Paul's Web Blog

Archive for July, 2011

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We are reaching the next stage in the legal cases to decide whether Obamacare is constitutional. For those of you who have been sleeping through the debate, here’s a quick summary. The Democrats passed a law establishing a mandate. The people with the means to buy insurance to pay for their medical expenses must buy. Many children, retirees and the poor are excluded because they are eligible to receive subsidized care. To give people the chance to buy insurance, many rules have been amended, for example, insurers are now prohibited from refusing cover because of a pre-existing condition. The hope is the combination of the law and new regulations will bring millions more people into the ranks of the insured.

One of the “big” cases was heard by Judge Roger Vinson in Florida. He produced what can only be described as a dramatic decision, striking the whole of Obamacare down as unconstitutional. In many ways the Judge gave a political rather than a legal decision, describing the current situation as parallel to the Boston Tea Party revolt against the tax on tea imposed by the British. It’s a call to arms and, to ensure the maximum impact for his judgment, he put the appeal on fast track. The GOP wants the case to reach the Supreme Court as soon possible, hoping the Republican appointees will agree with Judge Vinson. Standing in their way is the Court of Appeals for the 11th Circuit. Three judges, drawn by lot, are due to hear the case this June. Two of the three were appointed by President Clinton.

People usually point to the mandates for auto insurance, but this is different. You get a choice whether to drive. You don’t have a choice on whether you fall ill. The real argument comes down to this. When people have no insurance and cannot pay their hospital bills, the hospitals add the debts to their overheads and pass on the costs to the insurance companies as increased bills. If there’s still a shortfall, they get the taxpayer to contribute. So forcing people to buy insurance means lower premiums for the insured and less demand for taxpayers to contribute. Those who refuse to buy insurance will have to pay more tax. Either way, there must be more money available to pay for health care since the plan to clamp down on the rising cost of drugs was not included in the new law.

This appeal is bringing out the big guns. Paul Clement is representing the twenty-six states contesting the law. Equally high-profile Michael Carvin is representing the National Federation of Independent Business, while the government’s case is argued by Neal Katyal, the acting US Solicitor General. Yet for all this legal in-fighting, one fact is often overlooked. The law and regulations are in force. They are already changing the reality of health insurance on the ground as states move to create the insurance exchanges giving more people access to cheap health insurance. The states currently refusing to plan the exchanges run the risk of the federal government imposing a solution – assuming it wins the cases, of course. No matter who wins in Atlanta, it will move the cases against the mandate closer to the Supreme Court. We live in interesting times.

The politicians on the right attack everything about Obamacare as being the spawn of the Devil, inviting all those active in their local communities to find ways of opposing the arrival of death panels and the slightly less threatening insurance exchanges. Let’s not get into the debate that starts with the fact Obama used Mitt Romney’s law as a model for the federal law. No matter who first implemented which version of a mandate, this can all wait for the next Presidential election when it looks as though Mitt Romney may be picked to run as the GOP’s candidate (well, anything’s possible). Let’s instead focus on a simple issue we can all understand.

Insurance companies are for-profit so anything that threatens the bottom line is automatically “bad”. In an ideal world, companies would only insure the health of those people who never fall ill or have an accident. That way, all the premium income would be potential profit (once those pesky employees have been paid for doing nothing). Except no one can guarantee they will never have a day of illness or need some treatment as they get older. So, to shade the odds in their favor, the companies have consistently refused cover to everyone who has a pre-existing condition. Let’s face it, if people are already ill, they are going to want regular drugs and treatment just to keep them functioning. Better still, if the companies really spread the definition of “condition”, they can catch a whole range of minor problems and use them all as an excuse to refuse cover, no matter how unfair that might be.

So along comes Obamacare and, at a stroke, this instructs insurers to stop this practice. First as far as children and young adults are concerned. Adults come later. Needless to say there was a wailing and gnashing of teeth as the insurers insisted this change would put them out of business. So why look at Nebraska on this? Well, this Great Plains state has Dave Heineman and Rick Sheehy as governor and and lieutenant governor – both Republicans in a solidly Republican state – so it’s always interesting to see what Republicans do when told to implement a law which they ought to oppose root and branch.

Well, this February saw a positive change. Instead of having to wait for an insurer to refuse cover because of a pre-existing condition, a doctor can simply confirm its existence and this allows entry into the Pre-existing Condition Insurance Plan (PCIP). This plan offers access to a substantial network of primary and secondary care. More importantly, access is not conditional on means, nor are people charged a higher premium. In fact, the premium rates for PCIP members have dropped by 20%.

Some might suggest this is a better standard of care than those on a private plan. For Republicans what rubs more salt into the wound is that there’s a new drive to get even more people enrolled into PCIP. It seems Republicans support some bits of the President’s health insurance law but deny others. What we see in Nebraska is ironic. Instead of making access to PCIP difficult, the Republicans are encouraging ever more people to enroll in the state’s health insurance plan.

Let’s start with a not uncommon situation. Someone is brought into hospital unconscious. He or she has collapsed or been involved in an accident. Fortunately, there’s a driver’s license so the hospital knows the identity of the patient, but there’s one small problem. Without free access to this person’s medical records, how do the doctors know what existing health problems may be contributing to this collapse? Worse, there’s no way of knowing whether there are any drug allergies or whether drugs are already being taken which might interact with any new medications the hospital might propose to use. At best, this slows down decision-making. At worst, it exposes the patient to the risk the treatment might make their condition worse. In an ideal world, all medical records would be available online so that, with a patient’s identity, a hospital could get immediate access to all relevant information. Except this is not an ideal world and many doctors still keep only paper records.

Let’s be clear about this. The overall standard of care would improve if there was effective and comprehensive information sharing across all healthcare providers. Costs would be saved by removing the need for tests to be repeated. Doctors to a case can quickly see the pattern of diagnosis and treatment, avoiding diagnoses now eliminated and focussing the search on the remaining explanations for the symptoms. Even more importantly, it also allows a new pair of eyes to see what might have been missed or misinterpreted. When you can save costs and improve treatment outcomes, this is a win-win for everyone. Except it can never work unless there’s a better IT infrastructure to collect and store the information securely, and then only allow access to those with a need to know.

Now add in Obamacare. If you are going to mandate people to carry cover and make the insurance exchanges work properly, you need up-to-date information to identify those without cover and encourage them to enroll. Although federal and state agencies have some money to pay for this work, small practices and rural hospitals have neither the expertise nor the funding to implement effective IT systems. Worse, if local practices and doctors were allowed to implement their own systems, the result would be a piecemeal system with little chance of one system interacting effectively with any other. It needs a centrally coordinated design for all interested parties including the insurance industry. Obviously, the insurers are not going to be pleased if lists of their customers are accessed by the state. They will claim this is commercially sensitive information. Yet without a free exchange of information, it will be difficult to make public and private healthcare available to the maximum possible number of people.

There’s a certain irony in all this. Normally, we would think the improvement of our healthcare services would depend on better drugs and more effective treatments. Yet what we now see is that health insurance can never deliver a completely safe and effective service without proper information exchange. Worse, without access to the health insurance companies’ databases, how will the state enforce the mandate? Except the cost of all this IT work is billions of dollars and there’s no real sign the federal government has budgeted for it.

If you live in a capitalist society, this suggests you are in favor of capitalism. That’s the idea people save their money, invest it as capital into a business and then either take the profit or enjoy the dividends. In other words, you are in favor of the few successful entrepreneurs supplying goods and services, and being able to get rich. In theory, this “land of opportunity” approach to life is motivating. People see they can, literally, rise from rags to riches through their hard work. This is the ultimate upwardly mobile society you could ever want to live in. Except it all depends on there being no real limits on the amount of profit people can take from their businesses. So, if you can buy in goods for $1 per unit, there’s nothing to stop you selling them on for $100. Ah, the free market people have just jumped up, waving their fists in anger. They all protest the customers would all revolt and take their business to the sellers asking only $10 per unit. The businesses that overprice will all be driven into bankruptcy. Except that’s not what happens. Most businesses parallel each other when it comes to prices, or aim to be the price leader and increase the prices to suggest a better product or service. Capitalism only benefits the customer where the competition is real.

In most other countries around the world, there are codes of business ethics to limit the profit margins. Where voluntary self-regulation fails, the socialist governments either impose price controls on essential goods and services, or offer subsidies to keep the prices down. This perspective sees the customer as having rights to a fair deal. Companies in these countries either limit their profit-seeking or run the risk of penalties.

With this in mind, we come to our own National Association of Insurance Commissioners (NAIC). Working within the framework produced by Obamacare, the NAIC intends to make insurers more accountable by forcing them to spend a minimum amount of the premium income they collect on medical costs. Surely, as customers of the healthcare industry, we want to see as much of our premium spent on delivering quality treatment? Ah ha! If we do, then we are for a policy that limits the amount of profit an insurance company is allowed to make. We are against the excesses of unrestrained capitalism and all for socialism! So the NAIC is working on a formula to require every insurer to spend not less than 80 cents in every dollar collected on our health care. This increases to 85 cents for the large group plans.

Not surprisingly, the health insurance industry is up in arms, bitterly claiming the right to spend the premium revenue on their own pay, giving away generous dividends, and only spending whatever is left on our healthcare. You will understand, the NAIC is not introducing rules to provide cheap health insurance. The intention of the Affordable Care Act is to give us, the customers, better value for money. At present, we do not know when we are being gouged. If the NAIC prevails, insurers will be limited to 20% to cover their costs and leave a profit. That sounds about right.

When it comes to driving, age doesn’t often play a significant role, until you go shopping for an insurance policy. Unfortunately there are two demographic groups that fall into high risk driver categories based on age alone. These groups are at opposite ends of the spectrum, on one side we have young drivers paying huge insurance premiums, and the opposite side of the spectrum, the seniors are also paying car insurance as a high risk driver. The reason for this is based on statistics like the ones that come from the Institute of Advanced Motoring, that show in one year alone, New York experienced 550 serious car collisions where the driver was over the age of 70. The simple fact is that the over 65 group is a high risk driver group based on many factors, and members of this group will see higher insurance as a result, even if they’ve never had an accident. Here we will talk about why, and how to go around that if you are looking for lower car insurance and fall in this age group.

Statistically speaking from a quotes standpoint, drivers over the age of 70 will likely see insurance premiums as high as 33% higher than a 50 year old. These hikes keep jumping up with age, and by the age of 80, some drivers can’t even get insurance at all. In younger years where women see traditionally lower rates than men, this changes as time passes, and older women are seeing even more hikes than their male counterparts of the same age.

There are many reasons for this. Women become more nervous as drivers as they age, and get flustered faster which leads them right into more collisions. In addition, for both men AND women, reaction times when driving and eyesight changes are a mere biological fact of life, and affect the driving records of those over the age of 65. In addition, elderly drivers have a tendency to be more confused and disoriented at the scene of an accident than those that aren’t considered seniors. All of these standard factors of aging are all reasons why those in the over 65 group see higher rates than those in most younger demographics.

But hope is not lost, there are a few steps you can take if you fall into this older age bracket that will still help you see lower car insurance. If you can build a no claims record with one insurance company over time,that will help you get lower rates with other companies in the future if you want to switch. Driver’s education courses are also now being offered for seniors in many states as an effort to help them reduce their insurance costs. If you need to lower your car insurance quotes, you may want to look for insurance companies that will allow this discount for you.

As well, comparison shopping will always be an excellent way to lower your car insurance quotes. Today’s insurance business is very competitive, even in high risk driver’s categories such as seniors. If you have a good driving and insurance record, you are already well equipped to see good discounts on insurance, and many insurance companies will weight your history more than your age and you should see lower car insurance quotes as a result.