Category: Health Care Issues
Despite recent failures in at least three states over the last few years, to establish some kind of single payer “health care” system, that Senator Bernie Sanders so fondly refers to as “Medicare for All,” Sanders has once again proposed it for the entire United States. This seems to be a rather irrational idea because even when a strong effort was made in Bernie’s home state of Vermont to get such a system established, it failed abjectly.
Sanders, an Independent from Vermont, introduced a bill Wednesday (9/13) that would basically cover all American citizens (and, from what I have been hearing on the news, some non-citizens). By the way, how did Bernie manage to run for President as a Democrat when he has been an Independent? Politifact answers the question by saying that because his home state of Vermont does not require voters to be registered with a political party, Bernie can remain officially unaffiliated while calling himself a Democrat for the sake of his presidential bid. How convenient!
According to a Washington Post article entitled “Sanders Introduces Universal Health Care, Backed by 15 Democrats,” dated September 13, “the bill would revolutionize America’s health care system, replacing it with a public system that would be paid for by higher taxes.” Standard care such as emergency surgery, prescription drugs, mental health and eye care, would be covered, and there would be no copayments.
The Post article also reports that Americans younger than 18 years of age would be covered immediately and would receive universal Medicare cards. Then Americans who are not currently covered by Medicare would be phased into the program over a four-year period.”
Just a little editorializing here – I am sure that any bill by Bernie will revolutionize anything in America. Think Russian Revolution. No thanks! Then what about those of us adults not currently covered by Medicare that refuse to accept Bernie’s socialized medicine scheme? Are we going to have to build our own underground medical system?
Now this is where the real cluelessness of the loony left starts. The Post article states that private insurance would remain, only it would have fewer customers, and would only be used for elective procedures such as cosmetic surgery.
Here is a hint, oh clueless ones. Cosmetic surgery is not currently covered by most insurances. When it is an elective procedure, it is a cash pay proposition, and that market is functioning very well in terms of price competition and affordability. If cosmetic surgery is covered at all, it is for reconstructive surgery resulting from injuries or conditions that may have drastically disfigured people. So what is it, oh clueless Bernie and company? Is elective cosmetic surgery going to be taken over a third party that will only succeed in making it more expensive?
In this post and the next two, I will do a rundown of the three most recent (and resounding) failures of single payer coverage to take hold in single states. Let’s start with Bernie’s home state of Vermont.
An article by Politico entitled “Why Single Payer Died in Vermont,” dated December 20, 2014 examines the collapse of the single payer ideology in Vermont (for now). It states that Governor Pete Shumlin put the kaibosh on single payer health “coverage” in Vermont, saying that the state couldn’t pay for it. Politico reports that Shumlin said it is not the right time for Vermont to pass a single payer health care system.
His reasoning? He realized that the 11.5 percent payroll assessments on business and sliding premiums that could go as high as 9.5 percent of individuals’ income could hurt the state’s economy. So when would such tax increases NOT hurt the economy, may I ask?
The Politico article quotes Jack Mozloom, spokesman for the National Federation of Independent Business, as saying, “If cobalt blue Vermont could not find a way to make single-payer happen, then it’s very unlikely that any other state will.” He added, “There will never be a good time for a massive tax increase on employers and consumers in Vermont, so they should abandon that silly idea and get serious.” Bernie and his leftist Democrat cronies are always big fans of silly ideas, not to mention government central planning because, of course, no one is as intelligent as our government leaders, right? I guess us peons who are not in government are just too stupid to make our own health care decisions, at least according to Bernie and his cohorts. Oh yes, and according to Jonathan Gruber, one of the architects of Obamacare.
I think I will tackle Colorado’s epic fail to pass single payer “health care” during last November’s election in my next post.
Sources for further reading:
After I wrote my previous blog post about two important principles expressed during the Free Market Medical Association conference, the truth of those principles have continued to be confirmed in my mind throughout the past week, and will, no doubt, continue to be.
I will review those two principles just in case anyone is viewing this blog for the first time (but feel free to read my previous posts, of course). They are:
- Washington can’t fix health care.
- We have to fix health care.
Where do I start when it comes to confirmations of these two principles? A New York Times article written by Marc Santora from November, 2016 entitled, “Many Insured Children Lack Essential Health Care, Study Finds” states the following:
“A new study to be released on Monday by the Children’s Health Fund, a nonprofit based in New York City that expands access to health care for disadvantaged children, found that one in four children in the United States did not have access to essential health care, though a record number of young people now have health insurance.”
In the previous paragraph, the article uses the story of Margo Solomon who has “insurance” for herself and her four children, and yet getting treatment is another matter entirely. Solomon has trouble finding a doctor that accepts her insurance and she has the challenge of finding a specialist for three of her children who suffer from asthma and other medical conditions. The article also says, “And once in the door, she cannot afford the costs, including for deductibles and medications.”
Clearly, this “coverage” is the result of the Patient Protection and Affordable (?) Care Act. Wasn’t this insurance supposed to be for those struggling with health problems and lack of insurance coverage? But what good is insurance coverage if those who have it are still struggling to obtain and pay for the care they actually need? This is something Washington did, but what good is it? I am willing to bet that Solomon would say “Not much” if she is struggling to pay for the out-of-pocket costs such as deductibles and medications.
Who knows? Maybe those brilliant Obamacare “navigators” didn’t bother to tell her she might qualify for some of the cost-sharing subsidies as well as a premium subsidy for low-income people. But maybe she doesn’t qualify for those anyway. I don’t know the woman’s income situation or the levels of income required for those cost-sharing subsidies to apply. However, as challenging as health care is for her right now with her Obamacare “coverage,” (I assume that’s what it is), I would contend that she is much better off without any more government intervention in her personal business. I don’t see that it has helped her all that much.
I am willing to bet that this woman and her children would be much better served by a low-cost Direct Primary Practice, although I don’t know if there are any in her area. Or perhaps, if she could have a Health Savings Account coupled with a low-cost High Deductible Health Plan (a truly catastrophic plan) that would cover the bigger (and hopefully rarer) expenses. With such an arrangement, she could find the doctors she needed at a price she could afford because she could go into a doctor’s office WITHOUT an insurance card and find out how much they may charge for an cash-paying patient (often less than the insured patient) and pay cash for the service with her HSA. However, as I learned a couple of years ago, such a payment strategy for medical services is close to impossible now under Obamacare because of the essential benefits mandates that force insurance companies to cover services for which a health insurance buyer may have no use. I found that the high deductible insurance was very high even if coupled with an HSA when I was trying very hard to escape Obamacare.
This situation, and many similar ones, has been brought on by Washington’s meddling in the delivery of medical and surgical care. During the failed “effort” for the repeal and replacement of Obamacare, we saw that most of Congress only focused on the issues of how many people would be “covered” by health insurance. Yet, in so many cases like the aforementioned scenario, this “coverage” proves to be more and more worthless every day. Yet Washington and the media babble endlessly about “coverage.” Under Obamacare, my coverage stinks! The deductible for my husband and me is $11,500 this year.
So while Washington continues to babble cluelessly about “coverage,” the point made at the FMMA conference, that “we the people” must fix health care remains very solidly at the center of my thoughts. How do we do it? I contend that we start in little personal ways. I am making it a point to become a more educated consumer in my health care choices. I admit to making a few missteps, but I keep making it a point to learn more.
Once again, the doctors, nurses, and other providers of medical and surgical care cannot change health care by themselves. We, as patients, have to go find high-quality physicians and facilities that offer transparent and better pricing for services and use those services. I believe these actions can encourage a free market in health care.
Sources for further reading:
*If you would like to join me in my individual journey to fix health care in the United States, I encourage you to sign up for my email list at the top right hand of this post so that I can share my thoughts and strategies for creating and even better system of delivering medical and surgical care.
I packed up and headed off last Thursday for a conference called “Be a Beacon” being put on by the Free Market Medical Association in good old Oklahoma City, and I have come back with a renewed sense of mission for promoting the free market in medical care along with a great arsenal of information to use on my mission.
Thursday was my traveling day, which turned out to be pretty crazy (more about that later). Then the main part of the conference got started bright and early Friday morning. To begin with, there was a session about Direct Primary Care that I sat in on briefly while I ate breakfast. I was very interested in the way doctors who were involved in their own DPC practices were living, breathing testaments to the benefits of that primary care practice model and to the benefits their patients experienced by being members of such practices.
I am not going to give you a play-by-play of the conference because you can actually get that just by going to the FMMA website, but in this and future posts, I will describe some of the ways that the conference presenters impressed me and my takeaways from those insights.
Something said by the presenters for Texas Free Market Surgery, Dr. Patrick Kelley and his brother Sean Kelley, hit me hard, although it should be quite obvious. Wait for it …
- Washington can’t fix health care.
- We have to fix health care.
(Both these statements were on the Power Point in very large letters.)
Considering what happened in the failed effort to repeal (and possibly replace) the Patient Protection and Affordable Care Act (not so fondly know as Obamacare), I am sure that these two statements are no great revelation. After all, look at all the chicanery that took place around the discussions about various degrees of repealing Obamacare. The country witnessed a lot of wrangling back and forth between Democrats who clearly had no interest in really participating, just spreading unfounded panic, and Republicans (only a handful of which really understood the actual problems with the way health care is delivered). The end result last month was a defeated “skinny repeal” that was meant to reverse the worst aspects of the disastrous legislation and regulations attached to it.
I kept thinking during the entire debate about the cluelessness of many involved, as well as the media, because the entire conversation was about “coverage,” and rarely about lowering the cost of care itself, although Senator Rand Paul did speak up for that. So, back to those two very pivotal statements …
It does certainly appear to be a very correct diagnosis of our current health care woes – that Washington can’t fix health care. I agree with that statement 100 percent. The only thing Washington could do that would be right would be release all of its control of health care, and let the free market totally work its magic. The way Washington is right now – fat chance of that!
Then this week I read an online column by Craig M. Wax, DO in Medical Economics entitled “Both Political Parties Are Responsible for Healthcare Disaster.” This was actually written in the midst of the Senate discussion regarding the repeal of Obamacare. Here is a quote that very much demonstrates why Washington cannot fix health care.
” … It is clear that both major parties in power are conflicted and unduly influenced by major political contributors. It is clear that both parties are bought and sold to big industrial corporate interests compromising their philosophy and stated goals. The Democrats want to increase taxes and borrow money to keep the poor dependent on government and voting for them. The Republicans want to maintain big government and give preferential treatment to corporate interests to gain their votes. It is both sides crushing the taxpayers in the middle.”
Wow, that was well said! It certainly hammers home the statement that Washington can’t fix health care.
So that leads us to the next statement they made – “We have to fix health care.”
Who is “we?”
It is everybody who believes that the only real salvation for the delivery and costs of health care comes from principles of the free market – the freedom of doctors, nurses, third party administrators of self-funded insurance plans, and so many other providers in the delivery chain for medical and surgical care to create and implement innovative ways to drive down the cost of that care to make it available to everyone. The people in health-related careers cannot do it all though. They need the support of their patients who believe in what they are doing to spread the word about how free market health care works for them, and how it can benefit many more people if those people give it an honest chance.
I know I am committed to that. How about you?
For further reading:
The last couple of weeks have been extremely busy, and this resulted in my being unable to get a complete blog post written last week and the week before for the first time since I launched my blog in mid-January of this year. I actually started two posts, which I will complete very soon.
However, I want to pause a moment and think about my “journey” in advocating affordable medical and surgical care, especially in the midst of some potential local controversy in my little world of Iron County, Utah.
The message of how a truly free market in health care can make its costs so much more affordable is certainly a difficult message to get across to many people. From what I have read in writings by doctors I follow on Twitter and on other platforms, I believe one of the main problems is that government meddling in the delivery of health care has become such a norm, especially after Medicare and Medicaid were voted into existence by Congress in 1965, that way too many people have come to expect that if they do not like the way the delivery of medical/surgical care is working, the government will solve the problem. The government tends TO BE THE PROBLEM!
Over the years, government has increased its involvement in the way medical and surgical care is delivered with a plethora of regulation. Of course, the two most recent heavy-handed interventions by government are the Patient Protection and Affordable Care Act (better known as Obamacare) and the Medicare and Chip Reauthorization Act of 2015 (known very unaffectionately as MACRA).
It cannot have escaped anyone’s notice that Obamacare really IS IMPLODING. There are already areas in the country that have been reduced to a choice of only one insurance carrier. One of those areas is mine!
Worse yet, the insurance I have been stuck with the last two years is a monopoly in the state of Utah, and especially in my somewhat rural area. I will call this monopoly out by name because it is important for people to understand how such “health care systems” keep prices high by limiting the facilities and physicians people are able to use.
The culprit in my area, and I am sure many other areas of the country have their own similar culprits, is Intermountain Health Care, which is a “not-for-profit” organization. When I frequently reported on the activities of this much-revered “health care system” in my days working for a couple of weekly papers and one daily paper, I had no idea how Intermountain was operating to CONTROL its competition.
However, I learned that from my orthopaedic surgeon (and eventual employer), Randy G. Delcore, M.D.
One issue with Intermountain is that it is affiliated with a subsidiary insurance company known as SelectHealth. This insurance company has refused to contract with Dr. Delcore’s surgery center, Cedar Orthopaedic Surgery Center, even though the surgery center offers much lower pricing for orthopaedic surgeries than our local hospital does. Therefore surgical patients with SelectHealth are herded to the hospital for orthopaedic surgery procedures where it is guaranteed they will pay more just in deductibles and co-insurance because some of Dr. Delcore’s costs for procedures are well below the average deductible under Obamacare. I have explained in previous posts how hospitals and insurance companies collude to play a game of phony discounts that make people THINK they are getting a good deal, when they are not.
Not only does Intermountain refuse to contract with Dr. Delcore’s surgery center, but it also essentially bribes other insurers and third party administrators to refuse to contract with COSC. This situation is coming to a head even as I write this because the public schools in Utah are self-funded, and yet they have a third-party administrator known as Educators Mutual Insurance that broke off its contract with COSC about four years ago because the TPA was offered a larger “across-the-board” discount for medical and surgical procedures from Intermountain for canceling its contract with COSC than it would get if it continued to renew its contract.
After four years of remaining a physician on contract with EMI, but not being able to offer patients the real savings of procedures at COSC, Dr. Delcore made the very difficult decision to break off his physician contract with EMI. Then EMI did not waste any time in sending emails to those whose insurance it manages that they would have to find another orthopaedic surgeon … and isn’t it so convenient that Intermountain just happens to have two employed orthopaedic surgeons in our area to which patients can be herded?
If this is not monopolistic behavior on the part of Intermountain, I don’t know what is. I feel I can be open about this controversy because I submitted a “letter to the editor” on behalf of Dr. Delcore to our weekly paper, Iron County Today, and it should actually be in today’s edition. So the cat’s out of the bag. I have also been working at mailing out this same letter directed to public school insurance holders who are also Dr. Delcore’s patients. So if you’ve been wondering where I have been, this is what I have been up to while being a little delinquent from my blog, but I feel it is a worthy cause because it is an issue very close to my heart in terms of health care costs.
I don’t know, at this time, how publishing this letter will work out, but I hope we can wake people up to the harm that hospital and insurance company monopolies can cause to patients and society as a whole. I will keep you all posted on what happens next.
Just as little note here – when President Obama was promoting his signature “health care plan,” he praised Intermountain. This alone should tell you something about that company – control issues!
Photo by Daron Pealock, R.N., Nurse/Administrator at COSC- Post Acute Care Unit at Cedar Orthopaedic Surgery Center.
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:
Photo courtesy of canstockphoto.com
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.
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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!
Image courtesy of canstockphoto.com
In many of my posts, I complain about the way our Congress and President (not to mention the Congressional Budget Office and media) harp about how people will or will not be “covered” for receiving medical care. This outlook ASSUMES that it is just too darn expensive for the “average Joe” to just pay cash for his visit to the doctor or surgery. The ultimate irony is that plans within the Obamacare exchanges require quite a bit of out-of-pocket expense anyway – high premiums, deductibles, plus co-insurance, etc. Forking out all this money does not constitute my idea of “coverage.”
What if health (or should I say medical care) wasn’t generally that expensive?
When someone proposes that thought, many others express incredulity at such an idea. It’s as if people asking the question, “Does health care have to be outrageously expensive?” could be compared to someone asking “Is the Pope Catholic?” While there are situations in which the provision of medical care can become very expensive as in the case of heart attacks, strokes, critical injuries, etc., those are situations in which huge amounts of resources are required to save a person’s life and help them recover. That is what catastrophic medical insurance was always intended to do.
Then there are surgical procedures that can be quite expensive, but they do not necessarily have to be. Let’s just use the example of a hip or knee replacement. These procedures are often needed when someone’s arthritic condition has deteriorated to being “bone on bone.” I know personally how painful this can be because I experienced it with both my hips and needed to have them both replaced. Fortunately, medical science has made great inroads to replacing the bad joints and giving those with that condition a new lease on mobility and life.
However, joint replacements are not known to be cheap, and costs vary wildly.
I recently read an article that was published in February of 2013, but not much as changed since then. The article is entitled, “How Much Will Your Surgery Cost? Finding Out Cost of Hip Replacement Surgery is a Confusing Uphill Battle: Study,” which was credited to the Associated Press (1). The study the article discussed was published in the Journal of the American Medical Association Internal Medicine.
According to this article, researchers conducted a study of 122 hospitals in every state to find out how much a hip replacement would cost if performed on a healthy 62-year-old woman who was not covered by any insurance, but could pay out-of-pocket. According to this study, 15 percent of the hospitals contacted never provided even an estimate of a price, even after as many as five calls. The article reported that researchers were able to obtain cost information from approximately half of the hospitals contacted that included both the physician and hospital charges.
The study found that costs for hip replacement surgery could be as little as $11,000 or as much as $126,000.
The Associated Press wrote that American Hospital Association spokeswoman Marie Watteau commented on the study published in JAMA. She is quoted as saying, “hospitals have a uniform set of charges. Sharing meaningful information, however, is challenging because hospital care is unique and based on each individual patient’s needs.”
Really? It seems as if, especially in these times when patients even face high deductibles along with a responsibility for what is known as co-insurance, if they are insured, that hospitals could look at typical charges on a hospital bill for a total hip replacement and at least provide a ballpark figure with a disclaimer that complications could increase that cost.
It is interesting that a number of ambulatory surgery centers have begun to post transparent bundled pricing for many non-emergent surgeries. For example, at Cedar Orthopaedic Surgery Center, the cash price for the replacement of one hip joint is $17,500 (including the surgeon’s, facility, and anesthesiologist’s fees as well as the cost of the hip implant, initial consultation, and in-surgery radiology). This price is posted on COSC’s website. At Surgery Center of Oklahoma, the cost of a hip replacement is posted as $25,000 (which also includes the surgeon’s, facility, and anesthesiologist fees as well as the initial consultation). Each facility has a clear pricing disclaimer that enumerates any possible charges that are not included as part of the cash package as well as what is included, so there should be very little in the way of surprises. And yes, both of these facilities treats each patient as a unique individual.
So why is it so difficult for hospitals to provide at least a reasonable ballpark figure for costs? Well, I’ve given you quite enough to digest for today so I will cover that subject in my next post on health care issues.