Anyone ElseTerrified about Repeal of ACA Bill
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Pupmom: yeah... my expectations are low.... but I try to remain willing to be pleasantly surprised. I know that we are all grateful that it would appear that Alabama has been spared.
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Lumpie, yes I'm grateful, despite dire warnings from on high, and a sharpie graph to illustrate the threat, lol.
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The Scourge of Worker Wellness Programs
Employers have become obsessed with improving the health of their employees. But does it do anyone any good?
...wellness programs ... are ...a way for employers to save money.
Some... levying up to thousands of dollars in fines on workers who refuse to participate in wellness campaigns or fail to meet certain biometric measures of health. {These policies can} translate to a material punishment for those with physical disabilities {and others}.
These policies "reinforce the notion that your employer should be responsible for your health, thereby making employee health a business expense."
Health care in this country would be simpler and more humane if employers were simply removed from the equation.
{Timing is everything. I decided to post this link after hearing from friends about shockingly intrusive "wellness" programs in their workplace and strategies for dealing with said programs: i.e.: place fit bit in dryer. Regarding the source, readers may consult the media bias rating post above (8/4/2019) should they be so inclined.}
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The National Health Law Program has published two items regarding healthcare proposals and options:
Universal Health Care Guideposts and Principles ("white paper")
Medicare-for-All? Public Option? What Does It All Mean for Low-Income Individuals?
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Use of an Online Crowdfunding Platform for Unmet Financial Obligations in Cancer Care
Technologic innovations, expensive new therapies, and improved access to treatment have all contributed to the rising costs of oncologic care in the United States.1 The financial consequences for patients and their families are substantial. Patients with cancer often borrow money, avoid leisure activities, decrease food spending, sell possessions, go into debt, and/or declare bankruptcy,2 and they are at greater risk for disability or unemployment.3 These consequences are particularly great for patients who are underinsured or uninsured. Recently, online crowdfunding platforms are being increasingly used to supplement insurance and defray expenses, even for experimental and unproven treatments.4 We sought to characterize the use of crowdfunding to support oncology care needs, including any association between insurance status and other characteristics.
JAMA Intern Med. Published online September 9, 2019.
https://jamanetwork.com/journals/jamainternalmedic...
doi:10.1001/jamainternmed.2019.3330
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I Shed My White Coat to Find the Healthcare Bloat
A lot has gone wrong and more money won't fix it
Healthcare stakeholders are playing a game, marking up the price of medical care, then secretly discounting it depending on who's paying.
We learned that one-third of hospitals in one state had sued patients, some very aggressively. One Virginia hospital ... had sued over 25,000 people in a town of 28,000...
I was also encouraged to see outrage among doctors when I had explained to them that, unbeknownst to them, their patients had been sued for services they provided.
One-third of women in the U.S. with stage 4 breast cancer report being harassed by medical debt collectors. In some places, price gouging and predatory billing has become part of a new business model.
So how is it that healthcare costs have been skyrocketing each year? It's the money games of medicine, loaded with middlemen, kickbacks, and pricing failures. These money games today threaten the great public trust in the medical profession.
how is it that academic medical centers are the bastion of scientific genius, yet no one can give you a simple price?
https://www.medpagetoday.com/publichealthpolicy/ge...
Martin Makary, MD, MPH, is a professor at Johns Hopkins University and author of the new book The Price We Pay: What Broke American Health Care and How to Fix it
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Medicare for All: Dispelling the Confusion
Democratic presidential candidates need to better explain their proposals
...medicine is a profession with a mission -- "to cure sometimes, to relieve often, to comfort always" -- not a business.
https://www.medpagetoday.com/blogs/poplin-policy/8...
{Op ed re Medicare for all, some faults in our healthcare system and some options that may be advantageous.}
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I live in a third world small country in the Caribbean. When we get cancer, if the person cannot pay or has no insurance, the government offers free services. Surgery, chemo, radiation, HR meds etc. All up to date, if not cutting edge. I got the exact same treatment as my friend in Canada and my friend in London. None of us paid as UK and Canada also have national health insurance. It never ceases to amaze me that USA are so backward in this respect. It seems to me that the Insurance Companies have some kind of stranglehold over the US economy. I am also amazed that US citizens actually object to the idea of national healthcare for all. Boggles my mind.
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Trinigirl50: It is, indeed, mind-boggling! Thanks for sharing your experience. It is insightful.
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Association Between Having an Automatic Reenrollment Option and Reenrollment in the Health Insurance Marketplaces
Of the 11.4 million US health insurance marketplace enrollees in 2019, 3.4 million were automatically reenrolled based on their marketplace coverage in 2018.1 Marketplace enrollees are automatically reenrolled in their current health plan the following year unless they actively change their enrollment status by discontinuing their coverage or selecting a new plan. Enrollees who actively select a plan have been reported to make better plan choices2; however, requiring enrollees to make a plan selection each year may be associated with their becoming uninsured.3 In January 2019, the Centers for Medicare & Medicaid Services requested public comments on eliminating automatic reenrollment for marketplace enrollees.4 While evidence suggests that administrative barriers to reenrollment are associated with reductions in Medicaid coverage,5 it is unknown whether elimination of automatic reenrollment is associated with decreases in reenrollment in the marketplaces.
https://jamanetwork.com/journals/jamainternalmedic...
doi:10.1001/jamainternmed.2019.3717
{The administration is evidently contemplating eliminating automatic re-enrollment.}
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Employer Health Insurance Is Increasingly Unaffordable, Study Finds
A relentless rise in premiums and deductibles is putting insurance out of reach for many workers, especially those with low incomes.
https://www.nytimes.com/2019/09/25/health/employer...
https://www.kff.org/health-costs/report/2019-emplo...
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This is so scary for so many people!! Having a pre-existing condition is stressful enough without exacerbating the anxiety about losing insurance coverage. We all know there is evidenced based research that stress also exacerbates physical illness. Talk about kicking someone when they’re down.....
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Yogatyme: Yes. Sadly, as things are currently structured, we are all tremendously vulnerable when we need our health insurance/health care. It adds insult to injury that many of us have paid into the system all our lives but have no guarantees when we actually need coverage. And some people who have to quit their regular jobs so they can access Medicaid for critically needed care... what part of that makes sense?
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Lumpie, none of it makes sense. Have you seen the profits of BC/BS, Humana, United Health Care, etc and CEO salaries are ridiculous. Our local hospital CEO gets a raise and a bonus every year but staff have not had COLA raises in 5 years. About every 7 years they fire most of the seasoned nurses and hire new graduates. I am so grateful to be old enough for Medicare....as long as we still have it! This distresses me and it is so worrisome for those w insurance challenges.
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Wow, Yogatyme: Yes! I have seen the CEO salaries and I have had a similar experience (regarding the local hospitals). Sadly, as long as the country elects legislators who are ok with this arrangeent, it is what we will get. That's about the long and short of it. I don't understand it myself. I am not old enough for Medicare so I am walking the high wire re insurance coverage.
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Affordability Boards — The States' New Fix for Drug Pricing
On April 8, 2019, Maryland's General Assembly passed a law creating a prescription-drug affordability board to help the state regulate drug prices. This policy, which took effect on July 1, 2019, requires drug manufacturers to justify high prices or price spikes for both patented and generic drugs. If the board rejects a manufacturer's explanation for a pricing decision, it can, with the approval of the state legislature, set a lower price for the drug.
California's drug-transparency law, which went into effect in 2018, was hailed as one of the most transformative pieces of health legislation in the country. But that law requires drug makers only to provide notice before they raise prices above certain thresholds; it doesn't directly regulate prices.
We believe that the new law is a harbinger of what's to come in drug-pricing legislation. During the 2019 legislative session, eight additional states introduced bills that would create drug-cost commissions. Legislation is pending in half these states, failed in three states, and recently passed in Maine. Maine's affordability board act was part of a four-bill prescription-drug–reform package and is less detailed in its approach than the Maryland law. Like Maryland, Maine limits its board's scope to state, county, and local government health plans.
The challenge facing any state-level effort will be to achieve the kind of scale necessary to affect an industry that manufactures more than 4 billion prescriptions' worth of drugs each year for the United States alone. These new approaches are unlikely to be a substitute for a federal solution that alters the fundamental market factors responsible for driving up drug prices.
https://www.nejm.org/doi/full/10.1056/NEJMp1906010...
October 3, 2019
N Engl J Med 2019; 381:1301-1303
DOI: 10.1056/NEJMp1906010{NEJM allows access to a limited number of articles without subscription.}
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Trump expands private Medicare coverage in new executive order
Trump has recently rolled out a series of health care initiatives.
Read in POLITICO: https://apple.news/ADeg4LwMRReaTYGAISVbcgw0 -
In California, a 'Surprise' Billing Law Is Protecting Patients and Angering Doctors
The state's closely watched law is similar to an approach Congress is considering nationally.
California's surprise billing law limited the payments for out-of-network doctors to a formula based on what other doctors were being paid. Bipartisan bills passed by committees in both the U.S. House and Senate this summer use a roughly similar approach, often described as benchmarking.
A recent survey from the Kaiser Family Foundation found that 78 percent of adults favor a solution to surprise medical bills. When told this could reduce doctors' pay, 57 percent still support the idea.
the president of the Associated Anesthesiologists Medical Group in Palo Alto, said he was the first physician to try out California's appeals process. After the law passed, it prompted his practice to try to sign contracts with all the nearby insurance companies, most of which obliged, offering similar prices. Blue Shield, he said, was the exception. "We made several calls to their contracting officer," he said. "No one ever returned our phone calls. They just refused to acknowledge we existed."
After his practice treated Blue Shield patients at Stanford Hospital, Dr. Champeau received an automatic payment 35 percent lower than what the other insurers pay him, he said. After a long process, he lost the appeal. "Why on earth would they want to contract with me for the average going rate in my area when they knew they were going to be able to pay me 35 percent less?"
https://www.nytimes.com/2019/09/26/upshot/californ...0 -
Trump Outlines Medicare Reform Plan
More options, less waste-fraud-abuse
October 03, 2019
During a signing ceremony that had the aura of a campaign rally, President Donald Trump announced an executive order to "strengthen, defend, and protect Medicare for all of our senior citizens," at a retirement community in Sumter County, Florida, on Thursday afternoon.
He also spoke about plans to lower drug prices through importing drugs from Canada and other counties.
"In a little while ... your governor is going to be able to go out and negotiate to his heart's content ... I have a feeling when that happens the drug companies are just going to say 'we can't have this.' And they're going to drop their price."
HHS Secretary Alex Azar explained that the new order would direct him to propose and to implement a rule to grow the Medicare Advantage, and provide "more diverse and affordable plan options." The order gives the secretary 1 year to propose regulations to that end.
The new rule would encourage innovation in Medicare Advantage structures and plan designs, reduce barriers to accessing Medicare medical savings accounts, and promote "innovations and supplemental benefits and telehealth services," Azar said.
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Trump's Medicare Plan Gets Mixed Reviews
Attacks from the left, praise from the right, mainstream medical groups wait for details
Reactions to President Trump's plans to revamp Medicare -- outlined in an executive order released Thursday -- split largely along partisan lines, with most medical professional societies preferring to remain on the sidelines for now.
{One provider organization} worried that the administration seems to be wanting more information from every patient encounter, in order to pin certain providers as "outliers" for purposes of identifying excessive billings and fraud.
Groups representing nurse practitioners and physician assistants applauded the plan ..., citing its goal of reducing restrictions on advance practice professionals.
...the Main Street Alliance, a small business organization, ... was strongly critical of the plan. "President Trump's new Medicare plan doubles down on his support for the private insurance industry and seeks to expand privatization of the Medicare program," said its executive director...
https://www.medpagetoday.com/publichealthpolicy/he...
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Kristan Hawkins: I'm terrified at the thought of what government-run health care means for my children
https://www.foxnews.com/opinion/kristan-hawkins
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The 'Public Option' on Health Care Is a Poison Pill
Some Democratic candidates are pushing it as a free-choice version of Medicare for All. That's good rhetoric but bad policy.
"Proponents of the public option portray it as a nondisruptive, free-choice version of single payer. That may be good campaign rhetoric, but it's terrible policy."
{Authors discuss the disadvantages of "public option" (vs. public mandatory) reform plans. It includes interesting discussion of the structure of three European plans.}
https://www.thenation.com/article/insurance-health...
Authors David U. Himmelstein & Steffie Woolhandler are Distinguished Professors of Public Health at the City University of New York at Hunter College.
The "all sides" media guide, helpfully provided by by Beesie, (see page 14 of this forum) will allow you to gauge the left-right perspective of this publication.
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Marijen, Thanks for sharing Kristan Hawkins' perspective.
I have to admit that my few fears about a government run system are:
- Corruption (which is a really sad commentary on our society)
- What if the drug(s) I need is/are not covered?
- What if the system decides to reinstate some version of lifetime maximums?
But I weigh that against:
- We spend about double per capita what any other 1st world country does on healthcare
- We have far worse outcomes
- Many of us have healthcare costs that are CRAZY
- My access to providers of choice continues to decrease
- Patient and provider fights with insurance over payment are ... just unbearable
- What about all the bankruptcies (or big but less extreme losses) caused by medical expenses?
- What about losing insurance when you lose your job?
- What about all the people who have no coverage at all?
It's hard to say which would be better for me personally. When I look at society as a whole, I believe that a national healthcare plan would be better. It's interesting that no one even seems to talk about what is best for us all. All the discussion is about what is best for ME. I can't fault a mother for being concerned about her children. But I also think she is naive in supposing that the private system wouldn't turn upon her in only marginally different circumstances. It seems to me that her outlook is informed by the fact that she observes the landscape from relative terra firma.
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I think Kristin’s perpective is pretty right on, that’s why I posted it. Medicare for all is a bad idea because it is unaffordable, thus unsustainable. But your concerns and fears are also good points. I believe that Obamacare ruined it for everyone. If he had just left things alone and only addressed the people that did not have coverage it would have been a great move. Healthcare is a political tool. The democrats want the government to run everything. You are right that corruption is the first problem and the biggest. Plus what does the government run that doesn’t involve a lot of waste?
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People see the big numbers about cost and it can be scary but if you keep in mind all we pay now in premiums, co-pays, deductibles, other out of pockets, the uncompensated care, the bankruptcies and the bloated bureaucracy.... I am not convinced that we would be spending any more. Having worked i healthcare, it was really frustrating to be struggling to render care and to look around and there were twice as many non-clinical people as clinical staff just doing the billing and admin stuff. Obviously, a billing clerk doesn't make what a physician does, but that is very inefficient bloat. "Combined, the CEOs of the eight largest publicly traded insurance companies—including pharmacy behemoth CVS, which acquired insurer Aetna—made $143.5 million in total compensation in 2018, up 14.4%. those same companies recorded a combined $21.9 billion in profits in 2018 on revenue of $718 billion." That is a lot of money that is not providing healthcare. To put it more succinctly, my concern isn't that it is impossible for private health insurance to meet the public need. It is that it has lately failed to do so.
The modern world is complex. We need governments or (quazi?) public institutions to organize and deliver certain functions or to oversee their delivery in a manner that is prudent, not corrupt and serves the public interest. Large swaths of the public trust neither governmental organizations nor the private sector to do this. If we lose trust and faith in our ability to accomplish these fundamental tasks, not only are we unlikely to improve our healthcare dilemma, the trajectory does not bode well for our republic.
Source of quote: https://www.modernhealthcare.com/insurance/health-insurer-ceos-score-big-paychecks-despite-public-scrutiny
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Worse than the huge salaries of health insurer CEOs are the billions in profit.
Also, you see Nancy Pelosi has a bill to limit profit on drug prices to less than 2%?
There aren't enough doctors for Medicare for all
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March 27, 2019
What Medicare-for-All Supporters Won't Tell You
by Merrill Matthews | Publications | IPI Ideas
https://www.ipi.org/ipi_issues/detail/what-medicar...0 -
There aren't enough docs and there will be even less with Medicare for all. Medicare doesn't pay providers well. Private insurances pay better. This will not work. What's the incentive for someone to go through 8 years school and into debt to get Medicare payments. It's laughable.
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Actually, the current environment with insurance companies and money being king, very specifically drove my DH and sister in law, both physicians, to leave medicine. And I suspect they were not alone. I have spent most of my life in a socialized system. My family and I always got the care we needed. Including both rounds with cancer. State of the art tests, care and treatment. Not. One. Dime. My stress was purely would I survive. Then DH retired. My stress levels are off the charts because I never know now whether my treatment has been approved. Also, there are physicians for whom money is not the be all and end all, including DH who chose to accept a much lower salary, and not deal with insurance companies. Rather, it is galling in the extreme for administrators, and CEO's to make millions while providing no benefit to the patient. There is no reason for the obscene CEO salaries.
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Actually, a ton of insurance companies pay less than Medicare. As a provider, I'm on a number of panels that have worse reimbursement.
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