Patterico's Pontifications

10/9/2014

“Wait ‘Till It’s Free” — An Excellent Documentary About Health Care

Filed under: General — Patterico @ 7:47 am



A couple of days ago I watched Wait Till It’s Free, an excellent documentary about the state of our health care system. The filmmaker, Colin Gunn, has a clear point of view: he believes in allowing the free market to solve our problems with health care.

The film opens with stories that could be an ad for ObamaCare: interviews with real people who lacked health insurance and had their lives turned upside down by outrageous medical bills. The problem is real, and Gunn humanizes it. You feel for these people who, through no fault of their own, developed a serious medical disorder that ended up with them getting hit with tens or even hundreds of thousands in medical bills.

But Gunn doesn’t accept the lazy line that, because being uninsured in this country sucks, therefore we need ObamaCare — or, worse, a single payer system. Gunn is Scottish, and therefore has the perspective of someone who has been in the UK’s National Health Service. He tells some stories I never heard of before, that directly address the question of whether government-controlled health care leads to rationing and even the dreaded “death panels.”

If I heard the stories about the “Liverpool Care Pathway” when they first emerged, they didn’t make an impression — but they did as related in Gunn’s film. Essentially, a doctor named Patrick Pullicino left his patient one day thinking that he was in poor health from pneumonia and epilepsy, but was in no way terminal. He came back after the weekend to find that the patient had been heavily sedated and was on the “Liverpool Care Pathway” — a program designed to replicate the hospice experience for patients thought to be terminal. The problem was, the patient hadn’t asked for it, his regular doctor had not been consulted . . . and the hospital was getting a financial incentive to put him on it.

Yes: when the doctor looked into it, he found — and this has been confirmed — that hospitals get financial incentives from the British government to put elderly patients on the Pathway:

Hospitals are paid millions to hit targets for the number of patients who die on the Liverpool Care Pathway, the Mail can reveal.

The incentives have been paid to hospitals that ensure a set percentage of patients who die on their wards have been put on the controversial regime.

In some cases, hospitals have been set targets that between a third and two thirds of all the deaths should be on the LCP, which critics say is a way of hastening the deaths of terminally ill patients.

At least £30million in extra money from taxpayers is estimated to have been handed to hospitals over the past three years to achieve these goals.

Pullicino took the patient off the Pathway the second he learned about it, and the patient was treated successfully. Pullicino looked into the program further, and found that 130,000 patients per year are put on the Liverpool Care Pathway. After the scandal went public, a number of families came forward to say that their loved ones had unnecessarily been placed on this Pathway without their knowledge.

Government health care means rationing. The first to go will be the old people. Why do you think one of the ObamaCare architects wrote about the joys of dying at 75?

The film advocates bringing the free market back into the picture, and Gunn talks to doctors who have successfully done so, thus beating the oppressive bureaucracy and skyrocketing costs associated with government-dominated health care. One of the doctors describes the scam that is “uncompensated” health care. What happens is that “non-profit” hospitals jack up their prices to multiples of the actual cost. They give steep discounts — maybe 80% — to insurance companies, with the ultimate cost still being multiples of what they could charge. (The undiscounted costs are what the uninsured suckers interviewed for the film were stuck with.) Now the insurance company can tout the savings to their customers, and when the hospital does “uncompensated” care, it can recoup the hyper-inflated costs from taxpayer programs designed to recompense hospitals for the “uncompensated” care. It’s an instructive analysis that I didn’t know about before. You can read more about it here.

The film also interviews the maddeningly (to the left) pro-free-market John Mackey, CEO of Whole Foods. Mackey is anti-union, anti-ObamaCare, and pro-free-market. The left can’t stand his views. DRJ spotlighted Mackey’s proposed health care solutions years ago, here. They still make sense today.

My thanks to Colin Gunn for opening my eyes on some of these issues. You can buy his film for twenty bucks here if you’re so inclined.

Oh, and Mr. Gunn? Get your receipts in order. The IRS may come a’callin’ some day soon.

79 Responses to ““Wait ‘Till It’s Free” — An Excellent Documentary About Health Care”

  1. Ding.

    Patterico (9c670f)

  2. “When the hospital does “uncompensated” care, it can recoup the hyper-inflated costs from taxpayer programs designed to recompense hospitals for the “uncompensated” care. It’s an instructive analysis that I didn’t know about before.”

    Not to troll but I pointed this out years past. The most profitable customers are uninsured for the reasons cited. The least profitable Medicaid b/c the discounts are beyond 80%.

    Writeoffs from inflated Price Schedules in Hospitals are accounted for differently when it based on a Payer Contract versus an Individual. Hospital Administrators have knowingly lied about this for years b/c it allowed them to cry up a storm and get Govt help to “treat the uninsured.” It also allowed Hospital to screw ER Staffing Groups come contract time.

    This is why the Pricing Death Spiral embedded in Obamacare is a dark irony for the very Hospitals. Not only are Hospitals (who advocated like fools) getting more unprofitable Medicaid Patients. They have less profitable uninsured Patients. And to boot, the new Obamacare Individual Contracts mimic pricing in Medicaid.

    MD and Hospitals Admin poisoned the well with lies to the American people for years in order to get Govt cash. They lied about the state of health care provisioning and the efficacy the uninsured received (reference recent Virgina study on mortality rates of Medicaid patients versus other Payer Classes).

    Sorry but the MENTAL ILLNESS in Medicine that someone the sick should not have to pay for care is what led to this. Everyone wants to be the nice guy with someone else’s money.

    Rodney King's Spirit (8b9b5a)

  3. And to boot write this down ….. Socialized medicine does really good delivering medicine to the healthy but awful to those who are sick.

    This is why when folks ask Canadians about their Health Care you get these rosie outcomes. Of course, the Healthy like Social Medicine — they don’t have any out of pocket and since they are basically healthy the remedy is easy. Now when you get really sick, watch out — the Liverpool Care Pathway indeed. And the ratio of health to sick is like 4:1.

    Once again the BIG LIE (this time) about Preventative Medicine being some panacea is nothing more than a cheap out for Medical Professionals to assuage their guilt over the real sick being pains in the ass and not wanting to deal with it. But what is medicine if not to treat the sick???

    B/c bottom line 95% of preventative medicine is good hygiene, vaccinations, good diet, exercise and DNA. And is that is the benefits to Socialized Medicine — wow what a price tag for good water, vaccines, refrigerated food, a gym and good parents.

    Rodney King's Spirit (8b9b5a)

  4. Everyone wants to be the nice guy with someone else’s money.

    So true.

    I think we all have that in us. Sympathy and the sense of urgency to do something. Taken too far, these considerations outweigh the long term and the practical. So we wind up making the overall system less profitable, which means less new medicine, fewer doctors, and of course when supply drops, that means the whole thing spirals up in price anyway. Which means more sympathy and sense of urgency and more intervention and this recursive cycle endlessly screws up our medical system.

    When I enrolled my wife in Tri-Care when we first got married, they handed her a book entitled “Take care of yourself.” It’s still on the shelf in front of me. We chuckle about the attitude, but it’s actually advice. In the ideal medical system, everyone would be responsible for choosing what kind of coverage they wanted, and the prevention they wish to take (washing hands, exercising, not doing drugs, etc). Instead, we’re rapidly moving to a system where the government will pick winners and losers. Instead of a system where our outcome is linked to our choices, it will be based on something else entirely.

    All because politicians need voter blocs to be more dependent on their graces.

    Dustin (801032)

  5. I’m at the end of my COBRA. My pre-existing conditions make me uninsurable in the pre-Obamacare market. If I had a radio audience of three million computer illiterates with overweight bed partners, who buy first-generation computer data backup and sleep-number mattresses, I’d go bare and brag about my self-reliance. I don’t. Obamacare is in my future — November 15 to be exact.

    nk (dbc370)

  6. NK, the problem you describe is one that can only be solved by fixing the system right using proper market mechanisms along with a dash of Govt subsidy.

    First step if to free up premiums back to consumers by allowing them to buy insurance they want — not OCare crap covering sex changes operations.

    Second step is make people pay out of pocket for Outpatient thus stripping policies down to covering “things we would not wish on ourselves.”

    Third step is tort reform to enable the elimination of defensive medicine.

    By the time you are done counting the trillions saved …….. having medicaid throw out to the marketplace “Pre-existing Policies” is dirt cheap.

    Rodney King's Spirit (8b9b5a)

  7. Oh, I forgot. I’m not eligible for subsidies. I’ll be paying full fare. Can I brag about that bit of self-reliance?

    nk (dbc370)

  8. RKS, I totally agree with you. (Except maybe the tort lawyers part — I want lawyers around scaring the pants off doctors and medical administrators otherwise untouchable within their system.) Excpet now I have to swim in the sea I’m in.

    nk (dbc370)

  9. #5 And my wife has an OCare policy for the kids — it sucks comparatively speaking to my Employer plan. And the costs are pretty much the same.

    … that is why Insurers wanted OCare, higher prices for the same policies from Consumer who are heavily subsidized with tax dollars. They make more money — don’t let the 12% cap fool you. THe more the insurer spends on garbage medicine, the higher their profits. Electric Utilities figured this out years ago bloating Asset bases then going to the Public Service Commission and asking for a 8% return on assets. So eventually the Utilities ended up owning lots of assets that required no up keep but generated lots of income.

    When you look to Gov.t — dats what you git.

    Rodney King's Spirit (8b9b5a)

  10. If nk had a radio audience of three million computer illiterates with overweight bed partners, who buy first-generation computer data backup and sleep-number mattresses…

    Am I the only one who thinks this would make a good sitcom?

    Dustin (801032)

  11. #8, Sorry but what you propose drives insane amounts of over utilization in medicine as well as over the top protocols by the Boards of Medicine. Estimates are 33% of spending is driven by CYA. That is a big nut. I believe it b/c I see it in the flesh.

    Answer in Med Mal is make Judges / Jury be experts and make the losing attorney pay the fees of the winning attorney.

    What that does is it makes the Legal Profession more responsible and thorough in what cases it takes and how aggressively one defends themselves..

    Rodney King's Spirit (8b9b5a)

  12. We’re on the Highway to Hell and I’m feeling… alarmed.

    Colonel Haiku (2601c0)

  13. Wait, do the hippies who love Whole Foods know the CEO is conservative? Talk about irony.

    edoc118 (c37322)

  14. Oh, and Mr. Gunn? Get your receipts in order. The IRS may come a’callin’ some day soon.

    Already happened. Mr. Gunn is being audited by the IRS.

    Tanny O'Haley (066e8f)

  15. There is a simple way to get 1) everyone insured who wants insurance, 2) retain the private insurance system, and 3) reduce government participation and costs to a minimum.

    This is pretty much the reform plan that McCain proposed: everyone gets their own individual or family policy, priced solely on age (and maybe tobacco use). If they are employed, the company may subsidize it much as they do now, but it is YOUR policy, not theirs. If you leave that company you still have the policy and don’t have to deal with new insurance, reset all the deductibles, change doctors, etc, as you do now.

    Since it is all one huge pool from the insurer’s standpoint the impact of truly sick people signing up is spread out over millions of other policies (in Obamacare it is limited to a tiny fraction of them — well over 90% of all health policies are immune to the effect — and the effect on prices is large).

    To make this work, policies would have to be national, further reducing costs. You could add tort reform as well.

    Best of all, any federal involvement is limited to income-based subsidies and in deciding what policies would be eligible for same.

    But of course, this would require far fewer bureaucrats, remove Balkanized insurance company sinecures, and cut off some politician’s income streams. Probably too simple.

    Kevin M (b357ee)

  16. You know George Washington was killed by his doctor, right? He bled him to death? 😉

    In Illinois, you cannot file, repeat “file”, a med mal case without an attached affidavit by a doctor, licensed in the same specialty, saying it was malpractice.

    But I’m talking about a bigger problem. When I was in the hospital, the “chaplain” (a definite misnomer for those people) came in to talk to me about advance directives. During our conversation I discovered that she notarized patients’ assent even when the patient could not sign his name, make his mark, speak, or even move. She could tell when a patient “assented”. She freaked me out. I sent her away but now I’m wondering whether the hospital has my living will on file and which of the three boxes I assented to. I had very good insurance so I’m guessing it’s the first one. All extraordinary measures. 😉 Those people have a world of their own, with their own rules, and as long as they don’t rock their boat they’re safe within their system. They need the threat of a torpedo.

    nk (dbc370)

  17. Oh, I forgot. I’m not eligible for subsidies. I’ll be paying full fare. Can I brag about that bit of self-reliance?

    Perhaps. So many people are lying. Especially with regard to the unadvertised cost-sharing subsidies that are not subject to recapture.

    Kevin M (b357ee)

  18. Socialized medicine does really good delivering medicine to the healthy but awful to those who are sick.

    I said that about HMOs in the past. They destroyed themselves, and so will Obamacare.

    I totally empathize with you, nk. I was uninsurable too, so I went to work for the government on the advice of my insurance broker. It was a miserable experience, but my medical was paid for and maybe even saved my life a couple of time. (As an aside, that monitoring was good for me but ridiculously expensive for the carrier, as Rodney King’s Spirit points out). No one is proposing people like you be left out in the cold, even Limbaugh. Of course there should be medical care for you, and that would be a proper use of taxpayer money, but Obamacare is not the way to do it.

    As crazy as it sounds, and even though my life was changed for the worse by basically working for insurance, I still feel blessed. I hope your own situation is resolved soon.

    Patricia (5fc097)

  19. nk,

    Since there really is no meaningful alternative to Obamacare for the self-employed or early retired non-union non-government worker, why should this be an issue? Force majeure.

    Kevin M (b357ee)

  20. Kevin M (b357ee) — 10/9/2014 @ 9:20 am

    I’m easy to catch. My tax return has to agree with four others. 😉

    nk (dbc370)

  21. It’s only a question in that it would be “biting the hand that feeds me” for me to complain about Obamacare, if that’s what you meant by “issue”, Kevin. I can come back and complain about the premium, I suppose. I haven’t seen it, since the enrollment period hasn’t opened yet, but I’m sure it’s a lot higher from when “if you like your doctor, you can keep your doctor”.

    nk (dbc370)

  22. My wife, who is an RN, cannot wait until she’s expected to donate, without compensation, her time and skills. That’s what free means, right?

    Lorem Ipsum (cee048)

  23. Assuming that one is not eligible for subsidies, there are some rather pernicious pricing schemes in Obamacare, at least here in CA.

    For example, it is almost never a good idea to get the Platinum plan. I’d say never, but there may be some company where it makes sense, though I haven’t seen it.

    Looking at the 2015 rates, now up on the CoveredCA.com site, a 60-year-old getting a Blue Cross Bronze 60 HSA pays $544 a month (up from $451 in 2014). The maximum Out-of-pocket on that plan is $6250, so the absolute maximum one can possibly spend in-network during a year is $12,800. This is about the same as the Blue Cross Platinum plan’s premiums alone, and there is still $4K in OOP possible, with the same networks.

    Kevin M (b357ee)

  24. And again, there is a steep penalty for additional income.

    Two 60-year-old adults making $62K a year get $7300 in subsidy. If they make $63K instead, they get no subsidy. Ouch.

    Kevin M (b357ee)

  25. L.I.

    TANSTAAFL.

    Kevin M (b357ee)

  26. TANJ back at you, Kevin.

    nk (dbc370)

  27. “… that is why Insurers wanted OCare, higher prices for the same policies from Consumer who are heavily subsidized with tax dollars.”

    Rodney King’s Spirit – I question the idea that insurers wanted OCare every time I see it because it goes against every principle of sound insurance underwriting and pricing so I am curious where you get that impression.

    My recollection is that insurers were dragged kicking and screaming to the table through a campaign of public vilification and demonization, e.g. standard Obama thug tactics, and simultaneous pressure through state regulators over policy rescissions. It makes absolutely no business sense for insurers to step in and write policies for a blind pool of applicants with no distinctions for medical history, sex and age composition of the pool when the government sets the benefits you must include in the policies, caps the money you can make and approves your rates, but only reimburses you for a portion of your losses in the rigged market. The government can then further rig the market by stepping in and depopulating the pool as Obama did last fall by proclaiming people should be able to keep existing policies. That is not a market in which sane business people want to participate.

    Look at Massachusetts for proof for how few insurance companies initially joined that market in 2008.

    daleyrocks (bf33e9)

  28. #27 Insurers were very happy with the legislation. ARE very happy. And yes the subsidies flow right back to them. My wife OCare Policy with kids was on a parri passu basis with my new employer policy like $300 per month more expensive. She is switching come 2015.

    A few other examples of graft — the AMA to defend the CPT and ICD Terminology and profits. To boot the Govt expaned the ICD 9 from 10K codes to over 150K. So now they will make more b/c OF COURSE they are delivering more.

    AARP supported to defend their near monopoly with United on Medicare Supplemental. SCrewing millions of Senior on very nice Advantage Plans.

    …. no joke, the example of Utilities goosing up Assets base by buying useless assets to then increase profits is a note worthy example to those in the know of how this works.

    Rodney King's Spirit (8b9b5a)

  29. Did I say something?

    daleyrocks (bf33e9)

  30. I am sorry to say but the SUPPLY SIDE is 100% to blame for OCare but once you invite the Devil in all you can hope for is your are the last one consumed.

    Hospitals
    Doctors
    Insurers
    MedMal Lawyers

    …. all to blame and they will all bear eventually the fruit of the poison tree.

    Rodney King's Spirit (8b9b5a)

  31. #29 If I misunderstood then sorry.

    Rodney King's Spirit (8b9b5a)

  32. “#27 Insurers were very happy with the legislation. ARE very happy. And yes the subsidies flow right back to them.”

    Rodney King’s Spirit – Insurers get the same price whether a policy is subsidized or not. They are indifferent.

    With respect to happiness, it’s sort of like that old bad joke, if you are getting raped, you might as well lie back and enjoy it. Insurers are happy to the extent they are still in business and we don’t have completely socialized medicine. Inviting a layer of federal regulation on top of state regulation to mandate the content of their product offerings, approve their pricing, cap their profits but not their losses, potentially arbitrarily exclude their products from exchanges, can you explain to me my insurers would be happy about these circumstances or would voluntarily choose them if offered by the free market?

    daleyrocks (bf33e9)

  33. ‘death panels she said’

    re the Masscare bill, wonder why Ted Kennedy was smiling, at the signing ceremony?

    narciso (ee1f88)

  34. “re the Masscare bill, wonder why Ted Kennedy was smiling, at the signing ceremony?”

    narciso – Because the Dems got to implement what they wanted, not what Romney signed, d’oh!

    http://www.forbes.com/sites/theapothecary/2012/04/12/how-deval-patrick-gutted-romneycares-market-oriented-reforms/

    daleyrocks (bf33e9)

  35. The discussion so far has been somewhat hypothetical … what am I going to get when I get sick in the future? The problem is that the name of the Obamacare equivalent of the Liverpool Care Pathway won’t be as straightforward as “Obamacare Death Panel”, but I expect it will be equally deadly. If so, the real question is whether you will be designated as one of the participants in the new protocol, in which case dehydration, organ failure, and starvation will be your pathway to the future. I don’t think your will consider this to be much of a bargain. In the UK, 29% of all hospital deaths are accounted for in this fashion.

    bobathome (41dcc0)

  36. #32 Insurers get the same price whether a policy is subsidized or not.

    Maybe I am wrong but what I have seen over and over again is when you compare OCare Policies in the Individual Exchange where the subsidies flow, the prices are higher than similar policies in the Commercial market where they don’t. Especially for the Gold and Platinum Plans. Somewhat on the Silver and Bronze.

    Insurers know subsidies are going to the Individual Market and have goosed up pricing as such. A Chevy in the OCare is $50K, the same Chevy when I buy it from my Employer is $30K.

    Rodney King's Spirit (8b9b5a)

  37. So for example, I pay $550 per month for a ZERO deductible BCBS Policy via my Employer. $2,500 maximum out of pocket. National Plan which means I can go in network anywhere in the Country where my BCBS is accepted (which is everywhere)

    Find me anything like that on an OCare exchange …

    Rodney King's Spirit (8b9b5a)

  38. I question the idea that insurers wanted OCare every time I see it because it goes against every principle of sound insurance underwriting and pricing so I am curious where you get that impression.

    Hillary’s mistake was to exclude them. Pelosi/Reid’s staffers were smart enough to include them. They are counting on a gravy train that keeps going. Health insurance was always a loser financially. The companies want to be Administrative Service Organizations, which is what they do for self funding employer plans. They are counting on the camel staying inside the tent now that the nose is there. They are not really interested in the old business model. They want the feds to pay the bills and all they are expected to do is shuffle paper.

    I suspect that life insurance companies might be interested in real insurance, the catastrophic type. What we have had for 60 years is prepaid care and that is not insurance.

    Mike K (f5ff99)

  39. It’s tempting to pontificate on one side or another, but the exchange between nk and Rodney King’s Spirit has reminded me that the situation is so fundamentally screwed up that there probable isn’t a solution that won’t cause horrible pain in the short term.

    Could nk get insurance in something closely resembling the free market? Who knows? We haven’t had anything closely resembling the free market in health care since World War II at the latest. What we HAVE had is one legislative patch after another over wounds that nobody has seen unmanaged for decades. SOMETHING under all that mess is leaking puss and blood, but if we don’t get that mass of bandage off it’s kind of hard to tell what … and ripping the whole thing off in one go might well set off a hemorrhage we couldn’t control in time to save the patient.

    The core problem is that there is entirely too much law, and our dear leaders somehow seldom repeal what didn’t work last time before slapping on the next patch.

    What to do about it? Damned if I know. All I DO know is that if the mess of bandage, scab, sticking plaster, and what-have-you ever gets removed, the metaphorical stench is going to be epic.

    C. S. P. Schofield (848299)

  40. #38 Obama was smart to buy them off. Politically that is. They get mandatory coverage requirements to sell more policies, they get mandatory requirements for what they must cover to underwrite more expensive policies, they get huge deductibles and out of pockets to cover risk, they get a subsidized consumer who on an apples to apples basis pays more for the same coverage, and if the risk corridor blow op — the Govt bails them out (they assume but that is being fought).

    Looks like a good deal to me in exchange for a) not being vilified, and b) maxing my profits at 12% of collected premiums.

    More volume
    Higher prices
    Govt support for the riskiest of my policies

    Rodney King's Spirit (8b9b5a)

  41. #39 NK might not get everything he wants but with a Govt Subsidy he might get what he needs.

    Medicaid is the perfect solution for these situations but it would makes to allow them to work together with the private sector to structure a policy for NK’s risk pool.

    Not a one size fits all policy which forces NK to pay for maternity, sex change, drug treatment, abortions ………

    Rodney King's Spirit (8b9b5a)

  42. Well, like Ezekiel Emanuel likes to say: Build a man a fire and he’ll be warm for an hour; set a man on fire and he’ll be warm for the rest of his life.

    nk (dbc370)

  43. #42 When he is 75 that is. Like Logan’s Run. A Malthusian Utopia.

    Rodney King's Spirit (8b9b5a)

  44. “Maybe I am wrong but what I have seen over and over again is when you compare OCare Policies in the Individual Exchange where the subsidies flow, the prices are higher than similar policies in the Commercial market where they don’t.”

    Rodney King’s Spirit – In the commercial market employees rarely see the full cost of policies because employers typically subsidize a significant portion of coverage so pricing looks cheaper to begin with from that perspective. If you can back out the employer subsidy, the pricing may or may not be cheaper because in the commercial market insurers can still underwrite by group. For example, I worked in at a location of a company composed primarily of older employees, but only representing 5% of the workforce. We had more expensive medical benefits and no disability insurance, compared to other locations and subsidiaries, many of which came through acquisition. They were free to negotiate their own health and benefit plans and most did rather than joining our crap plans. The explanation I always received was we did not want to force the cost of our older workforce onto other locations by merging plans.

    daleyrocks (bf33e9)

  45. “Looks like a good deal to me in exchange for a) not being vilified, and b) maxing my profits at 12% of collected premiums.”

    RKS – I don’t know what this 12% figure you keep citing represents. Prior to the implementation of Obamacare last fall, regulations specified that insurers with loss costs below 80% and 85% on individual and small business policies (I may have the order messed up) had to rebate money to policyholders. The difference between 80-85% of a premium dollar is not profit. Out of that have to come selling, general and administrative costs, debt service, etc.

    daleyrocks (bf33e9)

  46. 39- Don’t most sound solutions to difficult questions require some amount of discomfort in the short term?
    We screamed about the solution to Stagflation, but we praised Reagan and Volker when it was in the rear-view mirror and during the resulting 20-some years of prosperity.

    askeptic (efcf22)

  47. “Looks like a good deal to me in exchange for a) not being vilified, and b) maxing my profits at 12% of collected premiums.”

    RKS – If heath insurers could make 12% on premiums they would jump at it. It’s not exactly the highest margin business in the world. It makes me laugh that people think it is.

    daleyrocks (bf33e9)

  48. So for example, I pay $550 per month for a ZERO deductible BCBS Policy via my Employer. $2,500 maximum out of pocket. National Plan which means I can go in network anywhere in the Country where my BCBS is accepted (which is everywhere)

    Find me anything like that on an OCare exchange …

    Well, among other things, it’s impossible to compare without knowing your age or whether your employer pays part of it.

    But f you want zero deductible national plans with low OOP, those are available under Obamacare. A Platinum Anthem Blue Cross PPO plan with no deductibles, 10% copay and $15 brand drugs is $545/month for a 45 year old living in Los Angeles.

    The maximum OOP is $4000, but with the low copays you won’t likely hit it, and if you do you probably won’t care as you’ve long since crossed into “catastrophic” territory.

    Kevin M (b357ee)

  49. Also, comparing employer plans is a tad unfair as there is a barrier: you have to be employable, which means you can only be so sick. Someone who is disabled or bedridden or otherwise unable to work won’t be on those plans, which keeps the cost down.

    It is only people who are self-employed, or early-retired, who have to bear the brunt of the ACA’s “generosity”. Everyone else is exempt from the costs.

    Kevin M (b357ee)

  50. BTW, I mentioned this before, but…

    NEWS ITEM: 2015 Obamacare rates published. Up 20% in my wife’s case.

    Kevin M (b357ee)

  51. I suspect that life insurance companies might be interested in real insurance, the catastrophic type.

    That sounds like a good idea, Mike K. Get your sore throats treated at a clinic, and have insurance for the big problems.

    There’s probably a law against it! :)

    Patricia (5fc097)

  52. “Not a one size fits all policy which forces NK to pay for maternity, sex change, drug treatment, abortions ………”

    RKS – Those one size fits all policies are one reason why premium rates are going up – the government mandated what each policy is required to be covered at a minimum.

    daleyrocks (bf33e9)

  53. “I suspect that life insurance companies might be interested in real insurance, the catastrophic type.”

    Mike K – A number of them used to play in that arena through high layer workers’ compensation reinsurance prior to a scandal in the late 19990s. Don’t know whether they are still in it.

    daleyrocks (bf33e9)

  54. You can get a plan that is very nearly a catastrophic plan under the ACA, even if you aren’t eligible for the young-people’s catastrophic plan.

    A Bronze level HSA plan has 1) an HSA, 2) a very high deductible (e.g. $500) and a OOP limit that isn’t all that much higher (e.g. $6250). Between those two levels, the insurance company is paying part of the bill but if you hit that first level, you are probably already in the catastrophic situation and will hit the next one soon thereafter.

    You also get the benefit of the “negotiated rate” in-network from the first dollar, and this can be quite a savings, often more than half the original bill.

    My wife had one of these last year, then was diagnosed with (a curable) cancer. It worked pretty much as a catastrophic plan should, except that there was some extra arithmetic in the middle.

    Note that before the ACA, she had a true catastrophic HSA plan that was cheaper with a wider network, but that got cancelled and was replaced with this.

    And as before the network really mattered. Pay attention to that most of all.

    Kevin M (b357ee)

  55. Um, that should be 2) a very high deductible (e.g. $4500). Kinda makes difference.

    Kevin M (b357ee)

  56. (upon rereading, that last is confused, try again)

    You can get a plan that is very nearly a catastrophic plan under the ACA, even if you aren’t eligible for the young-people’s catastrophic plan.

    A Bronze level HSA plan has 1) an HSA, 2) a very high deductible (e.g. $4500) and a OOP limit that isn’t all that much higher (e.g. $6250). Between those two levels, the insurance company is paying part of the bill but if you hit that first level, you are probably already in the catastrophic situation and will hit the next one soon thereafter.

    You also get the benefit of the “negotiated rate” in-network from the first dollar, and this can be quite a savings, often more than half the original bill.

    My wife had one of these in 2014. In July she was diagnosed with (a curable) cancer. The past few months have seen LOT AND LOTS of doctor visits and procedures and we are not yet done. It worked pretty much as a catastrophic plan should, except that there was some extra arithmetic in the middle.

    Note that before the ACA, she had a true catastrophic HSA plan that was cheaper with a wider network, but that got cancelled and was replaced with this.

    And as before the network really mattered. Pay attention to that most of all.

    Kevin M (b357ee)

  57. #44 Sorry but the numbers I quote are the actual charges to the Company. I pay $550 for a BCBS Policy with $0 Deductibile and 2500 max out of pocket on BCBS Florida. Company sponsored plan.

    And yes, the Subsidies do flow into the Insurers Pockets in the Individual Market. They do so in the form of higher premiums for similar products. So 12% for Overhead is a great deal given 12% of a much bigger number is more revenue for more overhead.

    Rodney King's Spirit (8b9b5a)

  58. #52 Of course and that is why the Insurers like it. They make more the more expensive the policy is for the same amount of overhead and costs.

    Rodney King's Spirit (8b9b5a)

  59. #48 Again, the total cost of the policy is $550. Can’t touch that in the OCare market. My employer, who is me, bears 100% of the cost. I am overweight and have diabetes and cholesterol.

    Point being the OCare plans are crap. You pay for poor coverage. When compared to similar plans in the Commercial Market — you over pay. Why? Mostly subsidy expectations by Insurers. And if they get stuck with bad risk, they get the Govt to bail them out.

    Rodney King's Spirit (8b9b5a)

  60. And you can get catastrophic thru a few insurers. For like $50 a month they cover Hospitalization and Cancer et al.

    Rodney King's Spirit (8b9b5a)

  61. Healthcare should be free. people shouldn’t die because they can’t afford treatment!

    Mr.gop (92bee7)

  62. RIP Jan Hooks… funniest woman ever to be on SNL

    Colonel Haiku (2601c0)

  63. I think the mark of a liberal is that they tend to not think through consequences. That pretty much seems to explain everything.

    DejectedHead (9b0c64)

  64. “#52 Of course and that is why the Insurers like it. They make more the more expensive the policy is for the same amount of overhead and costs.”

    RKS – Pull my other finger please.

    Where is this magical 12% originating from? Under Obamacare insurers always keep at least 20% of the losses they incur on the policies they write on the exchanges, which is essentially a blind pool of risk. Bailout is not the right word to describe the arrangement with the government.

    On the profit side, insurers start paying the government 50% of their profits if their costs are between 92-97% of premium dollars and 80% of profits if their costs are below 92% of premium dollars. If you were an insurer would you be more worried about taking on a bunch of risks you knew nothing about and providing coverage for a bunch of mandated new minimum items and the impact of potentially mispricing your products and eroding your capital base, drawing scrutiny from regulators and impairing your ability to stay in business or would you blindly jump in and write all the business you could believing there’s a jackpot waiting?

    I know which option I would choose, but others are free to differ.

    daleyrocks (bf33e9)

  65. high value placed on good intentions. little value on results. and they don’t embarrass easy.

    Colonel Haiku (2601c0)

  66. http://www.youtube.com/watch?v=cYfjq3ZYZbA&sns=em

    Sent from my iPad

    Colonel Haiku (2601c0)

  67. I talked to a friend today who works in the operating room of the hospital I used to practice in. Since I retired, the hospital has been sold to an order of nuns. Tax exempt, you know. Anyway, they hired a guy to run the hospital who used to work for Pepsi-Cola and he hired his brother-in-law, who is a chiropractor, to run the operating room. The hospital has been on a cost cutting binge, which included laying off experienced nurses and other staff, plus buying up doctors’ practices so they can control them.

    Recently, they got rid of the surgical group (my old one) that has run the Trauma Center for 35 years and brought in a new group that nobody knows. I have heard some rumors about trauma care since July1 when the new group (4 women surgeons) began to take call.

    Yesterday, the hospital had a surprise visit by the Joint Commission which has just yanked the hospital’s accreditation ! Also, the CMS came by and yanked that accreditation. All surgery is cancelled tomorrow and the place is like a kicked over anthill.

    It turns out that some employee, or former employee, blew the whistle on all the crap the new administrators have been doing.

    Welcome to the age of Obamacare. So far the news seems to be quiet but surgery is cancelled. I’m glad I retired.

    Mike K (90dfdc)

  68. @13. Yes. I have some “friends” who are recovering hippies and are all ga-ga over the fresh, chemical free, etc, etc foods at Whole Foods…. until it became known that he openly stated that Obama Care was a bad thing and that he would be opting out by letting his employees go to the exchanges and fend for themselves. I am not sure if he was tossing the employees a bone in the form of a small monetary stipend to apply to their medical insurance costs. All I heard was talk of boycott of Whole Foods. I don’t know if that boycott has caught on or not, and Mrs Gramps enjoys the shorter lines there.

    I am digging through some old medical bills and insurance documents so I can get the numbers right in a presentation of the pricing magic discussed up thread.

    gramps, the original (7adb80)

  69. #59

    Again, the total cost of the policy is $550.Well, Mr Sprit, you tossed down a challenge in

    And the total cost of the ACA policy, no subisdies, I quoted was $545/month. I happen to ahve used the network that policy covers and it is adequate, covering the 3 best hospitals in the area and the largest (by far) group (UCLA) which has more than a thousand doctors.

    My wife used that exact network for cancer. It included all of our first choices in treatment. Sure we were out $6K and the premiums — which we paid every last dime of –, but for several hundred thousand dollars in medical care it was other than “crappy.”

    Crappy plans exist. 9 out of 10 plans may well be crappy. But not all are. Obamacare sucks, except it doesn’t suck worse than having no insurance.

    Kevin M (b357ee)

  70. some kind of editing error in the above. Well, Mr Sprit, you tossed down a challenge in

    Kevin M (b357ee)

  71. Just for that, Haiku, now you have to watch a video titled “Eating Beaver Hillbilly Style” made by a “bushcrafter” who is also a professional chef who likes to “cook in the bush”.

    nk (dbc370)

  72. Already happened. Mr. Gunn is being audited by the IRS.

    I don’t think so. I think you’re thinking of another filmmaker who made an anti-ObamaCare movie.

    Patterico (9c670f)

  73. ummmmm barbecued rodent…

    Colonel Haiku (2601c0)

  74. #63

    Again, Insurers benefit from the cycle of having to cover more services, charge more money and then shaving their % off the top without having to invest much more in Overhead. Take a look at UHC stock price or Humana — speaks volumes to who benefits from Obamacare.

    In fact if you bothered to look at let us say Humana and United Healthcare you would see very nice profit growth for both in spite of the fact Obamacare threw a wrench in Humana’s business plans when it gutted Medicare Advantage. But now go look at Medicaid which is growing like weeds, look at how well Centene is doing.

    The CAP on profits put on by Obamacare and other legislative actions are nothing more than a diversion to placate some. Bottom line is the more you are forced to cover, the more you are forced to charge, the more you (the insurer) makes. Throw subsidies and they really make out because 10% on $2 is more money than 15% on $1.

    You simply need to look at Insurer’s P&L to see how wonderful this has all been for them. If you ask me just this is like I used to hear Electric Utilities claiming they made less money b/c the Public Service Commission would render judgement “they could only make 6% versus 6.2%” on Assets then the Utility would sandbag the Assets to make more money. PSC would claim they were helping the consumers by lowering costs for electric yet every year the Utility would make more money.

    Insurers are doing the same. That is why they are doing very well with OCare. That is what they paid their Lobbyist to get from the Administration in exchange for their support.

    Rodney King's Spirit (8b9b5a)

  75. #63 Good source ….

    http://kff.org/health-reform/fact-sheet/explaining-health-care-reform-medical-loss-ratio-mlr/

    More mandates = more premiums = more net revenues = more profits

    So even if margins were 20% of X before OCare, 15% of 2X is better

    Rodney King's Spirit (8b9b5a)

  76. “So even if margins were 20% of X before OCare, 15% of 2X is better”

    RKS – That is the loss ratio. There is also the cost ratio. Rather than just repeating the same point over and over why not take a look at margins in the industry and inform yourself.

    Ask yourself is you want to be in business with the government and even more tightly regulated by the government. Most conservatives would answer no for obvious reasons. Individual states where reforms similar to Obamacare have been tried in the past have resulted in the mass exodus of insurance carriers and collapse of the health care markets – because the insurance companies did not like it. The government changing the terms of the deal on the fly already shows the folly of getting in bed with them. Seriously, this is not rocket surgery, its business 101.

    daleyrocks (bf33e9)

  77. “Throw subsidies and they really make out because 10% on $2 is more money than 15% on $1.”

    RKS – Can you point out a health insurer making a 10% margin on its underwriting business?

    daleyrocks (bf33e9)

  78. I should modify that to say a 10% margin on basic ground up health insurance underwriting, not specialty products or servicing business.

    daleyrocks (bf33e9)


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