Category Archives: Healthcare

ACA, Medicare-for-All, Single Payer, Health Insurance and related topics

Most everything we think we know about the Affordable Care Act is probably wrong, owing to a combination of propaganda and abysmally poor news reporting on the subject. Starting in 2016, I began researching why insurance premiums were climbing so rapidly in the non-subsidized individual market. Our own premiums rose by +167% (about 2.7 times higher) in 4 years, before we had to drop out of the ACA markets. For 2018, insuring ourselves and our youngest daughter, who is in grad school, would have cost almost $24,000/year for a bare bones, basically catastrophic “Silver” insurance plan with high deductibles.

What happened? My paper goes in to all the details but here are some highlights:

  • All of the very high cost, high risk patients were merged into the small individual market risk pools. As of 2017, all of their high costs is shared exclusively with the other members of the small individual market pools – consequently, premiums skyrocketed.
  • Some persons receive subsidies to lower their monthly costs. The subsidy cut off level has no relation to actual insurance prices. The level is set by the regional poverty level whereas insurance rates are determined by pool risk, individual age and geographic location. There is no relationship between the subsidy cut off level and the price of insurance. This leads to bizarre situations where in several cities across the U.S., an age 64 married couple earning $65,000 per year is above the subsidy cut off level, and hence, receives no subsidy assistance – but their cost of a Silver plan is over $50,000 per year (see paper for details).
  • All health care market participants have engaged in acquisitions and mergers to give themselves greater market pricing power. This includes hospitals buying medical clinics, drug companies buying each other, retail pharmacy changes buying other chains and even insurance companies and more. Everyone has increased their pricing power except for individual consumers. The ACA, as implemented, prohibited individuals from forming groups to achieve volume pricing discounts. Literally everyone else merged to strengthen their market positions – except for individuals.
  • A big surprise – most ACA policies checked provide no coverage for hospitalization or surgery while traveling outside one’s narrow network of medical providers, which is typically an area as small as a few counties (see paper for details). Literally, the ACA leaves people without critical insurance protection while traveling in the United States.
  • The ACA actually does have a pre-existing condition exclusion, but in a different form and name. See the paper for a description of the types of pre-existing condition exclusions. The ACA implements a waiting period for certain pre-existing conditions. If you have no insurance in January but are diagnosed with cancer on February 1, you will have to wait 11 months before you can sign up for insurance. See the paper for details. Its a pre-existing condition exclusion in a different form.
  • Medicare-for-All has almost nothing in common with Medicare, other than the name. Similarly, everyone has different ideas as to what single payer means. Consequently, there is no coherent and workable proposal at this time.

Clearly we need to solve these problems. Medicare itself goes bankrupt in 2026 per the 2018 forecasts. My paper contains many pages of proposed solutions, some of which were adopted by my state, Oregon. Various drafts of the paper were read by state legislators, state health agency staff, insurance and health care industry staff.

Unfortunately, I learned most politicians do not want to listen to ideas on solving real problems and prefer to ram their ideologically preferred solution (whether it works or not) on to others. Consequently, at this point, I maintain this paper for my own records.

I have posted this paper here so that it can be indexed by the Internet search engines. Hopefully others will find it of interest.

ACA Individual Market (PDF) – about 50 pages

Keywords: Affordable Care Act, ACA, ObamaCare, Health Insurance, Premiums, Prices, Cost, Medicare, Medicare-for-All, Single payer, insurance risk, risk pools, individual, group

Robotics for rehabilitation medical care

This is total awesomeness! The application of robotics to assist those subject to physical disabilities:

It’s not only engineers who work in robotics

Source: It’s not only engineers who work in robotics | Robohub

My wife recently retired from nursing. She had worked as a Certified Rehabilitation Registered Nurse, working with spinal cord injury patients, and sometimes with traumatic brain injury patients. She tells me that tremendous advances are  being made toward spinal cord regrowth and repair – this is still a ways out but is another exciting development for those with these types of injuries.

How to get out of ObamaCare without paying a penalty

We, like many, have been  hit by extraordinary price hikes under ObamaCare. ObamaCare began in 2014. Since the first year, our premiums have risen 140% culminating in a 56% price hike in 2017. Obviously, ObamaCare’s nongroup market has failed and is collapsing (so say the insurance commissioners in Minnesota, Tennessee, the editors of the Chicago Tribune and others, former proponent Gov. Mark Dayton (D-MN), and former President Bill Clinton.)

There are ways to escape the crushing burden of ObamaCare’s extremely high insurance rates and rates that are increasing on an exponential trend line. Fortunately, there are perhaps 15-20 exemptions written in to the law. This post addresses only a few of those exemptions

The reason ObamaCare’s nongroup market has failed is due to a design and implementation error in the ACA. This is not rocket science.

Continue reading How to get out of ObamaCare without paying a penalty

Cover Oregon software failed due to “ideological blindness” to the organization and management failures

Cover Oregon ran Oregon’s failed online health insurance market; it never enrolled a private individual and is being abandoned in a shift to the Federal HealthCare.gov web service.

The system never worked but insiders refused to believe what they were seeing because a “true believer mentality won out”.

This mind set is common in too many software projects with thoughts like “its just a few problems and will work fine once we get through this”, “we will make up the lost time later”, “the defects are not that serious-they are fixable”, “we can just drop a few features”.

Though the beta site was limited to insurance agents and certified consumer assisters, exchange managers — not unexpectedly — encountered bugs. “On Day 1, agents couldn’t even log in,” Jovick said.

It was the reaction from certain other people in the room that was disturbing.

Troubleshooters for Oracle, the project’s lead vendor, “were flabbergasted” and completely stumped by how the system was malfunctioning, Jovick recalled. Rather than knowing who to call to get problems fixed, Oracle’s reaction was “Huh? How did that happen?'”At that point, no one realized Oregon and Oracle had built “this absolute disaster that just didn’t do anything,” Jovick said.

via Cover Oregon insider Tom Jovick speaks: Health exchange problems stumped Oracle, blindsided staff video | OregonLive.com.

The management team ignored the warnings of many consultants who found “lousy code”, poor testing, lack of test environments, and more.  They were true believers in the ideals of the project and were blinded to what was in front of them.

Oregon ended up enrolling people by hand using paper applications. They lost 20,000 applications and enrolled 4,500 “non documented” immigrants (formerly known as illegal aliens) who did not qualify.

There is a potential that the  Cover Oregon organization be shut down and the staff laid off  (Update: Cover Oregon was shut down after spending about $450 million and never enabling a single consumer to enroll online). From a traditional business perspective, it seems they made need an entirely new organization that is not carrying “emotional baggage”, which is unfortunate for the staff. From a marketing perspective the “Cover Oregon” brand is irreparably damaged and should be replaced.

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