Author Archive

Physician Capacity

A little while ago Scott Gottleib and Zeke Emmanuel co-authored an op-ed in The New York Times pooh-poohing the concern about physician shortages.

So certain are they that conventional wisdom is wrong that the piece is headlined, “No, There Won’t be a Doctor Shortage.” Right, and “if you like your health plan, you can keep your health plan — period”. Somehow such bold assertions have lost a bit of their luster over the past few months.

Now, they acknowledge that an aging population and the prospect of 30 million newly insured people may make it seem like there might be a problem, and the Association of American Medical Colleges says their members aren’t able to train enough physicians to fill the need, but what do they know about physician supply? Gottleib and Emmanuel know better.

As Exhibit 1, they look at Massachusetts. They write –

Take Massachusetts, where ObamaCare-style reforms were implemented beginning in 2006, adding nearly 400,000 people to the insurance rolls. Appointment wait times for family physicians, internists, pediatricians, obstetricians and gynecologists, and even specialists like cardiologists, have bounced around since but have not appreciably increased overall, according to a Massachusetts Medical Society survey.


I need somebody.
Not just anybody.

Read More » »

The Next Wave

Employers are already starting to get the same cancellation letters that went to millions of people in the individual market late last year. The Washington Post reports that the big surge should take place in October, but it will happen all through the year as employer plans come up for renewal.

shutterstock_160789127Contrary to many press reports this affects not just the small group market, but all fully-insured health plans. Very few meet the requirements of “essential benefits” of ObamaCare, which include things like pediatric dental coverage.

The Washington Post article tried to minimize the effects, quoting Jonathan Gruber, one of ObamaCare’s archictects –

“We’re ending discrimination [against people who are sick, and as a result] the people who were previously benefiting may now suffer,” Gruber said. “That’s sad for them, but it does not mean we should continue discrimination.”

He concludes that the number of losers will be “very, very small.” Right.

Writing in the New York Post, Betsy McCaughey does a pretty good job of rebutting Mr. Gruber. She estimates the number of people who will lose coverage is 25 million, which is the same estimate I’ve been using for some time now. But even she understates the problem by focusing entirely on the small group market.

Read More » »

Risk Adjustments in ObamaCare

Most of the commentators on the exchange roll out caution against the “death spiral,” in which failing to attract the young and healthy raises overall premiums. This further deters low-cost people from enrolling, resulting in even higher premiums.

This is absolutely true in a normal market. But a new report from the actuarial consulting firm Milliman shows how the Affordable Care Act has turned normal market principles on their head.

Here is the problem. Because health insurers are no longer allowed to ask any questions about an applicant’s health, they have absolutely no way of knowing who they are enrolling in terms of past or present illnesses or health conditions. They might attract a group of pretty healthy people or a group of pretty sick people, but they won’t know until people start filing claims. So it is impossible to accurately set premiums, at least for the first few years.

Another problem is that some insurers may attract a whole lot of very sick people while others attract mostly healthy people. In a particular state BlueCross may be known as the best place to go if you have cancer or heart disease, while Aetna may be famous for its discounts on gym memberships. The healthy people will be drawn to Aetna while the really sick people prefer the Blues. If companies could set premiums to accurately reflect their enrolled population, BlueCross premiums would be outrageously expensive while the Aetna premiums would be cheap.

ObamaCare tries to fix these problems in several ways.

Read More » »

Health Savings Accounts: Ten Years On

On a wintery Monday night in Washington about 70 people gathered at a banquet to celebrate the tenth anniversary of the signing of Health Savings Accounts into law.

HCCS-13NovDec-HSA-featureFittingly, the dinner, organized by the National Center for Policy Analysis (NCPA), was held in the O’Byrne Gallery of the DAR’s Constitution Hall where President Bush signed the law on December 8, 2003.

Represented were many of the people who conceived of the idea in the 1980s, the policy staff and legislators who enacted the first Medical Savings Accounts (MSA) law in 1996, the entrepreneurs and regulators who took the concept and created Health Reimbursement Accounts in 2002, and the companies who have turned the law into the products and services that benefit tens of millions of people today.

NCPA President John Goodman, who is often referred to as “the father of HSAs,” and myself opened the commemoration with a tribute to the late J. Patrick Rooney, Chairman of Golden Rule Insurance, who did more than anyone else to popularize the idea and shepherd it through the legislative hurdles.

Read More » »

Health Sharing Groups Grow

A 2011 survey found 8 out of 10 Christians are unaware of health sharing ― an alternative to health insurance. CCHF has long been talking about health sharing, including on radio interviews and in our new “Legal Alternatives” flier, which lists it as one of nine exemptions to the ObamaCare insurance mandate. Interest is growing. Since open enrollment began, Medi-Share had more timthumbthan 23,000 people asking for information in October alone, and 2,108 people joined. Samaritan Ministries, which routinely shares about $6 million in medical needs each month, received 754 new household enrollments in October, which added up to 2,483 individuals. Medical sharing is far less expensive than health insurance and exceedingly more personal. Read our 2010 report on health sharing. See comparison chart for two of the three ministries. Read personal stories.

Schizophrenia about High Deductibles

You may remember that when Health Savings Accounts were introduced there was almost universal outrage among liberals about the horrendous burden cost-sharing places on all but “the healthy and wealthy.” A press release issued by the Center for Budget and Policy Priorities (CBPP) within a week of the Ways and Means committee approving an HSA bill in 2003 said –

This legislation would lead many employers to move away from providing low-deductible comprehensive insurance, noted Edwin Park, a senior health policy analyst at the Center and the report’s lead author. Policies with deductibles of $1,000 or more, higher co-payments for medical services, and coverage for a narrower array of health services could well become the norm for employer-sponsored coverage, with employers expecting their workers to pay uncovered costs out of their tax-favored Health Savings Security Accounts, Park stated.

Low- and moderate-income workers, who would benefit little from the tax breaks that the new accounts would provide, and older and sicker workers, who could face large increases in out-of-pocket health care costs as a result of the loss of comprehensive insurance, could be sharply affected, he added.

Read More » »

How Do We Salvage This Wreck?

While all the analysts and pundits in the Capitol City are calculating the political consequences of the ObamaCare bomb, out here in the country we see things differently.

We care less about who is up and who is down for the November, 2014 elections than the fact that our friends and neighbors are getting cancellation notices for the insurance coverage they have. On January 1, 2014 they will be uninsured, and there is nowhere for them to go. There are some 16 million of these people with individual coverage across the country. Rather than reducing the number of uninsured, ObamaCare will add 16 million from the individual market alone and who knows how many more from employers dropping coverage.

Cartoon-Huge-Train-Wreck-6001These folks have been faithfully paying premiums for years. They have taken responsibility for their own situation. They haven’t gotten handouts and are not looking for any. But ObamaCare suddenly requires insurance contracts to cover a whole bunch of things they have no need for, like pediatric dental services or in vitro fertilization. Plus, the requirements for guaranteed issue and community rating have dramatically raised the cost of coverage. Obama has turned the entire country into New Jersey where similar requirements made even catastrophic coverage cost $1,900 a month for a single male.

Read More » »

What a Difference Four Months Make

Today it is impossible to get anyone involved in the ObamaCare website to say anything. Four months ago they were bragging about how brilliant they were in an interview in The Atlantic:

5187e0505150c1e79fc11790ba84451b“It’s fast, built in static HTML, completely scalable and secure,” said Bryan Sivak, chief technology officer of HHS, in an interview. “It’s basically setting up a web server. That’s the beauty of it.”

“This is such a lean site,” said Jon Booth, head of the web and new media group at the Centers for Medicare and Medicaid Services (CMS), in an interview. “HHS had a blanket contract when we when awarded this. Aquilent got creative and brought people on with powerful skills, like Ed and Jessica, a designer at Teal Media, and Development Seed. Most of my team is working on this site; we have internal UX, information architects, designers, developers, and infrastructure people that stood up the cloud environment. Their collaboration is one of the high points of this process.”

“The work that they’re doing is amazing,” said Sivak, “like how they organize their sprints and code. It’s incredible what can happen when you give a team of talented developers and managers and let them go.”

The entire article is worth reading as an example of unbridled hubris.

HT: Moe Lane.

The Tyranny of Electronic Systems

Some eight years ago the media was excited that Hillary Clinton and Newt Gingrich had formed an alliance about reforming health care. In 2005 Dana Milbank wrote in the Washington Post about a joint appearance in gushing terms –

Clinton, asked about electronic medical records, deferred, again, to her friend. “Newt has a very dramatic way of saying this,” she said, “which is ‘Paper kills.'” Gingrich sent the praise right back at her, hailing Clinton’s legislation on medical records as a “major breakthrough” in Congress. “This is absolutely the case that Hillary is making,” he said.

Of course, they were not alone. President Bush had already embraced the idea in his State of the Union speech to Congress.

Later, President Obama built the HITECH Act into his 2009 stimulus package and appropriated some $20 billion to make it happen. All promised to get everyone’s complete medical records in digital form by 2014.

Man, this is going to be GREAT! A model of modern efficiency! Bipartisan support! Interoperable! WOWSA!

Now, of course there were the usual naysayers and Gloomy Gusses. I was one of them in this research and commentary I wrote for the Heartland Institute. Dr. Bruce Landes, who comments here frequently, was another. Dr. Scott Silverstein at Drexel University was also skeptical. And Dr. Deborah Peele was very concerned about patient privacy in a digital era.

Most of these concerns were not about whether digital technology is a good thing. Of course it is, or can be, a very good thing. But the track record of top-down, politically imposed solutions is abysmal. And when you add vast amounts of money to the mix, chaos is inevitable. Great Britain went through a similar, though more modest, exercise and recently concluded that the whole thing was a failure, but only after spending some $12 billion.

Read More » »

What’s the Deal with the Exchanges?

Whether it is a website or a retail store, good marketing requires focusing on the product you are trying to sell. You feature it in the window display, whether that is a physical window or a digital one.

If you are selling cars, you put the shiny new model in the window, with banners talking about the features your target market most desires ― comfort, speed, economy, sex appeal. You let people test drive it so they will fall in love with it.

If you are trying to sell health insurance, you promote the most popular features of the insurance and let the buyers browse around the different models until they find the one that is just right for them.

That’s how does it. They put very few obstacles between the buyer and the browsing. All you have to do is enter your zip code to find out what is available in your area and the world of choices opens up. You can see what the benefits and costs will be. Only after you have made your selection do you have to start filling out the paperwork.

Obamacare-draft-APThat is not how the ObamaCare exchanges operate. You can’t see any actual insurance plans until you first fill out a whole lot of paperwork. Even Kentucky, the state with the best performance so far, requires you to complete a form including your name, address, phone number, and social security number, which must then be verified by “public records and consumer credit information.”

Read More » »