Archive for the ‘health care’ Category

So Spicey Spice sez that the CBO is wrong about how many people will lose insurance when the CBO says 24 million people will lose their health insurance under the House bill.

Turns out he might be right. According to the Trump Administration’s own estimates, the actual number is 26 million. I.e., the CBO underestimated how many people will lose their health insurance.

Which isn’t exactly what Spicey Spice was implying, but anyhow: The end result of 26 million more uninsured people is, of course, dead bodies. Lots of dead bodies. Uninsured people have a 40% higher death rate in a given year than insured people.

But they’re not rich people, so I guess that as far as Spicey Spice and the rest of His Fraudulency Donald the Trump’s regime is concerned, they don’t really count.

– Badtux the Healthcare Penguin

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… quit proposing Nazi policies like genocide. Yeah, some fine MAGAts in Maricopa County (Arizona) proposed liberal genocide and deportation of the Jews to save America for white people. Thereby proving that Maricopa County is one of the Orange Racist Pussy Grabber’s strongholds. Yay, Arizona.

Meanwhile, Paul Ryan literally flunks the answer to the question, “what is insurance?”. The answer to that question, of course, is that insurance is risk pooling. Let’s take leukemia. Leukemia is pretty rare, but when it happens, it costs $1,000,000 to cure it. So if leukemia strikes one in 10,000 people in a given year, then 10,000 people can each put $100 into the pot, and the lucky individual who comes down with leukemia gets his leukemia treatment.

Here’s the point: Yes, the healthy people are paying for the healthcare of the sick person with leukemia, but that’s because they didn’t know at the beginning of the year whether they would be the one person in the pool who came down with leukemia. So they pooled the risk — they put $100 into the pot so that if they did turn out to be the one person who came down with leukemia, they would get the health care they needed instead of dying. The whole point of a risk pool is that the people who don’t “win” the leukemia lottery end up paying most of the costs of the person who does “win” the leukemia lottery, so that if next year *they* are the one who “wins” the leukemia lottery, their leukemia treatment will be paid for too. It’s basically gambling, but gambling with the purpose of reducing overall risk rather than increasing it. The fact that 9,999 people don’t “win” the leukemia lottery doesn’t make it theft, no more than with any other lottery. It just means that if they play that game again next year and they *do* “win” the leukemia lottery, their health care is paid for.

What happens if you *don’t* have risk pooling? Lots of dead bodies. Because the vast majority of the people who do “win” the leukemia lottery every year are not millionaires like Paul Ryan and thus don’t have the personal resources to pay $1,000,000 for treatment. That’s why they joined a risk pool — to pool their money with other people so that if they *do* “win” the leukemia lottery, there’s enough money in the pot to pay the bill. That is why both the American Medical Association and American Hospital Association are both against any plan that reduces the number of insured people — uninsured people generally die when they don’t have the $1M to pay to cure an expensive illness. But the thought of dead bodies apparently gives Paul Ryan a woodie…

Yeah, if you don’t want to be called a Nazi, quit proposing policies that end up with dead bodies. Just sayin’.

– Badtux the Bodycounting Penguin

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AARP comes out against health care bill. Their takeaway: shortening the life of Medicare, hiking costs for those who can least afford higher insurance premiums, risking seniors’ ability to live independently, increasing insurance premiums for older Americans and not doing anything to lower drug costs, and giving tax breaks to big drug companies and health insurance companies.

In other words: A real shit sandwich.

And in the news yesterday, overshadowed by the health care shit bill, it’s Muslim Ban II. Whiter, cleaner, less offensive constitutionally, doesn’t violate due process rights of visa holders so the White House figures the courts are going to okay it. We’ll see.

So anyhow, Trump accused President Obama of releasing hundreds of Al Qaeda terrorists from Gitmo who went back to their old ways again. Only problem: Most of those were released by George W. Bush. Man, that Barack Obama and his magic negro ray of time travel mojo. He traveled back into time, all the way into the Bush Administration, and using his magic negro ray of mind control, forced President Bush to release 113 prisoners who later went on to join Al Qaeda! Wow, now if Obama could only use that time travel ray to go back in time and get us a better President…

– Badtux the Snarky Penguin

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The bill has been released for public viewing, after being kept secret in the House basement for several days. Read it here.

I haven’t read the full bill yet, that’ll take a day or two and a lot of drinks, but what I’ve seen so far looks like it’s a real shit sandwich. Instead of the mandate, they’re going to let insurers charge you extra if you have lapsed health insurance coverage. That isn’t going to work. The individual insurance market is going to death spiral because of the other half of the equation — health insurance subsidies are no longer going to be tied to income and the actual cost of healthcare, they’re going to be a fixed amount based on age, and the fixed amount is stupidly small. The average family plan on the current Obamacare exchanges is over $12,000 per year and the average individual plan is over $4700 per year. The fixed amount that is proposed is is $2,000 for a 27 year old and $4,000 for a 60 year old. I.e., well below the premiums, placing health insurance well out of reach for poorer people.

Add in the Medicaid expansion repeal, and you have the Republican health plan for everybody who isn’t part of the top 15%: Don’t get sick, and if you do, die quickly. Note: My income places me in the top 15%, but if I get sick and can’t work, the Medicaid expansion keeps me alive. Otherwise I die. And I don’t much like dying. :(.

– Badtux the Healthcare Penguin

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So, you get your economists who are saying, “competition will always reduce costs!”. Yet that is quite clearly incorrect for at least two places where the United States has more competition than in any other nation on the planet — healthcare, and higher education. WTF is going on here?!

The deal is that old criticism of economists — that they know the price of everything, and the value of nothing. If you have a life-threatening illness, the value of a cure for that illness is practically infinite to you. You’re not looking for the cheapest doctor. You’re looking for the doctor that can cure you — that has the latest certifications, the latest equipment, prescribes the latest medications, you’re going to pay for the best you can get. Because if you’re not cured, you’re *dead*. What good is saving money if you’re dead? So hospitals and doctors compete for your business not by being cheap. They compete by getting the latest certifications, the latest equipment, prescribing the latest medications. The fact that this results in an oversupply of doctors with that certification and equipment, and results in demand for that medication that allows its manufacturer to hike its price, is irrelevant to the doctors because they’re not paying the bill — patients (and their insurers) are, through higher prices and through overprescribing diagnostic tests.

The same is true of higher education, to a certain extent. Economists know the cost of higher education. But they don’t know the value of higher education. Education is your future. So you’re going to try to get the best education you can get, regardless of cost, because the better your education, the better your future will get. So colleges compete with each other based on how many high-priced “big name” scientists they have on staff, how much equipment they have in their labs, the plushness of their dormitories, the gleam of their shiny bright new classroom buildings and football stadiums, rather than competing with each other based on price.

Now: you and I both know that shiny isn’t always best. I graduated from a somewhat shabby state university with minimal college debt. I get paid the same as the people who graduated from Stanford or Cal-Berkeley that same year who will still be paying off their college debt a decade from now. Unfortunately, outcomes information is almost impossible to come by. So people use proxies such as the labs having the latest and greatest equipment, even if cheaper equipment would be just as good for their purposes. Which brings up another point that the “competition will always reduce costs!” guys just don’t get: they assume a world in which everybody has perfect information, where it actually is possible to tell that doctors A and B have equal results but doctor A is cheaper. But we don’t have perfect information. Hell, for a lot of things, we don’t have any information — we don’t have the outcomes information needed to know that doctors A and B have equal results, and it’s absolutely impossible to get pricing information out of doctors, they shrug and refer you to their back end billing people who then ask who your insurer is and tell you that it’d require submitting a claim etc. to know, literally nobody in that whole entire office knows how much your treatment will cost.

But the question of information is a topic for a post in and of itself, so I’ll leave you with the final takeaway: Competition does not always result in lower costs. In fact, we’ve proven with both healthcare and higher education that it can increase costs.

So take that and stick it up your ass crack and light it, neoliberal economists. Because reality simply *is* — and your “reality”, laughably, isn’t.

– Badtux the Economics Penguin

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There’s mumblings and grumblings now in the Republican caucus as they realize that anything they do that simply repeals Obamacare rather than replacing it would result in horrifying electoral losses in the House in two years. Thing is, nobody can agree on what a replacement would look like. So there’s been some mutterings about maybe just fixing the problems of Obamacare and calling it Trumpcare, rather than just outright repealing it.

So how could Obamacare be fixed?

1) Bigger risk pools. The problem is that Obamacare is issued on a per-county basis to county-wide risk pools. Thing is, some of your rural counties only have 500 people on Obamacare. One of those people gets leukemia — which only happens to one out of every 5,000 people ordinarily and costs $1,000,000 to cure — and suddenly each of those people is going to see their rates go up by $2,000. Whereas if you had a risk pool of 5,000 people, which on average will have one person come down with leukemia, their rates would only go up by $200 to pay for that patient.


a) Allow insurers to lump multiple counties into the same risk pool in order to keep rare but expensive illnesses from blowing rates out the top of the water.

b) Create a reinsurance pool for those ultra-rare events like the illness that ends up using $10,000,000 worth of care. The reinsurance pool would be nationwide and each insurer would contribute to the reinsurance pool according to how many insured they have. That means, on average, expensive but rare illnesses happening in one county but not nationwide would make all rates nationwide bump up by a few cents, rather than rates in one county bump up by thousands of dollars per year.

Now, what about insurance companies being able to sell nationwide? Doesn’t fix anything in larger states, but for the ten least populated states and territories, each of which has under 1,000,000 total inhabitants, it could allow increasing the size of the risk pool to something more reasonable. However: that would be devilish to regulate. I would say that the only way to make it work would be that the insurance commissioners of the states involved would have to come together into a joint commission to regulate the insurers that are issuing multi-state policies (that is, ones whose risk pool spans multiple states). Otherwise you’ll get situations where insurers are ripping off policyholders and no insurance commissioner does anything about it because none of them have a full view of the insurance company’s operations in that multi-state pool.

Easier to just create a reinsurance pool, IMHO. Getting insurance commissioners to cooperate with each other is worse than herding cats.


2) States not increasing their Medicaid funding to meet the 133% Medicaid cut-off, resulting in too many uninsured:

Change Medicaid to a lump sum granted on a per-qualified-resident basis. For those who are qualified under the law but not granted Medicaid by the state, instead enroll them in Medicare using the Medicaid money that would have otherwise gone to the state. Note that the various taxes that were raised for Obamacare already have sufficient money for 100% of the costs of caring for those patients, so this would not require raising taxes by any more than they’ve already been raised. It would just reallocate the existing Medicaid monies to go with the people who need insurance rather than just giving it to states as a block of money.

3) Narrow networks are causing insured people to lose access to their doctors or to specialists they need: Get rid of the narrow networks. Seriously. Narrow networks are currently being used to cherry-pick patients — the well patients go to the cheapest insurance companies, which have the narrowest provider networks but they don’t care because they’re well. Sick people who need access to better doctors get squeezed out of those plans because those plans don’t cover the doctors they need. Easiest solution: All plans are required to add doctors to their networks upon the doctor’s request and upon the doctor agreeing to take the negotiated rate which must be at or above the Medicare rate, and are not allowed to drop doctors from their network unless they’ve documented fraud on the part of the doctor and dropping a doctor from their network is appealable to an insurance oversight board, either a state-one one or, for those states that don’t operate their own exchanges, a nation-wide one.

4) The 400% poverty rate cut-off for subsidized coverage is too low in some locations where housing costs are really high or healthcare expenses are really high. Especially for older people whose health insurance is already 4x as expensive as for younger people. Answer: Make the cutoff a percentage of income rather than a percentage of poverty level. That is, if you spend more than 33% of your disposable income on healthcare, the excess gets subsidized away. So if you’re in Santa Clara, California, a very expensive place to live, you make $100,000 per year, and your rent is the average of $2,900 per month or $34800/year, and your effective tax rate is 22% meaning your after-tax income is $78,000 /year, your disposable income is $39,600. 33% of that is $13,068. If your family of four is actually paying $18,142 /year for health insurance, which was the average last year for a family plan, you would then get a subsidy of $5,074 to reduce your cost of health insurance to something more reasonable, i.e. you’d be paying $1089/month rather than $1512/month. That $422/month buys a lot of food and clothing for your family.

5) The coverage that you get does not pay for the healthcare that you need due to high deductibles and exclusions:
a) Your out of pocket must be capped at 33% of disposable income, period. Any additional must be covered by the subsidy.
b) Exclusions need to be severely limited to only non-life-threatening things. If for example you are diabetic and need insulin and syringes in order to live, they must be covered under that 33% cap.
c) Healthcare Savings Accounts need to be radically overhauled so that they actually work for people with high-deductible plans. In particular, contributions towards an HSA must count towards that 33% cap, and cannot exceed the cost of the deductible.

6) Some people just don’t have acceptable insurance plans available where they live, period, because insurers don’t feel like selling there, or there’s only one insurer that treats people badly, or whatever:

Medicare buy-in. The caps on out-of-pocket are the same as for private insurance. Medicare buy-in should be allowed across the board, with a requirement that the rates charged must be actuarially sound (that is, the cost of the premiums must cover the cost of providing healthcare plus overhead and reserves).

7) And finally: only sick people are buying insurance, and well people aren’t, which is making the risk pools too small: Levy a fine equivalent to what it would have cost them to buy into Medicare for the time that they were uncovered. Allow wage garnishment (up to 33% of disposable income). Fines go into the reimbursement pool. Suspend the fines if they purchase health insurance and hold it for a year. Yes, there’s a lot of people who would let it slide for a year. After that? If given a choice of spending 33% of their disposable income on Medicare or 33% getting sent to the IRS, most will choose the Medicare.

So that’s my seven step plan to fix Obamacare. Will it get implemented by the Republicans? Of course not. I haven’t the slightest damn idea what they’re going to do, but I do know that when Republicans talk about “fix”, they’re not talking about repairing something, they’re talking about what my vet did to my cat’s balls. So it goes.

– Badtux the Healthcare Penguin

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From a Facebook discussion:

MV: Some even call that being Christian.

Me: Oh puh-leeze. Everybody knows that when people came to Jesus to be healed, Jesus asked them, “how much money do you make?” and if they replied “I’m poor, Jesus,” said “get out of here, I don’t heal poor people.” It’s right there in the Bible, in Republican 5:13.

DA: It’s not in any Bible I have so I had to go online to Liberty University…This is the new King Donald version…. Book of the Republicans

Chap. 5 cont. 9And lo, did Jesus greet the masses to heal the sick and injured. 10“Verily, come forth and receive the healing grace of our Father’s love. Bring thine purse and gift your coin to my apostles.” 11“But, my Lord, there are many that do not have coin nor jewels to give.” said John, the Apostle. 12And Jesus did say “Do they not know that the Lord, thy God has expenses? Do they not know the cost of travel from Nazareth or of lodging for all the Apostles?” 13“Send them away. If thine wishes to receive the healing and grace of our Father, only gold will provide the means.”

Yep, that seems to pretty much be our nation’s conception of healthcare…

– Badtux the Healthcare Penguin

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