Tag Archives: health

Your New Health Care System

Prompted by the following news articles, I thought we could all use a reminder of the increasing complexity that is the US health care system.

Download (PDF, 894KB)

Prepared by the US Joint Economic Committee, Republican Staff
Chart Originally Released July 2010, Updated June 2012

PDF display courtesy of the Google Doc Embedder plugin.

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Filed under Consumer, Economics, Politics

Affordable Care Act: Medical Loss Ratios

Today I received a “Notice of Medical Loss Ratio for your Health Plan”. As a required notice under the Affordable Care Act, it informed me that my plan met or exceeded the minimum required loss ratio of either 80 or 85%. (The minimum refers to the percent of premiums spent on “health care services and activities to improve health care quality”.)

My logical questions are as follows:

  1. What were the medical loss ratios across insurance plans in the 10-20 years before the Affordable Care Act?
  2. Why would an insurer pay more than the minimum medical loss ratio?
  3. For plans failing to meet the minimum ratios, how are insurers held accountable and what compensation would plan members receive?
  4. Assuming it is easier to fraudulently engage in “activities to improve health care quality” than it is to fraudulently provide “health care services”, why wouldn’t insurers try to increase the former and decrease the latter?
  5. In collecting the data, writing the software, producing the requisite paper products, printing the letter and delivering it to my address as required for “MLR Operations” to comply with the ACA, which jobs were counted as saved or created by the current political administration?

8/1/2012 Update: It appears that distribution of premium rebates (arising from #3 above) is dependent on employers, not the insurance companies themselves (who distribute the notices). This further increases costs of business administration, and

“…employers are allowed to hold onto the premium rebates and use them to offset premiums for workers for next year, or apply the money to a company fund aimed at promoting wellness, rather than sending out individual refunds.”

So imagine you are eligible for a rebate, but your employer decides to spend it on wellness initiatives for the next year. Then you leave your employer. Are you entitled to a pro-rated portion of your rebate? How will firms create new policies around how they manage rebates? Why does this law take the worst aspect about healthcare in America (linking to one particular legal/tax definition of employment) and make it more ingrained?

Source: WSJ: Employers Move to Adapt to Health Law (Aug 1, 2012)

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YouTube: Sugar: The Bitter Truth

Robert H. Lustig, MD, UCSF Professor of Pediatrics in the Division of Endocrinology, explores the damage caused by sugary foods. He argues that fructose (too much) and fiber (not enough) appear to be cornerstones of the obesity epidemic through their effects on insulin. Series: UCSF Mini Medical School for the Public [7/2009] [Health and Medicine] [Show ID: 16717]

A fascinating lecture.

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Daibetes Diagnoses and HFCS Intake 1980-2008

=CORREL() in Excel 2007 gives a value of 62.7%

Sources:

USDA Economic Research Service Briefing Rooms (Table 52)

Centers for Disease Control Diabetes Program

Fine print:

  • HFCS intake prior to 1973 was less than 1 gram
  • HFCS grams/day is per capita
  • HFCS intake accounts for spoilage/loss
  • Diabetes diagnoses are for civilian, non-institutionalized persons

If you know of an online resource for obesity or diabetes statistics dating back to 1970, please let me know.

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