Tag: Insurance

Thanks Obama

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In news that should surprise no one, the cost for workers’ health insurance policies, as well as deductibles have skyrocketed over the past decade. 

This is not a surprise.  Obamacare was all about appeasing the malefactors in the insurance industry, and so it brought the fox into the hen house:

The high cost of health care is persisting during the pandemic, even for people lucky enough to still have job-based insurance.

The average annual cost of a health plan covering a family rose to $21,342 in 2020, according to the latest survey by the Kaiser Family Foundation, a nonprofit group that tracks employer-based coverage. Workers paid about a quarter of the total premiums, or $5,588, on average, with their employers picking up the rest of the cost.

An analysis of the results was published Thursday online in Heath Affairs, an academic journal. While premiums rose only slightly from the 2019 survey, the increase in premiums and deductibles together over the last decade has far outpaced both inflation and the growth in workers’ earnings. Since 2010, premiums have climbed 55 percent, more than double the rise in wages or inflation, according to the foundation’s analysis.

………

The survey also underscored how much workers with health insurance still have to spend out of pocket for their care. In addition to paying for their share of premiums, most employees face a hefty deductible — an average of $1,644 for an individual. That is more than twice as high as it was in 2010, when the average for a single person was $646, according to the foundation.

This was foreseeable in the plan, and made inevitable with Obama’s dissembling over the public option.

Can You Say ……… Dystopian? Good — I Knew You Could

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Google is looking at providing information services to employers to help them control their healthcare costs.

To put that into English, Google will collect enormous amounts of data about its clients employees in order flag people who are engaging in “Unhealthy Lifestyles” and mitigate employer exposure to healthcare costs.

Basically, they will spy on employees, and provide information that employers can use to meddle in their employees eat, when they sleep, etc.

And, though Google (Alphabet) will deny it, employers will use this data to fire employees who are flagged as healthcare cost risks.

If you want a picture of the Google’s future, imagine a boot stamping on a human face— forever:*

Without much fanfare, Verily, Alphabet’s life sciences unit, has launched Coefficient Insurance. It was only a matter of time before Google’s parent got into the health insurance business — in fact, one wonders what took it so long. With Google’s intimate knowledge of our daily patterns, contacts and dreams, the search engine group has for years had a far better picture of risk than any insurer.

That Coefficient Insurance, which is also backed by Swiss Re, would initially focus on the relatively arcane area of stop-loss insurance to protect employers from staff health cost volatility should not obscure its ambitious agenda for the rest of the industry. Thus, according to Verily’s senior management, it might soon start monitoring at-risk employees via their smartphones and even coaching them towards healthier lifestyles.

………

As with many services out of Silicon Valley, there is not much reflection about the probable reconfigurations of power among social groups — the sick and the healthy, the insured and the uninsured, the employers and the employees — that are likely to occur once the digital dust settles.

One would need to be extremely naive to believe that a more extensive digital surveillance system — in the workplace and, with Alphabet running the show, now also at home, in the car and wherever your smartphone takes you — is likely to benefit the weak and the destitute. Some good might come out of it — a healthier workplace, maybe — but we should also inquire who would bear the cost of this digital utopia.

………

Privacy law does not offer an adequate solution either. Under pressure from employers, most workers acquiesce to being monitored. This was obvious even before Alphabet’s foray into insurance, as plenty of smaller players have been pitching employers sophisticated workplace surveillance systems as a way of lowering healthcare costs.

If this does not scare the hell out of you, you have not been paying attention.

*Apologies to George Orwell.

In Preparation for the Debates, Here is a Medical Study

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It’s from The Lancet, and it shows that Bernie Sanders’ Medicare for all plan more than pays for itself:

Although health care expenditure per capita is higher in the USA than in any other country, more than 37 million Americans do not have health insurance, and 41 million more have inadequate access to care. Efforts are ongoing to repeal the Affordable Care Act which would exacerbate health-care inequities. By contrast, a universal system, such as that proposed in the Medicare for All Act, has the potential to transform the availability and efficiency of American health-care services. Taking into account both the costs of coverage expansion and the savings that would be achieved through the Medicare for All Act, we calculate that a single-payer, universal health-care system is likely to lead to a 13% savings in national health-care expenditure, equivalent to more than US$450 billion annually (based on the value of the US$ in 2017). The entire system could be funded with less financial outlay than is incurred by employers and households paying for health-care premiums combined with existing government allocations. This shift to single-payer health care would provide the greatest relief to lower-income households. Furthermore, we estimate that ensuring health-care access for all Americans would save more than 68 000 lives and 1·73 million life-years every year compared with the status quo.

When they ask Sanders, “How will you pay for this?”, his response, “How can you pay for not doing this?”

Ha Ha!

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If Uber loses its appeal on driver status, it faces over £1 billion in VAT to HM Revenue and Customs:

Earlier this week Uber London Ltd filed its full accounts up until December 2018 at Companies House.

The big news wasn’t that the division made a relatively meagre profit of £5.1m. (The profit is hardly indicative of anything due to the group’s structural complexity.)

It was Note 13 which recounted the following about Uber London’s contingent liabilities:

………

The most newsworthy part was arguably this one: “the Uber Group is involved in an ongoing dialog with HMRC, which is seeking to classify the Uber Group as a transportation provider. Being classified as a transportation provider would result in a VAT (20%) on Gross Bookings or on the service fee that the Company charges Drivers, both retroactively and prospectively.”

Uber London’s accounts do not provide any indication of the total sum being recorded as a contingent liability at Uber London’s parent, the Uber Group.

But various sources tell us the bill could be as large as £1bn, or more. These are not small sums.

………

This is a big deal because the threshold for UK businesses having to pay VAT at the time was a turnover of more than £81K (it’s now £85k).

Since Uber drivers mostly earn much less than that, most do not incur VAT liabilities. If Uber is deemed an employer, however, those revenues would then be deemed Uber’s rather than drivers’ — more than surpassing the VAT threshold and thus exposing the company to potentially huge VAT liabilities from then on.

So, in addition to cheating their drivers, they have been using their “Gig Economy” structure to evade taxes, and now it’s coming back to bite them in the butt.  Quelle surprise.

In related news, another scheme to cheat their drivers Uber’s auto insurance division has lost one of its underwriters, probably either because of the gypsy cab firm’s increasingly toxic public image, or because their risk reduction protocols, which would involve things like driver background checks, are woefully inadequate.

In either case, James River Group is claiming, “Pre-tax, adverse development of between $55 and $60 million,” which was enough for them to dump their largest customer and tank their own stock:

PEMBROKE, Bermuda, Oct. 08, 2019 (GLOBE NEWSWIRE) — James River Group Holdings, Ltd. (the “Company”) (NASDAQ: “JRVR”) today announced that it delivered a notice of early cancellation, effective December 31, 2019, of all insurance policies issued to its largest customer, Rasier LLC and its affiliates.  All insurance policies related to this customer are included in the Company’s commercial auto line of business within its Excess and Surplus Lines segment, and a majority of the insurance policies were due to expire on February 29, 2020.

 “This account has not met our expectations for profitability, and we think it best to terminate the underwriting relationship as of year end,” said J. Adam Abram, Chairman and Chief Executive Officer of James River.

Uber doesn’t just f%$# its drivers, it f%$#s its suppliers as well.

H/t naked capitalism.

I Heard an Ad from Doctor Patient Unity on the Radio, and Did Some Digging

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Congress is getting close to advancing one of the few significant bipartisan reforms to the health care system still on the docket: legislation to curb the practice of “surprise medical billing.”

Naturally, that progress has sparked a last-ditch, dark money blitz bent on sinking these relatively modest bills, which aim to make it harder for unsuspecting patients to get hit with exorbitant bills if they see the wrong doctor in an emergency situation.

A group called “Doctor Patient Unity,” formed in June, has bankrolled a sweeping campaign of radio and television ads to pressure senators up for re-election in 2020 to oppose proposals to reform surprise medical billing.

Now, the dark money group is going after key lawmakers with direct appeals to their constituents. A mailer paid for by Doctor Patient Unity, obtained by The Daily Beast, urges Rep. Tim Walberg’s (R-MI) constituents to call his office and tell him to “say no to rate-setting” and “to put patients first.”

………

“They’re throwing the full kitchen sink at our efforts here and seeing what will stick,” said a congressional aide, who requested anonymity to discuss the matter candidly. “It’s unclear whether or not members are seeing a huge influx of constituent calls, but it’s obvious what they’re trying to do here, which is to back members off this proposal.”

………

Those hospitals and doctors have led the charge in publicly opposing the changes Congress is mulling. But as for who exactly is pouring money into the mailers and TV ads, Doctor Patient Unity appears to have taken pains to conceal the identities of the individuals or organizations running and financing the effort. Public records provide some clues, however. Incorporation documents on file in Virginia list an address in the town of Warrenton that is shared by the prominent Republican law firm Holtzman Vogel Josefiak Torchinsky.

The group’s treasurer, according to filings with the FCC, is a woman named Janna Rutland. She serves as treasurer for a handful of other political and policy organizations, and appears to be an employee of the GOP consulting firm Crosby Ottenhoff, which counts a number of high-profile Republican candidates and party organs among its clients.

Emergency, anesthesiology, and neonatal intensive care practices are prime targets for private equity buys because the are typically involve people who are too desperate to do the deep digging required to avoid outrageous charging, which gives them almost unlimited pricing power.

Once again, there is nothing that Wall Street finance cannot get worse.

Amazon Abided

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Is anyone surprised that now that Amazon has bought Whole Foods, it is cutting out medical benefits for a large portion of its workers?

I’m not.

Jeff Bezos fetishizes cruelty toward his employees:

Whole Foods is cutting medical benefits for hundreds of part-time workers, the company confirmed to Business Insider on Thursday.

The changes will take effect on January 1 and affect just under 2% of Whole Foods’ total workforce, a Whole Foods spokesperson told Business Insider.

Whole Foods has about 95,000 employees, so it means about 1,900 people will lose benefits.

The benefits that the company is cutting are offered to part-time employees who work at least 20 hours a week. The changes will not affect full-time employees.

Whole Foods said it was making the change “to better meet the needs of our business and create a more equitable and efficient scheduling model.”

When I hear, “Create a more equitable and efficient scheduling model,” I think irregular schedules and more precarious work situations.

In Bezos world, happy employees are a sign of failure.

What’s Worse than a Corrupt Cop?

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When police showed up at Harry Schmidt’s home on the outskirts of Pittsburgh, he thought they were there to help. He was still mourning the disappearance of the beloved forest green Ford F-150 pickup that he’d customized with a gun storage cabinet, and he hoped the cops had solved the crime.

Instead, the officers accused him of faking the theft. The Vietnam veteran was now facing up to seven years in prison.

Schmidt was stunned, but he was even more upset when he found out who had turned him in.

Erie Insurance, one of the nation’s largest auto insurers, had not only provided the cops with evidence against its own loyal customer — it had actively worked with them to try to convict him of insurance fraud.

Erie had even paid part of the salary of the lead detective who knocked on Schmidt’s door that day, as well as that of the prosecutor who went on to charge him with felony insurance fraud. And it would also secretly cover the costs of an expert witness to testify against Schmidt in court.

Schmidt, a grandfather living on disability benefits from his war-related injuries, had no history of theft or fraud. But he found himself the target of an extraordinary alliance between private insurers and public law enforcement agencies — one that transforms routine claims into criminal evidence, premium-paying customers into suspects, and the justice system into a hired gun for a multibillion-dollar industry. It’s an arrangement essentially unheard of in other businesses, and one rife with potential conflicts of interest, as well as grave consequences for law-abiding customers.

If the above is scary, just think about how insurance companies literally have power over whether you live or die when they deny your medical coverage.

Not Enough Bullets

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The highest pay packages go to CEOs at healthcare companies. For the third time in four years, chief executives in the healthcare field led the S&P 500 in terms of total compensation. The typical CEO in the industry made $16.1 million last year, which means half earned more than that, and half made less.

A look at the top and bottom-paid CEOs last year, by industry, as calculated by The Associated Press and Equilar, an executive data firm:

1. Healthcare, median compensation of $16.1 million, up from $14.7 million a year earlier.

I so want the guillotine concession when the sh%$ hits the fan on the dysfunctional healthcare system in the United States.

Tweet of the Day

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During the 90s, the influencers said millions of lost jobs for the sake of free trade and globalization were worth it. Now, they tell us the loss of several hundred thousand jobs in the insurance industry for the sake of Medicare For All is intolerable. pic.twitter.com/krGH9kdHgC

— corey robin (@CoreyRobin) March 24, 2019

The reality of the situation here is that their objection is not to the loss of jobs, but the losses of the idle rich shareholders.

H/t Naked Capitalism

Only In the United States

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Insurance groups are recommending GoFundMe as official policy – where customers can die if they can’t raise the goal in time – but sure, single payer healthcare is unreasonable.

h/t @DanRiffle pic.twitter.com/zetPW0MgDd

— Alexandria Ocasio-Cortez (@Ocasio2018) November 24, 2018

Yes, this a copy of a letter from an insurer that is asking someone to do a GoFundMe before they will approve a procedure.

Alexandria Ocasio-Cortez is rightly horrified by this, and so should we all.

Meanwhile, In Connecticut

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The state insurance department has just banned Donald Trump’s proposed phony health insurance:

The Connecticut Insurance Department has determined state law prohibits the sale of skimpy “short term” plans that are being promoted by President Donald Trump as a cheaper alternative to Affordable Care Act coverage.

“Connecticut already has the necessary statutory consumer protections in place to prohibit ‘junk plans’ ” Insurance Commissioner Katharine Wade said in a statement released Thursday.

The department also said a review of the new Trump administration rules for short-term, limited duration plans require any of these policies sold in the state to cover the Affordable Care Act’s comprehensive “essential health benefits.”

Those essential benefits include hospitalization and outpatient care, as well as mental health, maternity, prescription drug coverage, pediatric care and rehabilitative services.

The ACA allowed people to purchase short-term plans, which usually lacked maternity, mental health, full drug benefit and other coverages, but limited their coverage period to three months. These policies were also not renewable.

But the Trump administration’s new rules, issued Aug. 1, allow for nearly a year’s coverage under a short-term plan. They also allow short -term plans to be renewed for up to three years.lans require any of these policies sold in the state to cover the Affordable Care Act’s comprehensive “essential health benefits.”

The Connecticut Insurance Department said state law prohibits exclusions for pre-existing conditions for any policy that has coverage of six months or longer.

………

Other states, including New Jersey and Massachusetts, also regulate short-term plans to make them follow nearly all the same insurance rules that the Affordable Care Act plans have. In some of those states, carriers have decided against offering any short-term plans at all.

I rather expect to see more of this in other blue states.

I am not sure of the end-game here, but this is a glorious f%$# you to President inverted traffic cone.

Thanks, Obama………

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One of the central tenets of the PPACA (Obamacare) was that the malefactors of healthcare, insurance companies, big pharma, corrupt medical coding, etc. needed a seat at the table.

The logical extension of this is the admission by Dr. Jay Ken Iinuma, former medical director for Aetna for Southern California, that he rejected claims without ever looking at medical records:

California’s insurance commissioner has launched an investigation into Aetna after learning a former medical director for the insurer admitted under oath he never looked at patients’ records when deciding whether to approve or deny care.
California Insurance Commissioner Dave Jones expressed outrage after CNN showed him a transcript of the testimony and said his office is looking into how widespread the practice is within Aetna.

“If the health insurer is making decisions to deny coverage without a physician actually ever reviewing medical records, that’s of significant concern to me as insurance commissioner in California — and potentially a violation of law,” he said.

………

The California probe centers on a deposition by Dr. Jay Ken Iinuma, who served as medical director for Aetna for Southern California from March 2012 to February 2015, according to the insurer.
During the deposition, the doctor said he was following Aetna’s training, in which nurses reviewed records and made recommendations to him.

Jones said his expectation would be “that physicians would be reviewing treatment authorization requests,” and that it’s troubling that “during the entire course of time he was employed at Aetna, he never once looked at patients’ medical records himself.”

This is what happens when you fetishize the market, and decide that people need “Skin in the Game”.

This is the natural consequence of keeping predators in our healthcare system.

Time to Retire, Nancy

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Nancy Pelosi is doing her level best to minimize the increased support for single payer healthcare.

I guess that she’s too interested in campaign donations from the insurance companies.

It should be noted that Sanders got 16 co-sponsors on his bill, something that would have been unthinkable 2 years ago.

It’s time for Nancy Pelosi to step aside.

Unfortunately, the likely successors (Hoyer, etc.) suck too.

Ahhh ……… The Glories of the Free Market

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Hospitals have had problems with staffing their emergency rooms, and have taken to contracting with a company called EmCare.

The result has been exorbitant fees charged by out of network doctors:

Early last year, executives at a small hospital an hour north of Spokane, Wash., started using a company called EmCare to staff and run their emergency room. The hospital had been struggling to find doctors to work in its E.R., and turning to EmCare was something hundreds of other hospitals across the country had done.

That’s when the trouble began.

Before EmCare, about 6 percent of patient visits in the hospital’s emergency room were billed for the most complex, expensive level of care. After EmCare arrived, nearly 28 percent got the highest-level billing code.

On top of that, the hospital, Newport Hospital and Health Services, was getting calls from confused patients who had received surprisingly large bills from the emergency room doctors. Although the hospital had negotiated rates for its fees with many major health insurers, the EmCare physicians were not part of those networks and were sending high bills directly to the patients. For a patient needing care with the highest-level billing code, the hospital’s previous physicians had been charging $467; EmCare’s charged $1,649.

“The billing scenario, that was the real fiasco and caught us off guard,” said Tom Wilbur, the chief executive of Newport Hospital. “Hindsight being 20/20, we never would have done that.” Faced with angry patients, the hospital took back control of its coding and billing.

Newport’s experience with EmCare, now one of the nation’s largest physician-staffing companies for emergency rooms, is part of a pattern. A study released Monday by researchers at Yale found that the rate of out-of-network doctor’s bills for customers of one large insurer jumped when EmCare entered a hospital. The rates of tests ordered and patients admitted from the E.R. into a hospital also rose, though not as much. The use of the highest billing code increased.

………

In the study, the researchers examined nearly nine million visits made to emergency rooms run by a variety of companies between 2011 and 2015, using data from a single insurance company that does business in every state. In exchange for access, the researchers agreed not to identify the insurer. Insurers and health care providers typically sign contracts forbidding them to reveal the prices they have agreed to, and the national trends in surprise billing detected by the Yale team are consistent with a broader study by government researchers.

The new data suggests that EmCare, part of publicly traded Envision Healthcare, did not sign contracts with the insurance company and was able to charge higher prices.

Fiona Scott Morton, a professor at the Yale School of Management and a co-author of the paper, described the strategy as a “kind of ambushing of patients.” A patient who goes to the emergency room can look for a hospital that takes her insurance, but she almost never gets to choose the doctor who treats her.

This actually highlights a flaw in Obamacare:  Whatever protection you have goes away when you get out of network services.

The larger picture is that for-profit healthcare is inefficient and morally bankrupt.

Clearly, the Problem Is Not Enough Markets

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Drug rehabilitation clinics are paying brokers to get bodies in the door:

Days after he relapsed on heroin last summer, Patrick Graney received an offer that was too good to turn down.

How would he like to get treatment in a beach town with a hipster vibe in South Florida — with all expenses paid, including airfare from his Massachusetts home? Graney didn’t have to think long. He was on a flight south the next day. Two months later he was dead.

The arrangement — according to interviews with Graney’s mother and girlfriend and saved Facebook messages he sent — was brokered by Daniel Cleggett, a flamboyant figure, and some would say a pillar, in the Boston-area drug recovery community. A former addict who has spent nearly a quarter of his life in jail, Cleggett has turned entrepreneur in the burgeoning treatment industry for people addicted to opioids such as heroin and prescription painkillers.

He presides over an expanding empire of treatment facilities in Massachusetts, but he has also helped recruit addicted young people from Massachusetts for drug rehab centers in South Florida, according to the patients’ families and others who know Cleggett and are familiar with the arrangements. Two of these young men, including Graney, died from overdoses in hotel rooms in the oceanside resort communities where they were sent for treatment.

………

Patient brokers can earn up to tens of thousands of dollars a year by wooing vulnerable addicts for treatment centers that often provide few services and sometimes are run by disreputable operators with no training or expertise in drug treatment, according to Florida law enforcement officials and two individuals who worked as brokers in Massachusetts. Cleggett refused to say whether he was paid to find customers for Florida treatment centers.

The facilities are tapping into a flood of dollars made available to combat the opioid epidemic and exploiting a shortage of treatment beds in many states. As center owners and brokers profit, many patients get substandard treatment and relapse.

The role of patient brokers in steering addicts to out-of-state treatment centers is now coming under scrutiny from law enforcement, including Massachusetts Attorney General Maura Healey, according to a spokeswoman for her office. “These recruitment operations take advantage of the desperation of people struggling with addiction to refer them to treatment centers not based on their best interest, but in order to get a commission,” Healey said in a statement. “Patients need to access safe and effective recovery options instead of being treated like paychecks.”

Such arrangements can be illegal in some cases under federal and Massachusetts law if facilities pay brokers to bring them patients and if patients are given inducements, such as free travel or insurance, to enroll in a particular treatment center.

(emphasis mine)

It seems that the only growth industry in the United States these days is parasitism.