Keeping your health care plan depends on who likes it.

View 796 Thursday, October 31, 2013

All Hallows Eve

“Transparency and the rule of law will be the touchstones of this presidency.”

President Barack Obama, January 31, 2009

 

Christians to Beirut. Alawites to the grave.

Syrian Freedom Fighters

 

What we have now is all we will ever have.

Conservationist motto

 

If you like your health plan, you can keep your health plan.

Barrack Obama, famously.

One reason I try not to be involved in breaking news is that much of the information needed to understand what is happening simply is not available. This was the case with the statement that 160,000 Kaiser members had got letters of cancellation of their plans. There were no other details, including who and why.

This probably comes closest to an explanation:

Kaiser Plans

From BuyKP.org

Click through: 2013 -> get a quote

Has this disclaimer:

The plans offered on this site are available for coverage starting in 2013 and are effective through December 2013. Please note that all 2013 Kaiser Permanente plans will be discontinued on December 31, 2013, so that we can renew coverage on January 1, 2014, onto a new plan that includes all the benefits of the Affordable Care Act.

So all their plans are canceled, to be replaced by ACA plans

David LeFevre

I have not received any such notice from Kaiser, and apparently there are exceptions. At least I hope so. When we were first married we had the usual young people’s health care insurance through the aerospace industry: basically, we pay for anything normal and were insured for anything major. That lasted until the 70’s by which time we had four boys, and I was setting out on a career as a free lance writer, which meant that my income was, uh, variable. Roberta worked in education and got medical insurance through that. We determined that what we really wanted was Kaiser health maintenance, which essentially was, pay your membership dues, pay a reasonable co-payment per visit, pay your dental and eyeglasses bills, and Kaiser took care of everything. It wasn’t easy to get into Kaiser except through a group, and free lance writers were not in any recognizable group. We managed to get into Kaiser through Roberta’s employer, and that pretty well chained her to that job, and a long freeway trip every day. Eventually she needed to retire. By then I was making a decent income, and there was this thing called COBRA under which you got to keep your health care plan for several years by paying a not small but not unreasonable monthly fee, and when that ran out the choice was to continue with Kaiser and pay it myself, or go find something else. We chose to stay with Kaiser, and they took care of all of us as a health maintenance organization, and over the years I realized just what a good deal we had compared to most of my friends including many in the movie industry.

That lasted until I turned 65, when I was told my rates would go up by a factor of four, but I had another choice: I could let Medicare pay my Kaiser dues, and things would essentially go on as they always had. By then all the kids were out on their own and not covered under the Kaiser plan anyway. As far as I was concerned those were the only choices – I never even considered going anywhere but Kaiser where we had been happy for decades. So we chose the Medicare Advantage option and I took out some kind of supplementary insurance plan for a nominal monthly payment. It all went smoothly and when Roberta turned 65 some years later her Medicare payments went to Kaiser as well (in the intermediate years she had been covered at Kaiser under my account so far as I can tell – the payments I had been making to Kaiser had covered a family membership although by that time she and I were the only family members. In any event that was my status and when in 2008 I developed brain cancer and needed a long and expensive series of radiation treatments involving about ten specialists everything was covered including the parking fees for getting to the treatment center.

And all was well and all has been well. Our copayments are reasonable, high enough to discourage frivolous visits but not so high as to make us reconsider going to the emergency room when it seemed reasonable to do so. I don’t think Kaiser can be cloned into a universal health care system, but if it could be I’d be in favor of that. The people there don’t seem to be spending their time wishing they were somewhere else. Everyone is cheerful and friendly, from the orderlies to the medical specialists. It all works, and I have found that true at five local Kaiser establishments and one in Texas.

So when I heard that Kaiser was cancelling its memberships I was concerned. I wanted details. I have yet to find many. I do not know why.

Source of Kaiser Health News quote Re:Kaiser Permanente cancellations

Jerry,

Here is an email exchange I had today with Julie Appleby, one of the co-authors of the Kaiser Health News article about Kaiser Permanente’s cancellations …..

——————————————————————————-

Hi, thanks for your note. We interviewed Kaiser directly.

You can also find more information about enrollment in group and non group coverage in California in this report http://www.chcf.org/~/media/MEDIA%20LIBRARY%20Files/PDF/C/PDF%20CAHealthPlansInsurersAlmanac2013.pdf

Best,

Julie

From: Steven Cooley [mailto:swcooley@me.com]

Sent: Wednesday, October 30, 2013 9:23 AM

To: Julie Appleby

Subject: Source for Kaiser Permanente cancellation number in Kaiser Health News article

Ms. Appleby,

In a recent article you co-authored in Kaiser Health News there is the following quote ….

"Kaiser Permanente in California has sent notices to 160,000 people – about half of its individual business in the state."

What is your source for this quote?

Thank you for your time and consideration.

Steven W. Cooley, M.D

The pdf referenced above doesn’t enlighten me very much, but it does present an enormous amount of information about health care financing in California. Indeed it tells me more than I really wanted to know.

What is clear is this: The Affordable Health Care Act, otherwise known as ObamaCare, will end a very great number of medical care plans. It is not true that “If you like your health care plan you will be able to keep it” or that “If you like your doctor you will be able to keep him.” Moreover, it was known at the time that President Obama famously made those promises many times. What it really meant is “If you like your health care plan and I think it’s good enough for you, you will get to keep it,” which is not quite the same thing. The purpose of the ACA was to end “inadequate” health insurance.

The new plans have all kinds of minimum coverage mandated by law: I am unable to confirm that the new plans require women older than 45 to have maternity care insurance, but that has been reported by many sources. There are a number of items mandated for the minimum plan acceptable to the ACA regulators; there is also the mandate that all plans must accept anyone applying without regard to pre-existing conditions. If you are in third stage pancreatic cancer, they still have to take you at the same premium that someone ten years younger and not afflicted will pay. That sounds wonderful, but what it means is that the younger healthy person must pay the same premium as the middle aged overweight person already suffering from pancreatic cancer; and that premium is going to be considerably higher than what the younger person was paying.

There are a hundred variations on that story, but that is the essence of it. And this is the source of the widening opposition to the Affordable Care Act: it turns out to be affordable for the old and sick, but not affordable to the young and well, whose best economic option is to have no health care at all, pay the fines (which are fairly nominal), and go take out a health care policy only when they are sick and need one. That is the best economic course, and it’s hard to show that it is not a moral choice. The alternative is for young people just starting a family to pay a substantial part of their income to support the medical care of older sick strangers; and it is not at all clear why they have a moral obligation to do that.

 

http://www.washingtonpost.com/blogs/wonkblog/wp/2013/10/29/this-is-why-obamacare-is-cancelling-some-peoples-insurance-plans/ 

The President’s Broken Health-Care Promises

It was well known, even in 2009, that millions would lose their health plans under ObamaCare.

By

Karl Rove

For nearly four years, President Obama has frequently offered some variation of this promise about the Affordable Care Act: "If you like your health-care plan," as he said in a speech to the American Medical Association in June 2009, "you’ll be able to keep your health-care plan, period. No one will take it away, no matter what."

NBC News caused a kerfuffle on Monday when it reported the Obama administration knew for years that millions would be forced off their preferred insurance plan. This hardly amounts to a revelation: the president and his people, along with Democratic Party leaders, had to know that this would happen.

http://online.wsj.com/news/articles/SB10001424052702303618904579167611885025296

 

I call your attention to another article in today’s Wall Street Journal:

One Quick Fix to Ease the Coming Doctor Shortage

The White House proposes to cut on-the-job training for new M.D.s just when we need more physicians.

By

Atul Nakhasi

Ryan Scully wanted to be a doctor from the moment he began volunteering as a paramedic and firefighter during his freshman year of college. In medical school at George Washington University, he passed all of his preclinical and clinical requirements, as well as two national licensing exams required of all medical students. Just before graduation in 2012, though, he learned that he had not been accepted into a residency training program necessary for gaining his certification as a practicing physician. He would receive his M.D. degree in May with the rest of his class—but without a hospital training spot, he could not practice medicine.

Last year 1,761 M.D.s shared the same fate. And now the White House wants to set aside even less money for doctor training while reorganizing the nation’s insurance market. At a time when the new health-care law is expected to create a demand for more physicians, a proposed $11 billion budget cut over the next 10 years guarantees there will be fewer doctors. This could have a serious effect on the health of the nation.

http://online.wsj.com/news/articles/SB10001424052702303680404579139563450701076

 

I have before commented that the real bottle neck to entering the medical profession is the lack of teaching hospital residencies.

I suggest we consider setting up some at VA centers in major cities. This would have the advantage of insuring better treatment for veterans while meeting some of the looming doctor shortage. I can think of other places for teaching hospitals. Yes, they are expensive, but it’s amazing how much a billion dollars will buy even in these days.

We already borrow money to pay Bunny Inspectors. May I suggest we would be better off paying that money to finance internships and residencies for recent MD graduates?

Enough for the moment. I will wait for comments before going on. It’s lunch time anyway.

Subject: The VA and teaching

Jerry, you said in today’s column that the VA should set up teaching residencies in some of its hospitals in major cities. I think you should know that there’s no need for them to do this, as they already have. As you probably know (but your readers won’t) I’m under the care of several different specialists at either the VA clinic in Sepulveda or at the VA medical center in West LA. (It’s that big building just to the west of the 405 at Wilshire.) Except for my ophthalmologist and audiologist, all of my appointments are with residents, although their attendings also see me after the resident is finished. And, the first time I was hospitalized for my low platelet condition, I was asked if I’d mind being examined by several students. Naturally, I gave my consent and was examined, one by one, by about half a dozen aspiring doctors. I know that the Wilshire VA is a teaching hospital, and unless I’m badly wrong, most if not all of their major facilities are.

Oh I knew that many already exist: my point was that more would be a better use resources than many of the federal government projects we fund.  Expand what we have and open some more; and of course the VA need not be the only places.