Relevant and even prescient commentary on news, politics and the economy.

Focusing on Congressional Efforts to Control Healthcare Pricing, They Do Not

Perhaps, I am on the wrong side of the argument on how to control healthcare costs of which one proposed solution is a part of the latest budget bill passed in a bipartisan effort in Congress on December 19, 2019. Others may disagree with me on my thoughts.

What was passed was superficial and will not fix the rising cost of healthcare which drives increased healthcare insurance deductibles and premiums. Oh, and surprise billing in hospitals still lives! Fixing surprise billing was set aside by Congress.

The latest bill (H.R. 1865) to impact the ACA passed the House 297 to 120 and the Senate 71 to 23. In the bill, the Health Insurance tax will be repealed in 2021, the Cadillac tax in 2020, and the Medical Device tax in 2020. The repeal of the three taxes will result in the loss of a projected revenue of $373.3 billion over 10 years. The largest projected revenue loss will come from repeal of the Cadillac tax ($197 billion), followed by the Health Insurance tax ($150.8 billion), and the Medical Device tax ($25.5 billion).

All repealed for Congress to be able to say we pushed back on costs and helped to prevent the rising costs by blocking mandated tax increases. Except they also undercut the ACA and increased the annual deficit.

I am going to skip the history involved in the delays of these taxes and go right to my objections after I tell you what these taxes were expected to do.

Cadillac Tax: As Newsweek reported in 2017, the so-called “Cadillac tax” would have capped the tax deductions individuals could claim based on their health insurance benefits. It would have imposed a 40 percent excise tax on employer-sponsored plans that exceeded $10,000 in premiums per year for a single person or $27,500 for a family. The Cadillac tax was set (for the umpteenth time) to take effect in 2022. The reasoning for this tax was to capture special plans for Execs whose plans were hidden amongst the regular plans.

Health Insurance Tax: The CMS’ Office of the Actuary calculated that the net cost of private health insurance grew 15.3% in 2018, up from 9.5% in 2017, the biggest increase since 2003. The actuaries said this was driven largely by the temporary reinstatement of the Health Insurance tax, which was suspended by Congress this year. Actuaries can say what they wish too, except it ignores the last 10 years of increased healthcare costs untouched by this tax.

Medical Device Tax: The medical device tax was a 2.3 percent excise tax on gross sales of medical devices used by humans (not animals) such as x-ray machines and hospital beds. It was implemented in 2013 but had been suspended since 2015, according to the Tax Foundation. It was thought the increase in healthcare would spawn the sales f equipment (it has) and the revenue  would subsidize the ACA.

Preventing the implementation of these taxes does “nothing” to forestall increasing healthcare insurance deductibles and premiums and healthcare costs. Also keep in mind, portions of the ACA were passed under Reconciliation, the loss of revenue from the tax cancellation may cause other cuts to the ACA as the ACA must be deficit neutral at 10 years which is 2020 (?). Fix the issue!

Past the leap, what will impact the rising costs and resulting prices of healthcare and healthcare premiums.

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Merry Christmas Bears and Others

2019 has been a strange year. I hope for  a better 2020 with  a Happy Landing later in the year.

In the spirit of Christmas; Be Safe, Enjoy Family, Be Thankful for Life, Give Freely to Others, Eat Hearty and Drink some good Beer, Wine, or Liquor of your choice, and Relax.

The appropriate saying for the time?

Then the Grinch thought of something he hadn’t before! What if Christmas, he thought, doesn’t come from a store. What if Christmas…perhaps… means a little bit more!

 

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The field was rigid and closed until Mark Thoma’s Economist’s View opened the debate to all comers

Noah Smith’s The End of Econ Blogging’s Golden Age, Bloomberg Opinion. December 17, 2019.

“If someone asked you to name the greatest economics blogger of all time, you might name Paul Krugman, or my Bloomberg Opinion colleague Tyler Cowen. But there’s a third name that deserves to be on that short list: Mark Thoma, an economics professor at the University of Oregon. On Friday, Thoma announced a well-deserved retirement. But the changes his blog made in the economics profession will endure.

Thoma’s blog, Economist’s View, began in 2005.”

The rest of the article can be found on the link provided above. As I was told, Angry Bear Blog linked to Economist’s View in the beginning.

Mark announced his retirement Friday, December 13, 2019. Best of luck going forward Mark.

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“Ignorance has Won”

“I didn’t find half a dozen people,” John Richards (96) said on his website about the past in his search for associates to join him.

Mr. Richards started a society after seeing the “same mistakes over and over again” in the usage of the Apostrophe. He had hoped he would find half a dozen people who felt the same way and join him.

“Instead, within a month of my plaint appearing in a national newspaper, I received over 500 letters of support, not only from all corners of the United Kingdom, but also from America, Australia, France, Sweden, Hong Kong and Canada.”

And the rules?

Apostrophes are used to denote a missing letter or letters and are used to denote possession. Apostrophes are never ever used to denote plurals.

John Richards started the Apostrophe Protection Society in 2001 to make sure the “much-abused” punctuation mark was being used correctly. After 18 years, he will be closing down the society.

Fewer people and organizations are caring about the correct use of the apostrophe in the English Language.

Apostrophe society shuts down because ‘ignorance and laziness have won,” Tim Baker, Evening Standard, December 1, 2019

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Something to keep in Mind when you enroll in Medicare Advantage Plans

It is not a dirty or hidden little secret. Insurance companies offering MA plans do not tell you that once you are in their plan, you are there potentially forever. Returning to traditional Medicare is ok but, getting a Medigap Plans to supplement the gap may lead to rejection or much higher premiums if you choose to come back and especially if their are pre-existing conditions.

The same as the Commercial MA companies, Medicare.gov websites are not always clear about the process of transferring out of MA to traditional Medicare and obtaining a Medigap plan. Being unconditionally accepted by a Medigap plan is guaranteed only within the first 12 months after enrolling in Medicare at age 65.

In 2019, one-third (34%) of all Medicare beneficiaries, 22 million seniors were enrolled in Medicare Advantage (MA) plans.

As most know, Medicare consists of Part A, B, C, and D plans. Part A has no premiums, Part B has a premium (paid to the Gov), and Part D (prescriptions) has a premium which is paid to commercial healthcare insurance. To cover the gaps in A & B and the gap, you buy supplemental insurance which is about the same as Part B in premium cost. Unless Medicare rules change, the most one can experience is changes in premiums.

In contrast, Part C or Medicare Advantage plans can cover a broad array of health services at a low cost. Unless one gets sick, the price for MA Plans can remain low. If one does gets sick, out-of-pocket costs can increase in later years. Once in an MA plan, getting out can result in less affordability. Medigap plans in all but four states can and do reject people or require higher premiums if you caome back to them after Medicare Advantage Plans. Diabetes, heart disease, or even a knee replacement can be criteria for exclusion.

“After Mills underwent a mitral valve repair and suffered a mild stroke with no lasting effects, the San Diego resident’s plan now charges him hundreds of dollars in monthly copays for drugs and other medical services. He had to pay $295 a night for his hospital stay.

But there was a much bigger shock. Mills, 71, learned that switching out of his MA plan he would incur exorbitantly higher costs the next time he needs a serious medical intervention. If he moves to traditional Medicare and a prescription plan, he will still need a supplemental Medigap plan to pick up his 20% copays and deductibles.”

Again, this is something most people do not know, an should know before they make any move to Medicare Advantage plans. Furthermore, there are many MA plans which have narrow networks to which you must go to. In comparison, traditional Medicare pays where ever you go in the United States.

Medicare Advantage Enrollees Discover Dirty Little Secret – Getting Out is a lot harder than Getting In, MedPageToday, Cheryl Clark, December 3, 2019.

A Dozen Facts About Medicare Advantage in 2019, Gretchen Jacobson, Meredith Freed, Anthony Damico, and Tricia Neuman, KFF, June 06, 2019

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The New Pharmacy Price Transparency Rule Put Forth by President Trump

The New Hospital Price Disclosure Rule Is Important, But Only A First Step,” Health Affairs, James C. Capretta, August 26, 2019

The new proposed regulation on hospital price transparency is an important step toward consumer-friendly price information. The regulation introduces into federal price transparency, requirements such as the concepts: of service standardization, consumer-friendly organization and terminology, and bundling of which all of are crucial for a marketplace to become price competitive.

As the administration acknowledges, this regulation by itself will not fully address the opacity of today’s market. Additional disruptive changes will be necessary to give consumers usable pricing information. Among which, meaningful transparency requires stricter standardization of the services being priced and “all in” pricing matching how consumers think about the services they need.

Additionally, the reform of the nation’s insurance payment system must be integrated into the price transparency effort to ensure consumers are price sensitive across a wider range of services. Suppliers of services will only compete on price when significant numbers of consumers have strong incentives to seek out low-cost alternatives.

Me: To which I would add there is a big difference between price and cost and it is not being acknowledged.

The Trump administration on Friday put forth two long-anticipated rules that increase price transparency for both hospitals and insurers.

The CMS’ hospital price transparency requirements finalize changes that require health systems to make their standard fees available on-demand and online. The “transparency in coverage” proposed rule would require health plans, including employer-based plans, and group and individual plans, to inform participants, beneficiaries and enrollees about price and cost-sharing information ahead of time.

The agency hopes increased price transparency will boost competition among hospitals and insurers to drive down healthcare spending.

Under the new price transparency rule, hospitals must publish their standard charges online in a machine-readable format. They will need to create at least 300 “shoppable” services, including 70 selected by the CMS.

Under the rule, hospitals would have to disclose the rates they negotiate with third-party payers, which some experts say could be illegal.

Hospitals get ready to fight CMS in Court over Transparency,” FierceHealthcare, Robert King, November 15, 2019

More after the leap!

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Mapping the Land

I looked at this at first, wondered what it depicted, thought it might be a piece of art, and puzzled over it a bit. It is a topographical depiction (Lidar) of the Mississippi River. If you look closely, you can see roads and various plots of land in addition to the movement of the river bed over time and the various elevations.

One of the key techniques used in modern cartography has its beginnings in 17th century map-making. Relief shading techniques as shown by the darker and lighter areas give dimensions such as height (lighter) and depth (darker) areas to maps so a viewer of the map could understand the terrain. For a hiker, an army, someone buying a piece of land, or building a fence, etc. could understand the area depicted and prepare for and not be surprised by it upon coming upon it. Today, GIS specialists can use applications like Photoshop and other digital software to create relief shading online.

 

What is this and how is this done? “Vibrant maps from aerial laser data — known as Lidar — show the position and elevations of the Mississippi river. This stretch shows historical movement and shape-shifting across three counties in Mississippi.” If you click on the link, you can also see the hand drawn topographical maps charted by Harrold Fisk in 1944 using aerial photography. In themselves, these  skillfully drawn maps are pieces of art which would depicting the same.

The National Geographic article shows similar topography maps of  “The Mississippi River, it’s hidden history, as uncovered by lasers” The laser depicted images are done by Daniel Coe a cartographer for the Washington Geological Survey using Lidar, a system of laser pulses also sent from aircraft to measure topography.

So, why the interest? Prior to leaving the Marine Corp, I had an opportunity to study surveying and also topography mapping as a way to a head start in finding a job once discharged. When I left the Corp, jobs were not plentiful, and I went to college instead. Even so, I was prepared for the transition by doing something in which I had an interest.

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Good Morning

I hope everyone had a good Thanksgiving with family, friends, or strangers.

My young and pretty 20 – something year-old wife and I were traveling years ago. We were standing in a long line into the only restaurant at O’hare airport. It was a couple of days before a holiday and the airport was packed.

If you frequent O’Hare today, you must be thinking; “What is he thinking? O’Hare has many assorted places to dine.” Like I said this was years ago. O’Hare was not as big then as it is today.

The line was moving slow and we finally arrived at the front. There were two men dressed in suits behind us, a rarity today, unless you are traveling for business and doing a meeting that same day . . . which I have done at times. The restaurant greeter came to get us.

I asked my wife if she minded if others sat with us as we were going to have a table for 4. She did not mind which I already knew and even so, thought I had better ask first. I asked the greeter if it was ok and of course she did not care as it was two more people out of her way. I turned to the two men.

“We have a table for four and wondered if you might want to join us as the restaurant is terribly crowded.” Of course they did not mind. The one had limited time in which to eat. We were thanked for our courtesy and kindness to include them, strangers, at our table. I do not remember their names. It did not really matter to me. That we could help someone else was more important.

My daughter who looks like a young version of her mom returned from Guatemala a few days ago. Each year, she travels there. No, it was not a vacation. She is a registered nurse (ER) and travels there with a team of nurses, techs, doctors, and surgeons to render aid in this part of North America to those in need. This time they performed 400 hundred surgeries during the 8 days they were there. She sends us pictures of the area and what facilities she visits. Each volunteer pays for their own transportation to there.

My youngest son has taken on similar acts of kindness and assistance to people in need as well as my oldest son. I am sitting here in the quiet of my oldest son’s family room. Everyone is still asleep after having a nice Thanksgiving meal yesterday with my daughter-in-law’s family.

We are doing well in life. I point to two examples of showing a degree of kindness and empathy for others regardless of who they are or from where they emanated. An action of kindness can be whatever you wish it to be towards others and it does not have to be of great magnitude. What matters is whether you will extend yourself to a stranger in need.

I hope you had a good Thanksgiving Day wherever you were yesterday whether it be with family, friends, or strangers. It is a day meant to be with others no matter where you were.

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Plastic: Part of the Problem . . . Part of the Solution – Part 4: Efficient Use of Recyclates

The problem of plastic waste seems insurmountable. The good news is plastic recycling is on the rise and that is good for the circular economy. In parts 1, 2 and 3, we delved into the role of the waste management and recycling industry and how material sorting technologies can help. Part 4 is all about the increased use of recyclates as an essential part of properly closing the plastic cycle.

The plastics industry is facing a great many challenges. Harvesting recyclates from waste is only worthwhile if the plastic has been properly sorted and does not contain any metal, and if the products made from the secondary raw material are similar in quality to those made from new plastic.

Manufacturing recyclates from plastic waste is the first step. But in order to fully close the plastic cycle, more recyclates need to be used in the manufacturing of new products. This is a lucrative business for plastics processors, as recyclates are cheaper than new materials.

With material costs in the plastics industry accounting for 40% to 80% of total expense, depending on the segment, using recycled materials can significantly increase profitability. In addition, the secondary raw material in its ultra-pure state has practically the same characteristics as new plastic.

Yet there are still a number reservations in the industry when it comes to recyclates. The quality of the input material is particularly important in this regard. Recyclates must be free from any contamination to protect processes and machines from damage and ensure that the final products meet high standards of quality.

Survey on the Use of Recyclates by Processers on the Leap

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