Archive for February, 2012

ObamaCare Reduces Access to Diagnostic Imaging Services

February 18, 2012

Advanced diagnostic imaging tools such as MRIs and CT scans have long been posterized as high tech villains responsible for the growth in medical costs.  There has always been the implication that they are somehow luxury items that are being prescribed unnecessarily to make money for imaging centers and physicians.  In fact, they have been identified as a major contributor to observed increases in life expectancy in the U.S.

Nevertheless, ObamaCare attempts to harshly rein in Medicare expenditures associated with advanced diagnostic imaging.  One control method is simply to increase the assumed rate of use of these expensive machines from currently assumed levels.  Plugging this arbitrary increase into the Medicare payment formula results in a lower Medicare payment per service to the imaging center.  Basically, the high capital cost of the machines is being distributed over a larger assumed patient pool so the payment per patient is reduced.

Of course, if the assumed utilization rate is incorrect, the imaging center may not recoup the cost of the machine.  In fact, the CBO identified this as the major downside of this proposal in its December 2008 analysis, noting that this could discourage centers in rural and suburban areas from acquiring advanced imaging equipment. This could result in a shortage of equipment and delays in diagnosis for seniors living in these areas.

A second control measure is the institution of a “prior authorization” policy.  Basically, the Government will hire Radiation Benefit Managers (RBMs) to evaluate all imaging requests before they are performed in order to weed out those considered “unnecessary.” The criteria the Government RBMs would use in making their evaluations would be formulated by HHS.  The argument for this control measure is very telling – the proponents argued basically that, after all, RBMs are used by private insurance companies.

The same private insurance companies that we were told were evil and greedy?  So now we have an evil, greedy, Government making these decisions!  And unlike any private insurance company, I see no provision in ObamaCare for making an appeal when a “prior authorization” request for diagnostic imaging is denied.

Also telling is the CBO observation that insurance company experience with instituting “prior authorization” shows that expenditure growth rates are only cut in the beginning of implementation, and resume their upward trend later.  Basically, it appears that, initially, doctors are on a learning curve as to how to submit the requests for imaging services, and so many requests are denied.  Do you really think it is appropriate for your Government to embrace reduced expenditures that it knows are rooted in the complexities of the “prior authorization” system and which will result in the denial of access to diagnostic tools for many patients during that learning curve period?

So where does all this stand at the present time?  A February 14, 2012, article in Molecular Imaging Magazine indicates that HHS has gone forward to implement these cost control measures.  You can read it here

This article indicates that diagnostic imaging spending/services have been cut back to 2004 levels, and that we can expect a lapse in life expectancy as a result.

Of course, the concept that the ObamaCare bureaucracy could evaluate “prior authorization” requests for diagnostic imaging in a timely manner is ludicrous. Therefore, even the fewer procedures that are eventually approved will be performed later than they should be, resulting in even higher mortality.

I’d like to ask former Speaker Pelosi whether she is now getting a clearer picture of ” ..what’s in the bill” …

Because we certainly are!

the Sceptic


ObamaCare Stifles Competition Among Insurers

February 13, 2012


ObamaCare forbids competition between insurance providers on any basis other than price of the policy – the premium.

Here’s the story.  Let’s say the minimum coverage established by the HHS Secretary (currently Kathleen Sebelius) does not include knee replacements for anyone older than 70.  Insurer A abides by this and does not cover this service.  Insurer B decides to cover knee replacements for old folks, but, as a result, the premium must be $7.50 per month higher than Insurer A’s premium.

Under ObamaCare, if Insurer B tries to explain the price differential by promoting their policy as better for knee replacements than Insurer A’s policy, they can be fined, or banned from the exchange, or go to jail!

What is the purpose of this seemingly unreasonable rule? The original reason given was to reduce overhead in insurance advertising costs and increase percent of revenues spent on payouts, but the real reason is – Uniformity.  Basically, if insurers can’t promote what makes their coverage better than others, this greatly reduces the incentive for any “Insurer B” to offer any features other than those required in the Government minimum plan.  ObamaCare’s goal is that no insurer will volunteer to provide knee replacements to individuals that the Government has determined are not worth this procedure.

Dirty little secret – the folks behind ObamaCare believe that insurance companies have been far too generous in their coverage and need to be reined in to reduce overall expenditures on health care.  They need to adhere to the Government guideline because the Government knows what is best for everyone – no exceptions.

No exceptions, that is for the “99%.” Of course, insurance will still be available for any condition from non-exchange, custom insurance policies -i.e.  those intended and priced for the “1%.”  So the rich will still have good insurance and get specialized care etc.  Aren’t you relieved?

Do you folks know this stuff?  Didn’t anyone tell you about this before this mess got enacted?  Did you just blow off all critics of ObamaCare because you believed the media story arc that criticism of ObamaCare was just hatred directed toward Mr. Obama?

Stick with me, and maybe I can help you to see what we critics see coming … before it’s too late to stop it.

the Sceptic

Contraceptive rule is only one tiny area of control

February 12, 2012

In all the brouhaha surrounding the Administration’s release of it’s contraceptive coverage rule, we may have lost sight of the overall scope of ObamaCare.  Secretary Sebelius is just starting to fulfill her responsibility under the Act to establish the minimum acceptable coverage that all exchange-offered policies must include.  There will be hundreds, perhaps thousands, of rules that must eventually be developed and wrangled over.

We critics of ObamaCare warned you of the vagueness of the bill and it’s blanket empowerment of the Federal bureaucracy to impose all it’s goals and biases and beliefs on both companies and individuals, but apparently no one really believed us.  Not surprising, since none of the details of the plan were in the bill.  As that notable moron, Nancy Pelosi, stated “We have to pass the bill in order to find out what is in it.”

Over the next 20 years we will gradually discover the goals, biases, and beliefs of our  Masters.  I hope we will not become discouraged, overwhelmed, or distracted regarding our fundamental opposition to the concept behind this mess.

Keep hope alive

the Sceptic


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