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September 23, 2010

The New Health Care Math

If you like the New Math ....

... you're going to love The New Health Care Math:

On Thursday, the six-month anniversary of the signing of the Patient Protection and Affordable Care Act, a number of its most central consumer protections take effect, just in time for the midterm elections.

Starting now, insurance companies will no longer be permitted to exclude children because of pre-existing health conditions, which the White House said could enable 72,000 uninsured to gain coverage. Insurers also will be prohibited from imposing lifetime limits on benefits.

The law will now forbid insurers to drop sick and costly customers after discovering technical mistakes on applications. It requires that they offer coverage to children under 26 on their parents’ policies.

It establishes a menu of preventive procedures, like colonoscopies, mammograms and immunizations, that must be covered without co-payments. And it allows consumers who join a new plan to keep their own doctors and to appeal insurance company reimbursement decisions to a third party.

Thanks to the Afforable Care Act, insurance companies will now be able to:

* offer more services
* to more people
* who have more expensive health conditions
* for longer periods
* and no upper limit on payouts...

... all for less money!

House Republicans continued to question Mr. Obama’s assertions, which he repeated Wednesday, that the law will lower premiums, pointing to double-digit increases recently announced by many insurers....

The administration has estimated that premiums should rise no more than 2 percent because of the new consumer protections, and warned this month that it would have “zero tolerance” for efforts to blame the law for larger increases.

If you're anything like I am, you're probably thinking that it doesn't matter what kind of math you use: no insurer can pay out increased benefits indefinitely without raising premiums to reflect the added cost and added risk.

Don't worry: as with the new math, technical accuracy is less important than promoting understanding of just how much better off we are under this new system.


Posted by Cassandra at September 23, 2010 01:33 PM

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Comments

Ever since FDR, Democrats have successfully convinced the american public that you can get something for nothing. Anyone with a brain knows that is not the case, but if it weren't for the endless supply of "marks", con men/politicians would have been put out of business long ago.

Posted by: a former european at September 23, 2010 03:30 PM

Tom Lehrer. There's a blast from the past.

Posted by: htom at September 23, 2010 03:37 PM

First shots across the bow from HHS a fortnight ago:

http://www.thedonovan.com/archives/2010/09/this_will_not_p.html

Memo to the insurance industry: You're gonna need a bigger bribe...

Posted by: BillT at September 23, 2010 03:41 PM

You're gonna need a bigger bribe...

A down payment to Pharaoh is the least requirement. A first born would be nice.

Posted by: Ymarsakar at September 23, 2010 04:20 PM

Wait, so if everything they said about Bush was only ever true of the Left, does that mean the Left are going to start eating up babies?

Btw, what do they do with the left over biological matter from partial and post birth abortions anyway?

Posted by: Ymarsakar at September 23, 2010 04:21 PM

Visual aid for the imagination handicapped.

Watch and see

Is that really going to come true as a prediction? Really?

Posted by: Ymarsakar at September 23, 2010 04:23 PM

Cassandra, you need to be brainwashed.
I recommend you do your homework.

Obama's people don't want reality to interfere with the laws.

After all, they are the gods of our universe. I think it is time to have a Gotterdammerung.

I am also tired, arthritic and cranky. I was up last night, reading my financial management tome, and nowhere does it say that government laws can actually regulate the laws of the universe. If you sell a bond, you have to sell a certain number in order to recover flotation costs, pay interest and principal.

By the same token, if you have to take on added risk, you have to increase the costs of doing so.
The investors demand it, as does the company the provides it.

Didn't we call this economics at one time?

Remember, I am cranky, so use small words.

Posted by: Cricket at September 24, 2010 07:29 AM

Cricket -- yes. we. did.

Posted by: BillT at September 24, 2010 08:19 AM

Here's an article that shows how we can:

* offer more services
* to more people
* who have more expensive health conditions
* for longer periods
* and no upper limit on payouts...

... all for less money!

link:

http://www.nytimes.com/2009/08/13/opinion/13gawande.html?pagewanted=1&tntemail0=y&_r=1&emc=tnt

Posted by: Craig at September 24, 2010 08:37 AM

ObamaCare clearly was written by The Party. See, further, how "loosely" Obama plays with history. After all, "He who controls the past, controls the future."

1984 arrived in 2008. Hopefully, we'll do better than Winston.

Eric Hines

Posted by: E Hines at September 24, 2010 09:02 AM

Cricket, I'll wager long odds your financial management tome also does not teach that insurance is a privately funded entitlement program, and not a private enterprise risk transfer business. Indeed, I'll wager all of your texts cynically elide the question altogether.

All part of the altering of facts and history process, the better to comport with Truth.

Eric Hines

Posted by: E Hines at September 24, 2010 09:07 AM

But they, too, have found ways to protect patients against the damaging incentives of a system that encourages fragmentation of care and the pursuit of revenues over patient needs.

It appears they also found ways to protect themselves against the damaging incentives of a system that encourages malpractice lawsuits at the drop of a hat.

They examined the data and found that in just one year 52,000 scans were done in a community of 300,000 people. A large portion of them were almost certainly unnecessary, not to mention possibly harmful, as CAT scans have about 1,000 times as much radiation exposure as a chest X-ray.

Mercer Medical Center in my neighborhood went broke because of -- among other things -- the number of malpractice suits brought by ER patients who had demanded CAT scans for such things as dislocated toes or broken fingers. MMC refused, and the patents sued, because they were "refused medical care."

Posted by: BillT at September 24, 2010 09:27 AM

Yeah... I'm not going to let this pass. Tell me, Craig, what do these solutions (in the opinion article you listed) have in common:

Reduction in the number of CAT scans - They examined the data and found that in just one year 52,000 scans were done in a community of 300,000 people. A large portion of them were almost certainly unnecessary, not to mention possibly harmful, as CAT scans have about 1,000 times as much radiation exposure as a chest X-ray.

Reduction in the number of hospitals - Asheville, after gaining state support to avoid antitrust concerns, merged two underutilized hospitals.

Reduction in the number of unneeded (aka AVAILABLE) beds - In Sacramento, a decade of fierce competition among four rival health systems brought about elimination of unneeded beds, adoption of new electronic systems for patient data and a race to raise quality.

They all represent REDUCTIONS in service and availability of service. And why? In an effort to keep costs down. Most places, that kind of thing is called rationing.

As Bill has pointed out "unnecessary" CAT scans are normally mandated either by patients (who will sue if they do not get them) or by hospitals (who fear malpractice suits if they do not provide a paper trail proving that they ran every imaginable test to ward off abuse by greedy malpractice lawyers. But I'd also like to add, hind-sight is 20/20. You DO NOT KNOW if a particular CAT scan will be unnecessary until after it is performed. It MIGHT just turn up something unexpected or life-saving. And wouldn't you say saving even one life is worth it?

Reduction in the number of hospitals. You'll note the anti-trust concerns were handwaved away, but with only one hospital in the area, what's to prevent trust-like behavior? The goodwill of the people involved? Government regulation (which would then necessitate government oversight which would in turn DRIVE UP COSTS)? Ignore that, let's assume everyone involved acts according to their better angels (and contrary to human history). One hospital means that in a crisis, what WAS available capacity is no longer available. God forbid a major catastrophy hits the Asheville area, where do you put the casualties?

And in Sacremento, they apparently made the decision that because those beds are not currently in use, they are "unnecessary". Well, I'm sure that will be great comfort to those who have to sleep in gurneys in the halls or tents outside when an earthquake causes the current capacity of the hospitals to be overwhelmed.

So please tell me. How does the reduction in the amount of available health care resources listed by this opinion piece (medical tests, hospitals, beds, etc) mean MORE service for MORE people? The answer is, it does not. It reduces costs by reducing service and resources.

Posted by: MikeD at September 24, 2010 10:18 AM

Mike, you evil genius. You also forgot to mention that when the bean counters (of which I am in training to be one) can torture numbers, the MSM fails to report the techniques used, unless it involves corporate bad faith. When bean counters torture numbers to reflect the Left ideology, unicorns dispense Skittles from their horns, and pass rainbows. Not only that, they gambol with kittens.

Thus, if there is a competition to reduce costs and raise quality, the focus is going to be on outpatient care and prevention.

Posted by: Cricket at September 24, 2010 10:38 AM

MikeD,

Reducing the number of UNUSED medical facilities is rationing?

I do not think that word means what you think it means.

I am also curious to know if you are one of the plaintiffs in some of those malpractice lawsuits BillT mentioned, since you such a proponent of "CAT scans for everyone!"

Posted by: Craig at September 24, 2010 10:58 AM

Reducing the number of UNUSED medical facilities is rationing?
I do not think that word means what you think it means.

Unused has many different definitions, depending on who is doing the defining. It can mean anything from "not occupied at present" to "unoccupied during 50% of the year."

What it does *not* mean is, "has never been used, for disaster contingency-only."

Posted by: BillT at September 24, 2010 11:15 AM

Hey! The GOP's Pledge to America promises to do seven of the things that Obamacare ACA already does (including some of the "New Math" provisions mentioned here):

“We will allow individuals to buy health care coverage outside of the state in which they live. ”

“We will expand state high-risk pools, reinsurance programs and reduce the cost of coverage”

“We will make it illegal for an insurance company to deny coverage to someone with prior coverage on the basis of a pre-existing condition.”

“[E]liminate annual and lifetime spending caps”

“[P]revent insurers from dropping your coverage just because you get sick.”

“We will incentivize states to develop innovative programs that lower premiums and reduce the number of uninsured Americans.”

“We will also enact into law conscience protections for health care providers, including doctors, nurses, and hospitals.”

I guess that Newsweek headline was right last year:

"We Are All Socialists Now"

link:

http://www.google.com/images?um=1&hl=en&tbs=isch%3A1&sa=1&q=%22We+are+all+Socialists+Now%22+newsweek&btnG=Search&aq=f&aqi=&aql=&oq=&gs_rfai=

Posted by: Craig at September 24, 2010 11:48 AM

Reducing the number of UNUSED medical facilities is rationing?

I do not think that word means what you think it means.

Well Craig, let's examine, shall we?

Currently Hospital A has 25 unused beds. As a cost saving measure (which in your words will "provide MORE service at lower cost) they remove those beds. Sell them for short term actuary gain in fact. Maybe even lay off a nurse or two (ah wonderful cost savings measures... they NEVER have negative impacts). YAY! Hospital A has now saved on the order of $100,000 per year. They're so thrifty

But, uh oh... a mean nasty fire breaks out in a crowded building and suddenly, twenty more patients than average come into Hospital A than average. Suddenly, instead of 25 "unused" beds, there are none available.

Now please, pay attention here, because here comes that "rationing" part you didn't think I understood the meaning of.

So Hospital A has twenty more patients than it has beds for. What to do? OH! I know... they ration the beds they do have, kick the least sick/injured people out of the beds that ARE occupied, and give those beds to the burn victims.

Everyone's happy now, and MORE people are getting MORE care for LESS money than ever before, right? Uh, no... more people are getting LESS care than before for possibly less money. But hey, there's no "rationing" right? Uh... actually, no... there WAS rationing, but what the hell do I know.

I am also curious to know if you are one of the plaintiffs in some of those malpractice lawsuits BillT mentioned, since you such a proponent of "CAT scans for everyone!"

Ignoring the fact that you're engaging in an Ad Hominem attack (as I have nothing to do with my argument... but hey... why debate the message when you can tear at the arguer, right?), I'll deign to answer your accusation. Though it is none of your DAMNED business what I do with my life, I have not ever had a CAT scan, I am not a health care professional, nor am I a lawyer, nor have I ever sued anyone, nor have I been sued by anyone.

Any other personal information you'd like out of me to ignore the content of my argument? My shoe size perhaps?

Posted by: MikeD at September 24, 2010 12:31 PM

What it does *not* mean is, "has never been used, for disaster contingency-only."

Craig wants to keep resources reserved for the rich and powerful. HIs faction. Or rather, his bosses.

Posted by: Ymarsakar at September 24, 2010 01:07 PM

Cricket, Obama is the messiah. He can make wine from water. he is the Miracle Boy. Or, at least, that's what people like Craig were paid to think and say.

Posted by: Ymarsakar at September 24, 2010 01:08 PM

And wouldn't you say saving even one life is worth it?

It's worth it if you pay Craig enough to make it worth it. Otherwise, probably not.

Posted by: Ymarsakar at September 24, 2010 01:10 PM

Here in Sacramento, and the general area, population is increasing. How can anyone rationalize reducing health care resources? MikeD is right this is the precursor of rationing. Obama is such a colossal liar I would believe nothing he says.

Our little wunderkind President has also sufficiently creeped me out with his fascist behavior the guy is genuinely to be feared for his incompetence. "Zero Tolerance" for insurance companies and others blowing the whistle on Obie's utopian ponzi scheme? Get stuffed Obama, you will be gone in two years unless the Republican idiots implode.

Posted by: Mark at September 24, 2010 01:32 PM

MikeD,

Here's one reason why CAT scans are not for everybody:

"The risk of cancer associated with popular CT scans appears to be greater than previously believed, according to two new studies published Monday in the Archives of Internal Medicine."

And:

"The cancer risk was greatest for young patients, this study found. For instance, a female who received an abdominal scan at age 3 had a 1 in 500 chance of developing cancer because of the radiation from that scan. That figure dropped to 1 in 1,000 by age 30, and 1 in 3,333 at age 70."

link:

http://online.wsj.com/article/SB126082398582691047.html

Posted by: Craig at September 24, 2010 02:30 PM

Also, Dr. Berwick is a real health care professional who knows what he's talking about and who has been an advocate for better healthcare long before Obama.

Until recently, he was the CEO of the Institute for Healthcare Improvement.

From their "About Us" page:

"At its core, health care is a highly complex system with many broken parts. The good news is that for every broken part in our system, there are remarkable examples of excellence — organizations that have overcome enormous obstacles to redesign the way patient care is delivered. Many of these organizations have significantly reduced waiting times, hospital-acquired infections, readmissions, staff turnover, and avoidable deaths — while dramatically raising patient satisfaction."

"The most forward-thinking of these organizations have already begun to view their mission as one of helping populations achieve better health at lower per capita costs. This is the future IHI envisions and wants to work with others to create."

link:

http://www.ihi.org/ihi/about

Posted by: Craig at September 24, 2010 02:43 PM

"The risk of cancer associated with popular CT scans appears to be greater than previously believed, according to two new studies published Monday in the Archives of Internal Medicine."

From the article:

Doses of radiation from the scans varied wildly, according to the study, even within the same procedure at the same hospital.

That is because of a lack of standardization in the machine settings or technicians failing to follow guidelines, not because of a problem with the procedure itself.

...said Amy Berrington, an investigator at the National Cancer Institute and an author on both papers, "Despite these concerns, CT scans provide great medical benefit. On an individual basis, if the scan is justified, then the benefits should outweigh the risks."

Posted by: BillT at September 24, 2010 02:53 PM

Keep stomping on the children, Craig. It'll get old eventually.

Posted by: Ymarsakar at September 24, 2010 04:40 PM

Here's one reason why CAT scans are not for everybody:

I'm sorry... so we're now OFF of me being a sue happy lawyer who doesn't understand what rationing means, and we're also going to ignore (and not even attempt to refute) every argument I've made so far and now we're moving the goalpost to my (non-existant) that "CAT scans are for everybody"? So we're off of ad hominem and we've moved to straw men. Care to throw in a little reductio ad absurdum for good measure?

The fact is, YOU stated (and I'm quoting, because I prefer to address the ARGUEMENT as it was made rather than some wild tangent):

Here's an article that shows how we can:

* offer more services
* to more people
* who have more expensive health conditions
* for longer periods
* and no upper limit on payouts...

... all for less money!

link:

http://www.nytimes.com/2009/08/13/opinion/13gawande.html?pagewanted=1&tntemail0=y&_r=1&emc=tnt

And I responded by pointing out that the NYT opinion article you linked does NOT increase services, but in fact reduces them. The arguments you've put forth against me included:

Reducing the number of UNUSED medical facilities is rationing?

I do not think that word means what you think it means.

And:

I am also curious to know if you are one of the plaintiffs in some of those malpractice lawsuits BillT mentioned, since you such a proponent of "CAT scans for everyone!"

Followed by:

Here's one reason why CAT scans are not for everybody:

Strangely, all you've managed by way of refutation is telling me I didn't know what rationing is (and I think I did a fair job disagreeing there), an ad hominem, and most recently a straw man. Do you REALLY have nothing better than that?

Posted by: MikeD at September 24, 2010 04:45 PM

Strangely, all you've managed by way of refutation is telling me I didn't know what rationing is (and I think I did a fair job disagreeing there), an ad hominem, and most recently a straw man.

Hmmm... I sense a pattern.

Posted by: Cassandra at September 24, 2010 04:56 PM

YOU stated

Craig isn't one identity, addressed by "you". He's more like a team of people. You all would be a more accurate term.

Posted by: Ymarsakar at September 24, 2010 05:09 PM

Stephen King's Children of the Pond...

Posted by: BillT at September 24, 2010 07:01 PM

Link

The fix was in.

They just make it up as they go along. There is no rule of law. The bureaucrats have a stronger claim for rule.

They just keep rephrasing things and lying to make shat look like food fit for the poor.

Posted by: Ymarsakar at September 25, 2010 07:39 AM

I said before that all this junk about Obama in 2008 and 2009 was just the tip of the iceberg. You hadn't seen nothing yet if you think that was corrupt and unethical and incompetent.

And all this stuff? It's not the tip of the iceberg. But it isn't Most of the Iceberg either.

It's sort of like a medium. You're seeing the deepness of the systematic and organized campaign in the service of evil. But it's not all of it. Or even, I would say, most of it.

The Afghanistan campaign, the casualties sustained there at Obama's direct orders, and the rule of racist law compromises a substantial chunk of the iceberg. But it wasn't what produced the iceberg or allowed such to become a danger. These are the products of a system that was put in place a long time ago, with deep roots. And the American people are still yet blind to the origins of all this.

Posted by: Ymarsakar at September 25, 2010 07:45 AM

There's no way America's enemies can be defeated when America doesn't even know the truth about the enemy.

It's impossible. You might as well sleepwalk around shooting at random lighted windows. It'll have about as much a positive effect.

Posted by: Ymarsakar at September 25, 2010 07:49 AM

We need to remember Health CARE and Health INSURANCE are not the same beast....

Posted by: Oh Hell at September 26, 2010 04:59 PM

How right you are, OH. The cost of insurance can't go down until the cost of care goes down.

Posted by: Miss Ladybug at September 26, 2010 06:31 PM

MikeD,

Dr. Berwick is not about reducing services. He is about reducing the inherent waste of resources in our corrupt and broken healthcare system.
By making the system more efficient, valuable resources can be directed to care for the people who need it most, such as children with pre-existing health conditions, at a lower cost.

As far as the ad hominem goes, I simply asked a (admittedly snarky) question. It was not meant to be some sort of character assassination attempt.

Regarding CAT scans, standardizing medical procedures for when and how a CAT scan could and should be used would save money and reduce law suits.

Posted by: Craig at September 28, 2010 07:40 AM

"Dr. Berwick is not about reducing services."

Oh really!? Hmmm.....that's not what he says:

Q: "Critics of CER have said that it will lead to the rationing of healthcare."

A: "We can make a sensible social
decision and say, 'Well, at this point, to have access to a particular additional benefit [new drug or medical intervention] is so expensive that our taxpayers have better use for those funds.” We make those decisions all the time. The decision is not whether or not we will ration care — the decision is whether we will ration with our eyes open. And right now, we are doing it blindly."

Posted by: DL Sly at September 28, 2010 08:47 AM

...standardizing medical procedures for when and how a CAT scan could and should be used would save money and reduce law suits.

Living in the best of all possible worlds, are ya?

The only thing that will reduce the number of malpractice lawsuits is the reformation of tort law -- as it stands now, a patient can sue a doctor who follows standardized procedures, but the result did not meet the patient's expectations, even if the doctor had *told* the patient beforehand that his expectations were unrealistic.

Posted by: BillT at September 28, 2010 11:03 AM

DL Sly,

It is fairly obvious that he is saying that, in the sense the US is rationing healthcare right now, which we are, we need to do it in a smarter way that actually helps more people get quality care.

Also from your article:

Q: CER sounds like evidence-based medicine.

A: It is evidence-based medicine. Anyone who says differently does not understand evidence-based
medicine. It means you are practicing according to knowledge. And it should apply across the board — procedures, clinical strategies, and biotechnology.

Posted by: Craig at September 28, 2010 12:52 PM

It is fairly obvious that he is saying that, in the sense the US is rationing healthcare right now, which we are, we need to do it in a smarter way that actually helps more people get quality care.

Over-generalizing. *Government-run* organizations are rationing healthcare, the privately-run organizations are, in the main, *not* rationing it.

And the government-run organizations are doing an abominable job overall, which is the reason they had to start rationing healthcare to begin with. All Dr. Berwick is saying is that government-run rationing will suddenly become more efficient under ObieCare because the people involved will magically *want* to make it work -- which ain't gonna happen in either of our lifetimes.

Posted by: BillT at September 28, 2010 01:18 PM

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