Saturday, March 28, 2015

Health Care Reform Articles - March 28, 2015

A Health Care Reform Blog––Bob Laszewski's review of the latest developments in federal health policy, health care reform, and marketplace activities in the health care financing business.

Headline: "Exchanges Struggle to Enroll Consumers As Income Increases" It's Because of the Obamacare Dichotomy

Here is an excerpt from a post on this blog from June 21, 2014:
Kaiser Family Foundation Survey Finds Most People Who Bought Health Insurance on the Exchanges Are Happy With It 

This week the administration reported that 76% of those who received a subsidy paid less than the full premium for the plans they selected. And, 69% are paying less than $100 after the subsidies––46% are paying $50 or less.

It would appear from this data that it is the lowest income people who are most often signing up for coverage. They are the ones who get the biggest premium subsidies as well as the reductions in their deductibles and co-pays.

So, the Kaiser Family Foundation has found that these people who are having their premiums and deductibles disproportionately subsidized are happy with their coverage. Hardly a surprise. If you paid for most of my insurance and cut my deductibles from the standard levels I'd be pretty happy too. 
My sense has always been that Obamacare appeals to people very differently depending on their incomes. I will call it the Obamacare dichotomy: Poorer people get by far the lowest premiums and deductibles from Obamacare and working class/middle class/wealthier people, who pay very high premiums for high deductible plans, get relatively very little from it.

Why do most people express dissatisfaction with Obamacare in most of the polls? Why did Obamacare fare so badly in the last election? It seems to me that all of this has to do with who benefits and who does not.

Small Company Has Plan to Provide Primary Care for the Masses

Thursday, March 26, 2015

Health Care Reform Articles - March 26, 2015

The Importance of Sitting With Patients

I had never seen someone so yellow.
It was as if someone had taken a highlighter to the whites of her eyes and coated her skin with a layer of mustard. In actuality, the cancer in her colon had crept to her liver, where it blocked bile from taking its natural path out of the body, causing the ominous yellow chemical to spill into her blood and tissues. She had left the hospital two weeks ago, hoping to die at home, but came back with worsening pain and bloating in her belly — and because she couldn’t stand to look at herself in the mirror.
“Doctor,” she said softly — it was a title that still didn’t feel quite comfortable to me, a newly minted doctor, especially coming from a patient several decades older than me. “You remind me of my nephew.”
She asked me to sit for a few minutes and, shamefully, I hesitated. I had eight more patients to see before rounds and was already running behind. But I sat — listening to a dying woman’s fondest family memories, my mind racing through a seemingly endless list of boxes I had to check that morning. When my pager went off five minutes later, I excused myself, promising to return in the afternoon to finish our conversation.
But I didn’t.
There were new patient admissions. Emergencies on other floors. Notes to be written, consultants to be called, outside hospital medical records to be procured.
When I got home that night, I kicked myself for forgetting to stop back to see her. I briefly considered going back to the hospital but, exhausted, told myself she’d be asleep by now and vowed to arrive early the next morning to spend extra time with her.
She died that night.
The most draining aspect of medical training, it turns out, is not long hours, brash colleagues or steep learning curves — it’s the feeling that you’re often unable to be there with and for your patients in the way you want, in the way you’d always imagined you would be.

Consumers Getting "Skinned" by Health Insurers

Thursday, 19 March 2015 00:00 By Wendell PotterCenter for Public Integrity | News Analysis
The reason health care costs are so high is because Americans don’t have nearly enough “skin in the game.”
That was the phrase that many of my former colleagues in the insurance industry and I began using in the early 2000s as a way to deflect attention away from us.  
Americans — especially American employers — looked to private insurers to help control medical costs. But insurers were failing miserably, and some of them — Aetna in particular — were also failing Wall Street.
Thirteen years ago, investors and Wall Street financial analysts were not happy with the way some managed care companies were running their businesses. They felt that Aetna and other big for-profit insurers were spending far too much of their policyholders’ premiums paying claims. And they didn’t like it that insurers hadn’t been aggressive enough in getting rid of  “unprofitable” customers.
One way to satisfy Wall Street was to begin shifting more and more of the cost of health care — and health insurance — to their customers. That meant that sick policyholders in particular would be paying more out of their own pocket for their care.
Our marketing folks came up with an almost Orwellian name for this cost shifting —consumer driven health care. In retrospect, it was a brilliant strategy, and one that got virtually no pushback from lawmakers or regulators. Little by little, year after year — and long before many people outside of Illinois had ever heard of Barack Obama — Americans began putting more of their skin in the health care game. They had no choice.
The strategy has been so successful that insurers are back in Wall Street’s good graces. Their profits keep breaking records, and so does the price of their stock.

But what’s good for them has been anything but good for a growing number of Americans.  Out-of-pocket expenses have gotten so high that nearly half of American families don’t have enough money in the bank to pay their deductibles if they get really sick.

Where the Republican Budget Plan Meets Reality on Health Care