Healthcare, health policy, cognitive science. , and the path to Universal Healthcare..
In January, for the first time since my diagnosis 36 years ago, I will have an individual health plan that offers quality coverage for me and my family. I will save $628 every month on premiums. Best of all — I wasn’t even asked if I’ve ever had cancer.
Opinion: Cancer survivor: Obamacare got me covered – CNN.com
“In terms of hiring, the health care expenses contribute a huge, huge component to your cost of operation,” Ms. Petrou says. So instead of bringing on full-time employees, she relied on contract workers.
She is looking forward to getting price information online from the Small Business Health Options Program, or SHOP, an exchange that was created by the new law. (Currently, business owners can obtain estimated SHOP prices online, but specific ones are only available by mail after filling out and mailing in a PDF downloaded from Healthcare.gov. Some states, including California, have their own SHOP exchanges, and their procedures vary.)
Ms. Petrou says the law could enable her to hire full-time employees, depending on the new costs of coverage. If so, she will either pay for a portion of the individual plans that her employees shop for on the exchange, or she may take advantage of tax credits and offer a small group plan. “We now have options to explore,” she says.
Some experts say this type of flexibility may have a big impact on the economy over all.
“Assuming we get the website working, it’s going to be the biggest step we’ve had in a long time in the U.S. in terms of changing the structure of the economy,” says Craig Garthwaite, assistant professor of management and strategy at Northwestern University’s Kellogg School of Management. Mr. Garthwaite is a co-author of one of two recent studies that conclude that the Affordable Care Act could spur entrepreneurship by easing job lock — where people stay in a job mainly for the health insurance.
In the Health Law, an Open Door for Entrepreneurs – NYTimes.com
‘Ground Control to John Goodman’ – A Uwe Reinhardt Appeal | A “HealthTweep” Pulse Check
This is a couple years old, but I just found it and since it has some Uwe “gold,” it’s worth reading!
John Goodman of the conservative Dallas based think tank National Center for Policy Analysis (NCPA) issued a “William Wallace-esque’ FREEDOM pitch today on his blog entitled Reforming Health Care the Right Way.
This is a man who previously claimed that there are ‘no uninsured’ (from a health insurance point of view) in America; after all Goodman posits that everyone has access to the ER, so what are you complaining about? (paraphrased).
In his blog post today one day after the historic Senate vote to advance the health care bill, Goodman opines on the ‘right’ and ‘wrong’ way to reform US healthcare.
What I find most insightful is his post is the rebuttal comment proferred by Uwe Reinhardt as to the fantasy world this man, and unfortunately many other ideological predisposed converts, apparently inhabit. The health care industry defies over simplification, yet ‘sound byte’ disingenuous over-simplification is the prima facie basis on which the ‘anti-reform crowd has stimulated emotive misunderstanding of the nature of the malady as well as it’s appropriate and quite comprehensive remedies.
Uwe Reinhardt Says:
December 21st, 2009 at 1:12 pm
I hear Richard Branson of Virgin Air is seriously exploring space travel as a commercially feasible project.
Once he has that done, I shall be able to book a flight to the distant planet on which John Goodman lives.
It is the planet on which all physicians always are purely the agent of their patients and do not have any economic conficts of interest — such as making money on tests they prescribe to anxious patients or from referring patients to imaging centers in which they have a state or to collegues with whom they play gold, and so on. Such conflicts of interest do not crop up on John’s planet, not because government forbinds them (there is no government on that planet), but because such conflicts of interest just don’t exist there somehow. Remember: it’s another planet!
On John’s planet it is also easy to have price competition among physicians, because all ill health on that planet can be cured with just one standard, well defined “unit of health care.” What that is I do not know, but John does, because he lives there. He’s probable consumed some, rationally, I wouold assume.
Contrast that with an earthbound hospital charge master with 20,000 itsems in it or the physician fee schedule with 7,000 items in it. How would one make diffenetials in the elements of those huge vectors understandable to patients?
John took on a new religion on that planet to where he actually immigrated — he once lived on earth. On earth he always boldly talked for decades about “Consumer Directed Health Care,” but neither he nor his entire think tanks (the NCPA) every did a stitch of work to help develop the user-friendly price information that patients as “consumers” would need to make rational choices in health care ex ante.
Once on the new planet, John realized that he sinned on earth and swore to do better there. Of course, on his new planet it’s easy: there is only one type of health care and one price. The redemption was a piece of cake.
All people on John’s planet have the same income — in fact, they all have John’s high income and all also have Ph.D.’s. or M.D.s So the problem with poor people not being able to afford high deductibles and therefore stiffing doctors and hospitals for it does not exist on John’s planet. Nor is there a problem with health illiteracry, because everyone on John’s planet has a Ph.D. or M.D. Every patient on John’s planet knows exactly what he or she needs before going to a doctor and simple shops around for a low price.
For the most part, an individual’s need for health care in a coming year on John’s planet is certain and predictable and thus not really insurable. Only the need for about 20% of all health care is stochastic and hence insurable.
On John’s planet, 50% of any large group of people account for 50% of all health spending — 80% of the people account for 80% of all health spending. Here on earth, 20% of the sickest account for 80% of all health spending, and much of that 80% will also be insured. It will be managed by some insurance clerk coming between doctor and patient.
Oh how I long to go to the planet where John Goodman lives, where life is so easy and so simple. I am so tired of the mess here on our planet. Aren’t we all?
Small wonder that John just up and left Mother Earth for a planet where all his theories actually work.
Selling Health Insurance Across State Lines:
An Assessment of State Laws and Implications for Improving Choice and Affordability of Coverage
By Sabrina Corlette, Christine Monahan, Katie Keith and Kevin Lucia
“Across state lines legislation was largely
unsuccessful because of the localized nature of how
health care is delivered. Respondents universally
reported the enormous difficulty that out-of-state
insurers face in building a network of local providers,
and insurers identified doing so as a significant barrier
to market entry that far surpasses concerns about a
state’s regulatory environment or benefit mandates.
State officials and insurers also noted that across
state lines legislation ignores the primary cause of
high prices—the cost of delivering care—and fails to
account for often dramatic differences in the cost of
care between states and regions.”
Followed Wendell Potter’s link from http://www.huffingtonpost.com/wendell-potter/romneys-phony-answers-to_b_1948449.html
TO the full pdf file:
http://chis.georgetown.edu/pdfs/Selling%20Health%20Insurance%20-%20fnl.pdf
The cognitive dissonance should make these people’s heads explode, but I don’t think there’s enough cognition to create the dissonance.
In dozens of interviews here, many said they feared they would be forced to buy insurance they couldn’t afford. Some said they were told (erroneously) that insurance penalties would come out of their Social Security checks; others said they’d heard the law meant they’d soon have to travel several hundred miles to see a doctor.
"They say it’s affordable, but when you ain’t got no money, nothing’s affordable," said 55-year-old Paul Bush of Midwest City, who accompanied his sister to a clinic for care last week. While he supports efforts in Congress to kill the program — "Heck yeah," he said — he wasn’t happy about Fallin’s decision to reject the Medicaid expansion: "The state could really have used the money."
Bush’s sister, Teresa Springer, might have qualified for care under a Medicaid expansion, but she supported Fallin’s decision.
Springer, who has applied for disability assistance, said she worried that fines related to the healthcare law would cut into her disability checks at the same time that some Republicans in Congress were talking about cutting food stamps.
"That’s all I have," she said after a visit to the Mary Mahoney Memorial Health Center in Spencer, Okla. "I’m going to either pay my bills or not eat." The law, she added, "is hurting everybody."
Obamacare meets extra resistance in Oklahoma – Page 2 – Los Angeles Times
Tuesday’s tepid brew of jobs data, delayed more than two weeks by the government shutdown, wasn’t worth waiting for. It shows an increase in total nonfarm employment by 148,000 in September over August, which is consistent with economic growth crawling along in second gear.
The report’s most notable nugget is the change in part-time work. Over the last month the number of workers in part-time jobs for economic reasons–slack demand, cutbacks in hours–has remained stable. Over the last year, however, it has fallen by 681,000. Those part-timers also constitute a smaller share of all workers–5.5% in September compared to 6% a year earlier.
That puts the lie to the popular conservative meme that Obamacare has transformed America’s workforce into part-timers. The idea is that employers wishing to evade the law’s requirement that they offer health insurance to employees working more than 30 hours a week will cut their hours to 29 or less. The shorthand about this provided by Sen. Ted Cruz (R-Texas), that one-stop shop for Obamacare disinformation, was "single parents who have been forced into part-time work."
Obamacare and part-time jobs: The myth exploded (again) – latimes.com
Don’t blame the health law for high levels of part-time employment. In fact, using the law’s definitions, part-time work isn’t increasing at all as a share of employment, at least not yet.
Nearly 8 million American were working part-time in September because they couldn’t find full-time work. Overall, 27 million people — nearly a fifth of all employees — are working part-time, well above historical norms.
Many critics of the Obama administration have pointed the finger for the prevalence of part-time jobs at the Affordable Care Act, the 2010 law better known to some as “Obamacare.” The law’s so-called “employer mandate” requires most midsize and larger companies to offer health insurance to their full-time employees. That, critics argue, provides companies with an incentive to hire part-timers instead.
The Obama administration earlier this year said it would delay the requirement until 2015 to give companies more time to comply. But some employers have said they are nonetheless cutting back on full-time hiring. Indeed, part-time employment rose early this year, while full-time employment growth stalled.
But a closer look at the data provides little evidence for the notion that the health law is driving a shift to part-time work, although it could as the mandate deadline approaches.
First of all, over a longer time frame, part-time work has actually been falling as a share of employment in recent years. Before the recession, about 17% of employed Americans worked 35 hours or less, the standard Labor Department definition of “part time.” During the recession, that figure rose, briefly hitting 20%. It’s been trending down since then, but only slowly, hitting 19% in September.
Don’t Blame Health Law for High Part-Time Employment – Real Time Economics – WSJ
Overall the number of uninsured Pennsylvanians increased by 11 percent from 2011 to 2012, while nationally the number decreased by 1.4 percent.
The numbers, based on data from the U.S. Census Bureau and the Centers for Medicare and Medicaid Services, reflect a troubling trend in health care insurance, which people traditionally received through their employer.
"We continue to see a dangerous erosion of employer-based coverage," said Andy Carter, president and CEO of the Hospital and Healthsystem Association that represents the interests of nearly 240 health facilities.
"The number of Pennsylvanians covered by private, employer-based plans hit an all-time low of 59.5 percent in 2012," he said.
And that’s not solely because people are out of work, he added.
"Three out of every 4 uninsured Pennsylvanians live in a household with at least one working adult, and nearly 4 out of 5 live in Pennsylvania’s suburban and rural regions," Mr. Carter said.
The association has advocated for the expansion of Medicaid as outlined under the Patient Protection and Affordable Care Act.
Uninsured in Pennsylvania reaches record high – Pittsburgh Post-Gazette
Not only can the medical-device industry easily afford the tax without compromising innovation, but the industry’s enormous profits are a result of anticompetitive practices that themselves drive up medical-device costs unnecessarily. The tax is a distraction from reforms to the industry that are urgently needed to lower health care costs.
The medical-device industry faces virtually no price competition. Because of confidentiality agreements that manufacturers require hospitals to sign, the prices of the devices are cloaked in secrecy. This lack of transparency impedes hospitals from sharing price information and thus knowing whether they are getting a good deal.
Even worse, manufacturers often maintain personal relationships (sometimes involving financial payments like consulting fees) with physicians who choose the medical devices that their hospitals purchase, creating a conflict of interest. Physicians often don’t even know the costs of the devices, and individual physicians often choose devices on their own, which weakens a hospital’s ability to bargain for volume discounts.
Such anticompetitive practices help generate a wide variation in the prices of medical devices — and contribute to higher prices in general. For example, the Government Accountability Office found that prices for cardiac implantable medical devices in the United States vary by several thousand dollars. And even the lowest-priced devices in the United States are expensive compared with those in other developed countries. According to the consulting firm McKinsey & Company, the United States spends about 50 percent more than expected on the top five medical devices, compared with Europe and Japan. McKinsey calculates that this amounts to $26 billion in excessive spending each year. Medicare, private health insurers and patients end up paying these inflated prices.
Excessive prices fuel enormous profits — profits that dwarf both the medical-device tax and the industry’s investments in research and development. Consider the device division of Johnson & Johnson, which in 2012 had an operating profit of $7.2 billion. By the company’s own estimate, the device tax would amount to at most $300 million, and its investment in research and development amounts to only $1.7 billion.
Tax the rich and better target the multinationals: The IMF has set off shockwaves this week in Washington by suggesting countries fight budget deficits by raising taxes.
Tucked inside a report on public debt, the new tack was mostly eclipsed by worries about the US budget crisis, but did not escape the notice of experts and nongovernmental organizations (NGOs).
"We had to read it twice to be sure we had really understood it," said Nicolas Mombrial, the head of Oxfam in Washington. "It’s rare that IMF proposals are so surprising."
Guardian of financial orthodoxy, the International Monetary Fund, which is holding its annual meetings with the World Bank this week in the US capital, typically calls for nations in difficulty to slash public spending to reduce their deficits.
But in its Fiscal Monitor report, subtitled "Taxing Times", the Fund advanced the idea of taxing the highest-income people and their assets to reinforce the legitimacy of spending cuts and fight against growing income inequalities.
"Scope seems to exist in many advanced economies to raise more revenue from the top of the income distribution," the IMF wrote, noting "steep cuts" in top rates since the early 1980s.
According to IMF estimates, taxing the rich even at the same rates during the 1980s would reap fiscal revenues equal to 0.25 percent of economic output in the developed countries.
"The gain could in some cases, such as that of the United States, be more significant," around 1.5 percent of gross domestic product, said the IMF report, which also singled out deficient taxation of multinational companies.
In the US alone, legal loopholes deprive the Treasury of roughly $60 billion in receipts, the global lender said.
The 188-nation IMF said that it did not want to enter into a debate on whether the rich should pay more taxes.
But, it said: "The chance to review international tax architecture seems to come about once a century; the fundamental issues should not be ducked."
