Marketing the Affordable Care Act

 

Infographic for Affordable Care Act

Countdown for the Affordable Care Act and Covered California

In my travels and daily life this week I have been surveying most people I meet. These are ordinary citizens, single Moms, minimum wage workers. My cohort has been fast food employees,  real estate agents, truck drivers, taxi drivers,  and the type of people we run across every day (In California).  This is not a scientific study.

Few if any of them have reliable and/or affordable health insurance, and I doubt if the figure of 8 million uninsured in California is correct.   I really don’t think statistics are that important except to number crunchers who seem to manipulate numbers to prove their point or determine what it will cost to implement the Affordable Care Act.  You are either insured, or not insured.  Many who have ‘Medi-Cal have it only in name…high shares of cost sometimes as much as 2,000/month and unable to access health coverage due to pre-existing conditions.  The devil is in the details and it is all supposed to be revealed with a wave of a wand and flashing of a magicians’ handkerchief.

Out of the first ten people I met not one of them  new what Obamacare planned to accomplish. The had never heard the term “Affordable Care Act”.  They had no idea what a Health Benefit Exchange is and also did not know when each step occurred for it’s implementation.

The Amazon Shopping Cart Model

The survey was accomplished in Riverside California a city which is fairly metropolitan and is ‘internet enabled” as much as any other city.  If they received Medi-cal  they were entirely passive about receiving the benefit, did not know much about share of cost or how it would change as income rose or as their children left home.

Despite all the television and newspaper reporting about Obamacare most did not “get it”.  The message has not been visible and there are no advertisement in newspapers, magazines or gathering areas such as shopping malls, theaters, or sport’s venues.

On the eve of Obamacare’s launch, the White House is lowering expectations for it, downplaying their assumptions for signups and emphasizing this won’t be a launch so much as the start of a conversation with the American people, and so on and so forth. The truth, of course, is they’re downplaying things because the exchanges, implementation, and promotional efforts for Obamacare are so far behind and have had such little impact on the very people the approach is intended to reach.

How little impact?

A new poll finds a majority of the public -- especially those lacking health coverage -- is unaware that new insurance marketplaces created by the health law are slated to open ... The poll also found deep skepticism of media coverage of the law, with more than half the public saying they don’t trust any media source to provide credible information. Two-thirds of the public were not aware when the new online marketplaces open to allow people without employer coverage to shop and purchase their own health policies, according to the poll by the Kaiser Family Foundation. These exchanges open Tuesday. Despite outreach efforts by the Obama administration and supporters of the law, the poll found the number of uninsured unaware of the opening date is even greater than the public at large, with three out of every four not knowing the marketplaces are supposed to open in October.

The rollout has not gone as expected, or as supporters had hoped. Even hours before open enrollment is set to begin, confusion reigns in states where navigators haven’t even gotten a chance to use the systems they’re supposed to guide people through. These IT problems are significant, but they will come and go in the context of these political battles. Some will seize on them as signs Obamacare will crash and burn. This isn’t the case, though – it’s not the glitches that will undermine Obamacare, it’s the effect it has on the people who already have insurance.

I don’t know whether to laugh or cry. My health insurer, Kaiser Permanente, has finally calculated what our family’s new health insurance rates will be under the grotesquely misnamed Affordable Care Act (a.k.a. Obamacare.) The upshot: my premiums are about to rise by 114.6%. My wife’s rates? Up 109%. Our kids? Don’t ask.

Yes, it’s time to say goodbye to my current plan, with its $232-a-month premium. That plan is being discontinued, I’m told, because it “does not meet the requirements of the ACA.” It was a nice plan, with low premiums, free physical exams, a high deductible and eligibility for a Health Savings account. We got access to Kaiser’s lower in-plan rates for minor medical care, and we had the peace of mind of substantial coverage if anything catastrophic ever happened. But that plan is going the way of Lake Superior sturgeon or the Hetch Hetchy meadows. It’s vanishing in favor of what someone else has decided would be progress. So now I’m being offered what’s dubbed the KP CA Bronze HSA 4500/40%. My new premium will $519.25 a month -- more than double my old rates.

I wish there was some way of regarding this new “bronze” plan as an improvement over what we had before. But that’s really not possible. The new deductible will be higher ($4,500 instead of $4,000.) My primary care benefit is worse (I’m now being told to pay 40% of billed charges, instead of a cap of $40.) My inpatient hospital coverage is worse (I’m to pay 40% instead of 30%.) Terms on emergency-room visits and prescriptions drugs are inferior, too. There’s probably a “silver” or “gold” plan that would match or even top my old coverage. But then I wouldn’t be looking at a mere 114.6% increase in my premium. I’d have to pay even more.

There’s little wonder that Obamacare remains unpopular, even if you don’t call it that. On the eve of its launch, CNN found 38 percent of Americans favor it and 57 percent oppose it – even when described in neutral terms. That measure of success or failure will have more to do with Obamacare’s survival as a long-term policy reality than any of the early glitches – and that’s something the American people themselves will determine according to their own measures.

-- Benjamin Domenech

Other key concerns include

SHUTDOWN APPROACHES AS SENATE POISED TO REJECT CR

HIGH STAKES FOR BOTH PARTIES IN LAUNCH

AFFORDABLE CARE ACT OR RIPOFF?

THE HEAVY LIFT OF LAUNCHING THE EXCHANGES

 

Technorati Tags: obamacare,hbx,hbe,health benefits exchange,medi-cal,affordable care act,navigators,domenech,consumer power report,kaiser family foundation

Secretary Jack Lew’s Message to Congress

 

Health Train Express' investigation reveals the enclosed letter from the Secretary of the Treasury, Jack Lew.

The news is not good. Our country has backed itself into a corner. The reasons are many, and finger-ponying and filibuster will not solve any problems. There is no rational reason to negotiate Obama Care Funding or link Government shut down with the challenges ahead.

Regardless of the outcome the news is disheartening. All of us have known this was coming and we have allowed our congressional representatives to kick the can down the road.

This is the consequence of citizen apathy and allowing politicians to grandstand for their own sake of power and narcissistic argument. This of course does not apply to all our representatives, however some leadership has gained control due to the specific nature of their local constituency.

Text of John Lew's letter to the Speaker of the Houses (and to all Americans)  this document loads very slowly.  If so try this link instead.

All of this takes place behind the center stage of Health Reform. In the desperation of taking credit for a long conceived goal for Americans the current democratic administration and democratic leaders have gained political capital by autocratic methods of decision making.

Republicans are in favor of health reform and are standing fast against the present financial methods of the Affordable Care Act and illegal powers delegated to the Department of HHS, without regard to expert authorities in health. Deadlines are near for a series o mandates, which will have consequential effects on our economy and business. Is Obama care even affordable?

Lew's Letter points out our plight. Some wish to prioritize debts. This is what most businesses do on the brink of insolvency. He argues that our credit worthiness is at stake. Can we guarantee all our creditors will be happy? No. Banks especially stand to lose more interest if we do not increase the debt ceiling.

In my home we have to prioritize some debt at times. The truth will set us free. To obfuscate our challenges with false hope and faulty reasoning as well as outright falsehoods is to damn ourselves and we will suffer the consequences. We are out of time.

We are still powerful even if our debt is excessive irresponsible and self-serving. Our credit-worthiness is a set of numbers that are arbitrarily set by bankers. Have you ever dealt with credit bureaus, and credit scores? Do we default on our loans? No, but we default on many obligations and legal mandates within the United States by offering false promises and misleading explanations.

Truth is always simple when explanations become complex, chaotic and dysfunctional you can be certain issues are manipulated. Statistics can prove anything. Attorneys can argue quite effectively against truth depending on their goals.

Note: These are my own opinions and may freely distributed, shared in social media, conventional newspaper and magazines..

GML September 25, 2013

 

Technorati Tags: treasury,jack lew,obamacare,debt,debt ceiling,govenment shutdown,creditworthiness,social media,opinion

Stop, Look and Listen

 

…to the ongoing Senate Filibuster sparked by Obama care defunding and Budgetary impasse. The filibuster is ongoing on C-Span Live .

Almost three  years from the date that the Affordable Care Act passed in 2010 and in the past 12 months as each layer of the law becomes exposed to the light of day, discussions, and analysis reveal serious issues with the law.  These are issues that should have been analyzed and discussed in committee and in the  Congress before it was passed into law by Democrats.

No one can predict accurately if the Affordable Care Act will suceed. Certainly not in the way mandates are put into effect.  While the goals are admirable to insure all our citizens the law is unpredictable whether it can be supported by business, insurers, hospitals and providers.

After ten to fifteen years of reimbursement decline these entities are in  no position to bear the brunt of further reimbursement decline. Yet HHS is demanding more administration, regulation, and expensive analytic studies with the hope that this will cut costs.

The issues are not political in nature and the substance of the argument is carried strongly by Republicans, and a few brave Democrats. The Democrats have a lot riding on this. It has been the theme of Democrats for the past four years. They want credit for a national health reform for which ObamaCare is not.  The Republicans are not just being obstinate nor grandstanding….they are out to protect the country from unconstitutional law.  Freedom is at stake here.

Tomorrow the House will vote whether to defund ObamaCare or shut down the government.  This should never have come to this point. 

The many features of this law were actually developed by ex-Senator Hillary Clinton (also recent Secretary of State) in 1992-1994 while Bill Clinton was President. At that time President Clinton assigned health reform to her as ‘the first lady’.   Many of the items can be traced directly to Clinton’s administration.

In previous posts I have outlined the deficits of Obamacare, and it’s consequences on cost, the economy, and whether the mandates can be funded.

THE TRUTH ABOUT THE HEALTHCARE LAW

Michael R. Connelly (ret) a constitutional lawyer read the entire Affordable Care Bill and basis his opinion on many issues that were not plead before the Supreme Court’s decision on Individual Mandates.  That was just one of the many talking points and did not address the other important conflicts with the constitution nor the misguided powers given to the Secretary of Health and Human Services. Never before has such arbitrary and absolute powers been delegated to an administrator. The law provides for little congressional oversight, nor built in checks and/or balances. Our congress was negligent and incompetent in drafting this law.

To begin with, much of what has been said about the law and its implications is in fact true, despite what the Democrats and the media are saying. The law does provide for rationing of health care, particularly where senior citizens and other classes of citizens are involved, free health care for illegal immigrants, free abortion services, and probably forced participation in abortions by members of the medical profession.

The Bill will also eventually force private insurance companies out of business and put everyone into a government run system. All decisions about personal health care will ultimately be made by federal bureaucrats and most of them will not be health care professionals. Hospital admissions, payments to physicians, and allocations of necessary medical devices will be strictly controlled.

However, as scary as all of that is, it just scratches the surface. In fact, I have concluded that this legislation really has no intention of providing affordable health care choices. Instead it is a convenient cover for the most massive transfer of power to the Executive Branch of government that has ever occurred, or even been contemplated. If this law or a similar one is adopted, major portions of the Constitution of the United States will effectively have been destroyed.

The first thing to go will be the masterfully crafted balance of power between the Executive, Legislative, and Judicial branches of the U.S. Government. The Congress will be transferring to the Obama Administration authority in a number of different areas over the lives of the American people and the businesses they own. The irony is that the Congress doesn’t have any authority to legislate in most of those areas to begin with. I defy anyone to read the text of the U.S. Constitution and find any authority granted to the members of Congress to regulate health care.

For those who might doubt the nature of this threat I suggest they consult the source. Here is a link to the Constitution: http://www.archives.gov/exhibits/charters/constitution_transcript.html

And another to the Bill of Rights: http://www.archives.gov/exhibits/charters/bill_of_rights_transcript.html

There you can see exactly what we are about to have taken from us.

There are better and more legal methods to provide needed care to the uninsured.

ORRIN G. HATCH, J. KENNETH BLACKWELL AND KENNETH A. KLUKOWSKI also support Mr Connelly’s position as published in the Wall Street Journal

This is far worse than ‘socialized medicine’ which presents a uniform and equitable health care system, even with it’s serious shortcomings. 

Technorati Tags: filibuster,rand paul,ted cruz,affordable care act,orin hatch,democrats,republicans,individual mandate,constitutional law,michael connelly,hhs,repeal,supreme court,obamacare,scotus

Covered California Health Benefit Exchange and Federally sponsored Health Benefit Exchanges

 

                             

 

How to find a job as a NAVIGATOR ?

It is not easy. Even Google and other search engines are confused. After spending an hour with multiple search terms this is my best guess,and estimate to help.

In California roughly 6-8 million uninsured may line up to learn about Covered California from a “NAVIGATOR”

As a physician or other independent health care provider you need to know how this will work in California. 

California is amongst   the states that refused to set up a  Federally operated exchange by not accepting federal grants to assist in the organizations

Those states who chose to go it alone are all unique and administered differently

This monograph applies ONLY IN CALIFORNIA

California has set a high bar to become a “Navigator” for the Affordable Care Act.

Despite what has been written about ‘non-profits’ California’s web site for Covered California outlines a list of requirements.  It is somewhat contradictory because in one section it states that you must be a certified and licensed insurance agent, yet in another it refers to non-profits.

Covered California also offers these tools for orientation about the program;.

Webinar  Assistance Program and the process to become a Certified Enrollment Entity  

This Covered California webinar will provide Certified Enrollment Entity applicants with additional information on “next steps” to becoming a Certified Enrollment Entity (CEE).  

This webinar reviews the process for affiliated individuals to become Certified Enrollment Counselors (CECs).  It will also provide details on the following:

• Next steps for the CEE is to identify staff that will become CEC
• CEE Administrative Training
• CEC next steps:
  • Criminal Disclosure Form
  • Background Screening and fingerprinting process and timeline
  • CEC training – process for registering and training timeline

  Note:  Webinars were held  February 2013 through September 2013  Content may be different. I recommend the latest webinar and slide deck

  
  Click here to view the "Next Steps" Webinar
• 
  Click here to download the accompanying slide deck

Slide Deck

These instructions were dated September 2013, however the webinars and slide decks were produced in early 2013.  All of this is subject to change and we advise calling the HBE for updates. 

Timeline:

Enrollment Assistance Program
Proposed 2013 Timeline- for FEDERAL HBE’s  does not apply to Covered California.

 

Certified Enrollment Entity Application Release
Summer 2013

Certified Enrollment Entity Training Begins
Summer 2013

In-Person Assistance Certified Enrollment Counselor Training and Certification Begins
Summer 2013

Open Enrollment Begins
Fall 2013

Navigator Program
Date

Navigator Grant Application Release
February 2014

Navigator Grant Application Submission Due
March 2014     

Navigator Grant Award
June 2014   

Navigator Training and Certification Begins
June 2014

Navigator Entities begin Enrollment Assistance
July 2014

Confused?  You will note that many of these dates are after HBEs are scheduled to begin after open enrollment.

If you live in a state that is or has set up it’s own HBE check with the state’s Health Benefit Exchange web site.  It may be hard to find.  In addition, those states who are setting up their own HBE are not listed on the Federal Web Site for how to apply.

The Covered California HBE offers enrollment material for Navigators and Independent Assistance Advisors. (note the distinction as explained at Covered California’ Slide Deck.

A greatly expanded monograph for Covered California

The Affordable Care Act’s  “California’s Navigator Program” on Amazon in a downloadable e-Book for $ 0.99 USD It should be available by October 1, 2013 .

The Affordable Care Act’s U.S. Federal and State Navigator Programs will also be available for $4.99 USD. Individual states are also available for $0.99 USD

Medicine's Search for Meaning - NYTimes.com

A Health Train Express Extra:

Medicine’s Search for Meaning

Medicine's Search for Meaning - NYTimes.com

Every day, we are reminded that the health care system is in crisis. We are going bankrupt. There are too many lawsuits. We practice defensive medicine. We restrict access. But surveys of doctors indicate a problem that penetrates much deeper than this. Today, almost 50 percent of doctors report symptoms of burnout — emotional exhaustion, low sense of accomplishment, detachment.

Countering doctor burnout with a refresher course on the capacity to heal.

House Bill Links Health Care Law and Budget Plan

 

Your Health and How has it become a “Crap Shoot”

Politics and health never have been a good mix. The outcome of the evolution of what political game playing and mixing the financing of health with political greed for power is now evident. While Medicare which was put into effect in 1964 has benefited millions of the elder population it too was passed without concern for cost and more important input from physicians (who were largely ignored when they warned it would eventually bankrupt the country. ) Congress was warned by many physician groups that the demand for healthcare can be infinite and by treating medicare as another insurer without restriction would inflate the national debt and fuel medical inflation.

Despite many wars much of our national debt can be attributed to Medicare liabilities current and future. Now the surge in Gen X, Y and Millennial adds to the disaster. Coupled with the national recession and evolution of the global economy it all crystallizes into what we now face.

Today's New York Times:

 

House Bill Links Health Care Law and Budget Plan

Sylvia Mathews Burwell, the White House budget director, told executive branch officials to begin preparing by updating their contingency plans. This has become so common that we now have what is a several thousand page manual on shutting off our government.

All or none? The Congress is using our health care as a political football. Neither side will not negotiate and it has gradually evolved into the present quagmire. Congress is having it's usual tantrum and is acting out it's negligence. 2010 was the time when this might have been avoided if the law was read and experts were allowed to apply the appropriate fixes to the bill(s).

“House Republicans muscled through a stopgap bill Friday that would fund the government only if all spending for President Obama’s health care law is eliminated. Senate Democrats and President Obama quickly made it clear they had no intention of going along, putting the government on a course toward a shutdown unless one side relents.'

'The 230-to-189 party-line vote in a bitterly divided House set in motion a fiscal confrontation with significant implications — politically and economically — but with an uncertain ending. Without a resolution, large parts of the government could shut down Oct. 1, and a first-ever default on federal debt could follow weeks later.

Each side predicted that the other would be held responsible, but determined House Republicans knew they were taking a risk even as leaders of the party’s establishment warned about the threat of destructive political consequences.'

Mr. Obama called House Speaker John A. Boehner on Friday evening but only to reiterate that he would not negotiate with him on raising the federal debt limit and said it was Congress’s constitutional obligation to pay the nation’s bills. Both sides described the call as brief and fruitless.

Congressional gridlock. It occurs frequently, not just in healthcare. We pay our Presidents and Congressmen well enough to do the 'people's business'. Through a variety of decisions government has forcibly intruded into your physician's and hospitals duties to provide for your health. The football has been intercepted and a one hundred yard game ending run to the goal is now in progress.

The conundrum is that Congress is really not interested in health....it is only interested in a 'victory dance' sponsored by either Elephants or Donkeys. The result will be a stable full of excrement on the floor....needing to be mucked out by the people's assets in the name of taxes and debt to foreign countries.

There must have been a better way to accomplish this goal.

A brilliant physician, Donald Berwick MD, was run out as head of HHS by his choice of words regarding the NHS of the U.K. Berwick is a highly respected former head of the Institute of Medicine, a credible authority on medicine, but a novice in the world of American politics. Our country has an anaphylactic reaction to words such as 'socialism','entitlement',

Berwick holds a position at Harvard Medical School. His N.H.S.remark was poorly worded and timed also a politically unwise statement in public about his wishes for our US health system. Other physicians, including Mike Leavitt and others have been ground up and spit out by politicians. Congress defies expert opinions in many areas of their decision making. Their bad choices overflow into all areas of society, from IT to immigration.

My health is not a Republican vs Democratic issue....to be kicked around for political expediency and headline news. Nor should it be for you either.

The real truth is Obama's statement when speaking to a labor group,

““They’re focused on politics,” Mr. Obama told autoworkers at a Ford plant in Liberty. “They’re focused on trying to mess with me; they’re not focused on you.”

Mr. President, no one is focused on your narcissistic goal of being the President who forced the wrong treatment on our health system. Inaccurate dosing, error in prescribing and malpractice.

(see non-disclaimer and waiver on the right hand banner.)

September 21, 2013

GML

Technorati Tags: obama,leavitt,berwick,gridlock,congress,boehner,government shutdown,labor,republicans,democrats,obamacare,medicare,affordable care act,genx geny,millenial,national debt,healthcare law,October 1st,United Kingdom,National health service

Mobile Health Apps on Facebook ??

Will there be a Facebook Mobile Health App in Your future?

At a high-profile event, Facebook's CEO once again stressed the importance of creating applications on his platform.

Historically, "Facebook apps" have meant social apps running on Facebook's website, like Zynga's once-popular, now-fading Web-based games. Distribution was the main part of its appeal.

Facebook already has a mobile health platform.

Now, Facebook wants developers to work Facebook into multiple tiers of the application-development process. To that end, it recently acquired Parse, which operates some of the back-end services mobile-app developers need.Last week, Zuckerberg addressed a crowd at Parse's developer conference, harping on the importance of developers using Facebook's services when building apps. His talk today made it even clearer that the company wants to be in as many applications as possible, making Facebook the platform upon which all applications are created.

Facebook's user base of 1.5billion certainly provides an excellent entry point for users looking for mhealth apps.

Social media is spreading it's tentacles into the health space. Entrepeneurs will find a way into the hearts of consumers, whether medical, hospital or device manufacturers. Many already have a facebook page. It would not take a great leap for developers to take it one step further.

Butterflies

It is late September and the Monarch Butterflies are in the air, migrating through my town. It seems like a time to republish my piece on chaos theory and the  'Butterfly  Effec"

By some chance here it is several years later and the Affordable Care Act will commence in several weeks.

Where is my butterfly net when I need it?

Health Care Reform is here, or is it? Frankly the whole thing is so complex that no one really knows how this is going to work, if it does. True to form our government is telling us we are going to save so much money by spending more money now. 17,000 IRS workers to keep track of who has purchased insurance, and who has not. There will be a new check box on your 1040 asking you to swear that you have purchased insurance. Insurers will undoubtedly issue 'stickers' to place on your 1040 forms.

Welcome to Democracy .

On Thursday, the California Occupational Safety and Health Standards Board voted to set up a committee to examine whether condoms should be required on all pornographic film shoots within the Golden State.

California has run out of money, but it hasn’t yet run out of things to regulate.

That's a great point. Does the government have the power to force you to buy something simply because you are alive? If that is true, what prevents the government from mandating that everyone must also buy a casket, funeral plot or urn for your ashes.

MORE B.S.

Health Care BS

I wrote this piece three years ago, and it is time to expose it to the light of day again. Most of it still rings true.

Cleaning the Augean Stables of the Health Care Debate

About Catron

Health Care Dues:
Twenty years on the front lines of health care finance, doing battle with the forces of darkness (i.e. CMS and the managed care companies).
Imaginable analysis of the current B.S.  we are all subject to on a daily basis.
A  worthwhile blog to add to my blog links.
Reenbean posted a very good summary of what is wrong with our patients. on SERMO.   The Patient Owns The Disease, in the  Emergency Medicine Categoy.
You will have to log in or join.  It is free and worthwhile.
******************************************************

Richard Reece of Medinnovation

del.icio.us Tags: health train express,medinnovation,Catron

today comments,
“The Affordable Care Act will start to roll out between 2010-2014. Given the volatile political scene, no one knows what this portends for physicians and patients. The only certainty in the new term is higher costs for all. But the uncertainty doesn’t dissuade a quasi-futurist like me.Whatever happens, the practice landscape will never be quite the same again.
For a piece of writing to be effective, you should choose a a suitable design and hold to it. For today, my design is 11 mindsets outlined in John Naisbitt’s book Mind Set!

Accountable Care Organization:  Ready, set, go…..

Accountable Care ???

1. While many things change, most things remain constant - I do not expect things to change radically or rapidly for physicians. Medicare and Medicaid will continue to be the big payer. Medicare will still pay 20% less and Medicaid 40% less than private payers. More doctors will stop accepting new Medicare patient/ Government will not come to grips with the Sustainable……..
For the remaining commentary, go here..

Solar Flare and Health Care

Catchy title ? I always wanted to be a poet (not what you think, click to see)  and it is obvious my poetry is at the second grade level (that’s pushing it a bit).

I awoke this AM, as usual, much to my surprise. Believing the apocalyptic prediction about last night’s stream of cosmic energy I donned my radiation suit and wore my dosimeter to bed.

During the night I had bad dreams about the electromagnetic storm and what it would do to your EMR, the Nation’s non-existent HIEs, my  own PC and hard drive as well as the electrical grid. And that says nothing about the billons of chips, ROMs, RAMs and the ability to fly drones over my home.  I pictures 747s, F 35s falling out of the sky, cruise ships floating (hopefully) dead in the water, the complete shut down of the government, and the cell phone network down.

 

Like many ‘facts’ that are passed along on ‘open source’ transparent communication on the internet where is the evidence for this statement that an EMF will destroy your ‘chips’, and erase data.
This says nothing about the negative effects on social media for health care, and advertising.
My messenger is still streaming, Google + is still there. I don’t know about Facebook or twitter, I only use them to feed my main squeeze G+ and hangouts.

I awoke this morning hoping to not be able to post this blog. A day off due to a solar storm does not seem that outrageous, and I would lose no income from a day off. I write this blog out of love, not that I couldn’t use the money during retirement.

Is there a CPT code for social media ? Will it be part of meaningful use? Are your outcomes improved by using social media.  How can we measure it.  Let’s form a committee to measure it.  I am applying for a ten million dollar grant from HHS to create a ‘pilot project’.  That is probably a better idea than most of the ‘pilot demonstration projects’ from HHS and CMS. 

Hmmm, maybe I should ask for $100 million USD so it will show up as a line item in the budget.  Ten million is chump change in the discretionary budget (for drones, seal team expeditions, and Obama’s campaign.

Monetize my blog?  Probably better chance of being hit by a meteor
.

Technorati Tags: monetize,blog,solar flare,cpt code,social media,pilot demonstration,hhs,cms,g+,hangout

Medical State of Mind

I read many blogs from medical students or doctors-in-training. I realized that some of us totally ignore medical education and what the future portends for our younger brethren.

Especially if you are retired, we owe it to them to "Pay it Backwards" and continue as champions for patient advocacy and care.

The alliance between patients and physicians grows stronger as the threats of the health insurance-government industrial complex grows stronger as well.

For those retired, disabled or who have migrated to non-clinical work, we owe it to ourselves to look back and kick the villains hard.

Indoctrination, automation, subjugation, must be curtailed in a subject as humane as health care.

There are many trainee blogs

Medical State of Mind

The Nuclear Option.

State of California Beneficiary Identification Card

   California Governor Jerry Brown and President Barak Obama
Despite California’s challenge with debt Governor Jerry Brown has a very experienced hand on the rudder..He is no stranger to adversity, and seems to be quietly picking away at the trash left behind by several recent governor’s.
Brown seems intent on accelerating California’s Health Insurance Exchange and preparing Medi-Cal’s planned expansion for the newly ‘insured mandate.  There is serious concern about Medi-Cal’s readiness to accept more ‘insured’.  Financially it will be a challenge even with Federal matching funds.
Surrounding the increase in eligible will involve careful examination of an eligibility process that is seriously flawed. Depending on that for a foundation will doom the effort to failure and offer an empty promise to hopeful patients who may be rejoicing prematurely
As a former provider (physician), how I hate that new classification of my intellectual ability, and also as a recipient during hard times on disability, the process is not consumer friendly.  Want that our government would become patient centric and consumer friendly as well as accountable as in the PPACA.
Medi-Cal in it’s present form is not insurance !  It is not even a ‘safety net.  It is more like a trampoline with large holes that let patients fall through or if they are fortunate to hit something solid….they bounce around quite a bit before obtaining benefits.
If Medi-cal want to provide insurance coverage then they should pony up and act like a regulated insurer, not some special government agency that completely misses the point …
In it’s present rendition medi-cal rules are complex, much more than I could address in a short bl og.  The rules and regulations are nicely detailed here.   Eligibility requirements are a maximum asset value of 2,000-4,000 dollars depending on family size. Does this mean to obtain guaranteed insurance one must also be destitute in addition to being previously uninsured? In addition one’s income must meet a threshold below `125% of the poverty line, indexed according to family size.  None of this has a familiar sound in the world of ‘real insurance.’  Medi-Cal’s mantra is if you aren’t poor when you apply, wait, when you start getting <Medi-Cal benefits…you will be destitute or worse.
Furthermore medi-cal benefits have a unique term called “Share of Cost’  The accounting of how income and expense are determined is subject to a strange algorithm of which no one can explain, and neither can the clerks and administrators of the system. Plainly or not so plainly the numbers are crunched several time using differing indices to derive ‘real numbers’ from a byzantine matrix of adjustments,  factors indexed my more unknown guidelines. And finally all the regulations are set forth in llllll.

It is an outrageous system , designed to limit benefits, and somehow save the state.  The fee for service is antiquated and should be completely abandoned without a doubt.
The hope for Medi-cal/caid is the managed care option which truly is managed with case workers and some indication of attempts to be a consumer friendly system.  One serious flaw is that one must have no share of cost to qualify for the managed care option/ Losing one family member increases your share of cost by over 1200 dollars (per month), and terminates your physician arrangement since one is cast back to FFS Medicaid, whose providers are different than managed care Medicaid.
I very much doubt these facts have ever faced the scrutiny of voters….I doubt if legislators are even aware of how bureaucrats have usurped what they think is a ‘generous safety net’.
The Medicaid Expansion proposed under the PPACA is the subject of much discussion:
Most government systems need an injection of sound business practices, and I am not talking about venture capital or profits. Systemic errors seem to go on and on unchecked simply by the sheer size of government agencies. Mistakes are buried…few are terminated for incompetence, they are shuffled to other positions in the civil service system. Good management in health care goes far beyond short term financial savings. In fact Medi-cal often creates worse situations for patients.
Rather than list more of my observations in my next several blogs I will outline measures to correct Med-cal’s shortcomings before it’s dysfunction is spread by PPACA.
This is a system ruled by the “Lowest Common Denominator” invented by committee and administered by uncreative people unwilling or unable to step out of the box, blindly following rules, with the over-riding fear of “fraud and abuse’.  Abuse, yes…by the very system set up to protect and serve, fraud…maybe some but often due to the sheer volume and complexity of the system itself.
As an indicator of the coming melt-down:
President Barack Obama thinks his health care law makes states an offer they can't refuse.
 
Whether to expand Medicaid, the federal-state program for the poor and disabled, could be the most important decision facing governors and legislatures this year. The repercussions go beyond their budgets, directly affecting the well-being of residents and the finances of critical hospitals.
The health care law will go into full effect next Jan. 1, and states are scrambling to crunch the numbers and understand the Medicaid trade-offs. Louisiana's health secretary, Bruce D. Greenstein, is concerned that the Medicaid expansion could replace private insurance for many low-wage workers in his state, dragging down quality throughout the health care system because the program pays doctors and hospitals far less than private insurance. He says the Obama administration and Congress missed a chance to overhaul Medicaid and give states a bigger say in running the program.
"Decisions are made by fiat," he said. "There is not any sense of a federal-state partnership, what this program was founded on. I don't feel in any way that I am a partner." The Obama administration says it is doing its best to meet state demands for flexibility..
As an indicator of the coming melt-down:
President Barack Obama thinks his health care law makes states an offer they can't refuse.
USA NEWS
Is Medicaid Expansion Good for the States?
Money fears vs. real benefits in Medicaid choice
Medicaid—the joint state-federal government health insurance program for lower-income Americans—would be expanded to cover those making 133 percent of the poverty level. States that refused to participate in this expansion would risk losing federal funding for their current Medicaid programs. However, the Supreme Court ruled the federal government could not withdraw existing Medicaid funding to punish states for not expanding their programs, thus giving states the choice to opt out of the expansion. More than a few states have expressed intentions of doing so.
Rather than fixing the underlying deficits (an not just financial) the Feds wanted to force states into their plan without relief. Fortunately the SCOTUS ruled otherwise.
Studies have shown that Medicaid patients fare worse in many cases than the uninsured. In many states, Medicaid pays doctors so little, recipients can't find a private physician to see them so they must wait, sometimes for hours, in hospital emergency rooms to get care. They deserve the dignity of private insurance, which states could provide if they were freed from Medicaid's mountains of red tape.
Empty Promise offered by PPACA
Further, the Medicaid expansion will harm the poorest and most vulnerable patients already on the program as they are forced to compete with millions of new patients seeking care from this limited pool of providers.
Many governors are rightly resisting adding another 16 million more people to Medicaid and are demanding that Washington give them more flexibility to improve the program.

Is this a system we want to expand to cover the uninsured?  Empty mandates again.
 

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