Health Wonk Review: Happy New Year! edition

Brad Wright hosts the first Health Wonk Review of 2013, and it's a doozy. From workers comp to government subsidized health insurance to new tech, there's something to whet your wonketite (that's word, right).

Pay & Chase for Individual Subsidies?

One of Medicare's biggest systemic failures (if not its biggest) is pay and chase. Claims must be processed in 15 days and payment sent, at some point down the road, usually a year or two after they get around to checking if the claim should have actually been paid. If they find out it should not have been paid they then try to recover these monies. A system only a politician could accept.

Appears that this is the plan for ObamaCare as well:

"Employers will receive notice if their employees are certified for premium tax credits and will have an opportunity to respond.  The IRS will then present the employer with a notice and demand for payment.  It appears that this will happen in 2015 for penalties owed for 2014."

January 1st, 2014 employees go to the exchange and gets a subsidy to buy coverage. Come some point in 2015 the IRS will send a notice to employers trying to collect the penalty. What if the employer proves the employee was not eligible for  the subsidy and thus they are not subject to the penalty? Does the IRS then go after the employee to recoup the subsidy? This is money that went to buy insurance so it is doubtful the employee would have it to repay. 

Can anyone dream of a system our government could implement that would accurately determine eligibility? They want individuals to instantly be able to price policies and buy online. How do you instantly gather that information from employers?

It almost seems as if there is some layer of administrative work provided at the employer level, between the worker and carrier,  that accurately and timely makes these determinations, within 30 day window or so. Those arguing, mainly clueless academics, that insurance could more efficiently be offered if decoupled from employment never grasped the administrative savings of bulk buying. If employers were not contributing that would make things easier, but I have yet to see an affordable or palatable system employers did not contribute to financially. If you think individual polices subsidized through the tax system would work you would just be ignorant. 25% of owed taxes aren't collected and fraud is rampant, see refund fraud as a clear example.

ObamaTax(es) for all!

Courtesy of Grace-Marie Turner (Galen Institute president and Forbes contributor):

■ "[T]he Medical Device Tax that hits entrepreneurial firms making equipment such as heart valves and hip replacement parts."

As regular readers already know, corporations don't pay taxes, their customers (that would be you) do.

■ "A new Medicare Tax ... a big hit especially for the self-employed."

That would also be job creators (who now won't be so inclined).

■ "The new Flexible Spending Account Tax limits the amount of money that workers can set aside tax-free for medical costs."

This is a double-whammy (at least): just as the ObamaTax itself has increased the cost of health care, ways to mitigate the damage are drying up.

There's more at the link - but only for those with strong stomachs (and/or access to adult beverages).

Gray Lady Joke of the Day

You really can't make this up:

"In a long-awaited interpretation of the [ObamaTax], the Obama administration said Monday that employers must offer health insurance to employees and their children, but will not be subject to any penalties if family coverage is unaffordable to workers."

Wait, what?

So first they make it impossible to write child-only health plans, and now they've decided that "dependents" doesn't include spouses?

But the best part?

Remember: the "official" name of the ObamaTax is the "Patient Protection and Affordable Care Act" [emphasis/irony added]. But they've now officially backtracked on that "affordability" requirement:

"[T]he meaning of “affordable” depends entirely on the cost of individual coverage for the employee"

Reminds me of something....

[Hat Tip: FoIB Holly R]

EHR and the MVNHS©

Electronic Health Record-keeping is an integral part of the ObamaTax and, as we noted last week, these records aren't necessarily safe from prying eyes. So how are we to know how safe our newly-digitized medical records will be once they're on-line in a national database?

Well, we can look to Britain's Much Vaunted National Health System© for a peek at our own future:

"More than one in three [Brits] have had their medical details uploaded onto a central database accessible by healthcare professionals across the country, many without their knowledge ... the majority of those patients whose records have been uploaded will not be aware and said there are dangers the information could be hacked, bought by private companies or matched to other publicly available details on individuals."

Of course, that last part is pure hype, right?

Maybe, but this kind of thing isn't exactly reassuring:

"[E]mployees, who work for NHS Lothian ... had the temerity to assume that their own medical records were their own business. Or at the very least, that they had as much right to read them as some other government employees did."

But why would they believe that? They've already ceded their health care to their fellow government bureauweenies, why would their medical records be sacrosanct?

When the government is in charge of your healthcare, they mean it:

"There is a fair warning system on the computers but people don’t always read it and they don’t actually realize they're not allowed to look at their own records"

Seems pretty clear to me.

And this is the (very near) future of our health care "system" under the ObamaTax.

[Hat Tip for NHS Lothian story: FoIB Fred W]

Another ObamaTax speedbump

Last Friday, an Illinois-based business was granted an injunction against HHS Secretary Shecantbeserious enforcing the birth control convenience item mandate.

Now, another federal judge has issued one on behalf of a Michigan-based property management company:

"U.S. District Judge Lawrence Zatkoff ruled Sunday in favor of Tom Monaghan and his Domino's Farms Corp ... Zatkoff granted Monaghan's emergency motion for a temporary restraining order until a final decision is made in the case."

And the slow slog continues apace.

This Sceptered Isle - Part CCXXV

From the London Telegraph, here’s new, yet more depressing news about the British National Health Service:

60,000 patients put on death pathway without being told but minister still says controversial end-of-life plan is 'fantastic’

In part, this is an old dispute about whether the Liverpool Care Pathway (LCP) is a gentle and dignified end of life treatment – similar to what America calls hospice – or instead is a “death pathway” designed to finish people off.  An estimated 130,000 patients per year are put on LCP. 

According to the Telegraph article. “The pathway involves withdrawal of lifesaving treatment, with the sick sedated and usually denied nutrition and fluids. Death typically takes place within 29 hours.”

But the new issue is not about speed.  The new issue is about ethics. It appears hospitals are not careful to advise conscious patients when they are placed on LCP or what will then happen to them.  It also appears family members and even family physicians are not being advised.

This new issue became public following a recent national audit of LCP conducted by the Marie Curie Palliative Care Institute in Liverpool and the Royal College of Physicians.  As though the scary numbers were not enough, the U.K. Health Minister Jeremy Hunt belittled the audit findings by saying “I would be very sad if as a result of something that is a big step forward going wrong in one or two cases we discredited the concept”

Wrong in “one or two cases”, would make Jeremy “very sad”.  Indeed.

From the article: “The national audit . . . examined a representative sample of 7,058 deaths between April and June last year. The figures were scaled up to give a national picture. It found that in 44 per cent of cases when conscious patients were placed on the pathway, there was no record that the decision had been discussed with them.”

Well then, Jeremy, 44% would be more than one or two.

Also according to the article, the audit “revealed that one in three families did not receive a leaflet to explain the process.”

Got it.  In the U.K. at least it appears that the National Health Service permits government functionaries to withdraw food and medicine from patients  - whom the functionaries also select  - without knowledge of the patient, the patient’s family, or even the family physician.

No need for mum to know that she's been put on the Liverpool Care Pathway at St. Lucifer General.  It's all the better to care for her.  No need for you to know about this either, it will only upset you.  So just fold your hands and relax.  All is under control - our control.

O brave new world that hath such people in’t.