The high cost of State run medical services

State-run health insurance is essentially a system that is designed to collapse. The first ones in are the winners; the last ones in are the losers.

The handwriting is already on the wall in California for the Pre-Existing Condition Insurance Plan (PCIP), which is the transitional program designed to carry us forward to January 2014, when health insurnce will be available to all, regardless of the risk to the insurer (which will ultimately be the US Taxpayer.)

According to recent reports of what is actually happening with the PCIP in California:

"California was expecting to have about 23,000 residents in its PCIP program by February 2011, and it was expecting those enrollees’ claim costs to average about $1,100 per member per month. As of the end of October 2011, the program had received about 8,500 applications and enrolled about 6,000 people. The program ended the month with 5,300 enrollees, up from 513 enrollees a year earlier. The enrollees have been averaging claim costs of $3,100 per member per month, officials say. The high cost means that, unless more funding surfaces, the program can afford to serve only about 6,800 enrollees at a time, not 23,000, officials say."

So it comes down to this: unless more funding "surfaces," or . . .

"He remembered theoretical conversations he had often had with the doctor on the subject of euthanasia: arguments with the doctor who was quite unmoved by the story of the Nazi elimination of old people and incurables. The doctor had once said, 'It's what any State medical service has sooner or later got to face. If you are going to be kept alive in institutions run by and paid for by the State, you must accept the State's right to economize when necessary.'" --Graham Greene, The Ministry of Fear (1943), p. 176.

The PCIP program mirrors the lessons of Mitt Romney's Massachussetts State medical service. Reality "could create a problem when it turns out that . . ." the original assumptions were wrong. Dead wrong.


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The truth about the Intercontinental Railroad

The Intercontinental Railroad that Barak Obama referenced in his Brent Spence Bridge Speech is a top-secret government project.

It benefits a few well-connected people, needs requires repeated bailing out to keep it from going totally underwater.

Like most government projects, it's paid for by a plan that calls for ". . . hundreds of billions of dollars in cuts in spending, but it also asks the wealthiest Americans and the biggest corporations to pay their fair share of taxes." That's how jobs are created, aren't they?

If you would like to learn about how people in an earlier era created jobs, you might enjoy reading about the transcontinental railroad.

Mitch Daniels - how can we overturn illegal police entry ruling?

Dear Governor Mitch Daniels,


Here are a few thoughts about the recent ruling in Barnes v. Indiana that denies citizens the right to resist illegal entry by law enforcement (i.e., government).
In the ruling, Justice Steven David says citizens should submit to the arrest and work out the details later in court.

While on one level submission seems like a good way to calm down a volatile situation.
On another level it opens the door to political abuse by neutralizing the 4th Amendment to the US Constitution.

How do you think the courts will treat the usual suspects who may be rounded up because of legislation such as the The Local Law Enforcement Hate Crimes Prevention Act?
Do Christians in Communist China who are arrested for worshiping outside of the state Three-Self Patriotic Movement find help from the court?
Did Jews who were arrested in Europe during the 1930s and 1940s find help from the court?


There are some people who take thought crime very seriously.
And yes, it COULD happen here.

The ruling is so blatantly dangerous that even the liberals are concerned about it (see Daily Kos  ).

What can we do to overturn this ruling?

PS
Here are a few resources that can help you see why overturning this ruling is important.

Your savings confiscated to fund a Guaranteed Retirement Account

The Federal Government has been playing cat and mouse with your private retirement funds for years. I'm referring to the serious thought our legislators have given to confiscating your tax-favored retirement savings to fund a new scheme: Guaranteed Retirement Accounts (GRAs).

All they've been lacking is a good crisis to exploit.
And they've been working hard to create one.

The concept of nationalizing private retirement accounts has already been tested in some of the more "progressive" countries of the world - and it works. The government of Argentina confiscated private retirement accounts in 2008.

Now we are being told of the European nations that are poised to grab private funds.  In "Europe Starts Confiscating Private Pension Funds"  Mark Hemingway (01/03/2011) cites Hungary, Bulgaria, Poland, France, and Ireland as making moves to confiscate private savings. Hungary, says Hemingway, informed citizens that

"they could either remit their individual retirement savings to the state, or lose the right to the basic state pension (but still have an obligation to pay contributions for it). In this extortionate way, the government wants to gain control over $14bn of individual retirement savings."

Back in 2008, Pamela Villarreal warned readers: Save your 401(k) before the Feds replace it with the GRA (Guaranteed Retirement Account). Villarreal outlines the plan to offer us a trade in. We can trade in our 401(k) savings for a new GRA account. In the account of this scheme we find the sort of language we've been hearing a lot of lately, language that refers to a tax-advantage of any kind as a tax subsidy.

The twisted logic behind this language is that all of your earnings belong first to the government. In other words there is no such thing as private property. Then, whatever money the government lets you keep is in fact a subsidy that you receive from the government. Let that sink in. What they are saying is that by saving your money so that you can some day write your own retirement paycheck, you are hurting other people. You are a bad citizen. They are about to correct your behavior.

A few months ago Mark Hemingway warned us about the move to nationalize private retirement funds when he wrote: Unions target your private retirement savings (10/30/10).

". . . why are unions pushing this? The average union pension plan is only 62 percent funded, far below the point at which the government considers a pension plan "endangered." Estimates suggest unions' multi-employer pension plans are underfunded by $165 billion and could be on the verge of collapse.

"Union leaders see these "retirement security" ideas like GRAs as vehicles to a back-door pension bailout, where union leaders will no longer have to worry about the fact they've underfunded their rank and file members' pension plans." 

Earlier in 2010, we saw that unions and the insurance companies and other big players had the muscle, the money, and the media mouthpiece necessary to push health care reform into law over the objections of the American people. They did this because they saw themselves as the ultimate beneficiaries, either in the form of a bailout or in the form of the creation of an artificial demand for the product.

Now they are coming for your retirement money in the same way.
Will we allow them to confiscate it?

I think not!
What can we do?
In this insane state of affairs, the best way to save your money is to spend it. I'm not counting on this Congress to act in my best interest. There are way too many non-elected, entrenched people in Washington DC who "think that when you spread the wealth around, it's good for everybody."
Everybody else, that is.

 So I suggest that we start the spend down right now.

Here are a few inspirations to help you get started on your 401(k) spend down shopping list:

• Lanvin cap toe sneakers ($540)
• arugula “I mean, they’re charging a lot of money for this stuff.”
• Wagyu steak ($59 - $300 per pound)

 Cheers!

What will Competition look like under the Health Insurance Exchange in 2014?

After 2014, those (few!) of us who don't receive our health insurance from our employer will be expected to use a Health Insurance Exchange to make our insurance buying choice. These wonders are the salient feature of the Patient Protection and Affordable Care Act (PPACA) -- legislation that promises to "bring to an end some of the worst abuses of the insurance industry."

For the unenlightened among us who can't figure out the Exchange on our own, there will be a cadre of impartial "Navigators" who will show the way.

What will it be like to buy health insurance on the Exchange?

We already have an Insurance Exchange! 

It is called the Medicare Plan Finder, and it is on Medicare.gov.
Go there. The blue and green colors are so . . . calming.
Try it out. The experience will be enlightening, especially if, like most people, you are confused about Medicare.

We also already have a "Navigators" program!

It is the State Health Insurance Assistance Program (SHIP - see shiptalk.org). SHIP "is a national program that offers one-on-one counseling and assistance to people with Medicare and their families." SHIP counselors are volunteers.

Insurance agents, brokers, and other Capitalist Roaders, in case you are wondering, are not allowed to volunteer to be SHIP counselors.

And another thing, in case you are wondering: What should we call "People on Medicare"? Medicarees?

So how is the Plan Finder working out for Medicarees? Well, just ask any SHIP volunteer why they don't just send everybody to medicare.gov during the Annual Election Period. You'll find out that there really is such a thing as a stupid question.

SHIP volunteers are adept at using the Plan Finder. Probably no one knows Medicare better than they do because they have devoted long hours to taking Medicare's boring training courses. That is not the problem. The problem is that SHIP volunteers do not understand the insurance products, and that's where the Plan Finder leads.

Nevertheless, plenty of people, besides insurance agents, are able to find and navigate the Plan Finder. The trouble is, most of these people, left to themselves, don't know what to do with the results. And SHIP volunteers are not allowed to make a recommendation. The Medicaree is expected to make his or her own decision best guess.

My little look at the Medicare Insurance Exchange and its cadre of Navigators doesn't begin to illustrate the frustration that the system is generating among the Medicare population. The Medicare Annual Election Period is about as pleasant an experience for people on Medicare as April 15 is for taxpayers.

Hey, I have nothing against SHIP volunteers. Some of my best friends are SHIP volunteers! I'm just sharing a few thoughts about what pre-Medicarees can look forward to in 2014.

One last thought: President Obama and his Congress have promised us that the Exchange will succeed in controlling costs and competition . . . well, we have only to look at the public school system to see where that is going.

A few years ago I heard a public school official boast about competition among the local public schools. She said the competition made the public schools better.

I wonder what competition will look like under ObamaCare.
I wonder if health insurance carriers will "compete" by forming athletic teams and recruiting plan members to play games?
I wonder if that school official is now working in the Obama administration?

Bed Race Competition
http://randompixels.blogspot.com/2010_08_01_archive.html

My doctor won't take Medicare!

I have to admit that I had difficulty imagining the day when we would start hearing the words:

My doctor won't take Medicare.

For me, it started last year, when Lafayette Indiana resident Donn Brown organized four Town Hall discussions about healthcare reform legislation. I noticed a predictable pattern: at some point in the evening, a Senior citizen would stand up and say:

I love my Medicare. It pays for everything!

But during the last meeting, of the physicians on the discussion panel responded:

And how will you like it when your doctor stops taking Medicare?

This elicited a nervous chuckle from some in the audience, and open scoffing from others.

Then a few months ago, one of my relatives from California told me about a letter her doctor sent in January to every one of his Medicare patients. The letter outlined his new office policy: From now on, all Medicare patients will pay for services rendered up front and in full. The office will file the claim with Medicare (which they are required by law to do anyway), and the reimbursement check from Medicare will go direct to the patient.

If you've ever looked at a Medicare Summary Notice, then you have a good idea of what this new policy means.

When I repeated this story to a friend of mine who works in an administrative position at a local hospital, he was appalled. He said, "I'd find a new doctor!"

He also said, "That will never happen here."


Just this week I heard two stories from local Senior citizens, each complaining that no local doctors are taking new Medicare patients. Both stories were about an elderly relative who tried to move back to the area to be near family. Neither one could find a local doctor that would take a new Medicare patient.


Another story I recently heard was about a lady who needed a diagnostic mammogram. She called a local provider last week (before Thanksgiving) to schedule the appointment. The first available time they could offer is in early February -- she has to wait at nearly TEN WEEKS for a diagnostic test. And this is a lady not on Medicare.

All of these stories has made reading N.C. Aizenman's Washington Post (11/26/2010)  article "Doctors say Medicare cuts force painful decision about elderly patients" all the more scary.

Aizenman tells of long waiting for diagnostic tests. Of doctors who ask Medicare patients to pay the full charges up front. Of doctors cutting back on the number of Medicare patients they see. And of doctors who aren't seeing any Medicare patients at all.

Reports like this are trickling in. But on the horizon are waves of Baby Boomers who will become eligible for Medicare benefits -- every year more and more and more of them.

The Baby Boom generation has been set up to fail by the generations that gave us  The New Deal and The Great Society. One of the unintended consequences of that legacy is the economic tsunami that is on the way.

On top of Medicare, the Obama Administration now has set up the US Taxpayer as the ultimate third-party payer of medical expenses for everybody.

We are seeing the balance tip in favor of the medical provider. The shortage of providers, plus the increasing demand for services, equals the bargaining power to refuse third-party reimbursements in favor of cash up front. [See "Mayo Clinic Won't Take Medicare", by Toni Brayer, MD]

I wouldn't be surprised if at some point our government will try to make cash up front payments for medical services illegal.

Recently I read George Gilder's Wealth and Poverty (1981). This book describes the economic conditions during the late 1970s that resulted from just 15 years of living under the burden of Great Society policies. I was amazed in retrospect, at how rapidly the economy recovered as people responded to the Reagan reforms. How quickly we have forgotten. 
 

Massachusetts School for Health Care Reform

The subtitle for the Patient Protection and Affordable Care Act is:

But THAT created a problem when it turned out that . . .

In a News Release (October 13, 2010) the Health and Human Services Press Office reminds us that: 

The Affordable Care Act makes it illegal for insurance companies to deny coverage to children with pre-existing conditions and makes discrimination against all individuals with pre-existing conditions illegal in 2014—a trend that was rising at exceedingly high rates in recent years.  In her letter, Secretary Sebelius further clarified the HHS regulation that implements a key early provision of the Affordable Care Act, signed into law on March 23, 2010 to prevent insurers from denying coverage to children based on a pre-existing condition.  This clarification outlines options available to insurers and states to offer child-only policies, but rejects the insurers’ idea of denying coverage to sick children outside the open enrollment period. 

If, on the one hand, we make it illegal for big, bad insurance companies to deny coverage to sick people, then what will we do, on the other hand, to make it illegal for people to wait until they are sick to apply for coverage?

Massachusetts is learning this basic insurance lesson the hard way. The state now is trying to use enrollment periods as a means of forcing people to apply for coverage before they need it. But as we see in the HHS Press Release above, the Federal Government already is committed to undermining this solution to the enormous moral hazard problem that the law has created.

About the Massachusetts problem, National Health Underwriter contributor Trevor Thomas writes (October 29, 2010):

Previously, eligible individuals in [Massachusetts] could buy individual health policies at any time. According to the state’s Division of Insurance, that created a problem when it turned out [insert laugh track] some would buy insurance only when they needed medical services and then would drop coverage after the insurance paid for the treatment. This caused health insurance rates to increase.

BUT, when the big, bad health insurance companies in Massachusetts tried to raise rates in order to cover the cost of claims, Governor Patrick took them to court. Boston Globe writers Wallack and Lazar ("Blue Cross Agrees to Reduce Rate Hike", 8/6/2010) report that the insurance companies - including Blue Cross,

agreed to accept “less-than-adequate rates’’ — which [Blue Cross spokesman Jay McQuaide] said are too low to cover its costs — to resolve the uncertainty for customers.
“We wanted to move beyond this,’’ McQuaide said. “We wanted to end the confusion for our customers and move on.’’
The agreement ends a four-month standoff between the insurer and regulators. In April [2010], the Division of Insurance denied 234 out of 275 rate increases filed by Blue Cross and five other insurers, including 72 out of 73 from Blue Cross, arguing they were excessive or unreasonable.

Popping the Benefits Bubble: What I'm waiting for next is when the Federal Government makes it illegal for auto insurance companies to deny collision coverage to people who have already wrecked their cars. Perhaps that's just too obvious.
If we outlaw discrimination against cars with pre-existing conditions, then it's too easy to see how THAT could create a problem when it turns out that . . .