Health for life

The health care commentariat are all wee-weed up over the just-released Kaiser Family Foundation survey on employer health benefits.  The report, based on telephone interviews of a representative sample of more than 2000 employers, shows that the cost of employer-provided insurance has increased by a whopping 8-9% this year. 

Supporters of Mr. Obama and Affordable Care Act argue the increases have preceded the chief provisions of the ACA and are the best evidence to date that federally-led health orm is necessary.  In the meantime, foes of Obamacare are glomming onto the increases as proof that current and anticipated federal mandates are doing nothing about the underlying causes of cost inflation and are ruining any hope of slowing it down. 

And so the debate goes on and on.

Unlike the political class, the DMCB has never found that there is any "single" culprit or simple explantion when it comes to health care cost trends.  In this instance, the 8-9% increase is likely due to variations in the underwriting cycle and a combination of insurance and provider market forces. They include new (and expensive) technology, an aging workforce, continued reliance on fee-for-service mechanisms, grabbing some additional  rate before federal oversight increases, the cost of covering all those college students and other various mandates.

But the perceptive DMCB will offer up one more cause: the provider equivalent of the insurer "death spiral."   If insurers are having a bad year thanks to increased claims, they can be forced to increase their prices.  In response, persons who dont need insurance exit, leaving only the persons who must keep the insurance because they know they are a bad risk. That leads to another bad year, another price increase and more exits until the insurer is left with a small book of business that is unaffordable.

Thanks to 1) 9% unemployment leaving persons without health insurance, 2) high "under" employment also leaving persons without insurance and 3)  high out of pocket expenses for those who do have insurance, the DMCB suspects many more persons with a choice are electing to not go to the hospital or the doctor.  That leaves fewer persons, but theyre sicker, higher cost and unable to pay. Less margin, bad debt and fixed costs are forcing providers to increase their rates. 

While this a arguably a form of cost shifting, the DCMB doesnt believe that term adequately captures what is going on.  If its right, the lower frequency of claims with a much higher severity could point to a true spiral and next years increases will also be unexpectedly high.  In addition, once the economy improves and all that pent-up demand can be addressed, itll get worse.

Combined with everything else going on, this doesnt bode well.

According to the White House, the health insurance exchange glitches are a symptom of high demand from a grateful citizenry eager to embrace Obamacare. While articles like this and this suggest that sloppy and amateurish programming is really behind the website crashes, the Disease Management Care Blog is concerned that early high demand - if it exists - could be an early sign of a coming insurance death spiral.

"Death spirals" occur when persons with high levels of risk disproportionately enter an insured population.  When that happens, premiums have to rise to match the increased expenses. That, in turn, causes persons with lower risk to drop their insurance, leading to an even higher proportion of high risk individuals, who drive prices even higher.

The DMCB intuitively doubts that the early high demand described by the White House is the result of healthy latte-sipping millenials and young invincibles having nothing better to do with their web-surfing time.  Rather, the persons most likely to be in a rush to get into the web site are persons who really need insurance.  Those would be the ones facing huge health care bills.
 
Another indication is the relative lack of the standard individual anecdote or "ledes" in media reports that hook the reader into paying attention.  Used by politicians and journalists alike, ledes put a "human face" on a narrative by bridging the personal and the policy.   

Supporters of exchanges would probably like to see something ledes along the lines of...

For years, 25 year old Ivanna Ceeadoc could only lurk outside the local health clinic and watch helplessly as her friends from the coffee shop down the street got free health communications from the nurse practitioners within.  But after using the health insurance exchange....

or

Until he signed up in the health insurance exchange, part-time jazz drummer and retail specialist Hank Erinfersumburgers never had to see a health care provider. Previously unaware of a bleak future of fast food and tight clothes, Hanks zero dollar co-pay now lets him see a dietician and have enough money left over for a lunch......

Young Ivanna and Hank havent made an appearance in the national health insurance exchange narrative because they probably arent part of the story.  More likely, its persons in their 50s and early 60s who have been hold they need a joint replacement, an angioplasty or back surgery....

 Ima Medeesazter was looking at a stack of medical bills a mile high.  Her surgeons plans included weeks in a hospital costing her hundreds of thousands of dollars. Ima put things off, but now that she used the exchange, she can look forward to getting to know her ICU nurses really well.......

Even more worrisome: this astonishing statement by HHS Administrator Kathleen Sebelius that she "doesnt know" how many have enrolled in health insurance since the October 1 opening date.  If the experts running the shop are unaware the Insurance 101 principle of knowing who and why persons are signing up for health insurance, they have no idea about the spiral threat.

Image from Wikipedia

I love challenges and the best part of food challenges is to learn along with other fellow food bloggers like curious as like me, i have been participating since i started blogging with a couple of food challenges happening in this virtual world and one of the recent food challenge is this International Food Challenge , a monthly event started by two wonderful food bloggers. Seriously i love this Internation food challenge, its a wonderful platform to learn various cuisine which is not that much familiar for many of us. Thanks to  Sara and Shobana, the brain childs of this event for inviting me to this food challenge.

This months challenge is Cantonese cuisine,well this cuisine is one of the main cuisine in China. Their basic cooking techniques include roasting,stir frying,sauting,deep-frying,braising,stewing and steaming. Since am living in China town here, i know how wonderful and quick this cuisine is. Have you ever tasted their cantonese fried rice with chicken,prawns and eggs together, my kid will go crazy for this rice. Am an ardent fan of their cuisine and i got an immense chance to make their spiral moon cake which is quite famous during Chinese new year.I have tasted this moon cake before few years and its was a mystery for me , seriously i wondered how this cake is prepared, but finally i able to make some moon cake at home through this challenge. The store bought moon cake and this homemade moon cake doesnt have that much difference apart from the mould the stored one goes for and they tastes much more delicious after a day.Yes its hard to stop just with one.


Recipe Source: House of Annie
Ingredients:
300grms Sweet potatoes (purple ones preferable)
1/4cup Milk powder
1tbsp Butter
1/2cup Sugar
1/2tsp Salt

 Boil sweet potatoes then peel and mash the sweet potatoes.

Add the remaining ingredients to the mashed potatoes and cook in a pan until it forms a paste.

Roll out into 10 balls. Put aside while making the pastry dough.

For the moon cake dough:
Water Dough (A)
1cup All-purpose flour
1tbsp Icing sugar
Pinch of salt
2tbsp Cold butter
5-6tbsp Water

Oil Dough (B)
3/4cup All-purpose flour
pinch of salt
1/4cup Oil
1/2tsp Pandan essence

For water dough:
Sift the flour,sugar and water.

Add in the cold butter into the flour mixture and mix it with ur fingers until the mixture ressembles as breadcrumbs.

Add in the water and to form a soft but not sticky dough,cover and keep aside for 20minutes.

If the dough is sticky add more flour to get the soft pliable dough.

For Oil Dough:
Sift the flour,salt.

Make a well in the centre of the flour and add in the oil and pandan essence.

Bring the flour from the sides and mix to form a softe coloured dough,dont overmix.

Cover and keep aside for 20 minutes.

Rolling the cake:
Divide both the dough into equal 10 balls.

Take one piece from the water dough, flatten it and wrap a piece of oil dough, pinch to seal the edges.

With the sealed side facing up roll it as a oval shape disc.

Roll up it to form as cylinder like shape, turn the cylinder towards u and roll again to for a long thin strip.

Roll it again as a cylinder and cut it in the middle to form two pieces.

With the cut side facing down,flatten the dough,making the edges slightly thinner than the centre.

Preheat the oven to 350F and line a baking sheet over a baking tray.

Now place the sweet potato filling, wrap it and pinch to seal and roll slightly as a round ball.

Place it to the lined baking tray and bake for 20-25minutes until the top turns slightly brown.

Tips:
I loved my filling much sweeter coz the outside cover will be very flaky and very less in sweet, if the filling is sweet the pastry will be well balanced.

The dough will get dry quickly, so work fast to roll them.

If you hard time in rolling the oil dough, dont hesitate to sprinkle some water and knead them as a dough.