For example, just a week or so ago we leaned of a teeneager with a heart condition that the Brits' "free" health care was unable to treat, thus forcing his parents to seek help from the much-maligned American health care system:
Turns out, little Baby Oliver was born with a rare heart problem that the "free" British health "care" system was unable to treat. So, of course, the compassionate and warm-hearted government-run service denied care doomed the baby to death. The parents, understandably, demurred, and successfully sought treatment in the United States.
Specifically, the Boston Children's Hospital, which, unlike its counterparts in the UK, boasts a 100% success rate.
Well, it's that time of year again, when the temps soar, folks head to the beach and the pool, and insurance companies announce when they'll be cutting checks to comply with ObamaCare's Medical Loss Ration (MLR):
In case you didn't know, the ACA requires carriers to pay out (at least) 80% of premiums collected in claims. For large groups, that requirement is 85%. Anything less and they have to send the difference to their insureds.
By the way, that MLR check's no bargain for insureds. As co-blogger Patrick pointed out a few years ago:
Over the years, we've reported on a number of health insurance claims that hit (and/or exceeded) the magic $1 million mark. These have always been rare, partly because, even in today's inflated medical expense environment, it takes a lot of medical care to reach that summit:
Cancers of various types accounted for almost $800 million in health insurance reimbursements fro 2014 through last year. And the total number of million dollar patients nearly doubled: from 104 in 2014 to almost 200 in 2017.
What's also interesting to me is that cancer was the #1 culprit: I would have guessed that the opioid crisis would have been to blame, but that doesn't seem to even register on the radar. Granted, these are from a study of self-funded plans from one carrier, but still; it's not as if employees and their dependents are immune.
What wasn't a surprise is the low percentage of folks who experienced these claims:
"Patients with claims of more than $1 million represented only 2% of the total number of stop-loss claims from 2014 to 2017."
But that low number comprised almost one-fifth of the total dollar paid out.
India faces an interesting challenge: how to provide health care to it most vulnerable (ie poorest) citizens. Currently, health care financing and delivery models are left up to the individual states (not necessarily a terrible idea, but that's for another post). The country's federal government has been tasked with rolling out private health insurance to some 500,000 of its citizens, which is proving - mas one might imagine - quote a challenge:
One challenge is infrastructure: "Although ... the IT infrastructure has been put in place, the involvement of hospitals — public and private — and insurance companies was still to be finalized." Sounds familiar.
The other problem is something we also face: how to provide care to an ever-expanding population with a shrinking supply of providers?
"It will not be possible for health care providers to respond to such a huge expansion of coverage without substantial investment in medical facilities and manpower,” said Owen O’Donnell, associate professor at the Rotterdam-based Erasmus School of Economics. “Without that, the extension of coverage risks being nominal rather than real.”
I bet. And again, similar to what we see here with, specifically, expansion of Medicaid "coverage" with narrower and narrower networks from which to obtain actual care. Wonder if our Indian friends will be more successful.
At least they're trying a privatized alternative, even as we plunge headlong toward single payer. What do they know that we don't?
So, low pay, horrendous workload, "free" health care. What's not to love?
■ Case Study #2, Direct Primary Care Fees:
So who gets to decide the single price and unit measure? If I sell my services as a doctor to a patient who is happy with the price and service, why do you get to choose what I price my service at? #FreeMarket#DPC
— Jackson Hole DPC, Jonathan Figg MD (@JacksonHoleDPC) July 9, 2018
As regular readers know, we've been longtime fans of the DPC model, while acknowledging its (substantial) limitations. But this is something that's been under our radar, and bears consideration. That is, DPC practices are, by definition, independent, and free to set their own fee schedules and rates. But this also means that it's currently kind of a "wild west" in terms of defining what is - and is not - a true DPC office. For better or worse, there doesn't seem to be a nationally recognized "DPC Association" that offers some kind of consistency across various practices. Now, I kinda like that, but it also means major 'caveat emptor' warning should apply.
"A Kansas mother says an insurance company wants her family to pay $132,000"
Now, if you're wondering about how that seemingly-arbitrary value was assigned, well, it appears to have been the sales price of said sculpture [ed: notwithstanding that "asking price" isn't necessarily "what someone ultimately pays"]. In the event, there was some dispute about whether or not the child actually touched, let alone knocked over, the piece.
The good news is that this is now settled:
Surveillance video shows the child wrapping his arms around it and then struggling to hold it up as it fell https://t.co/ITQnKZKSat
If you're fortunate enough to (still) have a PPO-type health insurance plan (coverage for both in- and out-of-network expenses), then you probably know the frustration of actually filing those OON claims. What if there was a simple, inexpensive way to get them paid with little or no hassle?
Well, as you might have guessed, there's an app for that: