The recent Supreme Court case that has some up in arms that health services transparency is hindered by the Court upholding that ERISA preempts state law and therefore Vermont cannot require that certain insurance plans report on every provider charge.
But whose goals are hindered? The primary purpose of all payer databases that collect and publish data on health care provider costs is for states and insurance companies in managing their costs, with limited access to such records available to consumers whom they'd like to enlist as unpaid confederates in their financial goals by "allowing" them to choose the cheapest providers around.
The decision by the Court really shouldn't matter to consumers, it's consumer neutral. In, "Gobeille v. Liberty Mutual," the Supreme Court sided with Liberty Mutual resolving that Vermont could not require all health insurers to report to a Vermont's All Payer Database (relying on an ERISA provision and preemption of a state law by a Federal law, http://www.supremecourt.gov/opinions/15pdf/14-181_5426.pdf).
But the case is another example of payers seeking to reduce their costs misleading and manipulating the public with claims that such information will "empower" them.
Under Obamacare, combined with the new capabilities of technology, we've found that data is being misused as part of a barbaric, biased selection process, a means of determining who lives and who dies using "metrics" that frequently reflect garbage in-garbage out but are being bandied about as means for payers to pursue the perfect patient by weeding out the imperfect among us. Under the phony veneer of "objectivity," data is being used to weed out the undesirables.
In the quest for the perfect patient, we've already seen consumers willing to turn on one another as the "cause" of our healthcare crisis--ready participants in the new selection process, perhaps not realizing that they too are imperfect.
For instance, if you don't smoke, you're young, you're not overweight but you don't exercise enough, you're on the payers' radar as a potential expense. Simply read articles like, "Sitting is the New Smoking," as described in the, "Huffington Post," 2014.
Not only should this approach frighten consumers, it should sicken them in terms of the medical choices being imposed on a public that is being manipulated into being stooges on behalf of payers' selection and deciding who "deserves" health care and the opportunity to live or die.
The first hurdle is admitting that data, the parameters under which it's collected, the interpretation of it once it's gathered is subjective, regardless of the temptation to consider it objective. That's an enormous hurdle.
"When did you stop beating your wife?" Ask the population this question and require a date for an answer and you get 100 percent of those answering the question admitting that they beat their wives. How data is gathered matters. What is excluded matters.
Regardless of data capabilities, cherry-picking what "facts" are gathered and considered and how they're used remains uniquely human and susceptible to uniquely human bias in spite of the "objective" veneer placed on such bias by the recitation of "data."
Moralizing and selection in our healthcare policy has reached new levels under Obamacare because it not only decides whose life is worth more and whose is worth less, but it PAYS providers to perpetuate its criteria for selection of life or death, treatment or no treatment through incentives paid to providers who do more of what is covered and advise against what is not, all with a focus on "outcomes" so that those who are granted treatment will provide "data" supporting the Obamacare selection process.
We've seen this selection process deeming some patients "unworthy" and others "worthy" from Obamacare's inception.
A falsehood was published to justify Obamacare's forced purchase of health insurance. Obamacare relentlessly repeated that having health insurance equals better healthcare, a point NEVER proven by any DATA UNLESS that health insurance sufficiently paid for needed medical services and therefore removed economic barriers from obtaining needed healthcare services.
Obamacare not only forces the purchase of a product proven for decades insufficient to cover the prices charge for needed healthcare services, but it actively put in place policies that support weeding out the sick by increasing patient copayments, coinsurance, and deductibles while forcing us all to pay for preventive checkups. Meaning, get a checkup, but if that checkup shows something then likely you're paying more to get that treated. Not something that reflects a policy of reducing economic barriers to healthcare.
Obamacare also did little to address the problem of balance billing where non-insurance providers can charge you the balance of what they want to charge whether or not you knew they were participating providers. Hardly the policy of reducing economic barriers to healthcare.
Obamacare also did little to hold down the ever-increasing out-of-pocket maximums set each year for how much we have to pay before reaching maximum coverage under our plans. Hardly the policy of reducing economic barriers to healthcare.
Obamacare also let lapse a law that permitted us to deduct medical expenses that exceeded 7.5 percent of our income thereby requiring those expenses to exceed 10 percent of our income before deductible. Hardly a policy of reducing economic barriers to healthcare.
But one group was satisfied with the forced purchase of their product--health insurers. By disregarding the DATA and misconstruing its conclusions, Obamacare foisted a nightmare on the American people where we're legally obliged to purchase a consumer financial product that is often inadequate in protecting us from financial devastation in the face of needed medical services …Or else.
Too late we realized this was a deliberate omission and untruth designed to promote Obamacare and its goal to reduce PAYER liability (government and insurance company) on behalf of patients thereby saving government money, preserving insurance company profits and preserving the exorbitant prices our providers charge.
But the misuse of data is worse than that under Obamacare and its selection process.
While insurance companies have ALWAYS used data to determine who's going to cost them more so they charge those individuals more because the RISK of having to pay out more is higher, Obamacare, ignored those statistics and instead chose for selection which groups to protect and which groups to penalize.
Obamacare's bias prompted the government to IGNORE certain segments of population that cost more based on overwhelming "data" and decided to moralistically PERMIT some individuals to be charged more while PROHIBITING others from being charged more both for healthcare services and premium costs for the health insurance product.
For instance, under Obamacare, ONLY if you smoke tobacco or if you're older, can you be charged more in premiums though there is overwhelming data that those with chronic drug addiction (prescribed or not), those who are obese, those with pre-existing conditions and pregnant women also cost insurance companies and other payers significant amounts of money. That's right, under Obamacare an obese, crack-smoking, pregnant woman, with a history of medical maladies cannot be charged more in health insurance premiums but if you're older or you smoke tobacco, you can.
This is based on Obama morality, not data. It is a selection process. Whether you agree with Obamacare's morality or not, it is not objective, it is not data-driven because DATA indicates that obese individuals, those with pre-existing conditions, those who become pregnant, those who are addicted to drugs other than tobacco, whether prescribed or not also cost insurers more. These policies are morality driven, not data driven.
Recall, the proposal for pre-existing conditions was that no one would be DENIED health insurance because of pre-existing conditions, NOT that premiums would be prohibited by law from reflecting the RISK of covering those with pre-existing conditions while still imposing such increased premiums on others.
Obamacare's selection process is also evidenced in the new CMS provision that pays physicians to provide end-of-life counseling discussing costs (including financial) benefits of possible treatments, discouraging such treatment when it's expensive. Insurance companies also pay providers to focus on outcomes, including programs run by insurance companies that pay physicians to refer patients to cheaper specialists in a certain geographical region.
For those who believe they are "good" healthcare citizens, this is a warning that they might find themselves on the wrong side of the selection "data."
We've already seen the clash with mandatory birth control coverage regardless of individuals' religious views. But Obamacare's morality goes further. In defiance of DATA, Obamacare requires that a woman's sterilization be covered for "free" under insurance while the cheaper and less complicated male sterilization is not covered.
Morality in healthcare is dangerous, whether imposed by someone you agree or disagree with. Recall that mandatory sterilization in the US existed until the 1970s, all performed by medical doctors with authority from government.
It's all part "outcome based" medicine that uses DATA, which we know is subjectively used and often subjectively chosen from among "all the data" to promote governmental payer interests, which mirror insurance company interests, pursuit of the perfect patient, one who pays for the health insurance product but who makes few to no claims under it.
Obamacare's hubris is that it presumes that its morality is superior to other cultural pulls on the healthcare system and therefore boldly made it federal law that every health insurance policy must cover certain things that Obamacare decided were MORALLY important often ignoring DATA.
These are not choices based on "well we've got to choose who gets healthcare based on DATA," they are choices based on morality--who matters more, whose care is worth more.
For instance, Obamacare is one of the most anti-male pieces of healthcare legislation that I've ever seen. Not only doesn't it cover male annual physicals, it also doesn't cover male counseling for domestic violence, it doesn't cover male choices to have vasectomies, and it forces every male to share in covering these options for females.
For consumers, whether it comes to "data," or "metrics" of any kind or how those data and metrics are used, we cannot rely on the alleged objectivity of such data which has been so manipulated to justify providing less to consumers, or certain classes of consumers, if we expect to stop the trend of focusing on achieving the "perfect" patient at the expense of creating a healthcare environment where needed medical services are accessible to our population regardless of the moral "worthiness" of patients at a cost that is covered by the product we pay for to help pay for those costs--health insurance.
