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Billion-dollar ObamaCare contract pays people to do … nothing?

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The New York Times finally gets around to reporting an ObamaCare phenomenon that has been well-known for months — that the so-called savings in the system came from substantially limiting access to physicians in provider networks

LTC8K6

May 13 2014, 09:24 AM

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...the so-called savings in the system came from substantially limiting access to physicians in provider networks

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http://dailycaller.com/2014/05/12/virginia-first-to-release-post-obamacare-premium-proposals-rate-hikes-for-all/?advD=1248,153371

Virginia First To Release Post-Obamacare Premium Proposals: Rate Hikes For All

Virginians will see upped health insurance premiums in 2015 ranging from 3.3 percent to 14.7 percent, according to the filings from the first state to release any information about what Obamacare could bring next year.

The premium proposals were submitted to the state insurance office for official approval and were made public Monday. Each health plan expects to increase its prices in 2015 past nominal increases for inflation, the Wall Street Journal reports.

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Virginia is the first state to release its rate proposals for 2015; Washington state is expected to follow this week. Many states won’t make the data public until late summer.

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nyesq83

May 13 2014, 04:45 PM

Paid $477 for May premium in Gold Plan. Got a doc recommendation. Called for a new patient appt. yesterday. Next available is June 12. wtf? I will fill out forms and go in person next week.

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C.S. Lewis and the Science of Obamacare
[go to link if you wish to understand the title better]

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Today, politicians constantly invoke the authority of science, research, and experts of every stripe in the service of government schemes to impose some necessary good. President Obama is right now traveling the country chatting with TV meteorologists and radio personalities about a new study the White House claims is “the most comprehensive, authoritative scientific report ever generated” on climate change. The report, we’re told, is “actionable science” that will “translate scientific insights into practical, useable knowledge that can help decision-makers and citizens anticipate and prepare for specific climate-change impacts.” And you know what that means.

More to the point, a new study in Annals of Internal Medicine tells us that Massachusetts’ 2006 health reform law saved lives. It is a fact: for every 830 adults who gained health insurance through Romneycare, there was one fewer death per year.

As if on cue, liberal commentators over the past week have been arguing that because Obamacare is modeled on Romneycare, the federal health care law will save lives, too. The New York Times estimates Obamacare will save 17,000 lives if you apply the Massachusetts ratio to the entire country. Harold Pollack at Politico puts the number at about 24,000. This time, the debate about Obamacare really looks like it’s over. According to health care policy blogger Adrianna McIntyre, “The findings aren’t bulletproof, but they’re close.”

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http://www.forbes.com/sites/michaelcannon/2014/05/13/romneycare-study-justifies-neither-that-law-nor-obamacare-nor-universal-coverage/

RomneyCare Study Justifies Neither That Law, Nor ObamaCare, Nor Universal Coverage

In a previous post, I noted that a recently published study by Benjamin Sommers, Sharon Long, and Kate Baicker suggested that RomneyCare has saved lives, but also suggested that those lives were saved at a very high cost:

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• The authors estimate that “for approximately every 830 adults who gained insurance [under RomneyCare], there was 1 fewer death per year.” If we assume the per-person cost of covering those 830 adults is roughly the per-person premium for employer-sponsored coverage in Massachusetts in 2010 (about $5,000), then a back-of-the-envelope calculation suggests that RomneyCare spent $4 million or more per life saved. The actual figure may be much higher if we include other costs incurred by that law. The World Health Organization considers a medical intervention to be “not cost-effective“ if it costs more than three times a nation’s per-capita GDP per year of life saved. This in turn suggests that RomneyCare would have to give every person it saves an average of nearly 30 additional years of life to meet the World Health Organization’s criteria for cost-effectiveness. Given that the mortality gains were concentrated in the 35-64 group, that seems like a stretch.
  
  As an economist might put it, this means there are likely to be policies out there that could save a lot more lives than RomneyCare does per dollar spent.
  
  Or as Sarah Palin might put it, even if RomneyCare saved as many lives as this study suggests, it still probably deserves to be death-paneled.

Chris Conover illustrates:

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• For every uninsured life (purportedly) saved by Obamacare, we implicitly will have lost the lives of at least 8 smokers who could have been saved had we instead put the identical amount of tax dollars into the smoking cessation program cited earlier…So once fully implemented, Obamacare will save far fewer lives than an initiative to eradicate smoking among the poor. And the latter arguably could be achieved at a much lower cost.

So even if RomneyCare has saved some lives, it may still be unwise policy, because another use of the same resources likely could have reduced avoidable deaths even more. Evidence that universal coverage produces some benefits is not sufficient to establish its advisability.

Harold Pollack, Jonathan Cohn, and Bill Gardner object that focusing solely on mortality ignores other benefits of health insurance, including greater financial security and non-mortality health benefits. I agree. I focused on mortality improvements not because they are the only possible benefit or the only benefit of interest, but because they were the main take-away from Sommers-Long-Baicker, and the information necessary to make my point was readily available.

But I want to home in on this part of Gardner’s response:

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• Cannon is asking the right question: Given limited budgets, is insuring the uninsured the best way to spend our resources? But his next step is weak. Cannon is right that the study shows that the mortality benefits of health insurance would not by themselves justify its purchase. But that’s an absurd requirement. Health insurance gives you access not just to live saving care, but also to the rest of medical care, including things like hip replacements that allow you to walk and run, and free you from chronic pain. Insurance also protects your family from financial ruin. It’s the total contribution of [government expansions of] health insurance to well-being that needs to be considered in deciding whether we should support universal coverage. If Cannon is going to place a value on being insured, he needs to consider the total benefit a person experiences from having health insurance, not just the chance that it will save her life.

I agree with the bolded sentence. Supporters of universal coverage do not.

Before one can reasonably determine whether universal coverage is advisable policy—whether it produces net benefits—one must tally all the ways it improves human well-being, and weigh those benefits against the costs of universal coverage, which detract from human well-being. Anyone who understands the economics of health and medicine, marginalism, deadweight losses, moral hazard, public choice, opportunity costs, and the influence of incentives and barriers to entry on innovation knows that economic theory cannot tell us which way the scales will tip. To know whether the benefits of universal coverage outweigh the costs, we need evidence.

Where is the evidence upon which the Progressive Left bases its core belief that universal coverage is net beneficial? Where are the studies that look at the effects of universal coverage on length of life and quality of life and financial security? Where are the studies that weigh those benefits against all the costs of universal coverage?

Spoiler alert: those studies do not exist.

In a 2008 review of the economics literature, Helen Levy and David Meltzer concluded that while there is convincing evidence that government-sponsored coverage expansions produce some health benefits among some populations:

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• The central question of how health insurance affects health, for whom it matters, and how much, remains largely unanswered at the level of detail needed to inform policy decisions…for most of the population at risk of being uninsured (adults ages 19 to 50), we have limited reliable evidence on how health insurance affects health. This lack of evidence and the resulting lack of consensus indicate that to summarize the effects of health insurance on health is, inevitably, to misrepresent. Definitive answers to the multitude of important questions about how specific health insurance policy options affect health are likely to be forthcoming only with investment of substantial resources in social experiments.

Since Levy and Meltzer wrote these words, only a few studies have augmented this literature. A study of Medicaid expansions in New York, Maine, and Arizona found a correlation between reduced mortality and broader Medicaid coverage. The Oregon Health Insurance Experiment, the most methodologically reliable study ever conducted on this question, found that expanding Medicaid improved mental health, self-reported health, and financial security among enrollees. But, perhaps due to a too-small sample size or perhaps not, it detected no impact of Medicaid on mortality or other measured physical health outcomes. Another randomized study found that universal coverage produced no health improvements on average among rural Ghanaians. A study of the near-elderly in the United States found the uninsured do not die sooner than the insured, and the authors found “a zero average effect of uninsurance on mortality and health” to be “plausible.” The Sommers-Long-Baicker study found a correlation between RomneyCare’s government expansion of health insurance coverage and improvements in mortality and self-reported health. (If I’m omitting any other contributions to the literature, please let me know.)

Though the available literature offers plenty of reason to question the benefits of universal coverage, we are not close to measuring its benefits in a scientifically reliable way. Even with these recent additions, the “investment of substantial resources in social experiments” that Levy and Meltzer seek – which I too have endorsed, and for which Robin Hanson started a petition – have not happened.

The state of the literature on the costs of universal coverage is worse still. I am aware of only one study that has even attempted to measure some costs of universal coverage and compare them to some of the benefits. (Again, if I’m overlooking studies, please let me know.) Amy Finkelstein and Robin McKnight’s “What Did Medicare Do?” attempted to measure Medicare’s effects on elderly mortality and financial security over the first 10 years of the program. While the authors found no discernible improvements in mortality, they did find that Medicare increased financial security among enrollees. However, they estimated those benefits to be worth less than 40 percent of the tax burden Medicare imposes (which reduces financial security for others). If these findings are accurate, then to justify its tax cost, Medicare would have had to produce non-mortality health improvements whose value exceeds 60 percent of that burden. One might expect it did produce such gains; but one might also have expected to find discernible mortality improvements.


Where are the studies that go beyond the explicit and excess tax burdens of government expansions of health insurance to examine all of the costs of universal coverage? That incorporate the hidden costs imposed by Medicaid’s prescription-drug price controls, plus the costs of Medicaid’s steep effective marginal tax rates? Where are the studies quantifying the effects of Medicare, Medicaid, and the tax exclusion for employer-sponsored insurance on effectiveness research, national saving, and innovation in the delivery of medicine? Health services researchers complain endlessly that health care delivery in the United States is unaccountable and uncoordinated, and that Medicare’s fee-for-service payment system is largely to blame. Where are the studies that quantify and incorporate that cost of universal coverage? RomneyCare and ObamaCare include community-rating price controls and mandates that impose hidden taxes in the form of higher health insurance premiums. Where are the studies that incorporate those costs? Where are the studies quantifying the effects of Medicare, Medicaid, and the tax exclusion on innovation in insurance design? Or on innovation in other sectors of the economy from which these government interventions siphon resources?

Finkelstein and McKnight’s noble effort notwithstanding, the economics literature weighs none of these costs. Without evidence showing that all the benefits outweigh all the costs, we still don’t know if universal coverage is net beneficial. Which is to say, we still just don’t know.

So how is it that despite this dearth of evidence, a vocal minority of the U.S. population is utterly and completely convinced that universal coverage is net beneficial? Like most humans (including me, probably), advocates of universal coverage criticize every new finding that casts doubt on their prior belief, and hail every new finding that supports their prior belief. But why do they hold this prior belief in the first place? How did they reach this conclusion when it seems clear that the evidence necessary to reach it does not exist? And how do they retain this belief, especially when the available evidence creates so much room to doubt the benefits of universal coverage?



Many advocates of universal coverage are incurious about this fundamental question. Gardner says, look at all the benefits, not just some of the benefits. Right on. Where is a parallel recommendation that we look at all of the costs?

Probably no advocate is more careful and thoughtful than Cohn. But not even he comes within 335 feet of demanding evidence on total costs vs. benefits. When he dismisses the idea that the OHIE’s failure to find mortality or physical-health gains from expanding Medicaid shows the program has failed, he does so on the grounds that the presence of financial-security and mental-health benefits “arguably offered plenty of justification for the law.” Catch that? The presence of some benefit is all we need. No discussion of costs, much less whether the same benefits could be achieved at a lower cost.

Pollack is equally thoughtful, yet equally puzzling. He will engage the question of cost-effectiveness, but does not call for experiments that would tally all the costs. “Of course, in principle,” he writes, “one might nail these questions with a hugely expensive ten-year randomized trial involving hundreds of thousands of people. In practice, that’s not going to happen. Sommers, Long, and Baicker do the next-best thing.” Sommers-Long-Baicker didn’t examine costs at all. Even more interesting is how Pollack concludes that experiments measuring the costs and benefits of universal coverage would be too difficult, yet will doggedly endorse a decades-long, hundreds-of-millions-of-subjects, multi-trillion-dollar, uncontrolled experiment with universal coverage that will answer exactly none of these questions.

I don’t mean to pick on Pollack or Cohn or Gardner. My aim is to highlight an odd dimension to the Left’s advocacy of universal coverage.

We have nowhere near sufficient evidence to conclude that, on balance, universal coverage improves health and financial security, much less that it produces more of those things than any other use of the resources involved. Indeed, the available evidence leaves plenty of room to question whether universal coverage even produces net benefits, while what Levy and Meltzer wrote in 2004 about the cost-effectiveness of universal coverage remains true:

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• There is no evidence at this time that would allow us to say whether money aimed at improving health would be better spent on health insurance or on inner-city clinics, community-based screening programs for hypertension, or advertising campaigns to encourage good nutrition, to name just a few possibilities.

Two pieces of evidence we do possess, however, are these facts. One, the Left has supported universal coverage for 100 years without any reliable evidence that it would improve human well-being. Two, Progressives show no inclination to abandon or even to qualify that support despite the lack of such evidence. This is not necessarily irrational behavior, though it has implications that might cause discomfort to Progressives.

For now, I want to know what Cohn, Gardner, Pollack, and others think about the foregoing.

kbp

May 13 2014, 08:39 PM

nyesq83

May 13 2014, 04:45 PM

Paid $477 for May premium in Gold Plan. Got a doc recommendation. Called for a new patient appt. yesterday. Next available is June 12. wtf? I will fill out forms and go in person next week.

Sorry you have to experience that. They went from the starting point of the original coverage and pushed towards a provider network that might be so limited that they had to rework it. In order to reduce the premium increase, they bumped deductible and co-pay. You're stuck with something in the middle, with some going a little further with the Gold and Platinum.

The next couple years will only be worse. Premiums are going up and traffic for the same Dr's will slow the process down further ...unless everybody wants even higher deductibles.

All this while we hear about the success!

Mason's link

 

Insurer: Obamacare Customers Must Break ‘Choice Habit’
Posted By Sarah Hurtubise On 5:06 PM 05/13/2014 In | No Comments

Health insurers are now openly admitting that with Obamacare’s reforms, patient choice can no longer be a priority for Americans.

“We have to break people away from the choice habit that everyone has,” Marcus Merz, CEO of Minnesota insurer PreferredOne, told The New York Times Tuesday. “We’re all trying to break away from this fixation on open access and broad networks.”

With boatloads of mandatory services provided each and every customer whether they’re wanted or not, health insurers’ costs are going up. If insurance companies are going to keep prices at a manageable level, narrow networks are one of their only options. So far under the health care law, networks are narrowing while premiums are going up.

While insurance companies are trying to acclimate their customers to narrow networks, the limited choices were clearly not part of the promise President Barack Obama made when selling his health care law.

“It you like your doctor, you will be able to keep your doctor. Period,” Obama promised in 2009 in front of the American Medical Association. “If you like your health care plan, you will be able to keep your health care plan. Period. No one will take it away.”

Both of those promises have turned out to be false. Keeping your health care plan went out the window long ago — and now health insurance companies are defending their narrowed networks, which exclude many doctors and providers that customers prefer.

Narrow networks have essentially made one selling point of the law obsolete. Obamacare supporters constantly warned that health insurance is necessary for everyone because people may get cancer unexpectedly and not be able to get coverage afterward.

But cancer centers, with their top-of-the-line physicians and expensive procedures, have been a primary casualty of narrow networks. According to an Associated Press analysis, just four of the 19 top comprehensive cancer centers are covered by all Obamacare exchange plans in their states. (RELATED: Report: Obamacare exchanges not covering best hospitals for cancer care)

Instead, as health insurers would say, patients will have to accept that they likely won’t be able to choose the best doctor and hospital to treat their cancer any longer.

Even if narrow networks are accepted as the new normal, choosing your narrowed health plan around a certain physician or hospital may still prove impossible.

California attempted to put a provider directory on its exchange website, but was forced to pull it several months in, admitting that it was filled with errors. But even if customers can figure out what their plan covers when they purchase it, networks can change.

The Georgetown University Center for Health Insurance Reform highlighted the problem of changing networks Monday, warning that networks are still in flux outside of Obamacare’s open enrollment period.

Even if a customer buys a certain health plan just because it covers his preferred doctor and hospital, they may be left without access to their choice. In one man’s case, according to health policy expert JoAnn Volk, it wasn’t until after open enrollment had closed that the Georgia resident found out that not only had his doctor withdrawn from the network, but “the community hospital that acquired all the medical practices in the county withdrew from the network.”

Volk offered several claims customers may attempt to negotiate with their company, but health insurers’ answer is clear: cost-focused patients shouldn’t expect a wide array of choices for their health care, according to Dr. Sam Ho, United Healthcare’s chief medical officer.

“It’s a new era,” Ho told The New York Times.