It is a given, Trump’s new executive order is calling for “market-based” pricing or whatever the market will bear pricing to replace Medicare set pricing. Trump sees a conflict between Medicare and the market. Well he is right; but, his solution ll only aggravate the problem of costs. It will drive up costs for everyone in Medicare, destroy traditional Medicare as healthcare for the elderly, steer more people into costly commercial healthcare, reduce Medicare funds at a faster pace, and allow the already profitable healthcare industry to increase profits well beyond what it is today.
But, but are Medicare Advantage Plans ripping people and Medicare off? “Yes they are” a for-profit industry is profiteering by taking advantage of a system of healthcare for which they wanted to be a part. As Trump signed the EO, it is stunning to watch a bunch of seniors up on the stage clapping as el jefe was showing off his executive order allowing commercial healthcare to further pickpocket them, exploit healthcare, and destroy Medicare. All smiles there . . .
Medicare Advantage programs are managed differently than Fee for Service traditional Medicare. Besides providing a series of services not found in regular Medicare, the MA plans instituted a different form of physician/hospital payment called Capitation. Capitation Payments are theoretically used by managed care organizations to control health care costs. The VA is a good example of this type of managing costs. A capitation payment model controls the use of health care resources by putting the physician at a financial risk if too many services are provided to patients or if quality decreases as witnessed by return patients for the same disorder or illness. To ensure patients do not receive suboptimal care through under-utilization of health care services, MAOs measure the rates of resource utilization in physician practices. These utilization reports are then made available to CMS to measure health care quality, utilization, costs, etc.. They are also linked to financial rewards such as withheld fees and bonuses.
Past the leap, I explain how the capitation model can be gamed by Advantage plans.
Yes, Iraq. It has not made front page headlines with so much else going on, but over the last several days there has been an escalating series of protests against corruption in various parts of Iraq and culminating yesterday in Baghdad with one being met by soldiers firing openly upon the demonstarters with the result being about 104 dead and 6,100 wounded. The government of Adel Abdul al Mahdi appears in danger of facing a no confidence motion and falling as it has lost the support of fellow Shia leader al-Sadr, who has a large faction of supporters in the parliament and how apparently is supporting the demonstraters.
Corruption has become an increasingly widespread problem around the world, so much so that we increasingly take it for granted and remain unimpressed by it. And we are tired of hearing about Iraq, a nation we made a mess of, are now mostly not much bothered with, and especially since it appears that ISIS has been largely defeated. Indeed, opposition to the deep government corruption there laid low while the war against ISIS was on. But now with its defeat, many want something done about it.
The appearance of a second whistleblower will muddy the waters for Herr Trump claiming the first whistleblower got his conversation all wrong.
The existence of a second whistleblower — particularly one who can speak directly about events involving the president related to conversations involving Ukraine — could undercut Trump’s repeated insistence that the original complaint, released on Sept. 26, was “totally inaccurate.”
Attorney Mark Zaid is also representing the 2nd whistleblower. It is said this whistleblower has first hand knowledge of some of the allegations made by the first whistle blower. The 2nd whistleblower has made what is called a “protected disclosure” and can not be retaliated against as the person is now protected by law.
Attorney Zaid tells ABC News’ Chief Anchor George Stephanopoulos the second person — also described as an intelligence official — has first-hand knowledge of some of the allegations outlined in the original complaint and has been interviewed by the head of the intelligence community’s internal watchdog office, Michael Atkinson.
The House and IG investigation is moving forward with what the Trump administration has criticized as 2nd-hand information by the first whistleblower and also the recently disclosed first-hand knowledge of what was said during the phone call by a 2nd whistleblower. The corners are being rounded on Herr Trump with little chance of escape from the accusations. It will be interesting to see how McConnell and Republicans handle the total package of disclosures by whistleblowers. Will they provide cover for a malfeasant president? McConnell already said he would block the impeachment once it gets to the Senate.
Thursday and I had to search around for someone who is an expert on Medicare Advantage Plans and Original Medicare. Nancy is one of those experts. Friday and Andrew Sprung has his commentary Trump’s Bid To Destroy Medicare up on xpostfactoid blog.
Commercial Healthcare Insurance has been become more and more expensive over the years with copays increasing, deductibles increasing, and premiums going up. Todays commercial healthcare insurance costs a single person ~$7200 and a family ~$20,000 with the single person paying 18% of the premium and a family paying 31% of the premium. Approximately 36 million people make less than $25,000 annually (retail workers, personal care attendants, warehouse workers and others as well). In a crude calculation, xpostfactoid: “The past ten years of healthcare cost increase relative to wage increase might cost a full-time average wage earner with family coverage $3,000-$4,000 this year in added costs and decreased wages, or, say, 6-8% of income.”
Today’s Employer sponsored Healthcare Insurance is unsustainable. The same holds true for Medicare Advantage plans due to the Commercial healthcare Insurance offering it as well. There are few controls which can be applied on the commercial side of the healthcare industry which is why there is a big push for true single payer healthcare of which Medicare and Medicaid are. If you wish more detail on how commercial healthcare insurance has exploded in cost, my earlier post Health Benefits for 2019: Premiums Inch Higher, Employers Respond To Federal Policy offers more detail pictorially and in verbiage.
As I have written other times, Medicare and Medicaid have been instrumental in reducing excessive U.S. healthcare costs. Medicare and Medicaid set the prices paid to providers with provider input and commercial healthcare insurance uses those prices to set their payouts. Medicare hospital rates are an approximate half of those paid on average by commercial healthcare insurance. Rates paid to physicians average about 78% of commercial insurance rates. In high-demand specialties and in regions with fewer providers; commercial healthcare insurers often pay four, five and six times Medicare rates. If you remember from Kocher and Berwick’s article, they proposed setting commercial Healthcare (while it still exited in the interim) payouts at 120% of Medicare rates.
This action by Trump and Republicans is a huge giveaway to the commercial healthcare insurance sector and the healthcare industry. Right now Medicare Advantage uses Medicare rates. If they can beat Medicare Rates, they keep the difference. If they can not meet the rates, the consumer pays the difference. What Trump has done is reverse the format. Medicare Advantage Negotiated Rates will be used to set Medicare Fee For Service rates to providers.
Past the leap is the President of Social “Security Works” Nancy Altman’s statement on Trump’s Executive Order talking about Trump’s lies.
The argument has been, if people like their private and company sponsored insurance plans they can keep them; but can they afford to do so?
In a recent LA Times and KFF survey, 40 percent of respondents said they had difficulty affording health insurance or health care or had problems paying medical bills. An approximate one-half of respondents said they or a family member skipped or postponed getting health care or prescriptions in the past twelve months due to cost concerns. Those with higher deductibles were more likely to report problems with affordability and were likely to say their insurance worsened over the past five years as compared to people with lower deductibles. Over the last decade, deductibles have increased 162% (see chart below).
The annual Kaiser Family Foundation Employer Health Benefits Survey: In 2019 the average annual premium for single coverage rose 4 percent to $7,188, and the average annual premium for family coverage rose 5 percent to $20,576. On average, covered employees contributed 18 percent of the cost for single coverage and 30 percent of the cost for family coverage with variation across firms. Of the 9,000 firms the survey was sent to, 4,395 firms answered this question of whether they offer healthcare insurance for a response rate of 58 percent.
Fifty-seven percent of firms offered health benefits to at least some of their workers. Smaller firm employees faced a higher risk of affordability especially during recessions. Fifteen percent of all covered workers including the 35 percent of covered workers in small firms are in plans with a worker contribution of more than half of the premium for family coverage (2019). In firms with a high percentage of low-wage workers, the average worker’s share for family coverage was 41%. This is many ways to say the same thing, the cost of healthcare is increasing and private company plans may no longer have a lessening capability to pay for healthcare.
Employer-sponsored health insurance is the largest source of coverage in the United States, covering about 153 million nonelderly people. I am sure many people would like to keep the private healthcare insurance and pay less for premiums than what they are.
Premium and Deductible Increase Charts and key thoughts after the leap
The House Democrats just released their drug pricing plan (summary) on the 19th. I read through it rather quickly and I found it to be interesting and having targets which could work. Rather than jump right into this, let’s talk about purchasing a bit and then what I believe would be better.
In a purchasing negotiation there are two typical ways used to negotiate a price to your company. The first strategy is to tell a supplier you have done a market study, another supplier can offer a better price, and all things are equal between him and the other supplier. The supplier has a choice of beating the new price or offering something else of value to the customer which will negate the difference and can not be acquired from the other supplier (whip-sawing a supplier is unethical and many do it).
The second strategy requires more work and requires you to understand the cost of materials, the process and its cost, and the overhead involved. It does establish a base in which a buyer can use to negotiate with “all” suppliers. With the former strategy, you are guessing whether you have a good price because you do not know the cost of manufacture. Purchasing has to be a bit more than just a clerk.
The House plan intends to negotiate on pricing using other countries (Australia, Canada, France, Germany, Japan, and the United Kingdom) pricing to measure against for the same drug. The legislation establishes an upper limit for the price as no more than 1.2 times of the volume-weighted average of the price of the six countries reached in their negotiation. Australia, Japan, and United Kingdom use a cost-based method of pricing a drug.
Here is a brief explanation of the House plan:
Year 1 and each successive year, the Health and Human Services (HHS) secretary would identify up to 250 brand name drugs appearing to lack pricing competition and having the greatest cost to Medicare and the US healthcare system. The data would be collected from Medicare, Medicaid, and healthcare insurance to determine aggregate cost based upon price and volume of sales.
The total of 250 items picked with:
the top 125 drugs in Medicare Part B responsible for a full 96% of Part B spending,
and 125 drugs responsible for 45 percent of the spending in Part D.
As show in the chart. “More” to be read after the leap.
The president’s lawyer Rudy Giuliani has revealed text messages of conversations between himself and senior officials at the State Department that he says show they endorsed his controversial dealings with Ukraine…During an appearance on Fox News show The Ingraham Angle last night, Giuliani revealed 15 text messages between himself, U.S. Special Representative to Ukraine Kurt Volker, and U.S. Ambassador to the European Union Gordon Sondland.
When I first heard the lying and very corrupt RUDY say this, I could only imagine the consternation of the people in the State Department over the fact that RUDY wants to drag them down with him. But here is the interesting news:
Kurt Volker, US special envoy to Ukraine, has resigned one day after the release of a whistleblower report alleging a coverup by the White House of a call between President Donald Trump and Ukraine’s President, three sources familiar with the matter confirmed to CNN. Volker was named in the report…here is no evidence of wrongdoing by either Joe or Hunter Biden. The news of Volker’s resignation comes just hours after the House Foreign Affairs Committee announced they would hold a deposition for him next week. “We still expect to hear everything he knows about this scandal,” said a congressional aide familiar with the deposition plans. But it’s unclear if he will still speak with the committee on the planned date. Giuliani denied to CNN on Thursday the characterizations of his interactions with Volker detailed in a complaint from an American intelligence community whistleblower, saying he had a “nice little trail” of text messages with Volker to prove his story. “I spoke to the State Department during the course of this situation, I told you, at least 10 times, and I met with them,” Giuliani told CNN.
Yes RUDY – we know you love to talk. Of course no sane person believes a word you say. Why should we expect Mr. Volker to come forward and do the right thing?
When I’m not reading and writing about the economy, I do occasionally comment elsewhere on political topics.
So it was on Thursday when, in response to this post asserting that Democrats were powerless to do anything – (including enforcing THEIR OWN GODDAM SUBPOENAS!) – and that it was “green lantern-ism” to believe otherwise, I decided I had had enough (see comment #25), for which I was called a “kook” and a disloyal Democrat. It would “hand the President a public relations victory,” it would have “undesirable optics,” and wouldn’t show “comity.”
Worse, most of these people – presumably people paying attention to the news – didn’t know that each House of Congress, like courtroom judges, have the the power of “inherent contempt,” meaning that they don’t have to ask a prosecutor to bring a case for contempt, they can imprison a non-compliant witness, obtain a conviction from the full House, and continue that imprisonment until the witness agrees to obey their subpoena.
Well, if I am a “kook” for wanting Congress to enforce its powers, so is Kurt Eichenwald of the New York Times, who has been absoluletely ON FIRE this week. Unfortunately, since twitter unrolls don’t play nice with blogger, I can’t reproduce it here, but go read the whole threads, here, here, and here.
And, while you are at it, read this 2015 article by Matt Yglesias about how, even then, “the United States was now exhibiting 11 of the 13 telltale signs of a fascist dictatorship,” and its scheme of Constitutional democracy is likely to fall in the near future.
It is simply ghastly that people like Nancy Pelosi and Joe Biden think all we need to do is elect Democrats in 2020 and all will be well. HELL, no!
Not a Human, but a Dance, Atlantic Daily, Ed Yong, September 19, 2019
I do not know about you when you receive a magazine you subscribe to; but when I get mine, I read it from cover to cover. I also send a copy to one who is incarcerated to read and it makes the rounds amongst the inmates. Since I chased prisoners in the service, it is not unusual for me to look after some of them.
Among the video’s 6.2 million viewers was Aniruddh Patel and he was was blown away by what he saw. A neuroscientist, Patel had recently published a paper asking why the near – universal trait among human of dancing was seemingly absent in other animals. Some species will jump excitedly to music; but, they are not in time with the music and lack rhythm.
Me: Recently on the show (my wife was watching) “Dancing With the Stars,” Nancy Wilson was asked if she had rhythm and could dance by her partner Her reply was; “I am Black” or of course I do fool. Some people are more equal than others. This definitely plays against my natural skill set as I must admit I lack rhythm and am also envious.
Some animals can be trained to perform dancelike actions such as in canine freestyle, but they do not do so naturally. Some birds will make fancy courtship “dances;” but “they’re not listening to another bird laying down a complex beat,” says Patel, at Tufts University. True dancing is a spontaneous rhythmic movement to external music. Our closest companions, dogs and cats, can not do such. Neither do our closest relatives, monkeys and other primates.
Patel reasoned dancing requires strong connections between brain regions involved in hearing and movement and such mental hardware would only exist in vocal learners or in animals capable of imitating the sounds they hear. That elite club excludes dogs, cats, and other primates, but includes elephants, dolphins, songbirds, and parrots.
Patel: “When someone sent me a video of Snowball, I was primed to jump on it.”
In 2008, he tested Snowball’s ability to keep time with versions of “Everybody” that had been slowed down or sped up. In almost every case, the parrot successfully banged his head and lifted his feet in time. Much like human children, he often went offbeat, but his performance was consistent enough to satisfy Patel.
Snowball was going through his own dance- dance revolution when another team led by Adena Schulz kept exposing him to new music, and learned that he likes Pink, Lady Gaga, Queen, and Bruno Mars.
Patel: “Dancing in human cultures isn’t a purely arbitrary invention,” Instead, he suggests that it arises when animals have a particular quintet of mental skills and predilections which Snowball the parrot exhibits also.
The Quiet Disappearance of Birds in North America, The Atlantic, Science, Ed Yong, September 19, 2019
If the pigeons disappeared from your local park, would you notice? What if the neighborhood finch stopped coming to the feeder? The starling no longer perched on the power line?
According to a new report, birds are disappearing and in large numbers. The total North American avian population has decreased by an approximate 29 percent over the past half century. There are 3 billion fewer birds today than when there were in 1970.
It is not a case of rare birds getting rarer either as the hardest hit species include every day birds such as swallows, sparrows, and starlings. 90 percent of the losses have come from 12 bird families. With the decreased numbers birds, we lose the function they bring to nature such as insect eaters controlling their numbers, plant pollination, those early morning songs, and more.
Researchers plan to investigate what is causing the drop; but, the condition of their habitat such as pollution and the reductions of it due to encroachment of the grasslands and wetlands by humans will probably play a big role. There are also the more mundane (and often preventable) threats, like running into windows and being killed by cats.
I can see the pollution part of it in my own neighborhood where grass clippings and leaves besides fertilizer residue are blown into the subdivision streets and washed down the drains leading to the wetlands surrounding us. And when I explain why they should not do such, they get indignant about it with the old “this is my land.” Except when your actions cause harm to the environment, the water supply, and the people around you; your ownership of the land and your actions are not exempt when you cause harm to others. It is called community.
“It is as if all birds are canaries and the entire world their coal mine.”
I have been watching Ken Burns’s “Country Music” series on PBS. May not watch too much more of it as I am not that interested in more recent country music, although I like some of it.
So the big story of this series is how much of supposedly “white music” is of African-American origin. I had long been aware of how the banjo was of African origin, the core country instrument beside the “fiddle,” aka “violin,” which is of European origin. But it shows that most of the important early Country music people had serious interactions with black musicians, relying on them for finding music as well as helping them developing their own styles. These figures include A.P. Carter, the founder of the Carter family, Jimmie Rodgers, Hank Williams, Johnnie Cash, and others.
All of this clearly rebukes the Country Music Association’s rejection of this year’s massive hit, “Old Country Road,” as being officially “country music.” Despite the fantasies of ignorant current racists, country music and rhythm and blues and, jazz, not to mention rock and roll, have always been curiously hybrid forms of music.
