Thanks ObamaCare!

So as a consequence of the arm twisting, refusal to reveal that effects and actual costs of O’Care to the Public, the Members voting for this travesty may result in some of these Perps seeking employment opportunities elsewhere after the upcoming election.

Dems find careers threatened by Obamacare votes

http://www.washingtonexaminer.com/politics/Dems-find-careers-threatened-by-Obamacare-votes-1228371-105059824.html

Seven months ago Speaker Nancy Pelosi spent a busy week rounding up votes to pass the Senate version of the Democrats’ health care legislation.

It wasn’t easy. She had to get Democrats who had voted no in November to switch to yes in March. And she had to get Democrats who had refused to vote for the bill in November without an anti-abortion amendment to vote for a bill in March that lacked that language.

She took the unusual step of scheduling the roll call for Saturday — so members wouldn’t go back to their districts and be besieged by Obamacare opponents.

Go Here to see how your Rep voted or consult the Congressional Record.

http://projects.washingtonpost.com/congress/

However, most of those that voted for the Bill admit reluctantly that they had not read it.

Cessna’s new Union Contract removes almost all flavors of health insurance packages for Union members now and mandates the choice of United Health Care Services or nothing. Blue Cross and Blue Shield and the few other packages offered even in the 2007 contract will be no longer serviced and be automatically rolled over into a United Health Care Services package which in the areas in and around Wichita very few doctors will take a variant form of United Health Care Services insurance outside of Wesley Hospital.

United Health Care Services model was mostly eyeballed by Humana and the United States Congress as the bare bones infrastructure for the few “variant” health insurance packages Americans will be expected to purchase by roughly 2014. United Health Care Services is deemed a lethal joke to the I.A.M. Union chapters of Wichita, as very few Family Practice Physician practices accept the insurance in Wichita and surrounding Counties and seeing such practices will imply heavy fines for violating the limitations of the contract for the UHCS package. Only one major Hospital in Wichita accepts UHCS packages (Wesley), and with a city this largely spaced out and reliant on automobile transport versus mass rail transit to get around having only one Hospital out of the various 4 main across the City and 8 or so hubs in the outskirts of Wichita can be dangerous if related to ER concerns.

Bloodbath…

@aye (#19).

First, thanks for the excellent commentary and questions.

I need to provide a little background information. In virtually no form of cancer is there a universally accepted, “standard” chemotherapy. For example, on the NCI’s website, listing state of the art cancer treatment for all forms of cancer, no fewer than two dozen different drug regimens are listed for metastatic breast cancer. Under the current system, doctors are free to choose from any of these, at any time in the course of the disease, and they are free to choose new drug regimens, appearing in the medical literature, or individualized for patients, based on existing and emerging laboratory tests (my own particular field).

Currently, doctors give first, second, third, fourth line drug therapy (my own sister has received, at last count, 7 different drug regimens, over the course of her 8 1/2 year battle with ovarian cancer). Some drug regimens make the doctors a lot of money. Others make them no money or even cost them money. Several studies have established that the profit margin of different drug regimens factors heavily into the selection of a given drug regimen. In other words, treatment is chosen as much on the basis of the benefit to the doctor as on the basis of benefit to the patient. This attitude works against individualizing patient care, based on individual cancer biology. This is also what I mean about the sellers (doctors) making the purchase decisions for their customers (patients), which is the fatal flaw in private health care and why private health care does not follow the principles of Adam Smith market economics.

Oncologists make 65% of their total income through buying drugs wholesale and selling them retail (see Wall Street Journal, below). Under the new proposed system, doctors would get together and agree, in advance, on which type of one-size-fits all treatment should be given to different forms of cancer and doctors would be paid a lump sum for the drug treatment of each patient. If the doctors wanted to give more expensive drugs, or new drugs, or new regimens, they’d be free to do this, only they wouldn’t be paid for this. Given that 65% of the physician’s income is from the drug treatment, this has the effect of incentivizing doctors to provide less treatment and the cheapest possible treatment.

The above approach, in my view and in the view of the Forbes editorialist I previously cited (#16), simply changes one bad incentive system (provide the most amount of treatment and the most expensive treatment possible) into another bad incentive system (provide the least amount of treatment and the least expensive treatment possible). This is vastly inferior to the Medicare approach of seeking to reward doctors for treatment outcomes, as opposed to treatment, per se.

– Larry Weisenthal/Huntington Beach, CA

Assembled below are relevant “takes” on this story from various news sources. I received these in an email from an advocate for cancer patients. I don’t have the time to provide links, but you can readily find the full text of each, via Google or Google News:

The Wall Street Journal: The old way of paying doctors for such care, called fee-for-service, “gives doctors an incentive to provide more — but not necessarily better — care, which can drive up drug usage and other costs. To start addressing the problem, the new federal health law calls for Medicare pilot programs that pay doctors based on the quality rather than the quantity of their services.” Cancer care costs are rising 15 percent to 18 percent a year, The Journal reports. “UnitedHealth estimates that drugs account for 65 percent of an oncologist’s income. In particular, the insurer says, there is concern that toward the end of a cancer patient’s life, doctors continue giving drugs as a way to keep being paid for the patient’s care” (Johnson, 10/20).

Kaiser Health News: “Payment for chemotherapy has been particularly controversial. That’s because some doctors, including oncologists, buy drugs at wholesale prices, dispensing them by injection or infusion to patients in their offices. Then they charge insurers higher, retail prices.” A report from the Government Accountability Office reports that Medicare reimbursed doctors $532 million more a year in 2000 than what the doctors paid for the medicines. That was changed in 2005, when Medicare started paying doctors the average sales price for the drugs plus 6 percent to administer them.

“United takes a different approach. Its program, now underway with five oncology practices in five states, pays physicians a lump sum for each patient’s total course of chemotherapy for breast, lung and colon cancer. The payment is based on regimens drawn up by the doctors themselves, plus a case management fee” (Appleby, 10/20).

The New York Times: “The new fee is meant to encourage doctors to follow standard treatments rather than opting too often for individualized and unproven courses of therapy, which can include the most expensive drug combinations. By proposing a different type of payment structure, companies hope to lower doctors’ dependence on a system that generates substantial sums for cancer specialists who routinely favor top-of-the line treatments.” Cancer care in the U.S. costs $100 billion a year, with the average per patient cost sometimes more than $100,000 a year (Abelson, 10/19).

Bloomberg: “How much the program may hurt doctor’ earnings isn’t clear. While the system is designed not to crimp physicians’ revenue in the first year, it may eventually pay doctors less than they would have made by choosing more-profitable drugs, [UnitedHealth Senior Vice President for Oncology Lee] Newcomer said. Bruce Gould, a doctor at Northwest Georgia Oncology Centers, the Marietta practice in the pilot program, said he’s willing to take that chance because doctors see the U.S. health care system as unsustainable, and are concerned that government and private payers may impose bigger cuts if oncologists don’t find their own solutions. The pilot project will help counter a ‘skewed reimbursement system’ that pays oncologists more for drugs than for office visits, nutritional care or psychological counseling, Gould said in a telephone interview” (Nussbaum, 10/19).

Reuters: “The five medical practices in the program have between 18 and 35 oncologists on staff and are based in Dayton, Ohio; Fort Worth, Texas; Kansas City, Mo.; Marietta, Ga.; and Memphis, Tenn. The regimens will be evaluated based on various health outcomes, as well as emergency room visits and complications” (Krauskopf, 10/20).

Minn. Star Minneapolis St. Paul, Tribune: UnitedHealth reported yesterday that its profits beat expectations. It reported $1.3 billion in quarterly profit, . “On Tuesday, Minnetonka-based UnitedHealth reported stellar third-quarter earnings, boosted by strong membership growth and lower hospital costs. … The insurer gained members in both its commercial and government businesses for health benefits. Its smaller health services businesses — pharmacy management and consulting and technology services — also grew rapidly. … Between now and 2014, health reform is expected to boost the market for UnitedHealth’s products as the federal government expands the Medicaid program and begins offering subsidies to help people buy private insurance on new health plan exchanges” (Yee, 10/19).

Morningstar Canada/The Toronto Star: “Medical costs continue to be the primary driver of higher earnings [for UnitedHealth], which is unfortunate for investors because various provisions of the health reform legislation will pressure medical cost ratios in 2011 and beyond. The consolidated medical cost ratio was 80.1% in the third quarter and 81% year-to-date.” Starting next year, insurers will have to spend either at least 80 percent or 85 percent depending on if they operate a small- or large-market plan (Coffina, 10/19).

The issue is one that the States have serious concerns about as the Buck really stops at State level.

ObamaCare Unrealistic Cost Estimates Exposed by Dem Governor

Richard Baehr
The single most compelling argument against the Patient Protection And Affordable Care Act, otherwise known as ObamaCare, was made today in the Wall Street Journal by the Democratic Governor of Tennessee Philip Bredesen. In essence, the subsidies offered to buy health insurance in the newly created exchanges beginning in 2014, are very attractive, and the penalties for companies who do not provide health insurance are quite modest (about $2,000 per employee).

As a result, many employers, a lot more than estimated by the Congressional Budget Office or by Democrats in Congress who shilled for the bill, will simply be much better off dropping their health insurance coverage, paying the penalty, and transferring the health insurance burden to the federal government. Bredesen makes the argument that his own state of Tennessee with 40,000 direct employees, would significantly reduce its health care costs in 2014 by doing the same thing private companies will be incentivized to do — drop health insurance coverage for its employees, and transfer the burden to the federal government through the newly created exchanges in each state.

Rather than 30 million people newly insured through an expansion of the Medicaid program income limits and the creation of the exchanges, there will be tens of millions of additional people, formerly covered by companies or governments, who may now be shifted onto the exchanges at additional cost to the federal government. This cost has not been included in any CBO estimate, and is the ultimate budget buster (as if $1.4 trillion annual deficits were not enough).

Of course, the identical scenario will play out in the market for individual health insurance coverage. Assuming the individual mandate is judged to be constitutionally acceptable, no thinking person would buy coverage in an exchange until he or she expected to have significant bills. At that point, this person would purchase coverage immediately, since the penalty for not buying insurance is only $750 a year, in almost all cases less than the unsubsidized portion of the insurance premium that could be purchased in an exchange.

Bredesen makes the case that the drafters of the health reform bill, all Democrats, clearly had no conception of game theory. They knew, or the lobbyists working, with them knew, what they wanted to happen — insure lots of people, and have the federal government pay for the new coverage. The cost of the bill was “scored” by the CBO, and determined to be a net deficit reduction bill, based on new taxes, and “savings” from the Medicare program (a big part from hammering the Medicare Advantage program). The Democrats wrote 2,000 plus pages of rules and regulations to presumably make sure everything worked out as they hoped. But there are other actors in the drama, who can compare two prices: say X and 2 X, and choose the strategy that costs them only X.

There is no believable federal budget for any year beginning in 2014 that is based on the numbers in the CBO estimate. The legislation and the system it created will be an enormous budget buster. We now have this honest assessment of how the bill will work, and what that will mean for the behavior of employers from an elected Democratic official with a lot of experience in health care reform efforts in his own state.

The urgency of the repeal effort should get a boost from Governor Bredesen’s common sense article. That will require Republican control of both Houses of Congress in 2013, and the defeat of Barack Obama in 2012. It is that simple.

Ed Lasky adds:

There are signals being sent that the GOP, should it assume control of the House, may refuse to fund the exchanges. Then what happens? Will employers who moved employees off plans be leaving the employees in no man’s land?

Will this then become the bludgeon to be wielded against Republicans — that they are denying medical care insurance to millions of Americans by refusing to fund the exchanges?

Richard Baehr responds:

That threat assumed Obama was still in office in 2013, or GOP only controlled the House. The cutoffs next year are pretty minor stuff, in terms of what is budgeted. But defunding some of the 159 commissions would be helpful interim step.

http://www.americanthinker.com/printpage/?url=http://www.americanthinker.com/blog/2010/10/obamacare_unrealistic_cost_est.html

That must be why the Individual States have Lawsuits pending in Federal Courts on this business. I recall the issue of unfunded mandates on No Child Left Behind. Some States are in financial trouble right now anyway. States generally have Balanced Budget Laws in place and cannot run deficits like the Federal Government and regulate Insurance anyway through Boards or Commissions and view it as Meddling ala 10th Amendment.

I’ll answer Trooper (#23) much later. Trooper posts very long quotations and even entire “professionally” written blogs and columns. I am then tasked with the job of writing original rebuttals. It’s a lot of work. I much greatly prefer to engage other people in one on one discussions, where one person writes an original opinion, provided links to references as necessary, and then I can provide a rejoinder or agreement (this does happen, sometimes).

With respect to Aqua’s comments about doctors leaving Medicare (#24)

Medicare sets different reimbursement rates across the country. If they paid so much that every single doctor and hospital wanted to participate, they are paying too much and not controlling costs. The way that you operate a successful business is to control your costs/don’t overpay. So you cut back until you can’t retain the vendors you need to run your business. That’s when you’ve gone too low and have to back off. Medicare has been positively brilliant at this.

Let’s look at reality. Medicare has the largest provider “network” in the nation, by far. When my mother, who lives in Kentucky, was diagnosed with lung cancer, she went immediately to NYU in New York, to have her operation performed by the best lung cancer surgeon in the world. No pre-authorization required. No need to first see a gatekeeper family practice doctor. Down the road, she developed a metastasis to a lumbar vertebra — a very dangerous area, as it could lead to spinal cord damage. The best treatment for this was proton beam radiation therapy and the best center for this, in the entire world, is Loma Linda University, in California. Again, straight to Loma Linda she went. No gatekeeper. No preauthorization. At other times, my father in law flew out to California from Kentucky to receive interstitial radiotherapy from the best specialist in the world for that procedure. My father got a 4 vessel “beating heart” bypass from a DeBakey trained cardiac surgeon. No preauthorization, no gatekeeper. I could go on and on and on and if someone wants to challenge me, I will go on and on. The issue is this: with no other healthcare plan in the world is there such a virtually limitless choice of truly excellent doctors and hospitals. In one’s home state or anywhere in the nation.

Surveys show that Medicare beneficiaries have the greatest degree of satisfaction with their health care plans. Health care outcomes are unsurpassed.

Why is Medicare in financial difficulty? Private health insurance premiums more than doubled during the Bush Presidency. Anthem announced a 39% rate hike in one year alone, last January, before passage of ObamaCare. Can you imagine the outcry were Medicare payroll taxes to have doubled during that time and been raised by 39% in a single year? Medicare provides the best care for the least cost.

Why do doctors drop out? Because Medicare doesn’t make sense for their particular, individual situation. They can make more money from non-Medicare patients, and they have enough non-Medicare patients that they don’t need Medicare. But the overwhelming majority of doctors and hospitals do gladly accept Medicare patients and make money from them. Were every doctor in America to participate in Medicare, then Medicare would be paying too much. Again, it’s just good business management.

Aqua quotes me:

Larry said:

Agree or disagree, but please put an end to the “death panel” and “rationing” talk regarding Obamacare. I’ll put my life in the hands of transparent panels of experts, accountable to me and my elected representatives, before I’ll put my life in the hands of opaque bean counters, accountable to shareholders.

Aqua asks:

First, why does it have to be either? My healthcare should be between me and my doctor. If my insurance doesn’t cover something, then I should have a choice to find a better insurance company or pay for the treatment myself. It’s that simple, whether you want to believe that or not.

I actually agree with you on this, and that’s exactly what the situation is now and it’s how it will remain. It’s how it works in most of the rest of the world, also. The whole concept of “rationing” was raised by conservatives, to scare people. A “death panel” consists of people who decided that a certain treatment or diagnostic test should not be covered by insurance (either private or public). But the patient can still receive the test or treatment, if he’s/she’s willing to pay for it him/herself. The truth is that there are vastly more “death panel decisions” of this type with private insurance than there are with Medicare.

With respect to health care being a state versus federal responsibility, that’s how it is now (a state responsibility, for people under the age of 65) and it introduces artificiality and inefficiency into the economy. People are tethered to jobs and to states for reasons of health insurance, as opposed to market dynamics. American corporations are at a competitive disadvantage with the rest of the world, because of our health care system.

– Larry Weisenthal/Huntington Beach, CA

Trooper, I’ll be glad to answer you on this. Just write to me privately about your situation. You don’t need to identify yourself. If you wish, just create a new anonymous gmail account. You can write to me at: mail@weisenthal.org. – Larry

All Boeing has to do is make a big donation to Obama and they will get a waver from the ObamaCare taxes.