Category: Health Care Issues

Mar
2

Coronavirus, Monday update

Posted by Joe Paduda on Monday, March 2nd, 2020 | Comments

Until things calm down we’ll do an occasional post on the biggest health story out there – coronavirus.

Thanks to Larry – here’s the latest numbers (as of 10 am EST 3-2-20) on cases, recoveries, and mortalities by nation. Source link here.

Note that all views/opinions/takes are based on what we know now – which will change as time goes on.

First, how afraid should you be?

Quick take – it’s worse than the flu, but way less dangerous than other diseases.

This isn’t Ebola – which has an 80% death rate.  It’s not MERS (death rate of 34.7%) or the plague (death rate of 15% if patients are effectively treated).

Based on very incomplete data, it looks like the death rate is equal to or less than the Spanish Flu – somewhere less than 2 percent. No question – that is a relatively high death rate – but it is based on very preliminary data.

Here’s a datapoint – in the US 18,000 people have died from the flu in the current flu season – and over 300,000 have been hospitalized.

So far, logic says you should be a heckuva lot more afraid of the regular flu.

More to the point, it appears those with compromised respiratory systems, or in poor health, or with other serious health problems are at much higher risk than healthier folks.

BUT – and it’s a big but – that mortality rate may be much lower, because:

  • a significant percentage of people that test positive for corona don’t have any symptoms
  • tests  – especially the one initially used in the US – weren’t very accurate

How contagious is it?

Probably about the same as a “regular” flu; again initial reports indicate corona is more contagious, but that may be because it was a brand new disease, wasn’t managed well at the outset, and started in a very densely populated area.

What are the symptoms?

Initially, fever and a cough; some victims go on to contact pneumonia.

Will corona go away when it gets warmer?

We have no idea. There is no scientific basis for President Trump’s claim that warmer weather will end the epidemic; this is a brand new virus and no one has any idea if or how it will be affected by weather.

Lastly – be very careful about information sources.

The World Health Organization is the best I’ve seen.

One that pops up at the top of google searches is RT. RT is funded, staffed, and written by the Russian government.  RT highly exaggerates death rates, here’s one example: RESEARCHERS DISCOVER MERS HAS A 65% FATALITY RATE

This is categorically false.

To date, White House announcements about corona haven’t been much better. White House statements have downplayed the risk of corona, the number of cases, how fast it is spreading, and claimed the flu’s death rate is the same as corona (it isn’t; so far corona looks to be 14 – 20 times more deadly than the flu).

What does this mean for you?

Science is important.

 

Feb
17

Could Medicare for All solve your healthcare cost problem?

Posted by Joe Paduda on Monday, February 17th, 2020 | Comments

You can’t afford other stuff because healthcare is so expensive. Would Single Payer/Medicare for All fix that?

I’m revisiting the topic so we can better understand the many variations of SP/MFA, how they are different, how those variations might work, and whether some version is a) politically viable and b) would solve the cost/access/quality conundrum.

Last week I made the case that voters want healthcare solved, and they don’t much care about the details and nuance. We also showed that employer-sponsored health insurance is a mess.

Can private insurers solve the healthcare cost problem? Well, on one level they get dinged if they control costs. A key point about for-profit insurers – the stock market loves and rewards revenue growth. In health insurance, revenue growth is overwhelmingly driven by higher medical costs. So, medical cost inflation = higher revenues = higher stock prices (yes, this is simplistic, but also mostly true).

Over the last two years insurers have kept premium increases low, but that’s due in large part to cost-shifting to members. In contrast, Medicare can’t cut costs by shifting them to you – benefits are set by law and rarely change significantly.

The big increase in Medicare 2000s was largely drive by the new Part D drug program; focus on per capita costs to account for changes in membership

 

As we’ve noted previously, facility prices are the biggest driver of cost inflation – and that’s where Medicare outperforms commercial payers. Of course commercial payers will say that’s because Medicare can force payers to agree to its prices – which, although true, begs the question – why can’t commercial payers do the same?

One main reason – in many areas, provider consolidation has given health systems market power – health providers have more leverage so they have an advantage in negotiations.

In 43% of markets, providers are super-concentrated, vs only 5% of markets for health insurers

But – in over half of the markets, insurers are highly concentrated – which means they have significant market power.

Reality is health insurers have failed to control members’ healthcare costs. There are lots of reasons – including provider market consolidation, but as one of my rowing coaches once said to me; “I don’t want to hear why you can’t, I want to hear how you will”.

What does this mean for you?

If for-profit health insurers had done their job – controlling costs and delivering better outcomes and patient satisfaction – you wouldn’t be reading this.

Medicare has a better track record controlling cost – which is by far the most important issue in healthcare.

Jan
29

Private health insurance has failed.

Posted by Joe Paduda on Wednesday, January 29th, 2020 | Comments

If you had “government” health insurance for the last decade, your costs would be 20 – 25% lower today.

That’s because private insurers have not controlled spending nearly as well as Medicare and Medicaid have.  This from KFN via Axios.

Doesn’t matter what your economic or political ideology is – that’s a fact.

You and your insurance company pay your doctors and hospital more than twice what Medicare does. Yes, the Feds can exert pricing power – but why can’t United Healthcare, or Aetna, or Blue Cross?

Those healthcare giants should be able to negotiate better deals with providers; they have massive buying power and millions of members to leverage. They should be able to use that power to give you lower insurance costs – but they can’t.

Those private insurers are (theoretically) more nimble, smarter, better run, and more efficient than the government. And they have hundreds of billions of healthcare dollars to leverage.

Yet they’ve failed to outperform a bunch of bureaucrats.

I won’t dive into the “whys” today, because that would take away from the over-arching truth – government has been much more effective than private insurers.

What does this mean for you?

Cutting your health insurance costs by a quarter = more dollars you could have spent on other stuff.

note – happy to hear other thoughts; please use citations to back up any assertions.

Jan
24

What would you do with another $8,000?

Posted by Joe Paduda on Friday, January 24th, 2020 | Comments

The US healthcare system is costing you $8000 more than it should.  That’s because you – the consumer – are at the mercy of hospitals, insurers, doctors, device companies, pharma.

You know this.

You know the healthcare “system” is designed to make money for healthcare providers, big pharma, device companies, healthplans – not to help you and your family stay healthy and functional. 

You know the healthcare system makes money – buckets of it.

You know we spend way more than any other country, yet we die younger.

You know  Purdue Pharma made tens of billions of dollars addicting your neighbors and kids, and got away with it for decades.

You know this because the hospital industry has never been more profitable. Oh, and rural communities are losing hospitals because those hospitals aren’t “profitable” – despite the fact that rural Americans are losing access to desperately needed healthcare.

You know this because you can’t “negotiate” with your local hospital, or insurance company, or pharmacy – because they have all the power and data and political influence, and you have none.

You know this because your healthcare premiums and deductibles and out of pocket costs keep climbing – and your wages don’t.

Healthcare is not, and cannot ever be, a free market. A free market requires buyers have the ability to make sellers respond to buyers’ needs – yet we all know we consumers have zero ability to make pharma, hospitals, big doctor groups, device companies respond to our needs.

How dysfunctional is this “healthcare system” that costs you $8000 more than it should?

Well, imagine if air travel was like healthcare…(link opens video)

This is why your family is paying the healthcare industry $8000 more than you should – the industry has all the power, we have none.

What does this mean for you?

This will continue until you decide it won’t

Jan
15

The greatest healthcare system in the world.

Posted by Joe Paduda on Wednesday, January 15th, 2020 | Comments

No better description of our totally dysfunctional “healthcare” “system” from a good friend and colleague. (this is not my situation)

I thought you might get a kick out of something that happened the other day.  I got a call from the hospital where I’ll be getting treatment over the next few months.  They wanted to let me know that they have an estimate, based on discussions with my medical insurer, as to what my out of pocket costs would be for the treatment that’s so far been prescribed.   After walking me through all the necessary ‘caveats’, the young lady then asked me how I would like to pay my responsible share, which is thousands of dollars.
Here’s how the conversation went:
Hospital Rep (HR):  How would you like to pay these fees that you will be responsible for?
Me:  Are you asking me to tell you that now?
HR:  Yes – we can take a credit card or a check number and routing number right over the phone and get it all taken care of right now.
Me:  But I haven’t even seen the charges or received treatment yet.
HR:  Oh, don’t worry – you’ll receive the treatment and then we can bill you for any other responsible charges
Me:  Is this a joke?  You expect me to pay for something off of a verbal discussion – no documentation, no explanation?
HR:  But I just explained it all to you.
Me:  Ok – let’s try this – how about I go through the treatment, you run the charges through my insurance, and then we can see what my responsible share is?
HR:  We can do that too but we prefer to get confirmation of payment up front.
Me:  So is that required?
HR:  Is what required?
Me:  That I pay upfront, with no documentation or having had the benefit of my insurance actually look at the charges first?
HR:  No, it’s not required, we just prefer it.
Me:  Got it – we’ll do it the old fashioned way.  Send it through insurance and we’ll handle the balance from there.
HR:  We do have payment plans available with no interest.  You could make a payment right now and begin that process right now.
Me:  Will that be available to me after insurance sees the charges?
HR;  Will what be available to you?
Me:  The payment plan option  you just told me about.
HR:  Oh yes.
Me:  Ok – let me try this again – send the charges to my insurance and once they adjudicate the claims I’ll get back to you on any charges I am responsible for.
HR:  Well, we know what your deductible is so why not just pay that amount now?  Again, we can take a credit card or a check number and routing number.
Me:  I feel like I’m in a bad Abbott and Costello routine.
HR:  Who?
Me:  Never mind – let me be blunt – I’m not paying for anything without documentation.  I appreciate you letting me know the estimate but I won’t pay off that either.  If that means you won’t perform the service, I’ll find another provider.
HR:  Oh, of course we’ll provide the service, we just wanted to remove the stress of financial responsibility before the treatment begins.
Me: Well, actually, I think you’ve done just the opposite
HR;  The opposite of what?
Me;  Never mind – I have two questions.  Can I still get treatment without paying any charges before treatment is provided and second, will you bill me after insurance has reviewed and adjudicated the charges.
HR;  Yes we will provide the treatments and yes we will bill you after insurance has handled the
charges.
Me:  Ok -thank you (and I ended the call).
Dec
11

Americans can’t afford healthcare

Posted by Joe Paduda on Wednesday, December 11th, 2019 | Comments

Gallup just reported a quarter of Americans have put off treatment for serious medical conditions because they can’t afford it.

They can’t afford it because:

  • US physicians make twice what docs in other countries do
  • Drug costs are much higher here than elsewhere
  • Hospitals are making bank
  • Administrative costs are twice what they are in other developed countries.

Data from Commonwealth Fund

Average physician income by specialty from FierceHealthcare.

US life expectancy is now 43rd in the world.

We pay twice as much as other developed countries for healthcare, and our outcomes are measurably worse.

What does this mean for you?

Until and unless we fix healthcare, your family and friends will face increasing costs and declining access; it’s highly likely some aren’t getting the medications, surgeries, tests, or therapies they desperately need.

Nov
12

Haven Healthcare’s next step

Posted by Joe Paduda on Tuesday, November 12th, 2019 | Comments

Is partnering with two big insurance companies to offer creative plans to two of its owners’ employees.

30,000 JPMorgan workers in Ohio and Arizona covered by Cigna and Aetna will be offered a plan that has no deductibles, with copays ranging from $15 to $110 depending on the service; facility copays will likely be higher.

Amazon’s also offering a Haven Healthcare plan in a handful of states. The giant seller-of-everything also just bought Health Navigator for an undisclosed sum.

From Motley Fool:

it will fold [Health Navigator] into Amazon Care, its new employee healthcare benefit that gives users access to virtual doctors and nurses…Amazon Care users (currently limited to employees in the Seattle area) can fill prescriptions through the e-commerce giant and choose between having them delivered or picked up at a participating pharmacy. By providing healthcare services to its employee base Amazon gets to test the waters and make fixes before the program is offered to a wider market.

Evidently Health Navigator uses an AI-based health bot which helps members diagnose illnesses, determine the right course of care, and then routes the member as appropriate.

While JPMorgan and Berkshire are likely funding Haven to help reduce their healthcare costs, Amazon’s got bigger plans.

With annual revenues around $340 billion, the giant company needs a really, really big market to keep growing. Healthcare is $3.4 trillion, massively screwed up, and just the kind of target Bezos et al need to keep the good times rolling.

What does this mean for you?

If you think Haven won’t succeed, did you ever think you’d be getting your groceries, tools, video, toiletries, prescriptions, car parts, medical devices, batteries, dog food, shoes, and music from an on-line bookseller?

Aug
19

Are health insurers’ profits and costs the problem?

Posted by Joe Paduda on Monday, August 19th, 2019 | Comments

There’s a lot of bleating about the huge profits made by health insurers, with some – including too many who should know better – complaining loud and long. [Insurers and pharma netted about $97 billion last year.]

While some would argue the billions raked in by insurers is far too much, let’s take a step back and look at the big picture.

First, insurers’ profits are a tiny fraction of our $3.6 trillion healthcare spend – as in >1 percent.

Second, healthplan, insurers, and other payers’ total administrative expenses amount to 8.3% of that $3.6 trillion – roughly $300 billion.

Oh, and a big chunk of most health insurers’ business comes from servicing governmental programs.  Example – 58% of United Healthcare’s revenue is from Medicare, Medicaid, and other governmental programs.

Frankly, given commercial insurers’ demonstrated inability to control costs and improve quality, that $30 billion may be too generous by far. But it’s clear the big problem with healthcare costs is not insurer profits or administrative expense.

It’s the underlying prices of healthcare.

What does this mean for you?

It’s not insurer profits.

Apr
10

On the one hand…

Posted by Joe Paduda on Wednesday, April 10th, 2019 | Comments

We have a healthplan you’ll absolutely love.  Covers EVERYTHING – glasses, hearing aids, nursing home care, doctor visits, hospital care, surgery, drugs – all FREE!

It’s the about-to-be-announced BernieCare 2.0, aka the “Whole Enchilada Plan”. You can go to  any doctor, hospital, acupuncturist, yoga instructor, therapist, or nursing home your heart – or other internal organ – desires. And did I say, it’s all for FREE!

On the other hand, there’s the SkimpyPlan – and as the Brits say, it’s “on offer” today. Well, it was until a Federal Judge ruled it isn’t.

SkimpyPlans cover, well, not much. Especially if you had one of those pre-existing condition things. You know, migraines, high blood pressure, the “C” word, bad knees, anxiety or pretty much anything else. Oh, and the list of doctors and hospitals is, well, “limited”… and they don’t cover drugs, or pregnancy, or, well, lots of things.

But hey! they’re cheap! Affordable even!

Ok, enough with the sarcasm, here’s where this is headed.

For some unfathomable reason Mitch McConnell and the current Administration think these SkimpyPlans are a great response to the not-hated-any-more ACA.  SkimpyPlans are pretty much the only plan offered by the GOP, and they are awful. They are getting hammered in the press as patients find themselves without coverage for needed care, facing tens of thousands in medical bills, stuck fighting faceless bureaucrats in some distant “insurance company” via voice mail.

Sure many are covered by their employers, even that is getting unaffordable for many AND sticking families with big bills. 

Then there’s the While Enchilada Plan – an end to paperwork, doctor shopping, copays and deductibles, and all FREE.

Do you see where this is going?

Nov
13

Tuesday catch-up

Posted by Joe Paduda on Tuesday, November 13th, 2018 | Comments

It’s been a very very busy time.

First, I’m pretty darn excited to note my alma mater’s football team goes into it’s match with Notre Dame ranked 12th in the nation. As a long-suffering Syracuse alum, this is territory we haven’t seen in decades.

Perhaps we’ll see Chris LeStage’s LSU Tigers in a Bowl Game???

OK, on to work.

The National Work Comp and Disability Conference is fast approaching. You can get a discounted registration here.

A bit further out on the schedule is WCRI’s annual confab – which will be in Phoenix AZ next February 28 – March 1.  You can get the details here. DO NOT WAIT to register; this always fills up so don’t procrastinate.

Next, a best-in-class work comp safety program is the product of a “great team” led by a very experienced and very competent leader. Joe Molloy at Northwell Health is innovative, focused on the right things, and committed to partnering with service suppliers. Joe’s team has reduced lost work days at a giant healthcare system by a third.

More proof of the ongoing effort by health insurers to move the US to single payer…this insidious plan is bearing fruit as we just received new evidence of its effectiveness – Americans don’t like their health insurance.

According to a national survey by ACSI, consumers rank their satisfaction with health insurance as equal to airlines. “Health insurance satisfaction is flat after two years of gains, staying lowest in the Finance/Insurance sector” Ouch.

I find it increasingly likely we’ll have some form of single payer, perhaps Medicaid for all – within a decade.  Health insurers continue to piss off customers on a regular basis, can’t control health care cost increases, and are lousy at branding.

They do have gazillions of dollars which they will spend to kill MFA or any other version of single payer – and they are pretty darn good at the government lobbying thing.

That said, when things can no longer continue, they won’t.

What does this mean for you?

It’s not a question of “if” we end up with single payer, it’s a question of when.