October 13th, 2013 kickstarts penalty year for health insurance

[Hemegroup]

I thought it was going to be January 2014, but my H&R Block rep who did my taxes last weekend (I know, late) turned the screen to show me. October 13th (at least I think that was the date I saw, I know it was October 2013) starts the penalty year which I believe ends in 472 or 479 dollars, something like that. The second year without insurance it goes up to over 500. Time to start searching for Geico plans ... although I may finally have GREAT health insurance ... in a town of 100 with no access in poor weather. Not sure how I'll be getting to use that great insurance lol ... but whatever. Good information for patients if you want to start spreading the word. Let's just hope Hillary gets in 2016 and cleans up this mess that I wish she had gotten the chance to do the first time.

[CAAdmission]

Hillary? Even better, find someone from another party that is less inclined to believe that government intrusion into our lives is to our benefit.

[Hemegroup]

That's right, CJ, Health Insurance is as important as Auto Insurance. Maybe you can get them to drop that one too. As for "another party", I remember a lot of "NO!!"s but zero suggestions or willingness to work towards a solution. Maybe instead of "another party", you should substitute 'people with ideas' not to mention ideals.

[CAAdmission]

You may find this hard to believe, but there are places where auto insurance is not mandatory. I know because someone without it ran a stop sign and T-boned my car.

 

If you think the govenrment can manage your life better than you can, more power to you. That's not my way.

[Hemegroup]

You may find this hard to believe, but there are places where auto insurance is not mandatory. I know because someone without it ran a stop sign and T-boned my car.

 

Bet you were glad you had your car insurance, weren't you. Or was that not your way, at that time?

 

I don't know of any places where at least liability isn't mandatory, but I do know there are plenty of people who don't pay their auto insurance .... and guess what, when they get caught, they pay a big ol' fine. I'd really appreciate if you could tell me where these places are, where auto insurance isn't mandatory, so I can avoid driving on their roads as much as possible.

[bradtPA]

Car insurance is not a mandatory requirement. You don't have to own a car it's just darn inconvenient if you don't.

[Hemegroup]

Well I would hope we're all assuming in the conversation that the discussion involves people who buy vehicles to actually drive them.

[mbalaban]

Umm, isn't there a difference between the act of purchasing a car and the act of just breathing and living?

[CAAdmission]

Umm, isn't there a difference between the act of purchasing a car and the act of just breathing and living?

 

Then there is also the issue that if you don't have insurance and never crash into anything, it would never be an issue. The government does not automatically insinuate itself into the situation.

 

Our healthcare system already spends too much money. Spending more is not going to help. With the lack of tort reforms and declining reimbursements you will have a hard time finding anyone to take care of you in 20 years.

 

Finally, from a "systems" perspective, it is better to have some proportion of the population die young. Imagine we cured cancer and heart disease. Now what happens? Everyone lives to be 100 and we spend billions on the last years of their lives while they all become demented in skilled care facilities.

[mbalaban]

Then there is also the issue that if you don't have insurance and never crash into anything, it would never be an issue. The government does not automatically insinuate itself into the situation.

 

Our healthcare system already spends too much money. Spending more is not going to help. With the lack of tort reforms and declining reimbursements you will have a hard time finding anyone to take care of you in 20 years.

 

Finally, from a "systems" perspective, it is better to have some proportion of the population die young. Imagine we cured cancer and heart disease. Now what happens? Everyone lives to be 100 and we spend billions on the last years of their lives while they all become demented in skilled care facilities.

 

Umm, the state governments say, if you choose to do this, then this is what we require of you, in the matter of auto insurance. Which, BTW, is a catastrophic policy and not a maintenance policy. The federal government has said, because you are alive, without choosing to do anything, we require you to get "insurance", which is not a catastrophe insurance, but a maintenance policy. Does your car insurance cover oil changes and tune ups?

 

I agree we are spending too much money on healthcare and I agree tort reform is direly needed. However, who is to gain from the ACA other than the health insurance companies? What about the cost of Rx's? How about we clear a bit of red tape and such so that it doesn't cost Rx companies trillions of dollars to get a new drug on the market? Or why is health "insurance" such a part of employment compensation? Is your car insurance a part of your compensation?

[CAAdmission]

You are preaching to the choir. The ACA is a feel-good socialist scam. Our present unfortunate situation is that a good proportion of the population has decent insurance and a lot of the population has none. The coming situation is that everyone is going to have crappy insurance except for the filty rich.

[physasst]

Nothing to add other than tort reform won't save any money in healthcare...not really. It's the shiny object in the corner of the room that physicians love to point at....."look, look" in order to rationalize their own behavior. There is no data to support substantial savings.

 

Now, back to your regularly scheduled programming...

[mbalaban]

Question physasst, do physicians pay for their malpractice insurance out of the money that gets paid to them by their patients (insurance, self pay, etc)? And if there were limits on liability for malpractice, wouldn't a physician be able to find a lower coverage policy? And doesn't a lower coverage policy cost less than a higher coverage does? And if the physician had lower coverages, and lower costs, then he could charge less to the patients and insurance companies.

That being said, have you heard about the growing number of doc's that are discontinuing using "insurance" and going to a self pay system? Oh, their costs are cut in half. Maybe it's the governmental intrusion that's jacking the price up?

[physasst]

Question physasst, do physicians pay for their malpractice insurance out of the money that gets paid to them by their patients (insurance, self pay, etc)? And if there were limits on liability for malpractice, wouldn't a physician be able to find a lower coverage policy? And doesn't a lower coverage policy cost less than a higher coverage does? And if the physician had lower coverages, and lower costs, then he could charge less to the patients and insurance companies.

That being said, have you heard about the growing number of doc's that are discontinuing using "insurance" and going to a self pay system? Oh, their costs are cut in half. Maybe it's the governmental intrusion that's jacking the price up?

 

1. Yes, stupid question

2. Not necessarily, in Texas insurance companies saved a some money, and while premiums dropped, the drop did not come even close to the money saved. So the real winners were the insurance companies....

3. Reductio ad absurdum....if this is your arguing style than you must enjoy echo chambers....

4. Hasn't happened. Not anywhere where tort reform has been passed...in fact, in many places healthcare costs went UP after tort reform...the data is there..of course, that would mean that you would have to actually LOOK at the data and not repeat Faux News talking points.

 

Here's something I wrote a few months back....it's really simple, but explains tort reform. I'm also working on a bigger, systematic review of tort reform data now...

 

http://www.pasconnect.org/does-tort-reform-work/

 

5. Concierge care is a niche. It will never be more than that because most people cannot afford it. There is an administrative surcharge for sure, but MLRs for private insurance show administrative and profit costs are much higher than for government.

 

Single payor is coming. It may take another 10-15 years, but it will come.

[Gordon, PA-C]

I thought it was going to be January 2014, but my H&R Block rep who did my taxes last weekend (I know, late) turned the screen to show me. October 13th (at least I think that was the date I saw, I know it was October 2013) starts the penalty year which I believe ends in 472 or 479 dollars, something like that. The second year without insurance it goes up to over 500. Time to start searching for Geico plans ... although I may finally have GREAT health insurance ... in a town of 100 with no access in poor weather. Not sure how I'll be getting to use that great insurance lol ... but whatever. Good information for patients if you want to start spreading the word. Let's just hope Hillary gets in 2016 and cleans up this mess that I wish she had gotten the chance to do the first time.

 

 

There's a loophole in the law. It states that if you have a religious objection, you can refuse health insurance and you dont have to pay the penalty.

[Gordon, PA-C]

1. Yes, stupid question

2. Not necessarily, in Texas insurance companies saved a some money, and while premiums dropped, the drop did not come even close to the money saved. So the real winners were the insurance companies....

3. Reductio ad absurdum....if this is your arguing style than you must enjoy echo chambers....

4. Hasn't happened. Not anywhere where tort reform has been passed...in fact, in many places healthcare costs went UP after tort reform...the data is there..of course, that would mean that you would have to actually LOOK at the data and not repeat Faux News talking points.

 

Here's something I wrote a few months back....it's really simple, but explains tort reform. I'm also working on a bigger, systematic review of tort reform data now...

 

http://www.pasconnect.org/does-tort-reform-work/

 

5. Concierge care is a niche. It will never be more than that because most people cannot afford it. There is an administrative surcharge for sure, but MLRs for private insurance show administrative and profit costs are much higher than for government.

 

Single payor is coming. It may take another 10-15 years, but it will come.

 

 

If you are going to cite med mal insurance companies, you need to use an example other than Texas. TMLT covers 90% of the physicians in the state, it is physician owned and operated, and it by company charter it is required to return all profits back to the policyholders in terms of either the TMLT rewards share program or in the form of reduced premiums.

 

Tort reform is not the best way to fix the system. The best way to to eliminate layperson juries and get special expert health courts, and to fix the sham medical "expert" system. There is no freaking way a layperson jury with an average 12th grade education can figure out which expert is right -- the one who argues that TPA administration to a 65 year old with a h/o mild questionable GI bleed is reasonable, or the expert who says it is malpractice.

 

"Expert" witnesses are hired gun whores paid by the highest bidder, and they will lie on the stand in order to make money. There was a case in Massachusetts several years ago where a so-called "expert" at Harvard claimed it was malpractice to perform an LP on a 10 month old with high fevers and altered mental status. What that "expert" didnt tell the jury was that he was getting paid a fat 100k for his testimony, and that if he had analyzed the case without testifying for the plaintiff that he would have "only" bee paid about 15k. On a per hour basis, he was getting paid more than 20 times for his testimony than he got for treating patients. Outrageous financial incentives like this encourage "experts" give tainted testimony that is NOT backed up by evidence. Courts dont admit evidence baesd medicine though, the only thing the courts evaluate is testimony from dueling experts, both of which have financial incentives to lie.

 

Even with all that though, med mal defendants win most of the cases against them. The lawyer lobby says that this means the system "works." Yeah I guess it does "work" if you think that having to pay an average of 200-500k to defend a suit that you win is OK. For providers, it is a lose-lose situation, even if you win at trial.

 

The real evidence that the lawsuit system in this country is broken is found in the internal settlement/win ratios at med mal firms. Health Affairs published a study in 2007 that showed that the average win/settlement ratio for 50 of america's largest med mal firms was around 15%. That means they LOSE on 85% of their cases with no money recovered. Despite that horrible loss ratio, the average profit per partner in those med mal groups was over 5 million. Lawyers are getting rich off of med mal lawsuits even when they lose 85% of their cases.

 

I agree with you about single payor -- but I'll go even further. Not only is single payor coming, but when it does providers will have no choice but to become employees of the federal government.

[physasst]

If you are going to cite med mal insurance companies, you need to use an example other than Texas. TMLT covers 90% of the physicians in the state, it is physician owned and operated, and it by company charter it is required to return all profits back to the policyholders in terms of either the TMLT rewards share program or in the form of reduced premiums.

 

Tort reform is not the best way to fix the system. The best way to to eliminate layperson juries and get special expert health courts, and to fix the sham medical "expert" system. There is no freaking way a layperson jury with an average 12th grade education can figure out which expert is right -- the one who argues that TPA administration to a 65 year old with a h/o mild questionable GI bleed is reasonable, or the expert who says it is malpractice.

 

"Expert" witnesses are hired gun whores paid by the highest bidder, and they will lie on the stand in order to make money. There was a case in Massachusetts several years ago where a so-called "expert" at Harvard claimed it was malpractice to perform an LP on a 10 month old with high fevers and altered mental status. What that "expert" didnt tell the jury was that he was getting paid a fat 100k for his testimony, and that if he had analyzed the case without testifying for the plaintiff that he would have "only" bee paid about 15k. On a per hour basis, he was getting paid more than 20 times for his testimony than he got for treating patients. Outrageous financial incentives like this encourage "experts" give tainted testimony that is NOT backed up by evidence. Courts dont admit evidence baesd medicine though, the only thing the courts evaluate is testimony from dueling experts, both of which have financial incentives to lie.

 

Even with all that though, med mal defendants win most of the cases against them. The lawyer lobby says that this means the system "works." Yeah I guess it does "work" if you think that having to pay an average of 200-500k to defend a suit that you win is OK. For providers, it is a lose-lose situation, even if you win at trial.

 

The real evidence that the lawsuit system in this country is broken is found in the internal settlement/win ratios at med mal firms. Health Affairs published a study in 2007 that showed that the average win/settlement ratio for 50 of america's largest med mal firms was around 15%. That means they LOSE on 85% of their cases with no money recovered. Despite that horrible loss ratio, the average profit per partner in those med mal groups was over 5 million. Lawyers are getting rich off of med mal lawsuits even when they lose 85% of their cases.

 

I agree with you about single payor -- but I'll go even further. Not only is single payor coming, but when it does providers will have no choice but to become employees of the federal government.

 

The med mal insurance companies are also making substantial money off of investments. There primary obligation is to their shareholders.

 

I will agree with you on dedicated malpractice courts. Here's the thing. There are direct and indirect tort reforms. INDIRECT reforms, IE; dedicated med mal courts, joint and severability, etc. actually did save money. But that's not what physicians/providers and the GOP keep parroting. They keep stating that DIRECT reforms, IE; caps are the way to go.

 

There is simply no evidence, not in Texas, nor in any of the other states BTW, but I used Texas as they have had the most aggressive reforms out of all of the states, that caps have saved any money. Expenditures have continued to grow, the small amount saved was minimally distributed to providers, primarily saved by the insurance companies, and haven't changed anything.

 

When I was doing my research for this systematic review, I was reviewing yearly increases in premiums, and noticed a HUGE spike in 2003. So, I dug further thinking that there must have been an increase in tort filings, or case losses in 2001 or 2002 to explain it. I couldn't find that. It didn't happen...but what DID happen, is that the med mal insurers lost money on investments in 2002. So, it would appear that they merely passed on their market losses to the providers despite no change in tort filings or suits.

 

The other thing is their loss ratios. The med mal insurers are making bank. Car insurance...the average loss ratio is 8%, IOW, 92 cents of every dollar is paid out in claims (competitive market)....Health insurance, slightly better Medicare is 8%, but most private insurers are 15-20% (I know, some are a little less, some are a little more, this is the average range)......So, only 80-85 cents of every dollar is paid out in claims....(The insurers got themselves into a little hot water in 2009 when they lied to Rockefeller in the Senate about this....they also claim that the higher price reflects advertising, marketing, and expenses....)

 

Med mal insurers????? Average I could find was 38%......IOW, they are only paying 62 cents out on the dollar in med mal claims. They claim that they need to keep large cash reserves in case they got hit with a bunch of BIG suits simultaneously, but this seems rather....shall we say excessive.

 

At any rate...it's a useful discussion to have, but we have to really look at the data. There are some indirect reforms that could help (although in the aggregate, the amount of money saved is still minimal) but direct reforms just don't work....

 

BTW, if anyone has published evidence that they do, I would love to see it.

[CAAdmission]

I wonder if there is any way to quantify the cost of defensive medicine. In an average ER shift I probably see 3 patients who are sent in by their PMD "just in case." When I try to street them, the SP usually says to run the tests the PMD wanted "just in case."

 

Even if tort reform had no direct effect, just the perception of improvement might mitigate some of this nonsense.

[physasst]

I wonder if there is any way to quantify the cost of defensive medicine. In an average ER shift I probably see 3 patients who are sent in by their PMD "just in case." When I try to street them, the SP usually says to run the tests the PMD wanted "just in case."

 

Even if tort reform had no direct effect, just the perception of improvement might mitigate some of this nonsense.

 

Maybe, but my belief is that it wouldn't. I think physicians and providers are great at rationalizing their behavior. We got into medicine because we care. Most physicians I know order something because they are scared of missing something....I think we agree on that.

 

Many will say that it is a fear of being sued. Yet most physicians have never been sued....

 

I personally think that it is a fear of letting the patient down. Of missing something and feeling responsible if it did turn out to be that 1 in a million bad pathology. It's part of caring. It's part of being a provider....I think we rationalize it by blaming the lawyer, because we feel guilty.

 

It's a tough thing....you feel guilty for ordering a test that you know has a low probability, but you also feel a sense of obligation...not to a mythical lawyer....but to the patient. You don't want to miss something that could kill them or cause permanent harm.

 

I'm actually working on a paper (one of 11 different ones currently) on the value and utility in second opinion visits, and we are mathematically modeling behavior, and looking at it from not only the perspective of correcting clinical errors, but also from the perspective of correcting physician incentives....hindsight and ego bias, etc. It sort of ties in with tort in a tangential way, but I think we need to be honest as providers about why we order what we order and when, etc. It's okay to feel guilty, but lets be honest about the reason behind that guilt...

 

Let's not play the victim.

[physasst]

I wonder if there is any way to quantify the cost of defensive medicine. In an average ER shift I probably see 3 patients who are sent in by their PMD "just in case." When I try to street them, the SP usually says to run the tests the PMD wanted "just in case."

 

Even if tort reform had no direct effect, just the perception of improvement might mitigate some of this nonsense.

 

BTW, there are studies that have looked at this.

 

Here's a link to an article I wrote in 2011 that ended up on Business Insider...

 

http://www.businessinsider.com/medical-malpractice-reform-truth-in-advertising-needed-part-two-of-three-2011-2

 

It's important to note that Lakdawalla and Seabury found that there was an increase in mortality with a decrease in medical malpractice expenditures. (Disclaimer-Darius (Lakdawalla) is a friend). Anyway, I also talk about a couple of other papers that looked at the effect of tort reform measures on defensive practices...

 

So far nothing substantial at all......Believe me...I'm not trying to be an ***, I wish it was true, but there is simply no evidence to support that...not so far....

 

Again, if you know of ANY...I would love to see it. I'm writing a fair amount on this, and this systematic review is HUGE....hoping to get it into Health Affairs....

[Hemegroup]

http://www.foxnews.com/politics/2013/06/30/administration-recruits-librarians-to-promote-obamacare/?test=latestnews

 

Spread the word, ladies :D

 

And good luck, 'loopholes' (how do I do that moving laughing icon). People want and are finally getting ... health insurance. Medicaid has arrived. And in case you haven't had a rep visit lately, Medicare is about to change. This is For the People. Don't ever lose sight of that, or else you are in the wrong profession (and I mean that most sincerely). Yes, there are going to be glitches to be worked out. Yes Specialists will be receiving less and Primary more. Just think Swiss Alps if you have emotional issues. Those evil Librarians, they're being taken over by the New World Order! (shakes fist, crepitus audible)

[Hemegroup]

I do want to add about Medicare ... in the region I currently work in, Inland Empire, CA, there will be a splitting into a choice of two County systems or choice of 4 HMOs. I would choose one of our County systems, it is virtually identical to Medicare except the scans take a few days and referrals take a week or two for visits (the other County system can take months tho, not sure how that'll play out once people get wise). Plus the clinic I'm currently in has the best Referrals Coordinator I've ever worked with. Now, I live in a small town so I'm not sure just how regional it is.Time will tell, wherever we are.