by Pappy This is a slight elaboration on a comment I made yesterday, so please don't go looking for a link.
Healthcare insurance is not the healthcare industry, just as automobile insurance is not the automobile industry. What we're seeing with the Affordable Care Act is not healthcare reform, because it's not really reforming the business of healthcare. It's technically healthcare insurance reform. But it isn't even that.
First let's understand what insurance is. I've included the Wikipedia entry for Insurance, so that we are all on the 'same page'. Go ahead and read it, please. I'll wait...
In world ruled by mathematics, the insured are therefore protected from a specific risk event, or risk events for a fee, with the fee being dependent upon the frequency and severity of the event(s) occurring.
Example: A cargo from Singapore bound for Amsterdam in the hull of a ship certified by a host nation whose flag it flies, sailing with a competent and certified crew, traveling on a safe route, will have a lower risk-level than a cargo traveling from Singapore to, say, Mombasa, in the hull of a ship flying a flag-of-convenience, with a pick-up crew, with the route traversing down the coast of Somalia.
Hence the people that are shipping the cargo on the latter ship will pay higher fees for insurance against loss of the cargo than would the shippers on the former vessel (the shippers in the latter instance would likely pay lower shipping costs, but that's for another time.)
Back to healthcare insurance.
What the Affordable Care Act (ACA) is, is a mandate that healthcare insurance be purchased by the denizens of the United States for themselves and their dependents, hence creating a 'risk pool', i.e., a fund for transferring or distributing risk among those mandated to buy healthcare insurance.
In the case of health risks it depends on a lot of factors as well. For example, if you're older, you'll likely have knee problems. If you're overweight, you'll likely have cardiac issues in addition to knee problems. And so forth.
In order for an insurer (private or governmental entity) to not lose their metaphorical shirt paying out on claims, they attempt to manage the risk. That could be done by increasing the risk pool (the purpose of the Affordable Care Act (ACA)) using statistics to determine the risk of loss or an event, or establishing loss or event parameters up front - suicide not being covered by life insurance, for example. Additionally, certain items may either be not covered or reimbursement schedules will be at the insurer's discretion.
The "tweak" here with the ACA is that the risk pool has deep-shallow payment. Low-risk insurance purchasers. like the young or very healthy, or earning a decent income will pay more for their low risk of incurring a medical event (pay more for being in the shallow end of the risk pool), in order to subsidize the insurance of those with high risk factors or lower incomes (being in the risk pool's deep end). The need for healthy young people with low health risks to purchase health insurance is thus required in order to financially cover the health care costs of their statistical opposites.
In essence, it is a perversion of what would normally and sanely be defined as "insurance." But this isn't a normal and sane situation.
Additionally there is a social engineering aspect applied to the ACA. Income is a factor in what one will pay for a policy. If one looks at the the Wikipedia entry on insurance again (go ahead, I'll wait,) one doesn't see where one's bank account or annual income should be a factor. In essence and stripped of politics, it's a redistribution of assets.
Another social engineering factor is the ACA addressing social/economic inequities. There is a high healthcare risk among pregnant lower-income women both prepartum and postpartum due to many economic, geographical, and most important, social factors. In order to cover this tragic problem and to standardize policies (as a way to keep administrative costs low) people are being mandated to pay for insurance policy features they may not or will not need, i.e., a post-menopausal woman being required to pay for maternity care features provided in her policy.
The other problem with this so-called healthcare reform is that it has the same issues as Medicaid and Medicare. It is payment-reimbursement driven. There really is no reform of actual healthcare-business issues.
Take for example, the legal side of healthcare. Obstetrics is a high-risk medical field; factor in the conditions of increased risks from social conditions (lack of or ignoring prenatal care, use of drugs during the pregnancy, poor physical health, etc.) and the risks become higher.
However, the legal system does not necessarily take those factors into account when a malpractice suit is filed. Insurance fees for insuring against malpractice claims in fields like obstetrics, neonatal medicine, and cardiology are astronomically high. Practitioners in those fields will then take steps to mitigate the risk of a lawsuit, adding to healthcare costs.
Another issue is that nowhere in the ACA (so far) is a list of defined costs for medical procedures, tests, treatment, etc. In fact, medical costs for the same procedure vary widely across the United States. That too is based on risks, on how expensive it is to "do business" in a given locale and also socially-imposed costs that have to be absorbed until reimbursement is made (if it ever is made). The mandate that treatment must be provided at emergency rooms regardless of ability to pay, for example. Southern California, particularly the Los Angeles area, has had hospitals close because the costs of operating them are not reimbursed or covered by incoming payments for treatment. Demographics also factors in heavily.
What is covered and not covered, and the quantity and quality also varies widely. Taking the maternity care cost issue, for example, is partially addressed by standardization under ACA, but imposes costs on those insured that will never use maternity care. It also leaves open what will be covered and not covered, and what will be paid for and not paid for.
We haven't even touched on reimbursement. That too varies widely. Nor are there transparent and publicly available defined reimbursement definitions and schedules available.
A nationalized health care plan adds in healthcare management, but that does not remove managing the risks or mitigating the costs of healthcare. Two things must still be controlled: expenses and income. I'll leave it to the reader to elaborate on both, but demographics, politics, and social engineering factors still play a role.
To repeat: A healthcare system is not healthcare insurance. What is being called healthcare insurance under the Affordable Care Act, is, for the most part, presently neither healthcare reform nor insurance reform.
Yep, I've been saying that since the bill was proposed.
AND its bad health insurance reform.
Posted by: Bill Clinton ||
10/27/2013 1:02 Comments ||
I believe Katie Pavlich is now saying the Website debacle is due to the Regime NOT WANTING knowledge of the plan's actual costs to be fully revealed just yet.
Excellent piece Pappy. It's not "insurance", when you have a $5000. annual deductible. You don't have insurance, you have a tax. The so-call reimbursement is simply another name for welfare and resources transfer. ACA is a cover for a new ponzi, tax scheme, nothing more.
A key indicator of a national population's health is life expectancy. When the greatest improvement would occur when young males quit killing themselves, you quickly understand that the solution isn't science, administration, or more programs. The Blue models have only heightened the effect rather than mitigated it. This is one big distraction from the social malaise that creates the symptoms that social engineers want to throw (other people's) money at. Until there is an awakening within the social swamps created by the Blue model, done to sustain its power, that the only real solution is a change in personal behavior, nothing is going to alter those numbers significantly.
One would think that the "Blue Model" planners would wise up. Rowe vs Wade and abortion on demand is decimating entire generations of ACA paying subscribers. Appears to be counterintuitive, until you realize denying services to seniors and programmed attrition are actually designed to eventually counter-balance the numbers.
Unless you are hitched to the plow and pulling, you're no long needed.
It seems to be a common practice to misname so-called 'reforms'.
Likewise: so-called 'Immigration Reform' has absolutely nothing to do with immigration and everything to do with Granting amnesty to people who broke the law (ILLEGAL Aliens). Gun Control has nothing to do with Guns and everything to do with control.
It's the deliberate misnaming of things to make them sound more digestable. Everyone is concerned about their 'Healthcare' right? Not so much 'Insurance'. Everyone wants to welcome 'Immigrants' right - they built this country. No so much ILLEGALs.
There is a method to their madness.
Another issue is that nowhere in the ACA (so far) is a list of defined costs for medical procedures, tests, treatment, etc.
The Central Planners have to game the system and its not even half-time yet. Contrary to all the benevolent hub-bub about affordability or availability the current monkey in the wrench is the concept of Adverse Selection. The term describes how ones propensity to purchase insurance is primarily associated with degree of risk - not ability to purchase. If not for traditional insurance controls such as underwriting the greatest payout would be to those most risk adverse. Can you say Death Spiral? The Statists recognize mandates that require people to purchase coverage will only mitigate a portion of the problems. The predictable next step will be price controls and dare we say rationing. Folks, the games called Equilibrium and its going to be quite mediocre.
Sen. John McCains daughter says her dad is depressed and frustrated with the tea party faction of the Republican Party, which she called the hyper-conservative wing.
A state of mind many in the tea party can relate to in their radical pursuit of a more fiscally responsible, limited federal government.
Were both frustrated with the idea that only the hyper-conservative wing of the party is going to represent the masses, Meghan McCain said during an interview with ABC and Yahoo News.
Ms. McCain, who has her own reality show Raising McCain, said the last time her father was so depressed about the state of politics was after his failed 2008 presidential bid, according to the Washington Times.
He is so depressed. He is so downtrodden, Ms. McCain said. The way hes talking about it, how hes never seen it this bad in his 30-plus years in office. There's more at the link
Well, when viewed by a RINO, it probably does look like "the hyper-conservative wing" cause they actually have principles (ie adherence to the Constitution, balance budgets). I'm sure to the Socialists, he looks the same or a useful idiot. The problem is perspective. Most of the non-Beltway Blend Party types think John and his cohorts are just, at best, the Stupid Party - "Look I'm just like the guys across the aisle".
How a Rino can sire a heifer baffles Zoologists
Posted by: Frank G ||
10/27/2013 11:28 Comments ||
The yawning boy in his one-piece sleeper was the creation in 1907 of Burr E. Giffen, an eighteen year old artist who worked in the advertising agency employed by Fisk Rubber Corporation. The slogan "Time to Re-Tire" and the drawing of the sleepy boy were copyrighted in 1910 and first appeared in an advertisement in the Saturday Evening Post on March 7, 1914. In 1918, another professional artist, Edward M. Eggleston, made an oil painting of the boy. Fisk spent millions of dollars publicizing the trademark, which was registered in over ninety countries. Publicity releases prior to 1928 said the Fisk boy, sometimes called "America's Favorite Son", ranked among the leading trademarks and was as well known universally as "The Little Dutch Boy". In 1930 the Fisk boy"s yawn was changed to a smile, but in 1934 he was changed back to his sleepy self. The original artwork had been so changed by all the retouching that in 1941 the Metropolitan Museum was commissioned to restore the painting. A number of artists were consulted as to whether a new boy should be painted, but they were unanimous that the charm of the original could not be improved upon.
Posted by: Barbara ||
10/27/2013 12:55 Comments ||
I find it interesting that a part of the party that wans fiscal accountability, less government, less intrusion, is viewed as radical. Along with the vilification of anyone who feels our government should act responsibly is just astounding. When both sides are so corrupt that they attack together against the Tea Party, we know the Tea Party is making headway.
I think we all now know how our founding fathers felt before the revolution or how the peasants of France felt during the time of Marie Antoinette.
Posted by: 49 Pan ||
10/27/2013 13:12 Comments ||
Should have retired when he went against Obama in 08. Country did not want him, bigger hint not possible.
Most Statesmen - after running and losing for the top spot, leave the limelight. McCain is no Statesman. He loves his Mavericky image, the press accolades (except when he ran against their Demi-God) and all the attention he gets as the MSM-anointed "Republican face".
Posted by: Frank G ||
10/27/2013 17:56 Comments ||
Well John-Boy, the Tea Party WAS in response to statesmen like you.
Posted by: Mullah Richard ||
10/27/2013 18:19 Comments ||
Johnny boy, if you're that depressed, you know what to do, just be sure to put the muzzle firmly in your mouth.
"Well John-Boy, the Tea Party WAS in response to statesmen like you."
I will restate what I said yesterday slightly differently...The Tea Party was in response to those people in the Republican Party who have a conscience. Clearly the Tea Party caucus has no conscience and no brains. God, I hope the Republicans run on the Tea Party platform...they will be out of office for another 8 years LMAO....
Posted by: Barbara ||
10/27/2013 19:23 Comments ||
Clearly the Tea Party caucus has no conscience
Sorry, Jerkface, I am quite certain that the average Tea Party member personally donates to charity an order of magnitude higher percent of income than the top half of the Democratic party, and significantly more than the typical Republican. They just understand that you cannot spend other peoples' money forever.
Clearly the Tea Party caucus has no conscience and no brains.
Seriously, dude. Is this your A game? If you hang around here long enough, you will notice that the prized qualities are insightful analysis, wit and the ability to spin up a good rant. All we have seen so far could come from a Web-based Insult Generator.
Personally, I find it curious that an alleged Canadian has such a hardon for the Tea Party, given they are not exactly a threat to your way of life.
a little Steyn for our latest douchebag troll - Jerk
Normally we wouldn't publish an article labeled "Dupe entry", but the cause is a noble one. One can hope Mr. Killa will learn from the experience, remaining to widen our count of valued Canadian participants. It has, after all, happened before -- for those of you who remember him, muck4doo original came to mock what he thought were unthinking right-wing idiots, but stayed because Rantburg was one if the few places he could enjoy challenging discussions on issues he concluded were important.
The witness who coughed up the intriguing tidbit about Obamacare's exemption from privacy protections was one Cheryl Campbell of something called CGI. This rang a vague bell with me. CGI is not a creative free spirit from Jersey City with an impressive mastery of Twitter, but a Canadian corporate behemoth. Indeed, CGI is so Canadian their name is French: Conseillers en Gestion et Informatique. Their most famous government project was for the Canadian Firearms Registry. The registry was estimated to cost in total $119 million, which would be offset by $117 million in fees. That's a net cost of $2 million. Instead, by 2004 the CBC (Canada's PBS) was reporting costs of some $2 billion -- or a thousand times more expensive.
Yeah, yeah, I know, we've all had bathroom remodelers like that. But in this case the database had to register some 7 million long guns belonging to some two-and-a-half to three million Canadians. That works out to almost $300 per gun -- or somewhat higher than the original estimate for processing a firearm registration of $4.60. Of those $300 gun registrations, Canada's auditor general reported to parliament that much of the information was either duplicated or wrong in respect to basic information such as names and addresses.
Also, there was a 1-800 number, but it wasn't any use.
So it was decided that the sclerotic database needed to be improved.
But it proved impossible to "improve" CFIS (the Canadian Firearms Information System). So CGI was hired to create an entirely new CFIS II, which would operate alongside CFIS I until the old system could be scrapped. CFIS II was supposed to go operational on January 9, 2003, but the January date got postponed to June, and 2003 to 2004, and $81 million was thrown at it before a new Conservative government scrapped the fiasco in 2007. Last year, the government of Ontario canceled another CGI registry that never saw the light of day -- just for one disease, diabetes, and costing a mere $46 million.
But there's always America! "We continue to view U.S. federal government as a significant growth opportunity," declared CGI's chief exec, in what would also make a fine epitaph for the republic. Pizza and Mountain Dew isn't very Montreal, and on the evidence of three years of missed deadlines in Ontario and the four-year overrun on the firearms database CGI don't sound like they're pulling that many all-nighters. Was the government of the United States aware that CGI had been fired by the government of Canada and the government of Ontario (and the government of New Brunswick)? Nobody's saying. But I doubt it would make much difference. Asked by Mother Jones to explain why Obama the candidate uses the Internet so effectively but Obama the government is a bust, his 2008 tech maestro Clay Johnson put it this way: "The first person that you need in order to start a Web company would be a Web developer; the first person you need to start a government-contracting firm is an attorney." The problem with Obamacare isn't the website design, it's the nature of government procurement in an unaccountable bureaucracy serving 300 million people.
"But ponder this: Had Obamacare been created (by O'Divine Intervention, no doubt)
as a private enterprise with Obama as CEO, it wouldn't have lasted a week. Not only would the stumbling company have been put out of business, so would its incompetent CEO. And we'd all--well, most of us--be better off." HT: Drudge
It was inevitable. There really is no fixing stupid. In Chicago, operators like the Champ have local democratic machine coverage. Failing that, they are simply sent down-state to a Federal Pen.
On the national stage, Champ's sorry ass is just hanging out. This latest ACA software scandal should be a white house clearer, an opportunity to tear out the Islamic décor, call in the 'bug man' and fumigate.
We should be preparing and presenting Plan C as an alternative to the Plan B (single payer national health system) that is already planned and waiting for presentation as soon as Plan A (the current Obamacrap) fails, as it must (and as it must have been intended to, because no one can possibly think it could have succeeded.)
Plan C needs to include transparency, free market and de-protection of medical monopoly/trust violations. But it may not matter, since too many people now believe 'free' health care is their right. Think it's expensive now - wait 'til you see what it costs when it's free.
Oh God, its the New England Patriots versus the Chicago Bears VIDEO again, playing for the Superbowl championship wid the Bammer = USA as McMann + New England, + CHINA as the Bears.
China wants its strategic access + "sole" overseas milbases for its PLA - unless Caroline Kennedy, Bammer + DepState, can give it that, espec as per setting a formal or pro-forma date for NEAR-TERM REUNIFICATION WID TAIWAN, THE BEST CAROLINE + OBAMA CAN DO IS DELAY A MAJOR MIL CONFLICT, POSSIBLY EVEN NUCLEAR CONFRONTATION [Limited Tac NucWar only?] INVOL CHINA, N-O-T PEVENT ONE.
Histoire' says so-called MUTUAL DEFENSE-SECURITY TREATIES BETWEEN ALLIES have been broken times before, hence can be broken times again - OBAMA HAS ALREADY UNILATERALLY BROKEN HIS OWN "RED LINES" SEVERAL TIMES.
'Tis a major reason why US Allies are feeling nervousy twitchy at this trime.
A multi-volume chronology and reference guide set detailing three years of the Mexican Drug War between 2010 and 2012.
Rantburg.com and borderlandbeat.com correspondent and author Chris Covert presents his first non-fiction work detailing
the drug and gang related violence in Mexico.
Chris gives us Mexican press dispatches of drug and gang war violence
over three years, presented in a multi volume set intended to chronicle the death, violence and mayhem which has
dominated Mexico for six years.