Archive for September, 2017

Graham-Cassidy Healthcare reform bill: sure, it’s dead but was it just AHCA 3.0? Let’s look closer.

September 28, 2017

Not living nor making my living with in the political pressure constant in Wash DC it’s hard to look at this new GOP effort, the Graham-Cassidy bill, without a healthy bit of skepticism.

Why is that? Have you ever witnessed some one make a decision based upon desperation or a willingness to “settle”? We all have. It’s common in personal relationships, it’s frequent in business decisions, and it’s compulsory in politics.

The Graham-Cassidy bill GCB) looks and feels a lot like a political effort to avoid “doing nothing” and facing constitutes after having made the promise to “repeal & replace” the ACA. If you were a GOP legislator up for re-election in 2018, especially in the House, do you want to go home  at the end of the year to face those who trusted you when you said “Obama-care must be repealed”? Of course you wouldn’t, no sane person would. But, we’re talking about politicians not sanity.

Here are a couple of points from GCB for reference:

  • Says it repeals the Individual mandate but truthfully only reduces penalty to zero. If you don’t want to buy, don’t worry, no penalty.
  • Says it repeals the Employer mandate but truthfully only reduces penalty to zero. If you don’t want to provide coverage, don’t worry, no penalty.
  • Maintains guarantee issue with no pre-ex while reducing penalty to zero for no coverage. Like the other GOP attempts this adds the burden to premium calculations and to premium payers.
  • Eliminates only the medical device tax while leaving all the others such as the Cadillac tax. Why not eliminate all the taxes.
  • Maintains Medicaid expansion and its subsidies but does so in a block grant manner.
  • Converts Federal subsidies given to states into Block grants so states can use as they please. Giving states flexibility sounds great but this may create chaos between states.
  • Gives states freedom to determine Essential Health Benefits and how block grant funds are to be spent. This sounds good except for the poor souls in liberal states like NY and Ca. who will see those funds spent on more freebies and no accountability.

There are countless other provisions that are a mirror of the two previous failed GOP attempts but I won’t burden you with this.

So, the language you will hear from supporters will be:

  • This is our last chance to get rid of the evil Obama-care.
  • If we don’t do something now then we won’t have another chance.
  • Doing something is better than doing nothing
  • Choice is clear, you’re either for Socialism or federalism.

If this effort fails the GOP folks can return to their districts and tell their supporters that “I tried but we just did not have enough votes” “Re-elect me again and we will continue our fight to repeal the evil liberal OB-care”.

Then, what are we suppose to do, vote for a Democrat or not vote. This is political baloney at its worst or best depending on your perspective.

If the GCB passes its initial vote in the Senate it will still face an incredible battle in the House. Plus remember that the House GOP is in a worse pickle that the Senate so they will try to flavor the baloney to their best interest.
I actually give it a 60/40 probability of passing the initial Senate vote.

OK, enough huh? Let’s watch this debate (debacle) unfold. It does not need to be this way but the swamp has not yet been drained, as they say.

Until next week, we’re all in this together.

Mark Reynolds, RHU
559-250-2000
mark@reynolds.wtf

PCORI – is this a worthwhile expense on your health plan or another example of Government bureaucracy and waste?

September 21, 2017

Evaluating the benefit of PCORI, the Patient Centered Outcomes Research Institute, relative to the impact on healthcare costs and efficacy of current treatment protocols may be impossible. One’s opinion may well be determined by your baseline feelings about redundant government programs, government bureaucracy, or even political positions.

One could also add data security to the list of concerns. More about that below.

Honestly, it is hard to justify the added expense to health plan costs or the benefit to healthcare practitioners and their patients. If the goal is to study comparative outcomes for current practice protocols then how will the analysis be delivered. One problem is that the PCORI has no authority to implement any findings nor to direct healthcare practitioners to modify their practices. Another problem may be human nature, that being, Doctors wanting to practice in their own experienced manner.

We all want affordable high-quality healthcare with the latest and most effective technology. There’s no argument there. But, given the history of what happens in the private sector when government intercedes don’t we have the obligation to investigate and challenge the established bureaucracy?

There are already at least two notable government agencies that experts say could incorporate the PCORI objectives with in their current structure. One is the National Institutes of Health and another is the Agency for Healthcare Research and Quality,

The Agency for Healthcare Research and Quality has the stated mission of “making health care safer, higher quality, more accessible, equitable, and affordable”. It is considered small by federal government standards with a budget of about $440 million. Believe that, small at $440m? Anyway, the mission for the AHRQ sounds like something we want so why couldn’t it dish out the $3.5 Billion expected to be awarded by PCORI?

Plus, the GAO (Government Accountability Office) states that the PCORI won’t go through a review by any independent outside entity until 2020, after the program has run it’s course, awarded an expected $3.5 billion and PCORI is no longer operative.

So, one must ask, is PCORI a worthwhile venture or just another government program scheduled to end but destined for in perpetuity?

After reviewing many of the awards given to date it is easy to lean toward the obvious: that PCORI has both great waste and great potential, depending on one’s fiscol perspective.
Let’s look at a couple PCORI awards:

  • One project looks at how doctors can create a “Zone of Openness” with patients which was part of $61 million in awards. Were you wondering about your doctor’s “Zone of Openness” the  last time you were waiting to see the doctor, dressed in your paper robe, sitting on that awkward metal bench covered in butcher block paper?
  • $14 million for a study on the appropriate dose for aspirin being taken to prevent heart attacks. Too much and you could bleed to death. How long have doctors been practicing this treatment protocol and they don’t know the correct dose?
  • $500,000 went to AHIP (America’s Health Insurance Plans) to “build and maintain support from health plan leaders” and to “identify important gaps in availability of health insurance administrative data”.
    A spokesman for AHIP stated that sharing health plan data is “complex” and “requires a significant amount of review and expertise from the industry”.
  • $249,000 went to Society of General Internal Medicine for a 2 year program, as stated “to help us develop a better understanding of the attitudes and knowledge of our membership”.
  • I’m not kidding!

Will we see any demonstrative results from the $3.5 billion in research awards expected to be doled out? Good question! Supporters say that we will see the results in articles published in medical journals and through presentations , seminars and other public dissemination. Since the PCORI has no authority the information obtained will not be sent out as directives to be followed. That part may be good.

In fact, some legislators and professional groups are concerned that the government, particularly CMS, may try to use the PCORI results to limit or restrict healthcare services to citizens covered by Medicare and Medicaid. That means our senior folks covered by Medicare and Medi-cal. We were told about this potential issue in 2009, remember. 

Will doctors change due to PCORI?

  • Some who belong to large practice groups might if directed to by their group.
  • If payments for services rendered are reduced as a result of  procedures deemed ineffective by PCORI then doctors may change. 
  • Unless there are consequences, either financial or legal, doctors may not modify their current practices simply because of a result of a PCORI award.

My initial opinion was that PCORI was another example of over-reach by the government adding cost to premiums as well as costing taxpayer billions of wasted dollars and unneeded oversight. After doing my research and preparing for this Post, I have found no reason to modify my initial opinion.
Hey, maybe my opinion is just like the results of the billions spent on PCORI; nothing changes!

One other thought has lingered with me since 2010. The ACA also mandated that all health plans submit their data to the CMS and PCORI for the purpose of analysis. By data I mean every individual’s personal & private information including SS#s, employment & health status, and specific information on every healthcare service incurred.

So, how has that data been protected and by whom? The list of entities that have had data breaches is endless and includes cities, states, nations, government agencies, many insurance carriers, and thousands of other private businesses.
Here is a short list with the estimate of records stolen :

  • US Office of Personnel & Management -22 Million
  • Yahoo 1st time -500 Million
  • Yahoo 2nd time -1 Billion
  • Equifax – 143 Million (this is recent and huge!)
  • E-bay -145 Million
  • Anthem -80 Million
  • Target -40 Million
  • Home Depot -56 Million
  •  Sony – 77 Million
  • What are the odds that your personal info was not part of at least one of these?
  • Do you think the health records of our citizens stored at CMS are an attractive target to hackers?

As I said, it was a lingering thought!

Well, you can give it some thought and ask yourself some questions. Have you read or heard anything about PCORI in the past 2 years. Probably not because one of the operative guidelines of PCORI is to be invisible and not draw attention.

Geez, does that makes sense; a government bureaucracy created to analyze comparative treatment outcomes but do so without making any news?

That’s it for now. Let me know what you think or if you’ve seen any data that shines a positive light on PCORI. I want to be fair in our review.

Next week we’ll look at the Graham-Cassidy Healthcare reform bill now being urgently pushed by the GOP. The Senate has until Sept 30th to get it started with only 51 votes.

Until next week, let’s work together and stay positive.

Mark Reynolds, RHU
559-250-2000
mark@reynolds.wtf

 

 
 

Two things that unite us as Americans: One is the start of the Football Season. The Other is Catastrophic events like 911 and hurricanes.

September 14, 2017

This week’s Post about PCORI, established in 2010 by the ACA, was printed, polished and ready to go until about 6am this Monday morning. That’s when I started watching the news that was showing the various memorial services to 911 on the East coast. It reminded me again of how united and how resilient the people of the United States are when times are tough.

Recently, we have all been saddened and heartened with the stories from Hurricanes Harvey and Irma. The pictures and interviews display how Americans of every race and origin willingly help out other Americans of every race and origin when the time comes.

The 911 memorials today may become a bit smaller in years to come but if and when the next event occurs we know that Americans will not hesitate to jump into the fight to help others when needed.
To quote the famous philosopher and great fiddle player Mr. Charles Daniels: “you just go ahead and lay your hands on a Pittsburgh Steelers’ fan and I think you’ll finally understand”.  Which means, that Packers fans and Cowboy fans or Dolphin fans alike will step up to help a fellow American when outsiders bring trouble to the United States.

As I watched a few of the speeches this morning it made me start to think about how, as Americans, we are resilient and we are resolved to the actions needed to protect ourselves and others from future harm. Americans will do what needs to be done if given good leadership and good planning.

However, over the past 16 years, plus the 10 years prior to 911, it seems that politicians often forget this aspect of our citizens and instead start thinking about their next election. Political correctness, identity politics, and a complacent culpable media add to the danger we face.

But this week instead of PCORI, the ACA, the media or politicians I want to focus on the core strengths we have as Americans. Those strengths that led our ancestors to leave their original homes to traverse across great oceans and  mountain ranges to build the greatest country the world has ever known.

The past 4 weeks have shown us how we come together when times are tough. The memorial ceremonies for 911 show us how we come together as a nation when attacked. Now, we just need to maintain that steadfast resolution on a day-to-day basis. Help your neighbor when they need it, forgive that careless driver that cut you off this morning, and continue to pray, praise and donate to our fellow Americans who need our help.

Let me finish with a thought about the idea that the football season being a factor of unity. Some may disagree (probably soccer fans) but for six months each year three hundred of million American come together to root for their favorite team or teams. Whether its high school, college, the NFL or even Pee-wee or arena one must admit that we are avid fans. Heck, look how many people watch the Super Bowl each year (without any rioting in the stands).
So, back your favorite team which I know for all of us is Team USA.

Next week, we’re back to common sense solutions for healthcare, OK?
And remember, we’re all in this together.
Until next week,

Mark Reynolds, RHU
559-250-2000
mark@reynolds.wtf

Promoting “polls” that suggest a change in “favorable vs. unfavorable” opinions is the new technic to support the ACA. Can we trust these polls?

September 7, 2017

You’ve probably seen them, too. Polls that show the “favorable” opinions about the ACA increasing dramatically. Since the introduction of the failed House and Senate bills to replace the ACA more articles are stating that opinion polls are showing the “favorable” attitude about the ACA increasing.

Who in the world did these polls approach. And I do mean “in the world”, because if anyone likes the ACA better now than before January 2017, they must have been people from other world counties. Another likely scenario would be that the polled population was previously uninsured who are now covered by either Medicare expansion or a state exchange with full or nearly-full subsidy.

Who could find the ACA more favorable after 7 years of:

  • Double digit premium increase (100%+ in many areas)
  • 50% fewer providers in the PPOs
  • Crappy benefits with higher out of pockets
  • Limited number of insurers

The answer is that no one would find the ACA more favorable unless:

  • You paid premium before but now it’s paid for you.
  • You were uninsurable before and had no coverage.
  • Had no coverage before but what the heck – its free now.
  • You are Harry R or Nancy P or Z Emanuel or J Gruber.
  • Or one of their relatives (even that’s unlikely, though).

The key to the outcomes in these kind of polls is often the format in which questions were formulated to meet the desired outcome of the pollster. In a sensitive issue such one’s health care it is easy to ask a yes-no question in a manner that leads the subject to the answer desired.
For instance: if I asked you “Do you think it’s fair for insurers to decline an applicant for coverage?” you could easily say NO. But, would your answer change if you knew that the applicant had several opportunities to enroll before but chose not to until just recently after a negative diagnosis was received?

Our citizens are smarter than politician think, or want for that matter, so they know what should be done. However, if they are polled with questions impossible to answer then it skews the outcome. As Ms. Vido, in My Cousin Vinny, said “It’s a bullshit question”. By that, as she goes on to explain – “It’s a trick question. No one could answer that question.” So how are we to believe these polls?

Or let’s say you were asked – “Sir, do you still beat your kids?”. Of course you don’t because you never have but you must answer yes or no. The point is that professional pollsters conducting polls for entities with certain agendas can make the American public seem like it supports or does not support an issue based on the specific outcome desired.

So, don’t you find it difficult to believe that any American would answer that he/she is more favorably inclined toward the ACA today than they were 1 or 2 years ago? Unless, it was because they were among the citizens outlined above.

I know I can be a skeptic or even a cynic, as I’ve mentioned before, but some things are beyond giving the benefit of the doubt.

Now, if you were to ask people the following questions you could be sure of people’s true opinions:

  • Do you think premiums increasing 100% per year is reasonable?
  • Do you think insurers should be subsidized by the government.
  • Do you think PPOs with half the Doctors carved out provide good service?
  • Do you think the premium you pay should be tax-deductible?
  • Do you think people who choose not to enroll should be GI with no Pre-ex later?
  • Do you want your plan to cover pediatric dental if you are a single 50 yr. old male?
  • Do you think healthy working-age people should get their coverage for free?
  • Do you think the Congress should have been better prepared to offer a replacement plan for the ACA?
  • Do you think calling the House or Senate’s bill a “repeal” was an assault on your intelligence?

I guess I got on to another rant there for a moment but you get my meaning. It is very difficult to believe that tens-of-millions of our hard-working premium-paying citizens would find the ACA more favorable today than they did a year or two ago.
But, what do you think?

Until next week, just remember that we’re all in this together.

Please keep praying for the folks in south Texas and Louisiana. They have a long haul ahead.

Mark Reynolds, RHU
559-250-2000
mark@reynolds.wtf