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

BMI and your health insurance premiums

While Rusty touched on this aspect of the role of employers in enforcing some notion of promoting reducing cost for premiums through wellness programs using ‘carrot or stick’ incentives comes further discussion via Truthout on the changing role of health insurance in America:

Numerous companies have redefined their health care incentive programs, focusing on punishment instead of positive reinforcement. Moreover, many of these so-called “health” initiatives center around a single goal: losing weight.

CVS Caremark, which employs over 100,000 individuals in the United States, recently announced that employees who do not submit to body mass index (BMI), blood glucose, and cholesterol testing and report their results to the company’s benefit firm will face a fine that amounts to $600 annually.

In a statement released by the company, CVS outlines the rationale behind its new program. It states in part: “our benefits program is evolving to help our colleagues engage more actively to improve their health and manage health-associated costs. An initial step to accomplish this goal is a health screening and wellness review so that colleagues know their key health metrics in order to take action to improve their overall health, if necessary.”

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Health Care Thoughts: Carrot and Stick

by Tom aka Rusty Rustbelt

Health Care Thoughts: Carrot and Stick

The Obama administration has issued regulations allowing employers to use both incentives and penalties in wellness programs.

There is some controversy here, such as:

employer plans setting and enforcing blood pressure and cholesterol standards

punishing smokers (less controversial perhaps) – is this punishing addicts?

there are many age and racial determinants in health, and civil rights advocates worry about back door age and race discrimination

There are limits and requirements on employers and the incentives/penalties. Employer cannot enforce penalties without offering wellness programs and services (smoking cessation tied to a smokers penalty). Nothing in the rules negates any ADA standards.

Really complicated. HT: New York Times 5/30/2013

 

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31 Million Uninsured Under the PPACA . . .

Over at “Economists View,” Anne and Muses are having a discussion over why some 30-something million will be uninsured under the PPACA Paul Krugman: The Obamacare Shock. The conversation goes back and forth citing references without giving any real explanation of what the 31 million is composed of and why they will not be covered. For some reason today, I can not log-in and add to the conversation with an explanation of the 31 million.

Perhaps it is a little known fact; but states today can, if they so choose to do so, qualify Medicaid coverage for everyone. States can also cover beyond 100% of FPL which some states do. The majority of states do not cover certain single adults as determined by each state’s rules for Medicaid coverage.

“Currently, few states cover non-disabled, non-pregnant parents up to 138 percent of FPL in Medicaid, and even fewer states cover such adults without dependent children. At present, only 18 states provide comprehensive Medicaid coverage to parents at or above 100 percent of FPL ($18,530 for a family of three in 2011), and the median state covers working and non-working parents up to only 63 and 37 percent of FPL, respectively. The majority of states do not cover non-disabled, non-pregnant adults without dependent children at any income level, and many low-income women only qualify for Medicaid coverage when they are pregnant. As has been noted, ‘it’s a very common misconception that Medicaid covers all poor people, but that’s far from the truth.'”

“Nationally, just over half (53 percent) of the uninsured who would be newly eligible for Medicaid are male. This is not surprising, since, as indicated above, Medicaid has historically had much broader eligibility for parents than for adults without dependent children, and a high proportion of these parents have been single mothers. ‘Overall, 47 percent of the uninsured who would be made newly eligible for Medicaid under the ACA are women.” Opting into the Medicaid Expansion under the ACA: Who Are the Uninsured Adults Who Could Gain Health Insurance Coverage?.

The expansion of Medicaid to 138% of FPL under the PPACA would have mandated state coverage for single adults not qualifying for the PPACA and its subsidies. The SCOTUS decision to allow states to back out of the expanded Medicaid coverage up to 138% FPL was previously mandatory under the PPACA with the threat of the removal of Medicaid subsidies. States not expanding Medicaid coverage will maintain the status quo and many who would have been covered under Medicaid may now go uninsured as they will not qualify for the PPACA. The state exclusions for which many blogs, politicians, and conservative think tanks such as Cato blame the PPACA as causing is the result of states not expanding Medicaid and accounts for 15.1 million uninsured of the potential 31 million. Another estimated 11.2 million are considered to be illegal residents of the US who will not be covered by the PPACA. Treatment of Non-Citizens under the PPACA and do not have healthcare insurance. The balance of the uninsured is made up of those exempt from being insured, those opting out and paying the penalty, those who may not understand how to apply for Medicaid, etc.

Without a doubt, Republicans hope the constituency will not understand the issues and blame the PPACA for the lack of coverage of single adults by using the 31 million as a political numeric. It is also doubtful whether there is a real concern by politicians for the coverage of illegal residents. I also believe it to be ironic when Republican-lead states are concerned a Republican-controlled House may pull the carpet out from under them by negating funding for the expansion of Medicaid in the future.

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Health Care Thoughts: I really shouldn’t write this…..

by Tom aka Rusty Rustbelt

Health Care Thoughts: I really shouldn’t write this…..

This will, if Dan publishes the piece, offend someone for certain.

I have a libertarian do-your-own-thing streak, but something recently really struck me as a tragic image.

So I am in the grocery store, and coming around the aisle hear the beep-beep of a back up alarm on a power cart. I often try to help power cart shoppers reach items on higher shelves, especially the little old ladies and men wearing veteran caps.

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What Obligations Do Mainstream Media Editors (e.g., The Washington Post’s) Have to Bar Their Regular Political Columnists (e.g., Michael Gerson) From Stating Bald Misrepresentations of Fact?

Compare:

When people realize that their most personal, sensitive, intimate, private health-care information is in the hands of the IRS that’s been willing to use people’s tax information against political opponents of this administration, then people have pause and they pull back in horror.

— Michele Bachmann, on ABC News/Yahoo, May 20 (H/T Glenn Kessler, in a spot-on takedown today)

And:

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The Internal Blue Cross/Blue Shield Revenue Service. Awesome!

“Since the I.R.S. also is the chief enforcer of Obamacare requirements, [Michele Bachmann] asked whether the I.R.S.’s admission means it ‘will deny or delay access to health care’ for conservatives. At this point, she said, that ‘is a reasonable question to ask.’ ”

— Bob Unruh, Why Obama Released Embarrassing IRS Bombshell, WND Exclusive, May 13

Yes, that’s right.  You read the title of this post correctly.  Obamacare turns out to be a single-payer healthcare insurance program, after all!

Or so says Michele Bachmann, anyway.  And she certainly would know.

This is great news, in my opinion.  But, I mean, who knew?  I’d thought until now that the only role that the IRS plays in Obamacare was to collect the penalty, via the tax apparatus, from individuals who aren’t insured through their (or a family member’s) employer and who choose to pay the penalty rather than buy insurance in the private market.  In other words, that the IRS role concerns only people who don’t have healthcare insurance, not people who do.

But apparently I was wrong.  I haven’t actually read the statute, which is infamously long, and somewhere in it, it requires all healthcare insurance premiums to be paid to the IRS.  The  name of which, once the full law kicks in next year, will be the Internal Blue Cross/Blue Shield Revenue Service.

Yes, the agency will still collect ordinary income taxes as it does now.  But it also become our healthcare insurer. Unless you are a conservative, in which case it will still require you or your employer to pay your insurance premiums to that agency. Or maybe just through that agency; I’m not sure which.  As I said, I haven’t read the statute, so I don’t know whether this will be like the Medicare system, or instead the agency will forward the premiums to your chosen private insurer, at least unless you’re a conservation, in which case the agency might use your premiums to pay for daycare for the young children of liberals.

Or maybe I’m misunderstanding completely, because of wishful thinking on my part.  Maybe instead, the statute requires the private insurance companies to get the agency’s approval before agreeing to pay a policyholder’s medical bills.

Yeah, that must be it.  The statute requires the private insurance companies to get the agency’s approval before agreeing to pay a policyholder’s medical bills. It’s odd, though, that three years after the statute’s enactment, this has never been mentioned before. By anyone.  Which makes that report about the Bachmann interview truly an exclusive.

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Medicare Claim Costs Growth Under 1% in 2013??? Why?

All nine of S&P Healthcare Economic Indices showed slower annual growth rates for February 2013 compared to January 2013. As measured by the S&P Healthcare Economic Commercial Index, healthcare costs covered by commercial insurance plans rose by 4.62% in February, down from +5.41% reported for January. Annual growth rates in Medicare claim costs increased by 0.78%, according to the S&P Healthcare Economic Medicare Index, down from +1.40% recorded last month.” Annual Growth Rates Decelerate in February 2013;  https://www.spice-indices.com/idpfiles/spice-assets/resources/public/documents/11477_sphealthcare-press-release.pdf?force_download=true

heathcare

When economists such as Tyler Cowen and Congressional leaders such as Ryan and McConnell are calling for cuts in Medicare, and Medicaid;  one has to wonder what the basis is for doing so. Medicare and its associated programs have dropped below 1% cost claims growth in 2013. According to Glen LaFollette and Louise Sheiner, healthcare in the US is sustainable at 1% growth and will not crowd out the other necessities. “An Examination of Health-Spending Growth in the United States: Past Trends and Future Prospects”  http://www.bancaditalia.it/studiricerche/convegni/atti/fiscal_sustainability/session_3/Follette%20Sheiner.pdf

 

What gives?

For partisan and give-Barrack Obama-no-quarter-reasoning, politicians claim the PPACA will have no or little impact on healthcare costs. Hoping for pie-in-the sky universal health care today, some rather reasonable writers and blogs have also joined the bandwagon of claims against the PPACA (or Barrack Obama) and are advocating the same lack of impact. Train-wreck Baucus successfully scuttled single payer healthcare insurance (with the help of Lieberman) and kept prominent advocates away from the bargaining table having  protestors arrested. Baucus now advocates backing away from the PPACA. Then what has made government healthcare programs decrease in cost? Maybe the last couple of years of decreasing cost growth are the result of the healthcare industry and the healthcare insurance companies taking heed to the needs of the population and developing a heart??? Naaaawwwwwww, I don’t think so. It is still the same industry; but as a result of the PPACA, the industry is rapidly preparing for the implementation of the PPACA.  Some answers PPACA:

hard times or recession, accounted for only about 1/3 (37 percent) of slower growth in the nation’s health care bill.  My guess is that most of the effect was felt in the private sector.

“During 2009–11 per capita national health spending grew about 3 percent annually, compared to an average of 5.9 percent annually during the previous ten years. job loss and benefit changes that shifted more costs to insured people. We found that these enrollees’ out-of-pocket costs increased as the benefit design of their employer-provided coverage became less generous in this period. We conclude that such benefit design changes accounted for about one-fifth of the observed decrease in the rate of growth. However, we also observed a slowdown in spending growth even when we held benefit generosity constant, which suggests that other factors, such as a reduction in the rate of introduction of new technology, were also at work.” The Independent Payment Advisory Board and Medicare Spending: New Research Suggests a Change in Our Medical Culture; Maggie Mahar, Healthbeat Blog, http://www.healthbeatblog.com/2013/05/the-independent-payment-advisory-board-and-medicare-spending-new-research-suggests-a-change-in-our-medical-culture/

and the chief Actuary for Medicare?

“Paul Spitalnic, sees the recent past as prologue – at least to the near future. On April 30, he sent a letter to Marilyn Tavenner, acting Medicare administrator, saying that based on the most recent numbers, the projected 5-year average growth in Medicare per capita spending ia 1.15% , and the 5-year average growth target is 3.03 percent.” As a result, he advised Tavenner that we won’t need the IPAB until 2016—at the earliest.”  The Independent Payment Advisory Board and Medicare Spending: New Research Suggests a Change in Our Medical Culture

If Spitalnic’s and the S&P Healthcare Indice projections prove true over the next few years; Medicare will not be growing faster than GDP and healthcare costs would not be adding to the deficit or crowding out spending on education, infrastructure or the environment as predicted. There is no evidence the trend will not continue and Medicare cost growth is at the lowest level since its beginnings.

Health Beat Blog: “Michael Chernew, a Harvard health policy professor and co-author of the paper, told Modern Healthcare that slower growth was due to more than the weak economy or increases in out-of-pocket spending as employers shifted costs to employees. Instead, the results appear to point to a shift in culture and physicians who have who have grown more focused on greater efficiency in the last five years.” Economy Less of a Factor for Healthcare Spending, New Studies Say“; Melanie Evans; Modern Healthcare;  May 6, 2013

Or perhaps it is what many have said with the advent of the PPACA, a change has and is being brought about in how we are being treated. The overall cost model is moving from a services for fees treatment scenario to a better outcomes and efficiencies for fees scenario.

“The cost saving measures within the PPACA appear to be keeping medical expenses flat during the implementation of efficiencies. For example, in 2012, the average price paid for medical care, doctor visits, operations, glasses, etc. rose at about the same rate as other prices in the economy or less than 2%. Healthcare share of the economy in 2011 shrank from 17.12% to 17.04% due to other aspects of the economy growing faster. BEA Analysis; USA Today; Health Care Spending is Transferred Out of ICU

“‘Until now, the government has paid on volume. Now, it’s trying to pay more on quality,’ says Person, a doctor of internal medicine, as well as CEO of Essentia, which has 18 hospitals and 68 clinics.” For example: “Essentia now provides 300 of the sickest congestive heart failure patients with electronic home scales that relay information, such as weight and symptoms, to a nurse several times a week. The steady monitoring of small things has cut 30-day admissions to less than one-tenth of the national average and saved millions of dollars.”  Health Care Spending is Transferred Out of ICU; USA Today; March 4, 2013;  http://www.usatoday.com/story/news/health/2013/03/04/health-care-spending-growth-slows/1963165/

This is precisely what was provided to me by the Great Lakes Home care nurses. Each morning I would weigh in and take my blood pressure three weeks after my open-heart surgery. The nurse would come once per week to my home to which I was confined and check on me. These type of visits by nurses also gave me an early exit from the hospital initially even though the visits were 2-3 times per week and at a far lower cost than keeping me confined to the hospital (I was bouncing off the walls and wanted out).

“One big change is the government’s revived push toward managed care. The government wants to pay a lump sum for a patient or diagnosis, demand higher standards and expect the medical provider to get the job done for that cost. Rather than cutting reimbursement rates, the government is raising the bar for what it expects for every dollar it spends.” Health Care Spending is Transferred Out of ICU

says Person, the hospital chief: It is now the law, and it has teeth. We’re getting paid less,” he says. “We have to be more productive and efficient.” Health Care Spending is Transferred Out of ICU. USA Today; March 4, 2013

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Health Care Thoughts: Welcome to The Matrix

by Tom aka Rusty Rustbelt    from a commentary I am writing……

Health Care Thoughts: Welcome to The Matrix

Big Data, Data Mining, Data Analytics

Health care providers create and store massive amounts of data generated by clinical and business functions. This hot new term for this mass of data is “big data.”

Until recently, the sheer bulk of the data prevented regular analysis, with summaries of key data sets being the most efficient use of executive and IT resources.

Huge leaps forward in data storage, data processing speeds and data analysis algorithms will allow the analysis of massive amounts of data, while health care reform will require the analysis of massive amounts of data.

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Health Care Thoughts: This is a little strange

by Tom aka Rusty Rustbelt

Health Care Thoughts: This is a little strange

California’s health care exchange is often cited as being as the forefront of complying with the letter and spirit of Obamacare.

So it seems a little strange that California has exempted most exchange information from the public records laws, including information about the contractors doing most of the set-up and operations.

There seems to no indication why this would make sense or be necessary, but questions are being raised.

For more: http://www.huffingtonpost.com/2013/05/09/california-health-exchange-secrecy_n_3247617.html

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In the Short Run, We Are All Dead. At Least According to That New Oregon Medicaid Study.

Well, we AB types–readers and writers, alike–are familiar with John Maynard Keynes’s famous line that “In the long run, we are all dead.”  By which he either meant that economists, if they are to be useful, must try to predict and recommend short-term government policies that avoid or help end current, severe economic downturns, rather than just predicting long-term economic results, or instead he meant that since he was gay and had no children, he didn’t care about the long-term economy and wanted economic policy to concern itself only with the here-and-now and never with the long run.

It’s a fielder’s choice, if you ask me.  Which is why you shouldn’t ask me.  And you shouldn’t ask Niall Ferguson either.

Conveniently, in the very same week in which high-profile economists are debating what Keynes meant, we learned that a study of the effects of access to healthcare insurance (in that case, through Medicaid) shows that access to healthcare does not reduce cholesterol levels, blood pressure, or blood-sugar levels, over a two-year period among people who have elevated levels of one of another of these ailments and who were not previously receiving medical treatment for them because they had no insurance. At least it did not in Oregon, where the study took place, for the sampling involved.

The study is being widely interpreted as showing that healthcare insurance does not improve actual health, and has lead some people to suggest that this means that we should not have healthcare insurance at all, whether publicly or privately financed.

But that’s ridiculous. Or at least it’s insufficient as a response.  What the study obviously shows is not simply that we shouldn’t have healthcare insurance but that we shouldn’t have healthcare. We should not have medical care.  At all.  No doctors, no hospitals, no prescription drugs, no medical devices.  None of it.  We’re spending huge amounts of money on healthcare, and now we know that it doesn’t improve health!

In the long run, we are all dead.  And if you have no access to healthcare and have, say, a heart attack, a stroke, cancer, a diabetic coma, or a serious physical injury, you may well die without medical attention even if you would have lived if you’d had medical attention. In the long run, we are all dead, and in the short run those who have a life-threatening illness or injury and no access to medical care may be too, even if access to medical treatment might have lengthened that run quite a bit.*

So we need to end the medical-industrial complex, because, after all, how much difference is there, really, between the long run and the short run?  Lipitor, insulin, and blood pressure medications are okay, I guess, if you have nothing better to spend your money on.

But even if you don’t, why throw your money away on stuff like that, when those things don’t even improve your health?  And, as for the government and Medicaid, and Obamacare, and Medicare, and all that: Well, what’s that line about, families are tightening their belts, so the government should, too?

At least now we’ve finally found the way to stop healthcare inflation.  End healthcare itself.

*Paragraph rephrased and clarified after initial posting, to avoid possible misinterpretation.

___

UPDATE:  This post, though obviously satire targeted at the rightwing’s conclusions about the study, also is intended to raise what seems to me a critical medical question that, to my knowledge, no one else has asked: Does the study indicate that the treatments for high cholesterol, high blood pressure, and early-stage diabetes are ineffectual?

It may be that the diet recommendations given to these new Medicaid patients–less salt, low sugar, lower-cholesterol diets, respectively–weren’t adhered to by most of the patients.  Or it might mean that, once diagnosed with one or another of these illnesses, those in the study who did not get Medicaid nonetheless changed their diet somewhat in light of the diagnosis.  Or it might mean that the medications that were prescribed for the Medicaid recipients who did obtain medical treatment are less effective than thought–which strikes me as something that should have been the headline takeaway, but obviously was not.

If there’s some other possible meaning to the study’s results, what is it?  Seriously.  If these treatments are medically ineffective, isn’t that something that the public should be told?  And if the treatments are effective in the general population, then why would these very same treatments–specifically, the medications–not work with the Medicaid recipients in the study? And, why aren’t these the questions that the pundits are asking?

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