HEALTH C ARE POPOUURI

Too much water has passed over the dam in the past few weeks when I had first intended to once again address the status of American Health Care. I can only skirt around the edges and hit on targets that reflect the deterioration of what was once the best system in the world.

One document that should be read was printed in the Wall Street Journal. If you go to this link (https://mail.google.com/mail/u/0/?tab=wm#inbox/145b4bfa6d297b8f) and scroll down you will be able (I hope) to open it.

The ersatz rationing of care that is already in existence as a result of the Nixon generation HMOs is going to worsen. The various European socialist oriented nations that have been held as models of universal health services have either had failures due to fiscal problems that have resulted in restrictions on readily available services or treatments.

Even in Sweden which has been held up as the best example of universal care  there is a developing private segment to counter act the prolonged wait, often months, for critical surgery or diagnostic testing. Those who can afford it will opt for this route; even though they by law are participants in the universal care.

Health care is now big business. Hospitals and large groups are buying independent practices to control patient flow into their hands. The number of physicians who receive a salary (employed) rather than having a ‘”private” or small group practice is now over 55% (as of two years ago) and is rising rapidly. 

Economic forces and rules/regulations are a costly burden that overwhelm individual doctors.

There are advantages as a salaried physician. The doctor is now an 8 0r 12 hour clock worker and once the shift is over his time is his own not patient related.

Although almost 10 million have been insured under the ACA program (the exchanges?) the number that represent those who had to seek new policies because their old ones were not renewed has not been revealed.

The number of new policies issued to the 18-34 yr. group has reached 28% near the 30% desired. The problem is that a large percentage of this group who have bought insurance have ongoing medical problems and could not get insurance before.

That is wonderful for them however the calculations establishing premium for the exchange issued policies was based on a large number of healthy or non-resource users in that target group to counter act the number of older citizens who need care.  

The big commercial insurers, Aetna, Cigna, WellPoint, have all reported to a varying degree expected loss on those policies for 2014, the results will be reflected in the next year’s rates. Some companies have been quoted by the papers to believe that the increases will in many cases be double digits. This will of course differ from exchange areas even in the same state.

Aetna and Cigna claim that their losses will not be too great because they are strictly monitoring costs. (decoding), refusing to pay for tests, examinations, dropping expensive medications from their formulary, dropping physicians who order lots of diagnostic studies from their “exchange provider panels”; in other words they are trying to influence the patient’s treatment.   

Also not publicized is that federal subsidies for state sponsored exchanges will expire beginning in 2015 and probably will need to be funded with new taxes on those residents. Already the District of Columbia has passed a law that will place a tax on all individual health insurance policies. The health insurance carriers are protesting that law claiming the tax should only be on policies sold through the exchange. 

Since there are 14 other states-not NJ-that have their own exchanges; I would suspect that Congress will pass an extension of those federal subsidies or Obama will do so by Presidential action.  

There have been almost daily articles in the Times and the WSJ relating to various problems resulting from enacting the ACA laws.