If you like your doctor, you can keep your doctor…

The New Neo Posted on by

…that is, if you’re willing to pay out of pocket to see him/her out of network, or buy a more inclusive plan and pay higher premiums.

I guess we just never heard the whole quote.

Many Medicare Advantage patients in New York are finding that their doctors are being bumped from networks, and that they will have to find others. These are elderly patients for whom such change can be particularly stressful. And although this is Medicare, not Obamacare, the latter was designed to affect the former by instituting cutbacks that would go to feed the new system.

These Medicare patients are in addition to a large group of non-Medicare patients in the private insurance system who are being dumped, and plans that are being canceled there. And while there’s no way to absolutely prove at this point that this is all (or primarily) the result of Obamacare, it’s highly likely, because many of these plans don’t conform with all the requirements of Obamacare, which is cited as the reason for their demise (the plans’ demise, not the patients’).

Let’s revisit Obama’s promise. Back in June of 2009 (and many other times) he stated the following:

President Barack Obama”˜s address to the annual meeting of the American Medical Association today didn’t break new ground, but attempted to assure doctors and their patients that his prescription for overhauling the health care system would be good for them.

For patients, he made a sweeping pledge that “no matter how we reform health care, we will keep this promise: If you like your doctor, you will be able to keep your doctor. Period. If you like your health care plan, you will be able to keep your health care plan. Period. No one will take it away. No matter what. My view is that health care reform should be guided by a simple principle: fix what’s broken and build on what works.”

Needless to say, that promise is ludicrous.

But it’s not only ludicrous because it didn’t pan out. It was ludicrous even at the time he said it. How could such a promise have ever been made—and, more importantly, believed?

More interesting to me than the question of why Obama said it (simple: he said it in order to sell Obamacare) is why anyone ever believed such a transparent lie. Some didn’t believe it but just pretended to, of course. But I can only assume that for many of those who did believe it, the mechanism was some combination of wishful thinking, trust, and gullibility.

The GOP should hang those words like millstones around the necks of Obama and the Democrats. I wonder if they will. Here’s one who’s giving it a try, anyway.

Thank you! Thank you!

The New Neo Posted on by

…and thank you yet again.

To everyone who donated in my latest pledge drive (and in the past, and in the future), I deeply appreciate what you’ve done to help keep me blogging (and eating, and putting gas in my car…). You really can’t imagine how grateful and touched I am by your generosity.

As an ex-dancer, the following seems like a nice way to convey my gratitude. It called a reverence, a French word (as is most of the terminology of ballet) meaning:

The last exercises of a ballet class in which the ballet dancers pay respect to and acknowledge the teacher and pianist [is the reverence]. Reverence usually includes bows, curtsies, and ports de bras, and is a way of celebrating ballet’s traditions of elegance and respect.

“Traditions of elegance and respect.” Maybe that’s what I’ve always liked about ballet—learning it, in particular. That, and the challenge, and the music…

Rollouts and websites and redesigns and new versions

The New Neo Posted on by

I’ve complained bitterly about the new Yahoo email, and I am not alone:

So many loyal Yahoo users are frustrated with the new interface. They used all possible words you can think of to describe their frustrations and anger: problematic, screwed up, upset, blew it big time, so bad, very frustrated, sucks, flawed, annoyed, absolute OUTRAGE, hate it, a pain in the a_ _, a complete mess, really and truly crap, a giant leap backwards, WORST redesign ever, the worst upgrade, disgusted, fed up, getting worse instead of better, absolutely horrible, terrible, awful, unbelievable, unusable, stupid, Done with yahoo, I am leaving Yahoo, Bye yahoo…

Yahoo has tweaked the redesign over and over, and virtually every single change has made it worse. They took away something that really worked, and “improved” it by taking away all the good features and adding every bad feature of g-mail, and then some that they’ve invented specially for this. If you want some of the awful details, look here.

In light of the Obamacare website debacle, I’ve been thinking about the whole question of designing something like that to be user-friendly, and why things are so likely to go wrong. After all, Yahoo isn’t the Obama administration or the government (it isn’t, is it? Tell me it isn’t). You’d think they could get it right. I realize that the problems inherent in Healthcare.gov are different then in a web email service, but I wonder whether some of the difficulties don’t stem from something about the mindset of the designers themselves.

Don’t want to step on any toes here, but perhaps these amazingly bright people (and I don’t mean that sarcastically) don’t think along the most practical of lines. Do they become entranced with some inside-baseball feature that only the geeky can appreciate, and ignore the way the minds of regular folk work?

Just as an example, I’ve noticed that the latest fad seems to be to hide things. Is it esthetics—do they like this because it gives the page a cleaner look? Or because it’s just plain nifty? You mouse over something and bingo, up pops something to click on as a way to get to something else (don’t even know if I’m using the right terms here, but I assume you know what I mean). But there was nothing about that word you had to mouse over in the first place that indicated the splendors hidden beneath it, so how were you supposed to know?

For example, on Yahoo email, the log-out tab is hidden. Why? Is it fun to have to make people go through an extra step in order to log out? Is that the way the designers get their jollies? It used to be the “sign out” button was right there in plain sight: click on it and you’re out. Now you have to mouse, and wait, and the big reveal doesn’t even work if everything hasn’t already loaded just right (and with new Yahoo email there’s often a long delay before that happens—if it ever happens).

Maybe the folks at Yahoo just have trouble saying good-bye. But my guess is that an awful lot of people have said a permanent goodbye to them. I’m not one of them—yet.

[NOTE: I just want to reiterate that I realize that the problems with the Obamacare website are not just worse, but are of a different order, and more basic. But I still wonder whether there’s something that makes it hard for IT people to understand how the minds of non-IT-people work.

Here’s an interesting piece on whether it’s the IT people or something else.

And according to this, Yahoo’s redesign of its sports site has provoked a similar reaction: rage. Whatever happened to “if it ain’t broke, don’t fix it”? I think that, with the re-design of the email, Yahoo is trying to emulate its competitor, gmail. Apparently, with the redesign of the sports page, it’s trying to emulate something about Apple. So, earth to Yahoo: stop imitating. Build on the unique characteristics that have drawn users to you. Have faith in yourself, Yahoo!]

And in other important news…

The New Neo Posted on by

…car colors continue to be every bit as boring as ever.

C’mon, folks—silver replaced by white? With brown and dark gray gaining?

What a disappointment. I’d been hoping for a break in the dreary monotonous neutrality of it all.

Car color ennui.

Here’s an antidote:

fiftiescar

When I was a child, I wanted to grow up and have a car just like that—except maybe I’d replace the white with pink.

Fixed!

The New Neo Posted on by

[NOTE: Lots of updates below.]

Oops, never mind, says Emily Litella.

By the way—why didn’t the government site just borrow this calculator, the one I’ve been using in my post-rollout reseach? It seems to work just fine, and gets the right premium figure for the 62-year-old subsidy-ineligible woman featured in the piece.

They’re fools or knaves, probably both, no doubt about it. This is absolutely basic: premiums vary depending on age, even with Obamacare. The only state in which they don’t (as far as I know) is good old Vermont, where everyone is equal, holding hands and singing Kumbaya as they eat their Ben and Jerry’s:

Vermont now has the fifth highest health insurance premiums in the country, in part because of state regulations limiting competition. There’s no reason to believe that will improve, as only two companies are offering plans under the exchange. At this stage, unsubsidized rates in the exchange have increased considerably. Any models showing a decrease in premiums are based on a high percentage of enrollees qualifying for subsidies. In addition, the viability of that model is dependent on a large number of the young and healthy paying into the system.

Vermont utilizes the “community rating” method to determine health insurance premiums. The intention of this method is to ensure that rates on particular policies are the same for everyone regardless of age or health. That means that a 57-year-old man will pay the same rate for an individual policy as a 27-year-old woman. Good for the 57-year-old man, not so good for the 27-year-old woman. Cynthia Cox, a health-care economist at the Kaiser Family Foundation, explains, “Younger people will have higher premiums in Vermont than they might if they lived elsewhere, whereas older people might have lower premiums than if they lived elsewhere.”

In other words, without a pool of younger, healthier participants, it’s difficult for any insurance plan to survive.

[Hat tip: Legal Insurrection.]

[ADDENDUM: It seems that another state with community rating re age is New York. Several other states limit how wide the variation between premium prices for young and old can be. Obamacare limits this ratio as well. But all states except New York and Vermont vary premium prices based on age, with younger people paying less, for obvious reasons. New York is better off than Vermont in this regard because its population is younger and Vermont’s older. See this for much more about Vermont’s unique problems.]

[ADDENDUM II: This pending court case has the potential to throw a large monkey wrench into the Obamacare works. I find it hard to believe that it will actually end up doing so, though, even (or especially) if it goes to the Supreme Court.]

[ADDENDUM III: Does this mean they’ll all apologize to Ted Cruz, the terrorist? Nah, not so much:

CNN reporter Dana Bash tweets “new: senior dem source tells me to expect every sen dem running in 2014 to back @JeanneShaheen proposal to delay #ACA enrollment deadline.”

Just a little while back they were refusing to delay the mandate as the Republicans asked. Now they’re begging for it. I wonder what changed :-).

Bryan Preston remarks:

A unified Republican Party could make great use of this turn of events. Let’s see how the actual Republican Party handles it.]

If only, if only, if only…

The New Neo Posted on by

…Stalin knew.

They must calculate that it’s better for Obama to be considered unaware to the point of negligence than to say he was aware of the debacle and let it go ahead anyway. I suppose they think that their rank and file will excuse it because it shows how lofty Obama is, how elevated above the common and petty concerns of lesser mortals.

[NOTE: Those of you who don’t understand the “if only Stalin knew” reference, please see this.]

Canada slides further down the slippery slope…

The New Neo Posted on by

…of death panels. And Adam Goldenberg applauds.

The “experts and wise community members” that make up Ontario’s Consent and Capacity Board can overrule a family’s decision about whether to continue life support for an ill member. It’s a cost-benefit ratio analysis in which society has an interest, and Goldenberg points out that Canadians “tend to have more faith in our government and our bureaucratic processes than Americans do in theirs.”

He also notes that at present in Canada and the US, such disputes are decided by judges:

When these family members disagree with a patient’s doctors, and when the doctors are nonetheless determined to act, the dispute generally goes to court, where it can take months or even years to resolve. That is how it works in other Canadian and American jurisdictions, anyway.

But—at least as far as I know (correct me if I’m wrong)—in the US judges decide disputes between family members about end-of-life decisions, a la the Schiavo case. Unlike the Canadian case, the type of disputes that send these cases to courts in the US are not ordinarily between the family and doctors. In the US, the family gets to decide, although the doctors can advise and give their medical opinions about what would be best. As far as I know (and again, please correct me if I’m wrong) the only reason doctors were involved in the Schiavo case was that Schiavo’s husband wanted the tube removed, not kept in place, and since there was a question as to whether her physical state would have warranted that, doctors testified.

But the Canadian case Goldenberg is describing is one in which the dispute is between the family and the patient’s doctors, where it’s the family that is trying to keep the tube in and the doctors who say it should come out. And since the government has an interest in the monetary cost of keeping the patient alive, it gets a say, too, in order to protect its finances, not just as some supposedly impartial arbiter in a dispute. That’s the slippery slope down which conservatives do not wish to slide, and which is a consequence of more government involvement in health care reimbursement.

Goldenberg ends with a swipe at Sarah Palin:

When humanity demands haste, and justice demands expert knowledge, Ontario’s death panels offer a solution””whatever Sarah Palin says.

Ah, but Palin never indicated that death panels don’t offer a solution. She’s well aware that they do, and are an almost inevitable outcome of the liberal mindset and increasing government control of health care. She thinks they are the wrong solution, an unconscionable intrusion by the state into decisions that should be up to the individual and the family.

Of course, that’s an oversimplification too. As I wrote in a previous post:

I agree…that Obamacare would mean that the government will be involved more and more in all sorts of health care decisions about how to allocate scarce resources, and that worries me a lot. I also believe that some entity would have been making more of those decisions as time went on and health care became more and more expensive. That’s been happening anyway, with health insurance companies often being the decision-makers.

I don’t know whom I trust less””the government or the health insurance companies. No, actually I do: it’s the government, sadly enough.

When health care is incredibly expensive and families can’t pay out of pocket, the person holding the funds has a say or the whole system goes kaput and becomes unworkable. That’s the sad reality.

Again with the hat: donation time!

The New Neo Posted on by

[BUMPED UP—last day for this appeal, although feel free to donate any old time.]

passhat

Yes, it’s hard to believe, isn’t it? Time passes so quickly when we’re enjoying ourselves.

But yes, it’s been a while since I asked you to donate to a semi-worthy cause: this blog. And so I’m going to ask you again to use the “donate” button on the right sidebar beside the photo of the hat, and give whatever you see fit.

Every single donation— large or small—adds up, and helps me a great deal in continuing the blog. If each and every reader gave even a few dollars, it would be a glorious thing. But whether you decide to donate or not, please keep visiting and keep commenting. I appreciate all of you. Comments and readers are a very big part of what makes this blog work.

I thank you all in advance. I’ll probably repeat this notice every now and then for the next week, the equivalent of jiggling that cup/hat. But I’ll be discreet about it. And it’s a lot better than those fund-raising drives they have on TV, isn’t it? No interruption of the scheduled programming.