And Then There Was One

Remember this Golden Oldie:


As we continue to watch the (increasingly *not* slow-mo) implosion of ObamaCare, there's news, and then there's news that's kind of under the radar.

First the news (about which I'm sure mist of our readers already know):

Wellmark is signalling that they'll follow Aetna out of the Hawkeye State:

"Wellmark Blue Cross and Blue Shield will no longer sell new individual health insurance policies in Iowa and some Iowans who have Wellmark insurance will lose it in 2018."

Which means that, in a few months, it's likely that Iowa's individual market will be down to exactly one carrier: Medica.

And just who is Medica?

Well, they're a regional carrier "offering health plans in Iowa, Minnesota, Nebraska, North Dakota, South Dakota and Wisconsin." Currently, they insure just shy of two million folks, but that includes all 6 states, and individual, group ad Medicare plans.

Which raises some interesting questions:

Several months ago, we discussed "capacity;" that is, how much risk (how many clients) a given carrier is actually able to take on at any given time. The issue is no less critical here: is Medica going to be able to absorb all those new insureds?

And our friend Chad N offers this observation:

"Now Aetna is exiting Iowa’s Obamacare market.  I believe that leaves only Medica who has been very non-committal about continuing (although I’d guess they will ask for a ridiculous premium increase and corner the market since HHS and the Iowa Insurance Division will have no other choice)."

Rock, meet hard place.

#ACAWinning!

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Once more unto the breach

Look, I've been a big fan of Direct Primary Care (DPC) and it's cousin, Concierge medicine, for a very long time. But it is not a panacea. And under the ACA, it makes very little economic sense for most people.

Here's why:

On Twitter, Dr Matt McCord published a very cool graphic about the benefits of DPC. I replied that yes, the model does make financial sense for many providers, but not for most patients.

He replied "Not true in our growing High-deductible health care marketplace. Buy your own #healthcare fiduciary for $50/month."

And I responded "uh-hunh. Now do chemo."

To which the good doctor replied "A classic argument. Cancer, Trauma, Acute MI..these are not elective/preventative events. That is what Insurance is for."

Bingo.

Because that's the whole point: DPC doesn't provide for serious health issues (nor does it claim to, of course). That's up to the insurance. But under the ACA, plans must include most primary care already, so one is paying for it...twice.

How does this make financial sense?

And this is the issue I have with a number of DPC proponents: they're framing their argument ineffectively. As long as ObamaCare remains the law of the land, there is never going to be a good economic rationale for DPC.

But there's a darned good health reason, and regular readers are already nodding their heads in agreement:

DPC guarnatees quick access to care. It's why Britons, who have "free healthcare" willingly pay big bucks pounds for the private version.

I wonder if/when our DPC friends will figure that out?

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Health Wonk Review: Pre-Passover edition

The Jewish holiday of Passover, which commemorates our freedom from years of slavery (among other things) begins next Monday evening. During the ceremony, we recite the 10 Plagues, and we actually have 10 great posts to offer, but I'm going to pass on linking posts and plagues.

Instead, I'm going to intersperse some interesting factoids about the celebration between entries. And please note that the factoids and the posts are not related:

■ On the seder plate displayed in the middle of the table, you'll find an egg, charoset (fruit and nut mixture), horseradish, greens, bitter herbs and the shankbone of a lamb.

Joe Paduda thinks it’s time to look to how ACA can be fixed, but doesn't see the Rocket Surgheons Powers That Be in DC actually doing that.  Instead, he's expecting Medicaid and Exchange de-funding, along with subtle efforts to add friction to enrollment and the individual markets. What a pollyanna 😃.

 
■ Abraham Lincoln Was Assassinated During Passover. According to the American Jewish Historical Society, many Jews were in synagogue for the holiday when news of Lincoln's assassination broke ... Sadly, a time that was supposed to be full of celebration became one of mourning.

Good friend David Williams has an interesting podcast with the CEO of CleanSlate, which uses medication as part of its treatment approach to fighting opioid addiction.

■ Matzah - unleavened bread - looks like a giant saltine. It's also the primary ingredient in "matzah brie" (fried matzah), a sort of Jewish French toast (and a particular favorite of your HWR host).

Uber wonk Roy Poses has a discussion on physician burnout with the CEOs of some big US hospital systems, including some of the most prestigious, and joined by the CEO of the American Medical Association.

■ Four glasses of wine are consumed during the seder, all of which need to be Kosher for Passover. When I was growing up, this meant cough syrup Manischewitz or Mogen David. But in recent years, very tasty real wines have become available (I'm partial to the Merlots).

Our friend Brad Wright discusses his own interaction with our health care system as he recovers from a bout with Guillain-Barré Syndrome. It's quite eye-opening. R'fuah shleima, Brad. [link]

On a happier note, he's also the proud papa of a beautiful bouncy baby girl (Mazel Tov!)

■ Libyan Jews took Passover so seriously that the women ground flour for the matzoh seven days ahead - wrapping scarves around their mouths and noses so as not to contaminate the flour with their breath.

I imagine he's tired of hearing this, but Jason Shafrin continues to earn his keep as our favorite health care economist with posts like this week's, where he asks a seemingly innocent question: "Are physicians benevolent public servants or profit maximizers?" [I suggested he embrace the healing power of 'and']

■ The seder is actually a service, complete with its own prayerbook, called a Haggaddah. There are an almost infinite variety of these available (I recently saw one based on the Harry Potter books).

Bradley Flansbaum's post actually ties up pretty neatly with Jason's. as he explores "The Great American Coding Swindle." AKA "How You, too, Can Game the System for Fun and Profit." 

■ In Afghanistan, a tradition of bopping each other on the noggin with green onions adds a festive air to the ceremony.

Our good friend Louise Norris, herself a veteran HWR hostess, offers us her take on clearing up some of the confusion over the ACA individual mandate penalty. Pretty timely, since tax day's less than a fortnight away. 

■ Syrian Jews have a custom of starting the storytelling aspect of the Haggadah by taking the matzah used during the Seder, placing it into a special bag resembling a knapsack, and throwing it over their shoulders. They then proceed to recite a verse in Hebrew about leaving the desert in haste.

And HWR co-founder (along with Joe Paduda above) Julie Ferguson sends along her colleague Tom Lynch's post on the impact the "Psychosocial Buzz" is having on timely Workers Comp payouts.

■ A small container of salt water symbolizes the tears we shed as slaves, and into which we dip the greens.

Steve Anderson sends along Wendell Potter's response to RyanCare. Spoiler Alert: He's not a fan.

■ Jews from Hungary like to bring the bling to their Passover meal by decorating their Seder table with gold and silver jewelry. The explanation offered for this custom is that the Israelites were given the precious metals by the Egyptians to hasten their exodus from the land.

Our own contribution this week is my post on a favorite golden oldie: price transparency in healthcare. Have we finally found my ideal (aka "The McDonald's Model)? Kinda looks that way (at least on a small scale).

Well, that's it for this edition. May you and your families enjoy a wonderful Passover and joyous Easter. And don't forget to join us on  April 20th when Brad Wright hosts.

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Killin' Time (and Doctors)

As we've noted over the years, Britain's Much Vaunted National Health System© may offer free health "care," but free isn't necessarily (or even usually) fast. Co-Blogger Bob tips us that it's not just the patients that are dying:

"A "talented" junior doctor who had spoken about the pressures of working in an A&E department has been found dead at her home."

[ed: A&E being "accident and Emergency" care facility]
What's particularly disturbing is that she's "the third female junior doctor to have gone missing or been found dead in Devon in little over a year." One committed suicide and another has been missing for over a month (after complaining of being depressed by the sad state of the MVNHS©).

Now, "Junior Doctors" (interns?) face incredible pressure here, as well. But stories like this put the lie to the claim that government-run health care is a panacea. In fact, as Bob's friend Larry V observes:

"As I understand it, the cost of "free" health care is to be told you have a condition that if untreated will kill you in two years, but no worries, you have an appointment with a specialist in three years"

Indeed.

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Desperate Agent Tricks

I often get raised eyebrows when I mention to folks that one of my group clients is a local cemetery (the folks in the front office). But that's really mild compared to the (alleged) antics of Durham (NC) insurance agent Monica Jubert:

"A Durham woman is accused of signing people up for life insurance – even one woman who was already dead – without their knowledge"

[ed: how do they know the dead woman had no knowledge of the sale?]

In all, she appears to have pocketed just shy of $20,000 in commissions on 16 policies. I can sort of see how this could happen: with smaller face amounts on younger people, applications are typically "non-medical," requiring only the signed form and the first month's premium.

In typical MSM fashion, the reporter can't be bothered to make a simple phone call to confirm this. And of course we can't have him learning that the $20 grand is likely the result of "annualizing" the premium: companies will often pay an agent a full year's commission based on a single month's actual premium.

I really don't understand how she thought she could sustain the ruse, though: at some point, that second month's premium would come due....

[Hat Tip: Co-Blogger Bob V]

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From the Trenches: Sharing Ministry Update

As Health Sharing Ministries continue to gain ground, we continue to collect anecdata thoughtfully shared with us by our readers.

Today, FoIB Thomas L reports on his own recent experience:

We are using a sharing ministry, Samaritan Ministries, as of September.  In Oklahoma, the premium increase for this year was announced at 51% and all but BCBS were exiting the market statewide*.  This is after an almost 40% increase the year before.

All told we would have been paying $1,200/mo for three people, ages 1, 23, and 35 with no known health issues or prescriptions.

Given that my deductible was $6,000 (lower for my wife and daughter), we could easily be $20K out-of-pocket before insurance covered a thing.  We cannot afford such an enormous fixed expense for such a speculative return, and always with the prospect of it spiking in cost or disappearing entirely the next year anyway.

Oh, for the days when I paid $75/mo through my work.

So far we are pleased with the service experience.  I asked many detailed questions over many hours and had them all answered with equally detailed explanations, but we have had no “shares”.  That will change, as we are expecting a second child, so we will soon find out how well Samaritan works for us.

* Tulsa, and Tulsa alone, has an off-exchange alternative offered as joint operation of two local Catholic hospitals.

Thank you, Thomas!

Now, are these plans right for everyone? Of course not, and I'm not aware of any that claim to be. But they're obviously right for some folks. As I've mentioned, I'm not comfortable marketing them, but only because of the perceived conflict between my role as a licensed insurance agent and the fact that these plans are not, in fact, insurance. Still, they're not to be easily dismissed.

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Pretty Transparent

We've blogged on price transparency in health care for a very long time. For a variety of reasons, my "McDonald's Model" has never really taken off, but hope springs eternal.

And sometimes, well:

[click to embiggen]

 

That's from "the website of Clinica Mi Pueblo, which is a chain of eight medical clinics in Southern California."

Interesting, no?

[Hat Tip: Naomi Lopez Bauman]

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