Friday, May 22, 2015

The Blind Men And The Elephant



“You have no idea”, the doctor muttered beneath his breath. He repeated the comment. “You have no idea”. Realizing that his statement had had little impact, the doctor decided that a stage whisper might be more effective. “None of you have any idea”. Success! He had our attention. It appeared that it was up to me to ask him what he was talking about.

The doctor explained the new reality of hospital emergency room care. E/R units, equipped with suites of examination rooms, were now limiting patients for a specific period of time, 13 to 16 hours, to maximize charges. If the patient’s conditions didn’t warrant admission, he/she was sent home. It didn’t matter if the clock ran out at 2 PM or 2 AM. When 16 hours hit, the patient was cut loose.

Payment dictates care.

The doctor is a first person observer of how the new law, the Patient Protection and Affordable Care Act (PPACA), has altered the delivery of hospital based care. He declared himself an expert on the PPACA.

* * *

I got a call from a chiropractor. His patient, one of my clients, was no longer covered for indefinite once a month visits. The government (Medicare) has sharpened the definition of medically necessary. The insurance companies quickly followed. Conditions need to be clearly defined and treatment plans must have a beginning, a middle, and a predictable ending.

The chiropractor is a first person observer of how the Patient Protection and Affordable Care Act has altered the delivery of ongoing care. He declared himself an expert on the PPACA.

* * *

The psychiatrist described her newest challenge. Treatment might be covered by Medicare and the insurers, but the tests to determine the most effective form of treatment might not. What’s covered and what’s not seemed like a moving target. The culprit had to be the PPACA.

* * *

I am reminded of the story of the blind men and the elephant. In the ancient Jain version, six blind men are asked to describe an elephant. They each feel a different part of the animal. Each is convinced that he, and he alone, understands the nature of the beast from his limited contact.

But the elephant is more than just the one part each encounters.

Insurance agents are first person observers of the PPACA. We see who can now access and afford insurance and who has been exiled from the market. We talk with doctors and hospital administrators. We fight with our insurers over claims. In February I was in Washington to meet with members of Congress and last week Columbus to talk with our representatives in the Ohio House and Senate. But like my friends the doctor, the chiropractor, and the psychiatrist, we too are simply describing the parts of the elephant we’ve encountered.



Monday, May 11, 2015

Psst, Would You Like To Hear A Secret?

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Senator Ron Johnson (R-WI) has a secret. The secret is that he is a realist. As such he has to balance competing interests on a daily basis if he would like to keep his job. And yes, he really wants to keep his job.
  • The most vocal members of his party want to repeal Obamacare (The Patient Protection and Affordable Care Act) immediately.
  • Americans, even Wisconsinites, seem evenly divided between repealing and reforming the new health care law.
  • Millions of Americans have directly benefited from key provisions of the law such as Open Enrollment, coverage for Preexisting Conditions, and the Tax Credit Subsidies.
  • The Supreme Court will rule on King v Burwell in next month. There is a very real possibility that the court may eliminate the subsidies for those Americans who purchased coverage through the federal exchange ( as opposed to a state run exchange.

The Supreme Court may help the coyote catch the roadrunner.

Senator Johnson has a solution. He has crafted a plan where Americans would keep their new coverage, and more importantly their tax credit subsidies, until after the next election. By kicking the can down the road till 2017 he solves two problems.
  1. It is after (he hopes) his reelection
  2. A new Republican president will be able to put forward a real plan.
Are you interested in the details? Do you what to know about the elimination of the individual mandate and other items on the Republican wish list? This post provides links the The Hill and other publications. Just don’t waste any time looking at the Senator’s website. There is nothing to be found there. See, this plan is a secret.

Senator Johnson’s most vocal constituents on the right can’t stomach anything less than complete repeal. And his constituents on the left will treat the Johnson plan like a piƱata.

Senator Johnson isn’t alone. Senators Orrin Hatch (R-UT) and Richard Burr (R-N.C.) and Congressman Fred Upton (R-MI)are already touting the second version of the Patient Care Act. According to Forbes, it’s terrific. Much like the Johnson plan, details, the real specifics of how this will affect you, are hard to come by. Their Press Release, however, is filled with glowing generalities and buzz words.

The Hatch plan solves many of the Republican issues with Obamacare by giving them new names. Don’t like the Cadillac Tax? The Hatch plan reduces “the distortions in the tax code that drive up health care costs (by) capping the exclusion of an employee’s employer-provided health coverage”. Hate the Tax Credit Subsidies? The Hatch plan would “Empower Small Businesses and Individuals with Purchasing Power (by providing) Targeted tax credit to buy health care”.

None of this is on Senator Hatch’s website. There just isn’t space for stuff like that. Besides, it’s a secret.