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 …

The Medical Cartel is Keeping Health Care Costs High

Watch "The Big Heist," a satyrical documentary about our broken healthcare systemBy Travis Klavohn and Dr. Laura Williams

In 2010, the small town of Collegedale, Tennessee had the dubious distinction of having the highest prevalence of Type II Diabetes in the world. Without a single endocrinologist in the small town, those suffering from this preventable and treatable form of the disease were unable to gain access to the treatment they needed.

Dealing with this issue firsthand, a local employer who operates a donut manufacturing plant decided to dedicate a portion of his warehouse to be used as a health clinic. By hiring an endocrinologist from Chattanooga to travel to his warehouse a few days a week, his employees were finally able to receive the help they so desperately needed. Read More …

Get the Health Incentives Right

Fixing our broken healthcare system, reducing costs, and improving care all comes down to getting the objectives and health incentives right.

Motivation - Fixing our broken healthcare system, reducing costs, and improving care all comes down to getting the objectives and health incentives right. This post is based on a comment I made when Pritpal Tamber called for “Creating a parallel system to health care” in MedCity News back in 2014.

At least for consumers, Modern Health Talk (www.mHealthTalk.com) can already be called the “Institute for New Health Thinking,” with well over 100 articles on Legislative, Public Policy, and Health Reform topics written for consumers, and over 700 on modern health topics in general.

I personally think fixing our broken healthcare system all comes down to agreeing on objectives and getting the INCENTIVES right, as I wrote five years ago when proposing a hybrid, public/private model of health care. The goal then was to exploit the different incentives of (1) capitalism and private sector organizations that measure success in business terms such as profit, ROI, and payback period, contrasted with (2) the public sector, which measures success quite differently and over much longer time periods.  Read More …

FCC Broadband Health Imperative – how we responded

FCC Broadband Health Initiative - Modern Health Talk respondsAs a retired IBM technologist, market strategist, futurist, consumer advocate, and founding editor of Modern Health Talk, I am please to respond to this FCC action and will describe my background afterwards. What follows is the detailed docket (16-46) with my responses inserted and key points highlighted. Read More …

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.

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.

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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 …

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 …

Corporate Behavior and Rising Health Care Costs

If healthcare corporations and insurance companies are persons, as the Supreme Court’s Citizens United decision says, then what sort of persons are they?

Click the image to watch

As presented in this award-winning documentary, which you can watch below, the operational principles and legal requirement of a corporation to serve shareholder investment interests, give it a highly anti-social “personality.” Corporations are inherently self-interested (profit-driven), making them often amoral, callous and deceitful, even breaching social and legal standards to get their way. And while they can mimic the human qualities of empathy, caring and altruism, corporations don’t suffer from guilt and can’t be jailed. In short, modern corporations behave like a psychopath, and they use their political clout to avoid regulation and reform.

Free-market capitalism is no longer played on a level playing field, even in healthcare, because large corporations unfortunately invest in lawyers and paid lobbyists to gain political influence and craft laws in their favor. They can effectively “buy” elections with unlimited funds directed in secret to political action committees. 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 …

Are Crypto-Currencies Safe?

Here's a Bitcoin - at least a representation of one since they're actually electronic

Here’s a Bitcoin – at least a representation of one since they’re actually electronic

Last week Yvonne and I closed on the sale of our Austin home and the purchase of another home in the Dallas area. The process was simpler than I remember from the past, and since we paid cash for the new home, we didn’t even need a notary. I just downloaded a few forms, signed them on the kitchen table, scanned into the computer, and sent them back to the Title Company through a secure email service. This experience foretells the future, but are crypto-currencies safe? Really safe?

The US Department of Health and Human Services (HHS) is soliciting research papers related to blockchain applications in healthcare. Blockchain is the enabling technology behind BitCoin and other crypto-currencies, and it’s catching on fast — maybe too fast. Judge for yourself. 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 …

How to pick the good smartphone health apps

With so much choice, here's how to pick the good smartphone health apps and avoid the bad onesBy Carol Maher (original here)

With an estimated 100,000 health and fitness apps available on the two leading smartphone platforms, iOS and Android, it seems there is an app for everything – from tracking your bowel movements, to practising your pimple-popping technique.

However, a number of apps are starting to raise the ire of government regulators. Brain-training juggernaut Lumosity was recently fined US$2 million (A$2.7 million) for making unfounded claims that its app could improve work performance and delay the onset of Alzheimer’s. 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 …

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.

Healthcare Costs are Rising Fast. Need Reforms

NEWS: 24/9/2015 – Healthcare costs are rising so fast in advanced economies that they will become unaffordable by mid-century without reforms, according to a new OECD report.

Fiscal Sustainability of Health Systems: Bridging Health and Finance Perspectives finds that going over budget on health spending remains endemic in most OECD countries. Maintaining today’s healthcare, and funding future medical advances, will be difficult without major reforms that will require health and finance ministries to work together, it says.

Read More …