Mid-week Potpourri

■ First up, Rich W warns that the new ObamaTax numbers are a lot more dangerous than we've been led to believe:

"[O]nly about 28 percent of enrollees, or 3.5 million, are between the ages of 18 and 34 -- the younger, healthier people needed to offset the costs of older, sicker ones."

That's bad news because it underscores just how unsustainable the whole system has become. Look for this number to get even worse as premiums and out-of-pockets continue to rise.

■ Talk about an understatement: FoIB Holly R sent us this link that starts out by noting that "[d]ifficult patients — those who are angry, abusive, or rude — may not get the best medical care." No kidding.

Click on through to see how patients that threaten to shoot their doctors fare.

■ This is actually two items in one. On the one hand:

"Maple syrup isn't just delicious, it could also cure Alzheimer's disease"

While you're pouring that tasty Grade A Amber on your flapjacks, don't forget to sprinkle some blueberries on 'em, too:

"Start munching on blueberries. Researchers at the University of Cincinnati say chowing down on the "superfruit" may help treat patients with cognitive impairments."

Yummy and helpful.

Self-service writ large

A while back, we noted with some disgust that "[t]he number of foreigners traveling to Switzerland to commit assisted suicide doubled over a four-year period." Seems that that enlightened country had made it even easier for folks to pull their own plugs.

Fortunately (for some values of "fortunate") the Golden State is making it unnecessary for those so inclined to have to book expensive airfare:

"Governor Jerry Brown signed a landmark bill into law ... [granting]terminally-ill individuals the right to die, or request life-ending medication from their physician."

He actually signed it this past fall; it takes effect early this summer.

There's a supposed "fail-safe" built into the law, requiring two doctors to agree that the "patient has six months or less to live and is mentally competent." There are some other caveats, as well.

Some folks are a bit leery that depressed patients might "doctor shop" to find providers more willing to participate. For what it's worth, California joins four other states that have legalized doctor-assisted suicide.

Yay?

[Hat Tip: Ace of Spades]

MVNHS© claims another one

It's almost as if nationalized health care schemes are designed to kill off their intended beneficiaries:

22-year-old dies of rare cancer after doctors mistook disease for pregnancy

To be fair, her initial pregnancy diagnosis was due to elevated hormone levels. But as time went by, and her pain continued unabated, one would think that her "care" providers would have at least tried to nail down a cause. By the time they finally got around to that, it was too late:

"[I]n February, doctors at Addenbrooke Hospital in Cambridge found Wright actually had adenocarcinoma— an aggressive form of cancer that affects multiple organs and was diagnosed as terminal. On Feb. 23, Wright passed away"

Well played, Much Vaunted National Health System©.

More (bad) trainwreck news

As we mentioned at the end of January, Open Enrollment v3.0 was pretty much doomed from the start:

"About 6 million people have signed up for health coverage that will take effect on Jan. 1 in the states that use the [404Care].gov enrollment."

That was way off the (implausibly) predicted 21 million anticipated to sign up. But it's also only part of the story:

"New exchange enrollment data released by the Obama administration reveal in multiple ways that ObamaCare is failing to live up to its goal of providing affordable care."

Most at risk? The very folks on whose behalf the whole effort was expended in the first place:

"Millions of working-class Americans face a choice between paying a penalty they surely can’t afford and buying a policy ... that may still wreck their finances if they land in the hospital."

And that's assuming that they can even afford to buy a plan in the first place. With ever-increasing premiums, deductibles and maximum out-of-pocket costs spiking, no wonder so many people are opting to just skip signing up in the first place. As we've noted time and time again, that $700 or so penalty fine tax is peanuts compared to the actual exposure dictated by massive ObamaPlan holes.

And the subsidies are doing little to mitigate the problem:

"While the cheapest bronze-plan premium (before subsidies) rose about $250 in Mississippi for a $25,000-earner, the subsidy fell $300, yielding the $550 increase."

Talk about a double whammy.

Sausage making at the MVNHS©

There's an old saying:

"Laws are like sausages: Better not to see them being made."

This seems to apply to how (at least one) nationalized "health" schemes work, as well. We've blogged on the shortcomings of the Much Vaunted National Health System© for many, many years; one thing we've consistently pointed out is that perhaps the most insidious form of health care rationing (and under any national health care scheme care is rationed) is the use of wait times to "cull the herd" of the most needy.

But don't just take our word for it; thanks to co-blogger Bob, we have access to "A Guide to Health Cover for the Self-Employed." Don't let the title fool you: the critical issues addressed apply equally to those who work for someone else.  And what's the Number 1 issue?

"Waiting times to see a doctor are lengthening – 70% of GPs surveyed for the Royal College of General Practitioners said patients will have to wait longer to see them over the next two years"

[ed: And don't be getting too smug about that; the ObamaTax has it baked into the cake]

Now, there's a double-whammy for self-employed folks: the obvious (and shared one) of 'care delayed is care denied,' but there's the additional onus that "[w]hile an employee with a sympathetic employer can easily take the time off work for appointments, it’s not so easy if you are self-employed."

Lotta truth there.

I was also bemused by this little observation:

"[T]he service we remain so justly proud of is cracking under the strain of an increasing population and a curb on expenditure"

Denial: not just a river.

Hey, it's only (YOUR) money!

A month or so ago, we noted that it costs taxpayers "$50,000 for every person who gets health insurance under the Obamacare law." Looks like that might be a bit optimistic:

"Watchdog finds $447 million IRS PPACA tax credit math error"

Ooops.

Apparently, the rocket surgeons at the Infernal Revenue Service misunderstood their own calculations due to a "programming error," which resulted in substantial overpayments on behalf of ObamaPlan victims buyers.

Here's the very best part:

"The accounting errors identified are primarily attributable to the lack of comprehensive testing"

Seems to be something of a habit with these folks, no?

Health Wonk Review is up

David Williams hosts this week's collection.

Note: This edition is rather heavy-handed on the politics. Be forewarned.

Ducking the MVNHS©

As we noted a few weeks ago, many (most?) countries with national healthcare schemes also have robust private insurance markets.

For the naysayers (via email):
 

<Click to embiggen>

And just how does it work?

So glad you asked:

"If you are taken ill, can you rely on the NHS to ensure you recover quickly?

Private medical insurance (or health insurance) is designed to cover the costs of private medical treatment, so that if you happen to have the misfortune to suffer from a disease, illness or injury you can rest assured that you will be well cared for to help you on the way to a full and speedy recovery.

While we are fortunate in the UK to have the NHS, the reality is that you can often wait months for diagnosis and treatment. Private healthcare not only enables you to receive treatment quickly it also offers you far more choice as a patient. You can choose everything from what treatment you receive to where you are treated."

"While we are fortunate..." Heh.

The site acknowledges something we've maintained for many, many years: that under the Much Vaunted National Health System© care may be free, it is strictly rationed. The most common rationing method is, of course, long wait times, where the beancounters in charge can be sure that at least a few of their fellow countryfolk will succumb to attrition.

But hey, it's free.

Clawbacks and fees, Oh my!

As we've mentioned before, more than a few folks who were initially eligible for ObamaPlan premium subsidies subsequently become ineligible, with predictable consequences:

"Consider the case of Erica Cherington that bought an Obamacrack plan for 2014 and only paid $89 monthly because her low income entitled her to a $284 per month taxpayer funded subsidy.Then she got a new job that paid more. As a result she had to pay back $600 of her subsidy"

But that was then, and this is now:

"Only 52 percent had to repay a portion of government subsidy during last year’s tax season, compared to 60 percent this year ...  three out of five customers who received advanced tax credits to help them buy private plans on Obamacare’s web-based exchanges must pay a portion back to the IRS"

That's because they mis-estimated [ed: is that even a word, Henry?] their 2015 income ... Of course they did: whose Ouija board has a $ sign? Sheesh!

And what, you may be wondering, was the average ding for this little "problem?" Well, how about $579? Of course, as we've pointed out numerous times, this represents one - maybe two at the outside - month's premium. Why not roll the dice; after all, the next Open Enrollment is only a few months away...

[Hat Tip: Rich Weinstein]

From the "No Kidding" Files

Courtesy of FoIB Holly R, we learn that making health care more convenient doesn't necessarily make it any less expensive. "Bending the cost curve down" has become the Holy Grail, but as we've seen over and over this just doesn't happen in a vacuum (or at all).

Or put in more relevant terms:

"Rand researcher Dr. Ateev Mehrotra said a minute clinic is to healthcare what an iPhone is to email.
 
“Because it’s so convenient for me to check my email on my iPhone, I check it a lot. Way more than I may need to,” he said."

Of course, checking your email really doesn't cost anything above the monthly Verizon (or whichever) charge; very different from the per visit charge (reasonable as it may be) at the Wally World Minit Clinic. And thus over-utilization rears its ugly head:

"[T]hanks to the rise of all these clinics, folks with a cold, the flu or a sore throat are getting care instead of staying home."

"So what?" you may ask, it's their choice, and their dollars. Ah, not so fast, grasshoppa: there's always a cost: over-utilization means higher insurance rates, for one thing. And even if one accesses that clinic without insurance. there's a societal cost as that provider is no longer available to care for a more sickly patient.

As I mentioned to Holly, this reminds me of a favorite saying:

You can have it good.
You can have it fast.
You can have it cheap.

Pick any 2.

Interesting SEP news

Open Enrollment v3.0 is fading quickly from the rearview, which means that you'll need to come up with a valid reason to trigger a Special Open Enrollment for the opportunity to buy an (overpriced, underperforming) ObamaPlan.

And by the way, the rules are the same whether you buy it on or off the 404Care.gov site.

As we noted earlier this year (3rd item), the bureauweanies in DC are tightening up the rules for those triggers, primarily because folks have figured out how to effectively game the system by using them. Carriers have been losing their shirts on these plans (awww!), and they really needed the Feds to step in and save themselves from...themselves.

So, said Capital City rocket surgeons have released new guidance on what does - and doesn't - constitute a Special Open Enrollment window. Frankly, I think it's about time, but one wonders why it took them so long to figure this out.

[Hat Tip: MMO]

MVNHS© Plays Grim Reaper

At first glance, this concept appears to have some merit:

"Mothers of children with fatal defects will have the option to give birth. Once the infant has been declared stillborn, doctors will remove its organs. They will then be used to save the lives of other children who are currently being placed on 7,000-strong waiting list"

After all, if the baby isn't itself viable, and could save the lives of others who may be, that's potentially a good thing, no?

The problem is, the Much Vaunted National Health System© hasn't shown itself to be particularly concerned with ethics, which leads folks to (justifiably) call into question the rationale behind this effort, not to mention the motivations of those tasked with implementing it.

This in particular raises moral hackles:

"Amid a chronic shortage of donated organs, mums will be 'supported' to have the baby at nine months so that the child's vital organs can be taken for transplant"

Law of supply and demand seems particularly tempting here; so who makes the call as to whether this or that baby is the viable one, and which is to be sacrificed? After all, these are the folks responsible for the (notorious) Liverpool Pathway.

Thus far, this is only in the "proposal" stage.

Thus far.

[Hat Tip: Co-blogger Mike F]

Another 1,000 Words on PPACA

Remember when The ObamaTax was going to "bend the cost curve down?"

Good times, good times.

[Hat Tip: A M Best]

1,000 Words (Give or Take)

Note well how the various age cohorts are clustered: very heavily skewed towards the more claims-prone older ages, very few in the crucial (ie low claims) 25-and-under crowd.

Think that's a problem?

Yup.

[Hat Tip: A M Best]

Wednesday LinkFest, FoIB edition

■ As we've noted, the issue of agent compensation (commissions) for writing new Obamaplans has become quite the issue. More than a few carriers have decided to stop paying agents, and thus staunch the flow of claims dollars pouring out the door. Kentucky has put carriers on notice that in the Blue Grass State such practices are a no-no.

Thanks to FoIB David Williams, we learn that California is considering outlawing this practice, and for the very reason we've long put forth:

"California’s health exchange may require its health plans to pay sales commissions to insurance agents to keep insurers from shunning the sickest and costliest patients."

Of course, by next year it may be a moot point.

■ Next, SoIB Gail S tips us to the latest in the struggle to find lost life insurance policies:

"Smaller insurers balk at searching databases to check if policyholders have died; ‘It wasn’t priced in’"

Which is true, of course, but belies two other more pressing issues: the fact that it's the insured's responsibility to make sure his or her beneficiaries know about any policies and, two, even if they *could* afford to track down who's currently at room temp, there's no effective means to do so. As we reported almost 4 years ago:

"[T]he SSA has itself acknowledged, the DMF [Death Master File] is itself rife with potential errors and misinformation"

Oh, I'm sure they'll get right on that.

■ Finally, longtime FoIB Jeff M alerts us that North Carolina Blue Cross/Shield's woes aren't going away any time soon:

"Blue Cross and Blue Shield of North Carolina finished 2015 with just $500,000 in net profit, due largely to losses associated with Affordable Care Act plans."

But that's only part of the picture:

"Reserves" are the insurance company's "cushion" against future claims [Correction: as Mike points out in the comments, it would be more accurate to say that reserves are amounts held back from current premiums to pay for certain past claims, not future claims]. It's important that they be sufficient to handle not only anticipated claims (which follow  generally predictable trends) but unexpected ones as well (say a major listeria outbreak). Jeff points out this little nugget on that article:

"The insurer reported having 3.2 months of reserves, a measure of how long it could operate if it did not collect any more in revenue, down from 3.6 months at the beginning of 2015"

Seems a little light, no?

Told ya so

While it may not be a surprise to those who've been paying attention, the overall response to the "benefits" of The ObamaTax have been, in a word, meh:

Poll: Only 15 percent say they have benefited from ObamaCare

Which is interesting, no? After all, the stated premise in the first place was that roughly 15% of us were (at any given time) uninsured. On the other hand, over a quarter of us feel harmed by the train wreck.

But here's what's interesting to me: over half of the respondents claim that they've been personally unaffected by it. So by the "glass half full" metric, it seems that a (bare) majority don't see any great benefit, but neither have they (personally) felt a terrible loss from it.

Yet.

But then, the (so-called) Cadillac Tax has been pushed back (again); since most folks get their health insurance through employer-sponsored plans, it'll be interesting to see if (how?) these numbers begin to move.

[Hat Tip: FoIB Sam B]