Author: Cathy Wentz

The Issue of Profit in Health Care – Part One

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I cannot even begin to count the number of times I have read comments and posts from people on social media, or in response to articles, where someone says that health care should not be for profit. Yes, on its surface, it sounds like a very noble sentiment. But that is just the surface.

We must start by digging beneath the surface of such platitudes, and consider what place health care has in everybody’s lives.

Those who advocate for single payer health coverage insist that “health care” is a basic human right.

In an article on the Medinnovation and Health Reform website, Richard L. Reece, MD (1) provided an excellent line of demarcation between medical care and health care. I will quote it for you verbatim:

“Medical care is what doctors can do for you. Health care includes what you do for yourself – such as diet, exercise, and lifestyle.”

As Shakespeare once said, “Ay, there’s the rub.”

With these two very common-sense definitions, which have been conflated as if they are really synonymous, we can discern the separate purposes of each term. I would conclude that the correct meaning of the term “health care” is how we, as individuals care for ourselves. Unless we are severely disabled in some way, we are all personally responsible for own own health care. If we maintain a sensible diet, level of physical activity, and avoid such unhealthy habits as smoking or inappropriate drug use, we can expect to remain relatively healthy. We can also take the responsibility to see a primary care physician for some basic preventive procedures, but that is our prerogative. Because it is our prerogative, we should have our own choices in which practitioners we see and how we pay for those procedures such as cholesterol testing, mammograms, etc.

For those of us who are physically and mentally capable of managing our own lives, I should add that common sense should guide us to budget some money for medical expenses that will help us to stay healthy or catch a problem soon enough to do something about it. I know that some people have had a problem with politicians making this statement, but it is really common sense – it might be a good idea to forgo the latest smart phone or video game system in favor of stashing away money for some basic medical services. One great freedom-loving way to do this free of too much government interference is to either maintain a Health Savings Account or get a low-cost membership to a Direct Primary Care practice if there is one available. Both routes are affordable even to lower income people, and anyone with an average intelligence should be able to manage such responsibility for their own health.

By the way, on the physical activity front, it takes little to no money to exercise – just personal discipline that anyone has the capability of developing. One does not have to belong to a gym; they can regularly walk, run, or buy some very inexpensive home exercise equipment and/or workout videos. Walmart and Target have very inexpensive exercise aids; I should know because I have bought them.

However, life happens, and there are illnesses and accidents that we cannot control. Let’s say that someone has a serious car accident that is not even their fault (it  happens) and they are injured. Then that person will clearly need medical care with the hope of healing and becoming healthy again. However, in that case, they are clearly not receiving “health” care; they are receiving the medical services of a doctor who must assess the extent of their injuries and recommend treatment. Of course, there are illnesses or conditions that can happen to a person no matter how they manage their health. I don’t think I have ever heard of a way to prevent multiple sclerosis. Once again, they would be receiving medical care that will hopefully take them back to a condition of general health or at least be able to maintain a relative degree of health and well-being.

I go back to the original definition of health care then. As long as we are not incapacitated in some way, we are capable of managing our own health care. Those who are incapacitated in some way will clearly need a personal caregiver and someone to provide the medical care they need to maintain life as well as possible. I do not object to some public provision to make sure the health and medical needs of the most vulnerable people are met. However, all of society should not be lumped into that system; instead such a system should be tailored to meeting the special needs of the most vulnerable people. In fact, I would argue that single payer systems such as Canada’s have been moving toward enabling physician-assisted suicide, so those who are considered to be a “burden” to society could be encouraged to exit the world, which is hardly my idea of care.

Let’s get back to the issue of doctors “profiting” from caring for people. Should not a physician who has very specific skills in treating illnesses and injuries have  same livelihood the rest of us expect? Remember these physicians have sacrificed personal lives, a decent post-college income, often a sizable portion of future earnings to pay off debts for their training, and most often sleep, to take people from a state of illness or injury to health again whenever possible. And yes, those who practice general medicine can encourage their patients to do what it takes to get or stay healthy.

I would like to add to that, most of us expect to “profit” to some degree from our work, and many of us are not as skilled as a physician and have not undergone what a  physician does to be trained in their work. Yet we expect that OUR livelihoods should provide us with more money than it takes to feed, shelter, and clothe us as well as maintain our health. We want our dinners out, movie nights, vacations,  top-of-the-line smart phones, etc. Those should all be funded by profit, not basic living costs. Ditto for doctors.

I have barely warmed up on this subject, and it’s already about as long as the last one, so I will simply leave you here … for now. I will take up the subject again in my next post.

Sources for further reading:

  1. http://medinnovationblog.blogspot.com/2009/04/differences-between-health-care-and.html

*If you would like to receive regular notifications of my posts, please subscribe to my email list. It is located to the upper right of this post.

At this time, the purpose of my emails is to inform you of my latest blog post so you don’t miss out on anything I write. I am also planning on providing you with some interesting educational information in the near future regarding how the United States got to the crazy place we are in right now with the dual goals of general health of the public (I hate the term “population health”) and making sure people with medical and surgical needs receive the care they need. I personally find it fascinating.

 

 

 

 


“But Everybody Is Doing It!”

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How many of us remember that when we were children and were trying to get our parents to let us do something we really wanted to do, and they were reluctant to approve, we would use the line, “But everybody’s doing it!” Of course, the standard parental retort was, “If everybody jumped off a cliff, would you?”

How do you argue with that logic?

As the controversy in the United States rumbles on about the best way to deliver and pay for health care, I hear a line similar to our childish coaxing of our parents being used by those who want to substitute our current health care “system,” if you could call it that, with single payer health care.

This is what I generally read, more or less, when someone decides that the only way out of the country’s current health care troubles is establish a single payer system:

“Most of the other industrialized countries have single payer health systems.”

To me, establishing a single payer system in the U.S. could be compared to jumping off a cliff – it is downright dangerous for many reasons, and we don’t need to do it just because all the “most of the other industrialized countries have single payer health systems.”

Before I go any further in this discussion, maybe it’s time for me to define this single payer health care phenomenon that so many people tout as the best way to deliver health care. Although I believe that most people understand this, single payer health care is administered and paid for, using various methods,  by the central government in a country (in our case it would be the federal government if it, God forbid, were implemented on nationwide basis). The funding for these “health care systems” is generally provided by taxing the populace. A couple of states in the union have attempted and failed to implement single payer “health care.” Those states are Vermont and Colorado. Now California is attempting to establish a single payer system.

In fact, according to an article on the website called “Healthy California,” (1) the California Senate voted 23 to 14  on June 1 to pass Senate Bill 562. This bill appears to be just in the “concept” stage right now, but its basic premise is to guarantee universal health care to every Californian. Once again, I am SO GLAD I don’t live in California anymore.

Single payer health care systems have become, for the most part, a pipe dream for people who believe that everybody should have access to health care.

But does everybody have access to the health care they need in those systems?

In my last post, I already stated that British doctors have been very unhappy with the pay and the working conditions in the National Health Service, Britain’s single payer health system. According to the article I was working from, many of the doctors were ready to go on a “work stoppage.” Work stoppages would deprive people of access to care. So how is care access improved?

However, that is just one element contradicting the “access to health care” argument for single payer health care. The media in Britain and Canada regularly bemoan troubles with access in their single payer systems.

Here are just a couple of examples.

According to a 2015 article in CBC News/British Columbia, entitled “Patients’ ‘Lives Ruined’ As Hip Surgery Waits Grow” written by Kathy Tomlinson (2), the average 2013 wait times for hip replacement surgeries in British Columbia were 48 weeks. They were 54 weeks in Alberta (note: more than a year). The article portrays the stories of two women who were in excruciating pain and disabled because of the long wait that is not a necessity in the United States.

In an April 2017 editorial in the National Review entitled  “The Pitfalls of Single Payer Health Care: Canada’s Cautionary Tale,” (3) author Candace Malcolm states that Canada’s situation has not improved. Actually, it appears that Canada’s situation is only getting worse.

Malcolm writes that the “government central planners” in the Canadian health care system address the issue of fund scarcity by rationing care and capping the number of procedures that are offered in a given year. Well so much for access to and quality of care in “Medicare for All” system.

The only assertion made by Malcolm that I would argue with is the ranking of care quality for Canada as one step above the United States. The ranking was done in 2014 by the Commonwealth Fund, which appears to be very pro-Obamacare and uses metrics that many doctors view as irrelevant.  The reference to this ranking is a little confusing because Malcolm goes on to say that many Canadians resort to the United States to get the care they need and that the U.S. provides a “parallel private system for very sick and very rich Canadians while acting as the driving force for global medical innovation.”

The British National Health Service doesn’t necessarily provide exemplary care either.

In one heavily publicized situation, a man who was suffering from frostbite after he fixed his son’s car in wintry conditions was told he would have to have his leg amputated below the knee. However, that surgery was called off. This man did his best to self-treat his gangrenous toes. and he visited a doctor every six weeks, but he eventually learned that he would need to have those toes amputated.

One British article in Metro about the situation was entitled “Man Cut Off Own Toe With Pliers After Being Forced to Wait for Operation.”(4)

The article reported that 57-year-old Paul Dibbins was told he would have to wait six weeks to have his toes removed even though they were gangrenous and there were clearly no other remedies. He is quoted as saying, “I did it because it’s what had to be done, my doctor told me my toes were going to kill me.”

Clearly, the British health care system did not comprehend the urgency of the situation – either that or the system had more very urgent situations than it was equipped or funded to handle adequately. So, I would argue that access to needed care was not in available in that case.

The Independent, an English publication, published an article in October of 2016 entitled, “‘Myth’ That NHS is Best Healthcare System in World ‘Must Be Debunked,’ says Conservative MP.” (5) The article was forecasting an upcoming speech by Owen Paterson, a conservative member of Parliament. Author Aine Fox wrote that Paterson was expected to speak regarding a report commissioned by UK 2020, a think tank founded by him. One of the many assertions in the report states that avoidable deaths resulting from serious diseases were more numerous, by the thousands, than many other places around the globe.

An interesting point I have observed whenever I read about demands by British citizens, doctors or leaders “to fix” the problems in the NHS is that the government is expected to take full responsibility for the remedies.

How about some enterprising, free-thinking physicians there stepping forward to suggest that the British government set some basic policies that would free people to develop a much more functional free market system? However, sadly enough, when people are stuck on a belief that the government bears responsibility for some aspect of their lives, it is hard for them to break away from that belief.

In light of all this knowledge, does the U.S. really want to get entrenched in that path? Why can’t we find another way to solve problems in U.S. health care that do exist?

Other solutions do exist, and they are already active in the U.S. economy – surgical centers with low transparent pricing, Health Savings Accounts, Direct Primary Care practices that do not accept third-party payments … and others.

I am trying to cut through the nonsense regarding the “reasons(?)” the U.S. should establish a single payer “health care” system. If you want to receive future posts debunking the single payer myths, consider yourself invited to subscribe to my email service that you can sign up for directly to the upper right of this post. I think the next myth I will tackle will be the issues around profit motives in health care.

Sources for Further Reading:

  1. http://www.healthycaliforniaact.org/the-california-senate-just-passed-single-payer-health-care/
  2. http://www.cbc.ca/news/canada/british-columbia/patients-lives-ruined-as-hip-surgery-waits-grow-1.2976196
  3. http://www.nationalreview.com/article/446689/canadas-single-payer-health-care-system-cautionary-tale
  4. http://metro.co.uk/2016/10/25/man-cut-off-own-toe-with-pliers-after-being-forced-to-wait-for-operation-6213983/
  5. http://www.independent.co.uk/news/uk/home-news/nhs-failing-debunk-myth-best-healthcare-system-world-cancer-owen-paterson-conservative-mp-a7377081.html

 

 

 

 

 


Why not Single Payer? I Will Tell You!

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I have recently posted a few articles on my Twitter feed and Facebook professional page about a new push to establish a single payer health care system in California, which I have newly dubbed the Socialist Republic of California, although it has been that way for many years. I never thought I would say this years ago, but I am very happy that I don’t live there anymore.

I suppose the single payer scheme was relatively predictable since the state is one of the leftist capitals of the United States.

Some of the reasons people frequently give for the U. S., as a whole, establishing is a single payer system is that “for profit” medical care is immoral. I think that is a big issue to tackle right off the bat, and debunk a few myths of the high moral standing of other countries who have single payer health care systems.

Let’s start by examining the way health care has been delivered for at least the last 30 or so years, and the costs associated with its delivery. When I was much younger, in my early twenties and I am 60 now, a visit to the doctor’s office for a health problem was relatively inexpensive. I remember needing to see a doctor because I was having pains around my rib cage that just were not going away. I was living with my parents at the time and trying to get my career going after finishing college and a career job immediately after that had not worked out so well. I had no insurance at the time, but the cost of the office visit was $25, which was really pretty reasonable even back then. My mother volunteered to pay it for me at the time, which I thought was very generous because I felt that it was my responsibility.

Fast forward to our present health care situation. Costs appear to have gone through the roof for services that are administered the standard way of the last 35 years or so, especially since the advent of “managed care” and Preferred Provider Networks. There is almost always a third party payer involved – either government (as in Medicaid and Medicare) or a commercial insurance payer. So, it seems that the larger proportion of the country has just become accustomed to having some kind of “coverage.” Now some people in California are saying everyone in the state should be “covered,” but I say they are looking in the wrong direction to solve the issue of health care costs and access to medical care.

As I have stated in earlier posts, many of our costs for health care are the result of an unholy alliance between insurers and health care/hospital provider systems, many of them “NON-PROFIT,” in which these hospitals charge as much as 550 percent more than Medicare is reimbursed for the same services. Then the insurers and the health care corporations negotiate a discount well below that.  Even if the discount is perhaps about 50 percent of the original outrageous charge, it is still crazy to pay any provider system THAT MUCH more than a standard Medicare reimbursement. Yes, many Medicare providers complain that Medicare reimbursements do not cover the cost of care provided to those patients, so they need to make it up in the private market with better commercial reimbursements, but 275 percent above Medicare reimbursement is INSANE. For more details on this situation, see one of my earlier blog posts: http://pollyhealthcare.net/health-care-vs-coverage/.

I have outlined our present situation because I believe that many people look at these shenanigans and think the only way out is to have a single payer system in which everyone gets medical care “for free,” and there is no profit whatsoever involved, as opposed to all of this insurance and provider nonsense. The trouble is that it’s not free. That health care will be  paid for by everyone with an income that is enough to pay taxes on.

Here lies the rub, many of the health care systems touted as providing free and equal access for everyone, are incapable of fulfilling those promises. Is it moral to make promises to a population that cannot be kept?

To avoid overwhelming you with scores of examples of single payer government coverage falling far short of its noble goals, I will give you just one today. More will follow in other posts.

When people say the reason for single payer health care being the “moral” thing to do is because no one should go without care because of a lack of money, what happens if the lack of money is coming from inadequate funding from the government that sponsors that health care system?

According to a January 2016 article in Investors Business Daily, “Britain’s Health Care: So Bad Doctors Don’t Even Want to Practice There,” (1) doctors were threatening to go on strike a week from that article’s publication. The article cited poor pay and working conditions as the reasons for the threatened strike. When there is a single payer health system, doctors and nurses are treated as slaves of that system. Is enslaving doctors, nurses, and other health care workers moral? We wouldn’t do it to anyone else, so why are doctors and other providers the exception?

The aforementioned article reports the following:

“As many as 37000 ‘junior doctors, or doctors in training who represent just half of all doctors in the National Health Service,’ Reuters reports, have said, ‘they would stage a 24-hour stoppage next week, followed by two 48-hour strikes.’

A walkout of disgruntled doctors, the first in Great Britain since 1975, would affect non-emergency care and cause surgeries to be canceled, leaving many Brits, who rely on government health care, to go untreated.

Of course, going without treatment is already part of the British health care experience. The National Health Service is a broken system in need of an overhaul. It can’t continue as is.”

So I ask – do we really want to imitate this system?

I admit the United States has many dysfunctions in the way it delivers and pays for medical care, yet we should certainly not want to imitate the British system that is failing its populace. Governments are generally inept at providing services for people. Just look at our Veterans Administration health care. While some veterans swear by it, others feel they have fallen through the cracks, and according to news reports, some veterans have died waiting to receive necessary care. So the care provided in that government system is not any more “equitable” than it is in the commercial market.

To place a finer point on the fallacy of the moral argument for single payer health care, a system that provides a very “one-size-fits-all” experience and often leaves people feeling trapped in that system even when they are not getting needed care, is no more moral than any other system.

In the U.S., there are a growing number of alternatives to our health care system dysfunctions such as very inexpensive Direct Primary Care, which I describe in this post (http://pollyhealthcare.net/almost-everybody-is-missing-the-point/) or transparently priced outpatient surgical care, that could also be provided charitably by a few funding mechanisms I can think of – more about that later.

In conclusion, I believe the good old American spirit of innovation and problem-solving can be a much better solution for this country’s health care issues than the worn out mantra of “Medicare for All.” I am just warming up on this subject; there will be more to come.

Sources for further education:

  1. http://www.investors.com/politics/editorials/why-british-doctors-do-not-want-to-practice-in-own-country/

 


So Much Misunderstanding about Health Care

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As I was looking through Twitter yesterday, I came upon a meme that really grabbed me because, unfortunately, I think it accurately describes many people’s uninformed attitudes about the place of health insurance in their lives and how it is best managed. Yet, I don’t totally blame most people because the “health care” systems and insurance companies are putting in a great effort to deceive people and make them feel totally dependent on insurance “coverage.”

This meme showed two conflicting statements:

  • One guy states that a sonogram costs $150 if the payment is in cash.
  • The other guy replies, “I’d rather pay the $800 and get credit toward my deductible.”

How crazy is this?

Unfortunately this is a common attitude in our country today. Such an attitude may be the result of people’s natural fear that, somehow or another, they will incur some huge medical bill, and want to be at least partly paid up on their deductible when that disaster happens. However, what if that disaster does not happen in that same year? What if the sonogram is almost the only medical service one receives in the year outside of possibly the follow-up visit to the doctor for the results of the sonogram and a few other routine visits?

I would argue that if a minimal amount of health care is needed in the year that person paid $800 to have a sonogram go through their insurance “coverage,” they probably paid $650 more than necessary just to have that bill count toward their deductible. Not to mention, every year the deductible is wiped clean and starts at zero for the next year. One exception to that rule would be the situation in which some insurance companies allow deductibles accumulated in the last quarter of the year to apply to the next year. However, eventually, the deductible will be reset back to zero.

Another issue with this mentality is that the $800 sonogram paid toward the insurance deductible was most likely based on a negotiated reimbursement rate between one’s insurance company and the service provider. The trick in this negotiation is that the provider (hospitals are generally guilty of this one) charges some outrageous fee and the insurance company has contracted with that provider to pay a lesser amount that may still be fairly ridiculous. The actual charge to the insurance company for the sonogram that was costing the patient $800 is probably much more, and the $800 is considered a “discount,” but only in the insurer/provider universe.

According to an article by Jed Lipinski in the Times-Picayune entitled, “Can’t bring myself to give them that money: Finding out your $284 blood test costs $34 nearby,” (1) a woman found out how insurance companies operate with health systems, much to her chagrin. She had a blood test, a comprehensive metabolic panel for kidney and liver function, done and received a bill from Tulane University Medical Center for $323. The article reported that this patient’s insurance company determined that she owed $284 of that $323. The real clincher was that the same test was available at a nearby lab called Quest Diagnostics for $34.

Now this woman had not made a deliberate choice to pay a large amount instead of a smaller amount to count toward her deductible and clearly felt blindsided by the bill she received. However, I am guessing from my personal experience, that she probably had the blood drawn conveniently at the medical center where she saw her doctor and then analyzed by whatever lab is contracted by Tulane to perform that service.

Another issue here is that it usually all appears so convenient to have one’s blood drawn at the same location as the doctor’s office and patients can just show their card at the front so the insurance carrier is billed for all services. Of course, nobody at the medical center is going to tell patients they can get a better deal elsewhere.

I think that the mentality that one might as well apply all their medical care to their deductible is prevalent because most people assume that ALL health care services are expensive by nature. So why not? Surely they may end up getting their deductible paid off sooner or later in a year because every time they see a doctor or get a medical test, it is guaranteed to be expensive. I believe that is also the reason the Congressional Budget Office attempts to make people panic about repealing and replacing Obamacare – because all medical care is, by nature, expensive so everyone must be “covered.”

However, as the story I just related demonstrates, that is not necessarily true.

I think it’s time that we all become true health care consumers and not blithely stick out our arm or head to a large medical center’s radiology department when we get test orders from the doctor we just saw there. Besides the option of Direct Primary Care in which many common lab tests are available with the cost of a monthly membership, we can look around if the physician we want to keep doesn’t happen to be a DPC doctor. When we have that lab test or x-ray order in our hot little hands, let’s change our mode of operation and ask ourselves, “Can I get this test less expensively somewhere else?”

Maybe we can, maybe we can’t, but why not ask the question?

Better pricing is often available if we shop around, and let’s certainly re-examine our attitudes about paying higher prices just to work toward a deductible. Who knows? If enough people made a habit of shopping around for procedures, the big bad health systems and their crony insurance partners just might think twice about their ridiculous charges and charge something more in line with reality.

I wouldn’t hold my breath on that one though.

Sources for further reading:

  1. http://www.nola.com/health/index.ssf/2017/05/blood_tests_new_orleans.html

 

Photo courtesy of canstockphoto.com


Where is Obamacare Repeal Going?

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There seems to be a temporary lull, as far as I have been hearing, regarding the progress of the American Health Care Act. This is mainly because a whole host of scandals are swirling around Washington, D.C. regarding a Russian connection to the Trump campaign, the firing of FBI Director Jim Comey, and one about whether President Donald Trump gave away some classified information to Russian officials during a meeting.

I think Senate Majority Leader Mitch McConnell is right in saying that less drama from the White House would help the Senate to concentrate on matters that affect the everyday lives of American people.

One of those issues would be health care in the United States and how to repair this very broken system that has become far too dependent on insurance coverage and government intervention. Although the talk in the media for the last week and a half has discussed the scandal du jour ad nauseam, it looks like there is a little bit of work regarding the nation’s health care policies going on in the background. Once again, it seems like some kind of “deadline” looms that is making Senate Republicans think that they may have to do something before June 21.

Why?

According to an article in the online publication Axios (1), this is the date by which insurers have to make a final decision regarding whether or not they will sell insurance  for 2018 on the federal Obamacare exchanges. I am not sure if the states with their own exchanges have alternate deadlines.

So, if the Senate can ignore the White House drama and plug away at the American Health Care Act that is now before it, they have a tough choice to make because they are faced with either passing a short-term stabilization bill of some kind to make sure that there actually insurers on most of the exchanges or try to work on the larger package of health care reform in a way that it could be passed and signed into law in time for that deadline. With all the deep division between the two major parties, as well as between different positions within the Republican party, I am not placing any bets on passing a larger package of sensible free market reforms that could be signed into law by the president in time for the June 21 decision crunch.

So what’s the Senate to do?

According to the Axios article, the Senate has the following options to consider:

  • Go ahead and fund the subsidies so the few remaining exchange insurers would know what they are dealing with in 2018 and would remain on the exchanges, at least for the coming year. (Hopefully such an action would only be considered temporary to provide a “bridge,” so to speak, as the Senate gives more in-depth consideration concerning the best way to repeal and replace Obamacare.)
  • Pass a bill by Senators Lamar Alexander and Bob Corker that would allow people to use premium subsidies to buy health care insurance not offered on the exchanges, which looks like it would only be available in areas where there are no insurance companies on the exchanges. (Once again, I hope this would only be a band-aid solution while the Senate mulls over the best way forward for a free market in health care.)
  • They could always just take their time to put out a bill, regardless of insurance decision deadlines, that allows a free market in health care that can really make health care and insurance affordable for the average person. (There is a great risk of widespread chaos in this scenario, but then maybe it is time for many people to have the government pacifier yanked out of their mouths; they may cry a lot for a while, but then those who know better could direct the ones being broken of their dependency into health care options that are so much better than what we have now.)
  • There may also be another option because Axios also reported that Senator Claire McCaskill has indicated she is planning to introduce a bill as well, but has not revealed anything about it.

Maybe I was at least partially wrong in one of my earlier blogs, when I said Congress needs to take their time to get health care reform right. On the other hand, the Senate cannot slap something together that can get passed and claim they have done the job for the American people. When that happens, I fear that people will just get used to the “new normal” and expect to always be able to buy insurance whenever and wherever they want with a subsidy from the government, which could be just as destructive as Obamacare.

The Senate prospects also look difficult because Republicans only have a narrow majority, so there will be very intense division in trying to repeal a law that Democrats doggedly defend.

For my part, I am going to try my best to communicate with my Utah senators, as well as other key senators, to impress upon them the necessity of getting health care reform right, and familiarizing them with some free market innovations they may not know about that can drive down health care costs without the involvement of insurance.

Source:

  1. https://www.axios.com/senate-grapples-with-looming-health-care-deadline-2411779537.html

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Almost Everybody is Missing the Point

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Every day the American Health Care Act is discussed in the media, most of the dialogue I hear is about how many people will lose their “coverage” or have their “health care” literally ripped away from them if the AHCA is successfully passed by both houses of Congress and signed into law by President Donald Trump. That’s quite a picture!

Such discussion only hammers home one major truth to me – most people have become so accustomed to having the availability of health care defined as whether or nor we have insurance coverage with supposedly convenient copays. It seems that the conventional “wisdom,” if you could all it that, is those without health insurance coverage do not have health care.  After all, health care itself is WAY to expensive to pay for it ourselves. Right?

This impression becomes further entrenched when patients inquiring about what a medical or surgical procedure might cost them generally get a non-answer like, “Well that depends on your insurance plan.”  Let’s say that I am either unfortunate, or fortunate, enough not to have health insurance in the current environment of narrow networks and “non-profit health care” systems that are raking up huge surpluses (i.e. profits). What if I first tell someone at a typical hospital I am not covered by any insurance and then ask how much a procedure will cost? It’s a toss-up as to whether they will quote me the “Chargemaster” price (think grossly inflated) or whether they will say, “We have discounts for our cash-paying patients.” (Fat chance of that.) I am betting that they would quote me the grossly inflated price first. Then, when I balk in horror, and ask if I can get a discount for paying cash, they will quote me something much more doable.

I just saw (and actually retweeted) a tweet this week that was actually a short snipped of the movie, “The Matrix,” a movie I have generally said I did not like (amid gasps of horror from my husband and son). I am thinking I may have to give that movie another chance. But I digress. In this little snippet, Laurence Fishburne’s character (Morpheus) says, “You have to understand that most of these people are not ready to be unplugged, and many of them are so inured, so hopelessly dependent on the system, that they will fight to protect it.”

That is what I see happening as the efforts to repeal and replace Obamacare go forward … people protesting in the streets, pleading to keep their “health care” in town hall meetings, and Democrat representatives and senators howling about mostly “guestimates” from the Congressional Budget Office that as many as 24 million people (a very suspect statistic) could lose health “coverage.”

What if basic health care was so inexpensive for the average person that the only occasion for which the average person would need insurance coverage would be situations like a cancer or other horrible diagnosis or accident? Yes, those things can happen to anyone at anytime, and it is nice to feel that we could have some protection from the curve balls of life that we cannot control.

However, there is so much routine care that should not even require insurance to pay for it – the annual check up, a cold or flu visit, even diabetes management – the issues for which we usually see a primary care practitioner.

There is a type of medical practice that is continuing to gain popularity as primary care doctors get burned out and tired of the same old song and dance from Medicare, Medicaid, and commercial insurance. Many primary care physicians are ditching third party payers entirely and establishing Direct Primary Care practices. These practices are third-party free, which means they do not bill or accept payment from Medicare, Medicaid, or commercial insurers. Instead, they have very reasonable pricing for the services they offer, well below the standard Obamacare premiums and deductibles. Most of them offer a wide array of services for a low monthly membership.

For example, one doctor that I am interviewing for an article I am working on now has monthly service fees of $55 for adults 19-69 years of age, $35 per child 18 years of age and younger, and $75 for seniors aged 70 years and older. Additionally, families of four (2 parents and two dependent children 25 years of age or younger) can have a monthly membership for $130.

What do patients get for this pricing?

  • Communications (phone, text, emails) with doctor and nurse.
  • Clinic visits (regular hours) when necessary
  • Yearly wellness and prevention planning
  • Some routine labs and tests
  • Medical equipment lease (crutches, etc.)
  • Annual flu shot
  • Access to discounted wholesale pricing on other services (labs, medications, procedures, etc.)

Another DPC practice has prices in the same range, more or less – $50/month for adults 20-45 years old; $10/month for each child with at least one parent as a member; $75/month for adults 45-64 years of age; and $100/month for seniors aged 65 years and older. Benefits in terms of access to care are somewhat similar, especially in terms of free office visits, after-hours communications with the doctor, wholesale medication and lab costs.

One person on a Twitter feed I frequent reported that their family premium is $1,600 per month with an annual deductible of $8,000. That family most likely has copays or coinsurance in addition to the frightfully high premium, so it is easy to see that access is much less expensive and available in a DPC practice.

So while many people fuss and whine about “losing their health care” and the Democrats go practically apoplectic over the AHCA, the real solution to health care access and costs is sitting right under our noses.

I would like everyone who reads this post to contact their senator (since that is where the bill is now) and tell them that the AHCA needs to be at least changed to allow free market access and cost solutions like Direct Primary Care. Please educate yourselves about Direct Primary Care, and other free market medical care solutions like ambulatory surgery centers with transparent pricing, because they can solve so many of our nation’s health care problems.

Photo Attribution:

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It’s Half-Done Anyway, but Hopefully Not Half-Baked

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Close up of female African American doctor holding patient’s hand

For those who have been struggling under the intolerable burdens of the Patient Protection and Affordable Care Act of 2010 (affectionately or less affectionately known as Obamacare), this has been an encouraging day. Why? The United States House of Representatives passed the newest version of the American Health Care Act with the purpose of repealing and replacing Obamacare.

This is definitely a hurdle jumped, especially since the House was not able to pass the original version of the AHCA. Apparently there were too many problems with it in the eyes of the House Freedom caucus, the more conservative wing of the Republican party. So some celebration is in order. However, this bill still has a tough road ahead as it makes its way through the Senate.

I really was not sure what would happen. I honestly was concerned that the Republicans would blow their chance to get rid of what I consider a law that’s hated by many people and only lauded by a few. Even the Democrats talked about “improving” Obamacare, although ironically their solution would be to make our health care system worse because it would involve even more strong-arm government control.

I learned, through the last episode in March, not to try to go through an entire bill and try to explain it while trying to translate governmentese without a translator. However, I am well aware of one of the most difficult sticking points in the bill – the issue of how our nation addresses the problem of pre-existing conditions.

Pre-existing conditions are a tough issue because I personally believe that the vast majority of Americans, myself included, want everyone to have access to medical care, whether they are already sick or not. However, some Economics 101 comes into play here. How do we take care of those of us who are less fortunate while allowing much more freedom of choice to the healthier members of our society and not forcing them to pay for someone else’s health problems unless they personally choose to do that?

When Obamacare became the law of the land, guaranteed issue became mandatory that, in effect, required insurance companies to cover citizens whether or not they had pre-existing conditions. Then the “community rating” scheme required that insurance companies not charge those with pre-existing conditions any higher premiums than any one else. As a result, everyone paid the high costs of covering people who already had some kind of illness. This caused premiums to continue soaring year after year after the implementation of Obamacare because insurance companies continued to lose money covering very sick people.

The money lost by insurance companies has continued to grow to such levels that over the last couple of years, several big insurers have withdrawn from the Obamacare exchanges where people needing to buy insurance in the individual market have had fewer and fewer choices.

As the House Republicans celebrated their victory in passing the controversial bill in the White House Rose Garden, Representative Paul Ryan said that it is very important that the AHCA not only pass the House but pass the Senate as well.

“The problems facing American families are real, and the problems facing American families as a result of Obamacare are just too dire and too urgent,” Ryan said. “Just this week we learned of another state, Iowa, where the last remaining health care plan is pulling out of 94 of their 99 counties, leaving most of their citizens with no plans on the Obamacare market at all.  What kind of protection is Obamacare if there are no plans to choose from?”(1)

House Majority Leader Kevin McCarthy also made the point that it is difficult to care for people with pre-existing conditions when there is no care at all. Now the point he was making was that there were areas where there would be no chance for people with pre-existing conditions to have their care covered by insurance plans if there were no insurance plans. Of course, while his point is valid that one cannot get their pre-existing conditions covered by insurance if there are simply no insurance plans to cover them, I would like to point out that it doesn’t mean these people could not actually get care. The question is how would that care get paid for? This is a question for another day.

Although I certainly appreciate the sentiment that insurance coverage for people who are already sick would be very helpful, there are other ways – free market ways – for these people to receive excellent care at a low cost. It’s called Direct Primary Care, which I will discuss at length in my next post.

 


Let’s Restore Common Sense to Medical Care Charges!

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As I was doing my usual scoping of Twitter posts the other day, and I came across one person I follow on Twitter (@StikNtheMud) whose Twitter feed has generally been dedicated to people expressing their disdain for their Obamacare insurance policies. I had actually not been on her Twitter feed for some time, so I figured it was high time to hang out there awhile.

There I found a veritable bevy of comments about the ravages of Obamacare on the average person. Here are a couple of quotes from commenters on this Twitter feed. The names have been withheld to protect the innocent victims of Obamacare.

  • “I don’t want Obama Care. It sucks for me. I lost my doctors, the cost for health care with it is so high. I don’t even go to the doctor anymore.”
  • “In Anchorage, premiums for a silver ACA (Affordable Care Act) plan for a 64-year-old couple making $82K a year =  $50,930 a year. That’s not a misprint.”

Believe me, these are only a couple of the many, many posts decrying the miseries of Obamacare.

So once again, I am beating the drum about so called “coverage” not equaling access to health care.

Wasn’t Obamacare enacted to make health care more affordable?

In the first post mentioned, the person wrote that health care costs are so high that she doesn’t even see a doctor now. Also, in looking closely at the second comment, this 64-year-old couple’s insurance premiums cost more than half their annual income. Clearly, with this annual income, this couple did not qualify for any premium subsidies, and they most likely have a deductible and co-insurance to pay in addition to that annual premium. A mortgage should not even be that much of a percentage of one’s income, much less health care costs.

The ultimate irony here is the name of the law that was supposed to bend down the cost curve for health care is the “Affordable Care Act.”

Posts like the ones above are a strong indication that our current health care environment remains generally Unaffordable, and has become even more Unaffordable each year since the implementation of Obamacare. I do understand that there are those who embraced Obamacare and its subsidies to reduce their premiums. However, if they have deductibles of $5,000 or more, how much use are those plans if they are not the kind of people who see the doctor more than once or twice each year?

Many people have been deceived into believing that if they are in a narrow Preferred Provider network, the contractual agreements between their health care providers and the insurance companies that “cover” them will result in less health care costs for them. NOT!

According to an editorial to which I often refer entitled, “Have PPO Networks Perpetrated the Greatest Heist in American History,” author Dave Chase (1) states that hospitals often charge 550 percent of the standard reimbursement by Medicare. Then the BUCA (Blue Cross Anthem, United Healthcare, Cigna, and Aetna) PPOs will discount such charges by about 50 percent. Well, a quick calculation reveals that 50 percent of 550 percent is 275 percent. Those are still very high charges, and I do not believe such charges actually reflect the cost of providing care.

I could not help but wonder why Medicare reimbursement is the benchmark for reasonable payments of medical costs because I often see complaints from doctors about how the low reimbursement rates by Medicare do not cover the costs of care. I do not think that a payment practice by insurers of reimbursing providers 275 percent of Medicare rates (regardless of whether those rates totally cover the cost of care) is reasonable either. Whatever happened to hospitals and other providers determining their costs (I’m sure they have some brains that can figure that out) and charging an amount with a reasonable profit margin over their costs?

In his editorial, Chase’s interviewee Mike Dendy makes the following statement: “A well-run hospital can make money from Medicare payment schedules. The problem is that most hospitals are not financially well managed and have no reason to be when they can pretty much charge for services at will.” So I guess that is the explanation for Chase using Medicare reimbursement as a benchmark for reasonable payment.

There are so many nonsensical factors that go into heath care pricing, mainly by the large health care systems that also try hard to eliminate the competition posed by independent doctors. These doctors generally have reasonable charges for their services,  but large health care systems (including “non-profit” ones) often either employ them or buy them out. My guess for the motivation of the “health care” systems is that they want to continue unfettered with their ridiculous prices for medical services. (Please see my Expert Posts category for more information on this one.)

So what use is “coverage” when all these ridiculous games are being played by “health care” systems and insurance companies? This has to be stopped!

Further reading:

  1. https://www.forbes.com/sites/davechase/2016/09/05/have-ppo-networks-perpetrated-the-greatest-heist-in-american-history/#2e8cfdfa3330

Image courtesy of canstockphoto.com