Tag Archives: Huffington Post

Reprehensible Republicans Ruin Medicare

Do you remember reading this from the Associated Press in mid-April? 

Suddenly, bipartisanship has broken out on Capitol Hill.

We were supposed to feel so proud of our Congress! They worked together, reached across the aisle, and enacted a permanent repeal of Medicare’s reviled SGR Fix (or Doc Fix)! 

Well, the Drive-By Media didn’t tell the rest of the story. What happened is this:

212 House Republicans and 46 Senate Republicans
joined the Democrats in radically changing the way
Medicare providers are paid
— and controlled —
by the federal government.

That’s right. The same GOP leaders vowing to repeal Obamacare just grafted it Big Time onto Medicare.

We expect this from the progressive members of Congress. But weren’t we supposed to expect a Republican Congress to lessen the size and scope of government? Didn’t last November’s election results reflect “a mandate to pass sensible legislation?”

And they wonder why we don’t take them seriously.

So who’s gonna pay for this knucklehead move? Eventually, you. 

Thanks to Congress, it’ll soon be very difficult to find a health care professional who’ll accept your Medicare card, since MACRA (Medicare Access and CHIP Reauthorization Act) applies Obamacare’s experiments to the whole program.

It wasn’t as if Medicare was untouched before MACRA, despite what HuffPo’s Jeffrey Young thinks. Thanks to Obamacare, pay-for-performance schemes like Accountable Care Organizations (ACOs) began in Medicare in 2012, and they’ve produced less than impressive results thus far. That didn’t stop our 2015 Republican “leaders” from expanding them.

What are ACOs? Think of the Health Maintenance Organizations (HMOs) of the 1990s, an idea that proved so wildly unpopular that patients revolted in near-universal protests about limited provider networks and rationed care. 

Still, the Obamacare Congress thought it was wise to apply HMO 2.0 to Medicare patients, but with an additional feature: patient satisfaction scores. That means ACO providers are financially rewarded for limiting care and procedures, but also have to make the patient feel happy about it!

(Never mind that payment for satisfaction is associated with higher health care expenses and a greater likelihood of hospitalization and death. The Obamacare Congress knows best.)

MACRA essentially forces all Medicare providers into Obamacare’s experimental ACOs. This spells the end to private independent healthcare practices, as providers must align themselves with a huge health system to survive.

Well, to be fair, doctors do have a choice. They can continue in traditional fee-for-service care, but anti-Obamacare warrior and ophthalmologist Kris Held explains the dangers of this route:

Government bureaucrats and committees will call the shots for Medicare patients. The law actually creates Alternative Payment Models (APMs) and a Merit-based Incentive Payment System (MIPS) which require physicians to follow a government rubric on which we will be graded in grade school fashion. Physicians, now defined as “eligible providers,” will get grades from 0-100 as determined by the Secretary of Health and Human Services. The grade for doing what the Secretary prescribes is called the Composite Performance Score. The score is publicly posted on the Physician Compare Internet Website of CMS, and the Secretary of HHS assigns each physician a payment adjustment factor based on this score. The payment adjustment factor will be positive, 0, or negative. Based on how well a doctor “performs” for the Secretary, the pay could be adjusted 9% up or 9% down, meaning the Secretary’s most compliant doctors will be paid 18% more than those who don’t perfectly make her wishes our commands. What will doctors put up with, and what will we do or not do for patients in order to be paid 18% more than those government deems “less quality” doctors and to avoid public humiliation on the government website? This is indeed chronic and continued abuse taken to a higher, institutionalized level.

That’s right. In either scenario, doctors will be scrutinized by federal bureaucrats aiming to reduce Medicare expenses by dictating care according to one-size-fits-all treatment protocols.

Since the passage of MACRA, many doctors are considering resignation from Medicare. “Opt out providers” will still treat you, but you’re gonna have to pay privately, outside Medicare’s supervision and reimbursement mechanisms.

This has one obvious disadvantage for the typical Medicare patient, since, depending upon the arrangement negotiated, costs may be higher to see these opt-out doctors. 

But it also means Creepy Uncle Sam won’t be in the exam room, and you’ll have care that is tailored to the individual, not forced onto you by Washington DC bean counters.

And it’s likely to be far more affordable than you may think, since health care professionals who opt out of arrangements with government and private insurance have reduced overhead costs. These doctors can charge less than their hand-cuffed peers, who can’t reduce fees for cash patients without violating government and insurance contracts.

As the Association of American Physicians and Surgeons pointed out when MACRA was passed, “opted-out physicians are able to charge a mutually agreeable fee (sometimes lower than the Medicare copayment), drastically reduce administrative overhead, give their patients the time that they need, keep records confidential, and prescribe according to their best judgment rather than a government-approved protocol.”

It’s reasonable to expect that, due to the “rising misery index” and increasing retirement rates among physicians, there will be far fewer of them in coming years. Among those that remain, a growing number will opt out of The System.

And you’ll know who to blame. This time, Republicans are the ones who apparently didn’t bother to read the bill.

Medicare providers wishing to learn how to opt out can visit here.

Americans wishing to do business with liberty-minded physicians can find them here.

Obamacare Scorecard: Takers Taking, Makers Breaking

When market research company J.D. Power released its 2015 Health Insurance Marketplace Exchange Shopper and Re-Enrollment (HIX) Study last Thursday, progressive health care reporters rushed to their laptops to declare Obama’s remarkable achievement:

Wowie!
Obamacare customers
are more satisfied
than people with job-based plans!

Vox’s Sarah Kliff offered her ‘splainer of the study, which was based on data collected from December 9, 2014, through February 24, 2015. 

People who had coverage through Obamacare had an average satisfaction score of 696 in 2014, thinking back to their last year of coverage. During that same year, people in mostly employer-based plans had a satisfaction rating of 679 — 17 points lower.

So did Sarah Ferris at The Hill:

People who bought coverage through ObamaCare are generally more satisfied than those with other types of insurance, according to a new national survey. ObamaCare customers rated their satisfaction over the last year as 696 out of 1,000, compared to the 679-point rating by customers with employer-based plans, according to a large survey by the consumer research firm J.D. Power.

And let’s not forget young Jonathan Cohn, who wrote a Huffington Post piece titled Obamacare News That Should Make Conservatives Happy, But Won’t:

J.D. Power uses a numerical index, from zero (low) to 1,000 (high), to measure consumer satisfaction. The figure for Affordable Care Act consumers was 696. To put that in perspective, the figure for people with employer-sponsored insurance — the source of coverage for most working-age Americans — was 670 [sic].

Here’s a question for Kliff, Ferris, and Cohn:

Are you really surprised that getting free stuff is popular?

…especially since J.D. Power found that “cost is the most influential attribute driving satisfaction among Marketplace plan members?”

Reporters of all stripes ought to know why Obamacare customers are happier than those in employer plans.

  • Obamacare enrollees enjoy the taxpayer’s helping hand with their premiums: in 2014, 90 percent received premium subsidies, and 69 percent paid $100 or less per month. 
  • Those in job-based plans are being increasingly hammered by rising out-of-pocket costs, as employers reduce benefits to avoid Obamacare’s Cadillac Tax. 

The New York Times provides one example of the excise tax’s impact on workers.

Starting this year, they have a combined deductible of $2,300, compared with just $500 before. And while she was eligible for a $1,400 hospital contribution to a savings account linked to the plan, the couple is now responsible for $6,600 a year in medical expenses, in contrast to a $3,000 limit on medical bills and $2,000 limit on pharmacy costs last year. She has had to drop out of school and take on additional jobs to pay for her husband’s medicine.

Remember: Obamacare enrollees don’t have to pay the Cadillac Tax; only those with company plans suffer that burden.

The real story in the J.D. Power release, though, is not found in comparisons of people with different types of coverage: it’s found when one examines the insurance satisfaction index over time.

In 2009, the year before Obamacare was passed, that number was 712 out of 1000. In 2010, it plummeted to 701. And now, for those with employer-provided insurance, that number is 679 — and 696 for those in the individual market.

In their reports, the research firm (strangely) never mentions the sampling errors and confidence intervals that would allow for meaningful year-by-year comparisons. However, they do say they consider a ten-point change to be significant.

So overall, Americans are vastly less satisfied with their health insurance since Obamacare started monkeying around with it. That’s the story.

But our progressive health care journos didn’t write about that tidbit, did they? 

Instead, they put a happy face on the numbers, gleefully announcing that those getting freebies are happy with their free provisions, and those subsidizing those freebies are much less so. 

Duh. They must think their readers were educated at the Jonathan Gruber School of Stupid.

[Sigh] It’s all fun and games until we “run out of other people’s money.”

Meet Jeffrey Young, HuffPo’s Medicare Donut Hole

On April 17, Huffington Post’s Jeffrey Young admitted he doesn’t know squat about Obamacare. 

Referring to a Bloomberg article on Obamacare polling, he asked his Twitter followers to enlighten him as to one woman’s claims.

And then he revealed that he has no idea whatsoever as to Obamacare’s impact on Medicare.

“Eventually” deducing that she’s “almost certainly on Medicare,” not Obamacare, he writes off her report as nonsense.

Why, it’s as if Medicare and Obamacare are two distinct and unrelated programs! 

His reasoning? On the one hand, some poor schlubs lost their plans and had to sign up for lousy coverage in the exchanges. On the other, there’s Medicare, the insurance plan for the elderly and disabled. And never the twain shall meet, right?

WRONG, Mr. Young.  And Ms. Stone isn’t a befuddled octogenarian who doesn’t know the difference. 

Ms. Stone was treated at physicians’ offices through Russell Medical Center, which has partnered with the University of Alabama at Birmingham Health System (UAB) since August, 2012. At the time, RMC agreed to a plan of “working together to solve problems in health care delivery.”  In September, 2013, UAB embraced Obamacare’s ambition to reduce health care costs.

Ms. Stone has never had heart problems, but during a routine blood draw, her triglycerides tested at 600, almost 10 times her usual result. Her internist put her on multiple medications and referred her to one of RMC’s cardiologists. 

She then became a cardiac patient. 

With three master’s degrees and two specialty degrees, including one in psychometry, Ms. Stone was no fool. “I knew the lab was wrong.” But she couldn’t convince her doctors to retest her.

“They told me I couldn’t get another test for three months and that I’d need to take all of these medicines in the meantime. They said Obamacare was the reason.”

And they explained how Obamacare is influencing patient care: “The doctors are very dissatisfied, and many of them are not able to give their patients the attention that they feel that they need because they can’t have too many appointments, too many tests.”

The unaware and uninterested Jeffrey Young, HuffPo’s Obamacare expert, admits he’s “puzzled” by this. And this revelation is surprising since he’s written about the donut hole repair, Medicare costs, and the increasing out-of-pocket costs Americans are enduring. He even weighed in on King v. Burwell. One could fairly assume he’s researched the law in its entirety. 

Did he stop reading Obamacare when it came to its reforms of Medicare? Did he get sleepy?

As a national health care reporter, Mr. Young ought to know that no other group is as affected by Obamacare as are seniors on Medicare. The law created a variety of pay-for-performance experiments in Medicare, including the following:

Section 3001: Hospital Value-Based Purchasing Program
Section 3002: Improvements to Medicare’s Physician Quality and Reporting System (PQRS)

Section 3003: Expansion of Medicare’s Physician Feedback Program 
Section 3007: Application of Medicare’s Value-Based Physician Payment Modifier (VBPM) to Physicians Payments 
Section 3022: Medicare’s Shared Savings Program for Accountable Care Organizations
Section 3023: Bundled Payment Pilot 

The goals of these experiments are to reduce costs (in large part by limiting tests and procedures) and to improve the quality of care by “rewarding value” rather than the number of services delivered. 

The problem? Federal government bureaucrats, not health care professionals, are the ones defining quality treatment. And when health care providers don’t attest to their compliance with government-approved standards, they’re penalized.

This is what ophthalmologist and Obamacare rebel Kris Held means when she refers to the law’s perverse incentives that shift focus away from what’s best for the patient to what’s best in the eyes of The System’s cost-cutters.

As physician editor of The Hospitalist Danielle Scheurer cautioned last year, “there is a legitimate concern that physicians will be overwhelmingly motivated to play to the test, so that their efforts to perform exceedingly well at a few metrics will crowd out and hinder their performance on unmeasured metrics. This tendency can result in lower-value care in the sum total, even if the metrics show stellar performance.” 

And lower-value care is just what Dell Stone received, thanks to bureaucratic interference with her treatment. When her triglyceride levels tested alarmingly high, her physician clicked the boxes in his electronic health record and prescribed heart medications, including a potentially dangerous statin drug. And due to the drive to keep testing expenses low, a second lipid panel had to wait.

Thankfully, when Ms. Stone returned to her cardiologist two weeks ago, her three-month wait paid off and she was granted a retest. This time her triglyceride reading was 67.

So, yes, Mr. Young, Obamacare did cause harm to this senior — and is in the process of harming countless others. 

When The System begins experimenting with your grandmother’s care, Mr. Young, will you bother to research Obamacare a bit more?

Citizen Journalist v. Citizen Cohn: Obamacare Is All About Redistribution

This morning Huffington Post’s Jonathan Cohn let the cat out of the bag, admitting that Obamacare was a redistribution scheme.

Touché, Mr. Weinstein.

Do you remember anyone — journalist or politician — divulging that information before the law was passed? How about when Obama was running for reelection? Of course not. The policy would have been as unpopular as the Cadillac Tax is now becoming.

It’s unclear when Jonathan Cohn learned Obamacare was a redistribution tool, but he admits he was pretty cozy with the Obamacare architects during the law’s creation, especially with Jonathan Gruber.

And remember when Jonathan Gruber told his guests that Obamacare was written in a “tortured way” so as to deceive voters, especially as regards its redistributive mechanisms? 

In terms of risk-rated subsidies, if you had a law which said that healthy people are going to pay in — you made explicit that healthy people pay in and sick people get money? — it would not have passed. Lack of transparency is a huge political advantage.

Where was the American press on this nugget? Oh, that’s right. They weren’t interested in doing any investigative journalism on the law. That discovery was left to a financial advisor in Philly, an ordinary American who tried for well over a year to get the incurious press’ attention.

But Obamacare doesn’t only redistribute wealth. It also redistributes health.

In his January, 2015, Forbes piece titled “Is Obamacare Squeezing The Middle Class?” John Goodman explains:

Poor, long-uninsured patients are getting Medicaid through Obamacare and finally going to the doctor’s office for care. But middle-class patients are increasingly staying away…Gallup polling shows what has been happening over time: Even though more people are insured today than in quite some time, more people are putting off medical treatment because of cost than has been the case in the past eight years.”

Even The Los Angeles Times had to agree:

[T]he law hasn’t provided much relief to American workers either, according to a new study of employer-provided health benefits. Workers continue to be squeezed by rising insurance costs, eroding benefits and stagnant wages, the report from the nonprofit Commonwealth Fund found…”Workers are paying more but getting less protective benefits,” the report’s authors noted. 

Last December, The New York Timessurvey showed the impact of health care expenses on Americans, concluding that:

Affording medical care is more of a hardship.
Out-of-pocket expenses have gone up.

It’s an axiom of economics (and common sense): when you increase the costs of a commodity, in this case health care, you reduce demand for it. And so middle-class Americans, hammered by rising expenses, are avoiding care, even if that doesn’t bode well for their long-term physical and emotional health.

This will be a story that plays out over coming years.

But the concepts of health and wealth redistribution should have been put before the American public, by lawmakers and journalists like Jonathan Cohn, before the law was passed — and then cemented by Obama’s reelection.

It’s likely, however, that they thought we were too stupid to understand how amazingly awesome Obamacare would be for us. Progressive elitists always think they know what’s best for the unwashed masses, and if they have to lie to get their policies through, they will. To Obama and his ilk, the ends always justify the means.