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

Health Care Thoughts…Tom’s avalanche theory

by Tom aka Rusty Rustbelt

Health Care Thoughts: Knowns, Unknowns, Unknown Unknowns, Unintended Consequences

Tom’s Avalanche Theory– once an avalanche is started there is no controlling it

Some of the probable unintended consequences (?) of Obamacare are started to play out.

The convergence of 1) a mediocre economy, 2) a weak labor major and the 3) health reform avalanche are causing a sea change in the relationship between employers and employees.

Current higher deductibles and higher co-pays will eventually lead to much higher deductibles and co-pays and employers dumping employees into exchanges. HSAs will likely become more popular.

This risk** and financial shift will weigh heavy on the working middle class.

So what if Obamacare flops? Is repealed? The avalanche has started and cannot be stopped.

The consequences for the provider side of the equation in another post.

**Jacob Hacker’s book on risk shift is well worth the read.

Health Care Thoughts: Really Narrow Networks

by Tom aka Rusty Rustbelt

Health Care Thoughts: Really Narrow Networks

“Narrow networks” are in the news as the ACA exchanges begin to do business (or not?).

From the Columbus Dispatch:

There may be other problems besides low payment rates. According to the Medical Group Management Association (MGMA) contracting is slow, uncertainty is high, and physician groups have not been read in to the administrative practices of the exchange plans.

(Disclosure: I have done editorial work and seminars for MGMA.)

But wait, we have almost three months, right? Insurance contracting and administrative processes can be put into place, right?

Three months is not really long enough. Physician practices may be satisfied picking up new Medicaid patients, or just staying with the existing practice base, or playing wait-and-see.

The insurers should have had networks fully in place before October 1. Now we scramble. Again.


Health Care Thoughts: Obamacare Updates

by Tom aka Rusty Rustbelt

Health Care Thoughts: Obamacare Updates

Latest news on Obamacare:

Narrow Networks – Some customers of the new insurance exchanges may be surprised at the “narrow network” included in their insurance coverage.

Narrow networks have a limited list of approved provider and will likely make out-of-network treatment difficult if not impossible.

This is just now hitting the news, a few days before the exchanges begin operations.

Private Exchanges – The concept of health insurance exchanges is being adopted by employers looking for cheaper coverage and fewer hassles, putting employees into private exchanges managed by various consultants and facilitators.

It is too early to judge the scope of this innovation, but it could become a very large factor in employer provided health insurance.

(Dan here…My own thoughts in comments)


Health Care Thoughts: What is a "health care economist."

by Tom aka Rusty Rustbelt

Health Care Thoughts: What is a “health care economist.”

During the past three years I have met several young “health care economists.” Clearly this is a hot topic.

I try to be helpful when appropriate, but I often become quite skeptical, and often subtly ask some questions to test expertise. The answers are often disappointing.

What should one know to be a “____________  economist” (trade, labor, health care) and who does the vetting?

I do not expect young economists to know the system at the detail level I do, nor do I expect them to be a Uwe Reinhardt, but how can we tell who is really qualified to claim a title of health care economist.

Your thoughts?


Health Care Thoughts: Obesity Again

by Tom aka Rusty Rustbelt

Health Care Thoughts: Obesity Again

According to NBC News this week up to 5000 air ambulance flights (out of about 600,000 per year) are being cancelled because the patient is too large to fit in the copter and/or too heavy for safe flying.

Typically some of the medical specialists will transfer to a ground ambulance, but the transport takes more time.

Some cities are buying special ground ambulance equipment with capacity up to 1000 pounds.

Hospital and nursing home equipment safety rated at 400 pounds is inadequate.

Whatever the cause/s, this problem (no pun intended) is getting bigger by the day.

Health Care Thoughts: ACA – reality sets in

by Tom aka Rusty Rustbelt

Health Care Thoughts: ACA – reality sets in

A letter from union leaders to Sen. Reid and Rep. Pelosi

Dear Leader Reid and Leader Pelosi:

When you and the President sought our support for the Affordable Care Act (ACA), you pledged that if we liked the health plans we have now, we could keep them. Sadly, that promise is under threat. Right now, unless you and the Obama Administration enact an equitable fix, the ACA will shatter not only our hard-earned health benefits, but destroy the foundation of the 40 hour work week that is the backbone of the American middle class.

Like millions of other Americans, our members are front-line workers in the American economy. We have been strong supporters of the notion that all Americans should have access to quality, affordable health care. We have also been strong supporters of you. In campaign after campaign we have put boots on the ground, gone door-to-door to get out the vote, run phone banks and raised money to secure this vision.

Health Care Thoughts: Obamacare Fail

by  Tom aka Rusty Rustbelt

Health Care Thoughts: Obamacare Fail

The Obama administration has delayed a key portion of the program, the 50+ regulations for employers on providing insurance and on the quality of insurance provided. So why the delay?

1) The administration could not explain its’ own rules and definitions, especially on seasonal workers

2) The proposed reporting and data collection system was a mess
3) The proposed enforcement system was still in its’ infancy, also see #2
4) The restaurant and retail sector told the administration what this would do to employment and hours
5) The 2014 election is looming already

Complexity is the enemy of smooth implementation.

(Interesting political theory among morning talking heads. The Democratic leaders intended to fix and improve ACA in conference committee, but the election of Scott Brown in Massachusetts made that unnecessary, so the unpolished version was passed.)


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.

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.