The Des Moines Register recently reported that Wellmark Blue Cross Blue Shield has been accused of violating federal HIPAA privacy regulations in the case of a patient with severe hemophilia. (See link to Register article below.) As reported, a representative of Wellmark was discussing the high cost of health insurance at a Rotary Club meeting last March. She gave an example of an extreme case that was costing $1 million per month. (ACA – Obamacare – prohibits insurance companies from placing any limit on the amount it will pay for patients.) She did not identify the patient by name, but described him as a 17 year old male with hemophilia. Maybe she should not have mentioned the age or sex of the patient, but that information alone did not identify who the specific patient was, and should not be considered a violation of federal privacy regulations.
Wellmark and other insurance companies must be able to cite specific high cost cases that are causing health insurance premiums to rise to unaffordable amounts. How can we openly debate ways to contain health care costs if we don’t know what is causing the high costs? Can we really afford to require insurance companies to pay out unlimited amounts for any patient? I recently heard that the last remaining company to offer individual health insurance policies in Iowa may charge more than $30,000 per year next year for a couple who are 55 years old. Health care wants are unlimited. Our ability to pay is not. We need to debate whether or not government should prohibit health insurance policies from having limits on how much they pay out for individual patients.
In The Des Moines Regiser’s report about Wellmark getting out of the health insurance market for individual policies under the Affordable Care Act (ACA), they reported, “Forsythe (CEO of Wellmark) cited a single Wellmark customer who has a rare genetic disease that is costing more than $1 million per month to treat.” One person – A million dollars a month. (See link to article below.)
One of the fatal provision of the ACA is the requirement that there be no limit in health insurance policies on how much can be paid for any individual’s care. No limit. Should we really expect others (society) to pay a million dollars a month for the care of ourselves or our family members? If you help to pay that much for someone else, then won’t you expect the same to be paid for you if you have the need? How can that be sustainable? Who gets to makes decisions regarding who we pay for and who we don’t? Unfortunate as it may be, it is a reality of life that we cannot afford, even as a society, to pay for everything we want. To the extent that those decisions, including limits on health insurance policies, can be made privately and voluntarily, we will have a more just, civil, and sustainable society.
I will respect the ruling of the Supreme Court in upholding the subsidies under Obamacare, but the decision was wrong.
Those who drafted, supported, and voted for Obama care clearly intended to withhold money from those states that did not set up their own state health insurance exchange – just like many other laws that require states to meet certain requirements in order to get federal money. In this case, they intentionally wrote the law to provide subsidies only to people in states who purchased their health insurance through an “exchange established by the state.” It was intended as a carrot or a stick to get the states to comply. Many did not comply, so the strategy backfired.
The job of the Supreme Court is to resolve disputes based on the law, the facts, and the Constitution. It is not the job of the Court to fix mistakes in political strategy. That is what they did, and it was wrong.
The Register recently criticized our fee-for-service health care payment system for causing over-utilization and for driving up health care costs. (2/12/2015 – “Florida, home of medical scans — and scams” – see link below) They gave examples of doctors ordering unnecessary test because they get paid more for every additional service that they provide. They advocated paying physicians a salary like Mayo Clinic does, so that doctors, “…have no personal, financial incentive to provide unneeded care.” They urged the Obama administration to, “…continue to work toward reimbursing providers based on quality instead of quantity while fairly reimbursing them.” I agree with the Register that, “Ultimately, reducing the overuse and misuse of health care falls to patients.” They urge patients to not rush to the doctor for every ache, ask questions when doctors order tests, resist clinic staff who want to schedule tests and procedures.
One thing the Register failed to mention is the importance of patients being required to pay out-of-pocket for some portion of their health care costs. To the extent that patients are not required to pay for some portion of their costs, they will not question the recommendations of doctors and other providers and they will tend to over-utilize health care. Requiring patients to make some out-of-pocket payment will also help reduce fraud, since patients won’t want to pay part of any fraudulent charges that billed to their insurance. Many insurance policies under Obamacare do seem to have significant deductibles and co-payments. That will go a long way to help keep down health care costs.
Link to Register article: http://www.desmoinesregister.com/story/opinion/2015/02/12/florida-home-medical-scans-scams/23278965/
Regarding The Register editorial today (11/17/2014) entitled “Obamacare foes are hoping for activist judges” Exactly the opposite is true. It is the Obamacare supporters who are hoping for activist judges to interpret the law differently than it was written. The letter of the law is clear. It states that only people who sign up for Obamacare through state run exchanges are eligible to get subsidies. Obama and his team created this threatening provision intentionally to pressure states to create their own exchanges. But more than 30 states, including Iowa, did not knuckle under to the pressure. The Supreme Court should uphold the law as written, not as Obamacare supporters wish or hope it was written. This is what happens when, as Nancy Pelosi famously said, “we need to pass this bill to see what is in it.”
A Supreme Court ruling today (6/30/2014) upheld our fundamental right to use our own private property in accordance with our own moral beliefs. The ruling gives priority to natural religious and private property rights over the politically created guarantee that private business owners will provide employees with a health insurance benefit that covers certain birth control pills.
The owners of Hobby Lobby objected to the Obama Care legal requirement that they provide their employees with an insurance benefit that covered morning after “abortion” pills. The law was in direct conflict with their sincerely held, honest and peaceful religious beliefs. Hobby Lobby has never used force or fraud to get people to either work for or patronize their business.
Governments are the only organizations that can legally use force against peaceful people. We created our government to use force, if necessary, to protect our fundamental right to life, liberty, property, and the pursuit of happiness. Government force should not be used to make peaceful people act against their own religious beliefs – no matter how good the cause or the intentions.
By the way, I am a peaceful, honest, pro-choice, atheist, libertarian.
The Register advocated for government operated long term care insurance in its lead opinion on 7/15/2013. (“Long-term care policies need attention”) We don’t need or want a government financed program for long term care insurance. President Obama backed out of a government sponsored long term care insurance program when he felt unable to promise that government would not some day step in and require taxpayers to subsidize the plan. We have Medicaid for the poor. That is enough. If anything, our government should encourage people to buy long term care insurance and/or to save for their own long term health care needs. Instead, our government seems content to keep interest rates artificially low so that people will borrow and spend. Low interest rates reduce the returns that insurance companies earn on their reserves, which in turn causes them to increase their long term care insurance rates. Letting interest rates rise to their natural levels would be one of the best ways for government to help improve the incomes of seniors, and help hold down the cost of long term care insurance.