500 Million Lines of Code

[Turdacious]

From a memo from the Clinton administration in 1993 about Hillarycare:

http://www.washingtonpost.com/blogs/won ... ents-show/
Same as it ever was.

[Turdacious]

Federal policies to reward high-quality health care are unfairly penalizing doctors and hospitals that treat large numbers of poor people, according to a new report commissioned by the Obama administration that recommends sweeping changes in payment policy.

Medicare and private insurers are increasingly paying health care providers according to their performance as measured by the quality of the care they provide. But, the draft report by an expert panel says, the measures of quality are fundamentally flawed because they do not recognize that it is often harder to achieve success when treating people who do not have much income or education.

Low-income people may be unable to afford needed medications or transportation to doctor’s offices and clinics, the panel said. If they have low levels of formal education or literacy, they may have difficulty understanding or following written instructions for home care and the use of medications. In addition, the clinics and hospitals they use may lack the resources and high tech equipment needed to diagnose and treat illnesses.

http://www.nytimes.com/2014/04/28/us/po ... i=12616893

Single doctor practices are also being harmed:
http://www.utsandiego.com/news/2014/apr ... -medicine/

[Turdacious]

The Doctors Company, the nation’s largest insurer of physician and surgeon medical liability, today announced results from the largest physician survey conducted to date on the future of health care in America. More than 5,000 physician members within The Doctors Company organization responded to the independent survey, and the overwhelming indication is that concerns surrounding a shortage of health care professionals may be exacerbated by current physician sentiment regarding the profession. Specifically, nine out of 10 physician respondents indicate an unwillingness to recommend health care as a profession. In addition, 43 percent of respondents indicate that they are contemplating retiring within the next five years as a result of transformative changes occurring within America’s health care system.

http://www.thedoctors.com/TDC/PressRoom ... _ID_004671

[Turdacious]

Democrats have been claiming a turning point in the battle over Obamacare for the better part of the last month. First came the news that 8 million people had signed up -- exceeding the law's goals -- and then came the Congressional Budget Office report that its cost estimates are decreasing.

President Obama even took something of a victory lap, declaring the debate over his signature health-care law over.

When it comes to the American people, though, there has been basically zero rallying effect. And in fact, they still expect Obamacare to do significantly more harm than good -- in about the same proportions as before.

http://www.washingtonpost.com/blogs/the ... lse-start/

[Turdacious]

About one-third of primary-care physicians and one-fourth of specialists have already completely closed their practices to Medicaid patients. Over 52% of physicians have already limited the access that Medicare patients have to their practices, or are planning to, according to a 2012 survey by Merritt Hawkins for the Physicians Foundation. More doctors than ever already refuse Medicaid and Medicare due to inadequate payments for care, and that trend will only accelerate as government lowers reimbursements.

Less widely known is that inadequate reimbursement by government insurance to doctors substantially increases private-insurance prices. According to a December 2008 Milliman report presented by Will Fox and John Pickering, a shortfall of more than $88 billion in payments from Medicaid and Medicare beneficiaries added more than $1,500 extra a year in premiums and $1,800 extra in total out-of-pocket costs to every family of four with private insurance. With increasing enrollment into government insurance, private premiums will undoubtedly rise even more.

http://online.wsj.com/news/articles/SB1 ... 71576.html

[Turdacious]

Despite the unemployment rate plummeting, more than 92 million Americans remain out of the labor force.

The unemployment rate dropped to 6.3 percent in April from 6.7 percent in March, the lowest it has been since September 2008 when it was 6.1 percent. The sharp drop, though, occurred because the number of people working or seeking work fell. The Bureau of Labor Statistics does not count people not looking for a job as unemployed.

The bureau noted that the civilian labor force dropped by 806,000 last month, following an increase of 503,000 in March.

The amount (not seasonally adjusted) of Americans not in the labor force in April rose to 92,594,000, almost 1 million more than the previous month.

http://washington.cbslocal.com/2014/05/ ... bor-force/

[Turdacious]

Same as it ever was...

[Turdacious]

As rocky as its rollout was, it cost the federal exchange, healthcare.gov, an average of $647 of federal tax dollars to sign up each enrollee, according to a new report. It cost an average of $1,503 – well over twice as much – to sign up each person in the 15 exchanges run by individual states and Washington, D.C.

What was not expected, said Angoff in an interview, is that the five states whose governors and/or legislatures were among the most adamant about resisting the Affordable Care Act — Florida, Texas, Georgia, Virginia, and Michigan — ended up with the lowest per-person enrollee costs. Florida’s cost per enrollee was just $76; Texas’ was $102, and Michigan’s $427.

“The states that fought the ACA the hardest ended up with exchanges that have been very efficient,” he said.

http://capsules.kaiserhealthnews.org/in ... e-bargain/

[Turdacious]

Local business owners might be hoping the Affordable Care Act’s insurance mandates cover sticker shock.

The law’s employer coverage mandate doesn’t take effect until 2015, but early plan renewals are starting to roll in. And for some businesses, the premium jumps are positively painful.

Local insurance brokers are reporting spikes ranging from 35 percent to 120 percent on policies that renew from July to December. The increases are especially acute among employers with workforces made up of younger, healthier men. That’s because Obamacare prohibits offering lower rates to healthier groups. It also narrows the allowed premium gap between older and younger enrollees.

“It’s like if there were no more safe-driver discounts with State Farm,” said local insurance broker Frank Nolimal of Assurance Ltd. “Everybody has the same rate, whether you have three DUIs, or you’re a (nondrinking) churchgoing Mormon.”

The changes put as many as 90,000 policies across Nevada at risk of cancellation or nonrenewal this fall, said Las Vegas insurance broker William Wright, president of Chamber Insurance and Benefits. That’s more than three times the 25,000 enrollees affected in October, when Obamacare-compliant plans first hit the market.

Some workers are at higher risk than others of losing company-sponsored coverage. Professional, white-collar companies such as law or engineering firms will bite the bullet and renew at higher prices because they need to compete for scarce skilled labor, Nolimal said.

But moderately skilled or low-skilled people making $8 to $14 an hour working for landscaping businesses, fire-prevention firms or fencing companies could lose work-based coverage because the plans cost so much relative to salaries.

Employees who keep their coverage might see leaner take-home pay, which could hurt the economy.

http://www.reviewjournal.com/politics/o ... acare-pain

With the 16th lowest average household income in the nation, this is gonna hurt.
http://www.statista.com/statistics/2331 ... -by-state/

[Shafpocalypse Now]

ACA is looking more and more like pork for the insurance industry at the expense of both doctors and patients.

[Turdacious]

In the midst of all the turmoil in health care these days, one thing is becoming clear: No matter what kind of health plan consumers choose, they will find fewer doctors and hospitals in their network — or pay much more for the privilege of going to any provider they want.

These so-called narrow networks, featuring limited groups of providers, have made a big entrance on the newly created state insurance exchanges, where they are a common feature in many of the plans. While the sizes of the networks vary considerably, many plans now exclude at least some large hospitals or doctors’ groups. Smaller networks are also becoming more common in health care coverage offered by employers and in private Medicare Advantage plans.

Insurers, ranging from national behemoths like WellPoint, UnitedHealth and Aetna to much smaller local carriers, are fully embracing the idea, saying narrower networks are essential to controlling costs and managing care. Major players contend they can avoid the uproar that crippled a similar push in the 1990s.

http://www.nytimes.com/2014/05/13/busin ... t_now&_r=0
If you like your doctor...

[TerryB]

ACA is looking more and more like pork for the insurance industry at the expense of both doctors and patients.

Bingo. Why do you think they aren't squawking too loudly, much less outright rebelling, about any of this. They stand to gain more customers (by force), have their competition reduced ("bad apple" insurers pushed out), have their losses covered by the taxpayers, and sit at the big table in Washington (until Washington decides to take them over outright).

[Turdacious]

ACA is looking more and more like pork for the insurance industry at the expense of both doctors and patients.

On that happy note...

The Doctors Company, the nation’s largest insurer of physician and surgeon medical liability, today announced results from the largest physician survey conducted to date on the future of health care in America. More than 5,000 physician members within The Doctors Company organization responded to the independent survey, and the overwhelming indication is that concerns surrounding a shortage of health care professionals may be exacerbated by current physician sentiment regarding the profession. Specifically, nine out of 10 physician respondents indicate an unwillingness to recommend health care as a profession. In addition, 43 percent of respondents indicate that they are contemplating retiring within the next five years as a result of transformative changes occurring within America’s health care system.

http://www.thedoctors.com/TDC/PressRoom ... _ID_004671

[Turdacious]

If aviation was done as professionally as medicine, we'd be splashing planes left and right, I am certain of it. No checklists,

"The Checklist Manifesto" is written by a surgeon who adapted aviation checklists to the hospital scenario.

IN Bethesda, Md., in a squat building off a suburban parkway, sits a small federal agency called the Office for Human Research Protections. Its aim is to protect people. But lately you have to wonder. Consider this recent case.

A year ago, researchers at Johns Hopkins University published the results of a program that instituted in nearly every intensive care unit in Michigan a simple five-step checklist designed to prevent certain hospital infections. It reminds doctors to make sure, for example, that before putting large intravenous lines into patients, they actually wash their hands and don a sterile gown and gloves.

The results were stunning. Within three months, the rate of bloodstream infections from these I.V. lines fell by two-thirds. The average I.C.U. cut its infection rate from 4 percent to zero. Over 18 months, the program saved more than 1,500 lives and nearly $200 million.

Yet this past month, the Office for Human Research Protections shut the program down. The agency issued notice to the researchers and the Michigan Health and Hospital Association that, by introducing a checklist and tracking the results without written, informed consent from each patient and health-care provider, they had violated scientific ethics regulations. Johns Hopkins had to halt not only the program in Michigan but also its plans to extend it to hospitals in New Jersey and Rhode Island.

http://humansubjects.energy.gov/doe-res ... 0_2007.pdf

FWIW, OHRP is part of HHS.

[Turdacious]

Double-digit premium increases will likely be seen this year because of Obamacare, according to an analysis from Avalere Health.

Many in the industry had expected the age mix of exchange enrollees to drive up premiums but Avalere said that wasn’t the case. Instead, the consulting firm this week blamed the increasing cost of medical care, utilization of services and new medical technology — all of which “make it likely that exchange plans will need to increase their prices.”

“This ranges from 16 percent in Washington, D.C., to 94 percent in Mississippi,” Avalere said.

http://www.benefitspro.com/2014/05/09/d ... ed?ref=rss

Any guesses on what the labor market effects will be in states with the biggest increases?

[Turdacious]

The research by Ms. Dafny, Mr. Gruber and Mr. Ody, to be published by the National Bureau of Economic Research next week, concludes that premiums on the exchanges are 11 percent higher than they would be if all the health insurance companies that sell policies in each state had participated in the new markets for health plans.

http://www.nytimes.com/2014/05/16/upsho ... .html?_r=0

[Turdacious]

Consumers who purchased new health plans from Blue Shield of California have sued the insurer, claiming they were misled into thinking the insurance would cover their desired doctors and hospitals.

In their complaint filed in California state court on Wednesday, San Francisco residents John Harrington and Alex Talon accused Blue Shield of misrepresenting that their plans, sold on California's health exchange, would cover the full provider network advertised on the company's website.

http://news.yahoo.com/california-consum ... ector.html
This will be interesting when it gets to the 9th Circuit.

[Turdacious]

The government may be paying incorrect subsidies to more than 1 million Americans for their health plans in the new federal insurance marketplace and has been unable so far to fix the errors, according to internal documents and three people familiar with the situation.

The problem means that potentially hundreds of thousands of people are receiving bigger subsidies than they deserve. They are part of a large group of Americans who listed incomes on their insurance applications that differ significantly — either too low or too high — from those on file with the Internal Revenue Service, documents show.

The government has identified these discrepancies but is stuck at the moment. Under federal rules, consumers are notified if there is a problem with their application and asked to upload or mail in pay stubs or other proof of their income. Only a fraction have done so, according to the documents. And, even when they have, the federal computer system at the heart of the insurance marketplace cannot match this proof with the application because that capability has yet to be built, according to the three individuals.

So piles of unprocessed “proof” documents are sitting in a federal contractor’s Kentucky office, and the government continues to pay insurance subsidies that may be too generous or too meager. Administration officials do not yet know what proportion are overpayments or underpayments. Under current rules, people receiving unwarranted subsidies will be required to return the excess next year.

The inability to make certain the government is paying correct subsidies is a legacy of computer troubles that crippled last fall’s launch of HealthCare.gov and the initial months of the first sign-up period for insurance under the Affordable Care Act. Federal officials and contractors raced to correct most of the technical problems hindering consumers’ ability to choose a health plan. But behind the scenes, important aspects of the Web site remain defective — or simply unfinished.

http://m.washingtonpost.com/national/he ... story.html

So the interface between insurance companies, HHS, and the IRS isn't complete (i.e. the website still doesn't really work).

[Turdacious]

Re the VA:

The agency tracks and widely reports the average wait time: 273 days. But the internal data indicates that veterans filing their first claim, including those who served in Iraq and Afghanistan, wait nearly two months longer, between 316 and 327 days. Those filing for the first time in America’s major population centers wait up to twice as long—642 days in New York, 619 days in Los Angeles, and 542 days in Chicago.

The ranks of veterans waiting more than a year for their benefits grew from 11,000 in 2009, the first year of Obama’s presidency, to 245,000 in December—an increase of more than 2,000 percent.

They show that while the agency has spent four years and $537 million on a new computer system, 97 percent of all veterans’ claims remain on paper. Since those numbers were tallied by the agency in January, the VA’s two top technology officers have announced their resignations, saying they had accomplished their goals.

The agency’s public pronouncements about hiring 3,300 additional claim processors since 2010 to cope with the influx of returning Iraq and Afghanistan veterans also were misleading, the documents show.

Because of turnover and the loss of more than 2,000 workers temporarily paid through stimulus funds, staffing at the VA’s 58 regional offices actually has increased by fewer than 300 people since September 2010—even as the volume of new claims increased dramatically.

At a majority of the regional offices—including those in New York; Chicago; Los Angeles; Waco, Texas; and Oakland, California—the VA employs fewer people than it did two years ago, according to the VA’s internal documents.

http://www.thedailybeast.com/articles/2 ... obama.html

[Turdacious]

Medicare paid for more than 200 million office visits for established patients in 2012. Overall, health professionals classified only 4 percent as complex enough to command the most expensive rates. But 1,800 providers billed at the top level at least 90 percent of the time, a ProPublica analysis found. Experts question whether the charges are legitimate.

http://www.propublica.org/article/billi ... newsletter

So much for controlling waste, fraud, and abuse in Medicare.

[Turdacious]

President Barack Obama appointed a new White House adviser Friday and charged her with overseeing the execution of major policies like health care, underscoring the growing concern in the West Wing about political problems that have arisen because of poor follow-through.

The White House said Kristie Canegallo will serve as deputy chief of staff and handle a diverse portfolio that will also include the include implementing education policies and managing the drawdown of the war in Afghanistan. Canegallo's promotion comes as Obama's chief of staff Denis McDonough seeks to institutionalize some of the White House's harsh lessons learned from the failed rollout of the enrollment website for the president's signature health law.

"The president has directed that whenever we go through a major event, we capture the lessons learned so that we don't repeat them, and that we adapt," McDonough said. "Given our experience with healthcare.gov, we have determined we need more senior-level focus on implementation and execution."

http://www.huffingtonpost.com/2014/05/1 ... 39445.html

[Turdacious]

In its latest report on the law, the Congressional Budget Office said it is no longer possible to assess the overall fiscal impact of the law. That conclusion came as a surprise to some fiscal experts in Washington and is drawing concern. And without a clear picture of the law’s overall financing, it could make it politically easier to continue delaying pieces of it, including revenue raisers, because any resulting cost increases might be hidden.

Charles Blahous, a senior research fellow at George Mason University’s free market-oriented Mercatus Center, calls the CBO’s inability to estimate the net effect of the law “a real problem.”

“The ACA’s financing provisions were assumed to be effective so as to get a favorable score out of CBO upon enactment, but no one is keeping track of whether they’re being enforced,” says Blahous, a public trustee for Social Security and Medicare. “We receive occasional updates on the gross costs of the law, but none on whether the previously projected savings provisions are producing what was originally projected.”

http://cdn.rollcall.com/news/-233551-1. ... gination=1

[Turdacious]

For months, there have been assertions that the mechanisms embedded in Obamacare, designed to offset losses that insurance companies will take this year on their exchange business, amount to a bailout of the insurance industry.

At the same time, it wasn’t clear where the money to pay for these “risk adjustments” would come from in the first place.

Even if the Obama team tried to re-program slush funds that it surfaced inside the Department of Health and Human Services, a recent analysis by the Congressional Research Service makes clear that first, Congress would have to separately appropriate the funds in order for any money to be spent on the Obamacare plans. That was never likely to happen.

Now we know where the “bailout” money is going to come from. It will be paid for by a new tax levied on the insurance companies.

Mandy Cohen, the Acting Administrator of the Centers for Medicare and Medicare Service’s Center for Consumer Information and Insurance Oversight, delivered that message yesterday. Cohen was testifying before the House Subcommittee on Economic Growth, Job Creation and Regulatory Affairs.

She said that if funding for the risk corridors can’t be financed off the money that gets clawed away from profitable insurers (therefore allowing the entire scheme to remain budget neutral) then CMS has the authority, if not the intention to impose additional “user fees” on all health insurers to cover the higher losses experienced by the Obamacare plans.

http://www.forbes.com/sites/scottgottli ... alth-plan/

[TerryB]

Good. They got in bed with the Administration, hoping to make even more money while distorting our healthcare.

[Turdacious]

The clearest explanation of the VHA I've ever seen.

[youtube]http://www.youtube.com/watch?v=x-5zEb1oS9A[/youtube]