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Sunday, December 22, 2013

Health Care Reform Articles - December 22, 2013

Health Care’s Road to Ruin

By 


HAVING spent the last year reporting for a series of articles on the high cost of American medicine, I’ve heard it all. There was Fred Abrahams, 77, a skier who had surgery on both ankles for arthritis — one in New York for more than $200,000 and one in New Hampshire for less than $40,000. There was Matthew Landman, 41, billed more than $100,000 for antivenin administered in an E.R. after a small rattlesnake bite. There was Robin Miller, a Florida businessman, who needed to buy an implantable defibrillator for his ill brother, who was uninsured; the machine costs tens of thousands of dollars, but he couldn’t get a price for a make or a model.
Extreme anecdotes, perhaps. But the series has prompted more than 10,000 comments of outrage and frustration — from patients, doctors, politicians, even hospital and insurance executives.
As of Jan. 1, the Affordable Care Act promises for the first time to deliver the possibility of meaningful health insurance to every American. But where does that leave the United States in terms of affordable care?
Even supporters see Obamacare as a first step on a long quest to bring Americans affordable medicine, with further adjustments, interventions and expansions needed.
There are plenty of interesting ideas being floated to help repair the system, many of which are being used in other countries, where health care spending is often about half of that in the United States. For example, we could strictly regulate prices or preset payment levels, as is currently done for hospital stays under Medicare, the national insurance program for people over 65, or at least establish fair price corridors for procedures and drugs. We could require hospitals and doctors to provide price lists and upfront estimates to allow consumers to make better choices. We could stop paying doctors and hospitals for each service they performed and instead compensate them with a fixed monthly fee for taking care of each patient. We could even make medical school free or far cheaper and then require service afterward.
But the nation is fundamentally handicapped in its quest for cheaper health care: All other developed countries rely on a large degree of direct government intervention, negotiation or rate-setting to achieve lower-priced medical treatment for all citizens. That is not politically acceptable here. “A lot of the complexity of the Affordable Care Act arises from the political need in the U.S. to rely on the private market to provide health care access,” said Dr. David Blumenthal, a former adviser to President Obama and president of the Commonwealth Fund, a New York-based foundation that focuses on health care.
With that political backdrop, Obamacare deals only indirectly with high prices. By regulating and mandating insurance plans, it seeks to create a better, more competitive market that will make care from doctors and hospitals cheaper. But it primarily relies on a trickle-down theory of cost containment. The Princeton health economist Uwe E. Reinhardt has called it “a somewhat ugly patch” on “a somewhat ugly system.”
With half a billion dollars spent by medical lobbyists each year, according to the Washington-based Center for Responsive Politics, our fragmented profit-driven system is effectively insulated from many of the forces that control spending elsewhere. Even Medicare is not allowed to negotiate drug prices for its tens of millions of beneficiaries, and Americans are forbidden by law to re-import medicines made domestically and sold more cheaply abroad.
And so American patients are stuck with bills and treatment dilemmas that seem increasingly Kafkaesque. The hopeful news is that American health care spending has grown at a slower pace over the past four years. While that is partly because of the recession, economists say, many credit the cost-containing forces unleashed by Obamacare with a significant assist. Even at that rate, many models suggest that nearly 25 percent of gross domestic product will be eaten up by health care in 20 years. That is not sustainable.

Single-Payer, Medicare-for-All Legislation Introduced

Senator Bernie Sanders
May 10, 2011
Sen. Bernie Sanders (I-Vt.) announced today that he introduced legislation to provide health care for every American through a Medicare-for-all type single-payer system.
Rep. Jim McDermott (D-Wash.) filed a companion bill in the House to provide better care for more patients at less cost by eliminating the middle-man role played by private insurance companies that rake off billions of dollars in profits.
The twin measures, both called the American Health Security Act of 2011, would provide federal guidelines and strong minimum standards for states to administer single-payer health care programs.
“The United States is the only major nation in the industrialized world that does not guarantee health care as right to its people,” Sanders said at a press conference on Capitol Hill. “Meanwhile, we spend about twice as much per capita on health care with worse results than others that spend far less. It is time that we bring about a fundamental transformation of the American health care system. It is time for us to end private, for-profit participation in delivering basic coverage. It is time for the United States to provide a Medicare-for-all single-payer health coverage program.”
McDermott said, “The new health care law made big progress towards covering many more people and finding ways to lower cost. However, I think the best way to reduce costs and guarantee coverage for all is through a single-payer system like Medicare. This bill does just that – it builds on the new health care law by giving states the flexibility they need to go to a single-payer system of their own. It will also reduce costs, and Americans will be healthier.”
http://sanders.senate.gov/newsroom/news/?id=47d632b8-4a43-4d2b-b500-cb2c105e93ef
American Health Security Act of 2011:
http://thomas.gov/ (select bill number and insert S.915 or H.R.1200)

The Obamacare Slippery Slope––What's Your "Hardship?"

As of this morning, here are the new rules.

If you had a health insurance policy that was cancelled, you are now exempt from the individual mandate and its tax penalty should you not decide to buy a replacement policy. In addition, you can now sign up for the very high deductible Catastrophic Plan that was originally reserved only for those under the age of 30.

If you did not have a health insurance policy that was cancelled, you are still subject to the individual mandate and you are not entitled any special treatment toward signing up for the Catastrophic Plan. You must pay the full price for an exchange plan and accept whatever out-of-pocket costs and network limits it might have for the money.

The administration made this change under the "hardship" provisions already part of the law. They have simply defined hardship as having lost your old individual plan and your not being able to find something without it being a "hardship" to purchase, presumably over price or coverage.

This change was brought about when a number of Democratic Senators, some of them facing a tough reelection battle, demanded this concession.

The change was made without consulting the health insurance industry and it was a surprise to them. It is another Obamacare change months after their 2014 rates were set under the presumption all of these cancelled policyholders would be paying a lot more premium into the pool than they pay today.

I have to believe this will not be the last concession to Democrats under reelection pressure.

One has to wonder how this can't other than further undermine how people feel about Obamacare––particularly its fairness––and taking their "social responsibility" to sign-up seriously.

With all of the Democrats whose reelection is threatened, how many more of these should we expect?

When it's all done, will this make those who lost their health plans happy?

Well, they had a health plan they presumably liked and/or could afford. Obamacare forced its cancellation. Now the administration is saying they will not fine them for being uninsured and will make a very high deductible plan available to them.

It's hard to see how they will see this as an improvement.
http://healthpolicyandmarket.blogspot.com/2013/12/the-obamacare-slippery-slopewhats-your.html?utm_source=feedburner&utm_medium=email&utm_campaign=Feed%3A+HealthCarePolicyAndMarketplaceBlog+%28Health+Care+Policy+and+Marketplace+Blog%29

New Health Law Frustrates Many in Middle Class


By ,  and 


Ginger Chapman and her husband, Doug, are sitting on the health care cliff.
The cheapest insurance plan they can find through the new federal marketplace in New Hampshire will cost their family of four about $1,000 a month, 12 percent of their annual income of around $100,000 and more than they have ever paid before.
Even more striking, for the Chapmans, is this fact: If they made just a few thousand dollars less a year — below $94,200 — their costs would be cut in half, because a family like theirs could qualify for federal subsidies.
The Chapmans acknowledge that they are better off than many people, but they represent a little-understood reality of the Affordable Care Act. While the act clearly benefits those at the low end of the income scale — and rich people can continue to afford even the most generous plans — people like the Chapmans are caught in the uncomfortable middle: not poor enough for help, but not rich enough to be indifferent to cost.
“We are just right over that line,” said Ms. Chapman, who is 54 and does administrative work for a small wealth management firm. Because their plan is being canceled, she is looking for new coverage for her family, which includes Mr. Chapman, 55, a retired fireman who works on a friend’s farm, and her two sons. “That’s an insane amount of money,” she said of their new premium. “How are you supposed to pay that?”
An analysis by The New York Times shows the cost of premiums for people who just miss qualifying for subsidies varies widely across the country and rises rapidly for people in their 50s and 60s. In some places, prices can quickly approach 20 percent of a person’s income.
Experts consider health insurance unaffordable once it exceeds 10 percent of annual income. By that measure, a 50-year-old making $50,000 a year, or just above the qualifying limit for assistance, would find the cheapest available plan to be unaffordable in more than 170 counties around the country, ranging from Anchorage to Jackson, Miss.
A 60-year-old living in Polk County, in northwestern Wisconsin, and earning $50,000 a year, for example, would have to spend more than 19 percent of his income, or $9,801 annually, to buy one of the cheapest plans available there. A person earning $45,000 would qualify for subsidies and would pay about 5 percent of his income, or $2,228, for an inexpensive plan.
Good Poor, Bad Poor

By 


On Sundays, this time of year, my parents would pack a gaggle of us kids into the station wagon for a tour of two Christmas worlds. First, we’d go to the wealthy neighborhoods on a hill — grand Tudor houses glowing with the seasonal incandescence of good fortune. Faces pressed against the car windows, we wondered why their Santa was a better toy-maker than ours.
Then, down to the valley, where sketchy-looking people lived in vans by the river, in plywood shacks with rusted appliances on the front lawn, their laundry frozen stiff on wire lines. The rich, my mother explained, were lucky. The poor were unfortunate.
Dissenting voices rose from the back seat. But didn’t the poor deserve their fate? Didn’t they make bad decisions? Weren’t some of them just moochers? And lazy? Well, yes, in many cases, my mother said, lighting one of her L&M cigarettes, which she bought by the carton at the Indian reservation. But neither rich nor poor had the moral high ground.
As the year ends, this argument is playing out in two of the most meanspirited actions left on the table by the least-productive Congress in modern history. The House, refuge of the shrunken-heart caucus, has passed a measure to eliminate food aid for four million Americans, starting next year. Many who would remain on the old food stamp program may have to pass a drug test to get their groceries. At the same time, Congress has let unemployment benefits expire for 1.3 million people, beginning just a few days after Christmas.
These actions have nothing to do with bringing federal spending into line, and everything to do with a view that poor people are morally inferior. Here’s a sample of this line of thought:
“The explosion of food stamps in this country is not just a fiscal issue for me,” said Representative Steve Southerland, Republican from Florida, chief crusader for cutting assistance to the poor. “This is a defining moral issue of our time.”
It would be a “disservice” to further extend unemployment assistance to those who’ve been out of work for some time, said Senator Rand Paul, Republican of Kentucky. It encourages them to sit at home and do nothing.
“People who are perfectly capable of working are buying things like beer,” said Senator James Inhofe, Republican of Oklahoma, on those getting food assistance in his state.

LePage stands by DHHS commissioner in wake of ‘incompetence’ claims

By Mario Moretto, BDN Staff
Posted Dec. 21, 2013, at 11:06 a.m.
AUGUSTA, Maine — After months of performance problems and scandals racked the state’s Department of Health and Human Services, Gov. Paul LePage on Thursday lodged a full-throated defense of embattled Commissioner Mary Mayhew.
Democrats in recent months have accused Mayhew and LePage of mismanaging several DHHS programs and facilities, including Riverview Psychiatric Center, and a new transportation service that arranges rides for MaineCare patients to medical appointments.
Mayhew shook off the attacks, saying in a recent email: “My energies are focused on the day-to-day operations of a complex, $3.4 billion organization and service to the people of Maine. I will not spend any time or energy legitimizing unfounded and politically motivated statements with a response.”
During a roughly 40-minute, wide-ranging interview Thursday, LePage spent some time arguing on his health chief’s behalf.
“She is far more right than she is wrong,” he told reporters. “She is doing a tremendous, good service for the people of Maine, particularly the mentally ill, the elderly and the disabled. No one wants to help these people more than she does.”
LePage acknowledged that there had “been a lot of talk lately about incompetence in my administration.” The governor recognized that there had been problems on several fronts, but said he was confident in the state’s ability to right the ship, with Mayhew at the helm.
Coordinated Transportation Services, or CTS, was awarded contracts to dispatch drivers for MaineCare patients in six of eight state service regions. They began operating in August, and it wasn’t long before thousands of complaints of missed or delayed rides inundated state officials, legislators and advocates.
Later, lawmakers learned that CTS had not obtained a performance bond, a type of insurance that would have reimbursed the state for services not provided by the company if its contracts were revoked. The bond was a required part of the contract, and legislators chastised DHHS for not ensuring it was in place before contracting with CTS.
“I still have a concern with CTS, and I have expressed it,” LePage said. “One is that they weren’t able to get a performance bond. No. 2 is that they have six contracts, and for someone not to have a performance bond and have a majority of the contracts, that’s a concern.”
LePage said he didn’t believe all six of CTS’ contracts would be renewed when they expire next year, but said he was pleased with improvements that had been made in the level of service.
Rep. Drew Gattine, D-Westbrook, is a member of the Legislature’s Health and Human Services Committee. He said Friday that he and other lawmakers were not as optimistic about the company’s ability to provide reliable service, and that there’s an appetite among legislators to see the contract terminated.

Obama says ‘we screwed it up’ on health law debut

By Roberta Rampton and Susan Cornwell, Reuters
Posted Dec. 20, 2013, at 8:28 p.m.
WASHINGTON — President Barack Obama on Friday defended his administration’s decision to delay for some people the requirement to buy medical insurance under his healthcare law, but acknowledged that the botched rollout of the policy was his biggest mistake of 2013.
“Since I’m in charge, obviously we screwed it up,” Obama said at his year-end news conference.
Officials said late on Thursday that people whose insurance plans were canceled because of new standards under the law may claim a “hardship exemption” to the requirement that all Americans must have coverage by March 31, or face a penalty.
The sudden change was announced four days before the federal government’s deadline to sign up for coverage that starts on Jan. 1 under the Patient Protection and Affordable Care Act, which was passed in 2010 and set up online exchanges, or marketplaces, for enrollment.
Republicans seized on the latest announcement as further proof that the law known as Obamacare is unworkable, but Obama said it was just a bump in the road.
“I’ve said before, this is a messy process,” Obama told reporters before leaving for Hawaii for the holidays.
Obama said he did not think the waiver for “a relatively small number” of people would shake confidence in the law. “This is essentially an additional net in case folks might have slipped through the cracks,” he said.
Obama, whose public approval numbers have dropped to historic lows over the health law’s debut, focused on a surge in enrollment in December that was a big improvement on the months since the HealthCare.gov website opened on Oct. 1.
He said that more than 1 million people have signed up so far for new coverage under Obamacare through HealthCare.gov, which serves 36 states, and 14 state-run marketplaces.
More than half of the signups came from the federal website during a December rush, he said. “The basic structure of that law is working. Despite all the problems, despite the website problems, despite the messaging problems, despite all that, it’s working,” Obama told reporters.
Still, there are lingering problems. Consumers were unable to access HealthCare.gov for a few hours on Friday, a critical time before the Dec. 23 deadline. Officials said they needed to repair a website error that occurred overnight.
Part of the backlash against the policy came when millions of people received policy cancellation notices, forcing Obama to apologize for a promise he made that people who liked their insurance policies could keep them under the reforms.
U.S. officials estimated that fewer than 500,000 people would be affected by the new delay in the so-called individual mandate. The mandate is a core part of the law that aims to provide coverage to millions of uninsured Americans.
The announcement raises fairness questions, however, because it gives a subset of Americans relief from the requirement to buy insurance. “It is the beginning of the end of the individual mandate,” said Republican Senator Lindsey Graham of South Carolina.
Republicans have opposed the health care law as an unwarranted expansion of the federal government.
Insurance industry trade group, America’s Health Insurance Plans, criticized the change that could divert more consumers away from the new plans offered under Obamacare.
“This latest rule change could cause significant instability in the marketplace and lead to further confusion and disruption for consumers,” AHIP President and CEO Karen Ignagni said in a statement.
Legal experts said it was unclear whether the change would spawn successful legal challenges. Nicholas Bagley, law professor at University of Michigan, said he doubted individuals who are ineligible for the exemption could sue, claiming it was unfair that others received the break.

Posted Dec. 20, 2013, at 11:20 a.m.
While growth in health care spending in the U.S. is starting to slow, the rapid growth that has been customary in recent decades largely wiped out any income gains the average American family experienced in that time.
Fortunately, the conversation has shifted in recent years to focus on better patient outcomes at a lower cost. And since health care spending is so high in the U.S. and especially Maine, there’s plenty of room for improvement.
Of the total amount spent on health care in the U.S., between a third and a half is unneeded, doing nothing to improve patient health. Often, the excess care exposes patients to unnecessary risk. And this waste starts in the exam room.
In Maine, a small initiative is underway aimed at forcing doctors to think twice before ordering that MRI for low back pain or prescribing antibiotics for sinus infections. Four sites in Maine — Penobscot Bay Medical Center in Rockport, Winthrop Family Medicine, Oxford Hills Family Practice in Norway and Bangor’s Penobscot Community Health Care — are piloting “Choosing Wisely.”
It’s a national initiative that has brought together evidence-based recommendations from professional societies that represent more than 60 types of medical specialties. Their recommendations are part of a campaign focused on both patient awareness — influenced by Consumer Reports’ involvement — and doctor training.
Each professional society involved — from the American Academy of Family Physicians to the American Academy of Allergy, Asthma and Immunology — has developed a list of five common tests, procedures and prescriptions that are especially prone to overuse and aren’t shown by research to be effective. The lists encourage doctors and patients to question those practices.
The patient awareness campaign — through posters on exam room walls and other means — is meant to give patients a tool to ask their doctors questions about the right course of treatment. For doctors, the training involved in Choosing Wisely is meant to give them the tools to explain why they might not, for example, order a bone density test for a young female patient.
It’s encouraging to see doctors, through their professional associations, take a role in combating excess spending in health care. Their primary lobbying organization, the American Medical Association, which isn’t involved in Choosing Wisely, has famously resisted major reform efforts throughout its history.
Doctors “are not only stewards of the wellness of their patients, they’re stewards of the resources that we have as a society to deliver that care,” said Dr. Noah Nesin, chief quality officer at Penobscot Community Health Care. “We can’t make our decisions in a financial vacuum.”
It seems simplistic, but patient-doctor conversations — often de-emphasized in a system in which physicians are pressed for time and can’t necessarily bill for conversations — can pay off in the form of higher patient satisfaction, better health outcomes and even a lesser likelihood of medical malpractice lawsuits.
While Choosing Wisely emphasizes evidence-based medicine and effective patient-doctor interaction, it’s unlikely to have a major effect — even if widely implemented — without other health system changes to back it up.
Fix for Cancelled Plans: What's the Impact in Maine?
12/20/2013   Reported By: Jay Field

An Obama administration announcement, late yesterday, exempts people from a tax penalty if their health insurance was cancelled under the Affordable Care Act and they fail to purchase new coverage next year. Consumers in this category also have the option of buying a "bare bones" to protect against catastrophic illness. State officials say relatively few policies in Maine have been cancelled under Obamacare. But one consumer, who did lose coverage, says the admintration's fix won't be much help. Jay Field reports.
Related Media
Mainers React to Fix for Cancelled PlansListen
 Duration:
2:49

Consider, for a moment, the case of Pam Pultz. She's a small business owner in Dover Foxcroft. And a couple weeks ago, Pultz found out she wouldn't be able to keep her existing insurance plan.

"I love my insurance and I rely on it completely," she says. "It is $241 a month. I have a very high deductible. But I have a very high end - I guess you would call it a 'Cadillac plan' - for that low monthly payment."

Pultz says she's in a real bind. Under the Affordable Care Act, she says a comparable plan would cost her $609 a month. The latest Obama administration fix would allow her to apply for a "bare bones" plan to insure her against catastrophic illness. Or she could go without health insurance, but avoid any tax penalty. 

I never thought I'd be an outlaw, but the Affordable Care Act might make me one

I'm not a Tea Party member, and I want Obamacare to work, but the ACA has actually made healthcare less affordable for me

By Diane Snyder
The Guardian, December 20, 2013
I want to – believe me, I do. But I'm not sure I should sign up for health insurance through the Affordable Care Act, because for me, it's not affordable.
Contrary to what you might think, I'm not some Obama-hating Tea Party supporter who resents government interference. I'm pretty far to the left politically, and as a freelancer without employer-sponsored healthcare, I really want Obamacare to work. I don't want to see it repealed, just improved, and if others like me don't sign up, perhaps this solidarity will make America's brave new healthcare world better for everyone – not the extension of the profit-making enterprise it remains. Leaving healthcare to the private sector, instead of expanding government-sponsored Medicare to those under 65, has not meant affordability.
But I hoped for the best when I registered through New York State's "marketplace" website (the name makes clear that this is business first, healthcare second). There you can compare plans from various insurers, and the most "affordable" one (from MetroPlus, without dental) was more than $350 a month – not affordable on my income. I was eligible for a subsidy, which reduced my monthly cost to under $200, but it was still nearly double the $100 I was hoping for.
Much has been written about the premiums being too expensive for people in their 20s, but the price is also a financial burden for me at age 43. Still, had that been the entire cost, I would have signed up. But additionally, each doctor's visit would cost $30, and there was a $1,750 deductible.
Quite a contrast to what I've paid the last several years. As a New York City resident, I've been eligible for a program called HHC Options, sponsored by the city's Health and Hospitals Corporation, which provides truly affordable care to low and moderate-income individuals. It's not insurance, and there's no monthly fee. You pay only when you see a doctor, and your copayment (between $15 to $60) is based on your income.
I felt guilty paying so little when I could afford a bit more, and hoped to contribute that when Obamacare kicked in – just not so much more. My healthcare expenses for last year (around $350) are about equal to the fine I'd pay if I don't get insurance by 31 March (and yes, the president just extended that deadline for some individuals, although now I have to figure out if I meet the requirements).
http://www.pnhp.org/print/news/2013/december/i-never-thought-id-be-an-outlaw-but-the-affordable-care-act-might-make-me-one

Mixed Messages Add Anxiety as Deadline Nears in Health Act

By 


WASHINGTON — For most Americans, Monday is the deadline to sign up for health insurance that takes effect on Jan. 1. It was supposed to be a turning point in the troubled history of the new health care law, the moment when the spotlight would shift from the federal government’s online marketplace to the insurance companies providing coverage to hundreds of thousands and eventually millions of people.
But as the date approaches, a series of decisions by the Obama administration to delay some of the law’s most important provisions and to extend some deadlines has caused uncertainty among insurers and confusion among consumers.

The Peril of Antibiotic Use on Farms

By 

After years of inaction, the Food and Drug Administration has finally taken an important step to reduce the use of medically important antibiotics in animal feed. The goal is to curb the rise of bacteria that become resistant to antibiotics used in both human and veterinary medicine.
Earlier this month, the F.D.A. issued a new policy asking drug companies to revise their labels voluntarily to remove statements indicating that the antibiotics can be used to promote growth in livestock. Such a labeling change would make it illegal to use the antibiotics for that purpose. Companies that comply will also have to ensure that the use of the drugs to treat, control or prevent disease in animals is authorized and overseen by veterinarians.
This step depends on the willing cooperation of the drug makers, which will have three months to tell the agency whether they will change the labels, and up to three years to carry out the new rules. Two major manufacturers have already said they will do so.
The rampant use of antibiotics in agriculture has been alarming. The drugs are given not just to treat sick animals, but added in low doses to animal feed or water to speed the growth of cattle, pigs and chickens, thus reducing costs for the producers. Such widespread use of antibiotics in healthy animals has stimulated the emergence of bacterial strains that are resistant to antibiotics and capable of passing their resistance to human pathogens, many of which can no longer be treated by drugs that were once effective against them.
Each year, at least two million Americans fall ill — and 23,000 die — from antibiotic-resistant infections. Doctors are partly to blame because many prescribe antibiotics for conditions like colds that can’t be cured with such drugs. The Centers for Disease Control and Prevention estimated in September that up to half of the antibiotics prescribed for humans are not needed or are used inappropriately. It added, however, that overuse of antibiotics on farms contributed to the problem.

In No One We Trust

By JOSEPH E. STIGLITZ
In America today, we are sometimes made to feel that it is naïve to be preoccupied with trust. Our songs advise against it, our TV shows tell stories showing its futility, and incessant reports of financial scandal remind us we’d be fools to give it to our bankers.
That last point may be true, but that doesn’t mean we should stop striving for a bit more trust in our society and our economy. Trust is what makes contracts, plans and everyday transactions possible; it facilitates the democratic process, from voting to law creation, and is necessary for social stability. It is essential for our lives. It is trust, more than money, that makes the world go round.
We do not measure trust in our national income accounts, but investments in trust are no less important than those in human capital or machines.
Unfortunately, however, trust is becoming yet another casualty of our country’s staggering inequality: As the gap between Americans widens, the bonds that hold society together weaken. So, too, as more and more people lose faith in a system that seems inexorably stacked against them, and the 1 percent ascend to ever more distant heights, this vital element of our institutions and our way of life is eroding.
The undervaluing of trust has its roots in our most popular economic traditions. Adam Smith argued forcefully that we would do better to trust in the pursuit of self-interest than in the good intentions of those who pursue the general interest. If everyone looked out for just himself, we would reach an equilibrium that was not just comfortable but also productive, in which the economy was fully efficient. To the morally uninspired, it’s an appealing idea: selfishness as the ultimate form of selflessness. (Elsewhere, in particular in his “Theory of Moral Sentiments,” Smith took a much more balanced view, though most of his latter-day adherents have not followed suit.)
But events — and economic research — over the past 30 years have shown not only that we cannot rely on self-interest, but also that no economy, not even a modern, market-based economy like America’s, can function well without a modicum of trust — and that unmitigated selfishness inevitably diminishes trust.

For Mothers-to-Be, Finding Health Care in a Group

By TINA ROSENBERG
Recently in a nondescript conference room near Union Square in Manhattan, eight very pregnant women, husbands, boyfriends and a sister sat in a circle around a small patchwork quilt for two hours and talked about managing the discomforts of pregnancy.
The remedies discussed ranged from the ultimate — epidural: yes or no? — to the prosaic, including that cliché of pregnancy: “I don’t get acid reflux if I have a pickle,” said a woman named Kimberly, to general laughter. “I have two pickles right before bed and it’s fine.”
They drank seltzer and ate strawberries, bananas, hummus and carrots and cereal bars. They watched videos about labor pain and interviewed doulas. The meeting looked like a social gathering or a support group.
It did not look like what it was: a doctor’s appointment.
The Institute for Family Health runs the group, using a model created by the Centering Healthcare Institute. Centering Pregnancy sites provide group medical visits for pregnant women; Centering Parenting sites gather new mothers and their babies for the first year of life.

When they arrived, one by one the patients rotated through stations to get their regular prenatal checkups. They took their own blood pressure, weighed themselves, stretched out on a cot behind a screen so Dr. Insung Min could listen to the baby’s heartbeat, and sat with Dr. Rachel Rosenberg (no relation) in another corner for the traditional chat with the doctor. The usual checkups, however, are only part of the health care the group provides. Being part of a community, the research shows, is also good medicine.
The idea behind Centering (the name refers to care that is centered on the patient) is to help mothers — especially low-income mothers — become more involved in their own care, to acquire the skills and confidence to take care of themselves and their babies, and to have a community.

Administration opens first hole in health law mandate

By David Lauter
9:37 PM PST, December 19, 2013
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WASHINGTON -- The Obama administration has opened a small, but potentially important, hole in a key requirement of the new healthcare law, letting some people who have had insurance policies cancelled avoid the requirement to buy coverage next year.
The change, announced Thursday night in a letter that Health and Human Services Secretary Kathleen Sebelius sent to a group of senators, marks the first exception the administration has allowed to the law's so-called individual mandate.
Under the new policy, people who have received notices that their health plans are being canceled would qualify for hardship exemptions allowed by the law. Under those exemptions, they could buy low-cost catastrophic health plans or skip buying health coverage altogether.
The low-cost plans, which provide bare-bones coverage, are otherwise available only to some people younger than 30.
The number of people directly affected by the change may be relatively small. Administration officials said earlier Thursday that they believed about 500,000 people nationwide had received notices canceling existing policies and had not yet bought new coverage.
Since those people already had purchased coverage at a time when no law required it, a large percentage of them presumably will buy coverage next year rather than take advantage of the new exemption.
But even if that turns out to be the case and the number of people claiming exemptions is small relative to the size of the insurance market, the political impact of the change could be large. The exemption policy constitutes the first crack in the wall for the requirement to buy coverage.
Republicans, who have campaigned fiercely against the requirement that people buy insurance, probably will now seize on the new exemption as a precedent.
Health insurers have insisted the mandate that everyone buy insurance is necessary to keep coverage affordable and were quick to criticize the new policy.
The change, coming less than two weeks before new health plans take effect on Jan. 1, "could cause significant instability in the marketplace and lead to further confusion and disruption for consumers," Karen Ignagni, the head of America's Health Insurance Plans, the industry trade group, said in a statement.


Health Plan Sticker Shock Ahead For Some Buyers

Counselors, who have been helping people choose policies, say many are focused only on the upfront cost, not what the insurance companies agree to pay.

By Carla K. Johnson
The Associated Press
CHICAGO — As a key enrollment deadline hits Monday, many people without health insurance have been sizing up policies on the new government health care marketplace and making what seems like a logical choice: They’re picking the cheapest one.
The Associated Press
Increasingly, experts in health insurance are becoming concerned that many of these first-time buyers will be in for a shock when they get medical care next year and discover they’re on the hook for most of the initial cost.
The prospect of sticker shock after Jan. 1, when those who sign up for policies now can begin getting coverage, is seen as a looming problem for a new national system that has been plagued by trouble since the new marketplaces went online in the states in October.
For those without insurance – about 15 percent of the population– “the lesson is it’s important to understand the total cost of ownership of a plan,” said Matt Eyles, a vice president of Avalere Health, a market analysis firm. “You just don’t want to look only at the premium.”
Counselors who have been helping people choose policies say many are focused only on the upfront cost, not what the insurance companies agree to pay.
“I am so deeply clueless about all of this,” acknowledged one new buyer, Adrienne Matzen, 29, an actor in Chicago who’s mostly been without insurance since she turned 21. Though she needs regular care for asthma and a thyroid condition, she says she’s looking for a low monthly premium because she makes less than $20,000 a year.
Hospitals are worried that those who rack up uncovered medical bills next year won’t be able to pay them, perpetuating one of the problems the new health care system is supposed to solve.

Story of the year: Just how radical Obamacare is

By Charles Krauthammer, The Washington Post
Posted Dec. 22, 2013, at 5:59 a.m.
The lie of the year, according to Politifact, is “If you like your health care plan, you can keep it.” But the story of the year is a nation waking up to just how radical Obamacare is — which is why it required such outright deception to get it passed in the first place.
Obamacare was sold as simply a refinement of the current system, retaining competition among independent insurers but making things more efficient, fair and generous. Free contraceptives for Sandra Fluke. Free mammograms and checkups for you and me. Free (or subsidized) insurance for some 30 million uninsured. And,mirabile dictu, not costing the government a dime.
In fact, Obamacare is a full-scale federal takeover. The keep-your-plan-if-you-like-your-plan ruse was a way of saying to the millions of Americans who had insurance and liked what they had: Don’t worry. You’ll be left unmolested. For you, everything goes on as before.
That was a fraud from the very beginning. The law was designed to throw people off their private plans and into government-run exchanges where they would be made to overpay — forced to purchase government-mandated services they don’t need — as a way to subsidize others. (That’s how you get to the ostensible free lunch.)
It wasn’t until the first cancellation notices went out in late 2013 that the deception began to be understood. And felt. Six million Americans with private insurance have just lost it. And that’s just the beginning. By the Department of Health and Human Services’ own estimates, about 75 million Americans with employer-provided insurance will see their plans canceled. And millions of middle-class workers who will migrate to the exchanges and don’t qualify for government subsidies will see their premiums, deductibles and co-pays go up.
It gets worse. The dislocation extends to losing one’s doctor and drug coverage, as insurance companies narrow availability to compensate for the huge costs imposed on them by the extended coverage and “free” services the new law mandates.
But it’s not just individuals seeing their medical care turned upside down. The insurance providers, the backbone of the system, are being utterly transformed. They are rapidly becoming mere extensions of the federal government.
Look what happened just last week. Health and Human Services unilaterally and without warning changed coverage deadlines and guidelines. It asked insurers to start covering people on Jan. 1 even if they signed up as late as the day before and even if they hadn’t paid their premiums. And is “strongly encouraging” them to pay during the transition for doctor visits and medicines not covered in their current plans (if covered in the patient’s previous — canceled — plan).
On what authority does a Cabinet secretary tell private companies to pay for services not in their plans and cover people not on their rolls? Does anyone even ask? The bill itself is simply taken as a kind of blanket authorization for HHS to run, regulate and control the whole insurance system.

Note: What Krauthammer seems to miss is that a government takeover of health insurance is a good thing, 
while a government takeover of health care is not such a good thing - e.g. the Canadian system 
has "socialized" insurance without socializing the delivery of care.
-SPC





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