A Transfer of Health Care

In my first post, I was inquiring about the number of uninsured. The number I keep hearing in the news these days is 47 million. In that post, I challenge that number. The number seems to be valid except that some of those individuals are choosing NOT to be covered. A government health plan will REQUIRE that they pay a premium (to an ins. co. or to the gov't) to be covered.

In a later post, I questioned the use of the term "Death Panel." I showed in the various parts of the bill that there will be government controls on the allocation of care through Comparative Effectiveness, Quality Adjusted Life Years, and Health Information Technology (HITman). HITman will determine whether or not you get a needed procedure.

What we accomplish with government health care can be easily stated. We will be reducing the cost of healthcare at the elderly and disabled level and increasing it at the younger (uninsured) level. It will be nothing more than a trade off. Someone does not get health care.

Lies and other Falsehoods

I was watching On the Record (Greta Van Susteren) last night. The topic was John Mackey's editorial in WSJ in which he offered an alternative reform to health insurance. Her first guest in that spot was Russell Mokhiber. I'ver never seen nor heard about him before. He was encouraging a boycott Whole Foods Grocery Stores (Mackey is CEO). Mr. Mokhiber said Mackey is a bad man for suggesting something other than a public option. He then said that there are 60 people dying everyday because they lack insurance; and in Canada there are none.

When someone throws out statistics, I immediately become wary. When those stats don't "feel" right, I immediately question. No one in Canada dies without insurance. Isn't that a comfort? You're dead but you had insurance when you died.

But I really questioned the "60" number. I got on the internet and found what he was referring to. The Institute of Medicine had done a report in 2003 that essentially determined how many people would have died if everyone had had insurance. Then they compared that to the number that had died. The difference was the assumed number that died without insurance.

There are many articles establishing the flaws in the study. But it was a number Mr. Mokhiber could use to his advantage. He threw it into his discussion and Greta didn't challenge it. Perhaps she had never heard it before and couldn't for that reason.

You really have to watch these people carefully.

Insurance company ripoffs

On July 22, President Obama said “you know, there had been reports just over the last couple of days of insurance companies making record profits. Right now, at the time when everybody’s getting hammered, they’re making record profits and premiums are going up.”

I pulled up some government statistics (National Health Expenditures) about health insurance. Hard working Americans paid $775 billion for premiums in 2007. The insurance companies paid out to our service providers $680 billion. That leaves them with $95 BILLION. No wonder he's attacking them. That means the insurance companies enjoy a 12.3% profit off of our premiums.

Oops. I must have done something wrong. Let me check my figures. Hmmm...still 12.3%. It's my understanding that they must pay administrative costs, state and federal fees, AND taxes from that 12.3%.

I don't understand. Why is he trying to tell us that the insurance companies are ripping us off? $95 billion sounds like a lot of money but a 12.3% profit before other expenses and taxes makes it sound more reasonable. Don't we want them to make a profit? Many of us are invested in insurance companies. If not directly, then we are invested through our retirement plans. Insurance companies are not the villains although Nancy Pelosi has called them that.

The reciprocal of the 12.3% is 87.7%. That is what is called the actuarial value or cost sharing. Under hb 3200, the basic plan requires a cost sharing of 70%; under the enhanced plan, 85%; under the premium plan, 95%. Seems to me the insurance companies already offer plans that pay out more than 85%.

HB 3200 will require the insurance companies to accept clients with pre-existing conditions and with a non-cancellation clause. If they don't raise premiums, what will those two things do to their 12.3% profit. They will also be required to cover at no cost to us any preventive medical procedures.

Do you really think they will stay in that business if they can't make a profit? Now you can answer the question that is frequently posed. "Can I keep my current policy?" Of course, you can; as long as the company stays in the business.

End of Life

Within Sec 1233 it says that there will be consultations between the patient and the doctor and such conultations will include:

‘‘(B) An explanation by the practitioner of advance directives, including living wills and durable powers of attorney, and their uses."

So what's the problem with that. Many responsible people have done this without consulting with their doctors. I did. Those documents are on the top of my desk and occassionally I pull them out to make sure they state my desires. My children know that if something happens, they should go into my office, find those papers and follow my directives.

Also in 1233 it says the consultations will include:

‘‘(E) An explanation by the practitioner of the continuum of end-of-life services and supports available, including palliative care and hospice, and benefits for such services and supports that are available under this title."

OK. I've got that covered. So what's the problem? I guess this is where the "death computer" comes in. Who or what determines that "end-of-life" is here? Is it the doctor/patient or is it the computer/doctor? Remember that on page 58 paragraph D we are told that when the doctor dials up the computer, he/she may be told "nope, can't do that."

Most of us, I believe, are ready to accept that we have reached the point at which all future medical procedures, while heroic, are futile. We just don't want the government to be the one telling us that. And with so much in this bill, that's the way it seems.

This bill is not about health care. It is about control - absolute control of our lives by the government.

Obama is correct

In every townhall (or other forum), President Obama chides the evil ones, the capitalist, those who are trying to make a buck. They take advantage of others. Like thieves, they take money from someone and hoard it or give it to others who are just as evil.

Last month we saw a blatant example of it. They stepped up, said their capital has a greater value and therefore, should get more for it.

Such greed.

And now that they are getting $7.25 per hour, they’re planning to ask for more. Will those filthy capitalists ever stop wanting more? They believe that their years of training is a sufficient reason to demand more. They go to work for 40 hours per week and probably give only 30 hours of effort. They believe they have a right to text-message, tweet, and facebook on the job. Train conductors and bus drivers have been proven to be doing this.

President Obama said he would reduce health care cost by reducing “hundreds of billions of dollars in waste and inefficiency in federal health programs like Medicare and Medicaid and in unwarranted subsidies to insurance companies that do nothing to improve care and everything to improve their profits.”

Obama is correct. We should get rid of all unwarranted subsidies, including food stamps, housing assistance, unemployment benefits, and minimum wage.

The President's lips are moving...

...and I have a tendency to not believe what he is saying. He and the others seeking socialism speak in half-truths. An example:

Lori Robertson of factcheck.org said that Division B Title II Subtitle C sec 1233 of hb 3200 does not address "death panels" or "pulling grandma's plug." That is true.

But anyone who has read the bill, knows it has many parts. So combine 1233 with Title IV - Quality, Subtitle A Comparative Effectiveness Research and also with Title I Subtitle G Sec 163 and voila', you've got the equivalent of death panels.

Another half-truth:

"President Obama has never said he believes in the public option." True. But as State Senator and presidential candidate, he has.

Others who are half-truthing for the President point to a clause in the Stimulus Bill about the Federal Coordinating Council for Comparative Effectiveness Reseach. It says:

"Nothing in this section shall be construed to permit the Council to mandate coverage, reimbursement, or other policies for any public or private payer." Whew!! That's a relief.

Ooops. They don't tell you that within hb 3200 a Center for Comparative Effectiveness Research is established within the Agency for Healthcare Reseaerch and Quality. And there will be a Comparative Effectiveness Research Commission which will oversee the CCER. Included in its duties is:

...to make recommendations to the Center for the broad dissemination of the findings of
research conducted and supported under this section that enables clinicians, patients, consumers, and payers to make more informed health care decisions that improve quality and value.

So the FCCCER will not mandate anything, but CCER will?

Watch out. Their lips are moving.

Is there a DEATH PANEL?

What was Sarah Palin thinking? She believes there is a DEATH PANEL!!

Sarah! Sarah! Sarah!

Obviously, she has not read hb 3200. There is no DEATH PANEL mentioned anywhere in the 1018 pages.

There is a DEATH COMPUTER!!

So she isn’t too far off the mark.

Here’s how it works. In a previous post, I talked about Comparative Effectiveness, cost-benefit, and quality-adjusted life years( QALY). TRILLIONS of our dollars have been (or will be) given to various governmental groups to study medical procedures. The results which come from these “consensus-based” organizations will be put into the master-computer data base. This is done by ‘‘TITLE XXX—HEALTH INFORMATION TECHNOLOGY AND QUALITY” which was part of the Stimulus Bill. It established the National Coordinator of Health Information Technology. I call it HITman (or woman).

So CE info is in the master data base. Now let’s put all of your heath info in there, too. Can they do that? Check this:

Sec 3000 (13)
QUALIFIED ELECTRONIC HEALTH RECORD.—The term ‘qualified electronic health record’ means an electronic record of health-related information on an individual that—
‘‘(A) includes patient demographic and clinical health information, such as medical history and problem lists; and
‘‘(B) has the capacity—
‘‘(i) to provide clinical decision support;
‘‘(ii) to support physician order entry;
‘‘(iii) to capture and query information relevant to health care quality; and
‘‘(iv) to exchange electronic health information with, and integrate such information from other sources.

HITman has put info about CE, cost-benefit, and now your personal data. With that, your QALY is calculated.

So you go to your doctor because you have a serious problem. He dials up the computer and inputs your current situation and the computer sends back an answer. Let me remind you of page 58 paragraph.

…such standards shall…
“(D)enable the real-time (or near real time) determination of an individual’s financial responsibility at the point of service and, to the extent possible, prior to service, including whether the individual is eligible for a specific service with a specific physician at a specific facility, which may include utilization of a machine-readable health plan beneficiary identification card… “

There you go!! It’s a DEATH COMPUTER.

This is post #7 discussing some critical parts of hb 3200.

Sec 1233 Advance Care Planning Consultation

This section adds to the Social Security Act:

(hhh)(1)…Such consultation shall include the following:

(E) An explanation by the practitioner of the continuum of end-of-life services and supports available, including palliative care and hospice, and benefits for such services and supports that are available under this title.

2(B)(3)(A)
…the Secretary shall include quality measures on end of life care and advanced care planning that have been adopted or endorsed by a consensus-based organization, if appropriate. Such measures shall measure both the creation of and adherence to orders for life sustaining treatment.

I have no problem with my doctor discussing this situation with me. But this is our government saying that this must be done. The government expects my doctor to discuss measures endorsed by a consensus-based organization. That organization is Federally funded and Federally controlled through the Agency for Healthcare Research and Quality. The measures are those that are appropriate based upon a comparative-effectiveness study considering a cost-benefit using quality-adjusted life years. Now I remind you of the portion of the bill related to computerization where it says (p58 of the bill) the system will determine if you may have such services from that particular doctor at that particular facility. So if you are not ready for end of life care and want to continue fighting for life, the computer may say “Sorry, you can’t have that.”

The government has already put 1.1TRILLION dollars of our money into CE. An additional $90 MILLION will be taken in 2010, $100 MILLION in 2011, and $110 MILLION in 2013. After that, it will be $375 MILLION each year. If that amount is invested, what is a fair return (savings) each year and where is it saved? Medicare!!! Where is the biggest problem in Medicare? END-OF-LIFE

Comparative Effectiveness in hb 3200

This is post #6 related to the proposed h b 3200. Hopefully, you have read the others.

On page 502 of the bill, the Sec. HHS is given the power to establish within the Agency for Healthcare Research and Quality (AHRQ) a Center for Comparative Effectiveness Research to conduct, support, and synthesize research…with respect to the outcomes, effectiveness, and appropriateness of health care services and procedures in order to identify the manner in which diseases, disorders, and other health conditions can most effectively and appropriately be prevented, diagnosed, treated, and managed clinically.

That sounds pretty nice doesn’t it? How in the world could that be bad? It seemed so good, I just had to check out the term “comparative effectiveness” because I knew the geniuses in Congress wouldn’t have create that on their on.

In “Comparative Effectiveness: Better Value for the Money?” (August, 2008) issued by the Alliance for Health Reform, they state: “…CE aims to assess how various procedures or interventions for a given ailment compare with each other.”

Can the government which controls the research establish health cost ceilings and floors for payments to providers (and therefore, the patient)?

I found a paper (“Comparative Effectiveness of Health Interventions: Strategies to Change Policy and Practice”) from 2007 issued by ECRI Institute. They are an Evidence-based Practice Center as designated by the U. S. Agency for Healthcare Research and Quality (AHRQ) and a Collaborating Center of the World Health Organization. I added the color. In the executive summary on page 1, I found this:

“Proponents of comparative effectiveness research say objections and counter-arguments should be anticipated. Comparative effectiveness guidance will be resisted if it is seen as primarily a tool to control healthcare costs. On the other hand, it is more likely to be embraced if the information helps patients and providers raise the quality of healthcare and reap greater value.” Again, my color added.

OK so don’t tell us that the goal is to reduce cost; tell us that the goal is to improve the quality of health care.

I also found a CBO report to Congress by Peter Orszag in December, 2007. This paper presents the pros and cons of CE research, who should perform the research, and whether or not cost-effectiveness should be considered in the research. This is very important because such an inclusion requires the use of another set of values called “quality-adjusted life years.” Included in the report is this:

“By convention, cost-effectiveness analyses report results as the cost per QALY gained, so a lower dollar amount indicates a more cost-effective service. If that metric is used to determine whether specific health procedures are covered by an insurance program, choosing a cost-effectiveness threshold can be a controversial endeavor.”

As an example, assume a procedure will cost $57,000 and the patient would “gain” 35 quality years (determined by a gov’t chart). That is a cost of approximately $1,629 per life year. Suppose that same procedure is considered for someone with only 5 quality years gained. That would be $11,400 per life year. Hmmmm, better not do that one.

But my gov’t wouldn’t do that.

Members of Congress like to model things by the way other parts of the world do them. QALY is applied all across Europe. Why not here?

The stimulus bill allowed for 1.1 TRILLION dollars set aside for such research. The current health care bill allows for an addition 90 MILLION in 2010, 100 MILLION in 2011, 110 MILLION in 2012. Then in 2013 and thereafter, there is a formula based upon fees charged to insurance companies and self-insured plan AND a transfer based upon the number of us in the Medicare program. That money is transferred from the Medicare fund!!!

Let me see if I understand this. TRILLIONS of dollars are going to be spent to find ways to save money in health care costs. What amount of annual savings should be expected if we invest TRILLIONS of dollars for research?

Health Choices Administration and hb 3200

This is post #5 on the proposed health care bill h b 3200.

The HCA is a new independent agency in the executive branch. The president will appoint a Commissioner with the approval of the Senate.

The Commissioner will:

1. establish qualified health benefits plan (QHBP) standards (define specific coverage)
2. enforce those standards
3. establish a Health Insurance Exchange (HIE)
4. administer affordability credits
5. promote accountability Quallified Health Benefits Plan offering entities (ins. cos.)
6. conduct random and targeted audits of ins. co. and employers
7. recoup audit costs from QHBP offering entities
8. collect data to promote quality and value, protect consumer, address disparities in health and health care, etc; share such data with Sec HHS
9. provide for civil money penalties
10. suspend enrollment of individuals in the plan
11. terminate the plan, if necessary
12. set standards for insurance definitions
13. issue regulations for the effective and efficient administration of the HIE
14. appoint an ombudsman
15. other duties as assigned

Through the HIE, the commissioner shall

1. establish standards for QHBP offering entities (ins. co)
2. negotiate with those entities for the basic, enhanced, premium and premium-plus plans
3. enter into contracts with those entities
4. facilitate outreach and enrollment into the plans (advertisements and door knockers)
5. establish risk pooling mechanisms
6. define: ‘‘employer’’, ‘‘employee’’, ‘‘full-time employee’’, and ‘‘part-time employee’’
7. may set an enrollment phase-in period for very large employers
8. execute a survey. The goal of the survey is to determine if there are significant groups and types of individuals and employers who are not Exchange eligible individuals or employers, but who would have improved benefits and affordability if made eligible for coverage in the Exchange. Specificall, the study shall examine the terms, conditions, and affordability of group health coverage offered by employers and QHBP offering entities outside of the Exchange compared to Exchange-participating health benefits plans; and the affordability-test standard for access of certain employed individuals to coverage in the HIE.
9. establish range of cost-sharing (ie 70%-97%)
10. ask the Sec of Treasury (tax cheat) for info about you.
11. seek info about you through means other than your tax return
12. establish penalties if you don't follow the rules

How will h b 3200 impact employers

This is post #4 related to the health care discussion. Be sure to read the three previous.

Page 74
Qualified employers with fewer than 11 employees shall be eligible to enroll in the Health Insurance Exchange in 2013.
Qualified employers with fewer than 21 employees shall be eligible to enroll in 2014.
Page 133
An employee who enrolls in the employers qualified plan cannot get the affordable credits (mentioned in a previous post) unless the amount charged by the employer is greater than 11% of the family income.
Page 144
If the employee opts out of the employee plan, the company must make a contribution to the Health Information Exchange. The rate paid is discussed below.
Page 145
The employer must provide substantial information to the Health Choices Commissioner, the Sec. of Labor, the Sec. of the Treasury (tax cheat) and the Sec. of HHS. This is modeled after the W-2 form - Name, SS#, were you covered, for how many months....etc
Page 146
If the company provides insurance for the employees, the co. must contribute at least 72.5% for single coverage and 65% for family coverage.
The co. must enroll an employee who fails to make a choice among plans provided by the employer. The plan for this employee must be the one with the lowest premium.
Page 147
The company must provide insurance coverage for part-time employees on a pro-rata basis.
Page 149
If co. does not provide insurance coverage or if the empployee opts out, the co. must pay an amount to the Health Choices Commissioner. The amount is determined by multiplying the applicable percentage times the average wages:

1. less than $250,000 per year 0
2. less than $300,000 per year 2%
3. less than $350,000 per year 4%
4. less than $400,000 per year 6%
5. over $400,000 8%

So if one employee opts out, the co must make a payment for that one employee.
Page 153
If the co. offers coverage, the co. is subject to insurance audits.
Page 189
The co gets a new tax credit. It is equal to 50% of qualified ins. costs. It is phased out:

1. If the average employee compensation is greater than $40,000, the tax cr. = 0
2. If the co has more than 25 employees the tax cr. = 0
3. Wages of any employee earning greater than $80,000 are not available for the credit.

If a co has elected to participate in coverage but later fails (determined by audit?), the co will be fined $100 per day per employee, until the error is corrected.

What a deal for companies!!!!

What will h b 3200 cost me?

This is part 3 of my coverage of the health bill. The House Energy and Commerce Committee has submitted something new but I haven't found that yet.

What will it cost each of us?

As a point of reference, the average cost of a plan provided by the employer in 2008 was approximately $12,700 for family and $4,704 for single coverage. Employers get the best deal from insurance companies because of the expanded risk pool. So let's assume that every family will have to pay $12,000 (a nice round number) in this gov't required plan. That's just the premium.

Good news!!! You may have a credit available to reduce that premium (page 137). If your income in terms of the FPL is $88,200 (family of 4), then you only pay $9,720 per year. In addition, your cost-sharing portion is 30%. As near as I can tell, the law means that after your initial deductible ($10,000) you must pay 30% of all covered healthcare services that you receive. Of course, in Part 2 of this discussion I mentioned that there are some health care items which must be free to you.

If your income is $66,150, then you pay $7,277 and your cost-sharing rate is 28%.

I use the $12,000 arbitrarily because if employers can get the best deal, then a gov't controlled environment would get at least that. However, nowhere in h b 3200 is a premium stated. It only mentions that the Secretary of HHS will determine premiums.

If your income is over $88,200, then you get no premium reduction. You pay the full $12,000 and your cost-sharing is 30%.

Let's try and example for your income over $88,200. Your family has been healthy all year. One child is hospitalized and released after 5 days. Assume total health care charges are $50,000. Your portion is $10,000 (the deductible) plus 30% X (50,000 - 10,000). That's a total of $22,000. Add that to your premium and your total cost is $32,000. In part 2 I mentioned medical bankrupcties, so get in line.

Let's assume all ins. co. will jump on this band wagon and you choose a policy from one and it is a Qualified Health Benefits Plan. It is possible that it later fails to qualify. If so, you may be penalized (not taxed) at the rate of 2.5% of your AGI - $26,000 (family of four). Less than $26,000 and you are not required to file a return and therefore will not be penalized. You can't cheat by covering only the adults and not the children. The penalty still applies.

If you are obstinate, and refuse any insurance, the penalty still applies. They will catch you. You know how your income is reported on W-2s and other forms. There will be reporting forms for insurance coverage. There will be a knock at your door and ..."I'm here from the government and I'm going to sign you up."

What will you get with hb 3200?

Hope you read my first post. This is part 2 of a discussion of h b 3200.

You will have access to a public or private plan. I'll describe the public plan. Keep in mind that all private plans must be equal to or better than the public plan.

The plan will have three levels: basic, enhanced, and premium. And there can be a "premium plus." The basic plan must include:

Guaranteed issue; guaranteed renewal; rescissions prohibited;
Hospitalization;
Hospital, clinic and emergency room out-patient services;
Health professional services;
Such services, equipment, and supplies incident to the services of a physician’s or a health professional’s delivery of care in institutional settings, physician offices, patients’ homes or place of residence, or other settings, as appropriate;
Prescriptions;
Rehabilitive and habilitive services;
Mental health/substance abuse disorder services;
Preventive services;
Maternity services;
Well baby and well child services.

The preventive services must be at not cost to you.
Your out-of-pocket expenses will be limited to $5,000 (single)/$10,000 (family).
There will be no annual or lifetime limit.
Benefits must be provided that are actuarially equivalent to approximately 70 percent of the full actuarial value of the benefits in the package.

BUT WAIT - THERE'S MORE!!

You can choose the Enhanced package. You get all the items listed above except for this change:
Benefits must be provided that are actuarially equivalent to approximately 85 percent of the full actuarial value of the benefits in the package. This just means you will pay less out-of-pocket.

AND THERE'S MORE!!

You can choose the Premium package. You get all the items listed above except for this change:
Benefits must be provided that are actuarially equivalent to approximately 95 percent of the full actuarial value of the benefits in the package.

OH, AND ONE MORE THING:

You can choose the Premium Plus package. In that, you get adult oral health and vision care. Children already get that under the Well Child coverage above.

That's a great list, so you know that private ins. co. will be jumping into that. There are big profits available!!

So...can you keep your current plan? Of course you can. If you have an individual plan, your ins. co. must model its benefits to the basic plan detailed above. You know it will jump on that advantage.

So...can you keep your doctor? Of course you can. Your ins. co. must provide "adequate networking." That means it must offer lots of choices of drs. and other services. Then there is this that really concerns me (it's on page 58):

One of the goals for financial and administrative standards specified in paragraph D on page 58 states that such standards shall

enable the real-time (or near real-time) determination of an individual’s financial responsibility at the point of service and, to the extent possible, prior to service, including whether the individual is eligible for a specific service with a specific physician at a specific facility, which may include utilization of a machine-readable health plan beneficiary identification card...

What a deal!!! How can anyone pass this up?