Archive for the ‘Common sense’ Category

Medical Insurance Is NOT Medical Care   1 comment

I know that flies right past the ears of many people, but take a pause and consider the implications of that statement.

Medical care is when you interact with medical providers and receive a diagnosis, surgery, therapy, a prescription and so on.

Medical insurance is how you pay for medical care.

Politicians use the terms interchangeably, but they are NOT the same thing. Whenever I hear someone use terms that mean different things as if they are the same thing, I become suspicious of their motives for conflating the two.

Of course, there are other types of insurance that we don’t do this with. Nobody confuses car insurance with vehicle maintenance, for example. I keep my own car clean and I pay out of pocket for repairs. If my car is damaged in an accident, my insurance covers the repairs, less the deductible, but I don’t call my insurance agent if I need an oil change or to replace my starter.

Homeowners insurance is similar. I don’t call my insurance company to finance painting the house. I call them when a tree falls on the roof.

Medical insurance ought to work the same way that car and home insurance do, but right now it doesn’t. Routine procedures, drug prescriptions for chronic disease, and a variety of other predictable and non-urgent procedures are all handled through insurance companies.

Now, take a pause and realize that one of the key differences between medical insurance and car or homeowners insurance is that medical insurance is a state-run and -regulated program with limited competition while care insurance has plenty of competition.

March is the month we renegotiate our car and home insurance and I received dozens of circulars in the mail offering me insurance plans that will meet my needs at a price I’m willing to pay. None of them offer to reimburse me for minor damage because they wouldn’t stay in business for long doing that.

Continuing this theme, repair shops, tire manufacturers, and other car-care providers all compete on price to get the largest possible share of the millions of car owners in the market for their products and services.

Meanwhile, the medical care market we currently know is provided by a mixture of public and private payers, and it funds a significant share of the vast majority of procedures. Providers don’t compete on price even for services that millions need on a regular basis.

When it comes to medical insurance, most people expect their coverage to give them more than they pay in. That makes no economic sense. If one person’s treatment costs $120,000 a year and they pay a monthly premium of $1,000, the company needs nine people to pay $1,000 a month, but those eight other people cannot consume any medical care services in order for the company to even break even.

The primary role of insurance should not be to pay bills. Insurance is customer peace of mind—a guarantee that a catastrophic event will not bankrupt us.

If medical insurance worked as it should, we would only use it for catastrophic medical needs. For more minor medical care services, we would be looking for the best-value care in the market because those costs would be coming out of our pockets. Yet the high levels of medical debt show that our current insurance system has strayed far from this model as the prices for minor procedures and treatments have gone through the roof.

Increased coverage sounds nice, but as our recent experiment in increased coverage shows, we’d still struggle with unaffordable copays and deductibles and staggering levels of medical debt. The first step toward obtaining an affordable medical insurance system that works for the maximum number of people is to let insurance be what it was meant to be: peace of mind against catastrophe.

Another Good Reason to Distrust Government   Leave a comment

Posted March 14, 2019 by aurorawatcherak in Common sense

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Handling Trolls You Know   1 comment

A while ago, an author I work with regularly took exception with my stance on prison reform. She — who has probably never met a felon — trolled me on Twitter and told me she wouldn’t work with me in the future until I changed my INFORMED opinion to match her feelings agenda.

Because I’d entered an obligation, I’ve continued to share her articles so long as they weren’t so far off the mark that I couldn’t agree with them in the slightest and then I just didn’t make a deal out of it.

But last week, I did an inventory to see if she had shared anything of mine since she’d decided she could ignore her obligation. I found no evidence that she had, so I informed her that I was no longer supporting her. That’s not entirely true. I would still support her if I found a redeeming comment there, but I don’t feel like I’m under obligation to support someone who is not keeping her commitments.

This isn’t about agreeing or disagreeing on topics. It’s about a verbal contract that was made to support one another through a blog. I welcome all debate, but when someone violates a contract with me, they can’t expect me to uphold my end of the contract.

Posted January 25, 2019 by aurorawatcherak in Common sense

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A Possible Solution   Leave a comment

Freedom is an amazing thing because people who are free are able to think for themselves and come up with innovative solutions to the problems as those circumstances affect them.

The answer to America’s medical care crisis is not direction from Washington – which has already screwed up the best medical care system in the world. It is also not European-style universal care.

When I developed appendicitis while on a medical exchange in France several years ago, I dosed myself with antibiotics and painkillers and got on a plane to the United States. I risked a ruptured appendix over the Atlantic rather than use the medical care system operated by colleagues I respected. That should tell you something about my experience with European-style universal coverage. I was not putting my life in their hands and I still wouldn’t even though I am not running a fever at the moment.

So, what is the answer? Well, how about choice and innovation? How about putting doctors and the patients in the driver’s seat? How about taking the exact opposite approach from what broke the system in the first place?

Thinks about this. There are plenty of industries where businesses compete against one another without undue government regulation. Choices and innovation increase while prices and other barriers to access decrease. Why do we assume that a similar approach to reforming our medical care system wouldn’t also result in similar outcomes? No, it wouldn’t happen overnight, but it might well push the momentum in the right direction.

Obamacare’s rigid and centralized federal regulation of the nongroup market has failed. Premiums rose at unsustainable levels, choices dried up and enrollment in the individual policies continues to decline. Seven states were granted waivers from Obamacare mandates giving them the freedom to try new approaches. Significantly, states are achieving these favorable outcomes without the expenditure of additional federal funds. Instead, under their 1332 waivers, they re-purpose federal money that would have been paid directly to insurance companies in the form of premium subsidies, using it instead to directly pay medical bills for residents in poor health. These findings suggest that the most effective means of undoing the detrimental effect of Obamacare’s federal regime of subsidies, penalties, and regulations while ensuring that everyone can access private coverage is to provide states with the resources and flexibility to achieve that goal, rather than lashing them to a failing Washington-dominated system.

How do we do that? Well, Lela is down with just ending Obamacare tomorrow, but I’m more in favor of graduated measures like the Heath Care Choices Proposal. Under the proposal, current federal entitlement spending on Obamacare’s rigid structure of insurance subsidies and Medicaid expansion would be reprogrammed into state block grants, with broad flexibility for states to develop more consumer-centered approaches to meeting the needs of the poor and the sick, while keeping coverage affordable for other enrollees.

June 2018, a group of state and national think tanks, grassroots organizations, and health policy experts developed a proposal to enable and encourage state innovation. The Health Care Choices Proposal would reverse the Obamacare polarity. In place of rigid federal constraints from which waivers could provide limited relief, the proposal would rely on states to devise ways to assist the sick and needy, without pricing coverage out of the reach of healthy and middle-income families. The proposal would repeal Obamacare’s federal entitlements to premium assistance and Medicaid expansion and replace them with grants to states to stand up consumer-centered programs. Instead of asking Washington’s permission for some limited flexibility, states would use federal resources to finance approaches that best serve the needs of their residents.

The proposal would put in place some conditions for the grants. First, every individual who receives subsidies from the federal government (including Medicaid and Children’s Health Insurance Program), would be given new freedom to spend that money on the coverage arrangement of their choice— vastly expanding their options. States, additionally, would have to use a portion of their federal allotment to establish risk-mitigation programs. The proposal would also require states to spend a specified portion of their federal grants on subsidizing private, commercially available insurance coverage for people with low incomes. States could not use the money to expand Medicaid or consign low-income people to state-contracted managed care plans.

The proposal would release states from Obamacare requirements on essential health benefits, single-risk pools, medical loss ratio, and the 3:1 limit on age rating. Nullifying these mandates and providing states with new flexibility would reduce premiums, allow premiums to more accurately reflect medical risk, and, in combination with risk mitigation, assure that the sick get the coverage they need without saddling the healthy with unfairly high premiums.

Most important, the proposal would replace the Washington-knows-best approach to health policy with one that invests states with the policy initiative, something the section 1332 waiver process cannot accomplish. The block grant approach provides certainty for state (and federal) governments by putting spending on a budget that can’t be increased, as is the case today, if a state or insurer decides to spend more money. The block grant also gives states greater certainty in projecting the amount of federal funding that will be available to them over time. And it helps consumers because it gives new freedom to people to control their federal subsidy and direct it to their choice of a wide range of private coverage arrangements. Regardless of the approach a state chooses to implement, an individual can claim the value of the benefits and use it on the private coverage arrangement of their choice.

States have shown they can take steps under Section 1332 to stabilize their markets without new federal money. It is utterly unnecessary to spend new federal money in the name of market stabilization.

Instead of providing new federal money or creating new federal programs, policymakers should revise the section 1332 waiver process. This would allow policymakers to make incremental progress toward the goal of transitioning from Obamacare’s Washington-centric approach to state-based health care reform. Obama Administration limits and statutory limits on the section 1332 process should be relaxed or removed during that transition. There already are a variety of proposals to do just that, including one from Senate HELP Committee Chairman Lamar Alexander. CMS should start by rescinding the December 2015 guidance, which imposes restrictions on state innovation that go beyond the already excessive statutory restrictions, creating burdens that are costly and time-consuming. In many cases, states have withdrawn their applications rather than see the process through to its conclusion. CMS should replace this process with a streamlined approach and develop model waivers organized around the principle of reducing premiums for private coverage in the broader non-group market, increasing choices for consumers. Such changes—while insufficient to the larger task of needed reform—would support states’ near-term efforts to address Obamacare’s damage to their broken private markets as part of a transition to the broader solution.

Posted January 4, 2019 by aurorawatcherak in Common sense

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Not A Solution   Leave a comment

So, the United States has a problem with a dysfunctional medical insurance system and a broken government-medical care system. So what is the solution. Well, it’s not becoming Canada.

The Frasier Institute recently undertook a research project to see how Canada’s medical care system stacks up to the rest of the world. When compared to 11 similar countries, including the United States, a recent study shows that whether it’s emergency room visits, same- or next-day appointments, seeing a specialist or getting elective surgery, Canada’s wait times are the worst.

In fact, in 2016, Canadians waited an average of five months for medically necessary specialist treatments. As a specialist working in a field where delay of treatment turns a manageable condition into a death sentence, that concerns me. Apparently it concerns Canadians as well because almost 60,000 of them visit the US and other countries for medical care each year.

Speaking of other countries, over in the United Kingdom, where they’ve had 70 years to figure out how to run a government-controlled health care system, over 80 percent of doctors say their workplaces are understaffed and the NHS reports a 45 percent higher hospital death rate than the US, which might explain why over 50,000 “non-urgent” surgeries were canceled in 2018 when their system was overwhelmed by flu season.

In Canada, apologists for the universal medical care system there (where private doctors are outlawed) claim the wait times remain a small price to pay for universal medicare care, but then why don’t we see similar issues in other countries with universal health care systems? Frasier’s research examined eleven other countries. While you could argue that the US doesn’t have a universal system (I wouldn’t argue that at this point), the other countries. Generally, they allow the private sector to provide core health-care insurance and services in which patients share in the cost of treatment and they fund hospitals based on activity. Canada funds most hospitals from a global budget.

You can look at the Netherlands, which was the top performer in the ability to see a doctor on the same or next day. Individuals are required a standard insurance package from private insurers in a regulated, but competitive market. A for-profit company is the market leader.

France has universally accessible hospital care delivered by public, not-for-profit and for-profit hospitals. In fact, about one-third of all French hospitals are operated on a for-profit basis.

Switzerland ensures universality in an environment of managed competition among insurance companies and medical-care providers. Cost sharing is a central feature. Individuals are expected to pay a deductible before insurance kicks in, and then there is a 10-20 percent insurance copayment, up to a annual maximum.

Germans use social/statutory or private insurance to a access public or private hospital care. Forty-two percent of hospitals are operated on a for-profit basis, but almost all hospitals are accessible by patients with the social/statutory coverage.

So, I believe there is a solution to the medical-care crisis in America, but I think other countries don’t have that solution.

The Problem   Leave a comment

Less than half of the 24 million proponents of Obamacare who said they would sign up during the legislative process in 2010 actually did so in the last eight years.

Why?

Well, they ran up against the cost of socialized healthcare.
Premiums doubled in the first four years of Obamacare. Last year, the average monthly premium for individual insurance was $476 per person per month in the 39 states participating in HealthCare.gov.

Here is Alaska, premiums in the individual and small-group markets doubled in those first four years and have tripled in the three years since. Alaskans in the small-group markets pay an average premium in excess of $1000 a month.

It gets worse than that, however. As premiums have gone up, choices have gone down. In more than 80 percent of counties across the US, there are only one or two health care plans available on the Obamacare exchange. That means millions of Americans now have far fewer choices when it comes to their doctor and health care network.

For the 11 million who did sign up for Obamacare, over 86 percent of them were enrolled in Medicaid. That didn’t ensure they have access to medical care because increasing numbers of doctors and other medical providers are no longer accepting Medicaid because they are reimbursed at an unsustainable level for the amount of staff required to handle all the related paperwork.

Medicaid is notorious for long wait times and poor health outcomes. It is a costly and unsustainable welfare entitlement program that delivers low-quality medical care to many of its enrollees. Because most doctors don’t accept Medicaid, recipients have little choice but to seek non-urgent care in expensive and overcrowded hospital emergency rooms where they often receive inferior medical treatment. When they do need to seek urgent care, they are routinely assigned to less-skilled surgeons, receive poorer post-op instructions, and often suffer worse outcomes for identical procedures than similar patients both with and without medical insurance.

Medicaid has become too large to provide good services to people who genuinely need public assistance. Eligibility expansions have crowded out those who need care and can’t afford it because taxpayer funds are being spent on individuals who could afford private insurance coverage. This diverts resources from the genuinely needy populations of the program.

You could perhaps make an argument for this if states that have expanded Medicaid had experienced better health outcomes for their poorer populations, but there’s no evidence that has happened. While most of those enrolled in Medicaid are relatively healthy children and their mothers, a small subset of enrollees have serious diseases like diabetes, HIV, anemia, or psychosis. These Medicaid patients are typically in worse condition at the time of their diagnosis than either the insured or the uninsured. They also typically have worse average health outcomes after treatment than either of those two demographics.

Compared to the privately insured, Medicaid patients have a 22 percent great chance of complications and a 57 percent greater change of dying following colon cancer surgery. They are more likely to die in the hospital than the uninsured. That’s right – the uninsured. That statistic comes courtesy of the University of Virginia, by the way.

Medicaid patients typically spend longer in the hospital (10.5 days) than both the insured (7.4 days) and the uninsured (7 days). This is because they are more likely to experience complications and that might explain why Medicaid patients have a 21% higher cost for hospitalization than the uninsured and and a 26% higher cost for hospitalization than the privately insured.

These sad statistics are not limited to adults with cancer, but also show up in stroke recovery and in pediatrics. The vast majority of children in and out of Medicaid enrollment are healthy, but of course that’s not always the case. Researchers have found that a child with asthma is five times more likely to see an asthma specialist if she has private coverage rather than Medicaid. Children with Medicaid are 50% more likely to be seen by an emergency room doctor, in large part because of the dearth of private doctors who will accept Medicaid patients. Those same doctors will accept someone paying case, so uninsured patients actually have more access to medical treatment than those insured under the Medicaid system.

The worst part of all of this is that Obamacare’s shifting of lower-income coverage to Medicaid has resulted in a crowd-out of private insurance and patients it used to cover. Yes, some few uninsured who were not previously covered by Medicaid may now have insurance (with no assurance of actual medical treatment), but even for the previously-insured, getting into see a doctor is now much more difficult, resulting in higher prices and longer wait times. Obamacare’s paperwork requirements on doctors have reduced the amount of time they can spend with patients, increasing diagnosis and treatment errors.

And, none of it was necessary. There are better solutions.

Cousin Rick is a world-renown research doctor who works for a major medical center and    would like not to identify himself, as that would likely ruin his career under the current tyrannical environment of the medical community. He is a frequent guest on my blog whenever the current  medical insurance stupidity becomes so great that he feels it necessary to vent.

Genesis of Violence   Leave a comment

Let’s say a man kicks down the door of his ex-girlfriend’s house and she shoots him dead in her foyer.

Who is responsible for his death?

Yes, she shot him, but don’t you suppose she was terrified that he was going to kill her and that’s why she pulled the trigger?

What if she had a restraining order against him because he’d been threatening her for months? Do you think maybe she was justified in shooting him then?

What if she called the cops and they refused to come because he was friends with some of the officers and they felt he was just blowing smoke?

What if his best friends had said she was just being hysterical? He was just trying to correct her negative behaviors. If she’d only just allowed him to beat her that night, all would have been well.

Would you find her guilty of murder if you were sitting on that jury?

Or would you acquit her because he was responsible for the violence and she had no other choice than to defend her life?

And, yes, I am discussing something larger than just a dysfunctional relationship.

Posted October 30, 2018 by aurorawatcherak in Common sense, Uncategorized

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