Expand and loot

In Burkean bells, Election 2010, Fuck The Poor, Glibertarianism, Mayhew On Insurance, Our Failed Political Establishment, The Party of Fiscal Responsibility, Vouchercare by David Anderson

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 …

Gini in a bottle

In Free Markets Solve Everything, Fucked-up-edness, Mayhew On Insurance, World's Best Healthcare (If You Can Afford It) by David Anderson

Let’s head to fantasy land — no you perverts, not that one… the one where Econ 101 is an accurate description of how the health service markets work.  In this world, information is widely disseminated, products and services are clearly differentiated, no single buyer or seller has enough market power to set or demand a price that differs from marginal cost, and all costs and benefits of a purchase/no purchase decision accrue to only the parties involved in a deal. Yes, as I specified this is fantasy land.  It is …

Payment models and death panels

In C.R.E.A.M., Mayhew On Insurance, World's Best Healthcare (If You Can Afford It) by David Anderson

JCJ asked an excellent question: Do you think in the future insurance companies will offer a single payment for services? My question has to do with my specialty – radiation oncology. If a woman undergoes lumpectomy for breast cancer and meets criteria for hypofractionated whole breast radiation (age > 50, no previous chemotherapy, separation (sorry, technical term) < 25 cm) yet still receives a more protracted course of treatments might insurance companies be justified in paying for the only for the shorter course and let the doctor explain the difference? …

Adverse Selection in New York State

In Mayhew On Insurance, World's Best Healthcare (If You Can Afford It) by David Anderson

Currently New York State’s individual insurance market is structured with only one of three major components of the Obamacare exchange products.  New York state requires insurance companies to sell insurance to anyone who applies for it.  This is community rating and it is a shared policy with Obamacare.  However, New York state has no mandate so the only people who are looking to buy insurance are those who are either currently sick or very strongly believe that they will soon be using a lot of medical services.  New York also …

What’s the fee cause it ain’t free

In All we want is life beyond the thunderdome, Mayhew On Insurance, Proud to Be A Democrat by David Anderson

Obamacare’s exchanges go live in three weeks and three days… or as we count time, a gross of coffee spoons. The big news this week is that actual pricing is starting to be released in a variety of states.  The Reality Based Community passes along the fact that Blue Cross and Blue Shield of  NorthCarolina released rates on everything they are offering on the North Carolina exchange/marketplace.   (Click to embiggen) There is  massive variance in non-subsidized costs.  The cheapest is $145 for catastrophic coverage for a 25 year old while …

Hey baby, what’s your network….

In All we want is life beyond the thunderdome, C.R.E.A.M., Fucked-up-edness, Mayhew On Insurance, World's Best Healthcare (If You Can Afford It) by David Anderson

Phoenix Rising asked a good question in my last health insurance post: If you can explain a bit about in-network vs. out-of-network co-pays & deductibles, that might be really helpful for those who don’t already have an oncologist. Every insurance product in this country has a network.  Federally administered Medicare has a network, and the smallest boutique insurance company has a network.  A single insurance company that sells multiple types of insurance (HMO, PPO, CHIP, Medicare Advantage, Exchange etc) will have multiple networks.  So let’s understand why insurance companies have …

What are those charges…

In All we want is life beyond the thunderdome, C.R.E.A.M., Domestic Affairs, Mayhew On Insurance, Politics, World's Best Healthcare (If You Can Afford It) by David Anderson

I’m a bureaucrat at a health insurance company which most of you have never and will never hear about. My job is to be a subject matter expert on a fairly arcane set of knowledge. I have seen some posts and some great comment threads at Balloon Juice where great questions are being asked and basic mechanical knowledge would be very useful. I will be writing a series of posts over the next couple of weeks/months that attempts to explain why a profit seeking insurance company does what it does. …