Month: January 2017
I am very frustrated by the outright lies the Democrats are trying to spread about the impending repeal of the Patient Protection and Affordable Care Act of 2010. Actually, the name “Affordable Care Act” is a misnomer. To most people who know better, the “reform” law, with its 2,500+ pages of economy-strangling regulations is more accurately known as the “Unaffordable Care Act.” I’ve seen this moniker cited by several people whose Facebook and Twitter pages I frequent.
Let’s Get Real
The Democrats’ new slogan about the likely repeal and replacement of Obamacare is “Trump wants to make America sick again.” Apparently Senate Minority Leader Charles Schumer (D-NY) and House Minority Leader Nancy Pelosi (D-Calif) engaged in a strategy session with President Barack Obama in the first week of the year.
According to a Jan. 4 article by the Washington Post, “Democrats: Trump Will Make America Sick Again,” a memo that came out of this strategy session partially reads as follows.
“Instead of fulfilling their promise to repeal and replace the Affordable Care Act, Republicans are going to make America sick again by offering no health care plan to the American people and actually dismantling Medicare, Medicaid, as well as the ACA.”
Although I will get back to the lie about the lack of a replacement health care plan, I am going to discuss the Democrats’ clinging protection of a crumbling Medicare and Medicaid system.
Let’s actually start with Medicaid, which is basically health care coverage for people with low-incomes. The scary truth is that states that are attempting to expand Medicaid under the rules of the ACA are finding that they face huge cost overruns.
For example, Arkansas is one of the states participating in Medicaid expansion, according to an Oct. 5, 2016 article entitled “Rising Cost of Medicaid Expansion Is Unnerving Some States,” written by Christina A. Cassidy on the Associated Press website. The article states that Arkansas has received 307,000 signups for the Medicaid expansion, which exceeds the projected 250,000. So the state is asking the federal government, which has been providing 100 percent of the costs for the expansion, for permission to charge some Medicaid recipients a premium for their coverage.
The same article states that Kentucky, another expansion state, has enrolled approximately 400,000 residents in Medicaid under the expansion. That state has budgeted $257 million for the fiscal years of 2017 and 2018, which far exceeds the original estimate of $107 million.
Creativity At Work
These are only a couple of examples of the budgetary havoc experienced by states that have expanded Medicaid based on the same old way of providing government coverage. However, there are bright spots of innovation that have the potential to actually provide needed health care for low-income people without busting a state’s budget or further inflating the national debt.
One of these bright spots include Healthy Indiana 2.0 (the latest version of the Healthy Indiana Plan), which utilizes Health Savings Accounts with contributions from the state as well as catastrophic insurance to cover for large medical expenses that cannot be anticipated. This program is already being used in Indiana. Another innovative proposal for covering the poor is being considered in New Jersey. This plan would incentivize physicians to work as volunteers in community clinics in exchange for state coverage for medical malpractice. This plan intends to provide primary care, and even psychiatric care, to low-income New Jersey residents at no cost to the residents, and has the potential to keep these residents healthy enough that the emergency room is very rarely needed.
Yes, there are great ideas out there for helping the poor receive health care, so any repeal of Obamacare does NOT mean that the poor would have the “rug pulled out from them.” I know that, as a conservative woman, I do not want to see anyone deprived of the medical treatment they need because of their inability to pay, but I feel that there are better ways of providing that care without increasing the national debt beyond sustainability or curtailing the free choices of American citizens because of “one-size-fits-all” government-controlled “health care.”
In the next few blogs, I will discuss some of these innovations at length.
Are you wondering why I have chosen the issue of health care to write about? Do you wonder what my background is that makes me knowledgeable about this subject even though I’m not a doctor and I don’t even play one on TV?
I could go way back to my experience working in claims and patient eligibility toward the beginning and midpoint of my working life, but I really don’t want to bore anyone to death with a long-winded account of my experiences. Although that experience shaped some of my ideas, nothing has shaped my current thoughts about it more than the last couple of years I spent working for Dr. Randy Delcore at Cedar Orthopaedic Surgery Specialty Clinic and Cedar Orthopaedic Surgery Center.
When I started working for Dr. Delcore as a public relations assistant, I had the tasks of assisting in the launch of a new website, working on an advertisement for local theaters, and taking care of any advertising. Another task he gave me led to the formation of strong opinions regarding the state of health care in America, which is a pretty big mess at the moment. Yes, it was in a mess before, but Obamacare only made it worse – not better, despite all the self back-patting he did at the end of his term in office.
A Time of Revelation
One day Dr. Delcore dropped a stack of magazines on my desk because he wanted me to educate myself about the general state of health care in our country, especially as it related to some of the issues he was experiencing as a fiercely independent physician. So I pored over all of them with voracious interest – some leaned left of center in perspective, others leaned right, and other publications were somewhere in the middle.
One article was a newspaper or magazine clipping (I don’t remember which) about a facility in Oklahoma City, Surgery Center of Oklahoma, that performed outpatient surgeries for prices much lower than average hospital prices. This piqued my curiosity because this was something Dr. Delcore was doing. I checked out the website and looked at the transparent pricing tool, which was something I already knew Dr. Delcore would want on the new website for his practice and surgery center.
In terms of educational material though, I was intrigued by the video blogs Dr. Keith Smith, the founder of SCO, had posted on the surgery center’s Facebook page. In fact, I could not resist throwing my two cents worth into the comments section. (I hope I didn’t wear him out with those.) Many of those blogs focused on the reasons that health care is so expensive these days. Some of the reasons Dr. Smith enumerated included government interference in health care and what he referred to as the large cartel hospital systems that overcharge insurance companies and then agree to some (still overpriced) reimbursement for medical services rendered. In fact, Dr. Smith has revealed all kinds of chicanery in the area of health care pricing as well as pointing to others that were writing about the same thing.
I have also communicated via Twitter and Facebook with many doctors who are truly frustrated about the direction in which the U.S. health care system is going as well as reading many articles and blogs they have written. By engaging in this discussion, I have seen the ways in which Obamacare has not improved the system, but has (I feel) made it only worse. I may have cast a protest ballot in the election (neither Clinton nor Trump), but I am truly hoping that President Trump does “drain the swamp,” especially in terms of the way health care works here.
Where Do I Go From Here?
I have so much to say about the current state of health care in the U.S., and can’t wait to share what I continue to learn about it. I honestly hope that if you, my readers, don’t already know about the many health care price drivers I will be writing about, you will be as outraged as I already am and motivated to communicate with your elected representatives to make some real constructive changes in this time of opportunity.
When the subject of health care is discussed, as it relates to repealing Obamacare, and what might replace it, one very important definition appears to be missing – that is health care.
A Source of Confusion
Here’s the problem – our 21st-century minds have come to equate health care with its payment. Granted, health care must be paid for by someone because doctors, hospitals, and other providers cannot work for free. However, the issue of health care has been convoluted with its payment with the assumption that unless someone has some kind of third-party insurance coverage for the medical care they receive, they cannot possibly have access to that care because the average person could not possibly pay for that care.
One of the problems is that health care in many facilities, especially in many hospitals, has become very expensive because of the price “negotiations” between those hospitals and insurers in which the hospitals charge some outrageous and unrealistic price and the insurer pays the price that it actually negotiated with the facility and calls it a discount even though that price may be very inflated. If you don’t believe me on that count, I would point you to an article I read several months ago and occasionally re-read just to keep it fresh in my memory. That article, written by Forbes Magazine Contributor Dave Chase,” is entitled, “Have PPO Networks Perpetrated the Greatest Heist in American History?”
To be quite transparent, I worked full-time for two years or so for Dr. Randy Delcore at Cedar Orthopaedic Surgery Specialty Clinic and Cedar Orthopaedic Surgery Center. I still serve him as an independent contractor. Dr. Delcore’s surgery center posts transparent cash pricing for many orthopaedic procedures at a fraction of the hospital prices for such procedures. With the huge deductibles that have resulted from Obamacare, patients have the opportunities to get their surgeries performed for much less than those high deductibles in many cases.
Free Market Health Care in the Midst of Obamacare
I will provide one example with a fictional patient. Let’s say Fred, your average middle class guy, needs a carpal tunnel release. The cash price for a carpal tunnel release at COSC is $1,850. That includes the surgeon’s fee, facility fee, and anesthesiologist’s services. So, Fred wants to find out how much it costs at a hospital nearby. I would tell him, “Good luck with that!”
I tried to comparison shop with hospitals in Utah. The University of Utah Medical Center advertises its carpal tunnel surgery, but does not even provide a price estimate online. I tried a few other facilities in Utah and did not find anything regarding price. One website for St. George Surgical Center provided an estimate of what the local hospital charges – $10,683.
The average Obamacare deductible has been approximately $5,000 if you get the least expensive plan in terms of premium, and let’s just assume that this was Fred’s choice in “coverage.” Therefore, the cost of a carpal tunnel release for Fred at COSC and many similar surgery centers around the U.S. (prices vary, but they are usually within approximately $1,000 of that price more or less) would not even come close to costing his entire deductible. So, in that case, Fred’s Obamacare “coverage” would not pay for his care at all. But could Fred receive the medical care he needed? Of course he can!
Dr. Keith Smith, founder of the Surgery Center of Oklahoma that also posts transparent surgery pricing on its website (in fact, I understand he was really the pioneer for posting transparent prices for surgery), said the following in one of his Facebook video blogs in November of 2015.
“What does it mean when a patient has one of these new Obamacare cards in their wallet but their out-of-pocket experience here at the Surgery Center of Oklahoma is better for them than if they had actually used that Obamacare benefit? What does that mean? That means they have coverage, but they really don’t have access to care … not that they’re not paying for completely out of their own pockets.”
So there you have it – having coverage does NOT necessarily get you “health care” under Obamacare – you may be paying for quite a bit of it yourself unless you are receiving Medicaid.
So how should our nation take care of the poor? Well, that’s a subject for another day. I promise to get around to this soon.
I watched the inauguration of President Donald Trump this morning as I worked at my laptop. I am always in awe of the moment of inauguration when the leadership of our country changes hands. President of the United States – what a huge responsibility for anyone to take on!
To be quite honest, I did not vote for Trump, nor did I vote for Hillary Clinton. I am afraid my vote was a protest vote because, in Utah, we had the opportunity to vote for conservative Evan McMullin if we were not crazy about either major party candidate. However, if I thought Utah was in real danger of going over to Clinton, I probably would have voted for Trump just to be on the safe side.
Why was I that opposed to voting for Clinton? There are many reasons, but not the least of them is that she would have continued and probably doubled down on Obamacare. There would have been even more government regulation of health care, hence even less freedom.
She was talking about increasing subsidies for health care plans, which only increases the government involvement in our personal business, not to mention an even more bloated national debt. I fear that she really does not understand the health care market and the fact that government has been the driver for more expensive health care, especially hospitals.
The crony capitalism that goes on between tax-exempt health systems, legislators and bureaucrats is one of those drivers. Large health care systems have the wherewithal to lobby and gain influence with our lawmakers. This is especially exemplified in an article I received from a new Facebook friend, Dr. Kathleen Brown who is a dermatologist in Oregon. The way these tax-exempt hospital systems are raking up bucks while providing fewer community benefits is disgraceful. I’ll let you read the article. Here’s the link.
It looks like many lawmakers in Oregon are getting frustrated with that situation. I think the tax-exempt status of cash-heavy “health care” systems is a non-partisan issue for two reasons.
- The way they come by all that surplus/profit (or whatever you want to call it) is by ridiculously overcharging insurance payers for patient services, but even the amount of reimbursement that is negotiated down leaves a profit margin for the hospital.
- Additionally, the fact that these tax-exempt “health care” systems are amassing so much money, much of it not being sunk into charity care, while they are not paying taxes is robbery of taxpaying citizens.
Because of government involvement in health care, the system has become way too complex and cumbersome, which leads to expensive health care.
I will be discussing in future blog posts the negative effects our bloated government has had on the delivery and payment of health care as well as some important definitions in the world of health care that I don’t believe the average person understands because of how these terms are convoluted in the mainstream media.
I wish everyone a great weekend as we (hopefully) really do look to a brand new day in health care.
To hear all the catastrophic laments of the left as President-elect Donald Trump prepares to take office as the 45th president of the United States, one would think Chicken Little’s prediction that “The sky is falling” was really about to happen.
Why are the Democrats, Socialists and those who follow them in such a tizzy? Besides the MANY issues that they have with Trump, one of the most valued promises I believe he made to the American people as he ran for president was that he would repeal and replace the Patient Protection and Affordable Care Act (fondly, or not so fondly, known as Obamacare).
During the past election cycle, Obamacare continued its death spiral, which seems to have gone on steroids for the year 2017.
Here are a few of the conditions that are contributing to the unpopularity of Obamacare, except in the leftist circles that seem to prefer staying aboard the Titanic as it sinks.
- Out of the 23 non-profit insurance co-ops that launched with the roll-out of Obamacare, only six remain standing. One of the most recent co-op failures is Health Republic Insurance of New Jersey with a whopping $46 million in debt, according to a September article by Fox News.
- Insurers are claiming big losses and even leaving some state exchanges. The companies that are still operating in the state and federal exchanges are raising their premiums for 2017.
- The average expected premium hike is approximately 8 percent. However, in some areas, according to Forbes Magazine, the average individual market will experience a premium increase of 24 percent.
This is just a thumbnail sketch of the miseries brought on to the average middle class American by Obamacare. I follow many people and groups on Twitter that talk about how worthless Obamacare is to them with its high premiums and deductibles.
However, this is what I hear from the Democrats and those who follow them- they say that if Obamacare is repealed, MILLIONS of people will go without health care. This just is not true. Although I have some rather anti-establishment views regarding any “replacement” of Obamacare that I will outline in future posts, the Republicans have made it clear that they have NO plans to pull the rug out from anybody, and they are discussing how to deal with challenges such as how to make sure that insurance for medical needs is available to everybody, including those with pre-existing conditions.
I have so much to say about this issue because it has been near and dear to my heart ever since the ACA was voted in, so stay tuned for more posts on this subject.