Tuesday, September 2, 2014

ObamaCare Chain of Events Affecting Health Care Premiums

Chain of events is a number of actions that are contiguous and linked together.

Definition, Chain of events

In writing about ObamaCare, it is important to recognize that one thing leads to another.

The health law and the health exchanges have created a chain reaction:

• The older and sicker enrolled at the cost of the younger and healthier.

• The law’s one-size-fits-all coverage accepted all comers and prohibited questions about health status.

• These two factors created financial winners (the poor and the sick and hospitals) and financial losers (the older, the healthier, and the health plans).

• The health plans, anticipating losses, did two things: they struck a deal with government to bail them out against losses, and raised premiums for much of the middle class and most of the small group or individual markets.

• The government, to prevent heavy losses, priced premiums for health exchange plans, at Medicare or Medicaid levels well below private rates.

• Many physicians and physician groups, leery of government pricing, declined to accept members of the new health exchange plans; and health plans narrowed physician choice, by not accepting physicians with histories of charging higher rates: both events aggravated the already existing physician shortage.

• Many consumers, perhaps one of five, decided to go without health plans, and an estimated one of ten physicians began to abandon traditional practices for direct pay independent practices without third party coverage or to accept cash in addition to insurance.

• Some consumers elected to go directly to direct pay physicians because of lower rates, quick access, and absence of bureaucratic controls.

• ObamaCare enrollment in 2014 and anticipated enrollment in 2015 and beyond was projected to be 26 million by 2016.

• Health care premiums rose at an accelerated, but variable rates, throughout the land, along with the cost of businesses for covering them, more patients enrolled or were dumped into Medicaid, which grew at 15% or more a year.

• The insurance industry, at the request of consumers who could not afford higher rates and higher deductibles, began to rapidly offer more policies to supplement its health policies. The commercial insurance industry started to mimic Medicare, with its robust supplement policies offered through AARP and others.

• Businesses, which had previously insured 150 million workers, began to either cease coverage or minimize benefits, to cut losses, stay profitable, and satisfy investors.

In the words of a sage, “ You can never tell what will happen, with one thing always leading to another.”

Monday, September 1, 2014

September Campaign Stakes

Thirty days has September,

April, June, and November;

All the rest have thirty one,

Excepting February alone,

And that has twenty eight days clear

And twenty nine in each leap year

Chronicles of England (1562)

There are sixty five days til the midterms,

Sixty five days more of spins and squirms.

One side will say what they do is positive.

The other will counter in the negative.

One side will claim there are fewer uninsured,

The other will say the numbers are unsecured.

Both sides know losing the Senate control,

Would put ObamaCare in deep,dark hole.

Sunday, August 31, 2014

New York Times Attacks “Hate Consuming” ObamaCare Opponents

Clergyman: “ I was interested to see a Bible by your bed. You actually find time to read it?” General Patton. “I sure do. Every goddamn day.”

From the movie Patton (1970)

Both read the the Bible day and night,

But thou read’st black where I read white

William Blake ( 1767-1827¬), The Everlasting Gospel

I read the New York Times every day. It is the Democrats’ Bible.

Its health reporters, like Robert Pear, are excellent. But its editorial writers are ideologues who never pull their punches when supporting ObamaCare. Their attitude is that conservatives are hateful moral degenerates for opposing the health law.

Take these opening paragraph in today’s editorial "Endless Assault on Health Reform."

“The opponents of the Affordable Care Act make secret of their consuming hatred for the law that has already provided health care to millions of lower-income people.”

The phrase “consuming hatred” is over the top. Conservatives are not hateful people. They are ordinary Americans. They oppose ObamaCare 55% to 37% in the latest poll averages. The majority of Americans do not like rising premiums, loss of doctors and health plans, millions of health plan cancellations, negative effects on employment, which are turning 90% of new U.S. workers into part-time employees, and the wholesale redistribution of health benefits from the middle-class to lower income people.

In its editorial, the Times is “tarring and feathering” conservatives and the federal appeal court in D.C. for voting 2:1 that the ACA could only offer subsidies to members of state health exchanges, rather than federal exchanges, because that’s what the precise wording of the law said. The Times calls the D.C. court decision a “ridiculously crabbed view” to take the exact wording of the law seriously.

Well, now, I do not know what “ridiculously crabbed view” means. But to call conservatives “ridiculously crabbed” sounds profoundly condescending to me. It smacks of moral superiority, of effete snobs at work. Belittling your opponents by referring to them as full of “consuming hatred” for a flawed law and having a “ridiculous” view of the law are not hallmarks of tolerance and fairness.

Perhaps future editorials in the liberal Bible will explain. The Bible teaches tolerance towards others, rather than doing unto them what you think they are doing unto you.
Ten Key Health Reform Words

The clock. aligned with the computer, is key to reforming care, to increasing efficiencies, to saving time, and to improving outcomes.

Saving time, with proper computer use, and with doctors spending more time with patients, is key to improving health care efficiencies and to saving money.

That is the message I have sought to convey in my blog posts using the following key words.

Health Reform - My blog’s slogan is “Where health reform, medical innovation, and medical practices meet.” Where they meet is at the clock, for time is a perishable asset. There is only so much time to spend with patients.

Medical Innovation - There are always better, simpler, and less costly ways of doing things. These things, through they may be disruptive, invariably save time and make time for the right things.

Primary Care Shortages - Despite arguments and substitutes to the contrary, an adequate supply of primary care doctors and more time to spend with patients is key to a better health system.

• Patient Engagement
- Engaging patients by informing them what’s at stake for their health and what to do to improve their health is fundamental to more effective health reform.

• Concierge Medicine
- Concierge physicians, with enough time to spend and listen to patients,may be key to better, more compassionate, more understanding care.

• Direct Pay Medicine
- Physicians dealing directly with patients and patients paying directly for routine care while being covered for catastrophic events is key to future health reform.

Health Savings Accounts - Employers ensure 160 million Americans. HSAs are a proven means of saving time and money for employers and workers.

Self-Funded Corporations - These corporations can bypass government and state mandates and save time and money by short-circuiting 3rd party government and private bureaucracies.

Women Physicians - As Margaret Thatcher said, “If you want something said, give it to a man. If you want something done, give it to a woman.”

• Consumer-Driven Care
- We are a consumer-driven nation, and health care is for the benefit of consumers, not government, halth plans, hospitals, or physicians.

Saturday, August 30, 2014

Doctors’ Discontent with ObamaCare

Today medicine is just another profession, and doctors have become just like everybody else: insecure, discontented and anxious about the future.

Sandeep Jauher, MD, director at Heart Failure Program at Long Island Jewish Medical Center, from his book, Doctored: The Disillusionment of an American Physician (Farrar, Strauss and Giroux, 2014) and from an article in the August 30-31 WSJ, “Our Ailing Health System.”

Today the WSJ published excerpts of a book by Dr. Jauher.

These excerpts included:

• In a 2008 survey, only 6% of doctors described their morale as positive.

• Eight –four percent said their incomes were constant or declining.

• Most said they didn’t have enough time to spend with patients because of paperwork,

. Nearly half said they planned to reduce the number of patients they would spend in the next three years or stop practicing altogether.

• This discontent has led to a looming shortage of doctors.

On Labor day, summer ends and fall begins.

With hateful TV ads to see which party wins.

Among the issues will be The Health Law Act,

And on health care if it has had an impact.

After Brown, Ukraine, Hamas,beheading, and ISIS,

ObamaCare may now seem to be less of a crisis,

At this painful juncture doctors know this,

With the profession something is amiss.

Doctors are no longer held in high regard.

Their high reputation has been tarred.

With blame for high costs by media reports.

Of Medicare fraud and abuse of all sorts.

A feckless and reckless health law reform,

has failed the health system to transform

Because of its many big government flaws,

It has caused doctors from practice to withdraw.

Ir has resulted in lost doctors and cancelled plans,

It has raised premiums and created benefit bans.

It has forced doctors to adopt EHR systems.

Disrupting routine relationships and rhythms,

Destroying physicians' clinical autonomies

Interfering with normal market economies,

While ignoring frivolous malpractice suits,

While licking courtroom attorneys' boots.

No wonder doctors are so discontented.

Their problems the health law has either been

By political rhetoric or facile pen been,


or circumvented.

Friday, August 29, 2014

More On Direct Patient Care

Plain directness can go a long way.

Anthony K. Tjam. “Have the Courage to be Direct,” HBR Blog Network, 2012

Healthcare providers are discovering strategic opportunities with large employers that are self-insured, but they need to be willing to partner more directly with payers and employers.

Phillip Betbeze, "Targeting Self-Insured Populations, " Health Leaders Media, August 27. 2014

I keep running across examples of “direct” patient care.

• Formation of organizations touting “direct primary care.”

• Self-funded corporations contracting “directly” for concierge and ambulatory surgical services.

• Independent “direct pay” providers bypassing 3rd party government and health plan middlemen.

• Physicians striking out and signing “direct contracts” with local businesses to provide comprehensive “direct primary care” to employees.

What does it all mean?

I suspect:

One, "being direct" is borne out of frustration with the current complex regulatory system, which seems to drive costs higher ever passing day.

Two, "being direct" is a bold attempt by businesses and providers to cut costs by cutting to the chase of health care matters by KISS (Keep it simple, stupid!),

Three, "being direct" exemplifies the American philosophy of “disruptive innovation,” i.e., there is more than one way to skin a cat by making things simpler, more direct, more convenient, more bundled, and less specialized.

I came across this direct way of doing things while interviewing “direct pay” concierge physicians and directors of ambulatory surgery centers for my book Direct Pay Independent Practices: Medicine and Surgery ( Amazon, Kindle book, $9.97).

Kindle books or e-books, by the way, are another example, of “directness" of bypassing traditional publishers by dealing directly with authors online.

If you give the matter any thought at all, you will realize “direct online care,” in the form of virtual medicine or telemedicine, has the potential of cutting out many health care middlemen.

Walmart and GE now directly contract for hip and knee replacements by contracting directly with health systems rather than going through health plans – it is simpler, more direct, and far less costly.

In Oklahoma City, many self-funded corporations and even public or government health agencies save money by sending patients directly to the Surgery Center of Oklahoma for routine surgeries for ambulatory patients.

In Wichita, Kansas, concierge physicians contract directly with local businesses for bundled primary care services. New corporate-provider partnerships are cropping up everywhere to simplify relationships and decrease costs, complications, and regulations of doing health care business.

Partnerships are replacing partisanship. Cooperation is replacing confrontation. And physicians and surgeons are learning the fundamental rule of health care nailing, "If you have a health care nail to hit, hit it on the head." Or, as Ben Franklin observed, "For want of a nail the shoe was lost; for want of a shoe the horse was lost; for want of a horse the rider was lost."