New, Improved Obamacare Program Released On 35 Floppy Disks

[joepistole]

As an aside, did I mention the conversation I had with a medical student a couple months back? So, a patient goes to see his doctor for a 'kink in the neck'. One (unnecessary) simple spinal decompressive laminectomy later and he's paraplegic and expected to die before the end of the year. Surgical notes: Patient entered with neck pain. Patient existed paraplegic. That is all that was written.

I wonder, do you think he'll show up as a medical error related death or just a death due to natural causes?

The more important question and the question you like to avoid is how would your libertarian vision of nirvana make things better? Mistakes happen. That's why we have regulation. In order to minimize mistakes we set up processes (i.e. regulations) to prevent mistakes. That's the whole Six Sigma thingy. The problem with our current healthcare system is the insufficient use of best practices and processes. https://en.wikipedia.org/wiki/Six_Sigma

And sometimes, even with the best practices, outcomes are not predictable because there are risks and we don't have crystal balls. Even Libertarians don't have crystal balls Michael.

 

[iceaura]

Whatever France is doing. Or Denmark. Or Germany. Or fucking Estonia.
We are not French or Danish or Estonian. What works there, does not work here.

Let's try one of them and make sure, OK? It can't be any worse than the current mess.

Maybe you're looking for Iraq or Greece? Yes, the European country you're looking for is Greece

Ok: By outcome stats Greece has a better medical care system than the US, and it's much cheaper, let's try that one.

Before I acknowledge that the United States is the only First World country that cannot adopt a working medical insurance system, and neither can any State within it, I'm going to need some evidence of its extraordinary uniqueness in that regard. I've got to see what works for the Germans in Germany and the French in France and the Danes in Denmark and the Swedes in Sweden and the Italians in Italy fail to work for the Germans, French, Danes, Swedes, and Italians in the US, before I accept that as some kind of law of the universe.

What you need to find is a country with Ghettos littering all of their cities making many areas no-man's land where even the police don't patrol

Germany, France, Ireland, Turkey, Estonia, Canada, all have ghettos worse than any in my home State. But they have working medical insurance setups, and my State - despite spending twice the money per capita - does not.

Actually, what it looks like is that the malfunctioning medical care setup is contributing to the ghetto misery and expansion in my State - one benefit of improving it might be a reduction in the misery of US ghettoes.

 

[Michael]

Drug Shortages, Price Gouging, and Our Broken Health Care System
- Michel Accad, 1/10/2015

The shaming campaign that followed last week’s news of two generic drug prices somersaulting into the stratosphere after being acquired by private companies is not too surprising. The idea that a drug which cost $13.50 one day can cost $750 the next, seemingly on the whim of greedy Wall Street investors and pharma start-ups, is fodder for the outrage machine. But what the outrage machine does not realize is the extent to which the generic healthcare supplies are constantly on the brink of shortage. Every week I get a “drug shortage report” by email from my hospital. It lists the various items in short supply. Some drugs (for the most part generic ones) may even be absent from the shelves. And every week, the email also reminds me that there is a national shortage of normal saline.

Normal saline, for heaven’s sake!

What’s going on? Is our productive capacity in such a shamble that we can’t have the wherewithal to mix sterile salt and water and put it into a bag? Let’s go back to the basics. Remember that in order for any product to be available in a sustainable way, there must be a supplier willing to make it and a buyer willing to pay for it at the price the supplier expects. Multiple buyers bid the price up, multiple suppliers bid it down. It seems that for something as commodified as normal saline, making plenty of it should not be too much of a problem. After all, there is no shortage of #2 pencils, even if the profit margin on pencils is minuscule.

Welcome to our glorious world of regulated health economics. On the buyer side, you have hospital administrators which have been trained to operate under the reality of fixed payments and onerous oversights. Every expense is a cost that cannot be passed on to the ultimate “consumer” of the good. Therefore, the lower the price of supplies, the better. On the supply side, the regulatory apparatus overseeing the making of medical products is not known for its flexibility. The last thing bureaucrats want is any intimation that they are not tough enough on bugs and safety. Manufacturers must follow rules which have no regard for market realities and for how much the intended customer will be willing to spend for the product. For something like normal saline, profit margins become dangerously thin and may even be negative.

(see link for the rest of the article).

 

[Michael]

Forbes: The 2016 Obamacare Rate
- Robert Laszewski 10/6/2015

You might recall that I have said we wouldn’t see the real Obamacare rates until the 2017 prices are published in mid-2016. By then health plans will finally have had a couple of years of credible claim data and two of the three “3 Rs” reinsurance provisions subsidizing the insurance companies will have gone away. I have also made the argument that after two years the Obamacare enrollment is coming up way short of what it needs for us to be assured that we have a sustainable risk pool—enough healthy people signed up to pay the costs for the sick.

Instead of moderate rate increases for one more year, the big rate increases have begun. They are particularly large among the health insurers with the most enrollment—the carriers with the most data. Texas Blue Cross stands out. The health plan commented in its federal government rate filings that it covered 730,833 Obamacare individuals in 2014 with premium of 2.1 billion and claims totaling 2.5 billion––for a medical loss ratio of 119%. The plan further commented that, after the “3Rs” reinsurance adjustments, they lost 17% to 20% of premium in 2014–that would be about $400 million. And, they are only asking for a 20% rate increase.

While we won’t see all of the rates in all of the states for a few months, some state regulators have begun to make the 2016 rate actions public:

• CareFirst Blue Cross of Maryland is asking for a 34% rate increase on its PPO plan and a 26.7% rate increase for its HMO. CareFirst has an 80% market share in the Obamacare exchange and only 30% of the eligible Maryland market has signed up on the exchange.

• In Oregon, where less than 35% of the eligible have signed up on the exchange, the biggest insurer with 52% of the market, Moda, has asked for a 25.6% increase. Lifewise, with a 19% market share, has asked for a 38.5% increase.

• Blue Cross Blue Shield of Tennessee, with a 165,000 members making up 70% of the Obamacare exchange is asking for a 36.3% increase. The second biggest player, Humana HUM +0.56%, is asking for a 15.8% increase. Less than 40% of the eligible exchange market signed up in Tennessee.

• Georgia is the second biggest Obamacare market for Humana, having enrolled 254,000 people out of a total market of 479,000, and Georgia “maybe its biggest misstep”. Its CEO has said about Georgia, “We can’t have one business being subsidized by another business.” Humana is asking for 2016 individual plan rate increases from 14.8% to 19.44%.

• In Iowa, with the lowest enrollment rates in the country, and where its biggest Obamacare insurer went broke last December, Wellmark Blue Cross, which only sells off the exchange, is asking for a 43% increase on its Obamacare compliant policies. Coventry, which has 47,000 Obamacare customers, is asking for an 18% increase for its on-exchange business.

• The Kansas insurance department has not made its rate increases public yet but has said that plans will increase by as much as 38%. Less than 40% of the eligible have so far enrolled.

• Pennsylvania is not encouraging with market leader Highmark asking for increases ranging from 13.5% to 39.65% and the Geisinger HMO asking for increases from 40.6% to 58.4%. Pennsylvania enrolled 50% of the potential exchange market in 2015.


-0-
Well isn't THAT fantastic for the economy! Think of the increase in GDP!
AND, given Inflation is so wonderful for the economy - that's an added benefit! I mean, we wouldn't want big scary Deflation to happen! We all know that as we become more productive each year, and come up with better more efficient ways to treat illnesses, the price goes down. Ooooh, sorry, but it doesn't happen like that in State hyper-Regulatory Captured "Markets". No, in regulatory-captured markets the price actually goes UP while the quality goes DOWN. Certainly not when the aim of the game is NOT healthcare per say, but rent-seeking.

Anyway, soon we'll get "Free" healthcare.
Won't that be a treat.
Imagine a Government-run Housing Ghetto. THAT is going to be Public Hospital.
What is it now in terms of Medical Error caused deaths? Oh yes, in our HYPER REGULATED DiseaseCare system, the chances of being killed by your healthcare treatment is up 500% (since 1990-2010, probably higher now) and presently kills off around 480,000 Americans annually, seriously wounding another 3 - 5 MILLION.

Healthcare is now the #3 killer in the USA. Almost #1, just give it a little time.

Interestingly, I read (these numbers are not published so could be anything) in Australia the rate is double. You're twice as likely to be killed by Government Regulated Public Healthcare compared with the USA. But, much like the paraplegic who is probably dead now, a lot of medical mistakes are written off, never reported and simply forgotten.

Enjoy the FREE - it's worth every penny.

 

[Michael]

Germany, France, Ireland, Turkey, Estonia, Canada, all have ghettos worse than any in my home State. But they have working medical insurance setups, and my State - despite spending twice the money per capita - does not.

Germany's population is imploding faster than Japan's. They're taking in 650,000 refugees per year to help make up the tax-base needed to deliver on all the "FREE" Germans are used to. And Germans are hard-working, efficient people (in my experience). Let's see what happens when many of them are replaced by people with a different culture. So, yes, let's see how it works out for them and "Socialism" as the decades unfold. It will be, if anything, interesting.

 

[Michael]

CNBC: Obamacare's many double-digit price hikes for next year
-- Dan Mangan, 4/9/2015

Insurers have asked for double-digit rate increases for nearly 1 out of every 3 Obamacare plans that will be sold on HealthCare.gov for 2016 coverage, according to a new analysis. And in three states—Delaware, South Dakota and West Virginia—every plan sold on HealthCare.gov is asking for 10 percent or more hikes in the prices of their premiums for next year, AgileHealthInsurance.com said in its report. Existing Obamacare customers in six other states on that federally run marketplace, which serves two-thirds of the United States, could also be in for a rude awakening come November when open enrollment resumes. In those other six states, a majority of plans are requesting double-digit hikes, ranging from Montana, where 86 percent of the plans have asked for such increases, down to North Dakota, where 67 percent of the plans are doing so.


-o-
Take a really good look at everything the State is 'regulating' and ask yourself if State-monopolies work. Free-market monopolies drive DOWN price and drive UP quality. State-monopolies do the exact opposite. What is the incentive to the person who works INSIDE a State-run monopoly? Is it to provide value for money? No, you can provide shit-for-money, people HAVE to pay (IF they want their Regulators to issue them a magical State-licence that says their competent). Again, the 'administrators' do NOT have to provide value for money. Whatever pedagogy they decide is good enough - IS GOOD ENOUGH. Full-stop.

That's how State-mandated monopolies work.

The State has 'regulated' and/or monopolized everything from our Central Banker f*cked economy and DoED rotten education to our totally ruined healthcare system. This is a problem OF the State's doing. The AMA itself stated it 'miscalculated' how many doctors would be needed, and because they (together with the State) determine the number - shock of all shocks, *GASP* they didn't get it right and now there's shortages. Big F-ing surprize there. What? Central Planning leading to shortages? No? Really? You don't say?!? I'd never of guessed.....

 

[pjdude1219]

Free-market monopolies drive DOWN price and drive UP quality. State-monopolies do the exact opposite.

untrue. monopolies of any always push price up and have zero effect on quality. this is literally the basics of economics. so once again micheal you fail econ 101. also the reason people get pissed about price gouging assholes on medical supplies and procedures is because demand for them is about the nearest thing to a perfectly inelastic good that exist in real life.

 

[joepistole]

untrue. monopolies of any always push price up and have zero effect on quality. this is literally the basics of economics. so once again micheal you fail econ 101. also the reason people get pissed about price gouging assholes on medical supplies and procedures is because demand for them is about the nearest thing to a perfectly inelastic good that exist in real life.

Actually PJ, quality also declines with monopolies because monopolies have no competition and as you correctly note prices do increase. So unless you are the monopolist, unregulated and even some regulated monopolies are bad news for consumers.

 

[pjdude1219]

Actually PJ, quality also declines with monopolies because monopolies have no competition and as you correctly note prices do increase. So unless you are the monopolist, unregulated and even some regulated monopolies are bad news for consumers.

quality should stay the same because a decrease in quality will reduce marginal utility which would decrease demand which would decrease profits. the perception of decrease in quality comes from the lack of improvement because there is no incentive to ever improve the product as R&D will increase costs and lower profits.

 

[joepistole]

quality should stay the same because a decrease in quality will reduce marginal utility which would decrease demand which would decrease profits. the perception of decrease in quality comes from the lack of improvement because there is no incentive to ever improve the product as R&D will increase costs and lower profits.

Not with monopolies, the monopolist will only provide the bare minimum quality needed to maintain the monopoly and that is a function of elasticity of demand. If demand is highly inelastic, quality will deteriorate more. There is little or no incentive for quality. Below is a little video which explains it.

Dead Weight Loss = Quality

 

[pjdude1219]

Not with monopolies, the monopolist will only provide the bare minimum quality needed to maintain the monopoly and that is a function of elasticity of demand. If demand is highly inelastic, quality will deteriorate more. There is little or no incentive for quality. Below is a little video which explains it.

that is not always the case. a monopoly settles at the point it makes the most money. this can be a point of relatively high quality. while being a monopoly has no incentive to increase quality it does have the incentive to mantain the quality that maximizes its profits. which of course is linked to elasticity. more inelastic the less the quality point is but that point will be mantained so long costs stay the same.

 

[Write4U]

Michael,
I love my freedoms also, ok?

You want a sample of a free (unrestricted) enterprise system?

Business Day
Drug Goes From $13.50 a Tablet to $750, Overnight

http://www.nytimes.com/2015/09/21/b...se-in-a-drugs-price-raises-protests.html?_r=0

By law, this was legal, but also highly unethical.
It probably is the most profitable part in the health care industry. Drug manufacturers are for-profit corporations and will charge what the market can bear to pay, not an ethically reasonable profit on an investment of time and money. Monopolies exist in many other areas of common National interest.

Greed is unique human quality, and is generated by the the universal constant of "movement in the direction of greater satisfaction".
But all you need to add is the "unrestricted movement in the direction of greater satisfaction" and you can readily see the inherent dangers of "invasive behavior" in the pursuit of those individual material goals, because "they were free to do so".

You recognized that government is primarily an administrative function and I agree. Government by definition is a NOT for-profit administrative organization. In principle, our government does not profit from the services it provides. This a good thing for the general population in many areas common to us all, such as defense, interstate commerce, and IMO, national health care. To insure uniformity in these areas of National Security, certain regulations must be adopted by all the individual States. Keyword here is "regulations" .

Unfortunately, for the reasons cited above, the regulations of elections of government itself have been corrupted by the introduction of Big Money and that of course is the natural result of an unrestricted free market. Today not reason but money equals free speech.
Such a scenario would change the entire government paradigm from Democracy into an Oligarchy.

ol·i·gar·chy
[ˈäliˌgärkē, ˈōli-]
NOUN
a small group of people having control of a country, organization, or institution:
"the ruling oligarchy of military men around the president"

• a country governed by an oligarchy:
  "the English aristocratic oligarchy of the 19th century"
• government by oligarchy.
• http://www.bing.com/search?q=oligarchy definition&qs=PA&pq=oligarcy&sk=OS1&sc=8-8&sp=2&cvid=1CE01F21AE0547E2A8ED21E6A682373F&FORM=QBRE&ghc=1

Is that what you want?

 

[milkweed]

Insurers have asked for double-digit rate increases for nearly 1 out of every 3 Obamacare plans that will be sold on HealthCare.gov for 2016 coverage, according to a new analysis.

MNSure (state version of obamacare) 14 - 49% rate hike for 2016.

 

[iceaura]

MNSure (state version of obamacare) 14 - 49% rate hike for 2016.

From a very low base - from $43 per month to $60 per month, in the one example I know personally.

And a completely screwed up billing system, boosting overhead costs. And the bureaucratic dropping of the major and most experienced provider, due to competitive bid requirements (rightwing pressure, that).

So Romney's kludge doesn't work very well. That is news? It's been obvious for decades now that pretending to have free market competition in medical care was costing the US a fortune in money, as well as preventing the provision of modern medical care to a large fraction of its population.

 

[milkweed]

From a very low base - from $43 per month to $60 per month, in the one example I know personally.

Your mixing the programs up. Ucare (medical assistance) = low income, no cost to $4 ($15.5K ind top income). IIRC, for the ind, its around $14K that the $4 monthly fee kicks in.
Your example is MnCare, low income ($15.522 ind up to $23.340) which has a sliding scale fee. MnCare used to cover all low income but not medical assistance persons but with obamacare, the low income single working people began to fall under medical assistance. Plus the MnCare coverage became real insurance. Formerly, there was a $10K med expense limit. MnCare at that time was very helpful for students.

MnSure is for individuals (and families) who have no employer coverage or independent/farmers/small business people. Their 2016 rate increase will be between 14 and 49% depending on which plan. This is the one tax credits are often used to help with costs.

2015 image:

Details from the 2015 hike:

http://www.mprnews.org/story/2014/10/01/mnsure-rates-2015

Additionally, it seems the tax credit will go up some to help offset costs. Right now, the Fed gov repays MN for tax credits but that subsidy will begin to decline in 2 or 3 years.

 

[iceaura]

Your mixing the programs up. Ucare (medical assistance) = low income, no cost to 4(15.5K ind top income). IIRC, for the ind, its around 14Kthatthe4 monthly fee kicks in.
Your example is MnCare,

You specified MNSure. I responded in kind.

My specific example (a family member) was from the Minnesota version of Obamacare, and its selection of approved providers, of which UCare was one until recently outbid. This:

MnSure is for individuals (and families) who have no employer coverage or independent/farmers/small business people. Their 2016 rate increase will be between 14 and 49% depending on which plan. This is the one tax credits are often used to help with costs.

Again, these increases are from a low base, and are partly driven by a bureaucratic mess imposed by Republican foes of the entire Republican designed Federal plan.

 

[joepistole]

Your mixing the programs up. Ucare (medical assistance) = low income, no cost to $4 ($15.5K ind top income). IIRC, for the ind, its around $14K that the $4 monthly fee kicks in.
Your example is MnCare, low income ($15.522 ind up to $23.340) which has a sliding scale fee. MnCare used to cover all low income but not medical assistance persons but with obamacare, the low income single working people began to fall under medical assistance. Plus the MnCare coverage became real insurance. Formerly, there was a $10K med expense limit. MnCare at that time was very helpful for students.

MnSure is for individuals (and families) who have no employer coverage or independent/farmers/small business people. Their 2016 rate increase will be between 14 and 49% depending on which plan. This is the one tax credits are often used to help with costs.

2015 image:

Details from the 2015 hike:

http://www.mprnews.org/story/2014/10/01/mnsure-rates-2015

Additionally, it seems the tax credit will go up some to help offset costs. Right now, the Fed gov repays MN for tax credits but that subsidy will begin to decline in 2 or 3 years.

The Medicaid subsidy might decline depending on what congress does and the state might be required to pick up as much as 10 percent of the total subsidy (i.e. Medicaid expansion) cost. But given 100 percent of that Medicaid expansion money is being spent inside the state, the state SHOULD be recovering that 10% and more from income taxes, sales taxes and property taxes. But the individual will not loose any tax credit in any case.

 

[milkweed]

You specified MNSure. I responded in kind.

You think you responded in kind.

Look at the IMG I posted for your convience. BLUE = Medical Assistance. NO PAY TWO CHOICEs of Providers. ORANGE = Mn CARE Limited pay Limited CHOICE of Providers - I think this is also same as Medical Assistance (2 providers). PINK = MnSURE Multiple plans via marketplace choices. THIS is the Rate Hike Area and what Michael is talking about.

If you attempt to sign up for MnSure when you qualify for MA/MnCARE they send to to a DIFFERENT WEBSITE to sign up. That website is MN DHS. See the links here:

https://www.mnsure.org/individual-family/cost/ma-mncare.jsp

My specific example (a family member) was from the Minnesota version of Obamacare, and its selection of approved providers, of which UCare was one until recently outbid. This: Again, these increases are from a low base, and are partly driven by a bureaucratic mess imposed by Republican foes of the entire Republican designed Federal plan.

ObamaCare works basically the same way MN does. If you qualify for no pay, you go on the Fed version of Medical Assistance (I cant remember if its medicade or medicare). If you are self employed, or employed where a health plan isnt offered, then you go through the private insurance via obamacare and may qualify for a tax credit (with an option to have that tax credit made as a direct payment to your insurance choice). These people are subjected to the rate increases Michael is talking about (aside from the rate increases via employer provided insurance).

So my point being you are still mixing things up. In MN there are 3 tiers. The tier you are referencing is the middle tier in MN and not subject to the 14-50% rate hikes Michael is talking about.

 

[milkweed]

The Medicaid subsidy might decline depending on what congress does and the state might be required to pick up as much as 10 percent of the total subsidy (i.e. Medicaid expansion) cost. But given 100 percent of that Medicaid expansion money is being spent inside the state, the state SHOULD be recovering that 10% and more from income taxes, sales taxes and property taxes. But the individual will not loose any tax credit in any case.

Medical Assistance For MN 2014 Fed share paid $4.9B Mn paid $4.2B
MnCare 2014 Fed share paid $242.5M Mn Paid $247M

http://mn.gov/dhs/images/Family-Self-Sufficiency-HealthCare-0815.pdf

 

[iceaura]

The tier you are referencing is the middle tier in MN and not subject to the 14-50% rate hikes Michael is talking about.

Michael doesn't know what Michael is talking about.

I was talking about the tier I was talking about, which is part of Minnesota's version of Obamacare and MNSure as you specified. In it, rates have been raised, just as Michael said. But the reasons for the boost traced directly back to Mitt Romney's plan and the rest of the long pursued Republican efforts to block even partial socialization of medical insurance in the US. This is a general truth of the exorbitant and still increasing costs of medical care in the US.