Tag Archives: Health Care

Trumpcare and Medical Travel: What Will Happen

The following infographic shows what will happen to the US healthcare system when the Senate rams the ACHA down our throats, as many are indicating will occur because McConnell and a group of GOP Men are hiding behind closed doors and won’t even tell their own party what’s in the bill they are writing.

What this will mean for medical travel is not hard to figure out. For some, it will offer an opportunity to seek lower cost medical care due to premiums that will increase and costs rising as well.

This will be especially true for self-insured employers who will want to save money by offering this to their employees.

Here is the infographic:

fa97feb3-c0f5-4fdb-9c79-6cfe82add29e-original

A Deeper Dive into Medical Cost Rising for Lost-Time Claims

It is said, a picture is worth a thousand words, and I have ten pictures, courtesy of NCCI’s Barry Lipton’s presentation on that subject.

It was brought to my attention by my fellow blogger, James Moore, of J&L Risk Management Consultants. I met James back in February at the NCCI 2017 Data Education Program in West Palm Beach.

Mr. Lipton is the Senior Actuary and Practice Leader, and his presentation was called, “Medical Cost Trends Then and Now.

Yesterday’s posts regarding the slight increase in the average medical costs for lost-time claims only scratched the surface of the subject. I hope this post will dive deeper into it, so that we can see the whole picture.

In my first post from yesterday, “Slight Increase in Average Medical Costs for Lost-Time Claims, Part 1”, I discussed how physician costs and prescription drug costs impacted medical costs for lost-time claims.

On the issue of physician costs, Mr. Lipton showed that there was a decline in the 2015 medical payments per claim due to physician costs, but as the following chart proves, despite this decline, physician costs contribute a larger share of the total costs.

Chart 1.

Chart 6.

Source: NCCI Annual Issues Symposium 2017

According to James, the main reason for the reduction in costs is the physician utilization per claim. Even though it is only a3% reduction, it is significant, James says, in a time of upward spiraling medical costs. Chart 2 bears this out.

Chart 2.

Chart 7.

Source: NCCI Annual Issues Symposium 2017

The second part of my post yesterday, “Slight Increase in Average Medical Costs for Lost-Time Claims, Part 2”, looked at the steady rise of the average medical cost for lost-time claim.

If we compare the chart from yesterday’s post to the one Mr. Lipton presented, we will see that his chart does show increases and decreases over time in the average medical costs per lost-time claim, but my chart indicates that ever since 1995, it has been rising steady.

Both charts, do show that the average medical cost per lost-time claim is hovering around $30,000, and if the numbers are consistent with ones for earlier years, represents almost 60% of the total claims cost.

My Chart.

Chart 2.

Chart 3.

Chart 4.

Source: NCCI Annual Issues Symposium 2017

To examine this in greater detail, Mr. Lipton broke down the Accident Years into three separate periods and slides, to show the change in medical cost per lost-time claim. He compared the change in Personal Health Care (PHC) Spending per Capita with the Medical Cost per Lost-Time Claim.

In the period, 1995-2002, the average growth rate (AGR) for WC was 9%, and the AGR for PHC was 6%. In the next period, 2002-2009, WC AGR was 6%; PHC AGR was 5%, and finally, in the last period, 2009-2015, the WC AGR was 1%, while the PHC AGR was 3%, as seen in chart 4.

Chart 4.

Chart 10.

Source: NCCI Annual Issues Symposium 2017

To understand what was driving the decline in Accident Year 2015, Mr. Lipton identified six different drivers, as indicated in chart 5.

Chart 5.

Chart 8.

Source: NCCI Annual Issues Symposium 2017

Finally, Mr. Lipton discussed how hospital costs contributed to medical cost per lost-time claims by highlighting the difference between inpatient and outpatient costs, which are rising.

The following chart looks at the four years prior to the 2016 Accident Year, 2012-2015.

Chart 6.

Chart 9.

Source: NCCI Annual Issues Symposium 2017

In 2012, Hospital Inpatient Paid per Stay amounted to $19,514, in 2013, it rose to $22,944 (18% increase), in 2014, it was $24,558, or a 7% increase, and last, in 2015, it was $25,320, or 3% increase over the previous year.

As for Hospital Outpatient Paid per Visit, the number are considerably lower for each year when compared to Inpatient Stays, but nonetheless have been rising.

So perhaps this, at the end is why the average medical cost per lost-time claim has been rising over a period of over twenty years, from 1995 to 2015.

I wrote to James last night when I saw his recent posts on this presentation, and he responded that we are both correct in our analysis, but looking at it from different points of view.

My conclusion after reading this presentation and my discussion with James suggests to me that there are two things going on here. One, when a worker is injured and receives medical care, unless and until he or she goes to a hospital, the best way to lower costs is through what James calls one of his six keys to reducing workers’ comp costs. One of those keys is medical control by the employer, which James said reduced cost by 75%.

But I also realized that when an injured worker goes to the ER or an Ambulatory Service Center as an Outpatient, has an Inpatient stay, that this is where the medical costs go up.

Naturally, Workers’ Comp medical spending is only a fraction of the overall health care spend of the US, and as costs for health care in general rise, so too does costs in workers’ comp.

So, while many have argued or shown that they can lower costs on the front end, from time of injury to return to work for most claims where no surgery is required, one of the largest reasons for the steady rise in the average medical cost per lost-time claims is hospital costs.

On this, both James and I agree. However, it is important that many in the industry see this as well. Keep thinking that it will change by doing this or that has not worked, the numbers prove that. Maybe it is time for something out of the box.

Infographic on Mobile Health

Here’s an infographic courtesy of URAC. What will this mean for workers’ comp, health care and medical travel?

Millennials and Mobile.png

Despicable!

“Capital is reckless of the health or length of life of the laborer, unless under compulsion from society.”

Karl Marx

“Our policy is to create a national health service in order to ensure that everybody in the country irrespective of means, age, sex or occupation shall have equal opportunities to benefit from the best and most up-to-date medical and allied services available.”

Winston Churchill

 

Here we have two quotes dealing with the same subject. The first quote is from the father of Scientific Socialism, i.e., Marxism and Communism, and the second quote is from the wartime Prime Minister of Great Britain, who was a staunch anti-Communist.

But what transpired today in Washington, is far from the view of Marx, or the view of Churchill. In other words, it is DESPICABLE!

Never before in the history of the United States, has the government of the people, by the people, and for the people ever taken away something the government gave them in the first place.

Not even the enactment of the 18th Amendment outlawing the sale and production of alcohol, stoops to the level of total disregard for the health and welfare of the American people. Alcohol was never something the government had to give to people, they produced it themselves. Our founding fathers were brewers and distillers of alcoholic beverages.

But the vote this afternoon represents a step towards a society this nation has not seen in many decades. You hear that Republicans want to take the country back. The obvious place they want to take us to is the 19th century, when no one had health care, there was no Medicare or Medicaid, or Social Security, Unemployment Insurance, and Workers’ Comp.

There are specific reasons for this, which I will discuss.

First, pure and simple, it is greed. They want the money dedicated for health care and the other medical plans for a huge tax cut for their wealthy friends.

Second, the health insurance companies can now get to pick and choose who they want to cover, what they will cover, and what they will charge you if you have a serious pre-existing condition or a life-threatening disease. We know this as adverse selection.

Third, they don’t believe in giving “entitlements” to anyone except the military and the wealthy.

Fourth, their libertarian, puritanical, Calvinism teaches them that the poor are undeserving of the benefits that money brings, so let them die, and who cares if they are poor, it is a sign of a moral failing.

Another quote from Churchill says that you can always trust the Americans to do the right thing after they have tried everything else.

Well, after today, we have tried everything else. We have given employers the right to offer health insurance to their employees, we have allowed private insurance companies to sell policies to individuals, and we have created separate health care plans for children, the elderly, the military and their families, members of Congress, and the poor.

But for all the reasons I have given above, and many more, this nation refuses to enact single payer health care, the only thing we haven’t tried, and the one form of universal health care every other Western nation provides its citizens.

One fellow blogger last year during the Democratic Primary, said that while he liked Bernie Sanders, he knew that the health insurance companies were not going to scrape their businesses and start from scratch.

But maybe they should. It is because the capitalist profit motive is at the heart of what, in the words of Walter Cronkite, our health care system really is. “America’s health care system is neither healthy, caring, nor a system.” Too many are profiting from other people’s misery, and driving many into poverty. This is the richest nation on Earth, and this is how we treat our fellow citizens.

It is strange that the Conservative Party of Great Britain believes in single payer, but the American Republican Party does not. The truth is, they are no longer the Republican Party but the Republican Libertarian Party.

Once upon a time, members of their right-wing decried the nation’s drift towards “Creeping Socialism.” With this vote, and with executive orders flowing from 1600 every day, we are witnessing “Creeping Fascism.’ The new Secretary of Labor comes from the fast food industry where workers were mistreated, and still are in some places.

Worker’s rights are being eroded with new overtime rules, wages are stagnant, unemployment is still too high despite what the government says.

One other reason for enacting single payer is that doing so will free employers from having to provide it to their employees, and workers over forty will not have to face losing their jobs and careers they spent their lives in.

We, as a nation, must decide; either we take away health care for millions of Americans, or we make sure everyone has it. There can be no half-measures. Many pundits have said the AHCA (Zombie Health Care Bill) will not pass the Senate, but that is what they said about the House of Representatives.

I hope the Senate will defeat this, but if they don’t, the only option left is single payer.

One More Thing on Health Reform

Could not ignore Joe Paduda’s first post this morning, which is also covered on the Health Wonk Review blog.

He lays out in great detail who would be affected by passage of this zombie legislation, and who would come out ahead,

It’s enough to make you sick, that such people exist who will take away health care from the very people who put them in office, and don’t care that many of them will die because they can no longer get health care.

Comedian Jimmy Kimmel went on his show the other night and confessed to the entire country about his newborn son’s heart disease. What was the response from the Nazi right? Attacks.

Why do these people continue to vote against their own economic interests? There are many reasons for this. The first one is simply, they don’t believe Democrats. And why? Because for far too long, Democrats have engaged in Identity Politics, and have ignored the heartland.

Second, the Democrats have generally avoided campaigning in, or developing their local or state parties in those states most likely to vote Republican, but would benefit from Democratic policies in education, job creation, health care, etc.

Third, Republicans have done a great job of convincing people of an “us versus them” mentality. Republicans sound like “us”, act like “us”, enjoy the same activities as “us”, where “they” do not. You hear the words, “elite”, or “elitist” thrown around, as was done yesterday in response to Kimmel’s plea by an alt-rightist.

Forth, Republicans know how to frame an argument by using simple words and phrases, where Democrats go into long, drawn out lectures on policy. They talk to Americans as if every American has a college degree in political science or sociology. Yex, polls do so that many Americans agree with Democratic policies, but we know that polls are not always accurate.

The last election proved that.

Lastly, the Democrats have been late to the party as to what is happening to working people, both blue collar and white collar workers. In fact, the Republicans know all too well what is happening, as they are responsible for the prolongation of their misery, and will do nothing to stop what is about to happen when jobs are replaced by automation.

Universal Basic Income (UBI)? Not from this crowd of neo-fascist, libertaritards. (Take that, Rush Limbaugh!) Want some more Oxycodone?

As we are witnessing day by day, the US is going backwards. All the way back to the 19th century, the very century the GOP is most comfortable with, because that is when they had complete control of the entire government, and their friends in industry were getting richer and richer, and there were no government programs or laws protecting workers and the poor.

So if this zombie health care law gets passed, look out…there will be more zombies where that came from.

The Zombie Apocalypse and Other Matters

For sometime now, your humble author has subscribed to a health care blog called Health Wonk Review.

Some of their posts are usually out of the scope of this blog, so I very rarely write about these issues, and many times, there are posts from Joe Paduda on subjects I’ve already read, or commented on, so to write about it would be redundant.

But in light of my post yesterday, in which I said, based upon Joe’s post, that the AHCA (Zombie Health Care Bill) was dead, here is the link to today’s Health Wonk Review. I cannot do any more justice to the discussion, so I will let it speak for itself.

Be frightened, be very frightened.

Ding, Dong, Health Care “Reform” Is Dead: A Political View

Time for another rant, but this time it is based on actual facts, plus an understanding of the real reason repeal and replace of the ACA is not going to happen.

There are many reasons for why repeal and replace has failed; some of them have to do with the complexity of the health care marketplace, others have to do with the fact that all the negative things the opposition said about the law did not come to pass, even though some people are paying higher premiums, or cannot find a doctor because there aren’t enough where they live and have to travel long distances to find a doctor (primary or specialist), or the insurance companies have exited the exchanges, thus limiting the number of payers.

Joe Paduda has been conducting an ACA Deathwatch, and yesterday, Joe wrote that ACA repeal will not happen.

This, he says, is due to the defection of one major GOP legislator, Fred Upton, of Michigan.

But what Joe does not say is why the GOP has been so single-minded in wanting to destroy the ACA (besides the obvious reason of tarnishing Obama’s legacy).

The one guiding principal and reason for “repeal and replace” is solely due to the adoption by the Republican Party (or should I say takeover) by out and out libertarians, and rampant libertarianism.

This has nothing to do with the Libertarian Party, although many members of that party were Republicans in the past; case in point, former New Mexico Governor Gary Johnson, who ran for President last year as the Libertarian Party candidate.

To prove to you that this is the case why the GOP has been so one-track minded, one only has to read the response from former GOP Congressman Joe Walsh (you remember him, the guy who yelled “you lie” to Obama during the SOTU speech).

Walsh, not to be confused with the Joe Walsh of rock and roll, said the following in his tweet response to Jimmy Kimmel’s tearful admission that his newborn son had a heart defect that needed surgery, and Kimmel defended the right of others not as fortunate as him and his wife to afford that surgery, which would have been fatal to any other child whose parents could not afford it.

Here is the exact tweet:

Joe Walsh@WalshFreedom

Sorry Jimmy Kimmel: your sad story doesn’t obligate me or anybody else to pay for somebody else’s health care.

At first, you might think this guy is a heartless SOB, but if you read the tweet carefully, and look closely at the word “freedom” after his name, and the tweet itself, you will see that to Mr. Walsh and the rest of his “Freedom” Caucus, it is not that he is heartless, it’s that he is brainless.

Because only a brainless idiot still clings to a political philosophy that time and again has been discredited. He believes he nor anybody else is obligated to pay for someone else’s health care, but I bet he does not feel that way when other people have to pay for his or his children’s public school education, or their ability to have lunch while in school or to even have books to read and pens and pencils with which to do schoolwork with. Or to bring it even closer to home, to have other people (namely taxpayers) pay for his health care when he was in Congress. Do as I say, not do as I do.

Or maybe he sends his kids to private school?

You see, the real reason the GOP is against the ACA is they don’t believe it is the role of the government to do anything for anyone, and that includes providing health care. They are fundamentally opposed to it on philosophical and ideological grounds, and like their Speaker, are slavishly devoted to the rantings and writings of a 20th century novelist and the reactionary views of an economist few have ever heard of.

You know, of course, where the Freedom Caucus came from? It is the legislative part of the Tea Party, founded by former Congressman Tom DeLay (there’s a name for you), and the Tea Party has nothing to do with a hot beverage. It means “Taxed Enough Already”.

But the real impetus behind the Tea Party was not the old folks demanding the government keep its hands off their Medicare. It came from the very wealthy who donated large sums to elect Republicans to office. It started with Howard Jarvis in CA, spread under Reagan and both Bushes, and popped up during the debate over the ACA.

Jimmy Kimmel said the problem with health care was partisanship; however, as written in Salon, the problem is with one party…the Republicans. This by no means lessens the impact of Kimmel’s plea.

The response from President Obama, DNC Chairman Tom Perez, and Senate Minority Leader Chuck Schumer was overwhelmingly positive.

The current occupant continued his insane view that the ACA was dead. Sort of like saying Andrew Jackson could have prevented the Civil War, or that he recently met with Frederick Douglass.

Finally, the defeat of repeal and replace is laid at the feet of those GOP congresspersons who are vulnerable in the next election, and are hesitant to incur the wrath of their constituents, if the recent town hall meetings are any indication.

Like health care itself, the defeat has many reasons, but at the core lies the simple fact that libertarian, free market solutions are more dangerous to the health of the American people than the alleged disaster the GOP has painted the ACA with.