Category Archives: Healthcare Reform

Denninger Predicts Severe Economic Contraction in 2024, Thanks to Uncontrolled Healthcare Spending

U.S.A in 2030?

If Karl’s right, you’ll find good deals in real estate in a few years. If you have any money left.

You must expect that no medical care will be available for anything currently paid for by “insurance” or the government.  This is likely too pessimistic but if you count on it and are wrong you die, so being pessimistic by a bit over what’s likely is good rather than bad.  If you can change a chronic disease outcome with lifestyle you better do it now.  If you can’t then get your affairs in order, make peace with God if you believe in him, and then figure out whether you want to settle some scores when the bad stuff starts, because it’s going to and you’re going to have a very bad time of it.D

You must also expect that state, local and federal governments will all get very aggressive in trying to increase tax revenue.  If you live in a large metro area where embedded costs are high you need to get out now.  There is a very high probability that either through internal rot and collapse (e.g. they can’t pay for infrastructure repairs and they fail) or due to either an external actor or an uncoordinated and thus impossible to interdict group of Americans who decide they’ve had enough of the Blue “steal it all” crap infrastructure collapse is initiated and the large Blue Enclaves go feral within days.

If you lose this bet you will die fast and nasty.  If you stay and “win” you still lose; you’ve already seen property tax ramps in most of these places of 100% or more.  If you look at the discounted inflation-adjusted value of your house you’ve lost half of its value over the last 20 years not including the taxes already paid and thus forever gone!  That is, even if you “win” and there is no mass collapse due to either disgruntled Americans or some external actor you will still lose in that the value of your holdings will be destroyed over the next ten years.  It will be gone.  For most people not in the 1% who “own” houses their real estate holdings are more than half of their net worth and for many people it’s essentially all of it.  Get the **** out now or you will lose all of that value.  That much is assured and that’s if you win the bet; lose it and it’s not just money you lose, it’s your life as well.

RTWT.

Steve Parker, M.D.

Steve Parker MD, Advanced Mediterranean Diet

Click the pic to purchase at Amazon.com

Denninger on Price-Fixing In the Drug Marketplace

All Karl below:

Time to stop being nice.

America, you’re being raped.  Flat-out raped.

15 USC Chapter 1 makes clear that price-fixing is illegal.  When it comes to drugs, which are physical commodities, Robinson-Patman (15 USC Chapter 1, Section 13) also makes discriminatory pricing illegal for buyers of like kind and quantity.

(a) Price; selection of customers It shall be unlawful for any person engaged in commerce, in the course of such commerce, either directly or indirectly, to discriminate in price between different purchasers of commodities of like grade and quality, where either or any of the purchases involved in such discrimination are in commerce, where such commodities are sold for use, consumption, or resale within the United States or any Territory thereof or the District of Columbia or any insular possession or other place under the jurisdiction of the United States, and where the effect of such discrimination may be substantially to lessen competition or tend to create a monopoly in any line of commerce, or to injure, destroy, or prevent competition with any person who either grants or knowingly receives the benefit of such discrimination, or with customers of either of them

It is illegal for a pharmacy to charge you $10 for a drug and someone else $100.  Or, for that matter, to charge one person $2.15 million and another a $100 copay.

It is illegal for a hospital to do the same thing.

Things like “GoodRX” and similar are flat out facial violations of the law.

So are “varying” co-pays for the same drug in the same quantity.

So, for that matter, are bribes on a differential basis for the same thing (Section 13 c, d and e)

So, for that matter, are inducing such practices or benefiting from same (Section 13 f)

An insurance company is never a consumer of the drug.  A person is.  Such practices as conspiring with pharmacies and hospitals to vary the price you pay is illegal and has been since the 1930s.

Never mind the first few Sections of 15 USC Chapter 1 which make any scheme to fix prices or lessen competition irrespective of upon whom the price injury falls, or even whether it occurs (proof of same is not required in the statute) a criminal, 10 year in prison, felony.

Drug prices in particular, since drugs are commodities, fall under Robinson-Patman.  There is no exception found in the statutes for drugs.

Source: Prison Or Gallows: Pick One – The Market Ticker

Well worth your time to read the whole thing.

Steve Parker, M.D.

Steve Parker MD, Advanced Mediterranean Diet

Click the pic to purchase at Amazon.com

 

Discover a “Fair Price” For Your Upcoming Medical Procedure

…at Healthcare Bluebook.

I don’t know if the site above is legitimate or not. But I like the idea behind it. Check it out and see what you think.

 

 

Is There a Premium Increase in Your Future: Health Insurers Are Vacuuming Up Details About You

From ProPublica…

“Before the conference, I’d seen a press release announcing that the largest health actuarial firm in the world, Milliman, was now using the LexisNexis scores. I tracked down Marcos Dachary, who works in business development for Milliman. Actuaries calculate health care risks and help set the price of premiums for insurers. I asked Dachary if Milliman was using the LexisNexis scores to price health plans and he said: “There could be an opportunity.”

The scores could allow an insurance company to assess the risks posed by individual patients and make adjustments to protect themselves from losses, he said. For example, he said, the company could raise premiums, or revise contracts with providers. It’s too early to tell whether the LexisNexis scores will actually be useful for pricing, he said. But he was excited about the possibilities. “One thing about social determinants data — it piques your mind,” he said. Dachary acknowledged the scores could also be used to discriminate. Others, he said, have raised that concern. As much as there could be positive potential, he said, “there could also be negative potential.” It’s that negative potential that still bothers data analyst Erin Kaufman, who left the health insurance industry in January. The 35-year-old from Atlanta had earned her doctorate in public health because she wanted to help people, but one day at Aetna, her boss told her to work with a new data set.

To her surprise, the company had obtained personal information from a data broker on millions of Americans. The data contained each person’s habits and hobbies, like whether they owned a gun, and if so, what type, she said. It included whether they had magazine subscriptions, liked to ride bikes or run marathons. It had hundreds of personal details about each person. The Aetna data team merged the data with the information it had on patients it insured. The goal was to see how people’s personal interests and hobbies might relate to their health care costs. But Kaufman said it felt wrong: The information about the people who knitted or crocheted made her think of her grandmother. And the details about individuals who liked camping made her think of herself. What business did the insurance company have looking at this information? “It was a dataset that really dug into our clients’ lives,” she said. “No one gave anyone permission to do this.”

Source: Health Insurers Are Vacuuming Up Details About You —… — ProPublica

Why Your Health Insurer Doesn’t Care About Your Huge Healthcare Bills

Health insurers don’t care because they’re just going to pass the cost on to you and your employer via higher premiums. And the more your employer pays for health insurance fees, the less they can put into your paycheck.

Article like the one linked below make my blood boil.

“After Aetna approved the in-network payment of $70,882 [for a partial hip replacement] (not including the fees of the surgeon and anesthesiologist), Frank’s coinsurance required him to pay the hospital 10 percent of the total.

When Frank called NYU Langone [hospital] to question the charges, the hospital punted him to Aetna, which told him it paid the bill according to its negotiated rates. Neither Aetna nor the hospital would answer his questions about the charges.”

Source: Why Your Health Insurer Doesn’t Care About Your Big… — ProPublica

Here’s a comment left under the article:

I am a physician and have seen these games for years.
It is obvious that the insurers collude with the hospitals and pharmacies, to raise the patients copays.
It is a way of transferring costs onto the consumer.
Each insurance company has a different contract, with each hospital and pharmacy.
For example, I recently needed an MRI. I priced the charges in advance with my local hospital.
If I used my small group blue x policy, I would be charged about $2,200 dollars as my copay. I negotiated to pay the medicare rate in full, and not use my insurance. I paid $240 dollars as the full medicare rate. It was much cheaper for me not to use my insurance, than to use my insurance and pay an inflated copay.

Pharmacies are a little more forthcoming about their pricing, so their games are a little more obvious.
A pharmacy will tell you the price of a drug, but you have to tell them your insurance first.
The chain pharmacies will change the list price for a drug, depending on the insurance.
For example, I told a patient that the silver sulfadiazine cream I was prescribing should cost about $10. The next day they came back furious at me. The local chain pharmacy said it was $440, and their insurance supposedly paid $400, leaving them a copay of $40.

I called around and I found that the full cost at the chain pharmacy without insurance was much less ($35). Walmart had it as one of their $4 drugs. The $440 cream at the chain pharmacy and the $4 cream at Walmart were made by the same generic manufacturer.
I don’t believe that the insurance company was dumb enough to pay $400 dollars for a $4 tube of cream. I think that the list price of the drug was inflated, by mutual agreement between the chain pharmacy and the insurer. By inflating the list price, the patient paid $40 for a $4 tube of cream through their copay. I doubt the insurance company paid anything.

How To Negotiate 80% Discounts Off Your Medical Bills

Click the link below for details. It’s a long article but could save you thousands of dollars unless you’re covered by one of the semi-socialized health insurance schemes like Medicare, Tricare, or Medicaid.

The author knows what he’s talking about. The only potential error I found is where he says federal law requires every U.S. healthcare provider must always charge the same fee for each specific service (CPT code). In other words, they can’t charge one person less or more than someone else. As far as I know, that only applies to Medicare (and Medicaid?) patients.

If you buy a lot of healthcare services, you must read this article.

In a nutshell, the author does this when he needs non-emergency services:

Here we go, step by step:

1) I usually prefer to skip the added expense of going to a GP or family practice intermediary just to get a referral to a specialist that can actually help, especially when I can determine what medical specialty is likely to be most helpful for by medical condition by visiting the website of the American Board of Medical Specialties.  (Is your ignition system acting up, your suspension riding a little rough, need new tires, brakes squeaking, transmission grinding?)                http://www.abms.org/member-boards/specialty-subspecialty-certificates/

2) Use the links on abms.org to visit the appropriate specialty board’s website, and then use their “find a physician” with the sub-specialty likely to be most helpful for the condition.

3) Start calling the sub-specialty physician offices listed, tell them you are a prospective new patient, and ask to speak to the Business Office Manager.  Ask him or her the following questions:   a) “Do you accept Medicare and/or Medicaid insurance?”  If yes, then…   b) “Super!  Do you accept cash payment at the time of service?”  If yes, then…   c)  “Great!  Then, of course, you will accept as payment in full, the Medicaid allowable, but paid in cash by me to you, directly, at the time of service?  Correct?”  If yes, then (e).  If no then (d).   d) “I guess I understand.  Well, then surely you will at least accept as payment the Medi­care allowable, paid in cash by me to you, directly, at the time of service?  If yes, then (e).  If no then conclude the call, because you cannot fix stupid.   e) “Thank you!  Can you please tell me what the estimated amount is for an office visit, using this fee schedule, so I can know how much money to bring, and please make a note on my account that we have negotiated a Single Case Agreement for me to pay these rates to you, in cash, at the time of service?   f) Tell him or her your specific reason for the visit (I am leaking red fluid on the floor of my garage) and that you want to be fully prepared for the visit.  Ask what diagnostic tests, if any, are usually required for this type of problem, lab, X-ray, CT, MRI, ultrasound, etc., and which ones would probably need to be done outside the physician’s clinic?    g) Make sure to get the business office manager’s name and contact information, and the appointment time and date.

Source: How to negotiate directly with physicians and hospitals. | Zero Hedge | Zero Hedge

Another Example of Corruption and Collusion in the Medical-Industrial Complex

“Patients frequently paid more for drugs through copays than the cost of those medications to insurers or pharmacy benefit managers, a research letter in JAMA indicated.”

Source: Over 20% of Copays Exceed Actual Drug Cost (JAMA) | Medpage Today