The DON’T GET SICK! Health Insurance Plan

Unc’s post reminded me to tell my story. So with unemployment comes a new healthcare insurance plan. It’s called “DON’T GET SICK!”. The idea is that if you don’t get sick, you won’t need healthcare. What could go wrong?

My wife and I agreed that with three kids we needed supplemental DON’T GET SICK! insurance. We found a Blue Cross/Blue Shield short-term plan for $350 a month, no physicals required. It isn’t great insurance. The copays and deductibles are high. It doesn’t cover pre-existing conditions. If I had another grand mal seizure and spent three days in the hospital it would cost many times more than the $3,000 I had to pay with great insurance. So as part of the DGS plan I’m extra careful about taking the medicine prescribed after the last seizure.

Still, it’s an improvement on the previous DON’T GET SICK plan. If nothing else it will keep us from being financially ruined in case we can’t avoid DON’T GET CANCER, DON’T HAVE A HEART ATTACK, and DON’T GET IN A DEBILITATING ACCIDENT.

Or DON’T BREAK YOUR WRIST. Right after we applied for the short-term policy the girls had a roller skating night with their school. I’m watching kids fall down left and right and thinking what a damned dangerous sport roller skating is. I counted off five people I knew who had broken arms on rollerskates.

Sure enough, Katie fell and sprained her wrist. My wife wanted to rush her to the emergency room – a $250 deductible on our good insurance, and who knows how much on DON’T GET SICK! supplemental insurance. When Katie wasn’t complaining about her wrist she could run around and dance, so I didn’t think it was serious enough for the ER. I Googled and found out that for minor sprains the treatment is ice, ibuprofen, and a wrist brace. We did all of that and she was fine in a couple of days. We’re definitely more discriminating users of healthcare than before.

My wife landed a job right after that, and we start on her insurance first of April. It’s much better insurance and doesn’t cost that much more than the DON’T GET SICK! supplemental insurance – about $600 per month for a family of five – because her company pays part of it. It eats up a big portion of her paycheck, though, and is going to rise $250 per month in October due to Obamacare. We’re hoping I’ll get a job soon to bring in more income and with any luck lower insurance premiums.

So How’s Romneycare Working in Taxachusetts?

ReasonMeanwhile Back in Massachusetts & Romneycare: “Challenge of saving money expected to dominate future”:

It’s going to be fun watching Romney explain why Obamacare am bad while Romneycare am good. He must be praying the Supremes will save his butt this Thursday and strike down most of Obamacare so it’s a moot issue.

Study: Many Clinics Not Taking Medicaid/CHIP Patients

Most Illinois Specialists Won’t Take Medicaid Patients:

The study used a “secret shopper” technique in which researchers posed as the parent of a sick or injured child and called 273 specialty practices in Cook County, Ill., to schedule appointments. The callers, working from January to May 2010, described problems that were urgent but not emergencies, like diabetes, seizures, uncontrolled asthma, a broken bone or severe depression. If they were asked, they said that primary care doctors or emergency departments had referred them.

Sixty-six percent of those who mentioned Medicaid-CHIP (Children’s Health Insurance Program) were denied appointments, compared with 11 percent who said they had private insurance, according to an article being published Thursday in The New England Journal of Medicine.

Mass. voters don’t like Romneycare

Boston HeraldRomneycare a big bust:

Think about how powerful Romneycare has been. In 2008 – when Obama was running for president and Ted Kennedy was towering over the Senate – nearly 70 percent of Massachusetts voters supported the plan. A mere 22 percent of right-wing holdouts opposed it.

After all, this is Massachusetts, where universal health care is a political mantra, like “collective bargaining rights” or “indicted House member.”

But after five years of actually experiencing this new universe, even the Kennedy Democrats have had enough. A new Suffolk University poll showed that nearly half of Massachusetts voters say the law isn’t helping, while just 38 percent say it is. As Michael Cannon at the Cato Institute pointed out, Romneycare is almost as unpopular here as Obama- care is across America.

Other than executive-style hair, what exactly is Mitt Romney bringing to the presidential race?

Previously Massachusetts’ MittCare Over-enrolled and Overbudget

CVS Caremark/BCBS of TN Kiss and Make up with Walgreen’s

Following up on the last post, it looks like the parties involved have straightened things out. Email forwarded from our HR department: Read more of this post

CVS Caremark and BlueCross/BlueShield of TN Divorcing Walgreens

From CVS Caremark, which manages pharmacy benefits for many insurance companies and benefit programs:

CVS Caremark Announces Plan To Remove Walgreens From PBM Pharmacy Network and Transition Pharmacy Care To Participating Providers:

Walgreens’ Demands Would Have Increased Pharmacy Costs For Payors and Plan Members

WOONSOCKET, R.I., June 9, 2010 /PRNewswire via COMTEX/ –CVS Caremark Corporation (NYSE: CVS) today announced that, while it has worked diligently to come to terms with Walgreens on an agreement that would allow Walgreens to continue as a member of the CVS Caremark PBM pharmacy network, it has no choice but to terminate Walgreens’ participation in its retail pharmacy networks effective 30 days from today, or as otherwise may be required by applicable law or contract requirements. In addition, CVS Caremark will terminate Walgreens’ participation in its Medicare Part D retail pharmacy networks effective January 1, 2011. CVS Caremark said that Walgreens’ most recent actions have violated the terms of its existing agreements and that Walgreens has failed to respond to efforts by CVS Caremark to continue business negotiations.

Walgreens responds:

DEERFIELD, Ill., June 9, 2010 – Walgreens (NYSE, NASDAQ: WAG) today issued the following statement from Kermit R. Crawford, executive vice president of pharmacy, regarding CVS Caremark’s statement that it would terminate Walgreens participation in CVS Caremark’s retail pharmacy networks effective 30 days from today:

“We are disappointed but not surprised that CVS Caremark has taken this action. In making our decision not to participate in any new and renewed plans by CVS Caremark, we sought to minimize any disruption to existing relationships between pharmacists and patients. CVS Caremark’s move plainly contradicts its own statement on June 7 that their mission is to provide broad access and choice for consumers. Their patent disregard for patient choice and broad access reflected in today’s decision reinforces our conviction that it would not have been in the best interests of our patients, pharmacists or shareholders to grow our business with CVS Caremark. Regardless of CVS Caremark’s decision, we are confident of our ability to continue to grow our business as a provider in hundreds of other pharmacy benefit networks and as a direct provider to employers.

Walgreens has had to terminate relations itself to maintain profitability: WA State Walgreen’s to Stop Taking New Medicaid Patients.

My friend Lara, whose husband is in their insurance business, forwarded this email from BlueCross/BlueShield of Tennessee:

On June 9, 2010, CVS Caremark – the Pharmacy Benefits Manager for BlueCross BlueShield of Tennessee – made the decision to terminate Walgreens’ participation in the CVS Caremark retail pharmacy networks effective July 9, 2010 (subject to state law and contractual obligations). This came two days after Walgreens informed CVS Caremark that it would not participate in CVS Caremark’s pharmacy retail networks going forward for members covered under new or renewed plans. As a result, BlueCross members will no longer be able to fill or refill their prescription at a Walgreens retail pharmacy, and will need to transfer that prescription to another pharmacy within the CVS Caremark retail pharmacy network before July 9, 2010.

BlueCross understands the impact this change could have on its members and is working closely with CVS Caremark to guarantee that effected members are communicated to quickly and offered options for their prescription drug needs, including:

  • Delivering to BlueCross members – via U.S. Mail – with a list of alternative retail pharmacies in the network so they can preserve uninterrupted access to their pharmacy benefit and their prescriptions.
  • Directing BlueCross members to other nearby network pharmacies through the “Find a Doctor” feature on bcbst.com or the “Find A Local Pharmacy” tool on CVS.com (registration required).
  • Providing BlueCross members with answers to commonly asked questions through an FAQ found in the Pharmacy section of bcbst.com, www.bcbst.com/learn/pharmacy/.

Note that this change does not affect the Walgreens’ specialty pharmacy benefits (SpecRx) as BlueCross holds this contract directly with Walgreens Specialty Pharmacy. Additionally, this change does not affect BlueCross’ contract with Walgreens’ mail order service for non-ERISA groups.

BlueCross and CVS Caremark are committed to ensuring that no disruption in pharmacy benefits is experienced by members due to the termination of Walgreens’ participation in the CVS Caremark retail pharmacy networks. Frequent communications through email, U.S. Mail and bcbst.com are planned to assist all BlueCross customers – members, groups and brokers – during this transition period.

“Texas doctors opting out of Medicare at alarming rate”

Houston Chronicle:

The problem dates back to 1997, when Congress passed a balanced budget law that included a Medicare payment formula aimed at reining in spending. The formula, which assumed low growth rates, called for payment cuts if spending exceeded goals, a scenario that occurred year after year as health care costs grew. The scheduled cuts, expected to be modest, turned out to be large.

Congress would overturn the cuts, but their short-term fixes didn’t keep up with inflation. The Texas Medical Association says the cumulative effect since 2001 already amounts to an inflation-adjusted cut of 20.9 percent. In 2001, doctors receiving a $1,000 Medicare payment made roughly $410, after taking out operating expenses. In 2010, they’ll net $290. If the scheduled 21.2 percent cut goes through, they’d net $72, effectively an 83 percent cut since 2001.

In 2008, 42 percent of Texas doctors participating in the survey said they were no longer accepting all new Medicare patients. Among primary-care doctors, the percentage was 62 percent.

PreviouslyWA State Walgreen’s to Stop Taking New Medicaid Patients

Govt Health Care Strikes Out in TN, ME, MA

“Science is founded on the conviction that experience, effort and reason are valid; magic on the belief that hope cannot fail nor desire deceive.” – Branislaw Malinowski

Reason has a recap of failed government healthcare programs. Short version: the states underestimated how many people and employers would drop private insurance once there was a public option, then they underestimated how much ice cream people would eat once it was free, and then like any government program they took the underestimate and lowballed it.

Reason forgot to mention Hawaii, which had to scrap its public health insurance after seven months due to unsustainable costs.

If state-run health care is financially unsustainable, it’s hard to image why federally-run health care will work.

WA State Walgreen’s to Stop Taking New Medicaid Patients

Seattle TimesWalgreens: no new Medicaid patients as of April 16:

Effective April 16, Walgreens drugstores across the state won’t take any new Medicaid patients, saying that filling their prescriptions is a money-losing proposition — the latest development in an ongoing dispute over Medicaid reimbursement.

The company, which operates 121 stores in the state, will continue filling Medicaid prescriptions for current patients.

In a news release, Walgreens said its decision to not take new Medicaid patients stemmed from a “continued reduction in reimbursement” under the state’s Medicaid program, which reimburses it at less than the break-even point for 95 percent of brand-name medications dispensed to Medicaid patents.

Walgreens follows Bartell Drugs, which stopped taking new Medicaid patients last month at all 57 of its stores in Washington, though it still fills Medicaid prescriptions for existing customers at all but 15 of those stores.

And if Walgreen’s was losing money on those Medicaid customers, it means the Medicare shortfall was being subsidized by private health care, as is often claimed. So what will happen if Obamacare wipes out the private health care market? Hat tip to Instapundit.

Previously

PEW Study: States Have $1 Trillion Pension/Benefits Gap

Pew Pension Study

MishPEW Study Shows Trillion Dollar State Pension Gap; Can Anything Be Done?

A $1 trillion gap. That is what exists between the $3.35 trillion in pension, health care and other retirement benefits states have promised their current and retired workers as of fiscal year 2008 and the $2.35 trillion they have on hand to pay for them, according to a new report by the Pew Center on the States.

Retiree health care and other non-pension benefits create another huge bill coming due: a $587 billion total liability to pay for current and future benefits, with only $32 billion—or just over 5 percent of the total cost—funded as of fiscal year 2008. Half of the states account for 95 percent of the liabilities.

PEW Healthcare and Benefits Study

And the actual numbers may be even worse, because most states’ reports haven’t taken 2008’s stock market decline into account:

All but three states—Idaho, Oregon and West Virginia—use a smoothing process in which investment gains and losses are recognized over a number of years. Smoothing is a way of managing state expenditures by preventing contribution rates from suddenly jumping or dropping. The number of smoothing years varies, with five years being the most common. Because only a portion of the 2008 losses will be recognized each year, there is a great likelihood that pension funding levels will be dropping for the next four to five years.

Socialized Medicine in Japan: “The doctor will see your bribe now”

Hot Air“VIP” Treatment Under Nationalized Health Care:

After such nice treatment as she got for her knee and her stomach, my mother never forgets to send “gifts,” typically cash and premium liquor to the doctors, expensive chocolate to the nurses — and of course, something extra special to my uncle, her brother. She was laughing that after her hospitalization, she spent more money on gifts than the actual medical bill. That means over thousand dollars of, let’s be honest, bribery.

Read the whole thing to see how Japan’s socialized medicine system works in practice, including long waits, with access and care according to who you know and how much supplemental insurance you’ve bought.

Via Insty.

Glendale, AZ Mayo Clinic Stops Taking Medicare

PattericoGlendale Mayo Clinic Won’t Accept Medicare:

“The Mayo organization had 3,700 staff physicians and scientists and treated 526,000 patients in 2008. It lost $840 million last year on Medicare, the government’s health program for the disabled and those 65 and older, Mayo spokeswoman Lynn Closway said.

Mayo’s hospital and four clinics in Arizona, including the Glendale facility, lost $120 million on Medicare patients last year, Yardley said. The program’s payments cover about 50 percent of the cost of treating elderly primary-care patients at the Glendale clinic, he said.”

Yet part of the plan for ObamaCare is to reduce Medicare expenditures. With lower payments and more people on that plan the reasonable prediction is that fewer doctors will take government insurance. It’ll be universal health insurance, except that doctors won’t universally take it.

Is that unexpected? Hardly. That’s exactly what happened in the French experience with universal health insurance:

A couple of things you can learn if you’re in France:

First, the meaning of “universal.” It doesn’t mean what you think if you’re a poor person in France, where “universal” health care is arguably better than elsewhere in the EU. It means about 75 percent. Le Parisien reports this morning that, as in the U.S., the more money you have the better care you get. Shocking. The paper backed up a recent study with a small-scale sting of their own and discovered that if you rely on France’s medical insurance alone, 25 percent of French doctors will refuse to treat you. That’s how you say ObamaCare in French.

PreviouslyAre Medicare cuts being subsidized by private health care?

Wal-Mart haters and big government lovers

I opened a new package of cold medicine this morning. To open it I had to cut through a sticker that read “If this product is found for sale at a location other than Wal-Mart please call 1-800-WALMART.” No doubt Wal-Mart negotiated a special price on the medicine, and either the manufacturer or Wal-Mart didn’t want other stores getting that price.

Wal-Mart’s critics often complain that Wal-Mart uses its market dominance to negotiate lower prices from manufacturers. I’ve never really understood the criticism. No one’s forcing the companies to do business with Wal-Mart, and Wal-Mart passes on the savings to the customer. That’s one reason their prices are so low, and those low prices are the main reason we shop at Wal-Mart.

I wonder how many of the people who criticize Wal-Mart for negotiating low prices from suppliers are in favor of the government forcing drug companies to lower their prices? Not negotiating, like Wal-Mart does, but forcing with all the power the federal government can bring to bear. I’m guessing there’s a lot of overlap between the two groups, with the common theme being anti-corporatism.

Oh, to have some spare time for research.

Electronics get cheaper, health care gets more expensive

Glenn Reynolds says of the digital camera’s improving performance and lower prices, “Yes, why isn’t healthcare this way? Hmm, what could be different?”

The most likely reason is Baumol’s Cost Disease, a 2007 word of the day that’s worth repeating.


Here’s a simple example from Wikipedia:

Baumol’s cost disease (also known as the Baumol Effect) is a phenomenon described by William J. Baumol and William G. Bowen in the 1960s. The original study was conducted for the performing arts sector. Baumol and Bowen pointed out that the same number of musicians are needed to play a Beethoven string quartet today as were needed in the 1800’s; that is, the productivity of Classical music performance has not increased.

In a range of businesses, such as the car manufacturing sector and the retail sector, workers are continually getting more productive due to technological innovations to their tools and equipment. In contrast, in some labor-intensive sectors that rely heavily on human interaction or activities, such as nursing, education, or the performing arts there is little or no growth in productivity over time. As with the string quartet example, it takes nurses the same amount of time to change a bandage, or college professors the same amount of time to mark an essay, in 2006 as it did in 1966.

Baumol’s cost disease is often used to describe the lack of growth in productivity in public services such as public hospitals and state colleges. Since many public administration activities are heavily labor-intensive and have a limited desirable provider-customer ratio, there is little growth in productivity over time. As a result, the costs of the bureaucracy will inflate quicker than the growth in the GDP.

From The New Yorker:

Read more of this post

Our government: lying about health care costs since 1962

NPR via ReasonLying for Health Care Reform – LBJ’s Example for Today’s Democrats:

We believe, after looking at the evidence, my co-author [David Blumenthal] and I, that if the true cost of Medicare had been known — if Johnson hadn’t basically hidden them — the program would never have passed. America’s second-most beloved program would never have happened, if we had had genuine cost estimates.

Amazingly, NPR even included this Ronald Reagan quote:

“One of the traditional methods of imposing statism or socialism on a people, has been by way of medicine. It’s very easy to disguise a medical program as a humanitarian project — most people are a little reluctant to oppose anything that suggests medical care for people who possibly can’t afford it. Now, the American people, if you put it to them about socialized medicine and gave them a chance to choose, would unhesitatingly vote against it.”