Archive for the ‘Blog’ Category

We all know the story of the young woman who is treated for breast cancer and then changes jobs and then loses her coverage for her “preexisting condition.” Each and everyone of us knows some variation on that story and universally, we think it stinks. I would say most of us know of a story where someone was quite ill and their benefits ran out. Now sometimes that happens in absurd end of life decisions and I’ll write about that another time. I’m again thinking of our young woman with breast cancer who survives her disease, but loses everything else. If you don’t think that these events are wrong, please stop reading this and don’t read anything else that I ever write. In fact, please don’t talk to me or anybody in my family. If you belong to a church, temple or mosque; quit. There’s no hope for you and any higher power would be embarrassed by his creation.

If you’re still with me then you have a thread of human compassion and decency and I think that is all that I am going to need. This brings us to “the mandate.”

How can basic human decency be equated with a government compelling its citizens to buy a product; in this case health insurance. Well, once again it comes down to math (with an ‘a’). Let us say that Congress passes the “Human Decency in Health Care Law” which states that no insurance company can deny an individual health insurance or cap the benefits what would be the decision of the rational consumer. Well, clearly, everybody who is sick and has been denied coverage will rush to their computer and sign up. What will the rational healthy people do? Nothing. If you cannot be denied coverage the logical person will not be paying for insurance when they are healthy. They will pay their occasional costs out of pocket, but the minute that they get sick, they would quickly purchase insurance. in fact, I am sure that there would be a special insurance broker in this setting. Just as we once bought “flight insurance” from a kiosk in the airport (what a scam that was), we could imagine insurance being purchased in emergency room waiting areas.

I know that healthcare is expensive. The point is that by having a large pool of covered lives, expenses can be predictably managed. Costs are kept reasonable by having a fairly healthy group of people. When the pool consists of only the sick, insurance can only become more and more expensive and ultimately unsustainable. We can only have our insurance equivalent of basic human decency by compelling the healthy to be insured.

Sure, we could have done this all through tax dollars and funded a single payor Medicare-Universal (wouldn’t that name have worked better than the Congressional Democrats term “public option.”) We have opted, for now, for a “free market” approach. The biggest problem is the fine is too little. In 2014 it’s only $95 or 1% of income. Over the next few years the fine will increase. Ultimately, it will need to be more expensive than basic bronze level insurance for people to be rational and be insured.

I know. Sometimes after going through insurance issues you feel a desire to reach for Walter White’s blue crystals. It’s understandable and we won’t count it as a preexisting condition.

I’ve written many times that the thing that I hated the most about a small business was shopping for group insurance. First, my needs were rarely the same as my employees and second, boy those choices were confusing. And, of course, the options were expensive. Sometimes, I would take a look at the individual insurance policies that I could find. They were cheaper and I was tempted. But then I looked into them in a little more detail. They had a flaw that was so epic it belonged in an Ancient Greek Homerian Epic Poem. These individual insurance policies were great until you got sick. That’s right, they charged a low fee and you felt like you were insured, but they could cancel you out as soon as you got sick. Now, I never bought any of those policies, but I have been on the other side dealing with a patient who was insured until he actually needed insurance.

Well, when they went about creating the Affordable Care Act someone decided that insurance that vanished on people when they got sick should disappear. Insurance that individuals buy would have the same protection as the group insurance that employers provide. When you read about the people who have lost their insurance, these are the people. A bad product has been removed from the market place. Sometimes I think that if Obama came out against sour milk, Fox news would rant about how he was taking away our rights to drink vile toxic beverages.

Here’s the problem. Insurance that will actually be there when you get sick is going to cost more than insurance that they can take away when you get sick. It’s not rocket science. If I can’t dump you the minute you cost too much, I’m going to be more expensive. Can’t get around that.

So, I’m sorry that people miss their cheap insurance. I guess that they liked the feeling of having insurance without having to pay. But I promise that when they have their first heart attack or breast lump, they will be happy to have these replacement policies.

Tomorrow will be another math day, so bring your pencils.

OK. Let’s get to some other conversations for an MD, MBA, TL (thought leader) By the way, the answer about time space was nothing more than Star Trekish babble, but hey, it fooled you.

Today a patient asked me if I was taking Obamacare. I’ve heard this a lot and I think it speaks to the fact that we have been through such a thorough disinformation campaign that few us have a clue anymore. Obamacare (and unlike the President, I hate the name) is not an entity like food stamps to accept or not accept. It is little more than a process of purchasing insurance.

Healthcare.gov is a website that sells insurance. If you want to complain about anything, it should be the amount of government money that went into developing a vehicle for selling insurance. That’s a completely legitimate complaint. You can complain about the problems that the website had, but, if you have ever used a new piece of tech, there are ALWAYS issues. That’s why Gmail was beta tested for years. IOS 7 and Windows 8 were greeted with universal scorn. Standard tech. To expect the US government to do better than Apple and Microsoft did with their core products would be unlikely.

Now, if you have ever bought insurance, it is hell. My least favorite part of buying insurance was navigating the marketplace. Each company has about a hundred different group options. Your head can explode comparing them all. Healthcare.gov made it easier. It grouped policies into categories that could be easily compared. It made the unmanageable, manageable. You could choose a bronze, silver, gold, platinum and the policies would offer options that would be increasingly desirable. Just like the metals, the better metal was associated with a better policy.

So given that Obamacare represents a methodology for buying insurance, I will be accepting all of the Platinum policies and a few of the bronze policies. Same as I have been doing all along.

I have no idea what they mean by this. It makes me think of when I was about 15. I went into New York City for the day and I was walking on the street. A not unattractive (but not an attractive) woman came up to me, looked me in the eye and said “want a date?”

I was psyched. I really was as good looking as my mother said I was. Here I was only in town for a few moments and women were waiting for the opportunity to date me. I must really be something.

I looked down (I really wasn’t capable of making eye contact) and said “Uhhhh, no thank you.”

By the time I finished my statement, she was gone. I heard her talking to the guy behind me on the street. “Want a date?” she asked him. I didn’t wait for his response.

Well, LinkedIn wants me to publish on “Healthcare Services.” I don’t know if I will be the only one they sent this email to or if everybody else “may be a winner.” I will, once again assume that Mom was right and that I really am special. Stay tuned for tales of my experience.