Fishy Food Pyramid Update

It's been a while since we've updated our (in)famous Food Pyramid. Recently, we received email from the 1Dental blog pointing out that:

"Harvard researchers found that polyunsaturated fatty acid consumption could be an effective treatment and prevention method for gum disease ... Polyunsaturated fatty acids found in foods like fish oil contain anti-inflammatory properties."

So there it is: eat more tuna, maintain healthier gums.

Now to go fire up the grill....

Say, Brother, Can You Spare $35.7 Million?

As we've long noted, illegal immigrants make up a disproportionate share of the uninsured, and account for untold millions of dollars in health care costs. Oh wait, did I say "untold?" Turns out, not so much:

"Beleaguered ... U.S. taxpayers coughed up a staggering $35.7 million this year in free emergency health care for more than 52,000 illegal aliens in Massachusetts, sparking outrage from candidates and critics who back a tougher line on immigration."

On the face of it, that $700 per illegal price tag doesn't seem too awful, but multiply that by the millions of these folks roaming the fruited plain, and you're talking about a lot of money. Now, it's not quite accurate to call all of these particular 52,000 illegals "uninsured," since almost 95% of those costs were borne by MassHealth. Of course, the folks who run that program were told to make themselves unavailable to the public, who might be (understandably) miffed at these revelations.

Beleaguered Bay State Guv Deval Patrick tried to deflect criticism by laying the blame on the Feds, but his argument is considered, at best, weak:

"The Patrick administration maintains that its hands are tied because failing to treat gravely illegal immigrants would be a violation of federal law, but some disagree ... 'My suspicion is it’s willful ignorance.'"

Regardless, the problem promises to get bigger, not smaller, since it's estimated that Massachusetts is home to almost a quarter million illegals.

Of course, one needn’t be an alien, legal or otherwise, to rack up some major health care costs. That's particularly true if you're a teacher in Buffalo, New York:

"Cosmetic surgery costs for Buffalo Public Schools employees have skyrocketed from less than $1 million in 2004 to nearly $9 million last year."

Now, some of these are no doubt legit (reconstructive surgery after breast cancer, that kind of thing), but $9 million worth? Probably not:

"The vast majority of those procedures ... were chemical peels, laser hair removal, skin rejuvenation and other skin treatments. All of them were elective procedures"

Whatever happened to mudpacks and cucumber slices?

49% of Georgia Seniors to Lose Medicare Advantage Plans

The campaign promise, "If you like your plan you can keep it" has lost its luster. The Chief Actuary at CMS estimates half of seniors on Medicare Advantage Plans will be forced out of their plans by Obamacare. He further concludes that:

in addition to losing access to the health plan of their choice, those who are able to remain in Medicare Advantage plans will face substantially higher out-of-pocket costs as a result of the cuts to Medicare Advantage in the new law.

The folks at Heritage concur and take it a step further. They have estimated the number of seniors by state, by county and Congressional district that will lose access to their MAP's.

Taking into account those who remain in the less-generous Medicare Advantage program and those pushed out of it completely, our report found substantial regional variations—benefit losses range from a low of $2,780 in Montana to a high of $5,092 in Louisiana. The percentage of beneficiaries pushed out of the program ranges from 38 percent in Montana to a 67 percent in Washington, D.C., and 84 percent in Puerto Rico.

Georgia seniors fall in the middle with almost half expected to lose their Medicare Advantage Plan due to cutbacks attributed to Obamacare. This is in addition to the 15,000 Georgia seniors that will lose the MAP in January, 2011,

As a direct result of the Medicare cuts used to pay for a massive Medicaid expansion and subsidy scheme under the new law, senior citizens and disabled Americans will pay more but receive less care, and despite repeated promises that “if you like your health plan, you can keep it,” half of those who like the Medicare Advantage plan they’ve chosen will not be able to keep their plan.

Today is election day.

As they say in Chicagoland, vote early and vote often.

Visit Georgia Med Supp for more information.

Grand Rounds: Electioneering edition

Dr Wes presents both sides of the political spectrum - Politically Correct and Politically Incorrect - in this week's roundup of great medblog posts. He's got my vote!

CBA vs Grandpa

[ed: Caution, there be wonkery ahead]

ObamaCare©'s grandfathering issues are well-documented here at IB, but we've never discussed them as they pertain to Collective Bargaining Agreements (CBA's). According to the American Benefits Council, CBA's enjoy special status under ERISA. They're so special, in fact, that:

"[L]egislation has been carefully drafted to avoid the imposition of significant legal requirements on collectively-bargained plans in the middle of applicable bargaining cycles. Congress has recognized that employers and unions must be able to negotiate over the terms and conditions of employment (including employee benefits) ... with the security of knowing that the benefits of the bargain will not be changed, midcycle, by unforeseen legislative initiatives."

Ahem.

Turns out, ObamaCare© doesn't work and play well with these arrangements. According to information we've received from Medical Mutual of Ohio, other than switching to a new carrier (which would, ironically, cause an individual plan to become ungrandfathered), any changes made that would otherwise cause the plan to lose its grandfathered status prior to the termination of the last CBA, will render the plan nongrandfathered once the last provision of the CBA terminates.

Simply put, CBA plans, which were ostensibly protected from these kinds of legislative shenanigans, are subject to the same vagaries as the rest of us. Now, that's not necessarily a bad thing - after all, CBA's impact the cost of production and distribution of many goods and services - but it's another example of the (perhaps unintended) effects of ObamaCare©.

[Hat Tip: FoIB Beth D]

"Bad" News, "Good" News

The "bad" news is that, as we've predicted for some time, employer-based health insurance is going away. The "scare-quotes" reflect my ambivalence to this development: on the one hand, I've never been a fan of employer-based coverage (although I do, of course sell it - I'm not an idiot). On the other hand, President The Won did, in fact, promise us that if we liked our current plan, we could keep it. That Beep-Beep you hear is the bus backing up to run over that promise again.

The latest corroboration of our prediction comes to us from John Vita, of GrantThornton (a "global audit, tax and advisory organization"). In email, Mr Vita writes:

"In a national survey of U.S. Chief Financial Officers (CFOs) and senior comptrollers conducted by Grant Thornton LLP ... 30% are planning on reducing health care benefits, 23% are planning on reducing bonuses and 18% will be reducing stock options/equity based compensation."

An overwhelming majority of the 508 U.S. CFOs and senior comptrollers who responded indicated that employee benefits (health insurance, etc) "as their greatest pricing pressure -- up from 68% six months earlier."

By the way, these figures couldn't be fresher: the survey was conducted just a few weeks ago.

The "good" news is that carriers are being enticed to change their minds about their moratorium on children-only health insurance plans:

"The Obama administration, aiming to encourage health insurance companies to offer child-only policies, said Wednesday that they could charge higher premiums for coverage of children with serious medical problems, if state law allowed it."

That last bit's interesting: states recently rushed to include ObamaCare© provisions in their own reg's, now the Fed's are telling them to throw the new rules under the bus. The problem, of course, is that what the Fed gives, the Fed can easily take away: given their track record of late (see above item), it seems to me that carriers would be even dumber than normal [ed: no mean feat, that] to fall for this line.

["Good" news Hat Tip: FoIB Jeff M]

ACO's Revisited: Connecting the Dots, Part 2 (Conclusion)

In Part 1, we posited several data points, and began our interview with "Dr Bill." Let's now wrap up that interview, and draw some conclusions:

IB: Okay, then in what way are hospitals becoming "predatory?"

Bill: Here's the catch for the hospitals: they want access to certain kinds of ancillary services, and want control those services in the community. So they look at, say, cardiologists that have EKG machines and cardiac imaging or the like, and say "well, we can lease up Dr So-and-so's practice, and make his practice a hospital outpatient department (HOPD) and increase Dr XYZ's earnings because now the hospital is billing services at hospital higher rates," part of which the hospital shares with Dr XYZ. The Hospital buys and owns the practices ancillary equipment which gets us the staff and the equipment." And then, of course, they don't really need all that staff...

IB: Okay, we get that. But how would that work from the physician's perspective?

Bill: Think of it as leasing the practice, with an option to buy. The hospital can then bill Medicare at its own, usually higher rates, and reimburse the doc at somewhat lower rates, pocketing the difference. But it's really a one-way street: the hospital gets paid more, but doesn't necessarily pay the doctor more, and the doctor has no idea what that differential is. As part of the agreement, the doctor has to disclose all his reimbursement info to the hospital, but the hospital doesn't have to reciprocate.

IB: A kind of "reverse transparency." Can you tell us a little more about the equipment issue?

Bill: The hospital leases the practice, but owns the equipment and the ancillaries. So it could be things like MRI machines, but it could also be the Durable Medical Equipment experts, the Physical Therapists, and the like. They can then pick and choose who and what they want to "keep."

IB: So it's a kind of "shell game?" How does that fit in with the Economic Credentialing?

Bill: Well, now they own (or at least control) the "structure," so they can micro-manage all they want. "Why did you keep Mrs Jones in an extra day?" or "Why did you use the expensive hip replacement unit on Mr Smith when the less expensive one would work just as well?" That last is especially onerous: yes, the cheaper unit might "work," but it's more likely to cause Mr Smith years of pain and, perhaps, a limp. But he survived and the follow-up is manageable, just prescribe some pills.

IB: So what you're saying is that the promise that "if you like your doctor" (which implies that you like the way your doctor practices) "you can keep your doctor" is under the bus?

Bill: Oh, absolutely! You may be able to see him, but maybe not. If you're on Medicare, and you need emergency surgery, for example, you're going to get the hospital-owned doc, who may or may not be your own, and you get no say in it. And the numbers are huge: your resident Medical Office Manager said Medicare patients make up 20% of her practice? Well, it's over 30% for us. So we can sell out to the hospital, or we can try to make do with a 30% cut in patients.

IB: Okay, that's a legitimate point, but yours is sort of an exception, isn't it? Most towns have multiple hospitals, so they're competing against each other. The doc's would be in the driver's seat, right?

Bill: You believe that? Tell me, how many hospitals in Dayton? Six or seven, right? But how many are owned by the same companies? They're all owned by two hospital groups. How much competition is there really?

Thanks, Bill!

So let's bring this full circle: remember those Data Points?

DP 1: Few doc's believe that ObamaCare© will improve health care, and

DP 2: There will be fewer physician-owned and/or specialty hospitals available, and

DP 3: ACO's will further consolidate available providers...

All of which, when put together, give us this:

"If Obamacare is completely implemented, doctors will no longer be practicing medicine. They will instead become the drones tasked with deciding who gets the meager healthcare crumbs doled out by the bureaucrats who have the ultimate power over patient life and death ... It spends 1.1 billion dollars to create ... the Coordinating Council on Comparative Effectiveness Research ... The council consists of 15 people appointed by the President ... A second board created by the stimulus bill called The National Coordinator for Health Information Technology “will determine treatment at the time and place of care."

Says whom? Some right-wing pundit with an axe to grind?

Nope, that would be Dr. Elaina George, a Board-certified Otolaryngologist (aka ENT doc)

That's the framework; here's the result:

"[These councils] are all isolated from day to day patient care; and therefore, are insulated from the real practice of the art of medicine."

But that, ultimately, is the goal: by removing the "human factor" from the equation, it's that much easier to commoditize the availability and delivery of health care. That is, they're there to ration care based not on the value of life but on the cost of the care. Dots connected.