† Healthcare “Reform” Horror Stories: James Bacon, blogger and author of the soon-to-be-published "Boomergeddon" (Oaklea Press, 2010), calls 29-year-old machine operator Josh Dent “an early victim of Obamacare” in this Washington Times op-ed, because the insurance he has through his employer, Acorn Signs, runs afoul of the “80/20 rule,” which requires all insurance plans to pay out at least 80 percent of premiums in benefits:

 

[U]nder the newly enacted Affordable Care Act, his insurance policy will get less affordable. A provision in the law is putting his insurance company out of business, and whatever replaces Mr. Dent's current policy will likely be much more expensive. …

 

Steve Gillispie, Acorn's president, is distressed by this unexpected development. A year and a half ago, he was facing premiums of $150,000 from an established insurer, up from $80,000 just three years before. Then along came Richmond, Va.-based nHealth. The start-up company, launched with the mission of making consumer-driven health care a reality, rescued him with a plan that kept premiums below $90,000 yearly. …

 

The company ran afoul of the 80/20 rule by charging premiums that were so low that the administrative expenses looked high by comparison. … NHealth keeps premiums low by using HSAs to incentivize employees to reduce their spending - buying generic drugs, for instance, and shopping around for cheaper pharmacies - and by showing clients how to self-insure for physicians' fees. If nHealth charges superlow premiums of $300 per month, paying $200 in benefits and keeping $100 for administrative expenses, its administrative ratio would be 33 percent - thus failing the Obamacare test and triggering penalties. …

 

Given continued uncertainties about how the regulations would be written, the company notified clients in June that the board had decided to shut down the company; it would honor all existing contracts but not renew them.

 

Meanwhile, insurance companies nationwide are raising premiums, and have built up large cash reserves in anticipation of Obamacare taxes and future premium reductions.

 

As for the 35 employees of Acorn Signs, they will not only lose the insurance plan they liked, they will not be able to keep the doctors they like - unless they pay for the privilege (making their health plan … even less affordable). Aetna, Cigna, the UnitedHealth Group and WellPoint are promoting affordable plans with reduced premiums in San Diego, New York, Chicago and other cities that require participants to choose doctors and hospitals from limited networks with the expectation that “businesses of all sizes will gravitate toward these plans in an effort to cut costs,” reports The New York Times:

 

The tradeoff, they say, is that more Americans will be asked to pay higher prices for the privilege of choosing or keeping their own doctors if they are outside the new networks. That could come as a surprise to many who remember the repeated assurances from President Obama and other officials that consumers would retain a variety of health-care choices. …

 

The last time health insurers and employers sought to sharply limit patients’ choice was back in the early 1990s, when insurers tried to reinvent themselves by embracing managed care. Instead of just paying doctor and hospital bills, insurers also assumed a greater role in their customers’ medical care by restricting what specialists they could see or which hospitals they could go to. …

 

The concept was largely abandoned after the consumer backlash persuaded both employers and health plans that Americans were simply not willing to sacrifice choice. …

 

But choice - or at least choice that will not cost you - is likely to be increasingly scarce as health insurers and employers scramble to find ways of keep premiums from becoming unaffordable. Aetna, Cigna, the UnitedHealth Group and WellPoint are all trying out plans with limited networks.

 

The size of these networks is typically much smaller than traditional plans. In New York, for example, Aetna offers a narrow-network plan that has about half the doctors and two-thirds of the hospitals the insurer typically offers. People enrolled in this plan are covered only if they go to a doctor or hospital within the network, but insurers are also experimenting with plans that allow a patient to see someone outside the network but pay much more than they would in a traditional plan offering out-of-network benefits.

 

For their part, doctors are pushing back at insurers’ efforts to steer patients toward “approved
practitioners, reports The Wall Street Journal:

 

Insurers have long charged patients greater out-of-pocket fees when they see doctors who are not in the health plan's network of contracted physicians. Now, insurers and employers are taking this a step further by dividing doctors into tiers based on factors such as quality and cost. For example, doctors deemed to be more efficient than average, perhaps because they order fewer questionable imaging scans, might rank in a higher tier. Performance, including favorable patient outcomes, also could boost a doctor's rating.

 

In such "tiered," or "limited," network setups, consumers may get lower out-of-pocket charges if they see a doctor in a preferred ranking. Patients would typically pay more out of pocket to see doctors who are ranked lower. At the most extreme, consumers may have to pay the full cost of seeing a physician who doesn't make the favorable list. …

 

In [a] letter, sent to major insurers, the doctor groups argued that recent research from Rand Corp. showed that the health-plan rankings are unreliable. They highlighted a study published in March in the New England Journal of Medicine that used claims data from four health plans in Massachusetts. It found that a two-tiered rating based on costs would incorrectly classify an estimated 22% of doctors.

 

"Physicians' reputations are being unfairly tarnished using unscientific methodologies and calculations," the letter said. The doctor groups asked the insurers to work with them to re-evaluate their ranking programs. …

 

A spokesman for America's Health Insurance Plans, an industry group, said insurers are already working closely with doctors to improve ratings, and "quality is the most important factor" in insurers' ranking and tiering efforts, not cost.

 

Editorial Note: Last month House Minority Leader John Boehner (R-OH) released a 41-page report, “ObamaCare: Three Months of Broken Promises” that evaluates healthcare “reform” and offers Republican solutions to the problems it creates (page 40).

 

† Nationalized Healthcare Always Leads To Rationing: The Sunday Telegraph (London) sounds the alarm that the UK’s National Health Service is planning “widespread” rationing -  particularly targeting the elderly, terminally ill and developmentally disabled - to hold down healthcare costs, including:

 

‡ Restrictions on some of the most basic and common operations, including hip and knee replacements, cataract surgery and orthodontic procedures.

 

‡ Plans to cut hundreds of thousands of pounds from budgets for the terminally ill, with dying cancer patients to be told to manage their own symptoms if their condition worsens at evenings or weekends.

 

‡ The closure of nursing homes for the elderly … and [reduction of] services that provide respite breaks to long-term carers.

 

‡ A reduction in acute hospital beds, including those for the mentally ill, with targets to discourage GPs from sending patients to hospitals and reduce the number of people using accident and emergency departments.

 

The Sunday Telegraph found the details of hundreds of cuts buried in obscure appendices to lengthy policy and strategy documents published by trusts. In most cases, local communities appear to be unaware of the plans. …

 

The Government has promised to protect the overall budget of the NHS, which will continue to receive above-inflation increases, but said the service must make “efficiency savings” of up to £20 billion by 2014, which would be diverted back to the front line.

 

Katherine Murphy, of the Patients Association, said the cuts were “astonishingly brutal” and expressed particular concern at moves to ration operations such as hip and knee operations.

 

“These are not unusual procedures, this is a really blatant attempt to save money by leaving people in pain,” she said. …

 

She added that it was “incredibly cruel” to draw up savings plans based on denying care to the dying.

 

This is the nationalized healthcare system that Donald Berwick, President Barack Hussein Obama’s unilateral choice to head up the Centers for Medicare and Medicaid Services (CMS) gushed that he is “romantic about” because it is “generous, hopeful, confident, joyous and just.” Obama has given Berwick the mandate to cut $500 billion from Medicare and Medicaid. We now have the blueprint he will use.

 

† Toyota President’s Congressional Testimony Canned, Panned: The New York Times is fed up with Toyota “repeatedly fail[ing] to report potentially deadly problems” to the National Highway Traffic Safety Administration, as required by law:

 

In 2004, Toyota issued a recall of 330,000 vehicles in Japan after complaints about cracking rods. It told American regulators that, because of different driving conditions, the problem did not affect Toyota cars in the United States. It said it had not received a single complaint in this country.

 

In 2005, Toyota notified the N.H.T.S.A. and issued a voluntary recall of nearly one million vehicles here because the steering rod could break. This year, lawyers for an Idaho family whose son died when his Toyota truck rolled over unearthed about 40 complaints about steering rod problems in the United States before the date of the Japanese recall. …

 

Toyota has a lot to explain about why it delayed informing American regulators about the faulty rods - and why it told the N.H.T.S.A. it had received no complaints in the United States. … If a $16.4 million fine is not enough to change Toyota’s behavior, then Congress should give regulators a bigger stick to work with.

 

† Updates To Previous Posts (fourth item, A To Z Approach On Illegal Immigration In AZ): After dozens of articles by the MSM reporting on AZ’s anti-illegal immigration law from the point of view of the illegals and their advocates, The Associated Press finally explains why the issue became a flashpoint in the state this year:

 

The anger has been simmering for years, and erupted into a full-blown fury with the murder of a prominent rancher on the border earlier this year. …

 

Turn on the evening news in Arizona and some report reflecting the state's battle with illegal immigration will likely flash across the screen.

 

A drop house crammed with illegal border-crossers smack in the middle of a suburban neighborhood. Traffic patrols and workplace raids that net the arrest of dozens of illegal immigrants, often in heavily Hispanic communities. Politicians speaking venomously about border violence and the leech of immigration costs on the state treasury. …

 

In some Phoenix-area neighborhoods, Spanish is so predominant both in spoken word and signage that residents complain they feel like they're in a foreign country. …

 

And the annual costs? About $600 million for educating illegal immigrants at K-12 schools, more than $120 million for jailing illegal immigrants convicted of state crimes and as much as $50 million that hospitals have to eat for treating illegal border-crossers, according to figures provided by Superintendent of Public Instruction Tom Horne, Gov. Jan Brewer's office and the Arizona Hospital and Healthcare Association.

 

Immigrant medical costs led the hospital to shutter a skilled nursing facility and its maternity ward several years ago, according to the hospital's top administrator.

 

None of this holds any truck with Doris Meissner and James Ziglar, both former commissioners of the U.S. Immigration and Naturalization Service (under Presidents Clinton and Bush 43, respectively), who argue in a Washington Post op-ed that, “However aggrieved Arizona may be, allowing states to set immigration policies violates established constitutional principles and fails to solve the overall problem” and that a Republican president would also have had to challenge AZ's statute in court. If Meissner and Ziglar are to be believed, it is equally Constitutional for the federal government to shirk its responsibilities as to fulfill them.

 

† Updates To Previous Posts (last item, Garbage In, Garbage Out: Part II): Going the state of CO one better, Washington, DC Schools Chancellor Michelle Rhee terminated 241 teachers over poor performance and licensing issues and put another 737 on notice that they have one year to improve their minimally effective performance rating or may be fired as well, reports The Washington Post:

 

Educators, politicians and even union leaders say that there is no place in the classroom for a teacher who can't produce results. But actually doing something about the situation is an entirely different matter. That's why D.C. Schools Chancellor Michelle A. Rhee should be supported for taking the difficult but necessary steps to rid the system of ineffective teachers. …

 

[T]he system could see nearly a quarter of its teachers dismissed within two years, a prospect Ms. Rhee called “daunting.” …

 

[T]ermination decisions were made after each teacher underwent a thorough review based on the district's new teacher evaluation system, known as IMPACT, that combined observations of teachers with student test score data. IMPACT replaced a completely subjective system, so it is hard to accept arguments about the new system - with precise standards, multiple observations by experts and clear expectations - being unfair. …

 

Union leaders have signaled plans to file grievances over all the dismissals. That's their right; but a better use of their time might be to work with Ms. Rhee to improve the performance of the 737 teachers in danger of losing their jobs next year.

 

Just as the increased availability of 3D ultrasound put the lie to claims by abortion activists that an unborn child is just “a clump of cells,” the efforts of education reformers like Rhee to weed out underperforming teachers puts the lie to union claims that they are as interested in educational quality as parents and taxpayers.

 

† Updates To Previous Posts (sixth item, Take The Veil Off, Or Go Home): Asked by a Saudi woman in France whether she may forego wearing a hijab now that the country has banned face-obscuring veils, Saudi cleric Sheik Aedh al-Garni issued a fatwa advising that she is permissible to do so in order to avoid harassment, reports The Associated Press:

 

Saudi Arabia, the birthplace of Islam, is one of the few Muslim countries where women are forced by custom to cover their hair with head scarves and their bodies with cloaks called abayas in most parts of the country. It is also common to see Saudi women wearing full-face veils. …

 

al-Garni's religious advice … generated some opposition from those less compromising. One cleric said it was better for Muslim women to avoid traveling to such countries unless absolutely necessary.

 

"We should not confront people in their countries or elsewhere," al-Garni was quoted as saying in the Saudi-owned daily Al-Hayat. "In case a ban is enforced against a Muslim woman there - and as a consequence there is a reaction or negative implications or harassment or harm - it is better for the Muslim woman to reveal her face." …

 

Not all Islamic clerics agree that the face veil is an obligation, with some calling it a tradition. But most clerics agree a head scarf is a religious requirement.

 

Beyond Saudi Arabia, the face veil is quietly spreading in other Arab countries. Some governments, like Egypt and Syria, have taken measures to limit its spread, such as barring it in universities and academic institutions.

 

Al-Garni's religious guidance, or fatwa, is an advisory opinion and not a law.

 

As a feminist, The Stiletto would prefer to see Muslim women freed from their prisons of cloth. But the conflicting opinions of the Saudi clerics on what Muslim women in Western countries should do clearly comes down to this choice: Take the veil off, or go home.

 

† Updates To Previous Posts (fourth item, Why We Need Gitmo): Mohammed al-Adahi, a Yemeni, challenged his detention at Gitmo, claiming that he stayed at an al-Qaeda guesthouse in Afghanistan to attend a wedding celebration in the summer of 2001 when his sister married an associate of Osama bin Laden and met the terrorist there. He said he then went to the al-Farouq camp, where many of the September 11, 2001, hijackers received military training, where he participated in the activities because he was “curious” about what it takes to become a jihadi – but got kicked out after a week because jihadis aren’t supposed to have nicotine habits.

 

Believe it or not, he got Judge Gladys Kessler of the U.S. District Court for the District of Columbia to believe his far-fetched explanations for everything in his CIA dossier, and a year ago she ordered him released from Gitmo on the grounds that his “admission that he trained at Al-Farouq is not sufficient to carry the Government's burden of showing that he was a part, or substantial supporter, of enemy forces.” The Washington Post believes that “judicial review of Guantanamo detentions is imperative to ensuring justice,” but points to this ruling as “illustrat[ing] the perils of allowing trial judges to assess intelligence information through the lens of conventional rules of evidence.” Nonetheless, The WaPo takes issue with an appellate court decision to overturn the habeas-corpus ruling, because it “allow[s] the government to meet an even lower standard of proof than the already relaxed standard now commonly required” in these cases:

 

The Supreme Court, which ruled two years ago that detainees have the right to have their cases heard by federal judges, did not set standards, and Congress and the White House have been shamefully inactive in filling in the gaps. The end result is a kind of Guantanamo roulette, where the predilections of judges shape the rules and determine the outcomes. This serves no one well - not the detainees, not the government and least of all the rule of law.

 

Sheesh! The way The WaPo is carrying on, you’d think Judge Dredd handled the appeal of Kessler’s ruling.