Health Insurance

[TomAz]

Our Governor and State Senate President both came out today and said that they had serious concerns about Medicaid expansion for Utah. I saw a similar statement from Mississippi's officials (who naturally already have the highest per capita Medicaid population in the country).

Tom where do you see the hospitals and medical professional associations coming down on the lobbying for this?

http://www.nytimes.com/2012/06/30/us...ansion.html?hp

This is the first really good article on the issue I have seen.

[marooko]

I like how education is always first up on the block.

[TomAz]

Mitch, I hate* to keep piling on.. but..

http://www.dispatch.com/content/stor...s-unclear.html







* - not really

[Miroir Noir]

You're not piling on, Tom. I have followed post 2008 politics closely enough that I should have known better.

[PotVsKtl]

It doesn’t make sense to have 45 million people without insurance. It’s not good for them because they don’t get good preventative care and disease management. But it’s not good for the rest of the citizens either, because if people aren’t insured, they go to the emergency room for their care when they get very sick. That’s expensive. They don’t have any insurance to cover it. So guess who pays? Everybody else. So it’s not good for the people that aren’t insured. We have to have our citizens insured, and we’re not going to do that by tax exemptions, because the people that don’t have insurance aren’t paying taxes. What you have to do is what we did in Massachusetts. Is it perfect? No. But we say, let’s rely on personal responsibility, help people buy their own private insurance, get our citizens insured, not with a government takeover, not with new taxes needed, but instead with a free-market based system that gets all of our citizens in the system. No more free rides. It works.

Thanks Mitt.

[TomAz]

1. Identify problem. 2. Claim free market is the solution. 3. Problem solved.

[PotVsKtl]

The point is that he's describing PPACA. Quote is from a 2007 debate.

[TomAz]

Funny how expanding Medicaid constitutes a free market solution.

[TomAz]

For those who might find this useful.

Originally posted on Reddit by CaspianX2, this is a good, simple breakdown of the Patient Protection and Affordable Care Act, a.k.a. ObamaCare, for anyone who isn't already up to speed or wants a simple overview. Also on Reddit at http://www.reddit.com/tb/vbkfm.

....

Why would people find this useful now, and not when it was first posted two pages back?

Also it's wrong in spots. (or oversimplified so much to create an inaccurate impression).

[PotVsKtl]

Funny how expanding Medicaid constitutes a free market solution.

Mitt Romney is a lying d-bag. That much is settled law. Massachusetts ACT expanded Medicaid and SCHIP. Is it an entirely free market solution? No. Is it identical in nearly all respects to PPACA? Yes. Did Mitt Romney propose it as a federal solution? Yes.

[TomAz]

You left out the part about Jonathan Gruber.

[PotVsKtl]

It smells like a steak dinner in here.

[TomAz]

http://video.foxnews.com/v/171536947...mp=sem_outloud


this is amazing. watch it.

[PotVsKtl]

Shockingly, "distinguished fellows" from the Heritage Foundation are no-talent lumpfish.

[PlayaDelWes]

Is anyone an expert yet on the transition from traditional PPOs to "Consumer Directed Health Plans"?

Is the idea that if you pay more out of pocket and are personally exposed to higher deductibles and higher out-of-pocket maximums, you may shop around for better value?

[TomAz]

That is the theory, yes.

[PlayaDelWes]

Any idea of the logistics on how one would shop around? At this point, I have no idea where my Doctor compares to others on cost.

[TomAz]

It's virtually impossible to price shop. It's complicated for doctors and nearly a mathematical impossibility for hospitals. And that's if you even had access to data.

My original answer is overly simple. The idea that with some 'skin in the game' you would become a cost-conscious purchaser of healthcare services. So when the doc says, I think you need this test, you could question him about why he believes the test is needed, what the test might possibly show, and do your own cost/benefit analysis. So that people become involved in their own care and just keep a watchful eye out for waste.

For the record, I am a skeptic of the whole notion. Initial data indicates cost savings, but nearly all of it attributable to positive selection (healthier people are more attracted to high deductible plans than sick people). The fact is the great majority of healthcare costs paid by insurers do not come from routine tests but rather what happens when shit goes bad: when you're having a heart attack you're not going to be thinking about the most cost effective alternatives to care.

[Miroir Noir]

Romney embraces his inner George W. Bush ("People have access to health care in America . . . After all, you just go to an emergency room"):

Pelley: Does the government have a responsibility to provide health care to the 50 million Americans who don't have it today?

Romney: Well, we do provide care for people who don't have insurance, people-- we-- if someone has a heart attack, they don't sit in their apartment and die. We pick them up in an ambulance, and take them to the hospital, and give them care. And different states have different ways of providing for that care.

[PlayaDelWes]

You're asking the wrong people if you are asking anyone other than me.

Tom, why does everything with ACA seem like one giant shell game with a bunch of administrative overhead?

I just watched a 10 minute video on my new CDHP. I am more confused now than ever. My plan next year is nearly $1,000 more, but for watching the video, I will now get $100 deposited in my HRA and another $500 deposited when I complete a health screening and a health assessment (see below). Is the primary cost save with ACA modeled after mail-in rebates where a lot of people just don't redeem and therefore they have a general revenue pickup?

In regards to the health assessment, I get a pretty comprehensive annual check-up from my Doctor, including all sorts of blood and other tests, but because he didn’t measure my waist this year, my 2013 visit doesn’t qualify as a “Health Screening”. Seems kinda silly to have a second exam just to get that waist-line measurement on paper.

Are these check-boxes part of the whole increase demand to reduce cost thing?

[TomAz]

I am not sure that any of that is happening because of ACA. These may just be changes your employer is making to your plan.

The whole Health Risk Assessment thing is a current fad; we'll see if it sticks much longer. The idea is that if you can identify people who are at risk for acute care episodes (eg, ER visit due to asthma attack) then you can take steps to encourage the individual to do things to manage his/her health more effectively and thus reduce the number of these acute care episodes. It's an attempt to 'bend the cost curve' and there is some science behind it but the whole trick is getting people to actually disclose personal information about themselves to their health plan and so you see these various incentive plans to get people to fill out the risk assessment form. Like, give you more money in your HSA.

As far as the assessment itself, I heard a speaker (an MD, on faculty at Tulane) give a presentation this year in which he said that waist measurement is the second most important piece of data on managing cardio risks, after blood pressure. Meaning more important than weight, or BMI, or LDL counts, or all that. So yeah there is a new push toward waistline measurements. Apparently the correlation between adverse cardio event (MI, CVA, etc) and waist size > 40" is quite strong.

[SlowMotionApocalypse]

Am I going to be "mandated" by law to actually go to the doctor instead of just paying a bill every month?

[TomAz]

no.

[amyzzz]

More incentive for me to get rid of my belly. (although my waist is nowhere near 40")

[TomAz]

Actually amy, it doesn't mean that at all.

[amyzzz]

bleh never mind, I'm on crack.

[TomAz]

The doctor said that having a waistline >40" is a strong marker for cardiovascular problems. That is not a reason to reduce your 26" waistline to 24"

[amyzzz]

I wish my waistline was that small.

[chairmenmeow47]

apparently my company is "self-insured" and we contract aetna. what the hell does this mean, tom? i don't feel like i understood the term when i tried to research.

also, i can't believe what a large percentage of costs are caused by a small percentage of people with chronic conditions. do you ever wonder if things like credits for not smoking are just the tip of the iceberg for employers managing our behavior to keep health care costs down?

[PlayaDelWes]

I am not sure that any of that is happening because of ACA. These may just be changes your employer is making to your plan.

So what you are saying is that Aetna is passive aggressively making things more expensive, difficult, and administratively burdening so we get all riled up and blame ACA?