Thank You Freedom Fest 2010

Last night was the conclusion of Freedom Fest 2010 at the Bally’s Casino in Las Vegas. The quality of this program was astounding and I congratulate all who were involved. You haven’t lived until you see Steve Forbes dressed up as George Washington in one of the skits at the closing banquet. We live in unique and dangerous times. As I’ve written to my clients on all too many occasions, the investment decisions that we make in the next couple of years will be the most decisions that we will ever make in our lifetimes. Get it wrong and we may be financially ruined, regardless of how many financial resources we have today. Get it right and even modest investors can make millions, securing the financial future for their families today and for generations to come. If you have never heard of Freedom Fest, click on this link and see what you missed. Something like 160 presenters over three days. I’ve been to lots of conferences and heard lots of speakers. The quality of the speakers at this conference was impressive. And the conclusion is unmistakable: the United States and most of the major countries around the world are on …

What’s Next??

Life is interesting.  Who would have guessed that Massachusetts would have a Rep Senator?  To replace one of the nation’s most liberal Senators?  The Senator who drove healthcare reform?  How did the Republican win?  By trashing healthcare reform — Kennedy’s healthcare reform. Priceless. Pelosi said today that she doesn’t have the votes to pass the Senate version of the bill. That leaves two possibilities if it is to get passed. #1 – The House & Senate could decide on a slimmer bill using the Senate’s budget reconciliation procedures to pass the bill with 51 votes. or #2 – The Dems and the Reps could get together and negotiate a slimmed down version of the bill that could garner Rep votes in the House & Senate. Given the anamosity in Washington and the arrogance displayed by the Administration and Dems in Congress, I think a snowball in Haiti has more of a chance. If that’s right, then it is budget reconciliation for the Senate — the “nuclear” option.  After losing the Mass. vote I’ve got to think that the Dems will be hard pressed to take such a political risk. But then, who expected a Rep to win in Mass??

Ping Pong

Want to play Ping Pong? Apparently the House and Senate do. The Dems have figured out that they do NOT want a conference committee to reconcile the different version of the House & Senate healthcare reform bill.  To have a conference committee means that they might have to have Reps on the committee.  No way. So instead the House apparently intends to bring the Senate bill to the floor and then offer amendments to the Senate bill.  We should assume that any amendment offered by Dems has been pre-blessed by the Senate.  Once the House has amended the Senate bill the bill is sent back to the Senate for passage. It pings from the Senate to the House and pongs back to the Senate. If the Dems plan everything right, the Senate will then pass the House bill without amendment and it can then be sent on to the President for his signature. The President is meeting with Dem House & Senate leaders today to broker a final deal.  The possibility that this breaks down is small.  The deal will be done shortly.

Regional Differences in Medicare Utilization

MEDPAC has come out with a new study of the variations in the level of care by area.  Not surprisingly, some areas in the US have much higher levels of care than others.  “Levels of care” are defined as the cost of providing healthcare to a Medicare patient, adjusted for geographical differences of labor costs, acuity of certain diseases and other factors that MEDPAC thought needed to be excluded or adjusted to compare “Levels of care” on an apples-to-apples basis. I think we can assume that areas that are HIGH cost are vulnerable to future reimbursement cuts and greater fraud enforcement risk. Those areas of HIGH cost? South Florida (surprise) including Ft Lauderdale, Miami & Pompano beach (highest by far) – Tenet, HCA & HMA Many Texas markets –Tenet, HCA & Universal Health Chicago – Vanguard Southern Lousiana (another surprise – #2nd highest) including all areas where LHC Group & Amedisys hang out – Tenet & HCA State of Mississippi (HMA is big here) Las Vegas  – HCA & Universal Health Tulsa & Oklahoma City – Pittsburg My identifying hospital companies in these market’s isn’t all inclusive.  LifePoint & Community also have hospitals in many of these markets, as does …

House Bill Introduced

Below is a summary of the House’s version of the healthcare reform bill.  There have been rumors that no amendments will be allowed on this bill so this may be close to the final House bill.  Once passed, they will wait on the Senate’s bill and then a committee will work to reconcile the two.  It still appears that the Senate does not have 60 votes for any bill and in my mind it looks likely that the Senate will use the budget reconciliation rules to pass the bill with 51 votes. Summary below by year. 2010 Health plans must spend 85% of premiums on medical care, or rebate extra to policy holders.  This excludes Medicare Advantage which has the 85% rule starting in 2013. Dependent age on a policy is increased from 19 to 26. Bans lifetime limits on health policies Ends practice of terminating healthcare benefits because of claims Reduces pre-existing condition look back to 30 days from 6 months and limits the period of exclusion of coverage. Creates $5 billion pool for those who can’t get insurance due to pre-existing conditions Reduces donut hole in Part D Medicare by $500 Eliminates co-pay & cost sharing for Medicare …