Category: Insurance

Yeah, a Big F%$#ing Deal

No Comments

Joe Biden has issued a rule banning surprise medical billing. 

I’m surprised, particularly its application to emergency services, where private equity has made surprise billing a central part of their profit generation strategies.  (Biden has a lot of PE types in the administration)

This is an very good, at least in the context of an executive order: (We really need a law to ban this)

The Biden administration on Thursday unveiled the first in a series of rules aimed at banning surprise billing.

The interim final rule bars surprise billing for emergency services and high out-of-network cost-sharing for emergency and non-emergency services. It also prohibits out-of-network charges for ancillary services like those provided by anesthesiologists or assistant surgeons, as well as other out-of-network charges without advance notice.

………

While public health insurance programs like Medicare and Medicaid already prohibit balance billing, people with job-based coverage or individual health plans frequently and unknowingly accept care from an out-of-network provider before they are slapped with a surprise medical bill. The new rule aims to put a stop to that.

………

This first round of regulation applies to providers, air ambulance providers, group health plans, health insurance issuers and Federal Employees Health Benefits Program carriers. The rule takes effect in 60 days, but most provisions don’t apply until January 1. Providers and insurers have until September 1 to submit comments.

Air Ambulance providers have been charging insane rates over the past few years as PE has snapped up more services.

The private equity model of medicine is to drastically overcharge people in situations where they have no choice.

Under the new rule, health plans that cover emergency services cannot use prior authorization for those services and must pay for them regardless of whether the clinician is an in-network provider or emergency facility. Likewise, insurers can’t charge their enrollees higher out-of-pocket costs for emergency services delivered by an out-of-network provider. They also have to count beneficiaries’ cost-sharing for those emergency services toward their in-network deductible and out-of-pocket maximums.

………

The Biden administration is still working out the details about how the dispute resolution process will work. But Congress laid out the broad-brush strokes in December’s No Surprises Act, which passed as part of its end-of-year spending package. Providers and insurers will have 30 days to agree to a price for the medical services delivered. And if they don’t settle, they’re supposed to enter arbitration, during which each side will present a final offer and make their case for why their recommendation is best. The arbitrator must then pick one of the two offers. But they can’t split the difference.

MY guess is that the PE parasites will still find a way to rat-f%$# people, it’s king of their “thing”, but it looks to be significantly harder now.

Personally, I favor a government owned National Health Service as a solution, but this is a positive move.

Everyone Hates Their Health Insurance Companies

No Comments

And all you have to do is read United Healthcare’s latest which is that they will be doing deep dives on all ER visits with an eye to denying payouts.

All insurance companies are bastards, and any policies to fix healthcare in the United State that involved them are doomed:

Doctors and hospitals are condemning plans by UnitedHealthcare—the country’s largest health insurance company—to retroactively deny emergency medical care coverage to members if UHC decides the reason for the emergency medical care wasn’t actually an emergency.

In the future, if one of UHC’s 70 million members submits a claim for an emergency department visit, UHC will carefully review what health problems led to the visit, the “intensity of diagnostic services performed” at the emergency department (ED), and some context for the visit, like the member’s underlying health conditions and outside circumstances. If UHC decides the medical situation didn’t constitute an emergency, it will provide “no coverage or limited coverage,” depending on the member’s specific insurance plan.

Emergency medical doctors and hospitals were quick to rebuke the plan. They say it sets a dangerous precedent of requiring patients to assess their own medical problems before seeking emergency care, which could end up delaying or preventing critical and even lifesaving treatment.

The policy was initially set to take effect July 1. But in an email to Ars Thursday, UHC now says it is delaying the rollout amid the criticism—at least until the end of the pandemic.

They are implying that if you have symptoms that look like a heart attack, and it turns out that it’s heart burn, you will be facing thousands of dollars that they won’t cover, because they are evil bastards.

Doctors are having none of this:

………

The delay is unlikely to ease critics’ concerns. After the policy was first announced last week, doctors were quick to note that assessing the necessity of emergency care before it’s actually given is nearly impossible. Many serious conditions have symptoms that overlap with nonserious conditions. For instance, chest pain may simply be a symptom of acid reflux or a panic attack, but it could also be a sign of a life-threatening heart attack. A bad headache could just be a bad headache, or it could signal a dangerous brain bleed.

In a 2018 analysis published in JAMA Open Network, researchers found that up to 90 percent of the symptoms that prompted an adult to go to the emergency room overlapped with symptoms of nonurgent conditions, which may be denied coverage in the future. But those same symptoms could also be linked to life-threatening conditions.

That analysis was spurred when the second-largest insurance company, Anthem, instituted a similar policy to UHC’s and began denying ED coverage.

In an accompanying editorial, one of the authors of the analysis—Maria Raven, chief of emergency medicine at the University of California, San Francisco—noted how problematic it is to retroactively evaluate emergency medical care. “My colleagues and I examined whether a patient’s symptoms at presentation to the ED could be labeled reliably as a non-emergency based on the discharge diagnosis—the diagnosis that Anthem is currently using to determine medical necessity,” she wrote. “We found it was impossible.”

It’s more than evil, it’s a public health disaster.

A significant proportion of vaccination reticence in the United States is driven by people believing that the medical-insurance complex will f%$# them like a drunk sorority girl whatever promises are made by the US government.

Our system is beyond broken.

Not Enough Bullets.

Unleash the Free Market

No Comments

New: This is a stunning chart.

The amount it costs to provide health care to people with employer insurance rises steadily with age.

Then, people turn 65 and go on Medicare, and the cost of health care drops precipitously.https://t.co/2HhgSvKrZr@matthew_t_rae @jcubanski pic.twitter.com/5kFiBllkj9

— Larry Levitt (@larry_levitt) April 27, 2021

This graph explains how the American healthacre system is failing.

If the market worked, healthcare costs would continue to increase, but they don’t.

Referring to the linked article, here are the money quotes:

  • Average health care spending per person per month for enrollees ages 60-64 in large employer plans ($1,061) is 38% higher than average monthly spending for traditional Medicare beneficiaries ages 65-69 ($770) (Figure 1). This comparison understates the savings that could be realized by shifting 60-64 year olds to Medicare, since one would expect 65-69 year olds to have roughly 20-25% higher spending, because health needs rise with age.
  • Average monthly health care spending for large employer plan enrollees ages 60-64 is similar to that of traditional Medicare beneficiaries in their early 70s, who tend to use more health care services than people in the younger age cohort.

I Guess Nancy Wants those Donations from the Insurance Industry

2 Comments

In yet another “Democrats in Disarray” story, the Washington Post notes that there friction between Nancy Pelosi and Bernie Sanders, because Pelosi wants to make Biden’s subsidies to Obamacare permanent, and Sanders wants to expand Medicare. 

This is really pretty simple, making the Obamacare subsidies permanent is a subsidy for the insurance companies, and not of people in need, while expanding Medicare helps everyone.

Pelosi wants to keep feeding money to the insurance companies because she wants to keep raising campaign donations from the insurance companies:

The White House is facing diverging pressure from two powerful allies — House Speaker Nancy Pelosi (D-Calif.) and Senate Budget Committee Chairman Bernie Sanders (I-Vt.) — over whether to use an upcoming spending package to strengthen the Affordable Care Act or expand Medicare eligibility.

Pelosi’s office is pushing the White House to make permanent a temporary expansion of Affordable Care Act subsidies that were included in the $1.9 trillion stimulus legislation last month, according to a senior Democratic aide who spoke on the condition of anonymity to describe internal conversations.

Sanders said in an interview that he is arguing for lowering the age of Medicare eligibility to 55 or 60 and expanding the program for seniors so it covers dental, vision and hearing care.

The contrasting visions for the next phase of President Biden’s legislative agenda reflect divisions within the Democratic Party about how Biden should further overhaul health insurance in the United States. Pelosi is looking to double down on the ACA, which has become more popular in recent years as it offers insurance subsidies to people well above the poverty line. Sanders, meanwhile, is looking for an opportunity to make progress on his longtime efforts to make government health insurance universal.

Lowering the Medicare age is better policy, because it puts more pressure on expanding the program in the future, while Obamacare, while better than what went before us, still sucks wet farts from dead pigeons.

Also, I would note that expanding Medicare is better policy, because older people vote in higher percentages than younger ones.

My prediction:  Biden goes with expanding subsidies to insurance companies, because, he’s always been a creature of the finance and insurance industries.

Interesting Take-Away on “Fixing” Obamacare

No Comments

Over at Naked Capitalism, a commenter makes a long and detailed post about Aetna and its pulling out of the exchanges. He ends with this:

Finally, two important take-aways from this. First, there is nothing in ObamaCare for Hillary’s “incrementalism” to address. It is simply too broken for even the industry’s master to deal with. Second, much as they tried, the Republicans did NOT kill ObamaCare. Capitalism did.

I think that this is an accurate description of the problems inherent in the system.

He also states that he was familiar, though not necessarily involved, in discussions on the “Public Option”, and that it was not killed as a sop to the insurers and big pharma, but because it it could not be made to work in the way that the Obama administration wanted it to, which was to screw sick people without making it too obvious:

………The public option (and this comes from as close to an insider as you’ll ever likely have) was put in as a dumping ground for the pre-existing conditions that the insurers didn’t want. It was in effect a high risk pool by another name, because “high risk pool” would make ObamaCare sound too much like car insurance, not a good selling point for sure. The problem was how to get high risk claimants into the public option without using the words pre-existing conditions. Could their actuaries identify these people by other criteria in a close enough fashion to where the math would still work out (i.e., where profit was still there). As time wore on, it became clear that this simply was not going to be possible, at least not to a level that was close enough to make the idea work.

This narrative makes sense to me, since most of Obama’s initiatives in the area of regulation and the roll of government have been directed toward privatizing profits and socializing losses. (He is very much a Chicago school kind of guy)

It’s a cogent critique which boils down to:  If you want healthcare to work in a profit driven marketplace, you can’t.

Of course the Teabaggers out there will have a different take, which is that Obamacare was designed to fail to force us into single payer, which would turn all of us into Kenyan Muslim Communists., but Teabaggers believe that markets can never fail, that they can only be failed.

And He Would Have Gotten Away with It Too, If It Weren’t for That Meddling Journalist

No Comments

David Sirota has been all over the conflicts of interest and corruption at the heart of the proposed merger between the health insurers Anthem and Cigna:

Late last week, there was some notable news in the arcane world of insurance regulation: Connecticut’s state comptroller, Kevin Lembo, called on Insurance Department Commissioner Katharine Wade to recuse herself from a review of the proposed merger of the nation’s second- and fourth-largest insurers, Anthem and Cigna, in which the state has a lead role. “The revelations and repeated reports about your financial, personal and professional ties to Cigna,” Lembo wrote to Wade, “will make it challenging for the Connecticut public to view the review process of the Anthem-Cigna merger as fair and transparent.”

Lembo’s letter marked the latest turn in a controversy that, while building for more than a year, has come to a head over the past month—driven in substantial part by the ongoing reporting of David Sirota, the Denver-based senior investigations editor for the International Business Times. On June 1, Sirota published a lengthy piece weaving together previously-known and new concerns over conflicts of interest surrounding the merger review: Wade, appointed to her role in 2015 by Connecticut Gov. Dannel Malloy, is a former longtime Cigna lobbyist, her husband is a top Cigna lawyer, her father-in-law works for a law firm that lobbies for Cigna, and her mother worked for Cigna as recently as 2013. Wade’s brother, Sirota reported, also “previously worked as a counsel” for Cigna. Further, after reviewing more than a decade’s worth of campaign finance data, Sirota showed that Anthem, Cigna, and Cigna’s lobbying firm gave more than $2 million to groups linked to Gov. Malloy, with much of that money coming since 2015.

Since then, Sirota has produced more than a dozen follow-ups on the topic—tracking, for example, grassroots groups and state legislators calling on Malloy to remove Wade from the merger review—as what he initially envisioned as a “good little blog item” turned into an investigative series.

 Unfortunately, IBT is suffering financial difficulties, so go to their Political Capital page, and clock on their ads.

Seriously though, this coverage is kicking some major ass.

End This Guy’s Political Career

1 Comment

This would create the largest health insurer in the country, but hizzonner thinks it’s fine to put a their own lobbyist in charge of creating a behemouth that would dictate healthcare to 53 million people.

Corruption doesn’t begin to describe this:

The regulatory review of the largest health insurance merger in U.S. history has now become a major political battle, pitting a national Democratic leader against his own party. On Friday, Connecticut Gov. Dan Malloy — a top Hillary Clinton surrogate who is the co-chair of the Democratic National Committee’s platform panel — faced pressure from his state’s Democratic House speaker to remove his appointed insurance commissioner from her role regulating Cigna’s controversial mega merger.

Connecticut House Speaker Brendan Sharkey’s call on Friday came after Clinton and former Health and Human Services Secretary Kathleen Sebelius raised concerns about the prospect of the merger harming the 53 million Americans who could be affected by the transaction. The deal is currently facing an antitrust review by state and federal regulators.

The political fight in Connecticut — which is leading states’ regulatory review of the merger — follows an International Business Times investigation documenting Connecticut Insurance Commissioner Katharine Wade’s personal and familial ties to Cigna, as well as an increase in campaign contributions to Malloy-linked political groups from donors affiliated with the merging companies. Wade, Cigna’s longtime in-house lobbyist, was appointed to her state government position by Malloy in early 2015 — just as Cigna and Anthem were finalizing their merger proposal.

“At a minimum, the commissioner should recuse herself from further involvement in the Cigna-Anthem merger review,” said Sharkey, according to the Connecticut Post. “Whether a potential conflict crosses a legal ethical line should not be the only factor here. Perception of a conflict is also an important part of the equation, and most onlookers, including consumer and health-care advocates following this issue all have the same perception.”

This is pay to play bullsh%$ at it’s worst.

I Need to Stop Calling Him Governor Rat F%$#*

1 Comment

He just jammed up the useless Baltimore Executive to force him to install air-conditioning before the start of the next school year instead of waiting for at least 3 years, and now he going to sign into a law a bill that provides free birth control to Marylanders:

Advocates say a new Maryland law will place the state at the forefront of efforts to require insurance plans to offer birth control at no out-of-pocket cost, expanding access to women and men who want to prevent unwanted pregnancies.

 The law goes further than President Barack Obama’s Affordable Care Act, which already reduced costs for women seeking birth control in many cases.

 Under the Contraceptive Equity Act, Maryland will be the first state to require insurance companies to cover over-the-counter emergency contraceptives, such so called morning-after pills, at no cost. Maryland also will be the first state prohibiting out-of-pocket costs for men who have vasectomies.

 Advocates who pushed the bill through the General Assembly say Maryland is the first state to pass such a comprehensive approach.

 “Maryland is on the forefront across the board with this act,” said Karen Nelson, president and CEO of Planned Parenthood of Maryland.

 Other provisions prohibit co-payments for any type of contraceptive and also ban preauthorization requirements for long-acting contraceptives such as IUDs. The law allows women to receive six months’ worth of birth control pills at one time.

Did I mention that he’s a Republican?

While I am not a fan of of the governor or many of his policies, he is not the kind of batsh%$ insane Australopithecine of many other (Scott Walker, Rick Scott, Paul LePage, Bruce Rauner, Sam Brownback, Matt Bevin, Rick Snyder, Pat McCrory,Greg Abbott, etc.) Republican governors.

Credit where credit is due.  He did the right thing. 

*Full disclosure, when we had problems with health insurance exchange, we called our state senator, and we ended getting a call from Hogan’s office, where a staffer fixed the problem.

Obamacare in a Nutshell

No Comments

Marcy Wheeler sees the elephant in the room about Obamacare, and by elephant in the room, I mean Republican thinking:

Partly, though, Obamacare is designed to underinsure people, because there’s a belief that unless people feel the sting of obtaining care, they’ll get too much of it. “Bending the cost curve” under Obamacare is largely driven by increasing the costs of actually using insurance to the end user as opposed to, say, eliminating the many layers of private profit that doesn’t actually improve health care but makes it expensive.

This is the problem at the core of Obamacare, and it is why allowing a Medicare buy in or a public option would have been so helpful.

It would have created an alternative to the contemptible greedheads who Obama shovels money at, and an infrastructure to move onto real publicly funded healthcare.

It’s the Insurance, Stupid

No Comments

We have yet another article wondering why fewer people are getting drivers licenses these days:

………

Young people are not getting driver’s licenses so much anymore. In fact, no one is. According to a new study by Michael Sivak and Brandon Schoettle at the University of Michigan Transportation Research Institute, the percentage of people with a driver’s license decreased between 2011 and 2014, across all age groups. For people aged 16 to 44, that percentage has been decreasing steadily since 1983.

It’s especially pronounced for the teens—in 2014, just 24.5 percent of 16-year-olds had a license, a 47-percent decrease from 1983, when 46.2 percent did. And at the tail end of the teen years, 69 percent of 19-year-olds had licenses in 2014, compared to 87.3 percent in 1983, a 21-percent decrease.

Among young adults, the declines are smaller but still significant—16.4 percent fewer 20-to-24-year-olds had licenses in 2014 than in 1983, 11 percent fewer 25-to-29-year-olds, 10.3 percent fewer 30-to-34-year-olds, and 7.4 percent fewer 35-to-39-year-olds. For people between 40 and 54, the declines were small, less than 5 percent.

………

Maybe it’s just that people today have more things they’d rather do than practice parallel parking between traffic cones. Or maybe it’s because the photos on those plastic cards are almost never flattering. Sivak and Schoettle are hoping to soon study possible reasons for the drop in driver’s licenses. But regardless of the cause, it seems that if you want to insult a teen today, shaming them for not being able to operate a motor vehicle might not be the way to go.

It’s not difficult to understand.

The FIRE (Finance, Insurance, and Real Estate) sector has been sitting athwart our economy sucking the marrow out of its bones for a very long time, and it appears that the insurance industry has finally reached a level where it’s breaking up America’s love affair with the automobile.

All in all, it’s king of a mixed emotions thing here.  The insurance industry and auto industry have both done a lot to f%$# up our country.

If only they could both lose.

How the Internet of Things Will Actually Be Used

No Comments

It will be invading our privacy and discrimination, all while presenting it as a benefit to the consumer.

You might want to check out this bit of propaganda from the insurance industry courtesy of the Washington Post, and imagine what they would do if they knew what food was in your fridge, or how often you drink, or what you set your thermostat to.

The term to describe this is “dystopian”:

For years, insurance companies have used estimates of your annual mileage to determine your car insurance rates. But with recent changes in technology, insurers now have an unprecedented ability to judge your actual driving habits. Armed with detailed data on how often you slam on the brakes and what times of day you’re on the road, insurance companies are increasingly relying on precise, technological means of assessing risk — and using that information to set your monthly premiums.

Liberty Mutual, the country’s third-largest property-and-casualty insurer, took the latest step in that direction Monday when it announced a partnership with Subaru. Beginning later this year, Subaru drivers who have paid for the automaker’s Starlink infotainment system will be able to download an app to their cars that notifies them when they are accelerating too aggressively or braking too hard.

The app is part of Liberty Mutual’s RightTrack program, which gives drivers a 5 percent discount on their rates for enrolling and additional discounts up to 30 percent for heeding the app’s guidance on driving safely.

Liberty Mutual, which began offering RightTrack in 2012, isn’t the only insurer to embrace usage-based insurance — a tactic that draws on a person’s real-world driving behavior to gauge his accident risk. Progressive, Allstate and State Farm operate similar programs, too.


.………

But as more Americans begin buying high-tech, connected cars that can talk to the Internet, other analysts say the rise of usage-based insurance raises uncomfortable questions for consumers and insurance companies alike.

“Don’t assume this is always going to be a way to lower your rates,” said Karl Brauer, an analyst at Kelley Blue Book. “It could be used against you to raise your rates long before you ever have an accident.”

Although many insurance companies say that agreeing to be tracked can only result in a discount, not a rate hike, those terms could always change in the future, Brauer and other analysts say. And people who drive safely one year but more riskily the next could effectively see their rates rise when an insurer decides to grant a smaller discount than before.

Then there’s the matter of consumer privacy. How long insurance companies can hold onto your data, and whom they can share it with, depends on each firm’s policies as well as state or local regulations. Insurers would also have to obey court orders for user data.But as more Americans begin buying high-tech, connected cars that can talk to the Internet, other analysts say the rise of usage-based insurance raises uncomfortable questions for consumers and insurance companies alike.

“Don’t assume this is always going to be a way to lower your rates,” said Karl Brauer, an analyst at Kelley Blue Book. “It could be used against you to raise your rates long before you ever have an accident.”

Although many insurance companies say that agreeing to be tracked can only result in a discount, not a rate hike, those terms could always change in the future, Brauer and other analysts say. And people who drive safely one year but more riskily the next could effectively see their rates rise when an insurer decides to grant a smaller discount than before.

Then there’s the matter of consumer privacy. How long insurance companies can hold onto your data, and whom they can share it with, depends on each firm’s policies as well as state or local regulations. Insurers would also have to obey court orders for user data.

………

Consumers who don’t want to be tracked don’t have to sign up. But when such programs become more common, opting out could serve as a “red flag” to insurance companies, according to Renee Stephens, vice president of U.S. auto quality for J.D. Power and Associates.

Insurers find behavioral monitoring attractive because it provides them with a clearer picture of the entire risk pool. By understanding better how each driver behaves, companies can design insurance plans that match a person’s risk more accurately and determine how much coverage a given driver requires.

Yes, just trust the insurance companies with your data, allow them to apply opaque algorithms to their systems, and the consumer will always benefit.

Yeah, sure, and Donald Trump does not have a comb over.

The insurance companies will use this to f%$# us like a drunk sorority girl.

Not a Good Sign

1 Comment

One of the features of Obamacare is the not for profit co-ops that are supposed to find an alternative to for profit insurers.

Many of them have failed, and now what is arguably the most successful co-op, Maine’s Community Health Options, has shut down individual enrollment:

Community Health Options, a not-for-profit co-op insurance company based in Maine that also sells health plans in New Hampshire, will limit individual enrollments later this month because of “higher-than-expected claims costs.”

It’s an inauspicious sign for the company, which was one of the few successful co-ops created by the Affordable Care Act. Twelve of the ACA’s 23 co-ops have folded or are in the process of closing down, all of which occurred this year.

Community Health Options is one of three insurers selling individual plans in Maine and one of five insurers in New Hampshire. Both states use the federal HealthCare.gov website for enrollment. The co-op will stop directly enrolling people in individual coverage on Dec. 15, and people who are signing up for its plans through HealthCare.gov will only have until Dec. 26, the co-op said on its website Wednesday.

The decision to halt enrollment early will not affect current members, and Community Health Options still plans on pursuing small employers into next year. “We aim to resume individual enrollment as soon as possible, but in the meantime continue to focus on group business,” CEO Kevin Lewis said in an e-mail Wednesday.

Community Health Options, which has 76,000 members, was one of the only ACA co-ops that didn’t lose money out of the gate. Several of the failed co-ops—written into the ACA as an alternative to the so-called public option—lost millions of dollars due to costly claims. Many older and sicker members chose the co-ops during the first two open enrollments due to their low premiums, but they also used a lot of healthcare services, which crushed the co-ops and their limited financial reserves.

The co-ops were supposed to be two things, a weak tea alternative to a public option, and to provide some cost competition with the for profit insurers who dominate their respective markets.

They are failing, and the largest insurer in the US,  UnitedHealth is threatening to leave the exchanges completely.

We are not yet in an adverse selection death spiral, but this is troubling.

Martin Shkreli Has Just Made Express Scripts® a Hero

2 Comments

This is a bigger shock than Darth Vader being Luke Skywalker’s father.

Deeply and ineluctiblky evil pharmacy benefits manager Express Scripts®, in partnership with the compounding pharmacy Imprimis®, will offer a $1.00 clone of Turing Pharmaceutical’s Dataprim anti-parasite drug:

Express Scripts, the largest pharmacy benefits manager in the U.S., said on Tuesday it will partner with Imprimis Pharmaceuticals to provide a $1 alternative to Daraprim, the 62-year-old drug for a rare parasitic infection. In September, the company that owned the drug stoked outrage when it hiked the drug’s price by more than 5,000 percent overnight.

 Imprimis, a California compounding pharmaceutical company, said in October it would make the alternative—a compounded formulation of the active ingredient in Daraprim, pyrimethamine, and another drug, leucovorin—available for $99 for a 100-count bottle, or less than $1 per pill.

 That compares with a price of $750 per pill for the drug provided by Turing Pharmaceuticals, the company that acquired Daraprim earlier this year and dramatically raised its price from $13.50 a tablet to $750.

Express Scripts® is so evil and incompetent that it stuns Richard Bruce Cheney, but Martin Shkreli has just allowed them to be heroes.

This is a mindf%$# on a level I would heretofore think impossible.

And Now We Learn that Her Insurance Company Demanded It

No Comments

Remember the story of Jennifer Connell, the Aunt who sued her nephew for injuring her wrist when he hugged her?

Not so much:

The law firm of Jainchill and Beckert released a statement on behalf of Jennifer Connell:

From the start, this was a case was about one thing:  getting medical bills paid by homeowner’s insurance.  Our client was never looking for money from her nephew or his family. It was about the insurance industry and being forced to sue to get medical bills paid. She suffered a horrific injury. She had two surgeries and is potentially facing a third.  Prior to the trial, the insurance company offered her one dollar. Unfortunately, due to Connecticut law, the homeowner’s insurance company could not be identified as the defendant.

………

Connell, a 54-year-old human resources manager, said she loves her nephew, but told the court he should be held responsible for her injury. Connell claims Tarala, of Westport, was negligent and careless, and is suing him for $127,000.

“Our client was very reluctant to pursue this case, but in the end she had no choice but to sue the minor defendant directly to get her bills paid. She didn’t want to do this anymore than anyone else would. But her hand was forced by the insurance company. We are disappointed in the outcome, but we understand the verdict. Our client is being attacked on social media. Our client has been through enough,” said her attorneys in a statement.

F%$# the insurance companies.

Seriously, just f%$# them.

H/t Crooks and Liars.

A Very Good Point on Obamacare

No Comments

The folks at Naked Capitalism have never been big fans of the PPACA, because they feel that it has far too many sops to the evildoers in the US healthcare system, in particular the insurance companies. (I agree)

Now Lambert Strether makes what is an obvious point, that the “Cadillac Tax” on high value healthcare plans are pretty clearly a tactic developed to union bust:


I haven’t written about much about ObamaCare’s “Cadillac Tax” mostly because it seemed (as we shall see) such an obvious union-busting measure that there wouldn’t be much of interest to say. However, a recent Kaiser briefing on how many employers will be affected by it has generated a lot of coverage, and, as it turns out, the Cadillac tax — not that anybody could have predicted this — turns out to be insanely complex, based on a crazypants neo-liberal economic assumption, and will screw over a lot more working people than originally thought. (There’s actually some pressure on the Hill for reform or repeal, and not just by the usual suspects, but I won’t cover the politics of it here).

………

And if the unions can’t deliver wages, and now they can’t deliver benefits — or prevent existing benefits from being taken away — what exactly do they deliver? So who is to determine what is “generous”? Workers, or pencil-necked< neo-liberal economists? Who never mention whether CEO health insurance — or top 20% health insurance, for that matter — is “too generous”? That said, let’s turn to the crapification. From the Kaiser briefing:

The potential of facing an HCPT assessment as soon as 2018 is encouraging employers to assess their current health benefits and consider cost reductions to avoid triggering the tax. Some employers announced that they made changes in 2014 in anticipation of the HCPT, and more are likely to do so as the implementation date gets closer. By making modifications now, employers can phase-in changes to avoid a bigger disruption later on.

………

So, a race to the bottom that starts out affecting “overly generous” health insurance, and ends up affecting more and more of the rest of us. Typical. I doubt this can be fixed by Congress this year or next, since the Democrats will not be able to admit that Obama has ever made a mistake in any aspect of his sorry administration, and Republicans have no choice but to throw red meat to their base by trying to repeal it all together. Pass the popcorn.

This is not a bug.  It’s a feature.

If you were come up with a way to get the truth for any people behind Obamacare, whether Obama, Gruber, or whoever, they all would say that they want to eliminate employer sponsored health insurance by making various claims about how having open insurance markets and “skin in the game” will make healthcare more efficient.  (All the available evidence shows otherwise)

Obama has been (at best) lukewarm on unions, with no effort to push card-check, his hiring of union-busting heiress Penny Pritzker, his aggressive support of union-busting mayor Rahm Emanuel, his tepid opposition to “Right to Work” legislation proposals put forward in many states, etc.

There are way too many people among Obama’s “Chicago School” policy advisers who see an Ayn Rand inspired dystopia as a model for a good society.  (As an aside, it turned out that even Ayn Rand could not live in the world which she hoped to create.)

Our country is looking more and more like the USSR circa 1987.

Today’s Must Read, from Paul Krugman

No Comments

Paul Krugman makes an interesting observation in the case of the lion killing dentist from Minnesota, and it has nothing to do with the ethics of killing things for your personal amusement, and everything to do with the fact that “Skin in the Game” does not work to control healthcare costs:

Wonkblog has a post inspired by the dentist who paid a lot of money to shoot Cecil the lion, asking why he — and dentists in general — make so much money. Interesting stuff; I’ve never really thought about the economics of dental care.

But once you do focus on that issue, it turns out to have an important implication — namely, that the ruling theory behind conservative notions of health reform is completely wrong.

For many years conservatives have insisted that the problem with health costs is that we don’t treat health care like an ordinary consumer good; people have insurance, which means that they don’t have “skin in the game” that gives them an incentive to watch costs. So what we need is “consumer-driven” health care, in which insurers no longer pay for routine expenses like visits to the doctor’s office, and in which everyone shops around for the best deals.

………

But what if even the underlying premise, that individual choice will hold down costs, is all wrong?

As it turns out, many fewer people have dental insurance than have general medical insurance; even where there is insurance, it typically leaves a lot of skin in the game. But dental costs have risen just as fast as overall health spending, and it may be that the reduced role of insurers actually raises those costs. According to the post,

In the rest of medicine, insurers have an important function in limiting costs and promoting quality. The market power of Medicare and major national insurance companies allows them to insist on better rates for their customers when they negotiate with doctors and hospitals.

“There’s been less presence from all kinds of insurance payers in the dental sector,” explained Andy Snyder, who is in charge of oral health at the nonpartisan National Academy for State Health Policy. “Medicare does not cover routine dental services, and private dental coverage is far less common than private medical coverage. So, the dental industry has faced less of the cost containment and quality improvement pressures that the rest of the health care sector’s experienced over the last couple of decades.”

So more skin in the game is not just useless but actually counterproductive.

Bazinga!

The Fix Was In All Along

No Comments

Three weeks ago, Vermont Governor, Peter Shumlin, having failed to secure an absolute majority in the election, throwing the results to the state house, announced that he was scrapping his plans for single payer.

While he claimed that politics had nothing to do with it, a subsequent analysis appears to indicate that he deliberately cast the numbers for single payer in the worst possible light:

Gov. Peter Shumlin could have proposed a financing plan for single payer health care that cost $1 billion less than the one he presented to the public Dec. 17.

Instead, demoralized after a stunning near defeat in the General Election, Shumlin scrapped his long awaited, universal, publicly financed health care plan because he said it would shock Vermont’s fragile economy.

………

But critics say now Vermonters won’t know if single payer could have succeeded in 2015, because after Shumlin decided it wasn’t feasible, he found a way to mitigate the inevitable wave of political backlash and appease his main constituencies: liberal advocates, business leaders, providers, and teacher and state employee unions.

Shumlin had said he would present a menu of options to the Vermont Legislature in the two year run up to the announcement, but instead he presented one plan that Vermonters could not afford.

One of the alternative plans proposed by his health care reform team that was not considered in the final analysis was a much less expensive, $1.6 billion option, that would have offered a universal, publicly financed insurance plan with benefit levels on par with what is available to most Vermonters in the commercial insurance market today, according to documents provided by the Shumlin administration.

“I don’t know exactly when he made that decision, but once it was made, there is no question in my mind that Shumlin pivoted to his roots and his instincts, which are purely political,” said Hamilton Davis, a journalist and longtime observer of Vermont health reform.

“He hung everything he could on it and walked away.”

John Franco, a prominent Burlington attorney who has been involved health care reform for two decades, says that Shumlin purposely chose a plan that covered 94 percent of individuals’ health care costs. Proposing an overly expensive option, Franco says, was a political calculation.

“If you build an airplane out of lead, it’s not going to fly,” Franco said.

………

But buried on the 260th page of the appendices to his report released just before New Year’s Day, is a financing plan that might have been a reasonable starting point for going forward.

This plan would have offered insurance at a level that is equal to the average employer plan now on the market and would have cost $1 billion less than the Cadillac level plan Shumlin rejected.

It appears that he overstated the costs by about $1 billion, which is over $3000 per resident of the state, over $5000 per worker, and that is not including the fact that he, “The Shumlin administration assumed there would be zero administrative savings to the program in year one.”

Why did this happen?

Perhaps because the legislature is voting on who gets the next term of Governor tomorrow, and some of the business and medical interests in the state cut a deal not to lobby for his opponent?

There is a part of me that is hoping that the legislature elects the Republican, because Shumlin has been a portrait in cowardice.

And Here is a Part of the Solution to Law Enforcement Impunity

No Comments

Here is a fascinating concept.

Given that police misconduct costs taxpayers millions of dollars, and a small percentage of the police are responsible for the bulk of these costs, how about requiring police officers to carry their own liability insurance, just as doctors are:

In almost every city across the US, tax dollars are used to cover the damages and settlements from lawsuits filed against their police departments due to officer misconduct. Taxpayers in essence pay out massive amounts in damages for officers not doing their job properly. Additionally, the cost is compounded because taxpayers are forced to continue paying the salaries of these criminal cops.

 City officials don’t have the guts to hold officers accountable for their actions. So a new approach is necessary to hold rogue officers responsible for their conduct.

 Just like doctors have to carry malpractice insurance, police officers should be required to carry professional liability insurance as a condition of employment.

 ………

 Similarly to how other professionals, such as doctors who are sued too many times become uninsurable, the demands of professional liability insurance will ensure risk reduction takes place. Meaning basically that if city officials won’t hold police accountable for their actions an insurance company on the hook for large police misconduct payouts certainly will.

 Problem officers would find their rates up until eventually they would become uninsurable, a wonderful way to have problem officers forced out of policing entirely.

 To avoid running into problems with union contracts, the strategy would allow cities to fund the base rate of the coverage, and officers funding any additional costs that would be associated with their claims history.

 In most cities, and Minneapolis in particular, it has been found that a handful of officers are responsible for the majority of complaints and lawsuits regarding police brutality.

Here is a quick rundown of how it would work:

  • Out of Control Cops: Evil.
  • Insurance Companies: Evil.
  • Insurance companies vs. Out of Control Cops: Pass the Popcorn.

Any questions?

Yes, the Goal is the Eimination of Employer Supplied Health Plans

No Comments

Remember when I said that I thought that one of the hidden goals of Obamacare was the elimination of employer sponsored healthcare plans?

Well, pretty much:

In a 2011 conversation about the Affordable Care Act, MIT economist Jonathan Gruber, one of the architects of the law more commonly known as Obamacare, talked about how the bill would get rid of all tax credits for employer-based health insurance through “mislabeling” what the tax is and who it would hit.

 In recent days, the past comments of Gruber — who in a 2010 speech noted that he “helped write the federal bill” and “was a paid consultant to the Obama administration to help develop the technical details as well” — have been given renewed attention.

 ………

 The issue at hand in this sixth video is known as the “Cadillac tax,” which was represented as a tax on employers’ expensive health insurance plans. While employers do not currently have to pay taxes on health insurance plans they provide employees, starting in 2018, companies that provide health insurance that costs more than $10,200 for an individual or $27,500 for a family will have to pay a 40 percent tax.

 “Economists have called for 40 years to get rid of the regressive, inefficient and expensive tax subsidy provided for employer provider health insurance,” Gruber said at the Pioneer Institute for public policy research in Boston. The subsidy is “terrible policy,” Gruber said.

 “It turns out politically it’s really hard to get rid of,” Gruber said. “And the only way we could get rid of it was first by mislabeling it, calling it a tax on insurance plans rather than a tax on people when we all know it’s a tax on people who hold those insurance plans.”

 ………

 The issue at hand in this sixth video is known as the “Cadillac tax,” which was represented as a tax on employers’ expensive health insurance plans. While employers do not currently have to pay taxes on health insurance plans they provide employees, starting in 2018, companies that provide health insurance that costs more than $10,200 for an individual or $27,500 for a family will have to pay a 40 percent tax.

 “Economists have called for 40 years to get rid of the regressive, inefficient and expensive tax subsidy provided for employer provider health insurance,” Gruber said at the Pioneer Institute for public policy research in Boston. The subsidy is “terrible policy,” Gruber said.

 “It turns out politically it’s really hard to get rid of,” Gruber said. “And the only way we could get rid of it was first by mislabeling it, calling it a tax on insurance plans rather than a tax on people when we all know it’s a tax on people who hold those insurance plans.”

Seriously, Obama, and the people who advise him, make Ronald Reagan look like a f%$#ing socialist.

Obamacare is chock full of manifestations of the unholy glee that Obama and His Evil Minions™ take in neoliberal free market ideology and the financial industry.

The most depressing thing is that the next president is probably going to be a lot worse.