It’s working! Single Payer is working!! And better than expected. https://t.co/lrQUqt5Xis— Rich Weinstein (@phillyrich1) March 9, 2019
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Saturday, 9 March 2019
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Friday, 8 March 2019
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Shot:
Chaser:
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Its working! The. ACA is working!! And better than expected. https://t.co/HJiyb0OxCN— Rich Weinstein (@phillyrich1) March 6, 2019
Chaser:
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Thursday, 7 March 2019
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I had completely forgotten this post from co-blogger Mike, but it is incredibly relevant today. For one thing, it echoes a longstanding principle here that health insurance ≠ health care. And it presciently touches on the (Evil) Individual Mandate and the Death Panel that have been ObamaCare hallmarks. Finally, it seems to be an early, distant warning about what lies in store for us if (when?) Medicare4All is actually implemented.
Oh, what's it called?
"Why isn't health care compulsory?"
Here's a taste:
"I’m not talking about health insurance. I’m talking about health care. Health insurance is not the same as health care. Who calls their insurance agent when sick or injured? Who calls an actuary? Don’t real people call their doctor or go to the emergency room?"
Indeed.
And there's this:
"First, all health care professionals become employees of the Federal Government, paid a living wage from public funds. Second, hospitals, clinics, labs and other facilities are nationalized and their staffs also become employees of the Federal Government ... it is illegal to seek or receive health care from anyone except a Federal health care professional."
Yes, yes it is rather scary.
And that's the point.
Read the whole thing here.
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Wednesday, 6 March 2019
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So, FoIB Steve Downey alerted us to this item at CNN:
"A woman received nearly $375,000 from her insurance company over several months for treatment she received at a California rehabilitation facility. A man received more than $130,000 after he sent his fiancée's daughter for substance abuse treatment."
Okay, that's (very) nice for them, but what's that got to do with the price of tea in China, or insurance, well, anywhere?
Well, these folks got these checks as a result of Anthem's (alleged) strong-arm tactics being brought to bear on non-network providers to join up. Generally, carriers pay even out-of-network providers directly (although at less than in-network rates, natch). This has the non-network providers unhappy...
What? So what's the big deal, you ask?
Well, if you're General Hospital and your patient just got the $375,000 from Anthem, how quickly do you think said patient's going to run it down to your business office to sign it over? Or even bother to do so? And yes, you can sue the patient, but that adds to your own wait time, as well.
Yeah, that's the big deal.
What will be interesting is to see whether the plaintiffs prevail. I doubt it, since Anthem's actions don't seem to be illegal. To the contrary, it could very easily be argued that the carrier has a higher duty to the insured, since there, at least, is a contract (the insurance policy). Not so with the non-network provider.
Oh, and lest one thing that this is some crazy new tactic: well, it's not. As I replied to Steve:
"We blogged on something like this *years* ago (will take a while to dig up), so nothing new under the sun, But *does* point out the lengths to which some carriers will go to get their way."
Well, I eventually did find that (very) old post, and I was right:
"When Premier's network contract with Anthem expired on Jan. 1, Anthem stopped paying Premier directly ... Anthem sent reimbursement checks of four and five figures to enrollees instead.”
We'll keep you posted on this latest attempt.
"A woman received nearly $375,000 from her insurance company over several months for treatment she received at a California rehabilitation facility. A man received more than $130,000 after he sent his fiancée's daughter for substance abuse treatment."
Okay, that's (very) nice for them, but what's that got to do with the price of tea in China, or insurance, well, anywhere?
Well, these folks got these checks as a result of Anthem's (alleged) strong-arm tactics being brought to bear on non-network providers to join up. Generally, carriers pay even out-of-network providers directly (although at less than in-network rates, natch). This has the non-network providers unhappy...
What? So what's the big deal, you ask?
Well, if you're General Hospital and your patient just got the $375,000 from Anthem, how quickly do you think said patient's going to run it down to your business office to sign it over? Or even bother to do so? And yes, you can sue the patient, but that adds to your own wait time, as well.
Yeah, that's the big deal.
What will be interesting is to see whether the plaintiffs prevail. I doubt it, since Anthem's actions don't seem to be illegal. To the contrary, it could very easily be argued that the carrier has a higher duty to the insured, since there, at least, is a contract (the insurance policy). Not so with the non-network provider.
Oh, and lest one thing that this is some crazy new tactic: well, it's not. As I replied to Steve:
"We blogged on something like this *years* ago (will take a while to dig up), so nothing new under the sun, But *does* point out the lengths to which some carriers will go to get their way."
Well, I eventually did find that (very) old post, and I was right:
"When Premier's network contract with Anthem expired on Jan. 1, Anthem stopped paying Premier directly ... Anthem sent reimbursement checks of four and five figures to enrollees instead.”
We'll keep you posted on this latest attempt.
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Tuesday, 5 March 2019
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Whew boy!
So, readers may recall our post from a month ago regarding a class action lawsuit brought by a large Georgia law firm "on behalf of thousands of Georgia healthcare consumers misled by Anthem's “deceptive marketing scheme.” The story is that these insureds were (allegedly) promised that "if you like your doctor, you can keep your doctor" [ed: ISWYDT]. This turned out to be, wait for it .... not the case, which left these poor folks with a lot of out-of-network issues. We promised to update this story as it developed.
There are developments:
It wasn't clear at the time just what relief these clients sought, turns out to be out of left field: instead of (or, perhaps, in addition to) monetary damages the firm "is asking a federal court to allow thousands of consumers victimized by multiple false marketing claims to be granted a “special enrollment period” to switch to a new health insurance company."
If the request is granted, it would be a first, and could set an interesting precedent.
Oh, and it's not just that the providers are out-of-network, but the carrier has also "revers[ed] its marketing promise that consumers would not be required to seek referrals before seeing specialists."
Still, I don't see how Anthem's (alleged) bad faith has anything to do with the ACA, nor that the Feds have the authority to make such an accommodation.
As before, we'll keep you posted.
[Hat Tip: Whitney D]
So, readers may recall our post from a month ago regarding a class action lawsuit brought by a large Georgia law firm "on behalf of thousands of Georgia healthcare consumers misled by Anthem's “deceptive marketing scheme.” The story is that these insureds were (allegedly) promised that "if you like your doctor, you can keep your doctor" [ed: ISWYDT]. This turned out to be, wait for it .... not the case, which left these poor folks with a lot of out-of-network issues. We promised to update this story as it developed.
There are developments:
It wasn't clear at the time just what relief these clients sought, turns out to be out of left field: instead of (or, perhaps, in addition to) monetary damages the firm "is asking a federal court to allow thousands of consumers victimized by multiple false marketing claims to be granted a “special enrollment period” to switch to a new health insurance company."
If the request is granted, it would be a first, and could set an interesting precedent.
Oh, and it's not just that the providers are out-of-network, but the carrier has also "revers[ed] its marketing promise that consumers would not be required to seek referrals before seeing specialists."
Still, I don't see how Anthem's (alleged) bad faith has anything to do with the ACA, nor that the Feds have the authority to make such an accommodation.
As before, we'll keep you posted.
[Hat Tip: Whitney D]
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Monday, 4 March 2019
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■ We've posted faily often about Health Care Sharing Ministries, most recently here:
"After some online research Mazie, who lives in Miami, found something he thought was a godsend: United Refuah HealthShare, a Jewish alternative to traditional insurance ... He was thrilled by the bargain-priced plans."
This was news because this model of health care financing is typically offered with a Christian slant (NTTAWWT). Regardless, they're gaining in popularity (sort of: there are about 1 million folks on these plans, which makes it a rounding error), and the movement wants a seat at the table as we look for ACA alternatives:
"The health sharing plan movement made itself felt recently at the Inter-Company Marketing Group’s 2019 annual conference."
Good for them!
■ It's true that we spend a lot of time dissing on Britain's Much Vaunted National Health Service©, and with (very) good reason. For example, FoIB Sally Pipes alerts us to this latest news:
"NICOLA Sturgeon has admitted she is not “surprised” that NHS waiting times are still getting worse despite bringing in a legal guarantee to prompt treatment seven years ago ... [Last] week, official figures showed a record 27.3 per cent of patients waited longer than 12 weeks in the last quarter of 2018, the equivalent of 200 breaches each day."
But hey, it's free!
And on its way here, if the M4A folks have their way.
■ Even with ObamaCare's actual body count, we're still doing pretty darned well in the health care results metric. From FoIB David Balat:
"The world’s leading medical journals report the U.S. has superior results, including for cancer, heart disease, high blood pressure, diabetes, and high cholesterol."
The Tweet links to an article behind WSJ's paywall, so...
"After some online research Mazie, who lives in Miami, found something he thought was a godsend: United Refuah HealthShare, a Jewish alternative to traditional insurance ... He was thrilled by the bargain-priced plans."
This was news because this model of health care financing is typically offered with a Christian slant (NTTAWWT). Regardless, they're gaining in popularity (sort of: there are about 1 million folks on these plans, which makes it a rounding error), and the movement wants a seat at the table as we look for ACA alternatives:
"The health sharing plan movement made itself felt recently at the Inter-Company Marketing Group’s 2019 annual conference."
Good for them!
■ It's true that we spend a lot of time dissing on Britain's Much Vaunted National Health Service©, and with (very) good reason. For example, FoIB Sally Pipes alerts us to this latest news:
"NICOLA Sturgeon has admitted she is not “surprised” that NHS waiting times are still getting worse despite bringing in a legal guarantee to prompt treatment seven years ago ... [Last] week, official figures showed a record 27.3 per cent of patients waited longer than 12 weeks in the last quarter of 2018, the equivalent of 200 breaches each day."
But hey, it's free!
And on its way here, if the M4A folks have their way.
■ Even with ObamaCare's actual body count, we're still doing pretty darned well in the health care results metric. From FoIB David Balat:
"The world’s leading medical journals report the U.S. has superior results, including for cancer, heart disease, high blood pressure, diabetes, and high cholesterol."
The Tweet links to an article behind WSJ's paywall, so...
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Friday, 1 March 2019
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Ooops:
"Friday’s report by the public accounts committee into the cost of clinical negligence in hospital trusts reveals that the bill has quadrupled in 10 years to [~$2 billion] and is expected to double again by 2021."
So why are these expenses climbing so high and so rapidly? Well, there seem to be a couple of factors in play:
"As well as increasing damages for a small and stable number of “high value” ... there is a growth in the number and cost of “low value” claims."
The vast majority of those "high-value" claims, by the way, are maternity-related.
But why the increase in claims themselves?
Apparently, there's a mysterious connection between "steeply rising demand and chronic staff shortages." I mean, who could have foreseen that in a government-run system? And this in turn has led to "endless examples of deteriorating patient safety."
— Prez Cannady (@prezcannady) March 1, 2019So about that bending the cost curve down by way of nationalized health "care:"
"Friday’s report by the public accounts committee into the cost of clinical negligence in hospital trusts reveals that the bill has quadrupled in 10 years to [~$2 billion] and is expected to double again by 2021."
So why are these expenses climbing so high and so rapidly? Well, there seem to be a couple of factors in play:
"As well as increasing damages for a small and stable number of “high value” ... there is a growth in the number and cost of “low value” claims."
The vast majority of those "high-value" claims, by the way, are maternity-related.
But why the increase in claims themselves?
Apparently, there's a mysterious connection between "steeply rising demand and chronic staff shortages." I mean, who could have foreseen that in a government-run system? And this in turn has led to "endless examples of deteriorating patient safety."
Hunh.
#Unexpected #MedicareForAll
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