Why American Health Care is So Expensive

[Private] Health Spending as share of GDP

This video by Vox and Ezra Klein explains why American health care is so expensive, and it does so simply and effectively. It mentions each of the top issues I write about here at Modern Health Talk, including the political influence of a medical cartel that profits from treating illness and injury with a fee-for-service business model.

The video gives me an opportunity to highlight the many issues contributing to our high costs, with a short description and reference articles for each.

  1. There’s No Easy Fix
  2. Market Forces Don’t Work in Health Care
  3. A Medical Cartel Influences Public Policy
  4. Direct to Consumer Advertising Influences Public Attitudes
  5. Incentives are Misaligned with Goals
  6. Health is Not a Policy Objective but a Political Weapon
  7. Inequality affects Health Wealth, Opportunity & Influence
  8. Single-Payer is Not Enough
  9. Public Health Programs are Effective
  10. Medical Schools teach Diagnosis & Treatment, not Prevention
  11. Disruptive Business Models Break From Fee-for-Service
  12. Tech Solutions Define the Future of Healthcare
  13. Aging Populations Stress Support Systems
  14. Important Documentaries

Read More …

Inequality, Healthcare and the Economy

Wealth Inequality in America

As Congress to vote on tax reform, I’m republishing this article to again raise the issue of inequality.

Rising inequality of income and wealth leads to inequality of opportunity and political influence, and that threatens our democracy. After a Washington Post article concluded that People have no idea what inequality actually looks like, I revised and republished this article, which I’m revising again today. It features a great video infographic and some disturbing videos that help us understand the corrupting influence of big money in politics, and the direct relationships between:

  • Special Interest Lobbying and policies that widen the income & wealth gaps,
  • between the widening gaps and Poverty,
  • between poverty and Obesity,
  • between obesity and Diabetes and other Chronic Illness,
  • between chronic illness and Rising Healthcare Costs, and
  • between rising healthcare costs and our Economic Problems.

Read More …

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 …

Republican Sabotage of Our Health Care System

Trump sabotage of Obamacare

EDITOR: Why does the self-styled “pro-life” party want so badly to raise the death rate through more guns and less healthcare? Some think it’s because white nationalists (aka white supremacists) fear that immigrants and minorities are getting more opportunities than they are. Others think it’s about wealthy elites maintaining political control in the face of sweeping demographic changes. Either way, it’s disgusting and tearing our nation apart. In the referenced article below, Congressional Democrats describe recent administration executive actions ACA Sabotage, to create a healthcare crisis, but Political Genocide may be a more fitting term.

If any of that makes you angry, watch the video at the end to learn why signing up for healthcare during the enrollment period os a good way to piss off Trump.

OBAMACARE SABOTAGE CONTINUES

Since his first day in office, President Trump has created vast uncertainty in health insurance markets. Here are some examples:

His Administration has refused to commit to making cost-sharing reduction (CSR) payments and failed to commit to enforcing the individual mandate, putting the integrity of the risk pool and affordability of coverage in jeopardy. Trump’s obvious attempts to manufacture a crisis caused uncertainty in the marketplace and prompted insurers to sharply increase premiums for the upcoming plan year, or pull out altogether.

By another executive order in October, Trump will allow associations to offer group insurance plans with skimpy benefits and offer lower cost plans to members nationally across state lines. Trump’s order would allow association health plans to be exempted from core Obamacare requirements like coverage of essential health benefits. The ACA’s essential health benefits include hospital care, prescription drugs, maternity care, and mental health. The aim was to broaden the risk pool by preventing insurers from offering cheap plans tailored to young and healthy customers at the expense of older and sicker people. Experts worry this will damage ACA exchangers and result in overall higher costs.

Trump wants to make it easier for businesses to require employees to pay for their own insurance using reimbursements. He also wants to open more loopholes for people to buy insurance outside of ACA markets, attracting younger and healthier people away from current markets. Experts think this will destabilize Obamacare by leaving behind a smaller insurance pool of older and sicker people, resulting in fewer insurers and higher premiums.

Trump’s executive order finally terminates CSR subsidies paid to insurance companies to help people between 100% and 250% of the poverty level pay for the insurance and health care they get through ACA exchanges. Ironically, Trump’s constant threats to terminate CSR subsidies caused uncertainty in insurance markets that exacerbated two problems he blamed on Obamacare – namely, high premiums and the exit of insurers. This intentional sabotage will harm the 7.1 million people, or 58% of Obamacare enrollees, who qualified for subsidies this year.

Signing up for insurance under Obamacare will be a lot harder this year. Trump has shortened the annual open-enrollment period (Now Nov.1 to Dec.15) and announced plans to take HealthCare.gov offline for 12 hours at a time during peek enrollment times, “for maintenance.” He also cut ACA enrollment advertising by 90% and cut funding for Navigator groups who help people navigate the complex enrollment process and pick a plan under the ACA exchanges or Medicaid.

Trump and GOP attacks on Obamacare could come back to bite them politically, because although they have pleased their base, they also made health care more expensive and more unavailable for many Americans, many of whom are in the red states where Trump won.

It’s Not Just Me, or the mainstream press, Saying This

U.S. Congress seal
Analysis by the nonpartisan Congressional Budget Office has shown that every Republican House and Senate bill to replace Obamacare would (1) increase overall costs significantly and (2) cause tens of millions of people to get health insurance coverage. Sabotage can be even worse, and Congressional Democrats have weighed in on that issue.

Democratic members of the House Committee on Energy and Commerce and the Senate Committee on Health, Education, Labor, and Pensions recently released a report warning that Republican actions are causing uncertainty in health insurance markets that is resulting in higher premiums and insurers pulling out. A Manufactured Crisis: Trump Administration and Republican Sabotage of the Health Care System is summarized here with quotes from insurance companies and regulators across nearly 20 states. Read More …

Trumpcare will kill more Americans than Terrorists have

Trumpcare protesters say, "We need Care, not Chaos."

Today I commented on The Senate’s Trumpcare Bill Will Kill 50 Times More Americans Than Terrorists Have. This FORBES article frames the issue in a way that puts the large numbers in perspective.

According to the bipartisan Congressional Budget Office, “15 million people losing insurance translates to at least 18,000 preventable American deaths.” If Republicans simply repeal Obamacare instead, 38,400 would die – or 100 times more than Terrorists have killed. Do I have your attention yet?

My Comment:

Forget politics and ideology for a moment, and look at healthcare from a business perspective, but ignoring the spin of the industry itself. To improve profits, you can either cut costs or increase revenue, or do both. 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.
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People Like the ACA, so it’s hard to Repeal. Here’s why.

It’s not surprising that so many people like the ACA (Affordable Care Act), and that it’s been difficult for Republicans to repeal.

ACA (Obamacare) versus AHCA

Here are 12 reasons people like the ACA (also known as Obamacare), along with detail in supporting charts that compare it with the Republican’s American Health Care Act (AHCA). Most of this work is attributed to The Century Foundation.

1.  The uninsured rate across all ages and income levels has fallen to the lowest level on record, thanks to the ACA’s health insurance exchanges, Medicaid expansion, and other provisions.

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American Health Care Act, a Summary & UPDATE

 

By Wayne Caswell, founding editor

UPDATE 3/24/2017 — Not enough Republicans agreed to pass the American Health Care Act, which would repeal much of Obamacare and kill thousands of Americans by leaving them without health care, so they pulled it.

UPDATE 3/24/2017 — Republicans in the U.S. House of Representatives scheduled a critical vote today but could not secure enough votes within their own party to pass the American Health Care Act. So Speaker Paul Ryan and and President Trump decided to pulled it. The bill to partially repeal Obamacare would partially fulfill a campaign promise and give tax breaks to wealthy benefactors, but it would also steal from the Medicare Trust Fund, gut Medicaid, and result in the deaths of Americans by leaving them without health care. Pulling the bill was a better option than facing angry constituents, 85% of whom were against it. Read More …

Healthcare as Public Utility

healthcare as a public utility - image of health care practitioner with handheld mobile deviceComputing functions once associated with PCs are moving back to big servers in the Internet Cloud, leaving mobile client devices to handle the user interface (UI) but not the data storage and analysis. I find this shift especially interesting, having grown up in the mainframe world at IBM as computing functions moved to PCs.

In the case of speech recognition and Apple’s SIRI artificial intelligence, even the UI function is now split between client & server. This has huge implications for healthcare, with IBM’s Watson and AT&T’s analytics engine aimed at different parts of the healthcare problem.

The networked mobile device (phone, tablet, etc.) will serve as a health gateway between a host of medical & environmental sensors and cloud-based services that collect & analyze the collected data. The benefits will not just target individual patients but be applied across large populations.

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 …

Universal Healthcare Opposition

Obamacare Protest Sign shows Universal Healthcare OppositionWhat is REALLY behind universal healthcare opposition? It’s the fear of helping “LOSERS”

I felt compelled to comment on this article in MedCity News. The article said FEAR was a dominant reason some Americans find it so hard to support the kind of universal healthcare that all other advanced nations have. The dark side of this belief is that “Nobody wants to pay for FREE healthcare for anyone who doesn’t work hard enough, doesn’t have enough determination, or is a Loser” and doesn’t deserve it. The US stands out in this regard, since we are the ONLY one among the 33 advanced nations that does not provide universal healthcare.

While these other countries see healthcare as a basic right and thus a social responsibility, in the U.S. it doesn’t seem to matter whether these ‘losers’ are old people or little kids, are people who lost their jobs, are people with serious health problems through no fault of their own, or are people bankrupt by a serious injury. Those who are afraid to help ‘losers’ speak of defunding the government or killing Obamacare, with no apparent concern that the OECD reports that 17% of US households live below the poverty line, or that they can’t afford healthcare and have an average lifespan 20 years less than those in affluent neighborhoods on opposite sides of the same town.  Read More …

Medical Marijuana Lowers Prescription Drug Abuse

Medical Marijuana Lowers Prescription Drug Abuse

Research Shows That Medical Marijuana Lowers Prescription Drug Abuse

Guest article by Helen Smith

The abuse of prescription opioids such as heroin, morphine and prescription painkillers is a global problem affecting up to 36 million people worldwide. Opioid addiction is of particular concern in the United States, with over two million people abusing prescription medications and around half a million addicted to heroin. The consequences of opioid abuse are immense; the Centers for Disease Control (CDCP) and Prevention notes that deaths via the overdose of prescription medications have risen four-fould since 1999; almost half of all opioid overdose deaths involve prescription medications. The most common medications which contribute to so many needless deaths, are methadone, oxycodone and hydrocodone. The CDC notes that around 1,000 people are treated daily in emergency rooms following the abuse of prescription drugs.

There may be a light at the end of the tunnel, though, with research showing that medical marijuana may curb the rate of prescription drug abuse. Read More …

Health Care Reform – Progress and Next Steps

Obama and White House staff react to passing of the ACA.

President Barack Obama, Joe Biden and the White House staff react to the passing of the Patient Protection and Affordable Care Act (ACA, or Obamacare) on March 21, 2010.

A special issue of JAMA, The Journal of the American Medical Association, on July 11, 2016 published this summary of the Affordable Care Act (ACA), by President Barack Obama, describing successes, challenges, and next steps. JAMA encouraged current and future presidential candidates to submit their own ideas on how best to reform healthcare, so here’s my list of What to Ask Clinton and Trump.

Obama’s article, included below in its entirety (with emphasis added), was accompanied by three editorials from Peter Orszag, former director of the Office of Management and Budget under President Obama; Stuart Butler, a senior fellow in economic studies at the Brookings Institution and former director of the Center for Policy Innovation at The Heritage Foundation; and coauthors Jonathan Skinner and Amitabh Chandra, economic and government professors at Dartmouth and Harvard. Read More …

What to ask Clinton and Trump about Healthcare?

I responded to a Huffington Post article about proposed changes to Medicare and questions that should be asked of Hillary Clinton and Donald Trump, but I went deeper into the serious healthcare issues, citing an article I posted yesterday about The Ideal Healthcare System. It referenced differences between public and private sector organizations but primarily spoke of the need to better align incentives to the nation’s health goals. Therefore, my questions to Presidential candidates relate to that larger view of health and healthcare.

What to ask Clinton and Trump about Healthcare?

What would YOU ask Clinton and Trump about Healthcare? (please comment below and share with others)

Read More …

Let the Health Care Reform Debates Begin, Again

Let the Health Care Reform Debates Begin, Again

Click the image to see some of our other articles on public policy and health reform.

Editorial by Wayne Caswell, Founding Editor, Modern Health Talk

According to Forbes, House Republicans released this week a 37-page draft of their plan to “replace Obamacare and reform entitlements.” To that I say, Let the Health Care Reform Debates Begin, Again.

Even though Obamacare has slowed the rising costs of healthcare as our population ages, significantly more work needs to be done to bring our total costs in line with what other advanced nations pay, and with better outcomes. Doing that – continuing to reform health care – has the potential of cutting our $3.4 trillion/year costs in half, thus saving well over $1 trillion/year. Those savings can then be redirected to other purposes, such as lowering taxes, paying down debt, or making strategic investments in education, poverty, research, and infrastructure. The aim of such reforms is to help all Americans regardless of age, income, or socio-economic status.

But powerful opposition to true reforms comes from within the medical industrial complex that stands to lose over $1 trillion/year in revenue and so spends three times as much on political lobbying as the military industrial complex. It’s important that the public keep House Republicans from being tempted to cave into the lobbying pressure. So what should our goals be? 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 …