Final Regulations For Obamacare Individual Mandate

Avik Roy: "White House Publishes Final Regulations For Obamacare's Individual Mandate -- Seven Things You Need To Know".

The bullet points include:

1. You pay a fine if your spouse and kids are uninsured
2. Pretty much any employer-sponsored plan meets the mandate’s requirements
3. The mandate fine is small, and will have even less impact over time
4. The IRS can’t go after you if you don’t pay the fine
5. Many older individuals will be exempt from the mandate
6. If you don’t file a tax return, you’re exempt
7. ‘Members of recognized religious sects’ and American Indians are also exempt

(See the full text of his piece for more details on each point: "White House Publishes Final Regulations For Obamacare's Individual Mandate -- Seven Things You Need To Know".)

Hsieh Forbes OpEd: "How Much Will Your Life Be Worth Under Obamacare?"

Forbes has published my latest piece, "How Much Will Your Life Be Worth Under Obamacare?"

Here is the opening:

How much will your life be worth to the federal government under ObamaCare? Less than you might think. We can make an educated guess by looking at which medical screening tests the government U.S. Preventive Services Task Force (USPSTF) considers worthwhile...

I also discuss problems with one-size-fits-all government medical recommendation, and how President Obama and his doctor knowingly violated guidelines set by his own federal task force.

(For more details, read the full text of "How Much Will Your Life Be Worth Under Obamacare?")

Catron: Sorry, Obamacare Isn’t Better Than ‘No Plan’

A core principle of medicine is "Primum non nocere" or "First, do no harm".

David Catron latest column explains how Obamacare has rendered U.S. health care far more dysfunctional than it was before "reform" was passed.

For details read his piece, "Sorry, Obamacare Isn't Better Than 'No Plan'".

Cronyism Update

The Hill reports, "ObamaCare's architects reap windfall as Washington lobbyists".

From the article:

Veterans of the healthcare push are now lobbying for corporate giants such as Delta Airlines, UPS, BP America and Coca-Cola, and for healthcare companies including GlaxoSmithKline, UnitedHealth Group and the Blue Cross Blue Shield Association...

The voracious need for lobbying help in dealing with ObamaCare has created a price premium for lobbyists who had first-hand experience in crafting or debating the law.

Experts say that those able to fetch the highest salaries have come from the Department of Health and Human Services (HHS) or committees with oversight power over healthcare.

Demand for ObamaCare insiders is even higher now that major pieces of the law — including the healthcare exchanges and individual insurance mandate — are being set up through a slew of complicated federal regulations...

(If you can stomach the sordid details, read the full text of "ObamaCare's architects reap windfall as Washington lobbyists".)

The Holy War Over Obamacare

Both conservative and liberal religious groups are trying to claim that God is on their side on the political fight over ObamaCare: "The holy war over Obamacare".

The Man Who Was Treated for $17,000 Less

Yesterdays Wall Street Journal had a very informative piece, "Jeffrey Singer: The Man Who Was Treated for $17,000 Less".

Read the whole thing!

UPS and ObamaCare

This headline pretty much speaks for itself: "UPS to drop 15,000 spouses from insurance, cites Obamacare" (Atlanta Business Chronicle, 8/21/2013).

Armstrong Interviews Umbehr On Concierge Medicine

Ari Armstrong has just published the following interview: "Dr. Josh Umbehr on the Concierge Medicine Revolution".

They discuss various models of direct pay and concierge medicine, including pros and cons.  I especially liked Dr. Umbehr's advice to patients on how to best protect their medical freedom.

I highly recommend reading the full interview!

Enforcers At Your Doorstep?

David Catron asks a good question in his latest American Spectator piece: "Will Obamacare Enforcers Appear on Your Doorstep?"

Quick Links: Cons, Reid

CNBC: "Obamacare is coming, and so are the con artists"

Ari Armstrong: "Harry Reid Confesses Truth About ObamaCare"

Massachusetts Update

Walter Russell Mead describes the latest from MA, "Romneycare Falters in Massachusetts".

Here's the opening:

Pundits on both sides of the political spectrum have noted that health care outcomes in Massachusetts are among the best indicators for Obamacare that we have, given the ACA’s similarity to Romneycare. Now a new study is out on MA health care, and it doesn’t paint a pretty picture...

Quick Links: Limits, Subsidies, Rap

WSJ: "Many Health Insurers to Limit Choices of Doctors, Hospitals"

CA Health Line: "Half in Individual Market Will Qualify for ACA Subsidies in 2014"

ABC News: "Michelle Obama Promotes Healthy Living With New Rap Album"

Bourque on Adverse Selection

At The Objective Standard blog, Stephen Bourque discusses why "The Solution to 'Adverse-Selection' in Health Insurance is Selfish-Selection".

One critical point:

Insurance is a product that certain businesses produce for trade and profit. Insurance companies price their product by assessing risks and accounting for many variables involving the market and their customers. Insurance companies and their customers (properly) deal with each other voluntarily, by mutual consent to mutual advantage. Insurance, properly speaking, is a kind of voluntary contract.

The coverage for “pre-existing conditions” that insurers are forced to provide is, strictly speaking, not insurance at all.

(For more, read the full text of "The Solution to 'Adverse-Selection' in Health Insurance is Selfish-Selection".)

Roy and Mataconis on the Latest ObamaCare Delay

Avik Roy reports: "Yet Another White House Obamacare Delay: Out-Of-Pocket Caps Waived Until 2015".

Doug Mataconis notes, "Another Obamacare delay shows the benefit of friends in high places".

Shared Patient Appointments

With the worsening doctor shortage, some medical centers are resorting to "shared patient appointments".

Blogger-physician Dr. Wes explains:

As health care reform kicks in to high gear, a new innovation in health care delivery is being touted at Cleveland Clinic: shared patient appointments. On the surface, this idea seems so efficient and social as patients with similar medical problems sit around in a group therapy session that masquerades as health care. After all, with the large influx of new patients to our health care system underway and the limited health care personnel resources available, the push for such a model was inevitable.

But many Americans are also noticing another disturbing trend: higher insurance premiums to offset the cost of those who do not have sufficient resources to pay for their care.  While the reality of our higher health care costs demand that the added costs be paid by someone, I suspect most of those who will be paying higher premiums didn't think they'd have to "share" their physician appointments with others...

BTW, these become more popular in Massachusetts after the imposition of Romneycare, as described by the Boston Globe in 2008.  Some patients found it better than waiting a long time to see a doctor, others have serious problems with the lack of privacy.

Looks like the rest of the country is starting to catch up to Massachusetts.

HHS Survey

Some friends recently received this request from the Department of Health and Human Services (HHS) to participate in a survey.

They chose to decline, sending the interviewer away when he appeared on their doorstep.

My friends had two concerns: (1) How confidential is there information and (2) Is that $30 coming from taxpayer pockets?  I share their concerns.

Dr. Wes: A Case Of Fraud

Cardiologist/blogger "Dr. Wes" described an interesting medical ethics dilemma in his recent blog post, "A Case of Fraud".

In short, a cardiologist had to choose between doing what was right for the patient vs. following Medicare rules.

I don't know how often this happens. And I'm glad this particular doctor fulfilled his responsibility to his patient.

But we'll see more of these conflicts as Medicare imposes increasingly restrictive rules on how physicians are allowed to practice.  Many current doctors will still quietly do the right thing for their patients. But over time, we'll see a new generation of doctors more willing to comply with government edicts even if it goes against their Hippocratic Oaths to work for their patients' best medical interests.

And this isn't just abstract theorizing.

Some day, you might be that patient in the cardiac cath lab. On that day, you'd better hope you have a doctor still willing to act in your best interests.

(Read the full text of "A Case of Fraud".)

Amerling on Unaccountable Care Organizations

Dr. Richard Amerling of AAPS discussed "Unaccountable Care Organizations" in his latest OpEd. 

An excerpt:

How is the ACO different from the HMO? The difference is merely cosmetic. The ACO is composed of physicians, other “providers,” and administrators. It contracts with the Center for Medicare and Medicaid Services (CMS) to provide care for selected beneficiaries. It receives a lump sum per patient per month from which all care is to be provided. Money not spent on care (“profit”) is split evenly between the ACO and CMS.

Money spent in excess of the “bundled” payment is a loss to the ACO. The ACO can also receive incentive payments for achieving (and reporting) certain “benchmarks” such as lowering blood pressure or cholesterol level. These “quality” indicators, which are based on large population studies, will almost certainly lead to over-treatment of individuals, particularly the elderly.

Like HMOs, ACOs will face very strong incentives to cherry pick the healthy and to limit access to specialty care, procedures, expensive drugs, and hospitals. These incentives are devastating to the truly ill. And the ACO is accountable to CMS, not to the patient!...

(Read the full text of "Unaccountable Care Organizations".)

NYT on Transparency and Tourism

Two pieces from the New York Times caught my eye recently:

Tina Rosenberg (7/31/2013): "Revealing a Health Care Secret: The Price"

(Includes a lengthy discussion of price transparency and the detailed look at how this helps the Surgery Center of Oklahoma provide good service at lower costs for patients.)

Elisabeth Rosenthal (8/3/2013): "For Medical Tourists, Simple Math"

(Includes discussion of how medical tourism can allow patients to receive excellent care at lower cost.)

I'm glad these ideas are getting wider attention!

Armstrong on His Wife's Experiences with Uterine Fibroid Embolization

Ari Armstrong has a nice write-up of his wife Jennifer's good experience as a patient with one of my partners.

Jennifer had pretty bad symptoms related to uterine fibroids.  Fortunately, my partner Dr. Brooke Spencer was able to offer "Uterine Fibroid Embolization" treatment, without risky surgery.

For more details, see the full text of his post, "My Wife's Experiences with Uterine Fibroid Embolization".

I'm glad things worked out so well for Jennifer!