Tag Archives: health care

The Veteran’s Choice Program

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This is a program that would give veterans the option of going to a private sector doctor in lieu of playing the delay wait game at a Veterans Administration facility, after the veteran has jumped through the requisite VA hoops.  After a political tussle in Congress over increasing/renewing its funding, some additional money was provided.  That additional funding was necessitated because

its popularity depleted the allocated funds more quickly than anticipated. Patient visits through the program increased more than 30% in the first quarter of fiscal year 2017, according to the VA.

Extra points for those of you who can say why the program is so popular.

Despite the success of this limited program, the Progressive-Democrats in Congress want to get rid of it.  Congressman Mark Takano (D, CA), for instance,

argued on the House floor in July that it’s a “mistaken belief that the private sector is better equipped to care for our nation’s veterans than specialized VA doctors.” But while the VA provides high-quality specialized care in certain areas, for the most part veterans’ needs are similar to everyone else’s.

Indeed.  Takano and his fellow Progressive-Democrats just want to maintain control over OPM. It’s a mistaken belief that the private sector cannot care for our nation’s veterans better than specialized VA doctors. As Burgess and Cleland (authors of the piece at the link) note, mostly our veterans’ needs are similar to everyone else’s.

Those few specialized needs unique to a veteran’s particular military history? The VA’s specialists, functioning in the private sector, can deal with those at least as well as they do now, and probably better and faster without the VA’s bureaucratic impediments.

Make the Veteran’s Choice Program functionally universal: privatize the VA, and use its current and what would have been its future budgets for veterans’ vouchers.

Veteranos Administratio delende est.

Death Panels?

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The Affordable Care Act required Medicare to penalize hospitals with high numbers of heart failure patients who returned for treatment shortly after discharge. New research shows that penalty was associated with fewer readmissions, but also higher rates of death among that patient group.

Because sometimes readmission is necessary for quality care—whether that readmission was driven by later complications, by too-soon original discharge in the Medicare (which is to say Government) pressure to hold down costs first, or by some other factor—but that Government pressure to push the patient out the door also pushes against the patient’s return.  Even when necessary.

Here are a couple of numbers from a study soon to be published in JAMA Cardiology:

One in five heart failure patients returned to the hospital within 30 days before the ACA passed. That dropped to 18.4% after the penalties. Mortality rates increased from 7.2% before the ACA to 8.6% after the penalties….

In other words, an 8% drop in readmissions is associated with a 19% rise in death rates for heart patients.  That’s not a favorable trade-off.

There is a legitimate interest in improving the quality of care for all patients, including those for whose care us taxpayers are paying, but readmission rate is not an accurate measure of that quality.  Readmission rate can only measure…readmission rate.  That metric addresses neither the reasons for readmission nor the reasons for the prior discharge.

Government pressure to hold down readmissions doesn’t quite amount to death panels, but the outcomes seem dismayingly similar.  To be clear, the results of the study do not establish a causal relationship, for heart patients, between the lowered readmission rate and the higher death rate.  However, the magnitude of the apparent association between the two desperately wants further investigation.

Obamacare Subsidies

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Recall that under Obamacare, health coverage plan providers are required to subsidize low-income Americans (who, under Obamacare, are required to buy the plans regardless of need for the plans on offer or ability to pay the vig for them) for their costs in buying those health coverage plans.  Recall further that the Obama administration paid those plan providers monies to reimburse them for those government-mandated subsidy payouts.  Recall also that Congress never appropriated any funds for the purpose of making those payments to the plan providers.  Finally, recall that a DC District court ruled those payments to the health plan providers illegal—because Congress had not appropriated any funds for the purpose.  Then the Trump administration ceased those payments to the health plan providers.

Oh, the hoo-rah from the Left.  Eighteen Progressive-Democrat-led States sued in Federal court (in San Francisco, California, after judge-shopping to find a suitably malleable court), centering their beef on how stopping the payments would set the Obamacare markets a-roil.  Never mind, now, how cynically irrelevant that plaint is to the actual case before the courts, which is whether the payments are legal, not whether they’re convenient.

Federal judge Vince Chhabria, of the Northern District of California, headquarted in San Fran, wound up ruling against the 18 States.  He also wrote,

And although you wouldn’t know it from reading the states’ papers in this lawsuit, the truth is that most state regulators have devised responses that give millions of lower-income people better health coverage options than they would otherwise have had

And he

cited an October press release by California’s health care marketplace, which said the premiums of nearly four of five consumers will stay the same or decrease after surcharges tied to the lost subsidies are factored in. The judge said dozens of other states also have accounted for the end of the subsidies.

And

One last point on the issue of confusion.  If the states are so concerned that people will be scared away from the exchanges by the thought of higher premiums, perhaps they should stop yelling about higher premiums. With open enrollment just days away, perhaps the states should focus instead on communicating the message that they have devised a response to the CSR payment termination that will prevent harm to the large majority of people while in fact allowing millions of lower-income people to get a better deal on health insurance in 2018.

Oops.  Just another bit of disingenuousity on the part of Progressive-Democrats as they try to keep honest Americans trapped in the Progressive-Democrat welfare cage.

Judge Chhabria’s ruling can be read here.

Health Plan Providers Are Concerned

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These providers, which surprisingly The Wall Street Journal misapprehends as insurers, are bracing for a drop in enrollment in the ongoing health plan provision program “turmoil.”  There’s this key passage in the article at the link:

[M]any firms say they expect to lose consumers who will bear the full brunt of the rate increases—those who aren’t eligible for the health law’s premium subsidies, which help enrollees with annual incomes of less than around $48,000.

Yet it’s the “health law” that exploded health plan costs—premiums and deductibles, especially—by mandating coverage for things citizens don’t need or don’t want and by mandating that many of those coverages be provided at no cost to the plan purchaser.  This has led to a burial of many of those costs into the charges made rather than listing them openly as separate line items on the charge sheet and a parallel creation of the claimed need for the subsidies.

Those costs put a premium on getting rid of Obamacare and replacing it with a private economy program of market oriented, actual health insurance policies sold by private companies not fettered by Federal government diktats.

That, in turn, requires three self-important Republican Senators to get with the program.  Senators John McCain (AZ), Lisa Murkowski (AK), and Susan Collins (ME), especially, need to hear about our dismay with their reticence—and on a national scale.  These worthies are responsible to their State constituencies, to be sure, but the US Senate is a national body; these Senators also have a national constituency to whom they’re responsible, for all that the rest of us don’t vote for them.

Health Plan Coverage and Contraception

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The Wall Street Journal has noted that the Trump administration has taken regulatory action to reduce, if not eliminate (the Supreme Court still has to do its job vis-à-vis a Little Sisters of the Poor case, as does Congress legislatively, contra a short handful of Republicans who prefer Obamacare intact over any step toward getting rid of it), the requirement that health plan providers provide contraception to women at no cost to those women coverees and do so regardless of any question of conscience or religious tenet.

Naturally, Progressive-Democrats and the Left generally have their collective panties in a wedgie over that.  However, they carefully ignore certain inconvenient facts.

One inconvenience is the actual cost of contraception—to the user, not the rest of us who must pay for these “free” items.  Contraceptive pills can be had at places like Walmart for $9/mo, vaginal contraceptives are cheaper, condoms (don’t men have a role here, too?) are $6.50 the dozen.  These are not prices that will shatter anyone’s piggy bank.

Contraceptives are used to treat medical conditions, and they can be terribly expensive?  That’s the other inconvenience.  No they aren’t; those aren’t contraceptives.  They’re medications used for treating a medical condition; they happen to have a (if not the) major side effect of being anti-conceiving.  Insurance plans already covered such meds, and Obamacare could have, too, but the Progressive-Democratic Party eschewed that when they rammed through Obamacare.

In the end, there’s no reason anyone should pay for contraceptives other than the users.  Full stop.