Author Archives: Mara

Did Edward Snowden Compromise Your Health?

Edward Snowden. Photo Credit Washington PostAs Edward Snowden “flees” to Hong Kong for some stupid reason after disclosing a tremendous amount of classified information, Americans are left to to wonder what the federal government knows about our internet usage, telephone calls, and other assorted electronic usage. For those of us who basically go online to find out what other people have found online, this will not be a particularly big deal. For others, it raises numerous red flags about why we’re being tracked in the first place.

What has come to my mind this week, though, is concern about the security of electronic medical records. Starting in 2015, doctors who choose to maintain medical records by hand will receive reduced Medicare and Medicaid reimbursement. Since these rates are already low, it’s pretty much a given that someone in your doctor’s office has finally learned how to turn on a computer. But thanks to Edward Snowden, who had been at his company for roughly 5 months before exposing the PRISM program, it’s also pretty clear that basic technological security in the United States has hit an embarrassing low point.

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Can you ever tell the doctor “no?”

Have you ever tried to say “no” to your doctor? Have you ever even thought that might be a good idea?

To open The New York Times‘ new series on “how the economic incentives underlying the fragmented health care market in the United States have driven up costs,” Elisabeth Rosenthal makes a compelling case for transparent pricing for medical procedures by emphasizing the expensiveness of colonoscopies and their limited returns. I agree with her: we should know what procedures cost – and what we’re likely to receive at the end – before they begin. This is not because you should have to choose whether or not you want a life-saving procedure, it’s so we understand better whether or not it’s worth paying for non-emergency services.

But as one of Rosenthal’s subjects points out in the piece, “if a doctor says you need it, you don’t ask.” Fear of death is among the strongest we have, and that’s not terribly unreasonable. So even if we knew the prices of our procedures, how – and why – would we ever say “no” to our doctors?

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On Fixing the Affordable Care Act

The Patient Protection and Affordable Care Act has to be one of the most important pieces of legislation in this decade. It’s also not perfect. The New York Times yesterday published an article pointing to fixes wanted by everyone from Families USA, a nonprofit advocacy group for healthcare access, to Richard Burr, a conservative Senator from North Carolina.

The New York Times identifies the partisan politics of the way the law was passed as the primary issue. A professor at GWU says that because of these politics, “we cannot use any of the normal tools.”

And yes, this is partially true. Shit has gotten partisan since…1988, 25 years ago, the last time a law cited in this NYT article was passed. If it feels reductive to dismantle the debate about a 1,000 page law to politics alone, that’s because it is. It is rare that legislation like this – so economically far-reaching – has actually made it through Congress and survived (er, sort of) multiple Supreme Court challenges.

The NYT knows this – or, at the very least, the authors of this article must. A good chunk of the article lists out different “key definitions” in the law that “must be changed,” to quote one accidental lobbyist. The changes to these “key definitions,” though, are not exactly obvious; otherwise, they would have been different the first time around.

Instead, so many people are affected by the passage of the Affordable Care Act that for every group who wants to change a definition or rule, another groups wants to keep it the same, and another two want to change it slightly differently. Families USA wants to make sure that “navigators,” the people who will help the uninsured access the state health insurance exchanges, are paid more. Another fifteen groups want the exchanges eliminated all together, leaving the collective salary for navigators at “zero.” For every business-owner who has 51 employees and doesn’t want to be required to assist in the purchase of insurance, there is another business owner who has 200 employees and still considers herself “small.”

The truth is, some of these rules are pretty arbitrary. Who knows what a “small business” actually means? What we do know is that a huge number of us are caught up in this law, and we all want the law to work better for us as individuals. Do I wish I could stay on my parents’ health insurance plan forever? Yes please. Do I think I should get a subsidy to purchase health insurance through the exchange? Obviously.

But this isn’t the way law works – you can’t make everyone happy, even in such a massive bill, even in 1,000 pages. So yes, 51-employee business owners may be pissed. But if you raise the requirements to purchase health insurance to only employers with 200+ employees, where are we leaving the employees who have 50 coworkers?

The politics behind this are driving the stability of the law, but it is so much more, and so much deeper, than the politics of partisanship.

We Can’t Communicate About Healthcare

About a month ago, the Kaiser Family Foundation did a pretty standard survey about Americans’ awareness of healthcare reform. The results of the survey, however, were slightly less than standard: 40% of Americans, and over 50% of people ages 18-29, are unaware of implementation of the Affordable Care Act.

This news should be shocking to supporters of healthcare reform and detractors alike. After all,  House Republicans just voted to repeal the Affordable Care Act for the 37th time last week. South Carolina’s Representative Mick Mulvaney knows theyr’e doing the right thing: “The guys who’ve been up here the last year, we can go home and say, ‘Listen, we voted 36 different times to repeal or replace Obamacare,’…tell me what the new guys are supposed to say?”

Yes, what are the new guys supposed to say, Rep. Mulvaney?

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Differing hospital rates prove, once again, that we don’t have this “healthcare” thing figured out just yet

CMS Data Set: Medicare Provider ChargeBetween health insurance exchanges not being implemented by the states and a study saying that Medicaid is effectively the same as other health insurance, you may have missed missed the released CMS (Center for Medicare and Medicaid Services) data that shows what 3,000 hospitals across the country are charging for services.

According to CMS, “hospitals determine what they will charge for items and services provided to patients and these charges are the amount the hospital bills for an item or service.” Some procedures feature a $50,000 difference depending upon where you have it done.

As usual, the only people who are paying these absurd costs are those who don’t qualify for Medicaid but don’t make enough money to pay for health insurance. Costs are driven up for the uninsured because insurance companies use their bulk purchasing power to get rates lowered significantly, and Medicare, a huge driver of hospital profits, simply pays whatever formula is set by the government for a certain procedure, rather than what is billed by a hospital. As discussed in last week’s post, “the uninsured” in most states is still going to refer to childless adults who are hovering around (and often, who are below) the federal poverty level.

In short, in many states, if you make $15,000/year (minimum wage), you’ll have to worry abou the market value of your emergency procedures. Expect the pundits on FOX News to chastise you for not shopping around for the cheapest hospital costs while you’re lying on a stretcher in the ambulance. Continue reading

The Medicaid Expansion that Never Was: How the Supreme Court’s Obamacare Decision Hurt Healthcare Reform and Left Millions of Americans Uninsured

Obama signs his healthcare reform into law | March 23, 2010In January 2014, 30 million more people will suddenly have health insurance – at least, that was the plan. Most of the provisions of President Obama’s signature legislation, the Affordable Care Act, will kick in on January 1, and regardless of what happens, millions of Americans will have access to something that 77% of us say is necessary.

In semi-short form (what, you didn’t want to read 906 pages?), if you earn below 400% of the federal poverty level and your employer does not offer health insurance (or it would cost more than around 9% of your income), you are eligible for a subsidy to pay for the plan of your choice through a state-based health insurance “exchange.” The Kaiser Family Foundation has a subsidy calculator  if you want to see what you’ll get (or if you want to be even more grateful for your employer’s health insurance plan, which you’ll likely get to keep).

In addition, a massive expansion to Medicaid is underway. In the law as originally passed, all 50 states (plus DC) were required to expand their programs to all adults who earn up to 133% of the federal poverty level. The first three years are 100% funded by the federal government, and the next ten years are also mostly funded by…the federal government.  And the states all went, “woo, money to help our most vulnerable populations!”

Or, alternatively, they all sued the federal government.

Yeah, it was that second one. Continue reading