Category Archives: Commentary

Another Unintended Consequence of Obamacare

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The commentary posted last week was about the financial burden being placed on States by Obamacare. The article titled “Electronic care: Why doctors quit,” by Charles Krauthammer describes an even more important unintended consequence. Doctors who have small practices, often the doctors in rural communities, don’t have the financial resources or technology support to comply with the law. They are retiring because the law requires so much of their time is used for regulatory compliance rather than providing health care. According to the article, the law has created “…a deep erosion of their autonomy and authority, a transformation from physician to ‘provider’.”

The article says virtually every doctor expresses bitterness about the electronic health records (EHR) mandate that produces “…nothing more than ‘billing and legal documents’—and degraded medicine.” One doctor observed that “…introduction of the electronic medical record into our office has created so much more need for documentation that I only see about three-quarters of the patients I could before, and has prompted me to seriously consider leaving for the first time.” Medical practices that hadn’t gone electronic by January 1st have had their Medicare payments cut by one percent. That penalty increases to three to five percent in future years.

What has Obamacare accomplished? Many more people have Medicaid, and that means it takes weeks or months to get an appointment at one of the few places that still accept it. Fifty year old women had their health insurance declared “non-compliant” because they didn’t have maternity coverage. Obamacare has accomplished spending $27 billion on “going paperless,” although the promised $77 billion in savings is nowhere to be found. None of this will make an impression on those who believe government should be in charge of our lives because we and those who have the archaic attitude that they want to own a profitable business can’t be trusted.

Unintended Consequences of Obamacare

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This posting only focuses on one unintended consequence, but it is certainly important to the budgets of state governments. According to an article by Carala K. Johnson of the Associated Press, “A tax on health insurers is helping pay for President Barrack Obama’s health care law, but it’s proving costly to state governments—as much as $13 billion in less than a decade.” The Health Insurance Provider’s Fee was supposed be covered by insurance companies because they would earn a windfall from Obamacare.  Those who wrote the law believed those companies should pay for the expansion of coverage, but they apparently didn’t know how business works. The insurance companies raised prices to cover the costs of the new tax instead of just absorbing the cost. Businesses tend to continue to stay in business by making profits from their activities. Expecting the insurance companies to simply absorb additional costs was, to be kind, both naïve and silly.

The price increases passed on by the insurers affected state Medicaid programs, and they have had a huge impact. “State governments pay insurers for the tax; the insurers then pay the tax to the federal government. The federal government then reimburses part of the costs to the state. It might sound absurd, but it’s not amusing to state governments, which lose 54 cents for each dollar of insurance tax.” Another strange and detrimental impact of the law is that the health care tax is not deductible for insurance companies, so state governments must provide additional funds to cover that additional cost.

I find the false economics isn’t the saddest part of the story. One of my doctors made the comment that insurance provided by Medicaid “is a myth.” He explained that people think they have Medicaid insurance, but find that a limited and shrinking number of medical practices accept Medicaid patients. The result is that a person with Medicaid coverage must wait many weeks or even months for an appointment. Not a good thing if you have a medical need. The outcome is that people who have Medicaid aren’t getting health care and the States are paying penalties. Maybe we should be thinking about a better way of solving the problem. Maybe businesses that have a reputation for finding competitive solutions to problems could be lured in by the promise of profits.

As an aside, I’ve heard one of the best parts of Obamacare is the allowing children to remain on their parent’s plans until age 26. If that’s such a great idea, why not 36, 56, or until the parents are no longer around? (Just kidding, maybe?)

Jefferson Parkway Legal Ruling

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I’m a bit late with this posting, since the ruling was made in mid-April. The article describing the ruling was written by John Aguilar in the Denver Post. He begins the article, “The controversial Jefferson Parkway, long entangled in a series of courtroom challenges, won a major legal battle Friday when the 10th U.S. Circuit Court of Appeals upheld a complex land swap that enables construction of the Broomfield-to-Golden highway to move ahead. The land transfer involved a 617-acre parcel on the southwestern corner of the Rocky Flats National Wildlife Refuge for a 300 –foot wide transportation right of way parallel to Indian Avenue. “A federal judge ruled in favor of the swap in 2012.The 10th circuit judges unanimously affirmed the ruling…”

Plaintiffs in the case had contended that backers of the Parkway “…think the future of the Front Range lies in building more roads, more strip malls, and more housing tracts.” They had claimed the U.S. Fish and Wildlife Service lacked the authority to make the transfer and violated environmental laws including consideration for the Pebble’s meadow jumping mouse, which has become a consistent component of opposition to any Front Range development project. There is, of course, the charge that construction would “…disturb plutonium buried in the soil of the defunct Rocky Flats nuclear weapons plant.”

The future of the Parkway is far from certain because opponents are unlikely give up their legal challenges. They have legitimate concerns that the Parkway will increase the amount of development in their area. It is common for people who are happy with their current situation to not want more people to come in to enjoy their area.

I wonder whether there could have been any development in the State of Colorado if the current rules had been in effect in the 1940s and 1950s. Could I-70 been approved to traverse Colorado with current rules? How could it possibly have been approved with the disruption to wildlife migration routes and other significant environmental impacts? Could the series of irrigation canals in the Denver metropolitan area that provide a wonderful system of hiking and biking trails have ever been built? Those are probably are unanswerable questions.

 

“Let’s Kill All the Psychiatrists!”

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anatomy-of-an-epidemicL. Ron Hubbard was one of the most prolific writers in history, authoring more than 1100 books. He was also the founder of the Church of Scientology, arguably one of history’s most controversial quasi-religious organizations. Many of the tenets upon which Hubbard based his church are inarguably crackpot, but after reading Robert Whitaker’s latest offering one could easily conclude that at least one of Hubbard’s paranoid beliefs, that psychiatric drugs and the doctors who prescribe them are the tools of the Devil, may contain a grain of truth.

Whitaker’s book, Anatomy of an Epidemic:  Magic Bullets, Psychiatric Drugs and the Astonishing Rise of Mental Illness in America, examines two related issues.  The first is the astronomical increase over the last 60 years in the number of Americans who have been diagnosed with anxiety, depression and bipolar disorders, and schizophrenia.  These conditions, now being diagnosed in as many as 850 adults and 250 children per day, often are so debilitating that sufferers are unable to hold a job and so become dependent on Social Security Disability Insurance (SSDI) to survive.  The exploding number of mentally disabled being granted SSDI is threatening to bust the agency’s budget as early as 2016.

In 1955, around the time that the first psychotropic drugs like Thorazine were discovered, there were 355,000 people in the US under diagnosis for psychiatric conditions.  Almost all were housed in state or county hospitals as was then standard practice.  This number represented one in 468 Americans.  By 1987, with the closing of most mental hospitals and the treatment of affective disorders well into the age of Lithium and Prozac, one in 186 Americans was on the mental patient rolls. Since then, in spite of the promises made by the psychiatric profession and Big Pharma that Selective Serotonen Reuptake Inhibitor (SSRI) drugs were the cure for America’s mental ills, the numbers are still going up.  Continue reading →

Refugee Ethics

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A reader and frequent commenter sent me an article by Richard D. Lamm that appeared in the Denver Post. The story is told of Martin of Tours finding a starving beggar during a 13th Century ride and dividing his cloak and dinner with the desperate man. The question is asked “What if instead of one cold and starving beggar, there are 100?” Considering the world situation, what if there are thousands or millions? There is another report that ISIS has slaughtered another several hundred people after taking a city in Iraq, and thousands or hundreds of thousands of people are being displaced. I have difficulty imagining there is anyone remaining in Syria other than the various fighting organizations or a place for an “ordinary citizen” to live. Thousands of people are taking the perilous trip across the Mediterranean to escape the anarchy and terror of Libya (and perhaps wishing Gaddafi could return). Lamm mentions increasing population “…and political unrest in most of the Middle East and Africa guarantee continued massive migration from that volatile area. Is Europe’s only ethical response to take them all in?”

Lamm mentions that “…the U.S. has its own substantial pressure from south of its boarder (sic).” He then poses the ethical dilemma. “A moral response to an individual or manageable group might not make sense if there are hundreds of thousands. Sheer numbers can totally change the ethical implications.” “The maximum generosity of the developed world cannot absorb the staggering numbers fleeing political chaos, war, violence, and lack of economic opportunity.” Later in the article he writes, “No nation can be expected to commit social and cultural suicide. No ethics can demand what the ecosystem or social fabric of a society cannot support.”

I have fretted since the first reports of ISIS slaughters in Iraq that we as a nation should feel ashamed. Regardless of your beliefs about the justification of the second Iraq War, we did overthrow Saddam Hussein and established a fledgling democracy. We then decided we were “war weary” and withdrew our soldiers. The situation that evolved was predictable. There was an opportunity, perhaps a slim opportunity, to assist in establishing a stable and perhaps even prosperous country where people wouldn’t be slaughtered because they practiced the wrong religion. We instead chose to fulfill a political promise. Is there anyone out there who continues to believe withdrawing was the right thing to do? We also helped “decapitate” the dictatorship in Libya and then sat behind our comfortable borders while terrorists took over.

Perhaps we should be asking whether we’ve learned anything. Are we going to repeat what we did to Iraq in Afghanistan?   I understand the Taliban developed a motto after the announcements that we were going to withdraw on a schedule. “You have the watch and we have the time.”

Credit Cards and Insurance Costs

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We recently received notice that our auto insurance will be coming up for renewal. Reading through the several pages of privacy notices and disclosures finally led me to the last page warnings about opening new credit card accounts. There are discussions about the importance of paying balances on time, which wasn’t a surprise. However, I thought many people might not be aware that the “insurance risk score” considers how many new accounts you’ve opened in the past twelve months and the past five years. According to the insurance company, “Research shows that consumers who open a large number of accounts experience more insurance loses.”

I was skeptical about the statement, thinking we have a long term relationship with our insurance agency and they undoubtedly understand our record of filing claims without checking how many new credit cards we’ve requested. I called our agent and was told that insurance companies do look closely at credit cards as a part of their assessment of “insurance risk score,” and opening new credit cards definitely can increase costs of both auto and home insurance. I was told that three new cards in three years would be considered a negative in calculating that score. I inquired whether cancelling seldom used cards would be a good idea and was told cancelling a card is equivalent to opening a card. This was making less sense to me all the time. Why would cancelling a card not be considered a positive if opening accounts is considered to be a negative?

I hope I can learn more. My cynical thought is that insurance companies are happy to have found a way to charge more. They are assisted by all the stores that offer discounts if you apply for their cards. The money saved by having those store cards might be more than offset by additional insurance costs.