A Public-Private Hybrid Healthcare System


American Healthcare is Going Public, and Private. (Click to read article)

I published this article back in 2012 but updated it now because Senators Bill Cassidy and Lindsey Graham just introduced a bill they aim to ram through Congress without a CBO score or public hearings. Senator Bernie Sanders also has an Obamacare replacement. It’s a form of Medicare-for-All, and it’s gaining wide support among Democrats and the public.

GOOD NEWS UPDATE: Republicans failed to get enough votes to pass the Cassidy/Graham bill.

As founding editor of Modern Health Talk, I think both sides need to step back from partisanship, look at the big picture, consider all stakeholders, look to other advanced nations for inspiration, and combine the best properties of each into a public-private hybrid healthcare model.

Is Health Care a Right? — Dr. Atul Gawande, a surgeon and public-health researcher, wrote an amazing article for The New Yorker that asks a question that’s been dividing Americans. His interviews offer important new insights that were missing in the Republican push to repeal and replace the ACA without a single public hearing. Not only do we need to understand what other nations do, but we also need to understand the different perspectives of our own citizens. This amazing must-read article is a good companion to my own article on Single-Payer. Read More …

A Single-Payer Healthcare System for All Americans

Will Fisher Explains Single Payer With Jelly Beans

Watch Will Fisher Explain Single Payer With Jelly Beans (YOUTUBE)

For most of us, getting healthcare in this country is way too hard, as the video at the end shows. So to those in Congress who would make it even harder, I say, “Keep It Simple, Stupid,” with a single-payer system providing universal coverage and healthcare for all.

Because so few people know what single-payer is, Will Fisher uses jelly-beans to explain it. To begin with, single-payer is NOT where the government employs the doctors and directly provides the care. That would be single-provider care.

Will’s jelly-bean analogy shows how we currently Pay for care and the savings from a single-payer system. But read on to see why even Bernie Sanders’ Medicare-for-All plan, doesn’t go far enough to achieve the far greater savings potential I so often write about.
Read More …

Medical Errors versus Malpractice Lawsuits

Medical Errors versus Malpractice Lawsuits

With every legislative session, lawmakers seem to further reduce the rights of people injured by medical errors and malpractice.

Often described as a form of corporate welfare, Tort Reform makes it more difficult for people to file lawsuits and caps any award they get for damages. Some states even require the losing party to pay the court costs of the opposing party, making malpractice lawsuits extremely risky for individuals facing opponents with deep pockets. Read More …

Why Republicans Want to Repeal Obamacare

Robert Reich on Why Republicans want to Repeal Obamacare

Here’s what Reich says about an Obamacare repeal:

  • 32 million people will lose coverage, [23M-24M if replaced with Senate or House versions, per CBO]
  • Tens of thousands of American’s will die as a result (over 50 times as many as killed by terrorists),
  • Medicare and Medicaid will be left in worse shape, and
  • The rich will get richer in a massive redistribution of wealth.

Missing from this list, and discussed after the video, is what appears to be racist resentment of having a black President in the White House, no matter how qualified. Repeal is also pragmatic, because it helps Republicans contain a demographic shift works against them and maintain control of Congress, the Presidency and the Supreme Court. Read More …

Influencing Healthcare Policy – Lobbying, Incentives & Insurance

Benjamin Franklin is credited as saying, "An ounce of prevention is worth a pound of cure," but policymakers seem more influenced by the money he's pictured on.

Ben Franklin said, “An ounce of prevention is worth a pound of cure,” but policymakers seem more influenced by the money he’s pictured on.

By Wayne Caswell, Founding Editor, Modern Health Talk

As President Trump’s administration transitions from the Obama era, a conservative ideological shift will influence healthcare policy, but so will other factors. They are discussed here, based on my response to “The Past, Present and Future of Healthcare Policy” at ReferralMD.

Influencing Healthcare Policy

Although The Patient Protection and Affordable Care Act, more commonly known as ObamaCare, has flattened the curve to the lowest annual cost increase in decades, it still has not reduced overall costs for many reasons. These include (1) special interest lobbying to protect industry revenues & profit, (2) misaligned incentives, and (3) an insurance middleman that adds more cost than value. It is unlikely that any “repeal and replace” strategy can live up to Trump’s promises because of these three factors. Read More …

US Healthcare System has Cancer. Can Trump Fix it?

By Wayne Caswell, founding editor, Modern Health Talk

Dr. Sudip Bose says, "The epicenter of health care is the doctor-patient relationship."

Opening his January 16, 2017 Huffington Post article, Dr. Sudip Bose said, “One thing is certain about the future of Obamacare, and that is that it will change under a Donald Trump presidency.“ Given his public statements, Trump will clearly make sweeping changes sooner than later, but what those changes will be is anything but clear. That’s why today’s article describes what I hope for, if not what I expect.

The US healthcare system has cancer – a malignant form that started way before Obama became President, and it has taken decades to grow to its current condition, where our very existence is threatened. It’s my hope (remember Hope & Change?) that healthcare reform under Trump will not just treat the symptoms of a growing healthcare cancer, like the lack of insurance competition or price transparency. I hope Trump will recognize the need to treat our healthcare system’s cancer aggressively, naturally and holistically. Will he? Read More …

Why Medicare-for-All is Not Enough

Doctors Prescribe Single-Payer Health Care Reform

Doctors Prescribe Single-Payer Health Care Reform

Dr. David Himmelstein speaks at a news conference about the new Physicians’ Proposal for Single-Payer Health Care on the steps of City Hall in New York, May 6. Photo: Annette Gaudino

Well before Bernie Sanders entered the presidential race, a nonpartisan group of 39 leading doctors set out to fix the glaring problems in the Affordable Care Act (ACA, or Obamacare). The single-payer plan they proposed, essentially Medicare-for-All, has since been endorsed by over 2,000 physician colleagues and published in the American Journal of Public Health, according to this article in Huffington Post.

The HuffPost article generated lots of reader comments, and I just had to respond because this is the sort of debate I love to jump into. It brings together many different perspectives, especially those of consumers who too often aren’t heard from by politicians. Here’s a summary of my responses and answer to the question, “Is Medicare-for-All enough?” Read More …

Getting Disability Benefits as a Caretaker

Getting Disability Benefits as a Caretaker

By Bryan Mac Murray, Outreach Specialist, Social Security Disability Help (Not affiliated with Social Security Administration)

Applying for Disability on Behalf of Someone Else

The Social Security Administration (SSA) knows that disability applicants are not always physically or mentally able to complete the application themselves. For this reason, there are processes in place that allow a caretaker to apply for Social Security disability benefits for someone else. Read More …

Chipping Away at Healthcare Special Interests Yet?

Is it just “One Step Forward and Two Steps Back?” or is something bigger happening?

Last week I read an excellent article in Huffington Post by Charles Francis, and it inspired today’s post about public interests versus special interests. In this article I’ll reflect on the healthcare progress consumers are making despite politicians working against them. But first, more on the obstacles we face.

Special Interests Pull Puppet Strings

In How Mindfulness Meditation Can Transform Health Care, Charles examines the need to change consumer behavior toward healthier lifestyles, so I thought about the role of incentives and awareness education. I’ve written about that before, but today I’ll take a broader look at the many factors influencing the health and productivity of our nation’s workforce and why I remain guardedly optimistic that we’ll overcome political corruption. Included are links to many related articles and this list of over 130 past articles on healthcare policy. Read More …

Texas has the Highest Uninsured Rate

Uninsured Residents - Red States versus Blue StatesThe data is in from a WalletHub analysis of 2015’s States with the highest & lowest uninsured rates, and as an Austin resident, I’m again embarrassed to say that Texas has the highest uninsured rate.

Having insurance is vital to the health of your family and your wallet. It can significantly reduce your out-of-pocket medical expenses, the leading cause of personal bankruptcy in the U.S. Today, however, 11.7 percent of all Americans — many of whom earn a low income — remain without coverage.

For the second year in a row, WalletHub’s analysts drew upon the most reliable data to estimate the rates of uninsured pre- and post-Obamacare for the 50 states and the District of Columbia. For a broad perspective of those rates, they broke the national figures down to the state level and other categories, including age, race and income level. A summary of their findings are included below. Read More …

Consumers Screwed with Insurance Loopholes

Insurance Loopholes & Master Pricing:
How Surprise Medical Bills Knock Consumers Down

Medical Records (photo courtesy of CX2)

Most of us know which local hospitals and doctors are covered by our insurance providers, but even when we make sure that we only see an in-network physician or surgeon, nearly one-third of privately insured Americans are still hit with higher-than-expected medical bills, often because their in-network hospital brought in or contracted out to an out-of-network service provider. How did we get to the point where so many consumers have so little information about what to expect when their hospital bill arrives? (read full article)

Consumers Screwed with Insurance Loopholes

As explained in this excellent article, even though Obamacare intended to address rising prices by promoting prevention, price transparency, and competition among payers & providers – and there has been progress – the system remains hopelessly complex and in need of serious and more aggressive reform.

I’m more convinced than ever that we need to move toward a single-payer system like Medicare-for-All, modeled after other nations that pay half as much and have better outcomes. Meanwhile there may be a role for the new Consumer Protection Agency, because complexity always allows the greedy to find loopholes and screw consumers, while it makes it more difficult for consumers to protect themselves. But if we rely too much on that, the agency could grow immense.

Most consumers, I think, are willing to assume more personal responsibility and Want to seek the best value in care, but that’s difficult to impossible under America’s current and convoluted Sick Care system, which has perverse incentives to view patients as paying customers and treat their symptoms, thus keeping them coming back, paying.

Republican Alternatives To The Affordable Care Act?

What Would Republicans Do Instead Of The Affordable Care Act?

By John McDonough and Max Fletcher

A new spate of proposals from Republican presidential candidates to repeal and/or replace the Affordable Care Act (ACA) raises the important question: Given an unobstructed opportunity, what would Republicans really do with the Affordable Care Act? Would they repeal the law wholly or just in part? With what might they replace it?

Some suggest that Republican Congressional leaders only advance full repeal to placate their Party’s conservative base, knowing well that repeal cannot survive a certain veto while Barack Obama is President. In January 2017, that obstacle will vanish if Republicans control the White House and both branches of the U.S. Congress. What then? Read More of this excellent article at HealthAffairs.org.

Patient Choices in the Used Car Lot of Healthcare

Used Car Salesman

Guest essay by Chris Oldenburg [with editor’s comments at the end]

In America we love our choices. Drive by any car lot and you might see 10 models that only differ in exterior color. We also love simplicity and service. Those cars had better have a clear cost taped to the windshield right next to a list of what’s included. Read More …

Another Essay on Health Reform and Insurance

Why is Health Insurance So Expensive?

By Jon N. Hall, 8/13/2015 (see full article)

“If insurance actuaries could predict with certainty that every year every house in Kansas would be destroyed by a tornado, how much would a Kansan be charged to insure his house against tornado damage? … After all, insurance is a business, not welfare; businesses exist to make profit.”

American Health Care is Snake Bit
The article makes the point that insurance always costs more than paying out-of-pocket if what is being insured is a certainty, and it argues that that’s what health insurance has become – essentially prepaid medical care. It concludes by saying, “If America wants to preserve the private health insurance business, then private health insurance policies need to revert back to being ‘catastrophic insurance,’ just as in the days of old. That means we’d all be paying more out-of-pocket.

Beyond that, the author offered no recommendations, so I chimed in with my own. Read More …

Supreme Court upholds Affordable Care Act… Again

BREAKING NEWS

Supreme Court says, "ACA OK"

The U.S. Supreme Court this morning ruled on the landmark King v. Burwell case about the legality of federal insurance subsidies. In their 6-to-3 ruling they saved coverage for more than 6M Americans.

According to FierceHealthPayer, Chief Justice John Roberts said, “Congress passed the Affordable Care Act to improve health insurance markets, not to destroy them. If at all possible, we must interpret the Act in a way that is consistent with the former, and avoids the latter.”

Here at Modern Health Talk, we applaud the Court’s decision.

Fixing the Primary Care Crisis

Available in print form on Amazon.com for $14.95As I keep reminding people, Americans spend twice as much as other countries on health care yet still live sicker and die younger, according to the World Health Organization. At $3 trillion/year, that’s about 18% of the nation’s GDP, and it’s not sustainable, especially as our nation’s baby boomers approach retirement age and start needing more medical care in their later years.

I’ve known Dr. Stephen C Schimpff (electronically) for years and have published several of his articles here on mHealthTalk. I’m happy today to promote his controversial new book, Fixing The Primary Care Crisis: Reclaiming the Patient-Doctor Relationship and Returning Healthcare Decisions to You and Your Doctor. ($3.95 for the e-book and $14.95 for the print edition)

Dr. Schimpff begins his book with an overview of what primary care is and is not, why it’s in crisis, and why the American medical care delivery system is so badly dysfunctional. He then explores the concepts of integrative medicine, trust and the all-important issue of healing. Read More …

Insurance Cost = Premiums + Deductibles + Copays

Obamacare Enrollment Drive

MIAMI, FL – FEBRUARY 05: Aymara Marchante (L) and Wiktor Garcia sit with Maria Elena Santa Coloma, an insurance advisor with UniVista Insurance company, as they sign up for the Affordable Care Act, also known as Obamacare, before the February 15th deadline on February 5, 2015 in Miami, Florida. Numbers released by the government show that the Miami-Fort Lauderdale-West Palm Beach metropolitan area has signed up 637,514 consumers so far since open enrollment began on Nov. 15, which is more than twice as many as the next large metropolitan area, Atlanta, Georgia. (Photo by Joe Raedle/Getty Images)

OPINION by Wayne Caswell, founder & senior editor, Modern Health Talk

This is an obvious opinion piece that I posted on Huffington Post in response to another opinion piece, It’s Not Just You — Those Health Insurance Deductibles Are Getting Scary.

MY RESPONSE:

The article was well written but misleading because it failed to acknowledge that Total Insurance Cost = Premiums + Deductibles + Copays. Instead, it focused almost exclusively on high deductibles. Read More …

Telemedicine as good as a Doctor visit?

Video ConsultationVirtual doctor visits via video conference are starting to go mainstream, with some people putting them on par with a regular trip to the doctor’s office. UnitedHealthcare, announcing that they’ll cover virtual doctor visits through American Well, Doctor on Demand, and NowClinic, is the latest to jump on the telemedicine bandwagon.

While these consultations previously would cost $40-50 per call, United members will only be charged a regular co-pay, making virtual medicine more affordable for more people. Coverage of the virtual visits will only be available only to UnitedHealth’s self-funded customers, as opposed to those with employer-funded plans, but the feature will expand next year to most members, showing just how fast telemedicine is taking off. Read More …

About Operating Room Safety

 Make Sure You’re in the Safest Possible Operating Room

Operating Room

The Hazards of Hospitals

We all think of the hospital as a place we go to get better, but hospitals in the United States are making people sicker at alarming rates. Between overtired interns, germ-covered doctors,  haphazard record keeping, and equipment failures, you might find yourself in more trouble than you were when you checked in. Here are some alarming statistics, followed by some patient recommendations.

  • 1.7 million infections are contracted in hospitals each year.
  • 1 in 5 patients suffer harm from medical errors, and 99,000 die from them.
  • You’re 30,000 times more likely to die from a hospital visit than a plane crash.
  • And more die from infections each year than from car accidents, breast cancer or aids.

High Anxiety

The simple mention of having a medical procedure brings out anxiety in most people. It’s human nature to become fearful when preparing to undergo a surgical procedure that requires in-patient treatment, sedation and operating rooms, as it is associated with pain and mortality. Read More …

Why doctors are so afraid of apples

Old Rotten AppleAs implied in An Apple a Day… the fruit and the smartphone can both keep doctors away, and that has many of them terrified for good reason.

Those at the top of the healthcare mountain especially fear the Healthcare MiniTrends, because they know 429 of the original Fortune 500 companies (1955) are no longer in business today. And they’re looking down at a new class of hungry competitors who are already exploiting these minitrends.

Let’s look at just two of the trends: (1) the new focus on wellness, and (2) new smartphone uses. Read More …