Category Archives: Healthcare Reform

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.”

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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
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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.

 

QOTD: David Burge and Kathy Shaidle On Manifestos

Modern Unabomber?

David Burge (@iowahawkblog) on Twitter, June 27, 2020:
By and large, anyone who publishes a “manifesto” should be hospitalized for psychiatric evaluation

To which Kathy Shaidle commented:

I’m in general agreement, because with very few exceptions, most “manifestos” are a contradiction in terms.

By definition, they are written to arouse outrage and action amongst the general population, but are more frequently just a record of someone talking to themselves. The Unabomber’s manifesto would never have been published if he hadn’t killed a bunch of people….

When I finish my U.S. healthcare reform white paper, I think I’ll call it a manifesto.

Despite $10,000 per person per year, U.S. still  not getting its money’s worth in healthcare

From UPI Jan. 31, 2020:

Despite spending far more on health care than other wealthy nations, the United States has the lowest life expectancy and the highest suicide rate, new research shows.

For the study, researchers at The Commonwealth Fund compared the United States with 10 other high-income nations in the Organization for Economic Cooperation and Development (OECD)—Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland and the United Kingdom—and with the average for all 36 OECD nations.

In 2018, the United States spent almost 17 percent of its gross domestic product (GDP) on healthcare. That’s more than any other high-income country and twice the overall OECD average. For example, New Zealand and Australia spent 9 percent of GDP on healthcare.

U.S. healthcare spending now tops $10,000 per person, and much of it is driven by private insurance costs such as premiums, according to The Commonwealth Fund report published online Jan. 30.

Source: U.S. health stats remain low despite trillions in healthcare spending – UPI.com

The numbers above are outdated. U.S. health care spending grew 4.6 percent in 2018, reaching $3.6 trillion or $11,172 per person.  As a share of the nation’s Gross Domestic Product, health spending accounted for 17.7 percent.

Click to learn what that money is spent on.

Steve Parker, M.D.

PS: Why not try to avoid healthcare spending by getting and staying as healthy as possible? Let me help now. And for less than $20.

Steve Parker MD, Advanced Mediterranean Diet

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

 

U.S. Medical Care Costs Rose 4.6% in 2019

…compared to 2.3% for all items in the Consumer Price Index.

Prescription drugs and hospital services each rose 3%. Physician services were up 1.4%.

Somethin’s gotta give.

 

PBMs: Are They Why Your Drug Cost So Much?

Don’t blame her

The American Prospect has an eye-opening article from 2017 that sheds light on pharmacy benefits managers (PBMs). Ever heard of them?

Author David Dayen starts with comments from pharmacy owner Frankil talking about how he determines how much money he makes on retail sale of a drug:

Like any retail outlet, Frankil purchases inventory from a wholesale distributor and sells it to customers at a small markup. But unlike butchers or hardware store owners, pharmacists have no idea how much money they’ll make on a sale until the moment they sell it. That’s because the customer’s co-pay doesn’t cover the cost of the drug. Instead, a byzantine reimbursement process determines Frankil’s fee.

“I get a prescription, type in the data, click send, and I’m told I’m getting a dollar or two,” Frankil says. The system resembles the pull of a slot machine: Sometimes you win and sometimes you lose. “Pharmacies sell prescriptions at significant losses,” he adds. “So what do I do? Fill the prescription and lose money, or don’t fill it and lose customers? These decisions happen every single day.”

Frankil’s troubles cannot be traced back to insurers or drug companies, the usual suspects that most people deem responsible for raising costs in the health-care system. He blames a collection of powerful corporations known as pharmacy benefit managers, or PBMs. If you have drug coverage as part of your health plan, you are likely to carry a card with the name of a PBM on it. These middlemen manage prescription drug benefits for health plans, contracting with drug manufacturers and pharmacies in a multi-sided market. Over the past 30 years, PBMs have evolved from paper-pushers to significant controllers of the drug pricing system, a black box understood by almost no one. Lack of transparency, unjustifiable fees, and massive market consolidations have made PBMs among the most profitable corporations you’ve never heard about.

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In the case of PBMs, their desire for larger patient networks created incentives for their own consolidation, promoting their market dominance as a means to attract customers. Today’s “big three” PBMs—Express Scripts, CVS Caremark, and OptumRx, a division of large insurer UnitedHealth Group—control between 75 percent and 80 percent of the market, which translates into 180 million prescription drug customers. All three companies are listed in the top 22 of the Fortune 500, and as of 2013, a JPMorgan analyst estimated total PBM revenues at more than $250 billion.

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PMBs initially came about as a means of saving costs. Why hasn’t that panned out?

The biggest reason experts cite is an information advantage in the complex pharmaceutical supply chain.

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This lack of transparency enables PBMs to enjoy multiple hidden revenue streams from every other player. “It’s OK to have intermediaries, we have Visa,” says David Balto, an antitrust litigator and former top official with the Federal Trade Commission. “But these companies make a fabulous amount of money, even though they’re not buying the drug, not producing the drug, not putting themselves at risk.”

The PBM industry is rife with conflicts of interest and kickbacks. For example, PBMs secure rebates from drug companies as a condition of putting their products on the formulary, the list of reimbursable drugs for their network. However, they are under no obligation to disclose those rebates to health plans, or pass them along. Sometimes PBMs call them something other than rebates, using semantics to hold onto the cash. Health plans have no way to obtain drug-by-drug cost information to know if they’re getting the full discount.

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It’s a long article and I confess I haven’t read the whole thing yet. I’ve read enough to rile up my sense of indignation! Pharmaceutical companies and health insurers don’t seem too upset. Because any costs associated with these third-party shenanigans is simply passed on to the consumer—that’s you—in higher insurance premiums, deductibles, and co-pays.

Steve Parker, M.D.

PS: Reduce your needs for drugs with a healthy diet and lifestyle. I can help.

Steve Parker MD, Advanced Mediterranean Diet

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