My favorite, my absolute all time favorite, involved a spaceship hovering over a farm house. As a tractor beam guided bottles of Stroh’s Beer from the refrigerator to the vehicle above, the farmer deadpans, “Don’t surprise me none.”
What are some of your favorite television commercials? Do you like the new La Quinta spots that parody tired sales clichés? Are you a fan of locally produced ads? The Cleveland market has several ads of young girls asking you to love your floor or Chevy as much as they love their daddies.
Which ads are you going to miss?
It all ends today. Local commercials were already being crowded out of the market by ads for and against President Obama, for and against Governor Romney. The candidates and their super PAC’s have an almost endless supply of money to run ads in a swing state like Ohio. But the Supreme Court decision is due today, June 25, 2012. The Court’s decision on the constitutionality of the Patient Protection and Affordable Care Act (PPACA) will dominate the airwaves for the rest of this year.
The Verdict? I have no idea. You will have that answer by the time you read this. The Court’s decision is just one piece of the puzzle. It is what the President, the Congress, the individual states and the American people do over the next eight months that will give us the entire picture.
The first actions will be the most meaningless. Unless the decision is completely, totally on one extreme or the other, both sides will declare victory. Both sides will treat that part of the ruling that favors the other side as an insignificant set-back that can be easily remedied. In the unlikely event, in my opinion, that one side or the other completely wins; the losing side will vow revenge and cry politics.
In any case, the ads start tomorrow. Both the Democrats and the Republicans will use the Supreme Court’s decision as the main reason to vote for their guy and the rest of the ticket.
The first victim of the Supreme Court’s ruling won‘t be any section of the PPACA. The first casualty will be the Truth. Black will become white. Day will become night. If you become confused, so much the better. And, if you are undecided and choose to stay home on Election Day, then they will have won. The hard-core of both parties, the people who are so sure, will always turn out. It’s you, the people who are up for grabs, that can’t be trusted to vote for the right guy.
So there will be ads, non-stop, till Election Day. And you will hear claims and counterclaims. You will be bombarded with meaningless statistics and weepy old people. What you won’t get is any nuance or a whole lot of truth. What will be missing are young girls that love their daddies and wall to wall carpet.
And now, a word from our sponsor.
DAVE
http://www.bcandb.com/
Sunday, June 24, 2012
Wednesday, June 6, 2012
A Pack Of Wild Dogs
Your ten year old comes crashing through the door with a story of being chased home from school by a pack of wild dogs. Do you
However, if you child would have burst through the door and said that a dog had chased him home, you would have gone to the door fully expecting to see a neighbor’s German shepherd, collie, or great Dane.
My favorite ten year olds are Doctors Arthur Lavin and Michael Devereaux the co-chairmen of a local lobbying group, Doctors for Health Care Solutions. Longtime readers of this blog remember this group as the stage props who show up with their white lab coats whenever a politician endorses the President’s health care plan.
Doctors Lavin and Devereaux, along with their own pack of wild dogs, surfaced again in last Sunday’s Plain Dealer. Appearing, fittingly, on Page 3 of the Forum (opinion) Section, they weaved a fact-less tale of illness, greed and desperation.
It is tempting to disassemble their article one line at a time. Several clients, one a young woman with a serious insurance issue and a far more serious health problem, have already participated in this exercise. I will try to keep this down to only a few of the obvious flaws.
The plot: A forty-five year old healthy female, a middle class Greater Clevelander with a good job and “excellent health insurance”, suddenly comes down with multiple sclerosis. Her insurance company drops her. Without insurance, her doctor the alleged hero of this story, drops her. Bills pile up. Treatments fail to keep her healthy enough to work. She loses her job and ends up on Medicaid. Now the government spends $40,000 a year for the doctors to treat her.
WOW! It is too gruesome to imagine. It’s like a pack of wild dogs chasing a ten year old home from school.
She lost her insurance? How? You can not be cancelled by your insurance company due to a health condition. Was this “excellent health insurance” from her employer? How did she lose the coverage BEFORE she lost her job?
The article is filled with random falsehoods and exaggerations. At one point our creative doctors claim that women pay roughly double the price of men. The key is the word roughly as in at 6’3” I am roughly 10 feet tall. I will be happy to bore you with the specific rates of where women are more expensive than men and where men are more expensive than women upon request.
The truth is stretched beyond recognition when the doctors deal with the number of uninsureds, the difficulty in acquiring insurance, and the benefits of the Patient Protection and Affordable Care Act.
Why does this matter? Even the most casual, neutral observer will see this for what it is, propaganda. And that is the problem. Most of what we are seeing is either hysteria from the left, like this, or hysteria from the right that would lead you to believe that the sick are dying on the streets in Canada. It is all so extreme and so unlikely that we start to ignore everything. It is understandable to scream “A plague upon both houses”, but the health care system affects all of us. We ignore this mess at our own peril.
There are real problems with the status quo. There are people falling through the cracks. Doing nothing solves nothing. Unfortunately, the PPACA does not adequately address many of these issues. But we will never get anything done if we are spending all of time fleeing from packs of wild dogs.
DAVE
www.bcandb.com
- Grab a shot gun and your copy of Old Yeller
- Call 911
- Pour a glass of milk, hand him a cookie, and return to whatever you were doing.
However, if you child would have burst through the door and said that a dog had chased him home, you would have gone to the door fully expecting to see a neighbor’s German shepherd, collie, or great Dane.
My favorite ten year olds are Doctors Arthur Lavin and Michael Devereaux the co-chairmen of a local lobbying group, Doctors for Health Care Solutions. Longtime readers of this blog remember this group as the stage props who show up with their white lab coats whenever a politician endorses the President’s health care plan.
Doctors Lavin and Devereaux, along with their own pack of wild dogs, surfaced again in last Sunday’s Plain Dealer. Appearing, fittingly, on Page 3 of the Forum (opinion) Section, they weaved a fact-less tale of illness, greed and desperation.
It is tempting to disassemble their article one line at a time. Several clients, one a young woman with a serious insurance issue and a far more serious health problem, have already participated in this exercise. I will try to keep this down to only a few of the obvious flaws.
The plot: A forty-five year old healthy female, a middle class Greater Clevelander with a good job and “excellent health insurance”, suddenly comes down with multiple sclerosis. Her insurance company drops her. Without insurance, her doctor the alleged hero of this story, drops her. Bills pile up. Treatments fail to keep her healthy enough to work. She loses her job and ends up on Medicaid. Now the government spends $40,000 a year for the doctors to treat her.
WOW! It is too gruesome to imagine. It’s like a pack of wild dogs chasing a ten year old home from school.
She lost her insurance? How? You can not be cancelled by your insurance company due to a health condition. Was this “excellent health insurance” from her employer? How did she lose the coverage BEFORE she lost her job?
The article is filled with random falsehoods and exaggerations. At one point our creative doctors claim that women pay roughly double the price of men. The key is the word roughly as in at 6’3” I am roughly 10 feet tall. I will be happy to bore you with the specific rates of where women are more expensive than men and where men are more expensive than women upon request.
The truth is stretched beyond recognition when the doctors deal with the number of uninsureds, the difficulty in acquiring insurance, and the benefits of the Patient Protection and Affordable Care Act.
Why does this matter? Even the most casual, neutral observer will see this for what it is, propaganda. And that is the problem. Most of what we are seeing is either hysteria from the left, like this, or hysteria from the right that would lead you to believe that the sick are dying on the streets in Canada. It is all so extreme and so unlikely that we start to ignore everything. It is understandable to scream “A plague upon both houses”, but the health care system affects all of us. We ignore this mess at our own peril.
There are real problems with the status quo. There are people falling through the cracks. Doing nothing solves nothing. Unfortunately, the PPACA does not adequately address many of these issues. But we will never get anything done if we are spending all of time fleeing from packs of wild dogs.
DAVE
www.bcandb.com
Monday, May 28, 2012
Isn't That Convenient?
The client was adamant. He didn’t want birth control covered and he didn’t want abortion. And because he had over fifty employees and because the year was 1991, I could get his group health insurance policy issued to his specifications. Was this a decision based upon his values and personal religious beliefs? Not hardly. The elimination of these benefits reduced his premium. He was not concerned about the needs of his female employees. The spouses and children of his male employees were not his problem. His daughter-in-laws could afford birth control pills and his granddaughters were still in elementary school.
If that same conversation were held today, his request would be couched with religious overtones. But truth be told, he would have pretended to have been Catholic if it would have saved him 2%.
The Sunday Plain Dealer had a half dozen letters to the editor about the recent lawsuit. A group of forty-three Catholic organizations including the archdioceses of New York and Washington, the University of Notre Dame and Catholic University of America, are suing to block requirements of the Patient Protection and Affordable Care Act to provide birth control, IUD’s, and the morning after pill. The letters feature Catholics defining Catholicism, Catholics attacking anyone out of step with the current Pope, and Catholics clarifying their belief that theirs is the only true version of Christianity.
As a non-Catholic, non-Christian, I have the opportunity to observe what appears to be a lot of heat, but very little light.
The fun part of this is that the PPACA does not guarantee these benefits, just the fight.
Free Preventive Care, no copays, deductibles, or coinsurance, is a key element of the Patient Protection and Affordable Care Act. It is the Obama administration and Kathleen Sebelius, the Secretary of Health and Human Services, who chose to define birth control pills, IUD’s, and the morning after pill as part of Preventive Care. That was a deliberate choice.
But when it comes to the PPACA, almost everyone is pro-choice. The Democrats chose to ignore the parts they don’t like. Republicans choose to ignore the parts that they once endorsed or created.
Are there people truly offended by the birth control provision or the individual mandate? Of course. But like my client of twenty years ago, much of this appears to be convenient agitation. They don’t want to implement the program and this is the excuse du jour. There are costs involved with any improvement in access to care or treatment. In our system, it will be the employers who will bear that burden. There are also some Americans who will disagree with this President no matter what. Some of those people are now, for the first times in their lives, rooting for Notre Dame.
Will the Supreme Court drop-kick the individual mandate? Will the Catholic Church have its day in court? Your guess is as good as mine.
I still contend that none of this really matters.
DAVE
www.bcandb.com
If that same conversation were held today, his request would be couched with religious overtones. But truth be told, he would have pretended to have been Catholic if it would have saved him 2%.
The Sunday Plain Dealer had a half dozen letters to the editor about the recent lawsuit. A group of forty-three Catholic organizations including the archdioceses of New York and Washington, the University of Notre Dame and Catholic University of America, are suing to block requirements of the Patient Protection and Affordable Care Act to provide birth control, IUD’s, and the morning after pill. The letters feature Catholics defining Catholicism, Catholics attacking anyone out of step with the current Pope, and Catholics clarifying their belief that theirs is the only true version of Christianity.
As a non-Catholic, non-Christian, I have the opportunity to observe what appears to be a lot of heat, but very little light.
The fun part of this is that the PPACA does not guarantee these benefits, just the fight.
Free Preventive Care, no copays, deductibles, or coinsurance, is a key element of the Patient Protection and Affordable Care Act. It is the Obama administration and Kathleen Sebelius, the Secretary of Health and Human Services, who chose to define birth control pills, IUD’s, and the morning after pill as part of Preventive Care. That was a deliberate choice.
But when it comes to the PPACA, almost everyone is pro-choice. The Democrats chose to ignore the parts they don’t like. Republicans choose to ignore the parts that they once endorsed or created.
Are there people truly offended by the birth control provision or the individual mandate? Of course. But like my client of twenty years ago, much of this appears to be convenient agitation. They don’t want to implement the program and this is the excuse du jour. There are costs involved with any improvement in access to care or treatment. In our system, it will be the employers who will bear that burden. There are also some Americans who will disagree with this President no matter what. Some of those people are now, for the first times in their lives, rooting for Notre Dame.
Will the Supreme Court drop-kick the individual mandate? Will the Catholic Church have its day in court? Your guess is as good as mine.
I still contend that none of this really matters.
DAVE
www.bcandb.com
Tuesday, May 22, 2012
Facts? We Don't Need No Stinkin' Facts!
Governor Ted was on a roll. Ted Strickland, our previous governor, is a national co-chairman for President Obama’s reelection campaign. It is his job to tell one side of the story. It is his job to shape the issues to his candidate’s advantage. And, if necessary, it is his job to bypass a fact or two en route to his desired destination. Governor Ted was born for this job. Lucky for him, the reporters were the Plain Dealer’s Sabrina Eaton and Stephen Koff.
The article, Health care law may be big issue for young voters, appeared in last Sunday’s Plain Dealer. The online version linked here is slightly different from the version that appeared in the Plain Dealer. The crux of the article was that young adults are thrilled to be able to stay on their parents’ group health insurance policies. Dumping the Patient Protection and Affordable Care Act (PPACA) could cost the Republicans the votes of everyone under age 28.
This is where Governor Ted comes in.
This act of journalistic sloth, printing that claim by the President’s reelection campaign without question, is inexcusable. The Plain Dealer reporters could have interviewed any health insurance agent. They could have contacted an insurer, like Medical Mutual of Ohio who, unlike the Plain Dealer, is still headquartered in downtown Cleveland. Or, they could have gone online and run a couple of quick quotes.
They chose to do nothing.
And speaking of nothing, covering your children on your employer’s group policy is not nothing. The employer may be paying some or even the entire premium. The parent may be paying all of the cost. Ask your boss how much, if anything, you are paying to cover your children.
Let’s look at some numbers. Medical Mutual of Ohio. Elite policy with an office copay, Rx card, and a $2,500 deductible. Cuyahoga County (most expensive in Ohio). Healthy non-smoker.
......Male..........................Female
....$107.95..........21........$136.50
....$110.56..........26........$150.57
There are less expensive policies. You would never know any of this if your only source of information is the Plain Dealer.
Is $107.95 a month less than your employer’s policy? Most definitely. And if you are paying for this coverage, you may be able to save money by ignoring Governor Ted.
I am not running a campaign, so I will tell you the whole story. Some adult children are benefitting from the PPACA. If your child is unhealthy, if your child has had a major illness or injury, or if your daughter is pregnant, your employer’s group health coverage and the law that allows your child to remain on your policy, is a godsend. That is not dramatic or scary, but it is real.
We need more access to quality health care, not less. We need more facts, not less.
DAVE
www.bcandb.com
The article, Health care law may be big issue for young voters, appeared in last Sunday’s Plain Dealer. The online version linked here is slightly different from the version that appeared in the Plain Dealer. The crux of the article was that young adults are thrilled to be able to stay on their parents’ group health insurance policies. Dumping the Patient Protection and Affordable Care Act (PPACA) could cost the Republicans the votes of everyone under age 28.
This is where Governor Ted comes in.
Without the health care law, this group could lose coverage under their parents’ plans and “it’s impossible to be able to afford an individual policy unless you’re a wealthy or semi-wealthy person,” Strickland says.It’s impossible? Balderdash!
This act of journalistic sloth, printing that claim by the President’s reelection campaign without question, is inexcusable. The Plain Dealer reporters could have interviewed any health insurance agent. They could have contacted an insurer, like Medical Mutual of Ohio who, unlike the Plain Dealer, is still headquartered in downtown Cleveland. Or, they could have gone online and run a couple of quick quotes.
They chose to do nothing.
And speaking of nothing, covering your children on your employer’s group policy is not nothing. The employer may be paying some or even the entire premium. The parent may be paying all of the cost. Ask your boss how much, if anything, you are paying to cover your children.
Let’s look at some numbers. Medical Mutual of Ohio. Elite policy with an office copay, Rx card, and a $2,500 deductible. Cuyahoga County (most expensive in Ohio). Healthy non-smoker.
......Male..........................Female
....$107.95..........21........$136.50
....$110.56..........26........$150.57
There are less expensive policies. You would never know any of this if your only source of information is the Plain Dealer.
Is $107.95 a month less than your employer’s policy? Most definitely. And if you are paying for this coverage, you may be able to save money by ignoring Governor Ted.
I am not running a campaign, so I will tell you the whole story. Some adult children are benefitting from the PPACA. If your child is unhealthy, if your child has had a major illness or injury, or if your daughter is pregnant, your employer’s group health coverage and the law that allows your child to remain on your policy, is a godsend. That is not dramatic or scary, but it is real.
We need more access to quality health care, not less. We need more facts, not less.
DAVE
www.bcandb.com
Monday, April 30, 2012
I Like My Funds Extra Slushy
Readers of this blog are aware of my fixation on transparency. Readers of my other blog, Again? Really?, know that I am particularly offended by slush funds, large amounts of taxpayer money redirected by government entities to surreptitiously benefit pet causes or personal gain. The slush finds of a local government might be in the thousands or possibly a million dollars or so. It takes the federal government to create a billion dollar boondoggle.
Insured Americans will be paying a new fee as of October 1, 2012. Anthem Blue Cross sent a warning announcement last week to advise us that they will be adding the charge to our bills. “The Affordable Care Act (PPACA) established the Patient-Centered Outcomes Research Institute (PCORI) to explore the effectiveness, risks, and benefits of medical treatments. This study is also known as Comparative Effectiveness Research (CER). PCORI is a nonprofit, nongovernmental organization supported by a trust fund that is financed in part by fees from health plan insurers.”
The fees are $1 per covered person in the first year. $2 per person in the second year. And after two years? The $2 per person per year will be adjusted for medical inflation.
Bureaucracies, in general, like acronyms, but the combination of acronyms and money make for a government love affair.
Comparative Effectiveness Research came into prominence as part of President Obama’s American Recovery and Reinvestment Act of 2009. $1.1 Billion was allocated.
The Department of Health and Human Services (HHS) explained that CER “compares treatments and strategies to improve health. This information is essential for clinicians and patients to decide on the best treatment. It also enables our nation to improve the health of communities and the performance of the health system.”
Gosh that sounds good.
According to the National Cancer Institute, CER has both its proponents and detractors. One key issue was brought up by Jeffrey Kindler, CEO of Pfizer, who wondered whether the results from Comparative Effectiveness studies would be “automatically linked” to insurance coverage decisions. In other words, will healthcare in the future become one size fits almost all and too bad about the rest.
In his paper “Comparative Effectiveness Research and Kindred Delusions”, Norton Hadler, MD expanded on the difference between efficacy and effectiveness.
I have nothing to add to that debate. My only question is “How Much?” How much money, your money in taxes and your money in fees, are we spending on this and who is getting it?
Billions of dollars funneled through the Department of Health and Human Services became even more of an issue last week when the Government Accountability Office (Yes, that GAO) found that the Obama administration was wasting $8.3 Billion on a questionable Medicare program.
As part of a “Demonstration Project”, HHS has created an experimental program to study the effects of money on the insurance market. This experiment is to award bonuses to high quality managed care Medicare policies known as Medicare Advantage. High quality, like intellectual honesty, was one of the first victims of this scheme. To make a long story short, the money, most paid out in the next three years, covers the cuts that were made in these popular programs by the President’s health care law. The PPACA took money away, but Health and Human Services put the money back in through the back door.
The independent Medicare Payment Advisory Commission panned the misdirection. The Republicans think that this looks suspiciously like a re-election driven decision. The New York Post didn’t bury the lead. They labeled it a political slush fund.
What we are talking about is money. We know where it comes from, US. What we don’t know is where it is going and why. Unlimited funds funneled through Kathleen Sebelius and her politicized Department of Health and Human Services are sure to arouse suspicions. Add to this an $8.3 Billion experiment and you have the potential for a real problem.
DAVE
www.bcandb.com
Insured Americans will be paying a new fee as of October 1, 2012. Anthem Blue Cross sent a warning announcement last week to advise us that they will be adding the charge to our bills. “The Affordable Care Act (PPACA) established the Patient-Centered Outcomes Research Institute (PCORI) to explore the effectiveness, risks, and benefits of medical treatments. This study is also known as Comparative Effectiveness Research (CER). PCORI is a nonprofit, nongovernmental organization supported by a trust fund that is financed in part by fees from health plan insurers.”
The fees are $1 per covered person in the first year. $2 per person in the second year. And after two years? The $2 per person per year will be adjusted for medical inflation.
Bureaucracies, in general, like acronyms, but the combination of acronyms and money make for a government love affair.
Comparative Effectiveness Research came into prominence as part of President Obama’s American Recovery and Reinvestment Act of 2009. $1.1 Billion was allocated.
- $300 Million for the Agency for Healthcare Research and Quality.
- $400 Million for the National Institutes of Health.
- $400 Million for the Office of the Secretary of Health and Human Services.
The Department of Health and Human Services (HHS) explained that CER “compares treatments and strategies to improve health. This information is essential for clinicians and patients to decide on the best treatment. It also enables our nation to improve the health of communities and the performance of the health system.”
Gosh that sounds good.
According to the National Cancer Institute, CER has both its proponents and detractors. One key issue was brought up by Jeffrey Kindler, CEO of Pfizer, who wondered whether the results from Comparative Effectiveness studies would be “automatically linked” to insurance coverage decisions. In other words, will healthcare in the future become one size fits almost all and too bad about the rest.
In his paper “Comparative Effectiveness Research and Kindred Delusions”, Norton Hadler, MD expanded on the difference between efficacy and effectiveness.
I have nothing to add to that debate. My only question is “How Much?” How much money, your money in taxes and your money in fees, are we spending on this and who is getting it?
Billions of dollars funneled through the Department of Health and Human Services became even more of an issue last week when the Government Accountability Office (Yes, that GAO) found that the Obama administration was wasting $8.3 Billion on a questionable Medicare program.
As part of a “Demonstration Project”, HHS has created an experimental program to study the effects of money on the insurance market. This experiment is to award bonuses to high quality managed care Medicare policies known as Medicare Advantage. High quality, like intellectual honesty, was one of the first victims of this scheme. To make a long story short, the money, most paid out in the next three years, covers the cuts that were made in these popular programs by the President’s health care law. The PPACA took money away, but Health and Human Services put the money back in through the back door.
The independent Medicare Payment Advisory Commission panned the misdirection. The Republicans think that this looks suspiciously like a re-election driven decision. The New York Post didn’t bury the lead. They labeled it a political slush fund.
What we are talking about is money. We know where it comes from, US. What we don’t know is where it is going and why. Unlimited funds funneled through Kathleen Sebelius and her politicized Department of Health and Human Services are sure to arouse suspicions. Add to this an $8.3 Billion experiment and you have the potential for a real problem.
DAVE
www.bcandb.com
Monday, April 23, 2012
It Sucks To Be Poor
It sucks to be poor. It is nobody’s goal in life to be poor, to wonder how you are going to feed your family, keep a roof over your head, or to be unable to afford the most basic of needs or wants. I’ve been poor, not homeless or destitute, but close enough to appreciate the fear and uncertainty that comes with an overdrawn back account and a baloney and tater tot dinner.
I’ve never received government assistance, not even unemployment compensation. So I have never had to check in with a government employee, told where I could live, or what groceries I could buy. And when I needed to take my children to the doctor, I’ve always had my choice of all of the pediatricians in town.
The poor have Medicaid.
Medicaid. Fraud ravaged. Doctor hated. Taxpayer resented. Medicaid. And no one likes Medicaid less than the people it was designed to help.
There are 1.7 million Ohioans receiving state funded medical assistance. Ohio is revamping Medicaid, again.
Eleven companies recently participated in a complex bidding process to win a piece of this action. Five won the opportunity to provide coverage. Five lost and are filing appeals. One, Anthem Blue Cross the #1 insurer of Ohioans, shrugged off its loss and walked away.
Medicaid, the State of Ohio’s single payer health care system for the poor, appears to be mired in controversy. As reported in the Columbus Dispatch, there are charges of more than just irregularities, mistakes, and a shocking lack of transparency. There may have been actual fraud and false statements on the applications.
Some of the companies that were shut out contacted London based Barclays to analyze the process. They found “Scoring results indicate considerable inconsistencies among bidders…Scoring processes are always complex, especially in markets this large, but typically not to this degree.”
In a rush to save $1.5 Billion (real or imagined) in the next two years, the state may have selected up to three vendors thanks to applications enhanced with inflated statistics. Though the process was supposed to “improve the coordination of care for 1.7 million recipients and improve health”, it may, instead, have been just one more arbitrarily awarded government contract.
It is one thing to entrust your children’s health to the lowest bidder. It is even worse to be herded to a facility or provider that lacks the integrity to compete fairly. But when you are a football, when you are tossed from one player to another, you don’t have much say in the process.
But then again, it sucks to be poor.
DAVE
www.bcandb.com
I’ve never received government assistance, not even unemployment compensation. So I have never had to check in with a government employee, told where I could live, or what groceries I could buy. And when I needed to take my children to the doctor, I’ve always had my choice of all of the pediatricians in town.
The poor have Medicaid.
Medicaid. Fraud ravaged. Doctor hated. Taxpayer resented. Medicaid. And no one likes Medicaid less than the people it was designed to help.
There are 1.7 million Ohioans receiving state funded medical assistance. Ohio is revamping Medicaid, again.
Eleven companies recently participated in a complex bidding process to win a piece of this action. Five won the opportunity to provide coverage. Five lost and are filing appeals. One, Anthem Blue Cross the #1 insurer of Ohioans, shrugged off its loss and walked away.
Medicaid, the State of Ohio’s single payer health care system for the poor, appears to be mired in controversy. As reported in the Columbus Dispatch, there are charges of more than just irregularities, mistakes, and a shocking lack of transparency. There may have been actual fraud and false statements on the applications.
Some of the companies that were shut out contacted London based Barclays to analyze the process. They found “Scoring results indicate considerable inconsistencies among bidders…Scoring processes are always complex, especially in markets this large, but typically not to this degree.”
In a rush to save $1.5 Billion (real or imagined) in the next two years, the state may have selected up to three vendors thanks to applications enhanced with inflated statistics. Though the process was supposed to “improve the coordination of care for 1.7 million recipients and improve health”, it may, instead, have been just one more arbitrarily awarded government contract.
It is one thing to entrust your children’s health to the lowest bidder. It is even worse to be herded to a facility or provider that lacks the integrity to compete fairly. But when you are a football, when you are tossed from one player to another, you don’t have much say in the process.
But then again, it sucks to be poor.
DAVE
www.bcandb.com
Wednesday, April 11, 2012
The Fixer
Her Nationwide guy suggested that she call me. And though I appreciate Mike’s confidence, I also know that his referrals are often people who have somehow fallen through the cracks of our system. This woman epitomized the permanent flaws in this and any system of health care. And more to my frustration than hers, I could not fix her problem.
Much like Eddie Vedder’s The Fixer, I have always been obsessed with making things right, of solving everyone’s problems. That empathy works well in what I do for a living. But I am deeply frustrated when I encounter a situation that can’t be fixed. Here is hers:
The woman, we’ll call her Maria, has group insurance through her employer. The cost of the policy has increased over the years, but the employer is still paying the vast majority of the premium. This year the employer changed the coverage to a High Deductible Healthcare Plan, in other words, a policy that qualifies for an HSA. Maria no longer has an office visit copay. Maria no longer has an Rx card. All of these expenses are applied towards her $4,000 deductible. In theory, this might save her money. In reality, she is screwed. She is on two very expensive medications. One is $885 for a three month supply. The other is $1,400!
Where does she come up with the money for these prescriptions? She makes just enough per month that she won’t qualify for any help from the drug companies. She makes too little to be able to afford the medications she needs to be able to work.
Got an answer? Neither do I?
No system could possibly sustain the cost of paying for everyone’s doctors’ visits, prescriptions, and hospital stays. We must contribute. We must either pay for insurance or be taxed by the government (or both) to fund the system that pays most of the bills. The balance, whether that structure includes copays or deductibles, must be paid by the person receiving treatment. Should we all be responsible for the same amount? Will there be a sliding scale based on income, location, or family size?
No matter the final outcome, most people will be offended when it is their turn to pay. Worse, many people will be forced to pay more than they feel that they can afford. And some will be buried in debt. The other choice is to simply limit the most expensive care based on survivability and efficacy. And that opens another set of worries.
In a recent Forbes article, Richard Grant argues that what we need is less regulation, not more. “Government’s main role has been to serve as the enforcer of a cartel that limits the supply of doctors, of hospitals, of drugs, and of innovative alternatives.” There is truth to all of that. And if we reversed our course and somehow made it to a completely open market, the well-off and educated, like Mr. Grant, might receive better care for less. Unfortunately, the Maria’s of our world would be collateral damage. I’m not sure which regulations Mr. Grant would like to eliminate. Do we want to trust the marketplace to license doctors and approve prescriptions?
The HSA policy is a half-hearted attempt at empowering the patient and controlling costs. It succeeds at neither. Does Maria need to be on these expensive medications? Would more common, less expensive drugs, be almost as good? Since at least one of these drugs is for a mental condition, would she have the needed faith in a new prescription that was purchased not because her doctor thought it was better for her, but because she can’t afford the good one? The experiment is doomed to failure.
And I can’t help her. And there is no moment worse for a Fixer than when he realizes that there is nothing that he can do.
Much like Eddie Vedder’s The Fixer, I have always been obsessed with making things right, of solving everyone’s problems. That empathy works well in what I do for a living. But I am deeply frustrated when I encounter a situation that can’t be fixed. Here is hers:
The woman, we’ll call her Maria, has group insurance through her employer. The cost of the policy has increased over the years, but the employer is still paying the vast majority of the premium. This year the employer changed the coverage to a High Deductible Healthcare Plan, in other words, a policy that qualifies for an HSA. Maria no longer has an office visit copay. Maria no longer has an Rx card. All of these expenses are applied towards her $4,000 deductible. In theory, this might save her money. In reality, she is screwed. She is on two very expensive medications. One is $885 for a three month supply. The other is $1,400!
Where does she come up with the money for these prescriptions? She makes just enough per month that she won’t qualify for any help from the drug companies. She makes too little to be able to afford the medications she needs to be able to work.
Got an answer? Neither do I?
No system could possibly sustain the cost of paying for everyone’s doctors’ visits, prescriptions, and hospital stays. We must contribute. We must either pay for insurance or be taxed by the government (or both) to fund the system that pays most of the bills. The balance, whether that structure includes copays or deductibles, must be paid by the person receiving treatment. Should we all be responsible for the same amount? Will there be a sliding scale based on income, location, or family size?
No matter the final outcome, most people will be offended when it is their turn to pay. Worse, many people will be forced to pay more than they feel that they can afford. And some will be buried in debt. The other choice is to simply limit the most expensive care based on survivability and efficacy. And that opens another set of worries.
In a recent Forbes article, Richard Grant argues that what we need is less regulation, not more. “Government’s main role has been to serve as the enforcer of a cartel that limits the supply of doctors, of hospitals, of drugs, and of innovative alternatives.” There is truth to all of that. And if we reversed our course and somehow made it to a completely open market, the well-off and educated, like Mr. Grant, might receive better care for less. Unfortunately, the Maria’s of our world would be collateral damage. I’m not sure which regulations Mr. Grant would like to eliminate. Do we want to trust the marketplace to license doctors and approve prescriptions?
The HSA policy is a half-hearted attempt at empowering the patient and controlling costs. It succeeds at neither. Does Maria need to be on these expensive medications? Would more common, less expensive drugs, be almost as good? Since at least one of these drugs is for a mental condition, would she have the needed faith in a new prescription that was purchased not because her doctor thought it was better for her, but because she can’t afford the good one? The experiment is doomed to failure.
And I can’t help her. And there is no moment worse for a Fixer than when he realizes that there is nothing that he can do.
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