This includes dental care and vision care for kids

The  Administration’s Message

Never mind if  you do not need or want  these  benefits.  Never mind if they do not apply to you, your family, or your health situation. Never mind if you can afford them or not.   Your pre-existing plans that do not have them are kaput. According to the law,  insurers will have to cancel them, and you will have to shop around on or state exchange websites to replace those substandard plans.

Message Raises These Questions

What does this message imply?


·         Health insurers are dishonest and unscrupulous in offering policies that do not cover everything clinical and preventable.  Calling some insurers “bad apples”  implies insurers are not honest and above board in their dealings with the public.  Insurers are the "demons" of our health system.

·         Government and only government knows what standards should  apply to  the electorate and their families. After all, it was the first President, George Washington, who said at the first Constitutional Convention  “Let us raise a standard to which the wise and honest can rise.”

·         Insurers conned millions of honest Americans into buying plans that they knew did not meet government standards and that  they dishonestly  knew to be inadequate.

·         Citizens who bought these plans and who pay monthly for them must be protected as set forth in the Patient Protection and Affordable Care Act.   It is our patriarchal duty to protect citizens against the unscrupulous in the health care industry.

·         If the premiums and deductibles are “unaffordable. “ it is the function of government to step in and provide subsidies to make them affordable.

·         Because of lack of consumer wisdom and knowledge, freedom of choice of health plans outside of government approval of plans on the exchanges is no longer an option.

Tweet: Insurers must cancel all “substandard” health plans that do not contain 10 essential benefits mandated by the health law.

Wednesday, October 30, 2013

 ObamaCare Marketing Strategy: One Size Fits All
One size fits all.
 Marketing Strategy, and a cliché that has been in common use  for five decades
As I view cancelling of health policies for millions on the individual market, who represent 7% of Americans under age 65,  these thoughts spring to mind.
These cancellations reflect a political philosophy that says,
·         Eat your broccoli, it’s good for you.

·         Government knows best, you do not know what is good for you.

·         Only government knows what is good for your health.

·         It’s not what you want or need or are willing to pay for, it’s what government wants you to have and what  you must pay for.

·         No matter what you think you need, you must pay for what others need.

·         It is not whether; don't dither; it’s what you  must do;  we are all in this together.

·         Birds of different feathers must flock together.

·         In the name of  equity, government plans are “better”  because they cover every eventuality,  everybody must have more comprehensive plans, even if they are more expensive;   it's all right for the White House to tell an untruth as long as it is for your own good.

·         Everyone is the same,  regardless of gender, age, or health, or risk, and whether one has been on a bender.

·         You can’t keep the plan you like,  only the plan the government likes.

·         If you like your plan, forget it.

·         Individual  choice or freedom of choice  has no place or space in the scheme of things; that’s up for government to decide.

·         Health plans are the enemy because  insurance rests on the assumption that calculating premiums is based on risk.

·         In an equitable society, relative risk is the enemy,  absolute security, government-guaranteed,  is the goal.

·         Health care  profits are the enemy of government.

·         Everybody is equal, but some are more equal than others, if they agree with your policies; government never wavers but it reserves the right to waiver, 

·         Therefore,  consequently, and axiomatically,  one must standardize,  homogenize, equalize,  normalize, and bring all down to one size that fits all.

·         Everybody must have essentially the same coverage, and only government can dictate, pardon, mandate, what that coverage is and how much it costs.

Tweet:   Cancellation of millions of policies in individual markets is  a conscious government decision to reduce all policies to one size fits all.

On Health Plans and Narrowing The Physician Network

I keep six honest serving men

(They taught me all I knew);

Their names are What and Why and When,

And How and Where and Who,

Rudyard Kipling (1865-1936), The Elephant’s Child

Let’s say you’re a health plan executive.  Your stakeholders want a return on investment. This return depends on your company growing and making a profit.   ObamaCare threatens this investment and the profit by putting a lid on marketing on management , forcing you to drop plans that don’t meet minimal  government  standards,   raising the cost of doing business because of onerous regulations,  and  cutting your return by 7% or so on Medicare Advantage Plans.

What to do?  You drop physicians decreasing your profit from the physician network by cancelling their contracts.

It isn’t rocket science.

What – You look at what doctors are costing you money, and you determine it is physicians who order the most tests,  perform and most tests and schedule the most visits..

Why -  You consider the reasons why is that these physicians regularly  spend more on average of  patients’ premium dollar than other physicians.

When – You drop these physicians out of your network, i.e., the physicians with whom you do business  before January 2014,  when ObamaCare kicks in in earnest in January 2014.

How –  You simply review your claims data and cut out 10% to 15% of doctors who are ordering the most Medicare Advantage services.

Where  -  You do it  in those physician markets where Medical Advantage costs are high and physicians  and their associations are more tractable, then you do it nationally.

Who -   You pick the physician who are high rollers, and you do it in the names of efficiency and quality – without mentioning the unmentionable – profit.

It is all done on the basis of sound business principles.  That’s why United Healthcare and other health plans is dropping 10% to 15% of its doctors from Medical Advantage Plans, and why it will force man seniors to find new doctors or change plans.  According to Todd Baker, director of professional relations with the Ohio State Medical Association, “This is one of the most significant (provider) network narrowing’s we've ever seen in the Medicare Advantage world,”

As nearly as I can tell from multiple sources, about 25% of 50 million Medicare recipients are on Medicare Advantage plans.  This amounts to 12.5 million people.   If United and other health plans drop 10% to 15% of those in Medicare Advantage plans that would mean 1.25 million to 1.87 million seniors would have to switch doctors.  

A small number, to be sure, when you consider 50 million Americans are on Medicare.  But losing your doctor is irritating   if you are a Medicare recipient whose doctor is being dropped,   And it may anger you  if you believed President Obama in 2009 when he promised, “ If you like your doctor,  you will be able to keep him. Period.” In the case of Medicare Advantage plans,  a period has become a question mark.

Tweet:   Insurers may drop 10 to 15% of doctors involved in Medicare Advantage plans, meaning 1 to 2 million seniors may have to switch doctors.  



Monday, October 28, 2013

President Obama’s Unawareness
If only I had known.
Fourth century proverb
What did the President know and when did he know it?
Question dating back to Watergate
The president lack of awareness about adverse events is astonishing.  He must live in a  isolated impenetrable bubble,  isolated from public opinion and advice from his political advisors.
Otherwise,  how could he possibly and conceivably be unaware that:
·          he did not know the IRS was targeting conservatives when the IRS head made over 150 visits to the White House over the course of a year before the scandal broke;

·         the IRS official responsible for the targeting would  operate out of the White House and would direct ObamaCare implementation;

·         where he was or what he said the night of the Benghazi attack could  not remain a  mystery because it doesn’t wash;

·         his National Security Agency was monitoring the phone calls and e-mail messages of other world leaders:

·         his promises that people could “keep their health plans and doctors, period.” was false and misleading - period;

·        online marketing of  his namesake landmark domestic achievement was unteste and not ready for primetime and would be a disaster ;

·        ObamaCare would potentially cause insurers to abruptly cancer  middle class health policies of as many as 16 million people;   

·         85% of Americans who liked their policies would not only lose their plans but their choice of doctors as well;

·         two-thirds of people in individual and small group markets  and the young and healthy would see premiums and deductibles rise and be told  government endorsed plans were “better” and would be for their own good because the new plans offered services many patients felt they did not need but others did. People are asking, "Why can't I just keep what I have?
Why did he not know these things? Was it false pride,  hubris, or arrogance?  Why did he not examine the consequences of his policies beforehand?    These mishaps and lack for foresight strain the credibility of the President’s leadership.   The president should lead and take responsibility for his administration’s actions rather than follow from behind and blame others for failed policies.

Tweet:   President Obama and defenders say he is unaware  why bad things happen to one with good intentions; ignorance is no longer a sufficient excuse.

Two Cheers for Capitalism, A Call for Balance
A capitalistic society does not want more than two cheers for itself.  Indeed, it regards the impulse to give three cheers for any social, economic, or political system as expressing a dangerous – because it is misplaced – enthusiasm.
Irving Kristol (1920-2009), Two Cheers for Capitalism, Basic Books, 1975

Why not three cheers? Why any cheers at all?
After all, capitalism’s excesses do many appall.

The answer, is that overall, above all capitalism works,
While collectivism, or social welfare-ism , is for clerks,
Who think they know best how to set bureacratic rules,

But  too often think of others as unelightened mules.
Yet clerks know little about generating wealth,
And even less about what makes for health.

President Kennedy said capitalism can lift everyone's boat,

That it is efficient in redistributing social goods that float.
The social welfare state may glow for the ideologue,
But ideologues get lost in mystical anti-business fog.
They tend to think other people’s money is their own,
That it is on loan and can be thrown from their throne.
That  it grows willynilly from taproots of centralized trees,
That government can seize from others what it pleases.
So government gets caught up in idealistic enthusiasm,
It believes  it is  part and parcel of society’s cytoplasm.
The problem is that gov does not perform,
When it strives and seeks society to reform.
It gravitates towards the iron tyranny of the D.C. status quo,
Individuals, innovators, and entrepreneurs become the foe,
As social welfare and government dependency grows,
Government debt mounts and the economy suffers woes.
It all boils down to a question of lack of political balance,
Of  monetary dys-equilibrium  to use economic parlance.
So two cheers for capitalism, when and where it  is needed
One cheer for social equity, when capitalism needs to be weeded.
Two cheers for market-driven health care,
One  cheer for a central  system deemed “fair.”
Two cheers for a direct doctor-patient relationship,
One cheer for intervening third party one-upsmanship.
Two cheers for a simpler, understandable  health narrative.
One cheer for a complex confusing imperative

Tweet:   The health system badly needs a better balance between market and health needs of consumers and demands of a protective government.

Sunday, October 27, 2013

Don’t Know Much about Geography, but I Do Know Something about Healthcare. gov

Don't know much about geography

Don't know much trigonometry

Don't know much about algebra

Don't know what a slide rule is for

But I do know one and one is two.

Lyrics, by Sam Cooke, of What a Wonderful World, based on book by Kenneth Davis,  Don’t Know Much about Geography
I don’t know much about geography, but I do know something about
I  know 14 states run their own state exchanges (California, Colorado,  Connecticut , Hawaii, Kentucky, Maryland, Massachusetts, Minnesota, Nevada, New York,Oregon, Rhode Island, Vermont, and Washington);  two (New Mexico and Idaho)  run their exchanges using the federal exchange infrastructure; and the other states  depend on the federal government to create and manage their exchanges.
I know most of those states who run their own exchanges are blue or purple states, while most of those who let the federal government do their exchanges are Red states.
I know the state exchanges are functioning better than the federally run exchanges. 
I know the federal government has yet to get its technological act together after spending roughly $1 billion and 3 ½ years to prepare for
I  know the federal government says that will be ready to go by November 30,  that December 15 remains the drop dead date for enrolling,  and that by January 1 everything will supposedly be ready to go.
I  know that almost everybody – Democrats and Republicans and the public at large – consider the rollout a “disaster.”
I know the enrollment period will be extended to March 1, and that nobody will be penalized for not signing up. 

I know that penalizing someone for not enrolling when they have no means of enrolling makes not  sense.

I know the middle class making more thant $46,000 and not eligible for subsidies will rise up in anger when they learn their premiums and deductibles are higher and often unaffordable because of services they do not think they need.

I know that one function of,  the ability to browse and compare health exchange plans, was changed so that this information was not available until after people had enrolled.
And I know that the number of expected enrollments are behind schedule,  that only about 25% of those who create accounts have so far enrolled, and that the number of plans being cancelled because of the inability to meet ObamaCare standards far exceeds those being enrolled.  It is estimated 16 million policies will be cancelled over the next several months;   how many people will enroll or take Medicaid plans is unknown, but it likely to far short of 16 million.
In the meantime, as of this date, October 27,  the  Advisory  Group says 116,000 people have picked a private plan  or enrolled in Medicaid.    The federal government estimated 500,000 would have done so by October 31. 

So I know the government is behind schedule.

Here is the Advisory Board tabulation of accounts created and people enrolled.

Entity                                   Accounts        People Enrolled 

Federal government                     __               __             

California                              125,959             __

Colorado                                 18, 174             395

Connecticut                            10, 768            3847

Hawaii                                      1, 181            __

Kentucky                                 51,482           26, 194

Maryland                                40, 703            ___

Massachusetts                        25, 703            ___

Minnesota                              18,917             3,769

Nevada                                  38,393             1,757

New York                                  ___             37,030

Oregon                                   11,500               ____

Rhode Island                            7,482            2.652

Vermont                                 8,739              1,588

Washington                          89, 273             35,578

Note:  __ means no information is available.

Tweet:   Red states depending on lag behind blue -purple states running their own exchanges in enrolling people in health exchanges.

Saturday, October 26, 2013

ObamaCare Fantasies and Krauthammer Realities
We have been seduced by computer glamour …Glamour is a powerfully pervasive tool. Taken as a guide rather than the literal truth, it can lead to positive lifestyle action.  But it is also an illusion. In the real world hidden details matter.
Virginia Postrel, “Obama’s Virtual Fantasy Coludn’t Handle Messy Reality, Bloomberg, October 24, 2013

When you run something this large, it has no chance of succeeding.

Charles Krauthammer, MD (born 1950),  on Fox News video discussing Obamacare and

Two fantasies have seduced President Obama..
One:  the government elite and its central planners know what’s best for people and can virtually manage their personal and health affairs.
Two:  the computer and its spin-offs is a  powerful and pervasive force capable of  managing society down to the last detail.
In his new book,  Things That Matter: Three Decades of Passions, Pastimes, and Politics,  Charles Krauthammer, MD, a political columnist  and a psychiatrist,  puts these two fantasies into perspective.
To begin with,  he says, it is important to get the politics right.  

In his book, he talks of his  journey from being  a life-long Democrat and  a Great Society liberal to a reluctant Reagan admirer to a contributor to Fox News and a commentator widely regarded as the most persuasive voice of American conservatism.  

He notes that he is not the first to make the journey from liberralism to conservatism..  Ronald Reagan,  Irving Kristol,  Pat Moynihan, and others made that same journey before him. 

He expresses his opinions in a weekly Washington Post column,  syndicated in 350 newspapers,  and in numerous talk shows, the most notable of which is a nightly Fox News appearance.
Krauthammer’s voice is not shrill.    It is pragmatic, reasonable,  empirical, nonpartisan.    He is simply saying that the Leviathan government model doesn’t work in the real world.    A more limited smaller government works better and is more in keeping with individual,  aspirations, skills, dreams, and freedoms.
He read widely before reaching these conclusions.  Though his reading and his own empirical observations,   he became slowly converted “ to a philosophy of restrained, free-market governance that gave more space and place to the individual and to the civil society that stands between citizen and state.” 
doctor,  graduated from  Harvard Medical School and trained as a psychiatrist at Massachusetts General Hospital, where he served as chief resident in Psychiatry  He regards the health care system  as a delicate ecosystem  developed over the course of 70 years. The professon,  he feels, is not capable of being overturned or transformed by federal mandates and bureaucratic regulations.
Tweet:   That and other computer apps can transform medicine and that government knows best is fantasy now colliding with reality.