Using a bigger net

Right now, one of my company’s competitors is running a series of radio ads.  The ads tout that in the small and medium group market segments, 90% of their groups renewed last year.  The implication is that 90% of their customers/decision makers are happy, so your small company should buy their product.

Being an employee of a major competitor what I hear is 10% of their customers are pissed off enough to engage in the very expensive, time consuming, disruptive no-fun task of changing insurance companies, but hey, that is just me. 

As a policy blogger, I also hear the reasoning why so many preventative care procedures weren’t covered in the pre-Obamacare world.

The theory of change for preventative care as a cost control measure is that wide spread but small costs to treat a population in order to prevent a small number of people from that population from requiring very expensive treatment leads to a net cost reduction.  There were two problems with this idea from a pre-Obamacare insurance company business model perspective.  Read more








The Difference Between Democrats and Republicans

In California, a Democratic Party-run state:

Dozens of workers at a call center in the Sacramento suburb of Rancho Cordova began fielding calls after a countdown to 8 a.m. Tuesday, the time the state’s health exchange opened for business. The agency that runs the exchange, Covered California, reported on Twitter that more than 30,000 telephone calls were received during the first 90 minutes of operations. Another 1,200 were on hold and about 4 percent had hung up.

Peter Lee, executive director of Covered California…said Tuesday was just the starting point, and it was evident that exchange officials had work to do after the website and phone system were hit with a crush of inquiries.

Gov. Jerry Brown, meanwhile, announced he had signed a package of bills to help implement the new law and expand the state’s Medi-Cal program for those who are too poor to pay for the subsidized insurance.

“While extreme radicals in Washington shut down our government, here in California we’re taking action to extend decent health care to millions of families,” Brown said in a statement, referring to the impasse in Congress that has led to a partial shutdown of federal government operations.

Meanwhile, as a result of the government shut down triggered by those GOP extremists, there’s this news:

Cecil_Beaton_Photographs-_General;_China_1944,_Canadian_Mission_Hospital_in_Chengtu_IB2569C

At the National Institutes of Health, nearly three-quarters of the staff was furloughed. One result: director Francis Collins said about 200 patients who otherwise would be admitted to the NIH Clinical Center into clinical trials each week will be turned away. This includes about 30 children, most of them cancer patients, he said. (From behind the WSJ paywall via the Atlantic) (h/t a tweet from science writer extraordinaire Steve Silberman aka @stevesilberman.)

So there you have it:  Democrats strive to get sick people care (and the well, protected), and labor to fix  the bits that don’t work.

Republicans leave kids with cancer on the street.

Update:  H/t commenter Baud, it turns out   that Americans in those (GOP-led) states that have chosen to abandon their responsibility to their citizens actually do twant healthcare from the Feds (via TPM):

Nearly three million people have visited the federal health insurance marketplace created by Obamacare on its first day, according to the U.S. Department of Health and Human Services.

Since midnight, 2.8 million people have visited the website, which will serve consumers in more than 30 states, and 81,000 have called the marketplace’s call center. Those numbers were current as of late Tuesday afternoon.

Image:  Cecil Beaton, A mother resting her head on her sick child’s pillow in the Canadian Mission Hospital in Chengtu, 1944.



Expand and loot

Good news (via Politico) for Pennsylvania:

Republican Pennsylvania Gov. Tom Corbett is planning a Monday press conference to throw his support behind a version of Obamacare’s Medicaid expansion, industry and legislative sources tell POLITICO.

Corbett’s eyeing versions of expansion that rely on private-sector health plans rather than adding to the public Medicaid rolls, similar to approaches being considered in Iowa and Arkansas, according to the sources. The approach would bring in billions of Obamacare dollars marked for states that back expansion and use them to buy private insurance for the state’s poorest residents.

Medicaid expansion is a good thing for the working poor in Pennsylvania.  The Oregon study strongly indicated that Medicaid significantly improves health and quality of life for its recipients.  Pennsylvania is one of the last Obama voting states that had been holding out  and it is a large hold-out.

The bad news on this probable announcment is that the expansion is being done in a cockamanie manner designed to prove that government can’t work.  Simply expanding state Medicaid elibigibility rules would be faster and cheaper (as Medicaid pays a low reimbursement rate) than sending people to exchanges for products that have yet to be designed.  Two steps forwards, one step back and then a piroutte towards social justice…..








Focus group

We’re getting set to try to pass a local tax levy to build a new public school. As you know, I am a public school enthusiast but I also have a child in the local school system and we need a new school.

Because this is a majority Republican county and city I will be working with mostly Republicans to pass a tax levy. Obviously, these aren’t the Tea Party “base” of the GOP. These Republicans support “government schools” and also are mindful of the fact that tangible things like “schools” and “parks” and “libraries” don’t just form like Fruit On the Tree of Liberty and then drop to the ground to be gathered, but have to be paid for with taxes and then built. I think you would all call the levy people Chamber of Commerce Republicans, and that would be exactly what they are except they’re all in Rotary here, not the Chamber.

I have worked with some of them once before on a library levy, in 2006. In that campaign, we did what is called a “stealth levy.” A stealth levy is where one puts the tax increase on the ballot in a low-turnout election cycle and then targets supporters rather than do a big general push because the theory is a big general push only fires up the anti-tax people. The stealth levy worked, BTW, so don’t come crying to me with your “ethical” concerns on stealth. We won’t be using that this time out because there’s already been public meetings and such on finalizing the building proposal and now funding for that specific building plan will go on the ballot.

I’ll do GOTV which I like to think I am quite good at and don’t need any help with but I also will have to make some sort of “pitch” for the tax to local Democrats and, also, people who generally don’t vote. I know what I’ll say to (current) school parents, but what’s the best selling point for people who 1. no longer have children in the system, and 2. never had or never will have children in the system?

A practical hard-nosed explanation of why we need a new school? Property values? For The Children? Civic duty?

The tax isn’t that much so quit being such Dickensian misers? I voted for the senior center levy and I’m not a senior?

The general lay of the land is the public school is a big part of the town. Sporting events, music, social lives of parents, etc. It’s a rural school in a solidly working class/middle class area, so it’s not ultra-fabulous or state of the art or anything, but the (probably dicey and perhaps completely invalid) “grade” of the school is “excellent.” Also, all the employees live here and teachers (although they are union thugs) are not reviled and loathed. All three local judges are married to teachers and the mayor was a teacher before he was a mayor. Political environment would thus be: generally favorable toward public school system BUT read my lips no new taxes (knee-jerk default position).



Saving us all from the threat of health insurance

Good for her for keeping Medicaid expansion in the news:

Democratic Sen. Capri Cafaro unveiled during a Tuesday news conference the latest legislative measure aimed at reforming and expanding Medicaid in Ohio. And while Cafaro’s proposal included some new policy, the senator focused mostly on trying to dispel a central Republican complaint — Medicaid expansion would siphon money from state coffers. Cafaro argues that expanding Medicaid would save Ohio billions.
The Northeast Ohio senator provided an analysis of Medicaid spending by the Health Policy Institute of Ohio and Ohio State University that showed that the state’s Medicaid spending would reach $17.4 billion in 2025 if no expansion is agreed to. Ohio could save up to $3.2 billion during that period if lawmakers pass an expansion, according to the analysis.
The GOP-controlled legislature jettisoned the expansion, and a handful of bills circulating the Statehouse seek to reform or expand the federal program.

Cafaro’s legislation is supported by Senate Democrats. No Republicans have endorsed the measure.
“Given what we have laid out, why would somebody not support this?” Cafaro said. “We’ve taken the cost considerations off the table. We are promoting efficiency, we are promoting shared responsibility by both individuals and providers…and we are covering more people. I’d like to know why somebody would say no.”

We already know why Republicans say no, because the Ohio Tea Party has one issue and that issue is opposition to Obamacare. Without that opposition, the Ohio Tea Party has absolutely nothing to offer or talk about and they go back to being what they were prior to Obamacare – the same old cranky and disgruntled GOP base:

The most outspoken House Republican supporter of Medicaid expansion (not much competition for that distinction) has attracted attention from the Toledo Tea Party, which is actively seeking a candidate to challenge her in the 2014 primary.
Rep. Barbara Sears of Sylvania, a member of the House GOP leadership team and considered one of the most knowledgeable members on Medicaid and health care, has backed Gov. John Kasich’s effort to expand Medicaid to Ohioans making up to 138 percent of the federal poverty level.
The expansion is possible under Obamacare – an association that prompted Tea Party groups in Ohio earlier this year to threaten GOP lawmakers with primary challenges if they support it.
The Toledo Tea Party quotes Linda Bowyer, spokeswoman for Conservative Coalition: “NWOCC supporters are very upset with Rep Sears and her continuing efforts to implement Obamacare Medicaid Expansion.” She added: “We’ve been interviewing candidates throughout northwest Ohio. Our supporters have made it clear to us that we need to support candidates who will actively work to oppose Obamacare, and oppose any candidate that is working to implement Obamacare.”
Sears said she is confident she will prevail in next year’s election. Asked if she knows of any colleagues yet who are facing tea party primary challenges over Medicaid expansion, Sears said there is a reason her name is the only one on the expansion bill.

This probably doesn’t help her any:

considered one of the most knowledgeable members on Medicaid and health care

Oh, definitely get rid of her, then. Cull the knowledgeable members – immediately.