Category: PPACA

The Washington Monthly – Ten Miles Square – The Quiet Triumph of Obama Care

The Washington Monthly – Ten Miles Square – The Quiet Triumph of Obama Care:

We understand why President Obama trumpeted the killing of Osama bin Laden while barely mentioning health reform, his most significant domestic accomplishment in his State of the Union address last week. Ten years after 9/11, the killing of Bin Laden was an indisputable triumph for President Obama, welcomed by almost every American. In contrast, the Patient Protection and Affordable Care Act (ACA), enacted with only Democratic votes by the scarcest of margins in 2010, remains a complex, highly controversial piece of legislation with outcomes and costs that remain to be seen in the years ahead.

Yet surprising even to many advocates of health care reform, evidence is emerging that the ACA is already improving life for millions of average Americans. It is promoting long-overdue fundamental changes in our dysfunctional medical system. Moreover, because those reforms are starting to directly address heightened economic insecurities of average families – the personal financial conditions that will largely determine this year’s election outcomes – President Obama would be wise to more forcefully and more specifically explain how his health care bill is already helping millions of vulnerable families and the country as a whole. Sure, financially-pressured families will celebrate the derring-do of Seal Team Six. They should directly appreciate the immediate impact of improved insurance coverage and reduced medical costs.

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Like it or not, Obamacare forces drug company disclosure – News – ReviewJournal.com

Like it or not, Obamacare forces drug company disclosure – News – ReviewJournal.com:

The New York Times and the Wall Street Journal have taken the lead in writing about potential conflicts of interest between doctors and medical manufacturers. Although philosophically on opposite sides, both newspapers have raised questions in chilling stories about doctors taking money from drug and device manufacturers.

The Times’ reported that some doctors practice medicine differently if they take money and are more willing to prescribe drugs in risky and unapproved ways.

In the regulations being finalized, executives at the top would be responsible for the accuracy for that disclosure. The information would be on a searchable website so the public can check it out. About 1,100 companies would have to file reports.

Every transaction may not be dubious, but when more than one out of four doctors are paid for consulting, lectures or enrolling patients in clinical trials, you deserve to know if your doctor might have a financial interest in a particular company.

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The Bomb Buried In Obamacare Explodes Today-Hallelujah! – Forbes

The Bomb Buried In Obamacare Explodes Today-Hallelujah! – Forbes:

This is the true ‘bomb’ contained in Obamacare and the one item that will have more impact on the future of how medical care is paid for in this country than anything we’ve seen in quite some time. Indeed, it is this aspect of the law that represents the true ‘death panel’ found in Obamacare—but not one that is going to lead to the death of American consumers. Rather, the medical loss ratio will, ultimately, lead to the death of large parts of the private, for-profit health insurance industry.

Why? Because there is absolutely no way for-profit health insurers are going to be able to learn how to get by and still make a profit while being forced to spend at least 80 percent of their receipts providing their customers with the coverage for which they paid. If they could, we likely would never have seen the extraordinary efforts made by these companies to avoid paying benefits to their customers at the very moment they need it the most.

Today, that bomb goes off.

Today, the Department of Health & Human Services issues the rules of what insurer expenditures will—and will not—qualify as a medical expense for purposes of meeting the requirement.

As it turns out, HHS isn’t screwing around. They actually mean to see to it that the insurance companies spend what they should taking care of their customers.

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That Government Takeover Thing

[Cross posted from Doctors for America Blog.]

As many of us in DFA know, one of the more fevered arguments against the PPACA, both before and after its passage, was the cri de guerre, “It’s a government takeover of health care!”

This argument left me often fumbling for an answer. I know enough about international health care, and enough about our true homegrown versions of government health care (the VA, TriCare, the Indian health Service) to know that PPACA ain’t it. Not even close. Trying to explain the difference among single payer systems and true government runs systems and private but universal systems, did not cut the mustard (or get through the neural programming, George Lakoff would say). “Obamacare” was a government takeover, and I was just a dupe if I couldn’t see it.

Apparently, the answer was in plain sight, and I just was not aware of it. While researching another topic, Google took me to an interesting, but very public place that I had overlooked before. It is on the GOP.gov web site from over a year ago, and billed as “Courtesy of the Senate Republican Policy Committee”:  159 Ways the Senate Bill Is a Government Takeover of Health Care

As you scroll through the list, you might get the feeling that every single line in the bill represents a fundamental alteration in health care as we know it, changing our current “system” into some form of crypto-socialist mockery of the free market system we’re all so pleased with. I guess a conservative minded person might indeed scroll through all of these initiatives and gasp in horror, but as I read through it, it seems like a very good list for us to trot out and show all of the good stuff actually in the bill!

The idea that various projects and initiatives to promote administrative simplification on insurance claims, to promote quality of care in the Medicaid program, to promote Patient Centered Medical Homes,  grants to support physicians and others entering primary care and geriatrics, to develop quality measures, to figure out how to align payment incentives to promote the best patient care, and on and on, that these somehow represent a sinister plot requires epic, delusional almost, paranoia.

One of our kids’ favorite books growing up was “A House is a House For Me.” It was a delightful exploration of how, when looked at with the appropriate viewpoint, everything was a house: a sock for a foot, a shell for a hermit crab, or a tree for a monkey.

So, in the minds of the GOP Senate Republican Policy Committee, any law or regulation or initiative, can be a “government takeover.” This is not new, of course, Ronald Reagan famously opposed Medicare as the clear path to Soviet style communism, and the John Birchers, now resurgent, thought former Supreme Allied Commander and then President of the United States Dwight Eisenhower was a Soviet agent. The difference now is that this is mainstream political rhetoric, even articles of faith, in many circles.

So, in our new book, “A Regulation is a Government Takeover To Me!” we will explore how there are really no legitimate functions of government, Constitution notwithstanding. Protecting air and water safety is a government takeover of drinking and beathing,  food safety rules are takeovers of eating, and promoting homework and hard work in school is a takeover of parenting. See how that works? Although, I understand that all limitations of birth control and sex education are intrinsically appropriate uses of government.

Will Record Surpluses Among Not-for-Profit Blues Plans Trigger Price Wars in 2011? (with Table: Not-for-Profit Blues Plans Hold $27 Billion in Excess Capital) | AIS Health

Will Record Surpluses Among Not-for-Profit Blues Plans Trigger Price Wars in 2011? (with Table: Not-for-Profit Blues Plans Hold $27 Billion in Excess Capital) | AIS Health:

 “Record surpluses amassed by not-for-profit Blue Cross and Blue Shield plans during the first nine months of 2010 could be used to price products more aggressively next year. And that could put pressure on competitors to hold down their rates or risk losing market share, according to one equities analyst. But other industry observers tell HPW that Blues plans are more likely to hold onto their surpluses due to increased regulatory scrutiny over rate hikes and the unknown financial impact of the health reform law.”

I mainly put this here to remind me of the Medical Loss Ratio implications of PPACA, specifically the minimum requirements coming into effect this year. The fact that NOT FOR PROFITS don’t meet these standards voluntarily, eagerly and easily tells you almost all you need to know about our broken system, but go to the link and scroll down and see the MASSIVE financial reserves these guys are amassing.