Category Archives: Healthcare Reform

Kaiser Family Foundation’s 2020 Employer Health Benefits Survey 

This annual survey of employers provides a detailed look at trends in employer-sponsored health coverage, including premiums, employee contributions, cost-sharing provisions, offer rates, wellness programs, and employer practices. The 2020 survey included 1,765 interviews with non-federal public and private firms.

Annual premiums for employer-sponsored family health coverage reached $21,342 this year, up 4% from last year, with workers on average paying $5,588 toward the cost of their coverage. The average deductible among covered workers in a plan with a general annual deductible is $1,644 for single coverage. Fifty-five percent of small firms and 99% of large firms offer health benefits to at least some of their workers, with an overall offer rate of 56%.

Source: 2020 Employer Health Benefits Survey | KFF

Get and stay as health as possible so you don’t need to use health insurance or pay high deductibles before insurance kicks in. Let me help.

Steve Parker, M.D.

Looks Like Blue Cross Has Lost a Huge Antitrust Lawsuit

From The New York Times, Sept 24, 2020:

The nation’s Blue Cross plans have reached a tentative $2.7 billion settlement in a federal lawsuit filed by their customers that accuses the group of engaging in a conspiracy to thwart competition among the individual companies, according to two people with knowledge of the discussions.

The settlement, which was first reported by The Wall Street Journal, would need to be agreed to by each of the three dozen Blue Cross insurers that make up the trade group, the Blue Cross Blue Shield Association. Judge R. David Proctor of the U.S. District Court for the Northern District of Alabama, who is overseeing the case in that state, also still needs to approve the proposed settlement.

It seems that the judge did indeed approve the settlement. I’v read elsewhere that the settlement was only $2.67 billion. This the culmination of litigation that started in 2012. Check the settlement website to see if you qualify for a piece of the pie. The lawyers are asking for 25%. From the settlement website:

Plaintiffs allege that Settling Defendants violated antitrust laws by entering into an agreement not to compete with each other and to limit competition among themselves in selling health insurance and administrative services for health insurance. Settling Defendants deny all allegations of wrongdoing and assert that their conduct results in lower healthcare costs and greater access to care for their customers. The Court has not decided who is right or wrong. Instead, Plaintiffs and Settling Defendants have agreed to a Settlement to avoid the risk and cost of further litigation.

Steve Parker, M.D.

PS: Keep yourself as healthy as possible so you don’t have to get mired in the medical-industrial complex. Let me help.

Snapshot of the Swiss Healthcare System

Switzerland?
<p class="has-drop-cap" value="<amp-fit-text layout="fixed-height" min-font-size="6" max-font-size="72" height="80"><span class="has-inline-color has-black-color">The Swiss have the U.S. beat in terms of longevity and percentage of gross domestic product devoted to healthcare. Their healthcare system may or may not have something to do with it.</span> Switzerland, which has twice as many square miles as New Jersy, only has 8,700,000 people compared to the 331,000,000 in the U.S. The Swiss have the U.S. beat in terms of longevity and percentage of gross domestic product devoted to healthcare. Their healthcare system may or may not have something to do with it. Switzerland, which has twice as many square miles as New Jersy, only has 8,700,000 people compared to the 331,000,000 in the U.S.

From Health Systems in Transition:

Abstract

This analysis of the Swiss health system reviews recent developments in organization and governance, health financing, health care provision, health reforms and health system performance. The Swiss health system is highly complex, combining aspects of managed competition and corporatism (the integration of interest groups in the policy process) in a decentralized regulatory framework shaped by the influences of direct democracy. The health system performs very well with regard to a broad range of indicators. Life expectancy in Switzerland (82.8 years) is the highest in Europe after Iceland, and healthy life expectancy is several years above the European Union (EU) average. Coverage is ensured through mandatory health insurance (MHI), with subsidies for people on low incomes. The system offers a high degree of choice and direct access to all levels of care with virtually no waiting times, though managed care type insurance plans that include gatekeeping restrictions are becoming increasingly important. Public satisfaction with the system is high and quality is generally viewed to be good or very good. Reforms since the year 2000 have improved the MHI system, changed the financing of hospitals, strengthened regulations in the area of pharmaceuticals and the control of epidemics, and harmonized regulation of human resources across the country. In addition, there has been a slow (and not always linear) process towards more centralization of national health policy-making. Nevertheless, a number of challenges remain. The costs of the health care system are well above the EU average, in particular in absolute terms but also as a percentage of gross domestic product (GDP) (11.5%). MHI premiums have increased more quickly than incomes since 2003. By European standards, the share of out-of-pocket payments is exceptionally high at 26% of total health expenditure (compared to the EU average of 16%). Low and middle-income households contribute a greater share of their income to the financing of the health system than higher-income households. Flawed financial incentives exist at different levels of the health system, potentially distorting the allocation of resources to different providers. Furthermore, the system remains highly fragmented as regards both organization and planning as well as health care provision.

I wonder if we should adopt some of their system’s attributes.

Steve Parker, M.D.

We Must Have Healthcare Price Transparency! #HealthcareReform

From the Independent Women’s Forum:

anesthesiologist medical doctor working with anesthesia patent
Not Perla Ni

A few days after a breast biopsy at a Stanford Health Care facility, Perla Ni opened her bill: $143,396.66.

A breast biopsy takes about 45-minutes. Ms. Ni had a high deductible insurance policy, and she paid $7,750 out of pocket. Her insurer, able to negotiate a discount, paid $67,088. By the way, Ni’s insurer is raising its premiums.

Dr. Marty Makary, Professor of Surgery and Health Policy at the Johns Hopkins School of Medicine, and an advocate of price transparency, points out over at Market Watch that what Ms. Ni paid out of her own pocket would have covered the entire cost of the same procedure at the respected Surgery Center of Oklahoma, which requires cash and posts a menu for its prices.

Source: Independent Women’s Forum

Insurance companies care less about keeping costs down when they can simply pass the costs on to you via premiums next year.

For more details, see Dr Markary’s article at MarketWatch.

Steve Parker, M.D.

ObamaCare 10 Years Out: Disappointing

ObamaCare is more formally known as the Affordable Care Act (ACA), which was passed in 2010. From an article published March 5, 2020, at The Hill:

In its first decade, ObamaCare has failed to solve many of the health care problems it was supposed to address. Even worse, it has compounded many of the issues it was meant to fix — the law of unintended consequences in action.

hospital emergency room entrance

First, then-candidate Barack Obama said his namesake act would “cut the cost of a typical family’s premiums by up to $2,500 a year.”In reality, the opposite has occurred. According to the Department of Health and Human Services (HHS), “premiums have doubled for individual health insurance plans since 2013, the year before many of Obamacare’s regulations and mandates took effect.”

***

Third, President Obama repeatedly assured voters, “If you like your health care plan, you’ll be able to keep your health care plan, period.” After ObamaCare was enacted, millions of Americans were unable to keep their pre-ObamaCare health insurance plan.

Individual market premiums were $2789/year in 2013, compared to $5712/year in 2017.

Obamacare proponents promised that the plan would drastically reduce the number of uninsured folks. Wasn’t it 30 million uninsured? But there are still 28 million uninsured. And it’s probably going to get worse since citizens are no longer forced to buy something they don’t want or can’t afford.

Nearly all of Obamacare remains in effect except for the mandate to purchase health insurance whether you want it or not.

The author of the article is affiliated with The Heartland Institute.

Source: ObamaCare: 10 years of distress and disappointment | TheHill

Steve Parker, M.D.

PS: Avoid the medical-industrial complex by getting and keeping as healthy as possible. Let me help:

President Trump’s Healthcare Reform Proposals

Somewhere in the Southwest?

Washington Examiner has an opinion piece on Pres. Trump’s proposed (or initiated/) healthcare reforms:

“Patient choice and control are at the heart of Trump’s plan. It includes alternative forms of coverage, such as association health plans and short-term limited duration plans. It invests in telehealth services, which have been critical for patients during the COVID-19 pandemic. It gives major discounts to seniors for their prescription drugs. The plan increases access to direct primary care, which all but eliminates the insurance bureaucracy that decides what patients will and won’t get.

Perhaps most importantly, it requires price transparency, so patients know what services and procedures cost before they are forced to pay for them. It tips the scales in favor of patients to lower premiums and the cost of care. There will be no more surprise billing bankrupting families.”

Click for the President’s September 2020 executive order. I haven’t read it yet.

Steve Parker, M.D.

Steve Parker MD, Advanced Mediterranean Diet
http://amazon.com/author/steveparkermd Click the link to purchase at Amazon.com. E-book versions also available at Smashwords. com.

AARP, United Healthcare, and CVS Promote Higher Prescription Drug Prices for Seniors

Like type 1 diabetics, many type 2’s need insulin shots

From Washington Times:

Most folks think of the AARP as a membership organization that gives older Americans discounts on magazine subscriptions and cellphone plans. In fact, those business lines are secondary to AARP’s real source of income, a lucrative partnership with United Healthcare.

AARP partners with United Healthcare to offer health insurance plans to its membership. On its face, there’s nothing inappropriate about this type of affinity branding; the problem is that United Healthcare (and, frankly, other insurance companies) have made some decisions at the expense of seniors and the Medicare program, which should run counter to what a seniors-focused advocacy organization endorses. Recent actions by United Healthcare to limit seniors’ access to less expensive versions of Medicare drugs calls into question whether the AARP is looking out for older Americans or its own bottom line.

This is one of many reasons why healthcare is so expensive in the U.S. Spending on prescription drugs here accounts for nine to 9% of total healthcare cost. Annual pharmaceutical spending per capita is $1,443 compared to a range of $466 to $939 in other high-income countries.

We in the U.S. spent $334 billion on prescription drugs in 2017.

Source: AARP, United Healthcare and CVS keep prescription drug prices higher for seniors – Washington Times

Steve Parker, M.D.

PS: Reduce your healthcare costs by getting and staying as healthy as possible. Let me help….

Steve Parker MD, Advanced Mediterranean Diet

Click the pic to purchase at Amazon.com. E-book versions also available at Smashwords. com.

ZDoggMD Ranting About Insurance Company Games and Lack of Price Transparency

I was glad to see this. The concept covered is one reason I’ve been working on my healthcare reform manifesto for months. Price transparency is a key component of fair and sane healthcare reform. Z  has a huge audience compared to mine.

Insurance Companies are to Blame for Surprise Medical Bills

From Townhall.com:

Private health insurance companies routinely deny legitimate medical claims. Most denied claims for doctors are for in-network (so-called “contracted”) services. In these cases, patients never see a bill, and the doctor must separately try to resolve the dispute with the insurance company. For out-of-network (“non-contracted”) claims, however, the doctor is required by law to send the patient a bill while trying to resolve the billing dispute. Most of these denied claims are for legitimate emergency services. They are simply routine claims, not exorbitant or outlier charges as some folks lobbying for the insurance industry would have you believe. Don’t take my word for it. Consider recent comments from former health insurance executive Wendell Potter, who spent more than 20 years working for the giant health insurance companies Humana and Cigna. He explains the real cause of surprise medical bills. According to Potter, “It’s because of a scheme quietly hatched by insurance companies like the ones I worked at, where they decide which hospitals and doctors to include in their networks. They make these choices based largely on what will maximize profits and minimize care.”

Source: Insurance Companies are to Blame for Surprise Medical Bills

Steve Parker, M.D.

PS: Avoid the medical-industrial complex by getting and staying as healthy as possible. Let me help.

Steve Parker MD, Advanced Mediterranean Diet

Click the pic to purchase at Amazon.com. E-book versions also available at Smashwords. com.

 

National Health Expenditures in U.S. in 2019

I’ll be using these stats in my upcoming healthcare reform manifesto unless I can find 2020 numbers:

  • National health expenditures (NHE) grew 4.6% to $3.8 trillion in 2019, or $11,582 per person, and accounted for 17.7% of Gross Domestic Product (GDP).
  • Medicare spending grew 6.7% to $799.4 billion in 2019, or 21 percent of total NHE.
  • Medicaid spending grew 2.9% to $613.5 billion in 2019, or 16 percent of total NHE.
  • Private health insurance spending grew 3.7% to $1,195.1 billion in 2019, or 31 percent of total NHE.
  • Out of pocket spending grew 4.6% to $406.5 billion in 2019, or 11 percent of total NHE.
  • Hospital expenditures grew 6.2% to $1,192.0 billion in 2019, faster than the 4.2% growth in 2018.
  • Physician and clinical services expenditures grew 4.6% to $772.1 billion in 2019, a faster growth than the 4.0% in 2018.
  • Prescription drug spending increased 5.7% to $369.7 billion in 2019 [that’s 9.7% of NHE], faster than the 3.8% growth in 2018.
  • The largest shares of total health spending were sponsored by the federal government (29.0 percent) and the households (28.4 percent).   The private business share of health spending accounted for 19.1 percent of total health care spending, state and local governments accounted for 16.1 percent, and other private revenues accounted for 7.5 percent.

Steve Parker, M.D.