patrick.net

OK, after studying the CNA for a bit, it seems that their financial interest is in keeping legal minimum ratios of nurses to patients, and in guaranteeing nurse pensions.

Those things are basically good, but could of course be abused, by guaranteeing that we all pay more for extra nurses that may not really be needed, and by perhaps making taxpayers liable for nurse pensions.

http://www.nationalnursesunited.org/issues/entry/ratios

It all depends on the exact numbers.

Anyway, I'm happy to help them protest Blue Shield, which really is screwing me.

My sister in Michigan is a nurse. I wrote her about this and she confirms my suspicion that the ratios in California are mostly about protecting nurse jobs at the expense of the public.

The legally required California nurse to patient ratios seem too low. It's kind of a scam and is probably one of the things driving up medical costs here.

So to summarize:

1. Yes, we need minimum nurse ratios.
2. The minimum nurse ratios in California take it too far, and look like an unneeded cost driving up the cost of health care.

Pat, 1:6 is really low. I've never had less than 8 in one shift. No wonder California is broke. Michigan is broke too. That ratio must drive up the demand for nurses to unreal levels- a constant shortage.

Jo

--- On Thu, 1/27/11, Patrick Killelea wrote:

> > From: Patrick Killelea > > Subject: Re: nursing ratios
> > Date: Thursday, January 27, 2011, 10:16 PM
> > Wow, in CA the law says they must
> > have 1 nurse for every 6 psych patients. Do you think that's
> > about the right number, or are they just trying to employ
> > more nurses?
> >
> > 1 to 35 is crazy though, for sure.
> >
> > Pat
> >
> >
> > Josephine wrote:
>> > > Pat, No mandatory nurse ratios here in Michigan. My
> > last night on the
>> > > last job I was the only nurse for 35 psych patients.
> > I've decided to
>> > > take a break for now.
>> > >
>> > > --- On Thu, 1/27/11, Patrick Killelea > > wrote:
>> > >
>>> > >> From: Patrick Killelea > > Subject: nursing ratios
> > Date: Thursday,
>>> > >> January 27, 2011, 7:21 PM Hi Jo, does Michigan
> > have mandatory nurse
>>> > >> to patient ratios like California does?
>>> > >>
>>> > >> http://www.nationalnursesunited.org/issues/entry/ratios
>>> > >>
>>> > >> Pat

I switched to Blue Cross in the end. If everything goes through, my rate will hopefully go from $1120.00 to $575.00 per month for me, my wife and 3 yr old. Much better but still...screw Blue Shield.

Wow, which Blue Cross shield plan do you have exactly? I want to see if I can get it.

Yeah, is that individual coverage with your rate of $575 per month for you, your wife and 3 year old? That's a pretty good darn low rate. What kind of deductible/plan was it out of curiosity?

The insurance plan is a PPO. I think is is called Anthem Blue Cross Premier. Deductable is $2500 per person and $5000 per year per family (plan includes all 3 of us) Office visits are $30. Free physicals, Pap and mamogram for wife etc.

I live up in the sierras so price may change based on another zip code etc.

You can call Allied Brokers who is in Palo Alto: Agent is Sandy White 650 328 1000. Tell her Phil & Sarah Fay referred you, I just got an email this morning saying a $25 fuel card for any referrals, that could come in handy so do let me know if it works out!

Good luck

Donna Dubinsky, formerly of Palm Computer, writes in NY Times of how she and various family members were rejected for insurance in 2005:

http://www.nytimes.com/2011/02/20/opinion/20Dubinsky.html?ref=opinion

Wow, Donna Dubinsky had pretty much the same experience as me, and she's got to be a multi-millionaire.

Any idea how I can contact her?

I dunno, Patrick. Maybe indirectly via twitter?

http://twitter.com/ddubinsky

My experience in 2004 was the same. Before my COBRA ran out I stupidly went to an orthopedic surgeon in late 2003 to look at a severe knee pain problem I was having. There was no diagnosis (and it went away on its own -- probably just got out of bed wrong) but Blue Cross still declined me.

yeay free market.

Here's what I think:

If you have diligently ensured that you have been continuously covered since age 21, whichever group plan was the last one you were on damn well should continue to cover you at the REGULAR rate, and not some damned jacked up HIPAA or other high-risk rate, based on some next-to-nothing "pre-existing condition".

That's how simple it should be. And then there should be cost controls. Iron clad cost controls.

Hey, I finally got a reply from the White House to my complaint that Blue Shield is raping millions, that the healthcare law sets no limit to their premiums, and the healthcare law does not require any justification for the massive pay-or-die increases.

Unfortunately the email from the White House is from "no-reply@correspondence.whitehouse.gov" so I can't reply and let them know that "health care reform is STILL an unmet promise to the American people."

Here's the letter anyway:

The White House, Washington

February 28, 2011

Dear Patrick:

Thank you for writing. I have been moved and inspired by the stories of Americans struggling with health care, and I appreciate your perspective. It is because of the many men and women facing frustration, hardship, and financial burden in addition to significant health problems that we worked so hard to get health reform done.

After a century of striving, after a year of debate, and after a historic vote, health care reform is no longer an unmet promise to the American people. It is the law of the land. While some reforms will be put in place later, a host of desperately needed reforms have already gone into effect. To learn more about what health reform means for you, visit www.HealthCare.gov or www.WhiteHouse.gov/HealthReform.

As we work together to improve the lives of all our citizens, please know the trials and triumphs of Americans like you motivate my Administration to work even harder to overcome the challenges before us. I am confident we will emerge from these tough times stronger than before with a renewed promise of a better future for all.

For more information on resources that may be available to you, please visit http://go.usa.gov/aIv or http://go.usa.gov/aI7 or call 1-(800)-FED-INFO. Those seeking assistance with health care can also call the Department of Health and Human Services at 1-(877)-696-6775.

Again, thank you for contacting me. I wish you all the best.

Sincerely,

Barack Obama

Visit WhiteHouse.gov

Patrick, both my spouse and I are now working as contractors and use private health insurance. We have no pre-existing conditions, healthy - so, for a family of 3, we have a BlueCross/Anthem plan of $600 (Premier PPO). Our deductible is high, but we hope to have a safety net for catastrophes. We are actively looking at better insurance plans.
We learned from our insurance broker that a 2 person LLC that has a payroll for the 2 persons for atleast 2 months of the previous quarter can get group insurance coverage. But the only thing good about these "group plans" is that you pay a % of the actual costs + copay for a medical event. For example a $1000 MRI might end up as $350 in your bill. And there are a lot of limitations like any annual exams within 6 months of the plan starting will be charged more etc.
Something to think about and discuss with your health insurance broker/agent.

My 45th birthday is like my drop-dead date for getting out of this country I guess, given that's when the big rate rise happens.

Wonder if Japan will have blown itself up by then. Certainly possible.

I think the Japanese are not as self-destructive as Americans. There's no one there calling for a repeal of universal health care in Japan, right?

Don't think so -- they don't have an infestation of Internet Libertarians like the US does.

The Japanese political arrangement closely mirrors our own tho. The current PM corresponds to a "Democrat" and just got his budget through the lower house, but how to pay for it is going to be blocked by the upper house, which the "Republicans" (LDP -- the more conservative and rural party) control.

The bond debt the Japanese government needs to float this year is Y44T, or $440B at a reasonable exchange rate, or the equivalent to $1.2T when scaled relative to GDP (our 2011 deficit is going to be ~1.6T). So their annual deficit is lower, but they've been running deficits like these for 10+ years now, so the total debt situation is completely out of hand -- 2X their GDP now.

Federal spending in Japan is, when adjusted for GDP, equivalent to $3T, compared to our own $3.8T.

City and ward taxes are pretty high in Japan, so maybe their total government spending is already higher than ours.

Their core problem is that they're not taxing people enough. Dunno why, really, I guess as long as it's easier to borrow than to tax they'll just borrow.

I talked to a doctor recently and she said she's losing patients left and right to Kaiser. Their employers are no longer even offering PPO as an option. These are folks she's had as patients of a decade or more. I wonder if the other insurers even stand a chance against managed care. Perhaps Kaiser will end up being our national health service. The insurance and hospital legs are non-profit, so the government will have some leverage to keep them in line... I hope.

EBGuy says

The insurance and hospital legs are non-profit, so the government will have some leverage to keep them in line… I hope.

The MRI machines cost KP the same, and recruiting doctors & other healthcare staff costs KP the same as everyone else. All KP has to do is prove that after paying for the construction of new facilities to accommodate the millions of new converts they're getting from overpriced PPOs, and after buying all the new high-tech equipment, and after paying all their doctors, they still need to raise rates in order to cover the escalating costs. Until you address the wages of doctors, nurses, prescriptions & healthcare equipment, an aging & more obese by the day American patients, you will have rising healthcare costs.

KP does have the advantage that it's a one-stop shop that trims a lot of the fat and duplication of roles involved with PPOs and independent doctor offices. No longer are there 1-3 people at a small doctor's office who's full-time job is billing insurance companies, waiting for an EOB & payment check to arrive, then billing the patient for their share & waiting for the check to arrive (and re-billing if corrections are necessary), re-inputing all that mundane data that over and over, then having the accounting department deal with even more duplication of efforts, etc.

At KP, you deal direct & avoid all the needless duplication of backoffice jobs that have zero to do with providing healthcare. You even prevent the duplication of efforts when it comes to the lab...they draw your blood and post your results online a couple of hours later for you and your doctor to review...try that with Quest Diagnostics of LabCorp where the fastest turn-around time is 2-3 days, though more normally 1 week since it's another appointment and bunch of backoffice duplication of efforts all over again.

I've had KP in the past and was happy with them, but my wife made me move to Anthem Blue Cross since she's one of those "anti-KP snobs" who can't be convinced KP does a good job, though they never tried them. As long as I'm relatively young and can afford the ever-escalating costs of the inefficient PPO system, I'll please her by paying for a PPO for our family through a high-deductible HSA plan which makes sense for our healthy young family. I'll go back to KP in a heartbeat if my PPO policy premium ever goes up 70% like Patrick.

I personally was always satisfied with the level of care I got at KP....but don't worry, I don't want to even attempt to try to convince all of you that are on PPOs that they provide excellent care, since I can't even convince my wife :( .

Mark_LA says

Until you address the wages of doctors, nurses, prescriptions & healthcare equipment, an aging & more obese by the day American patients, you will have rising healthcare costs.

Don't forget hospital administrators! Those bastards make a fortune.

And hey, obesity is very profitable for US corporations (McD, Coke, snack food, etc). What are you, Unamerican or something? ;-)

A Chinese guy I know told me that I should invest in both Coke and in dialysis machine companies so I can make a profit from causing diabetes and then profit again from treating it! I think he was joking. Not sure.

The MRI machines cost KP the same, and recruiting doctors & other healthcare staff costs KP the same as everyone else... Until you address the wages of doctors, nurses, prescriptions & healthcare equipment, an aging & more obese by the day American patients, you will have rising healthcare costs.
MarkLA, Thanks for your comments. The general impression I've gotten about Kaiser is that doctor's who also want to 'have a life' seek them out. The tradeoff is lower (by how much?) pay for a more regular (or at least predictable) work schedule. Even my regular doctors office (PPO) was having trouble retaining doctors; I believe that's one reason they joined forces with Sutter East Bay Medical Foundation. The MF helped them with recruitment and also got them the economies of scale with back office support (computerized records, scheduling, etc) to at least try and keep pace with Kaiser.
I believe that HMOs are also better equipped (and incentivized) to have healthier patients. Also I did post a link a while back that showed a Blue Cross affiliate (I think) trying to manage a group of users that use medical services excessively if not closely monitored (it may have been diabetics). They were able to contain and lower costs by avoiding preventable hospitalizations. I still believe competition and multipayer is the way to go. Ask me again in several years and maybe I'll be beating the single payer drum... Glad to hear about another positive Kaiser experience.

Blue Shield has now said it will delay its latest rate increase for the rest of this year instead of just for 60 days:

http://money.cnn.com/2011/03/16/news/companies/blue_shield_rate_withdrawal/index.htm?source=patrick.net

This is good for now, but I have so little faith in our system now that I expect they will just make up for it in January.

We desperately need a public insurance option.

Mark_LA says

EBGuy says

The insurance and hospital legs are non-profit, so the government will have some leverage to keep them in line… I hope.

The MRI machines cost KP the same, and recruiting doctors & other healthcare staff costs KP the same as everyone else. All KP has to do is prove that after paying for the construction of new facilities to accommodate the millions of new converts they’re getting from overpriced PPOs, and after buying all the new high-tech equipment, and after paying all their doctors, they still need to raise rates in order to cover the escalating costs. Until you address the wages of doctors, nurses, prescriptions & healthcare equipment, an aging & more obese by the day American patients, you will have rising healthcare costs.

KP does have one other advantage over most of the others, which is they have a comprehensive electronic medical records system. Most PPOs have only minimal electronic records (basically just what they need to do billing), and the doctors offices themselves for the most part use paper systems, or if they have electronic records they aren't integrated with anyone else.

73% is way above average for most insurers and policies, including Blue Shield of CA.

Have you disclosed how much of this was due to arriving in a new, higher age bracket? This could be a good part of the 73%.

Secondly, have you thought about buying medical insurance from a COMMERCIAL insurer, as opposed to a non-profit organization?

You are now considering using the government to help you buy health insurance?

I would say you you should stick to websites and go hire yourself an independent health insurance broker BEFORE you get real sick and have no other choices.

So far, seem like you are getting what you deserve.

ChrisLA says

ChrisLA says

forward

forw

Everybody I know of works for money or profit or whatever you want to call it. (If you want to barter, or volunteer, or live off of a trust fund, that's OK to.)

Profit happens when your revenues exceed your expenses. Nothing wrong with that, unless you are a collectivist who resents other people saving and investing their money, instead of blowing it on non-essentials.

Folks. Blue Shield CA is a non-profit that runs far behind Wellpoint, United Healthcare and other FOR-PROFIT commercial insurers, in california. Just look up market share at the CA Dept website.

Save some money, invest it and you can become a capitalist too. This is why China is emulating USA today.

If Patrick wants greater profits from this website, he might do the following:

1) Google on "adsense hotspots" ( bottom of page is not one these area)

2) Better integrate ads with content

3) Have links same color as fonts, so that more people click on ads.

4) many of those insurance ads pay $3 per click. So, a health insurance forum IS a good idea.

Live long and prosper / profit!. Greatly

Patrick

bayhousehunter says

Patrick, both my spouse and I are now working as contractors and use private health insurance. We have no pre-existing conditions, healthy - so, for a family of 3, we have a BlueCross/Anthem plan of $600 (Premier PPO). Our deductible is high, but we hope to have a safety net for catastrophes. We are actively looking at better insurance plans.

We learned from our insurance broker that a 2 person LLC that has a payroll for the 2 persons for atleast 2 months of the previous quarter can get group insurance coverage. But the only thing good about these “group plans” is that you pay a % of the actual costs + copay for a medical event. For example a $1000 MRI might end up as $350 in your bill. And there are a lot of limitations like any annual exams within 6 months of the plan starting will be charged more etc.

Something to think about and discuss with your health insurance broker/agent.

I hoped your broker showed you two SEPARATE policies, one for one spouse, and a second for the other youinger spouse and the one child. Sometimes you can save this way, and most insurers let you do that.

ChrisLA says

forward

WIKIPEDIA

Medical professionals are not paid high salaries by international standards. ..... Therefore, some prefer to work in different occupations, for example in the lucrative tourist industry where earnings can be much higher.

The San Francisco Chronicle, the Washington Post, and National Public Radio have all reported on Cuban doctors defecting to other countries.[52]

Black market healthcare

The difficulty in gaining access to certain medicines and treatments has led to healthcare playing an increasing role in Cuba's burgeoning black market economy, sometimes termed "sociolismo".

If one travels to Cuba you can quickly see that the Cuba government does NOT locals inside most tourist hotels.

Coffee is ready!

ljacobs says

forward

$87,000 RN in San Francisco, CA

Average RN salaries for job postings in San Francisco, CA are 20% higher than average RN salaries for job postings nationwide.

http://www.indeed.com/salary/q-RN-l-San-Francisco,-CA.html

You can also go to the SF HR dept site to get other numbers.

Many nurses make $100,000+ plus big benfits and OT.

Blue Cross is essentially non-profit, I don't know if Blue Shield is the same. The insurance companies are only reacting to the new health care law. If the government interferes with their business to the extent that they are no longer really insurance companies, they will have to raise our rates or be unable to cover anyone.
How much would your car insurance cost if you required them to sell a policy that will fix your car, and you buy it after you already crashed it? Oh, and your car insurance must also automatically cover anyone else who may be driving your car illegally without your knowledge, whether or not he has a license, etc.
Life insurance would probably be very expensive if your family wanted to buy it after you were already dead also.
The basic function of insurance is to spread risk of an event happening to you among a larger group, and paying when such an event happens. In life insurance, it's death. In medical events, the insurance companies have to calculate not jut how likely something is to happen to you, but how much it will cost to treat. If the government requires health insurance companies to cover more possible events, with more expensive claims, they must raise rates.
The government has prevented the insurance companies from being able to offer you to be OUT of the pool of sick people. Your insurance company was forced by the government to lump you together with the unhealthy people who are already sick.
My car insurance is ridiculously low. One reason is that if I had any speeding tickets, drunk driving or moving violations, etc. they would not have let me in their pool of insured drivers.

I guess a quick visit to a California hospital may be informative. These people are being treated and they have no insurance. The hospital treats them, then looks for someone to gouge so the hospital doesn't go bankrupt. I get crashed into and must go to the ER. The hospital will bill MY insurance company a big chunk of change to try to get me to cover those who came in all day with no insurance. Have you BEEN to a California hospital lately?
Providing medical care to millions of those who pay nothing, many of whom are here illegally, is expensive. The hospitals pass this cost onto those who have insurance.

I thought it was because we did need to use the insurance last year, but that’s not it. They even sent me their chart to show that my premium is the same as everyone else in my age and family category.
They’re just screwing everyone equally.

It's largely based on what group rate you can get. A friend works for a small company (fewer than 20 employees) and he pays over $800 a year for family coverage (although the out of pocket deductible is much lower then yours, something like 4k a year), the company I work for (about 300 employees) family coverage is something like $450 a month and the company my wife works for (3000+ employees in the medical field) pays about $100 a month for coverage to cover both of us.

So better rates are out there. My suggestion would be try to team up with other independent companies to obtain better rates. If you could get together maybe 100 small business owners together and form say the XYZ corp, with the total employees of XYZ corp around 300, your rates would get much better. All other finances would be separate, your just forming a corporation to get better medical benefit group rates.

This farmer co-op is just one example of what I'm talking about, I'm sure others exist, and if they don't there nothing stopping you from forming your own group.
http://www.choicesmagazine.org/magazine/article.php?article=101

Take a look at this:
https://www.greathealthplan.org

Great health plan?

If you go to the website looks like this is NOT health insurance, but a discount plan instead.

"team up with other independent companies" ? Not possible.

Above post looks like well disguised spam.

kimboslice says

Providing medical care to millions of those who pay nothing, many of whom are here illegally, is expensive. The hospitals pass this cost onto those who have insurance.

A friend of mine is an RN in an emergency room, and she frequently complains about all the money illegal immigrants are costing our system. Out of curiosity I did a little research to see if the statistics reflected her personal experience/views. This was several months ago, I don’t remember exact numbers, but it was a lot lower than I thought it would be based on what she was saying. I think it was around 2-3% (maybe less) if I am remembering correctly. This was only illegal and just in California (high level of illegals), not total uninsured that I was looking into.

A lot of this cost is because they come into the emergency room for anything, and I mean anything, and they do this because the emergency room is their only way of getting care.

Health Insurace Pro says

“team up with other independent companies” ? Not possible.
Above post looks like well disguised spam.

Since I'm a regular poster, with hundreds of postings and comments it's unlikely my post is well disguised spam. So for the "Team up with other independent companies" comment, I ask why not? If you could contract 50 or even 100 small local businesses in your area and form a co-op for the purpose of insuring there employees at a lower cost. So you approach a health insurance company and say we have 500 employees, what rate you going to give us? Instead of "not possible" perhaps you can enlighten us Why it's not possible.

TechGromit says

Health Insurace Pro says

“team up with other independent companies” ? Not possible.
Above post looks like well disguised spam.

Since I’m a regular poster, with hundreds of postings and comments it’s unlikely my post is well disguised spam.

I don't know perhaps you have been a "sleeper" spammer, slowly building credibility waiting for the right topic to arise just to slip in some subtle spam.

Ahhhh... just kidding, reading someones post history is a good way to detect spam.

Just got a call today from some astroturf group in Pennsylvania that wanted my signature for recalling Obamacare. Not gonna happen.

Thanks. Obamacare is definitely flawed, but compared to the Republican plan of "death for everyone who failed to get rich" it looks pretty good.

Thanks. Obamacare is definitely flawed, but compared to the Republican plan of “death for everyone who failed to get rich” it looks pretty good.

Common let's be fair, they are not going to let the non-rich just die. First they will bleed them and their families for every cent they can driving them into bankruptcy or debt slavery. Then they will let them die.

And, yes as horribly disappointed as I am in Obamacare it is better than the Republican plan.

You still do not get it.

The only effect of Obama insurance reform (in no way it's about healthcare but about insurance) is the carte blanche to insurance companies to gauge their prices.

This reform was created by Health Insurance CEOs. Their first goal was to kill public option. (Mission accomplished). Second was to milk the public for as much money as possible. This is done in many ways: raising premiums, increasing deductibles and reducing services, outsourcing everything possible and impossible to India, reducing salaries and benefits (have you heard about recent reduction of salaries to Kaiser Permanente nurses and strikes in LA?)

However, the most important is getting practically free loans guaranteed by Federal Government. That's what enables them to not care about the patients. It's very simple, since the end of 2009 they really do not need you. They need to be government compiant, (HIPPA, SOX etc.). In this case they get Government guaranteed loans with rates way below inflation. Banks are happy, they need no securities to create these loans and still get some interest on zero investment. Executives have their fat bonuses funded. Who needs patients, nurses, labs, even doctors? Even more so, those are dangerous, they may want to do something. They may want to change some processes, equipment, software. That would force another proof of compliance. "No, thank you, all we need are happy government not any crap like patient care."

That's all direct result of Obama reform.

With private health care poor people usually get some care. There are religious organizations, true non-profit clinics, altruistic doctors etc. The most important, there is no shortage of available care.

Obamareform creates a deficit of healthcare. Anything in short supply comes at a premium. Both insurance premium and lower quality premium.

As the result of Obama reform health care has to become unaffordable to working class (even those who are blind enough to consider themselves still in middle class).

No wonder, when services are scarce, they are affordable to rich only.

michaelsch says

With private health care poor people usually get some care. There are religious organizations, true non-profit clinics, altruistic doctors etc. The most important, there is no shortage of available care.

ideology-driven bullshit.

Troy says

michaelsch says

With private health care poor people usually get some care. There are religious organizations, true non-profit clinics, altruistic doctors etc. The most important, there is no shortage of available care.

ideology-driven bullshit.
“Nessuna soluzione . . . nessun problema!„

Very strong argument. Could you pls specify what's the ideology.

On the matter, I remember how in 80th most of my friends had no health insurance, but were able to get treatment when needed.

From 1991 to 2000 I held no health insurance. Paid $50 for private doctors visits as needed. Did not need much more than that.

I was a software contractor, my wife was a PHD student at UCLA. She had a UCLA health plan, but it did not cover the family. We checked that in case of emergency UCLA Med. Ctr. would admit us. Payments would be nogotiated later on.

The only issue I had was once when my son needed physical exams for some kind of sporting activity.

Called a private clinic, we agreed on something like $60. Later on I got a bill for several handreds, with a bunch of tests listed (apparently some of them not done at all and some completely unnecessary.)

Had to write a nasty letter to them. Have not heard from them since.