Friday, February 27, 2015

Rationing the MVNHS©

In response to yesterday's post on the apparent death-spiral of the Much Vaunted National Health System©, frequent (and valued) commenter John Fembup observed that this is not really news; in fact, Dr David Owens (former chief of the Service) noted the likely future 40 years ago:

"The National Health Service is a rationed service. There will never be a government or a country that has enough resources to meet all the demands any nation will make on a national health service."

That quote, by the way, comes from a report of the annual meeting of the National Academy of Sciences in DC in 1976.

It should come as no surprise to regular IB readers that what Dr Owens observed must, in fact, be the case. Almost 6 years ago, co-blogger Bob explained it in easily understandable economic terms:

"The economics of goods and services can be reduced to simple demand and supply. Health care is no different. It follows economic theory just like every other consumer good.At either extreme you have inelastic price curves and elastic curves. Most consumer items track a bell curve but some things are totally elastic or totally inelastic."

That is, health care is, in fact, a good and a service (depending on whether you're talking about a cast, or the orthopedist affixing it to your arm). Regardless, there is only so much of it at any given time (there's not an endless supply of cardiologists, for example). And folks who deliver health care expect to be paid for their services, as those who supply bandages and syringes expect to be paid for their products. How much we're willing to throw at a given patient then becomes an issue.

When the cost of health care is perceived to be free (as in a nationalized scheme), the demand is going to go up. But from where do the funds come to pay for unlimited services and supplies?

One could ask Venezuela about that, no?

Thursday, February 26, 2015

MVNHS© Circling the Drain?

While prognosticators opine breathlessly on the potential Halbig/King/Burwell fallout, it may be instructive to cast our eyes eastward to see how Britain's Much Vaunted National Health System© is faring:

"NHS may be forced to abandon free healthcare for all, says Britain's top doctor"

Wait, what?

That can't be good.

Surely he's overstating the case, right?

Not so much:

"If the NHS continues to function as it does now, it’s going to really struggle to cope because the model of delivery and service that we have at the moment is not fit for the future."

Turns out, if something's "free" it's likely to be much in demand, and you know the old saw: "You can have it fast. You can have it cheap. You can have it good. Pick two."

Under a nationalized health are scheme such as the MVNHS©, it's readily apparent that the folks in charge have long opted for the first two. Now, they're even failing at least one of those, which does not bode well for the average Brit.

Interestingly, the good doctor is calling for a more holistic delivery approach, with services more centrally located and delivered. Now, how - or even if - that can be accomplished becomes the next big challenge.

Health Wonk Review: Decade edition

The venerable Health Wonk Review celebrates its 10th anniversary, and I can think of no one more fitting to present it than David Williams. His own blog also turns 10 this weekend (we beat him by a month), so he's a natural to host this very special 'Review.

Wednesday, February 25, 2015

Gruberized

This just in ........
Massachusetts' governor has fired Obamacare architect Jonathan Gruber from a board that oversees the state's health insurance exchange, a source confirmed to the Washington Examiner.
Gruber ignited a controversy last December when a series of videos surfaced where the Massachusetts Institute of Technology professor discussed the “stupidity of the American voter” was vital to passing the 2010 Affordable Care Act. - Washington Examiner

I guess he feels really stupid now.

Biting the Hand .......

In a recent campaign speech to participants of the Council on Aging the Arrogant One let his feelings be
known with regard to financial planners.
President Obama made only one reference to any insurance-related product today at an AARP event in Washington. He thanked AARP for helping the White House organize the aging conference, and then used the rest of the appearance to blast financial advisors who "receive backdoor payments or hidden fees for steering people into bad retirement investments that have high fees and low returns." - Life Health Pro
Either El Presidente is unaware that AARP would not exist if not for fee's and commissions paid by carriers in exchange for an endorsement, or he knows but fails to connect the dots.

Can you say backdoor payments to AARP?

Oh, and speaking of low return retirement investments, how is Social Security doing these days? Let's consider those that work until their 65th birthday and then drop dead the day after they retire.

What kind of ROI do they get?

#AARP

No fees, please

Over at LifeHealthPro, Craig Gottwals has a very interesting take on the role of fees in the age of MLR (Medical Loss Ratio). Craig's an attorney specializing in health care law, so what he says has a lot of credibility.

In a nutshell, one of the challenges facing agents in the fully insured large group market (where most of the whole fee discussion takes place) is how employers and their agents deal with the annual rate increases. Traditionally, it's not been unusual for the employer to pay his agent a fee for procuring coverage, and the agent then negotiates with the carrier to deduct the cost of commissions from their premium calculations.

Alternately, the agent might agree to a simple commission reduction (although this might be classified as rebating, but that's another post).

Regardless, the goal is to find a way to lower premiums.

Craig asks a simple question: Will this strategy still work in the age of MLR?

The short is answer is "No," but I really recommend reading the whole thing. There's precious little insider lingo, and he does a great job of explaining why this arrangement is not only spinning wheels, it can actually put you in reverse.

Recommended.

Tuesday, February 24, 2015

Solyndra-care

If you liked Solyndra you are going to love the Obamacrack co-ops.
* Only one Obamacare co-op made money during the first three quarters of 2014.
* Taxpayers are set to lose more than $1 billion of the $2.4 billion loaned to the co-ops - nearly double the loss of Solyndra. - Insurance News Net
Reminds me of a line Gov. Romney used in one of the debates with Obama. It seems like Obama only picks losers.
According to S&P, almost a third of the co-ops received more than $20,000 in federal loans for each person covered in 2014:
*The Minuteman Health Inc. Co-op in Massachusetts got more than $156 million and covered only 1,822 people - nearly $86,000 per enrollee.
*The Land of Lincoln Mutual Health Insurance Co-op in Illinois got more than $160 million and covered only 3,428 people - nearly $47,000 per enrollee.
*Freelancers Co-op of Oregon (Health Republic of Oregon) got more than $60 million and covered only 1,279 people - more than $44,000 per enrollee.

The money would have been better spent on vouchers and let these people buy coverage from a real insurance carrier.

Where do I go to get my tax money back?

#co-op  #obamacare #acquisitioncost