Accountable Care Act–Needs To Take Time Out and Re-Group, Implementing a “Static” Law With Current Day Complex
Posted Nov 22 2013 12:26pm
I don’t know about you but this is the conclusion I have drawn here and we are to the point of having way too many segmentations that exist in healthcare and in other places as well that are directly or indirectly affected by the new law to have much of anything make sense! Digital centric laws are needed soon before we all go crazy. What we have today is not working. When you have verbiage that has to be matched with technology after the fact, you have what we have today, as the modifications with all the connected data we have today is making a huge mess. Businesses are not required to contribute any models and are on their own to change and modify daily as needed for profit.
If you have not noticed Obamacare is just like the markets with the continuous rise and fall of the machines. Rules are made but the machines run them. Nothing changes until changes are made on servers. Modeling is more important today than it has ever been. In no way does this mess compare to when Medicare started, it wasn’t that frigging complicated back then so toss that out the door if you think things are going to calm down, as they are not.
How do you take very complex math models from insurers that change all the time and apply a “static” law? I think I said that already with this post about rise and fall of the “machines”.
Doctors and patients as well as hospitals are trying to figure out what coverage the patient has or will have, and premiums are all over the place. Some make sense even though they might not be affordable and some are just off the wall and this is due to many many years of segmentation used by insurers. The ACA is all about minimizing the segmentation, in other words taking the common values and dumping the garbage if you will with developing and maintaining specific risk groups. The entire focus of insurance is to spread the cost out over the largest risk group you can so it’s affordable. So we have this with “yes your are in network”, but wait a minute, second thought, “no you are not” and this applied to doctors, patients and hospitals.
We are getting back to square one where you buy a product and you don’t know exactly what you have, you don’t know exactly what doctor or hospital you can visit and use and last the premiums are based on mathematical risk assessments that clash with all of this. On top of all of this, insurance subsidiaries are getting to be so numerous you don’t know who does end up getting your bottom line dollar so as patients you end up contributing to big corporate profits and you don’t even know it. And let’s add on the sequester with yet another issue with the 2% cuts for doctors and hospitals and the insurers like United cutting reimbursements even more, so what’s the next goal, cut doctors to half of the Medicaid rates?
Formulas and models need simplicity so we can work with it and get care when we need it…government can’t model, insurers use and abuse math models and code so where’s a happy medium here…I don’t see one on the landscape yet and rather see a bunch economists guessing all over the place who used to be experts but are not anymore as the algorithms eat their lunch too when they try to put some kind of economic spin on the mess. Economists are just about non-effective unless they are physicists and can help create good win-win models and help us can the erroneous ones that have only one focus, profit. We are going to need to return to some simpler pricing formulas that works for everyone and I think more are winning with insurance premiums but I can’t even say that for sure as the policy may be affordable but the network of providers is far from being adequate.
We are under the attack of the killer algorithms as Algo Duping has become precedence and the rich who build them are getting richer and won’t share their money. As Bill Gates said the hardest sell of the “Giving Pledge” is getting the rich to part with their money. Something needs to give to start the flow of the money back to the middle and lower class and right now I’m tired of reading about some new analytics or code that will set the world on fire with efficiencies as it’s gone, all we have now is code to make the wealthy richer as whatever technologies get created, the low and the middle class can’t afford it unless we have to give up all our data to corporations and banks can get even richer.
The screenshots by the way reference a game that has been created to exploit the data selling epidemic and you can read more here and watch the video, it’s very well done and factual as well when it tosses reality in your face and of course it’s everyone’s individual choice to choose reality or “so called magic”…again as more algorithmic formulas clash and grind with the establishment of a “static law”, it’s not going to stop or change until we explore some better methodologies so as a consumer of the 99% you can pretty much count on the fact that the rich will continue to get wealthier as we lose even more ground and are at the mercy of what the “rich” corporations want to allow for the rest in the way of money and access…this really needs a fix and a joint effort from all and a full embracement of reality of how the machines are programmed to function to work to direct decisions in today’s word.
Business should be held accountable and be transparent as there’s no other way to even up the technology advantages if not. Scroll on down and watch the 2nd video in the footer, the Quant video and see how sometimes there’s no physics in business models and as Paul Wilmott says, “we’ll just choose six” when the Quants run out of logic and data mechanics to even build a model so you end up with erroneous fictional algebra that keeps moving money to the 1%.
So below you have the next “let’s pick six” remedy below with delaying enrollment by a month to allow the Quants of the insurance companies the opportunity to create new models, and will we ask to see them, probably not as gov can’t or won’t model and seems to be permanently placed behind one big eight ball. Look at the classifieds sometimes and see the large number of job openings at health insurers for Quants. BD
Health and Human Services plans to delay the start of the second year of Obamacare enrollment by one month to allow insurers more time to set rates after assessing their plan experiences during 2014, a department official said Thursday night.
The decision means that sign-ups for the 2015 plan year would begin on Nov. 15, 2014 and end on Jan. 15, 2015 instead of the Oct. 15-Dec. 7 window previously announced. The date change, first reported by Bloomberg, also lengthens the enrollment period by a week. Doing so would give companies more opportunity to account for individuals, particularly young adults, who come in late during the plan’s first year, which has gotten off to a rocky start. The goal is premiums that more accurately reflect costs for those insured.
The HHS official termed the change “good news for consumers, who will have more time to learn about plans before enrolling.” Insurers would have until late May 2014 to submit applications to offer health plans during 2015, and the state and federal exchanges would get more breathing room to ensure their enrollment systems are ready for individuals.
The change will not affect any coverage during Obamacare’s first year, which is set to begin on Jan. 1.