Bigger doesn't imply better. Bigger often is a sign of obesity, of lost control, of overcomplexity, of cancerous cells
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May the source be with you, but remember the KISS principle ;-) Bigger doesn't imply better. Bigger often is a sign of obesity, of lost control, of overcomplexity, of cancerous cells |
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| Price gouging is a pejorative term referring to when a seller spikes the prices
of goods,
services or commodities to a level much higher than is considered reasonable or fair, and
is considered exploitative, potentially to an unethical extent. Usually this event occurs
after a demand or supply shock: common examples include price increases of basic
necessities after
hurricanes or other
natural disasters. In precise, legal usage, it is the name of a crime that applies in
some jurisdictions of the
United States
during civil emergencies. In less precise usage, it can refer either to prices obtained by
practices inconsistent with a competitive
free market, or
to
windfall profits. In the former
Soviet Union,
it was simply included under the single definition of
speculation. The term is similar to profiteering but can be distinguished by being short-term and localized, and by a restriction to essentials such as food, clothing, shelter, medicine and equipment needed to preserve life, limb and property. In jurisdictions where there is no such crime, the term may still be used to pressure firms to refrain from such behavior.
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Balance Billing is a scam that it is still legal in many states. And medical providers use and abuse it, especially for ambulance and IR services.
Even if the bill is correct, you should still set up a time to speak with someone in the billing office — someone with the authority to negotiate on your balance. Go into the conversation equipped with the knowledge that Medicare and insurance companies rarely pay the hefty price tags that consumers see.
Standard practice for insurers is to negotiate with providers to pay merely a fraction of the cost. In the case of inpatient hospital bills, for example, a NerdWallet study found Medicare negotiates, on average, a 73% discount. While the ambulance service may not agree to such a large discount for you, coming to any negotiation equipped with such knowledge will put the company on notice that you aren’t going to lay down and take its bullying or an inflated bill.
Consider how much you are able to pay. If the ambulance service isn’t willing to deduct a good portion of the original bill, think about how much is fair and reasonable for the service your husband received and your budget. Negotiating a lower balance, even if you can’t pay it off in a lump sum, will remove a considerable burden from your shoulders. It may even benefit the ambulance company, which might fear receiving no payment from you at all, since the majority of bills in collections are never paid off. If you do set up a formal payment agreement, make sure to get it in writing.
Negotiating with an ambulance service or any medical provider is not easy, but it is possible. Be persistent. If your efforts prove fruitless, you can always consider hiring a professional. A medical billing advocate is able to represent clients’ interests much in the way an attorney would advocate for you in a courtroom. Their experience and expertise in the field can sometimes prove more effective (and less stressful) than taking on a stubborn provider alone.
Patient advocates are often members of your family, nonprofit organizations or clergy, and may not charge you for their services. In most cases, however, there will be a fee associated with patient advocates, and it usually depends on the amount of time they spend with you and your doctor. Advocates on the hospital staff may have their charges built into your bill. For this reason, costs may vary from as little as $75 for a single doctor’s visit to a few thousand dollars for an extended hospital stay.
Medical billing advocates usually have more concrete charges. Some charge hourly, at a rate of $100-$200. Others charge as a percentage of savings—usually 25%-35% of the price they got your total charges reduced by, but some charge as little as 15% of savings.
You can find patient and medical billing advocates through the National Association of Healthcare Advocacy Consultants or the Alliance of Claims Assistance Professionals.
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Jan 19, 2019 | economistsview.typepad.com
anne , January 15, 2019 at 05:59 PM
https://prospect.org/article/three-bernie-sanders-bills-arrest-highway-robbery-prescription-drug-marketmulp -> anne... , January 16, 2019 at 04:33 PMJanuary 14, 2019
Three Bernie Sanders Bills to Arrest the Highway Robbery in the Prescription Drug Market
Allowing foreign imports, authorizing Medicare bargaining, or setting prices at what other nations pay -- all good options
By DEAN BAKERThe prescription drug market in the United States is an incredible mess. From an economic standpoint, everything is wrong. Drugs that would sell for a few hundred dollars in a free market often sell for tens or even hundreds of thousands of dollars because we give their manufacturers patent monopolies. This leads to the sort of distortions and inefficiency that would be expected from tariffs as high as many thousands percent.
From a heath perspective the situation is no better. The huge markups give drug companies enormous incentive to misrepresent the safety and effectiveness of their drugs and to push them for uses where they may not be appropriate. This is a big part of the story of the opioid epidemic.
Cumulatively, it is a huge deal in both economics and health. We spent more than $430 billion (2.2 percent of GDP) on prescription drugs last year. These drugs likely would have cost less than $80 billion in a free market. The difference of $350 billion is almost five times the annual federal budget for food stamps. This is real money.
This is the backdrop for three bills proposed last week by Senator Bernie Sanders, along with Representatives Elijah Cummings and Ro Khanna, to address the high and rapidly rising cost of prescription drugs. The three measures provide alternative paths for reducing drug prices.
The first one, "The Prescription Drug Price Relief Act," would end the patent monopoly for any drug that sold for a price exceeding the median price in five other major countries: Canada, the United Kingdom, France, Germany, and Japan. This would allow large savings since drug prices in these countries are roughly half as much as in the United States. Drug companies would have a choice of either lowering their prices or losing their patent monopoly.
In the latter case, the competition is likely to push the price well below the levels in the five countries. While these nations do regulate drug prices, patent monopolies still let the companies charge a price that is far higher than the price that would exist in a competitive market with generic competition.
The second bill is "The Medicare Drug Price Negotiation Act." This bill would allow Medicare to negotiate collectively for the drugs purchased through Medicare prescription drug insurance. Since this program spends roughly $100 billion annually on drugs, it should have serious bargaining power.
Anyone designing a rational drug insurance program would have required negotiation when the program was created, but rational design was not necessarily the top priority at the time this program was enacted.
Anyone designing a rational drug insurance program would have required negotiation when the program was created, but rational design was not necessarily the top priority at the time this program was enacted. Representative Billy Tauzin, who headed the Energy and Commerce Committee, which structured the Medicare prescription drug legislation, resigned immediately after the bill was signed into law to become head of the pharmaceutical industry's trade association.
The third bill, "The Affordable and Safe Prescription Drug Importation Act," is also an effort to take advantage of the fact that drugs are so much cheaper in other countries than in the United States. This bill would allow people to freely import drugs from other wealthy countries that have safety standards that are comparable to those in the United States.
This bill both highlights the sharp differences in prices between the United States and other countries and calls out one of the big lies used to justify these differences. Allies of the drug industry often claim that we cannot count on getting safe drugs from other countries, implying that countries like Canada and Germany do not protect their populations from unsafe drugs.
This is, of course, absurd. The standards in these countries are every bit as high as in the United States. And, if we think the quality of imported drugs is a problem, we all should already be very worried because many of the drugs and ingredients in drugs sold in the United States are already imported, largely from China. So the idea that we can't be assured of the safety of imported drugs is simply an industry talking point, not a real concern.
Which of these paths for reducing drug costs is best? Importation is probably the most far-reaching, since it should quickly bring our prices down to the level of other wealthy countries. As a practical matter, however, progressives should back anything that moves the debate forward.
We really need to turn the industry on its head, paying for research upfront and then having drugs sold in a free market, like paper plates and shovels. It is absurd to pay for research that has already been done, at the point when people are suffering from serious conditions jeopardizing their health or their life.
No one thinks it makes sense to pay firefighters based on the value of their work when they come to our burning house with our families inside, yet this is essentially how we pay for drug research under the patent monopoly system. In fact, the story is even worse with drugs, since typically we have a third party payer (either an insurance company or the government) who we are trying to get pick up most of the tab.
These bills would not fully solve the problem, but each would be a big step in the right direction. Sanders, Cummings, and Khanna have done a great service in pushing them forward.
"No one thinks it makes sense to pay firefighters based on the value of their work ..."Plp -> mulp ... , January 18, 2019 at 01:41 PMWe value fire fighters as worthless, by not paying most fire fighters in the US.
After all, requiring the people saving your life to be paid kills jobs, so we end up with unpaid life savvers.
We should appply the same principle to people providing life saving food, the people building the roads needed to deliver life savings, the people making the vehicles used by those providing life saving services.
In fact, no one should be paid to work! Thats free lunch economics!
Sarcastic, yes.
Dean Baker meantioned nothing about costs, which are always labor costs.
Look, Keynes argued that when there were unemployed workers, and capital is scarce, government should tax and spend to pay workers to build capital.
For drugs, paying unemployed researchers to build capital, eg, life saving drugs, then taxing the drugs produced to repay the cost of developing the drugs, with so many new drugs developed, the private capital in drug factories, etc will produce so many drugs that drug prices fall to total labor costs per unit, plus the drug tax.
We know there are unemployed drugresearchers because NIH always runs out of money to pay all thre recent collage grads seeking grants to fund their hoped for job as a researcher.
Mulp what about monopoly profits my friendPlp -> anne... , January 17, 2019 at 08:40 AMResearch could rise and marketing cuts pay for it
Yes there's slack created
In marketing jobs and funding entertainment of courseBernie and Liz are too valuable to waste running foranne -> Plp... , January 18, 2019 at 09:21 AM
The Dem nomLeave that for a clever weather vane
Like Harris and that jersey senatorThe gal from the Bronx
is another Bill BryanShe is the future
The gal from the BronxJulio -> Plp... , January 18, 2019 at 09:21 AM
is another Bill BryanShe is the future
[ Funny and right and especially clever. ]
Agreed completely.Christopher H. said in reply to Julio ... , January 18, 2019 at 10:01 AM
Warren, in particular, makes a great senator but I doubt would make a great president.Disagree, unfortunately in the American system the President gets all the attention and can spread the message.Plp -> Christopher H.... , January 18, 2019 at 01:43 PMEither Bernie or Warren would be good. I'd much prefer Bernie.
No problem if they win the POTUS jobStill I'd prefer AOC
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Jan 08, 2019 | jessescrossroadscafe.blogspot.com
Stocks and Precious Metals Charts - Risk On Again - Distractions from the Real Problems and Issues
"On April 3, Nina Dang, 24, found herself in a position like so many San Francisco bike riders -- on the pavement with a broken arm.Within so many of the corporate dominant monopolies like Healthcare, Banking, Pharmaceuticals, some companies seem to be free to do just about whatever they wish in billing consumers.A bystander saw her fall and called an ambulance. She was semi-lucid for that ride, awake but unable to answer basic questions about where she lived. Paramedics took her to the emergency room at Zuckerberg San Francisco General Hospital, where doctors X-rayed her arm and took a CT scan of her brain and spine. She left with her arm in a splint, on pain medication, and with a recommendation to follow up with an orthopedist.
A few months later, Dang got a bill for $24,074.50. Premera Blue Cross, her health insurer, would only cover $3,830.79 of that -- an amount that it thought was fair for the services provided. That left Dang with $20,243.71 to pay, which the hospital threatened to send to collections in mid-December..."
Sarah Kliff, A $20,243 bike crash: Zuckerberg hospital's aggressive tactics leave patients with big bills
"Monopolies hurt the public and the republic alike; the job of policing that power must be taken seriously."
Elizabeth Warren
Healthcare in the US is bordering on insane when it comes to billing practises and lack of practical recourse or common sense, with Big Pharma running a close second. But the Banks are not all that far behind.
I have met many, many dedicated professionals in the healthcare industry, but like most participants they are just being swept along because they have little practical recourse or power. To speak up is to be punished, and severely.
A simple law that states that when a patient is brought into a hospital emergency room for treatment, their private insurance and the treatments must be provided at the network rates in their insurance policy, or at the prevailing rate for a Medicare patient, whichever is lower. And any uncollectible services to be written off or compensated by government will be done at the Medicare rate and not at some ficitonal billing statement.
I believe that New York State has a law requiring ER and Hospital doctors to accept private insurance for patients as if they are in-network. This includes those 'consultations' which happen during a hospital stay by doctors who accept no insurance and who charge whatever they feel like charging for some service, of which provider or price the patient is never informed beforehand.
The real solution is of course universal healthcare, which has been implemented for years by every major developed nation but the US. This will not happen for the same reason that we are seeing no movement towards meaningful reform in Pharma or Banking. And you know exactly why, unless you have been living in a bubble or are willfully blind.
Stocks managed to extend their rally today despite some setbacks.
We will see what Trumpolini has to say about our 'crisis' at the southern border this evening, and the trade war, and probably whatever else crosses his mind. My only certainly is that it will not involve any meaningful reform in healthcare, finance, insurance, or pharmaceuticals.
Have a pleasant evening.
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Mar 21, 2018 | www.nakedcapitalism.com
Enquiring Mind , March 20, 2018 at 9:17 am
RabidGandhi , March 20, 2018 at 6:16 amShame is a 20th century concept ill-suited to this modern post-tobacco settlement world. Where some saw a consumer victory after decades of warnings on packs by getting big tobacco to acknowledge risks, others saw methodology victory for the neo-liberal machine, and an instruction manual .
Like the Big C, cancer, that machine keeps rolling along. Now it is mainstream, to be emulated instead of castigated. At least that is what appears to have happened among those shame-free star pupils of Big Pharma and their fellow travelers in FIRE, aided and abetted on the Big Screen where deviancy got defined down so far it got erased. Political and economic trends ebb and flow, with some elements of populism appearing on the horizon. Greater awareness of the plight of one's fellow humans may help focus the mind.
notabanker , March 20, 2018 at 6:36 amBottom line, experts say, medical professionals should make the patient aware if they prescribe a high-priced medicine and explain why it's beneficial. Patients should play defense and ask their physicians about the cost of every new prescription.
Bottom line, it's doctors and patients fault for not defending themselves against the ludicrously corrupt health insurance industry. Bottom line, medical professionals and patients have to spend their time and effort (increasingly dwindling, because markets) to try to avoid being charged a month's pay for a tube of ointment. Because, bottom line, changing the system is not an option, so keep banging your head against that wall!
oh , March 20, 2018 at 2:30 pmYeah, try getting a straight answer on what this stuff will cost BEFORE you take possession, er , are treated. "$200" has turned into $1000 bills from a third party device company that magically turns to $0 after 3 months of emails and phone calls. I've walked out of hospitals after getting full disclosure of costs minutes before a procedure that was scheduled weeks in advance.
The neolib corruption numbness has to seep through the cartilage into the bones to call these practices anything but criminal.
Amfortas the Hippie , March 20, 2018 at 4:15 pmThere is really no excuse for the crooks in the medical (health care? nah!) industrial complex not to provide costs of any procedure or service ahead of time. I admire you for walking out minutes before the procedure and more people should do the same. I would do the same and have.
Bukko Boomeranger , March 20, 2018 at 7:06 amIf there's no "Price Discovery", is it really a "Marketplace"?
towards the end of my six and a half year slog through the disability process(sic), I learned about Cuba. I got a price for a new hip pretty easily from them (around 10 grand, including a "bungalo on the beach with a private nurse for recovery")
so I called the nearest hospital, and asked what a new hip would cost me, cash money, walking in the door.
The person obviously didn't understand the question, and after some time of me waving my arms and trying to word the question in a form she would understand she said" oh insurance takes care of that and it depends on many factors"
"such as?" sez I
Her:" like what kind of replacement they use which is up to the surgeon and many things"
This went on and on, and I finally got her not nailed down at around 300 grand.
Then I asked her what medicare would pay for the same thing and she hung up on me. It ain't a "Market", it's a Racket.
(and, about the toenail fungus my grandmother would tell her to just pee on it .)
HistoricalPerspective , March 20, 2018 at 11:32 amBy the "logic" of the guest post, bottom line is it's that baby's fault for not being strong enough to defend itself against the big kid who took its candy. It's the woman's fault for dressing that way before she was raped.
The victims should be blamed because they didn't play defence well enough against the criminals who write the rules of the system. I presume your comment is to flesh out the BS justification from the article, Gandhi, not to endorse it. Excuses like the one capping the guest post, instead of rabid outrage, are part of what allows the crimes to continue. I can see why so many Merkins want to burn the (family blog)er down, even though they wind up voting for Trump as a means of expressing that feeling.
jackiebass , March 20, 2018 at 6:31 am" experts say "
Seriously, who are these 'experts'!?!? Between the 'experts' , who blame the victims, kick cans down the road and pass the bucks to the lay-people (no one is an expert in everything, i.e. everyone is ignorant about something at some point in their lives) they're suppose to be advising whenever 'expertise' is required, and the 'journalists' who give them a venue to spew their apocryphal twaddle in an attempt to portray themselves as 'experts' when their true intentions are to gaslight, obfuscate and divide common sense and decency. Throw in the politicians, crony capitalists and all the other puppet masters and you have the perfect storm so many Americans, like myself, finds themselves drowning in. Once upon a time expertise inferred wisdom. Those days are history.
divadab , March 20, 2018 at 8:00 amI don't know if it works but I've been told that petroleum jelly will cure toenail fungus. it seems salves or topical medicines are usually expensive. I use a salve that I apply to the rash from my. Eczema. I have used it for years and the price is constantly increasing. When I started using it the cost was $50 per tube. The last tube I got cost $480. I was prescribed an inhaler for Bronchitis. It cost almost $500 and didn't seem to do much to relieve the symptoms. Fortunately my insurance payed for the medicine. It still makes me mad when I think about what was charged for these prescriptions.
Arthur J , March 20, 2018 at 10:13 amThere are much cheaper alternatives to inhalers for asthma or bronchitis. Buy a "Nebulizer" (we just bought a portable one for $50), which is a vaporiser, and get your doctor to prescribe "nebules" of albuterol sulphate and/or sodium chromalyn to load into the nebulizer. We get a prescription refill of nebules for $3.49 v. over $50 for a ventolin inhaler . And there is no propellant in the nebulizer which there is on an inhaler.
The greed and parasitism of the pharmaceutical cartel is criminal.
Eudora Welty , March 20, 2018 at 12:32 pmMy gp told me to use Vick's VapoRub for my toenail fungus. I asked the pharmacist and she said it has about a 10% success rate, same as the petroleum jelly from which Vick's is made. There was some branded treatment, $40 for a 2ml bottle that she said worked maybe 15% of the time. Only been a few weeks, but so far I haven't seen much of a change.
home for wayward trout , March 20, 2018 at 1:00 pmYes, I used Vick's Vaporub on a toe fungus and it worked. I was told it wouldn't work.
RalphR , March 20, 2018 at 8:22 pmThe People's Pharmacy has a lot of information on toenail fungus and also has an article recommending treatment with mentholatum.
I now go to their website before filling any prescription I'm given by a doctor.
donw , March 20, 2018 at 12:42 pmI did (after trying other topical but non-prescription products) and it didn't initially.
But then I used it in conjunction with a lotion with a lot of hyaluronic acid in it. Hyaluronic acid is widely used in cosmetic products to increase penetration of the active ingredients into the skin.
Worked great.
Just by sure to apply any treatment to the cuticle, particularly at the root of the nail. That is where the fungus lives.
Marie Parham , March 20, 2018 at 6:42 amIt is a fungus, so being outside in the sun wearing flip flops might kill it.
Normal , March 20, 2018 at 6:42 amLast summer I had toenail fungus and researched how to treat it. Soaked my feet is diluted vinegar a few days and scrubbed the area. Then I used https://www.cvs.com/drug/miconazole . It worked. Next time I have an annual checkup I will talk to my nurse practitioner. Web MD was a big help. https://www.webmd.com/skin-problems-and-treatments/guide/fungal-nail-infections-topic-overview#1
So was Mayo clinic
https://www.mayoclinic.org/diseases-conditions/nail-fungus/diagnosis-treatment/drc-20353300
I am not recommending websites replace physicians, but apparently it is necessary to always second guess the physicians.
My treatment cost less than $10.XXYY , March 20, 2018 at 10:22 amHow about requiring every provider to give a firm quotation on every product and service? Every other industry has to live with this constraint.
sharonsj , March 20, 2018 at 12:58 pmI'm amazed this simple idea never gets traction. Car mechanics, e.g., are required by law to provide a written estimate before work begins; if something is found that will change the estimate, they have to get your OK. Car repairs are usually much cheaper than medical bills and are often equally or more opaque to diagnose.
Having doctors and medical offices provide you with an estimate after diagnosis but before treatment does not seem like it would be terribly hard. They (uniquely) have visibility into your insurance arrangements, their reimbursement rates, their costs, overhead, profit rates, and so on. Software for this purpose would make pretty short work of boiling this down to the out-of-pocket for the patient. The patient could then either OK it, negotiate other options, or decide to shop around. If the provider later tries to charge more, the patient would have something on paper to justify refusing it.
There's no reason patients should be treated like a bottomless bank account by the medical industry.
oh , March 20, 2018 at 3:02 pmMany doctors have no clue what things cost. I received a single shot of cortisone for an arthritic shoulder and was charged $200. When I complained to the health care system, I was told that, had I been insured, the cost to me would be $100 less. When I complained to my doctor, he had no idea about any of this.
P.S. I knew the owner of an herb farm who had foot fungus. She visited a podiatrist and was prescribed some expensive salve which didn't work. The woman then went out on her farm, gathered some herbs according to an old remedy, made her own salve and was cured.
JTMcPhee , March 20, 2018 at 10:25 amI was told to get the shot for shoulder pain (was a bad idea from this quacK). The "doctor" had no idea what it would cost!! At any rate it cost me over a $100 even with Kaiser coverage and it did NOT help. It hurt a lot for a few days (in more ways than one). What a fraud this industry is.
I dread the day I'd have to go to the hospital where I it was such an emergency that I'd be at the mercy of this robber baron system
FluffytheObeseCat , March 20, 2018 at 11:19 amHad any car or truck repair work done lately? Or speaking of things automotive, have any of us had experiences with the sales machinery of car and truck dealers, new or used? Speaking of transparency in pricing, firm quotes and all that? As just one example of how The Machine actually works? Catch-22: "They can do anything to us they want that we can't keep them from doing." http://www.slate.com/articles/life/the_spectator/2011/08/seeing_catch22_twice.html
nycTerrierist , March 20, 2018 at 3:07 pmBig ones twice in the past four years on the RAV4. 2 different shops, in different states. They both gave me firm, up front price quotes. One was wrong on the low side, and the owner called me with the real price and an apology before doing the work. Just like the law requires.
This kind of fair dealing and respect for the customer never happens in medical practices. The doctors rarely soil their highly educated minds with matters of cost; everyone else in the office has little authority, and the chubby young women who sit up front in scrubs do as little as possible for the captives they call patients.
Paul P , March 20, 2018 at 7:19 pm"This kind of fair dealing and respect for the customer never happens in medical practices. "
This! And stress over billing affects health!
it is stressful and aggravating that doctors can't/won't address cost at the point of service. This destroys patient's trust in the physician as well.
Therapeutic relationship is wrecked as well as health and personal finances.anonymous , March 20, 2018 at 6:57 amThis NYS law applies to services, not drugs. It's a start:
Emergency Medical Services and Surprise Bills Law – New York State
https://www.health.ny.gov/regulations/ bill /ems_and_surprise_bills_law_faq.htm
If they do not participate in a patient's health care plan, they must upon request from a patient inform the patient of the estimated amount they will bill absent unforeseen medical circumstances that may arise. Under subdivisions (3) and (4), physicians in private practice also must provide information regarding any other ..Eureka Springs , March 20, 2018 at 7:03 am"We're talking about mild toenail fungus. The price tag is difficult to rationalize, experts ( and every breathing human ) said."
Enquiring Mind , March 20, 2018 at 9:07 amWe're talking about mild toenail fungus. The price tag is difficult to rationalize, experts said.
What kind of "expert" tries to rationalize cost of prescription on severity, rather than, say, cost of making the product?
16,500 for the course of an eleven month treatment with 6 percent chance of working. Seems like a medical RX vacation almost anywhere else in the world would be prudent.
Jon S , March 20, 2018 at 12:34 pmWhat kind of expert, you ask?
Today's fast-paced, stimulating world in pharmaceutical revenue management and marketing needs H1-B visa assistance to hire the kind of expert that is not available in sufficient quantity or quality to allow efficient pursuit of medical excellence. In past years, such personnel were to be found only in select industries such as tobacco and other personal care products. Building the right team, with applicable key performance indicators and mission-critical elements, is too important to be left to chance so every avenue must be explored, every base touched. Consumer options are opened up in the free market of healthy competition for products rather than stifled under excess regulatory and legal layers.
That kind of expert. /s
sgt_doom , March 20, 2018 at 1:54 pmI really enjoyed that!
Lambert Strether , March 20, 2018 at 7:07 amMan oh man!!!!
Had a deja vu moment there -- thought I was back as an employee during a leveraged buyout by the typically sleazy PE firm of Baird Private Equity!!!!!
Miamijac , March 20, 2018 at 7:28 amSounds like Soloviev wasn't a "smart shopper"!
Croatoan , March 20, 2018 at 8:17 amTeatree oil, anti fungal. >$3.00. They only have a license to practice.
Kevin , March 20, 2018 at 9:06 amJust be careful with the natural stuff
"The results of our laboratory studies confirm that pure lavender and tea tree oils can mimic the actions of estrogens and inhibit the effects of androgens ," said Korach. "This combinatorial activity makes them somewhat unique as endocrine disruptors."
https://www.nih.gov/news-events/news-releases/lavender-tea-tree-oils-may-cause-breast-growth-boys
oh , March 20, 2018 at 3:14 pmMy wife is a massage therapist and dispenses oils occasionally. NEVER use straight oils – ALWAYS use a carrier oil in conjunction.
BTW – anyone else notice the toe fungus ad placed above the comments we're being watched!
cnchal , March 20, 2018 at 8:29 amAnother myth propagated by the hand maidens to the Pharma industry.
sgt_doom , March 20, 2018 at 1:55 pmThe title of the post is a bit misleading.
It should have been "Bill Of The Month: For Toenail Fungus, A $16,500 Prescription and less than 10% effective".
. . . She began swabbing it on the two toenails, as directed, having been told it would take about 11 months to treat the fungus .
– – – –
Unbeknownst to her, Kerydin, which it turned out costs nearly $1,500 per monthly refill . . .
– – – –
In its application for Food and Drug Administration approval granted in 2014, Anacor Pharmaceuticals highlighted that a yearlong treatment of Kerydin completely cured toe fungus in 6.5 percent of patients for one trial, and 9.1 percent of patients in another.The post's title diminishes the scale of the scam by a factor of at least 100.
lyman alpha blob , March 20, 2018 at 3:52 pmVery well articulated and thought out!
Props and kudos!!!
Joel , March 20, 2018 at 8:35 amThat last bit blew my mind. Why in the hell is the FDA approving anything as a treatment that can only be shown to cure what it's supposed to less than 10% of the time!?!? And we know how the approval process scam works – the companies only submit the best results in the first place and leave out the data the shows treatments to be less successful.
That being said, who would like to try out my new wonder drug? It cures absolutely everything that ails you at least 5% ot the time. I call it Plaisibeaux – the ingredients are French and they're a trade secret. Any FDA employess around who can fast track this one for me?
Stillfeelinthebern , March 20, 2018 at 2:43 pmMy simple stupid solution just avoid them entirely, the docs the tests the meds the hospitals. Advil is cheap and works for most of the pain. A couple of other basic meds for occasional random stuff that I buy when I travel outside the US. Try to work out a bit and eat more or less right. Except for easy obvious stuff I never met anyone that actually got better by going to a doctor. When its time to die I guess I will die.
oh , March 20, 2018 at 3:16 pmX1000
Couldn't agree more.
sierra7 , March 20, 2018 at 10:00 pm+1
mark , March 20, 2018 at 8:35 amIn our healthcare system (and I guess totally), when you're healthy you're wealthy!
Thomas Briggs , March 20, 2018 at 9:14 amIt's really worse than the article suggests. Kerydin (tavaborole) isn't even all that effective. In one trial, "cure" was achieved in about 7% of cases and in other trials "completely or almost clear nail rates" were achieved in 15 – 30% of cases:
In clinical trials, tavaborole was more effective than the vehicle (ethyl acetate and propylene glycol) alone in curing onychomycosis. In two studies, fungal infection was eliminated using tavaborole in 6.5% of the cases vs. 0.5% using the vehicle alone, and 27.5% vs. 14.6% using the vehicle alone.
https://en.wikipedia.org/wiki/Tavaborole#Therapeutic_trials
For those interested, this is the original paper that the Wikipedia entry is based on:
https://www.sciencedirect.com/science/article/pii/S0190962215015121
oh , March 20, 2018 at 3:18 pmLast visit was a snake bite. Antivenom was about 60k. Pretty sure same can be had in Mexico for less than $1,000, maybe much less. That was 5 years ago. I refuse to participate any longer, & I have good insurance. I hope eating better, exercise, & homeopathic treatments can work for me. Have not seen a doctor since & won't unless taken unconscious.
Pat , March 20, 2018 at 9:19 amAgree with you. Eat healthy foods, exercise, homeopathic or ayurvedic treatment when absolutely necessary. No need to go for their "free" physicals. Listen to your body.
XXYY , March 20, 2018 at 10:32 amSo a physicians assistant diagnosed a fungus strictly on observation, calls in a prescription for an ineffective and more difficult to use but massively expensive prescription and it is the patient's fault.
Don't know about the rest of you, but I see at least three problems in that that have nothing to do with the patient OR even the obscene greed of the pharmaceutical industry but a whole lot with the Braun Dermotological Center.
Kevin , March 20, 2018 at 11:02 amI have no proof, but my guess is that these medical centers have sweetheart deals with mail-order pharmacies for various overpriced drugs. We took my son to a dermatology place several times for acne treatment; they would commonly propose something I had never heard of and urge us to order from a particular mail-order pharmacy, often providing coupons. I saw no reason not to get it from our local pharmacy but they were strangely insistent on us doing it by mail.
One obvious problem with mail-order pharmacies is made clear in this piece: by the time you find out how much things cost, it's already a done deal. At a retail pharmacy, you can walk away without paying. This is obviously a feature of mail-order pharmacies, not a bug.
Katniss Everdeen , March 20, 2018 at 11:33 amThe proliferation of specialty medical centers around the western Chicago suburbs has been amazing to witness – similar to the proliferation in the number of bank outlets prior to the crash
Joel , March 20, 2018 at 4:45 pmNo kidding. How is prescribing a drug, even a cheap one, that's "effective" only 7% of the time even considered medical "treatment?"
And what in the world is that "statement" pictured above? It's flat out false. Is it somehow supposed to be official? Where did it come from?
"Total Rx cost" in January: $56.52???? No, it was $1,496.09–same as in February.
"You paid" (Patient paid?) in January: $56.52? No, the patient paid $1,439.57, "funded" through her HRA and shown with an asterisk at the bottom. $56.52 was apparently a drug company rebate / coupon.
About the only true thing in January was that the insurance paid $0.
The "You paid" in February was not, in fact paid by the patient, but by another drug company rebate / coupon. She was not even asked to write a check for the copay, an expense she would have expected.
The "Your Cost" of $620.43 at the top appears to be the sum of the two drug company coupons for January and February, although no time frame is specified. At this point, the patient had written NO checks, even for the copays.
As an aside, where is the $60 "Copay/Co-insurance for January?
The patient's actual "cost" over the two months would most accurately be represented as the sum of the two months' Rxs–about $3000–plus two $60 copays. "You Paid" should be what she actually paid, either out of pocket or through the HRA, and any fees or copays that were covered by drug company rebates should be clearly noted as CHARGED but ABROGATED.
I'd suggest that deliberately confusing and understating seemingly obvious terms such as "cost" and "paid"
deliberately obfuscates the situation in order to sell expensive drugs that people would balk at purchasing if they knew the true "cost."And all of this is before figuring out, for a Medicare recipient, how all these worthless, expensive drugs, coupons and rebates propel the patient toward the "donut hole," an entirely different kettle of fish in which nobody pays for nuthin' except the patient.
anonymous , March 20, 2018 at 9:48 am+1 These "statements" web pages or whatever are designed by either morons or sadistic fiends. Probably the same ones that design cell phone bills
vidimi , March 20, 2018 at 10:05 amThis reminds me of the time I was billed $300 for a foot splint by a podiatrist that my insurance refused to pay for. I could have bought a foot splint off Amazon for $30.
Always ask for prices for any treatments or medicines. I trust my dentist way more than any doctor I've been too.
Bugs Bunny , March 20, 2018 at 10:46 amthis stuff is free in france for anyone with a social security number
Jon S , March 20, 2018 at 12:40 pmKerydin has not been approved by the European Medicines Agency. You shouldn't state things as fact unless you can back them up.
crittermom , March 20, 2018 at 10:15 amI'm sure he meant "medicine that fixes toe fungi" is free in France, not Kerydin. And of course Kerydin isn't approved in Europe, with a 7% efficacy rate, it's doesn't really have medicinal value. It would only be prescribed in the US.
Lord Koos , March 20, 2018 at 1:08 pmStories such as this are infuriating.
I went to a Podiatrist a couple years ago for a different problem but mentioned I thought I had a toenail fungus, too.
The Dr confirmed that but instead of prescribing something he recommended coconut oil. He said it worked much better & faster than any pills he could prescribe & he was right.
I had a large jar of solid coconut oil (around $6) & applied it with a Q tip.
In very short time the fungus was gone.A girlfriend had gone to her Dr who prescribed pills.
Her fungus returned within a few months.
Mine hasn't.JamesG , March 20, 2018 at 10:41 amThis is not surprising – before I read your post I was thinking, there is probably a simple home remedy for that condition. There are a lot of useful drugs out there, but there are probably just as many that are useless, ineffective, or that have dangerous side effects and unintended consequences. I took over-the-counter anti-allergy meds for my hay fever for years, only recently reading that they (Claritin, etc) are now implicated in the onset of Alzheimer's. Thanks a lot
Steve Roberts , March 20, 2018 at 10:42 amI caught a similar prescription with a high co-pay and refused to pick up the merch from the pharmacist.
I then treated my fungus with Lamisil an OTC product which works for me.
otis , March 20, 2018 at 11:22 amI was written a script for a tube of cream that supposedly cost nearly $3k. It's hard to know what the pharmacy benefit manager actually paid because they are pretty secretive about that sort of thing. Per a friend she estimated it at probably $50 which is still idiotic. It was an anti-itch cream and wasn't any better than a $2.50 tube of cortisone cream.
perpetualWAR , March 20, 2018 at 11:32 amFor the love of Pete. Isopropyl alcohol costs $1.79. Cut your toenails then apply with q tip. No more nail fungus. One bottle = many years supply.
I'm amazed people will take pills to cure nail fungus. So Dumb.
$14.000 annual toe cream. Dumb dumb dumber.
Thanks for posting these absurd bills. It lays bare the financialized health care holocaust underway in the USA.Synoia , March 20, 2018 at 11:49 amToenail fungus? Get apple cider vinegar.
Why do people not first look at home remedies?
Apple cider vinegar clears that up in a snap.Fred , March 20, 2018 at 1:00 pmFungus can be treated by soaking in a 25% solution of vinegar, twice a day for two weeks.
Change the pH, kill the fungus.
That was my prescription for a fungus on my foot, by my doctor. And it worked.
Pogonip , March 20, 2018 at 1:16 pmI pay less for my medicines when I pay cash as the pharmacy gives me a discount. But, because Part D has a penalty for not enrolling, I use it for 5 of medicines and then pay cash for one of them and pay about $5 more per month. Not to mention my doctor offered to do my stints for half price if I paid for cash. The whole healthcare system is a mess.
Anonymous , March 20, 2018 at 1:54 pmI don't know about other countries, but here in the U.S. you should always, always, always assume that in any transaction you engage in, the seller has been financialized and will actively try to squeeze more money out of you, the ideal being to take all your available money and give you nothing in return. Be wary.
There are plenty of honorable exceptions, like the honest doctors and the mechanics described above. Cherish those sellers, patronize them, spread the word of mouth, especially if you think capitalism is the best of all possible economic worlds. The rent-seekers, if they continue unchecked, will destroy capitalism, because it requires some minimum level of trust to work. The odds that the seller will provide a good product or service have to be at least better than even.
jrs , March 20, 2018 at 3:51 pmPhilia is a necessary casualty of identity politics. Society depends on the collective will of people to take actions that are not in their direct benefit because they know others will make them. The "Tragedy of the Commons" does not occur when philia is strong because people know they can trust others not to abuse common resources. Once people do not trust others to act for the greater good it is a race to the bottom. The problem with identity politics is that it creates distrust of others outside ones own identity group as 'others' who cannot be trusted.
CrosslakeJohn , March 20, 2018 at 3:12 pmoh yes identity politics created that, as if there wasn't far stronger prejudice by dominant groups long before identity politics was even a glimmer in it's dad's eye.
rps , March 20, 2018 at 4:48 pmTen years ago or so in Corte Madera California, I was very lucky to find a podiatrist who was doing research on toenail fungus. I had nine of ten toe nails involved, some since high school (so for decades). His protocol for this was
1) pulse dose of two Lamasil tablets at the start of treatment
2) OTC bottle of fungoid tincture (with little brush built into the cap) from drug store with half a Lamasil tablet dissolved in it
3) every morning in the shower, scrub the nail ends with a toothbrush and a chlorine powder cleaner like Comet
4) brush a small amount fungoid tincture onto nail ends after morning shower and at night before bed.
5) keep nails short with clean cut endsAs I recall, the Lamasil pulse dose kills the fungus in the nail bed right away, and the fungoid tincture wicks into the nail every time and carries the anti-fungal drug to the fungus residing within the nail. The chlorine cleaner acts as a dessicant and pH modifier.
Ultimately, he gave me the few necessary Lamasil tablets as free samples, and back then the fungoid tincture was maybe $4/bottle at walgreens.
The new nails grew in from the nail beds perfectly, and after many months I had perfect toe nails and ceased treating them. They have remained so ever since.
I have always wondered if this approach was ever published in a medical journal. No significant money to be made from it by the manufacturer of Lamasil, so it's hard to see who had an incentive to promote it.
Disclaimer: I am not a doctor and am not giving medical advice. Pursue at your own risk.
Thanks!!P Fitzsimon , March 20, 2018 at 4:57 pmWhy your pharmacist can't tell you .
WASHINGTON -- As consumers face rapidly rising drug costs, states across the country are moving to block "gag clauses" that prohibit pharmacists from telling customers that they could save money by paying cash for prescription drugs rather than using their health insurance The pharmacist cannot volunteer the fact that a medicine is less expensive if you pay the cash price and we don't run it through your health plan ."The White House Council of Economic Advisers said in a report this month that large pharmacy benefit managers "exercise undue market power" and generate "outsized profits for themselves."
Bill Carson , March 20, 2018 at 6:09 pmI'm going to get in trouble for saying this but toenail fungus isn't exactly leprosy. I've had a case continuously for 40 years after damaging my toenails in an accident. About 20 years ago I went to a doctor to see what could be done to get rid of it. He said I can give you a prescription that may cure it . But would you rather risk your liver or take the fungus with you to the grave after a full and healthy life with the fungus. I dont know what it would have cost because I chose the fungus. If it had cost $1500 and he hadn't told me the cost I would have been most unhappy.
Bill Carson , March 20, 2018 at 6:28 pmThis is shameful and absurd. However, the article mentions that there are "pills" that can be prescribed to treat the toe fungus, but some people taking those pills (terbinafine aka lamisil) have developed severe liver damage leading to liver transplant or death.
How much does it cost to just remove the toenail?
Bill Carson , March 20, 2018 at 6:46 pmWhy does this prescription cost $1,650 per month and not $16,500? Or $165,000? Or $1,650,000? Who decided that $1,650 was reasonable and $1,650,000 wasn't?
Bill Carson , March 20, 2018 at 6:39 pmOops, I meant $1,500 per month. But it probably costs more now anyway.
And how do they make an ointment last only a month? I've got some ointments under my sink that are 30 years old.
mtnwoman , March 20, 2018 at 7:40 pmI'm a lawyer. I took Contracts 25 years ago in law school, but I seem to remember that there are certain elements to a contract that have to be present before the parties can be bound. Let's see
1. Offer
2. Acceptance
3. Consideration
4. MutualityNow, it seems to me that Consideration can't just be left blank. It is a very rare (non-medical) contract indeed where the buyer says, "I want X, no matter what it costs."
If I stay at a hotel and they have a mini-fridge with various refreshments and snacks, and I take a Diet Coke and a Milky Way, they can't legally charge me $10,000 for that.
I don't know why this isn't considered defrauding the consumer. We should be able to sue the crap out of these companies.
Tim , March 20, 2018 at 9:09 pmGive the medical practitioners a break! So now they need to puruse the Wall St Journal daily to see what pirate has acquired what formerly cheap generic drup to monopolize it and raise the price 500%?
Yes, the price was outrageous. How is the practitioner supposed to know every patients health care coverage and what one particular insurance carrier will cover for what drug? What's $50 for one person is $1500 for another, depending on their insurance.
Our entire health care system sucks. The only people who like it are the Insurance and Pharma execs.
I won't give a doctor a break that prescribes a non-essential medicine with a 6% success rate.
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Mar 17, 2018 | www.zerohedge.com
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Approximately 63% of Americans have no emergency savings for things such as a $1,000 emergency room visit or a $500 car repair, according to a survey released Wednesday of 1,000 adults by personal finance website Bankrate.com, up slightly from 62% last year. Faced with an emergency, they say they would raise the money by reducing spending elsewhere (23%), borrowing from family and/or friends (15%) or using credit cards to bridge the gap (15%).
http://www.zerohedge.com/news/2016-01-07/sad-state-affairs-two-thirds-a
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You are going to need five things, which I am going to give to you, today, free of charge!
- Some absolutely critical industry vocabulary
- A clear understanding of how healthcare is priced in the USA
- Insight into to actual pricing
- A proven negotiation strategy, including:
- a. The point of contact
- b. Foreknowledge of what prices medical providers will usually agree to
- c. A sample offer and agreement
- The confidence to successfully negotiate
Unfortunately, I couldn't come up with a better way to impart to you an understanding of the industry lingo, other than these simple handouts. However, this information is so important for you to be able to understand any negotiation strategy that I simply must slog through each term with you now. Please, I ask that you hold your questions and comments until I get through the vocabulary. Many of the terms are cross-referenced, and will become more clear after we here them all.
- Premium: The monthly amount enrollees pay the insurance company to be covered.
- Deductible: The amount paid by the member before insurance will begin to reimburse services. It is reset annually, and based on the level of benefits or amount of premium paid. For example, with a $1,000 deductible the patient must pay medical providers for the first $1,000 of allowable expenses incurred by the patient each year, after which costs may be split according to a coinsurance arrangement, and/or may be limited to the patient's out of pocket expenses.
- Coinsurance: A cost-sharing requirement of some insurance plans where the patient assumes a percentage of the costs for covered services after the amount of the deductible has been met. Coinsurance is described as a ratio, for example 30/70, meaning the patient is responsible for paying 30% and the insurance will pay 70% of the allowable.
- Copayment (co-pay): The amount to be paid to a physician by or on behalf of the patient in connection with the services rendered by the physician. It is due at the time of service, is a fixed dollar amount determined by the insurance company based on the level of benefit, and is usually found printed on the patient's insurance card.
- Out of Pocket Expense: The total of covered health care expenses that are paid for by the member or patient, not including any premium. This is typically the total of the deductible and any coinsurance paid during a year. It may be a maximum amount where after 100% of allowable expenses are paid by the insurance company.
- Explanation of Benefits (EOB or ERA: Electronic Remittance Advice): The insurance company's explanation of the benefits they have, or have not, paid to a medical provider, along with any remaining amounts for which the patient is responsible, if any.
- CPT code: Current Procedural Terminology codes maintained by the American Medical Association. These five digit codes describe most medical, surgical, and diagnostic services and are used for administrative, financial, and analytical purposes such as on fee schedules and bills. These CPT codes are also known as Level 1 HCPCS codes, with Level 2 HCPCS codes being for non-provider medical services like ambulances and prosthetic devices. The CPT code is equivalent to a part number, SKU Stock Keeping Unit, or UPC Universal Product Code.
- Inpatient Prospective Payment System (IPPS): A system of payment for the operating costs of acute care hospital inpatient stays under Medicare Part A (Hospital Insurance). Under IPPS, each case is categorized into a diagnosis-related group (DRG). Each DRG has a payment weight assigned to it, based on the average resources used to treat Medicare patients in that DRG.
- Diagnosis-Related Group (DRG): a system to classify hospital visits into similar groups. Its intent is to identify the products that a hospital provides, such as an appendectomy. DRGs are assigned by group based on diagnosis (ICD code). DRGs may be further grouped into Major Diagnostic Categories (MDCs). DRGs are used to determine how much Medicare and some insurance plans pay hospitals and other services like home health.
- ICD code: The International Statistical Classification of Diseases and Related Health Problems provides codes to classify diseases and a wide variety of signs, symptoms, abnormal findings, complaints, social circumstances and external causes of injury or disease. Supposedly, every health condition can be assigned to a unique category and given a code.
- Billed charges (usual and customary fees): The undiscounted fees a healthcare provider lists on the bill (list price, or retail). These fees are usually set well above the highest allowable of all the provider's contracts, sometime as much as 800% or even 1,000%. The purpose of this overpricing is to force the insurance companies to the negotiating table.
- Allowable: The discounted fee for service a healthcare provider has contractually agreed to accept from an insurance company. It is listed by CPT code on the EOB or in a fee schedule available from your insurance company, Medicare, or Medicaid. UNDERSTANDING THIS TERM IS THE KEY TO UNDERSTANDING HEALTH INSURANCE AND TO NEGOTIATING DIRECTLY WITH MEDICAL PROVIDERS.
- Global Period: The number of days after a medical procedure when the fee for office visits is included, contractually, in the allowable for the procedure. It is typically 30, 60, or 90 days.
- Elective: For our purposes, care for any medical condition that is not an emergency.
- Emergency: A medical condition manifesting itself by acute symptoms of sufficient severity, which may include severe pain, such that the absence of immediate medical attention could reasonably be expected to result in serious jeopardy to patient health, and/or serious impairment to bodily functions, and/or serious dysfunction of any bodily organ or part.
- EMTALA: The Emergency Medical Treatment and Labor Act (EMTALA) is a federal law that requires anyone coming to an emergency department of a hospital with an emergency condition to be stabilized and treated, regardless of their insurance status or ability to pay.
- Insurance Verification: the process where a healthcare provider contacts the financially responsible party (usually an insurance company, Medicare, or an employer) and verifies that coverage is in effect and the information current. This generally includes the amount of the deductible met by the patient, copayment amounts, and coinsurance terms.
- Precertification: The process of obtaining approval from insurance, in advance, for a proposed treatment or diagnostic test, and is NEVER required for emergency care.
- Medicaid: The United States health program for eligible individuals and families with low incomes. It is a means-tested program that is jointly funded by the states and federal government, and is managed by the states. Generally is the lowest allowable fee for medical care.
- Medicare: a social insurance program funded by taxes and administered by vendors hired by the United States government. Medicare provides health insurance coverage to people who are aged 65 and over, or who meet other special criteria such as a disability. Generally it reimburses close to the average allowable fee for medical care. It is the easiest fee schedule to access at: www.CMS.gov
- Tricare: Health insurance for military personnel and their dependents.
- Workers Compensation: Insurance that provides medical care for employees who are injured in the course of employment. It is usually has the highest allowable fees for medical care.
... ... ..
To begin to understand how healthcare is priced, we are going to look at
- the doctor's bill given to a patient,
- the claim forms the doctor and hospital send to the insurance carrier, and
- ERAs that the insurance carrier then send back to the patient and the providers.
As we have already learned, all healthcare services have been assigned a code by the AMA, a five digit CPT code. So, if you trip and fall off your patio, you might get a doctor's bill like the following table located in your handouts:
On the hospital's bill you might see something like this:
It is important to understand that the amounts shown on both of these bills are un-discounted Billed Charges (Usual and Customary Fees). They are the highest price the provider might ever hope to receive for the service, also known as full retail, or MSRP. Don't panic when you get these bills, because as everyone knows, "Never pay retail."
You may receive other bills from several doctors such as anesthesiologists and radiologists, as well as laboratory services, therapists, and the ambulance company. The bills all look similar, and the strategy and tactics I am presenting, today, should work for each of them as well.
If you have insurance, the providers will send your carrier a claim with essentially the same data as is on the bill they will provide to you if you are not insured, or if you simply request a copy.
An important fact is that Federal Law, as a requirement for the medical provider's participation in Medicare, requires that a medical provider charge every patient the same amount for a given CPT item. What it does not require, however, is that a medical provider accept the same payment amount from every patient for a given CPT item. This allows insurance companies, government payers, and you to negotiate a discounted fee, known as a contracted allowable, and not be in violation of the law.
The purpose of this overpricing by the medical providers is to force the insurance companies to the negotiating table. The insurance company is bringing a large volume of patients to the medical providers, the members in their network, so they are able to negotiate a lower discounted allowable fee from the medical providers. However, if the insurance carrier is not able to negotiate a contractual allowable fee schedule, then they will end up paying the higher billed charges of the out-of-network provider for the members that still end up being treated by that medical provider in emergencies when precertification is not required.
This creates a tiered-pricing structure for medical services that looks very much like this table in your handouts:
At this point, if you are paying close attention, then it should start to dawn on you where I am leading you with this talk, which, after all, is titled: How to negotiate directly with physicians and hospitals.
Spoiler Alert: You are learning how to negotiate for Medicare rates, at worst, and Medicaid rates, at best. In our example, a bilateral elbow fracture patient in Texas received surgeon and hospital bills totaling $179,219. Medicare allows $30,542 and Medicaid $22,600, which means the government negotiated an 83% or 87.4% discount, respectively. You can too!
Before we move on to providing you with access to these fee schedules, and then a negotiation strategy, do you have any questions about how healthcare is priced in the USA?
Now, on to where you can find these prices. Well, if you have insurance, then after you receive medical care and the healthcare providers send their claims to the insurance carrier, you should receive from the payer an Explanation of Benefits (EOB), or you probably can go online and view an Electronic Remittance Advice (ERA). For every CPT code that the providers billed , you will see both a billed charge and allowable.
Quick show of hands: how many of you have received a medical bill, or an EOB, and threw it away because you could not understand it? That is intentional! They want you to be confused. However, after today, I doubt that you will ever do that again.
What if we do not have insurance, or we want to know the allowable, because we think this is important information to know so that we can negotiate before receiving healthcare? Think having a baby or elective surgery. Do not worry! The federal government provides us with the Medicare rates online, and I believe that each state provides its Medicaid fee schedules online.
- Medicare Physician Fee Schedule Look-up Tool: https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/PFSlookup
- Medicare Acute inpatient hospital stays: https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/AcuteInpa
- Texas Medicaid Fee Schedule: http://public.tmhp.com/FeeSchedules/Default.aspx
You would soon discover, however, that it is much easier to determine the allowable for a physician service than a hospital service, for which you will likely need to look up the DRGs for the ICD codes and then try to cross-reference them with the IPPS Fee Schedule, at a minimum, or you may even need to look up and calculate conversion factors. It is not easy, again, intentionally so!
Regardless, we would first need the CPT codes for the services you are seeking from the physician, and probably the ICD codes, too, in order to price hospital services. You could try to guess at the diagnosis and the services you think the doctor is going to provide to you, and then try to use a search engine to determine the ICD codes and CPT codes, or buy a coding book.
"I know I need a hip replacement. My trainer at the gym told me so. I'll just Google, hip replacement ICD and CPT code."
Good luck with that! The odds of you guessing the correct diagnosis and appropriate procedures (without going to medical school) are incredibly slim, especially with the new ICD-10 diagnosis codes. Also, chances are good that your athletic trainer doesn't know what the hell she is talking about when it come to medicine, and in reality, you probably just need a new athletic trainer, and not a new hip.
Is your head spinning, yet? Good! Now, stop it, because you will see that we don't need to do any of that! It's all just a red herring designed to keep us confused and the health insurers in business and profitable. Sounds a lot like our banking system, no?
Fortunately, as you will now learn, there is a much more simple and better way to be 100% certain of your diagnosis, diagnosis code, procedure, procedure code, and even the medications the physician will offer you, at least for elective conditions. Here it is. If it isn't an emergency, then make a doctor's appointment!
You may be thinking, "Isn't that putting the cart before the horse? Don't we want to know the costs in order to negotiate the fees before the services are provided?" The surprising answer is, no! Why? Well, because we only need to negotiate the fee schedule, specifically, Medicare or Medicaid, and not the exact fee. This is very important. Think back to the tiered-pricing structure.
Eventually, we may want to know the actual (or sometimes estimated) allowable amounts in order to budget for elective procedures, but this occurs after, or at the time of the physician's office visit, when they can provide us with the ICD codes, CPT codes, and usually the allowable amount, too! Later, we may choose to audit the allowable amount they give us, to make sure it is correct, and we were not over charged, but this is seldom done, as most people still trust their doctor, and the discounts you will be receiving are so HUGE you may feel a little guilty. Also, I will tell you, the auditing process is very tedious, not to mention the appeal process.
Therefore, we are now going to start talking about a negotiating strategy before we even attempt to access any pricing data. Again, we first need to know the diagnoses and proposed treatments. So, the solution is to start with a simple negotiation with the physician's office, probably just for the cost for the initial office visit, at the very least, and maybe some expected diagnostic tests. This is best done over the telephone, is easier and more successful than you might think, and is analogous to finding a mechanic to, "just take a look," at your car and tell you what is wrong with it, and then getting an estimate to repair it. Just like we expect to pay a little bit for the mechanic to diagnose our car, we should expect to pay a little bit for the doctor to diagnose us. The funny thing is that my mechanic and Medicare both charge or allow about $100 for a diagnosis. This is not so funny if you are the surgeon that spent 13 more years in school than the auto mechanic with a high school diploma.
Here we go, step by step:
1) I usually prefer to skip the added expense of going to a GP or family practice intermediary just to get a referral to a specialist that can actually help, especially when I can determine what medical specialty is likely to be most helpful for by medical condition by visiting the website of the American Board of Medical Specialties. (Is your ignition system acting up, your suspension riding a little rough, need new tires, brakes squeaking, transmission grinding?)
http://www.abms.org/member-boards/specialty-subspecialty-certificates/
2) Use the links on abms.org to visit the appropriate specialty board's website, and then use their "find a physician" with the sub-specialty likely to be most helpful for the condition
3) Start calling the sub-specialty physician offices listed, tell them you are a prospective new patient, and ask to speak to the Business Office Manager. Ask him or her the following questions:
a) "Do you accept Medicare and/or Medicaid insurance?" If yes, then...
b) "Super! Do you accept cash payment at the time of service?" If yes, then...
c) "Great! Then, of course, you will accept as payment in full, the Medicaid allowable, but paid in cash by me to you, directly, at the time of service? Correct?" If yes, then (e). If no then (d).
d) "I guess I understand. Well, then surely you will at least accept as payment the Medicare allowable, paid in cash by me to you, directly, at the time of service? If yes, then (e). If no then conclude the call, because you cannot fix stupid.
e) "Thank you! Can you please tell me what the estimated amount is for an office visit, using this fee schedule, so I can know how much money to bring, and please make a note on my account that we have negotiated a Single Case Agreement for me to pay these rates to you, in cash, at the time of service?
f) Tell him or her your specific reason for the visit (I am leaking red fluid on the floor of my garage) and that you want to be fully prepared for the visit. Ask what diagnostic tests, if any, are usually required for this type of problem, lab, X-ray, CT, MRI, ultrasound, etc., and which ones would probably need to be done outside the physician's clinic?
g) Make sure to get the BOM's name and contact information, and the appointment time and date.
After your office visit, if it turns out that you need a procedure such as day surgery at an Ambulatory Surgery Center (ASC), an inpatient admission at a hospital, a diagnostic test like an MRI or CT, or a series of treatments such as physical therapy, then you simply repeat the above negotiation, starting with the facility your physician recommends, and in the case of a hospital or ASC, always where he or she has privileges. ASC's allowable rates are always much lower than a hospital, so act accordingly. When telling the BOM that you are a prospective new patient, make sure to give the name of your physician. Instead of just making a note of any negotiated agreement in your account, the BOM and you should execute a written Single Case Agreement. It is usually a one-page agreement that looks something like this sample found in your handouts:
It should be obvious to you why, when possible, these negotiations should occur before treatment, which is more often than you might imagine. In general, elective conditions are negotiated in advance in this manner. Next, we are going to look at emergency conditions, which are more than likely negotiated after examination and treatment.
Before we do, are there any questions?
Ok, so I experience some kind of true medical emergency, where my life or limb is in jeopardy, like a heart attack. mrs_horseman puts me in an ambulance that rushes me to the Emergency Room at the hospital, and they run all kinds of tests, and give me some very expensive medications. Fortunately for me, a long enough timeline has not yet passed, my survival rate has not dropped to zero, and I don't even get to go to the cath lab or have emergency heart surgery. However, we do get several large medical bills from the hospital, ER doctor, ambulance, laboratory, and cardiologist. I either have no insurance, am self-insured, or I have a catastrophic insurance plan with a very high deductible that I am not likely to meet with this event, or this year. What do I do?
When I receive each bill, I immediately call each provider and get the name and address of the BOM. I then draft a Single Case Agreement Offer and Acceptance, and I offer to pay the estimated Medicaid allowable clearly labeled as such (by using the tiered-pricing structure I covered earlier) and expiring 10 days after it is received. I may also include some horseshit narrative about how I just received a small windfall, and was advised by my attorney to settle my hospital bill before I piss it away on fast women and slow horses, or worse, squander it. I send this to the BOM, Certified Mail-Return Receipt Requested , with my attorney copied on the bottom of the offer. The BOM may argue the accuracy of my Medicaid estimate, and make a counter offer with a more accurate Medicaid allowable, but the odds are very, very, high that he or she either agrees to the Medicaid allowable, or counters with something like a Medicare allowable. Either way, at this point I have successfully negotiated somewhere around an 83% - 87% discount on average, less for doctors, more for hospitals.
It is important to lock this agreement in, quickly, before my account is sold to a third-party collection agency, which is nowhere near as likely to accept such a deep discount, and far better than a healthcare provider at actually getting blood from a turnip. Medical providers are now turning their accounts over to collections as soon as 90 days from the date of service, which can mean that you are still being treated for this condition when this happens! Do not let this happen to you! Open the bills! Mail the offer! Maybe they say no, but that is not likely. On the other hand, the collections agencies are working very hard to get you on a payment plan for Billed Charges, with interest, for the rest of your life!
Does this sound unlikely? Too good to be true? Then consider this: Medical providers are highly incentivized to give the patients they treated huge discounts. Why? Because they know that collecting money from patients foments malpractice litigation. They would rather have you pay them pennies, than have you sue them for millions.
There it is. I said it. Think about that for a moment.
Now, considering the minimal risk of negotiating, and the large potential reward, do you now have the confidence to successfully negotiate directly with physicians and hospitals?
Before I spend just a few more minutes talking about pharmacies, and then finally some self-insurance goals, are there any questions or comments?
I recently had breakfast with a pharmacist friend of mine that has worked as a manager for Walgreens for more than a decade. mrs_horseman is probably smiling when she hears that I have a pharmacist friend, because she knows how I feel about most of the people in that industry. Nonetheless, I told him about this presentation I am making, and asked if he had any advice for negotiating directly with the pharmacies for medications. It turns out, he does, and I would have never guessed the tactic he described.
Are you ready? Coupons and free discount cards. He explained that if one simply goes online and searches for Walgreens coupons, it is usually possible to save between 5% and 60%. He specifically recommends Good Neighbor Pharmacy Prescription Savings Club.
http://www.mygnp.com/prescription-savings-club
He says that when you purchase medications, then you have 5 days to return to the same location Walgreens and bring a coupon for reimbursement of any savings. He says that if you are paying cash, then you must be sure to request a generic, if available. For long term meds, he explains that the drug manufacturer's web sites will often offer a free co-pay assistance card. If you have insurance, then you can present the free card from the manufacturer to the Walgreens pharmacy, and it will cover your co-pays. In closing, I want to talk just a bit about insurance and one of the situations where we would want to be able to negotiate directly with physicians, hospitals, and pharmacies.
As we have discussed, today, one of the primary benefits of having health insurance is to take advantage of the discounts negotiated by the insurance company or government. However, we just learned that providers are usually willing to accept similar discounted rates from cash pay patients.
The other big benefit of health insurance is to share with other people the risk of having to pay large bills that are the result of serious and unexpected injuries or illnesses. This is the traditional role of insurance. However, the costs and benefits of sharing risk are directly related to the health and healthcare consumption habits of all the members of the risk pool. As the post-vasectomy head of a healthy household, do I really want to be swimming in the Obamacare risk pool with millions of morbidly obese, perpetually pregnant, HIV infected drug abusers? No. It is too expensive!
What to do? Well, what do many smart employers in Texas do to save money with Worker's Compensation Insurance? They self-insure! They have money put away in case of an emergency. If they have an employee that is injured, then they negotiate directly with the healthcare providers, and pay deep discounts well below the statutory Worker's Compensation allowable, which we learned earlier is usually the highest allowable. They pay themselves a premium each month, which is effectively a forced savings plan. Sometimes, these companies may also purchase a relatively inexpensive health insurance plan called catastrophic, just in case a really big and expensive event occurs, like the whole oil refinery blows up and puts a few hundred employees in the hospital. However, if nothing happens, and the employees don't have any accidents, the company gets to keep most of the money, instead of giving it all to the insurance companies!
Hmmm. I wonder. Could I do that for my health insurance? Yes, and in fact mrs_horseman and I do exactly this. We have a high-deductible catastrophic health insurance plan and a $600 savings line item in our budget that we pay ourselves every month. We bet on ourselves to be healthy, unlike an HSA, where you bet on yourself to be unhealthy. This is true, and why we simply refuse to take the pre-tax bait of an HSA.
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Patient Observer , November 27, 2017 at 5:12 pm
Mark, today's posting provided is a nice change of pace to a topic of local impact (for me at least). UGC presented a good overview peppered with supporting data.marknesop , November 28, 2017 at 12:10 amIn an earlier career incarnation, I worked as a systems analyst involved with development of online systems for state social services. Data showed that our systems were able to administer a comprehensive health care program for social services recipients for about 3-4% of the cost of services. Private medical insurance providers required approximately 20% of the cost of services to provide similar services. Yet, private providers were supposedly driven by invisible market forces to maximum efficiency. BS. In fact, they are driven by greed and they found it much easier to maximize profits by colluding with politicians and health care providers. That is the trouble with free markets – its just so damn easy to cheat and cheaters are never in short supply.
One more thing, prescription drugs costs may exceed $600 billion in the US by 2021:
That would be nearly $2,000 per year for every American!
If a tiny fraction of that amount were spent on prevention, education, improved diets and other similar initiatives, the population ought to be healthier and richer. But, greed overpowers the public good every time. The US health care system is a criminal enterprise in my opinion. The good that it does is grossly outweighed by greed and exploitation of human suffering.
I believe the author is also a systems analyst, so you are thinking along similar lines.ucgsblog , November 28, 2017 at 4:05 pmI agree with that. Plus, it seems like they have an entire staff dedicated to giving their "customer" the run around. A friend of mine had to deal with several different departments regarding his healthcare bill. The billing office told him that they only deal with billing questions, and that for explanations for the bill, he should call the doctor's office. The doctor's office told him to call the hospital, since that's where the service took place. The hospital told him to call his primary doctor, who sent him there, and his primary doctor referred him back to the specialist, where he was referred back to the billing department, which promptly told him that they're closing for the day, since he spent 6 hours being transferred from one department to the next.
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anon@gmail.com , November 27, 2017 at 6:02 pm
I find it terribly silly that we should even consider med student's debt as an excuse. First, American doctors are the best paid professionals in the country. Internists make a median 190 thousand a year, and they are among the worst paid specialties. I cannot possibly see the problem with paying your income for 5 years, knowing that you get access to a caste that will allow you make good money into your eighties.ucgsblog , November 28, 2017 at 4:08 pmSecond, the debt is not that high as you claim. Harvard Medical School tuition is 64 thousand. You can rent across the street with 20 thousand a year – I currently live there.
Third, med students know all this. The reason why they borrow far more is because they know they can afford it. I went to med school somewhere in a developing world. We shared toilets in the dorm. As a matter of fact, most under-30s in Boston live in shared accommodation. The outliers? Med students. Even the lowly Tufts and BU students that I met own cars and live by themselves, mainly in new buildings across the street from their hospitals.
Every time I go to the doctors, I am thinking how I am going to sue their asses if they make a mistake.
It's not an excuse. It's a bill. When you rent an apartment, did you know that most landlords also factor in the property tax when figuring out what your rent payment should be? Similarly, the interest payments on the doctoral students' loans are passed off to the consumer, and that is yet another reason why Healthcare is so expensive. That's why I think that medical school should be free for those students who promise to charge their patients no more than x amount of money.
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Ryan Ward , November 28, 2017 at 3:40 am
With health care in general, there's a bit of a trade-off. The most cost-efficient systems, like the system in Sweden for example, are fairly regimented and don't leave much room for individual choice (unless someone pays out of pocket for treatment completely outside the public system). On the other hand, systems that give people a little more choice, like the system in Germany, tend to be a little on the pricey side. I think, given American political culture, something along the lines of the German model is much more likely to attract widespread public support. In any case, it's still cheaper than the American system, and achieves some of the best results in the world. https://en.wikipedia.org/wiki/Healthcare_in_Germany
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James lake , November 28, 2017 at 12:21 am
This is s very interesting insight into healcare in the USA. The cost is shocking.marknesop , November 28, 2017 at 10:25 am
I live in the UK and the healthcare system is paid for from taxation.
When it was established over 70 years ago it's
The health service would be available to all and financed entirely from taxation, which meant that people paid into it according to their means.
It was the best thing in my view that government has ever done.
Good healthcare should be available to all and not dependent on peoples ability to pay.However there always a private healthcare system that ran alongside it
And over the years it had been unpicked as successive governments have tried to privatise it. Claiming they will save the taxpayer money
– opticians and dentistry have become part private after 18 if you are employed.
Which many people do not mind.
-Elderly care was also privatised as it's the most expensive
-care for the disabled also is a issue for local councils
-Mental health became care in the community – society's problem!Privatisation has meant profits for businesses, poor services to vulnerable groups.
And yet still more and more taxation is needed for the NHS!
The issue of more money was even part of the Brexit debate as it was stated that leaving the EU would mean more money for the NHS which people are proud of.There was a quote I was thinking of using in the lead-in, but decided in the end not to since I didn't want to have too many and it might have become confusing. It related that you would get the best medical care of your lifetime – after you died, when they were rushing to save your organs, for transplant. Obviously this would not be true if you were not an organ donor (at least in this country) or died as the result of general wasting away so that you had nothing left which would be particularly coveted. But this is a major issue in medicine in some countries and there have been various lurid tales of bodies being robbed of their organs without family permission, bodies of Ukrainian soldiers harvested of their organs and rackets in third-world countries where the poor or helpless are robbed of organs while they are alive. From my standpoint, since I haven't done much research on it, I have seen little proof of any of them despite plenty of allegation, but it is easy to understand that traffic in organs to those who will pay anything to live a little longer would be tremendously profitable, and the potential for disproportionate profit seldom fails to draw the unscrupulous.Patient Observer , November 28, 2017 at 12:49 pmAs I alluded in the lead-in, Canada has what is sometimes described as 'socialized medicine' and alternatively as 'two-tier healthcare' although I have never seen any real substantiation for the latter charge. My mom had an operation for colon cancer some time back, and she paid nothing for the hospitalization or the operation. My father-in-law is scheduled for the same operation as soon as he gets his blood-sugar low enough, and he already had one for a hernia and removal of internal scar tissue from an old injury – again, we paid nothing. He had a nurse come here for a couple of months, once a week, to change his dressing (because the incision would was very slow to heal because he is diabetic – nothing. That's all great, from my point of view, and I've paid into it all my life without ever using it because I was covered by the government under federal guidelines while I served in the military, although I was a cheap patient because I never had to be hospitalized for anything and was almost never even sick enough not to come to work. But the great drawback to it, as I said, is the backlog which might mean you have to wait too long for an operation. And in my small practical experience – the two cases I have just mentioned – both were scheduled for surgery within a month of diagnosis. So perhaps the long wait is for particular operations such as heart or brain surgery.
The Albanian Kosovo Liberation Army harvested organs from captured Serb civilians and soldiers:et Al , November 28, 2017 at 1:32 amhttps://thebloodyellowhouse.wordpress.com/
In December 14th 2010, Dick Marty, Rapporteur of EU Commission pass for adoption to the Council of Europe a report on allegations of inhuman treatment of people and illicit trafficking in human organs in Kosovo organized by KLA leader and Kosovo Prime minister Hashim Thaçi . An official report accusing Kosovo's prime minister of links to a "mafia-like" network that killed captives in order to sell their organs on the black market was yesterday endorsed by a Council of Europe committee.
Bold text emphasis added.
Nothing came of the charges that I am aware of and it is business as usual with Kosovo and Albania.
Per Wikipedia:
The Washington Times reported that the KLA was financing its activities by trafficking the illegal drugs of heroin and cocaine into western Europe.[16]
A report to the Council of Europe, written by Dick Marty, issued on 15 December 2010[23] states that Hacim Thaçi was the leader of the "Drenica Group" in charge of trafficking organs taken from Serbian prisoners.
On 17 February 2008, Kosovo declared its independence from Serbia. Thaçi became Prime Minister of the newly independent state.
So, there you have it – the war criminal, drug runner, murderer and organ thief/butcher became the PM of Kosovo, a nation created and nurtured by NATO with a nod and a wink from the EU. Simply disgusting but typical treatment for Serbia by the fascist/racist and genocidally inclined West.
Thank you very much for a very interesting article UCG! Quite the horror story. I've heard quite a few about the US over the years from people I know too. I think one of the BBC's former America correspondent gave an interview to the Beeb as he was leaving America a few years back (MAtt Frei?) and was asked what were the best and worst things about living there. The worst was certainly healthcare.yalensis , November 28, 2017 at 3:21 amI've also read that healthcare costs for the self-employed, independents, freelancers can also be crushing in the land of the free where everyone can become rich. Has this changed? I would have thought that those were the ideal Americans, making it off their own back, but apparently not.
There's also another issue that is not addressed: an ageing population. This is a very current theme and it is now not at all unusual for people to live another 30 odd years after retirement. Now how on earth will such people manage their healthcare for such a period? Will they have to hock absolutely everything they have? America is already at war with itself (hence the utmost need to for foreign enemies), but nothing is getting done. Just more of the same. Meanwhile the Brits are trying to copy the US through stealth privatization of their health system. It might work as well as privatizing its rail service
Thanks for an interesting post, UCG. Hopefully this will stimulate some ideas on how to fix the American healthcare system, which seems to be badly broken.Patient Observer , November 28, 2017 at 4:34 amBroken for us but working perfectly for Big Pharma and insurance companies. That is a fundamental reason why it will be extremely difficult to "fix" because it ain't broken as a money making machine.yalensis , November 28, 2017 at 1:25 pmTrue. And the insurance companies, in particular, have been really raking it in, especially with Obamacare and the various Medicare Advantage options.
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kirill , November 27, 2017 at 8:38 pm
Interesting article. Looks like the rot in the US is terminal. But Canada and its "socialized" medicine is not far behind. Operating an emergency ward with only one doctor doing the rounds at the rest of the hospital during the night is absurd. But that is what major Canadian hospitals do. Don't bother going to emergency at 2 am unless you are literally dying. Wait until 7 am when the day day crew arrives and you can actually receive treatment.Ryan Ward , November 28, 2017 at 3:19 amThe problem in Canada, as in the USA, is overpaid doctors and not enough of them (because they are overpaid). Instead of paying a doctor $300,000 per year or more, the system needs to have 3 or more doctors earning $100,000 per year. Then there is no excuse about being overworked and "requiring" a high compensation. Big incomes attract crooks and not talent. If you want to be a doctor then you should do 5 years of low income work abroad or at home. That would weed out a lot of the $$$ in the eyeballs leeches. A nasty side effect of having overpaid doctors and living adjacent to the US, is that they act like a mafia and extort the government by threatening to leave to the USA. I say that the Canadian provinces should make all medical students sign binding contracts to pay the cost difference between their Canadian medical education and the equivalent in the USA if they decide to run off to America.
At the undergraduate level, the physics courses with the highest enrollment are aimed at streams going into medicine. There are hordes of money maker wannabes trying to make it big in medicine. But they are all nearly weeded out and never graduate from medical school. So the system maintains the fake doctor shortage and racket level salaries. On top of this, hospitals pay a 300% markup for basic supplies (gauze, syringes, etc). It is actually possible for private individuals to pay the nominal price so this is not just a theory. Clearly, there is no effort to control costs by hospital administrations since basic economics would imply that hospitals would pay less than individuals for these items due to the volume of sales involved. At the end of the day North American public medicine is a non-market bloating itself into oblivion since the taxpayer will always pay whatever is desired. That is, the spineless politicians will never crack the whip.
This is part of the problem in Canada. One way to help deal with it in my view, beyond simply cutting doctors' fees (which any government with the political will to do so can do) is to simply make it easier for International Medical Graduates to get licensed in Canada. Canada has legions of immigrants (and could have pretty much however many more it likes) with full medical qualifications who would be thrilled to work for much less than the current pay rates. It's a scandal how many qualified doctors we have in Canada driving taxis rather than practicing medicine. If we just took advantage of the human resources we already have, we could easily say to doctors who threaten to leave for the US, "Fine, go. We've got 10 guys from India lined up to do your job." This isn't to say that doctors shouldn't be very well-paid. Anyone who has ever known someone in med school knows it's hell. But doctors would be very well-paid at half the rates they're getting now.marknesop , November 28, 2017 at 10:32 amAnother part of the problem is an over-reliance on hospitals. There are a lot of people in the hospitals more in "holding" than anything else, because there's no space in the proper facilities for them (The book "Chronic Condition" talks about this). The problem with this is that the cost per day to keep someone in the hospital is much higher than in other kinds of facilities. This is an entirely unnecessary loss.
For all that though, the Canadian system is leaps and bounds better than the American. We spend a vastly smaller percentage of our GDP on health care, and in return achieve higher health outcomes, as measured by the WHO. If we were willing to spend the kind of money the Americans do on health care, we could have patients sleeping in golden beds even with the structural flaws of our current system. That's worth constantly remembering, because some of the proposals for health reform floating around now lean in the direction of privatization, and we've seen where that road leads.
Before he retired from politics, Keith Martin was my MLA, and he was also a qualified MD. He used to rail against the convoluted process for certification in medicine in Canada, while others complained that we were subject to an influx of doctor-immigrants from India because Canada required less time spent in medical school than India does. I never checked the veracity of that, although we do have quite a few Indian doctors. My own doctor – in the military, and still now since he is in private practice – is a South African, and he explained that he had gone in for the military (although he was always a civilian, some military doctors are military members as well but most are not) because the hoop-jumping process to be certified for private practice in Canada with foreign qualifications was just too onerous.Unsurprisingly, I completely agree on the subject of privatization, because it always leads to an emphasis on profit and cost-cutting. I don't know why some people can't see that.
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kirill , November 27, 2017 at 8:38 pm
Interesting article. Looks like the rot in the US is terminal. But Canada and its "socialized" medicine is not far behind. Operating an emergency ward with only one doctor doing the rounds at the rest of the hospital during the night is absurd. But that is what major Canadian hospitals do. Don't bother going to emergency at 2 am unless you are literally dying. Wait until 7 am when the day day crew arrives and you can actually receive treatment.Ryan Ward , November 28, 2017 at 3:19 amThe problem in Canada, as in the USA, is overpaid doctors and not enough of them (because they are overpaid). Instead of paying a doctor $300,000 per year or more, the system needs to have 3 or more doctors earning $100,000 per year. Then there is no excuse about being overworked and "requiring" a high compensation. Big incomes attract crooks and not talent. If you want to be a doctor then you should do 5 years of low income work abroad or at home. That would weed out a lot of the $$$ in the eyeballs leeches. A nasty side effect of having overpaid doctors and living adjacent to the US, is that they act like a mafia and extort the government by threatening to leave to the USA. I say that the Canadian provinces should make all medical students sign binding contracts to pay the cost difference between their Canadian medical education and the equivalent in the USA if they decide to run off to America.
At the undergraduate level, the physics courses with the highest enrollment are aimed at streams going into medicine. There are hordes of money maker wannabes trying to make it big in medicine. But they are all nearly weeded out and never graduate from medical school. So the system maintains the fake doctor shortage and racket level salaries. On top of this, hospitals pay a 300% markup for basic supplies (gauze, syringes, etc). It is actually possible for private individuals to pay the nominal price so this is not just a theory. Clearly, there is no effort to control costs by hospital administrations since basic economics would imply that hospitals would pay less than individuals for these items due to the volume of sales involved. At the end of the day North American public medicine is a non-market bloating itself into oblivion since the taxpayer will always pay whatever is desired. That is, the spineless politicians will never crack the whip.
This is part of the problem in Canada. One way to help deal with it in my view, beyond simply cutting doctors' fees (which any government with the political will to do so can do) is to simply make it easier for International Medical Graduates to get licensed in Canada. Canada has legions of immigrants (and could have pretty much however many more it likes) with full medical qualifications who would be thrilled to work for much less than the current pay rates. It's a scandal how many qualified doctors we have in Canada driving taxis rather than practicing medicine. If we just took advantage of the human resources we already have, we could easily say to doctors who threaten to leave for the US, "Fine, go. We've got 10 guys from India lined up to do your job." This isn't to say that doctors shouldn't be very well-paid. Anyone who has ever known someone in med school knows it's hell. But doctors would be very well-paid at half the rates they're getting now.marknesop , November 28, 2017 at 10:32 amAnother part of the problem is an over-reliance on hospitals. There are a lot of people in the hospitals more in "holding" than anything else, because there's no space in the proper facilities for them (The book "Chronic Condition" talks about this). The problem with this is that the cost per day to keep someone in the hospital is much higher than in other kinds of facilities. This is an entirely unnecessary loss.
For all that though, the Canadian system is leaps and bounds better than the American. We spend a vastly smaller percentage of our GDP on health care, and in return achieve higher health outcomes, as measured by the WHO. If we were willing to spend the kind of money the Americans do on health care, we could have patients sleeping in golden beds even with the structural flaws of our current system. That's worth constantly remembering, because some of the proposals for health reform floating around now lean in the direction of privatization, and we've seen where that road leads.
Before he retired from politics, Keith Martin was my MLA, and he was also a qualified MD. He used to rail against the convoluted process for certification in medicine in Canada, while others complained that we were subject to an influx of doctor-immigrants from India because Canada required less time spent in medical school than India does. I never checked the veracity of that, although we do have quite a few Indian doctors. My own doctor – in the military, and still now since he is in private practice – is a South African, and he explained that he had gone in for the military (although he was always a civilian, some military doctors are military members as well but most are not) because the hoop-jumping process to be certified for private practice in Canada with foreign qualifications was just too onerous.Unsurprisingly, I completely agree on the subject of privatization, because it always leads to an emphasis on profit and cost-cutting. I don't know why some people can't see that.
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James lake , November 28, 2017 at 12:21 am
This is s very interesting insight into healcare in the USA. The cost is shocking.marknesop , November 28, 2017 at 10:25 am
I live in the UK and the healthcare system is paid for from taxation.
When it was established over 70 years ago it's
The health service would be available to all and financed entirely from taxation, which meant that people paid into it according to their means.
It was the best thing in my view that government has ever done.
Good healthcare should be available to all and not dependent on peoples ability to pay.However there always a private healthcare system that ran alongside it
And over the years it had been unpicked as successive governments have tried to privatise it. Claiming they will save the taxpayer money
– opticians and dentistry have become part private after 18 if you are employed.
Which many people do not mind.
-Elderly care was also privatised as it's the most expensive
-care for the disabled also is a issue for local councils
-Mental health became care in the community – society's problem!Privatisation has meant profits for businesses, poor services to vulnerable groups.
And yet still more and more taxation is needed for the NHS!
The issue of more money was even part of the Brexit debate as it was stated that leaving the EU would mean more money for the NHS which people are proud of.There was a quote I was thinking of using in the lead-in, but decided in the end not to since I didn't want to have too many and it might have become confusing. It related that you would get the best medical care of your lifetime – after you died, when they were rushing to save your organs, for transplant. Obviously this would not be true if you were not an organ donor (at least in this country) or died as the result of general wasting away so that you had nothing left which would be particularly coveted. But this is a major issue in medicine in some countries and there have been various lurid tales of bodies being robbed of their organs without family permission, bodies of Ukrainian soldiers harvested of their organs and rackets in third-world countries where the poor or helpless are robbed of organs while they are alive. From my standpoint, since I haven't done much research on it, I have seen little proof of any of them despite plenty of allegation, but it is easy to understand that traffic in organs to those who will pay anything to live a little longer would be tremendously profitable, and the potential for disproportionate profit seldom fails to draw the unscrupulous.Patient Observer , November 28, 2017 at 12:49 pmAs I alluded in the lead-in, Canada has what is sometimes described as 'socialized medicine' and alternatively as 'two-tier healthcare' although I have never seen any real substantiation for the latter charge. My mom had an operation for colon cancer some time back, and she paid nothing for the hospitalization or the operation. My father-in-law is scheduled for the same operation as soon as he gets his blood-sugar low enough, and he already had one for a hernia and removal of internal scar tissue from an old injury – again, we paid nothing. He had a nurse come here for a couple of months, once a week, to change his dressing (because the incision would was very slow to heal because he is diabetic – nothing. That's all great, from my point of view, and I've paid into it all my life without ever using it because I was covered by the government under federal guidelines while I served in the military, although I was a cheap patient because I never had to be hospitalized for anything and was almost never even sick enough not to come to work. But the great drawback to it, as I said, is the backlog which might mean you have to wait too long for an operation. And in my small practical experience – the two cases I have just mentioned – both were scheduled for surgery within a month of diagnosis. So perhaps the long wait is for particular operations such as heart or brain surgery.
The Albanian Kosovo Liberation Army harvested organs from captured Serb civilians and soldiers:et Al , November 28, 2017 at 1:32 amhttps://thebloodyellowhouse.wordpress.com/
In December 14th 2010, Dick Marty, Rapporteur of EU Commission pass for adoption to the Council of Europe a report on allegations of inhuman treatment of people and illicit trafficking in human organs in Kosovo organized by KLA leader and Kosovo Prime minister Hashim Thaçi . An official report accusing Kosovo's prime minister of links to a "mafia-like" network that killed captives in order to sell their organs on the black market was yesterday endorsed by a Council of Europe committee.
Bold text emphasis added.
Nothing came of the charges that I am aware of and it is business as usual with Kosovo and Albania.
Per Wikipedia:
The Washington Times reported that the KLA was financing its activities by trafficking the illegal drugs of heroin and cocaine into western Europe.[16]
A report to the Council of Europe, written by Dick Marty, issued on 15 December 2010[23] states that Hacim Thaçi was the leader of the "Drenica Group" in charge of trafficking organs taken from Serbian prisoners.
On 17 February 2008, Kosovo declared its independence from Serbia. Thaçi became Prime Minister of the newly independent state.
So, there you have it – the war criminal, drug runner, murderer and organ thief/butcher became the PM of Kosovo, a nation created and nurtured by NATO with a nod and a wink from the EU. Simply disgusting but typical treatment for Serbia by the fascist/racist and genocidally inclined West.
Thank you very much for a very interesting article UCG! Quite the horror story. I've heard quite a few about the US over the years from people I know too. I think one of the BBC's former America correspondent gave an interview to the Beeb as he was leaving America a few years back (MAtt Frei?) and was asked what were the best and worst things about living there. The worst was certainly healthcare.yalensis , November 28, 2017 at 3:21 amI've also read that healthcare costs for the self-employed, independents, freelancers can also be crushing in the land of the free where everyone can become rich. Has this changed? I would have thought that those were the ideal Americans, making it off their own back, but apparently not.
There's also another issue that is not addressed: an ageing population. This is a very current theme and it is now not at all unusual for people to live another 30 odd years after retirement. Now how on earth will such people manage their healthcare for such a period? Will they have to hock absolutely everything they have? America is already at war with itself (hence the utmost need to for foreign enemies), but nothing is getting done. Just more of the same. Meanwhile the Brits are trying to copy the US through stealth privatization of their health system. It might work as well as privatizing its rail service
Thanks for an interesting post, UCG. Hopefully this will stimulate some ideas on how to fix the American healthcare system, which seems to be badly broken.Patient Observer , November 28, 2017 at 4:34 amBroken for us but working perfectly for Big Pharma and insurance companies. That is a fundamental reason why it will be extremely difficult to "fix" because it ain't broken as a money making machine.yalensis , November 28, 2017 at 1:25 pmTrue. And the insurance companies, in particular, have been really raking it in, especially with Obamacare and the various Medicare Advantage options.
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Ryan Ward , November 28, 2017 at 3:40 am
With health care in general, there's a bit of a trade-off. The most cost-efficient systems, like the system in Sweden for example, are fairly regimented and don't leave much room for individual choice (unless someone pays out of pocket for treatment completely outside the public system). On the other hand, systems that give people a little more choice, like the system in Germany, tend to be a little on the pricey side. I think, given American political culture, something along the lines of the German model is much more likely to attract widespread public support. In any case, it's still cheaper than the American system, and achieves some of the best results in the world. https://en.wikipedia.org/wiki/Healthcare_in_Germany
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anon@gmail.com , November 27, 2017 at 6:02 pm
I find it terribly silly that we should even consider med student's debt as an excuse. First, American doctors are the best paid professionals in the country. Internists make a median 190 thousand a year, and they are among the worst paid specialties. I cannot possibly see the problem with paying your income for 5 years, knowing that you get access to a caste that will allow you make good money into your eighties.ucgsblog , November 28, 2017 at 4:08 pmSecond, the debt is not that high as you claim. Harvard Medical School tuition is 64 thousand. You can rent across the street with 20 thousand a year – I currently live there.
Third, med students know all this. The reason why they borrow far more is because they know they can afford it. I went to med school somewhere in a developing world. We shared toilets in the dorm. As a matter of fact, most under-30s in Boston live in shared accommodation. The outliers? Med students. Even the lowly Tufts and BU students that I met own cars and live by themselves, mainly in new buildings across the street from their hospitals.
Every time I go to the doctors, I am thinking how I am going to sue their asses if they make a mistake.
It's not an excuse. It's a bill. When you rent an apartment, did you know that most landlords also factor in the property tax when figuring out what your rent payment should be? Similarly, the interest payments on the doctoral students' loans are passed off to the consumer, and that is yet another reason why Healthcare is so expensive. That's why I think that medical school should be free for those students who promise to charge their patients no more than x amount of money.
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Patient Observer , November 27, 2017 at 5:12 pm
Mark, today's posting provided is a nice change of pace to a topic of local impact (for me at least). UGC presented a good overview peppered with supporting data.marknesop , November 28, 2017 at 12:10 amIn an earlier career incarnation, I worked as a systems analyst involved with development of online systems for state social services. Data showed that our systems were able to administer a comprehensive health care program for social services recipients for about 3-4% of the cost of services. Private medical insurance providers required approximately 20% of the cost of services to provide similar services. Yet, private providers were supposedly driven by invisible market forces to maximum efficiency. BS. In fact, they are driven by greed and they found it much easier to maximize profits by colluding with politicians and health care providers. That is the trouble with free markets – its just so damn easy to cheat and cheaters are never in short supply.
One more thing, prescription drugs costs may exceed $600 billion in the US by 2021:
That would be nearly $2,000 per year for every American!
If a tiny fraction of that amount were spent on prevention, education, improved diets and other similar initiatives, the population ought to be healthier and richer. But, greed overpowers the public good every time. The US health care system is a criminal enterprise in my opinion. The good that it does is grossly outweighed by greed and exploitation of human suffering.
I believe the author is also a systems analyst, so you are thinking along similar lines.ucgsblog , November 28, 2017 at 4:05 pmI agree with that. Plus, it seems like they have an entire staff dedicated to giving their "customer" the run around. A friend of mine had to deal with several different departments regarding his healthcare bill. The billing office told him that they only deal with billing questions, and that for explanations for the bill, he should call the doctor's office. The doctor's office told him to call the hospital, since that's where the service took place. The hospital told him to call his primary doctor, who sent him there, and his primary doctor referred him back to the specialist, where he was referred back to the billing department, which promptly told him that they're closing for the day, since he spent 6 hours being transferred from one department to the next.
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"The art of medicine consists of amusing the patient while nature cures the disease."
"No, I mean I'm sorry that you've inherited such a miserable, collapsing Old Country. A place where rich Bankers own everything, where you've got to be grateful for a part-time job with no benefits and no retirement plan, where the most health insurance you can afford is being careful and hoping you don't get sick
Cory Doctorow; Homeland
"Until fairly recently, every family had a cornucopia of favorite home remedies–plants and household items that could be prepared to treat minor medical emergencies, or to prevent a common ailment becoming something much more serious. Most households had someone with a little understanding of home cures, and when knowledge fell short, or more serious illness took hold, the family physician or village healer would be called in for a consultation, and a treatment would be agreed upon. In those days we took personal responsibility for our health–we took steps to prevent illness and were more aware of our bodies and of changes in them. And when illness struck, we frequently had the personal means to remedy it. More often than not, the treatment could be found in the garden or the larder. In the middle of the twentieth century we began to change our outlook. The advent of modern medicine, together with its many miracles, also led to a much greater dependency on our physicians and to an increasingly stretched healthcare system. The growth of the pharmaceutical industry has meant that there are indeed "cures" for most symptoms, and we have become accustomed to putting our health in the hands of someone else, and to purchasing products that make us feel good. Somewhere along the line we began to believe that technology was in some way superior to what was natural, and so we willingly gave up control of even minor health problems."
Karen Sullivan; The Complete Family Guide to Natural Home Remedies: Safe and Effective Treatments for Common Ailments
No, I haven't abandoned Uncle Volodya, or shifted my focus to American administration; what follows is a guest post on the American healthcare system, by our friend UCG. As I've mentioned before – on the occasion of his previous guest post, in fact – he is an ethnic Russian living in the Golden State.
As an American in America, naturally his immediate concern is going to be healthcare in America; but there are lessons within for everyone. Don't get me wrong – doctors have done a tremendous amount of good, and medical researchers and many others from the world of medicine have made tremendous advances to which many of us owe their lives. Sadly, though, once a field goes commercial, the main focus of attention eventually becomes profit, and there are few endeavors in which the customer base will be so desperate. While there are obvious benefits to 'socialized medicine' such as Canada enjoys and American politicians scorn as 'Commie' – enough to earn the admiration of many – it results in such a backlog for major operations that those who don't like their chances of dying first, and have the money or can somehow get it, often flee to America, where you can get a good standard of medical care without running out of time waiting for it.
Without further ado, take it away, UCG!!
Healthcare in America
This article is my opinion. My hope is that others will do their own research on America's Healthcare Industry, because this is an issue that needs to be addressed, and for this article to be a mere starting point in this research. The reason for my citations is so that you, the reader, can verify them. Once again, this is my opinion. I write this in the first paragraph, so that I can avoid stating "in my opinion" before every sentence.
Let's start with Owen Davis who was charged $14,018 for going to a hospital because he sliced his hand, and they fixed it . A study published by Johns Hopkins showed that for $100 of ER treatment, some hospitals were charging patients up to $1,260 . A redditor claimed that :
I tore my ab wall a month ago and didn't think much of it until my pain kept worsening. I went to an immediate care facility to rule out a hernia (I had all the symptoms) and they told me to get to ER ASAP. I go to the ER and they give me a CT scan and one x-ray and say it's not a hernia and let me go. Fast forward to today and I got a bill for $9,200 and $3,900 of it is out of pocket. $9,200 for two tests???? No pain meds were administered; it was literally those two tests. What should I do to contest it? I will be calling tomorrow to demand an itemized bill, but is there anything else I should do in the meantime?
All of these took me a few minutes on Google to find, and another few minutes to post. The reason I chose that reddit, is because one of the readers offered an ingenious solution: Next time you hurt yourself – book a return ticket to NZ – go to accident and emergency, say you're a tourist and you hurt yourself surfing, pay nothing – fly home and pocket $8,000 in spare change. If that was me, I'd spend at least $2,000 on tourism in New Zealand. You guys have that system, so you clearly deserve the money! Anyone interested in a startup?
But I am not done with examples just yet. Shana Sweney described her experience in the emergency room : I delivered in 15 minutes. During that time, the anesthesiologist put a heart rate monitor on my finger and played on his phone. My bill for his services was $3,000. $200/minute. I talked to the insurance company about it – and since I ran my company's benefit plans, I got a little further than most people, but ultimately, that was what their contract with the hospital said so that's what they had to pay. Regardless of if he worked 15 minutes or 3 hours. Similarly, my twins were born prematurely and ended up in the NICU for 2 weeks. While the NICU was in-network for my insurance, for some mysterious reason, the neonatologists that attended the NICU were out of network. I think that bill was $16k and they stopped by to see each kid for an average of about 30 min/day.
Almost done with the examples, just please bear with me. How would you like a hospital billing you $83,046 for treating a scorpion sting , if a Mexican ER might have treated you for the same type of sting for $200? Perhaps being charged $546 for six liters of saltwater is more to your liking? $1,420 for two hours of babysitting ? $55,000 for an appendicitis operation ? $144,000 to deliver a perfectly healthy, albeit quite impatient baby? According to my interpretation of the sources linked, all of these actually happened. I encourage you to do your own research.
The World's Biggest Legalized Corruption (IMHO)
$984.157 billion. That's $984,157,000,000. That is how much money I believe the United States wastes on Healthcare. Not spends; wastes. As in money down the drain. The astute reader figured out that equates to five percent of America's 2016 GDP . Said reader is absolutely correct. How did I estimate such a gargantuan amount? According to the OECD data , in 2013 the United States spent 16.4 percent of its GDP on Healthcare; the two next biggest spenders, Switzerland and the Netherlands spent 11.1 percent. Even if one was to give the United States the benefit of doubt, and claim that the United States healthcare is just as efficient as that of Switzerland or the Netherlands – which is most likely not true according to an article from Business Insider , but even if it was – that meant that the United States wastes 5.3% of its GDP on healthcare. Wastes. I just want to make sure that the amount of this alleged legalized corruption, which will most likely reach a trillion dollars by 2020, is noted.
Let me place those funds into perspective: it's almost as much as the amount that the rest of the World spends on the military, combined . The SCO member states, including China, Russia, India, and Pakistan spent roughly $360 billion on the military . The wasted amount is equivalent to the GDP of Indonesia, and greater than the GDP of Turkey or Switzerland . In 2016, the US Federal Government spent $362 billion, or 36.8% of the wasted amount, to run all Federal Programs , including the Department of Education and NASA, with the exception of Social Security, Medicare/Medicaid, Veteran's Affairs, the military, and net interest on the US debt. All other Federal Programs were covered with the $362 billion. The US Federal Debt stands at $20.4 trillion , meaning that the debt can be paid off in 30 years, merely if the Healthcare Waste is eliminated.
But why stop there? The US Housing Crisis started partly because loans were allowed to be taken out without the 20% down payment. Could this funding, if applied directly to the housing market, stop the 2008 Great Recession? Absolutely, and all the Federal Government had to do was to gear these funds towards down payment on subprime mortgage loans to meet the 20 percent barrier. I can go on and on about what can be accomplished, like making collegiate attendance free, or at least very inexpensive, or drastically improving the quality of education, paying off the national debt, reinvesting into the economy, reinvigorating the rural sector, and so on, and so forth. A trillion dollars is a lot of money.
Lobbyists, the Media and the Waste
Any guess how much was spent on lobbying by the Healthcare, Insurance, Hospitals, Health Professionals, and HMOs? How about 10.5 billion dollars? I knew that was your guess! That's a lot of money, and that does not include "speaking fees", or when a politician who constantly made calls beneficial to the Healthcare Lobby gets $150,000 to speak in front of an audience after they retire from politics. Obama made a speech in front of Wall Street, netting $400,000 . And by pure coincidence, only one Wall Street Broker was jailed as a result of the scandal. That $10.5 billion is just a tip of the iceberg, because "speaking fees" are notoriously hard to track, and not included in said amount.
Obama genuinely tried to reform US Healthcare to the Swiss Model. He was going to let Wall Street slide, he was going to let Neocons conduct foreign policy, just please, let him have healthcare! First, the lobbyists laughed in his face. Second, they utilized the Blue Dog Coalition to block Obama's attempt at Healthcare Reform, until it was phenomenally nerfed, and we have the disaster that we have today. As a result, Obama's Legacy, Obamacare is having major issues, including the rise of racism.
Obamacare helped the poor, (mostly minorities,) at the expense of the middle class, (mostly whites,) thus transferring funding from whites to minorities. While the intent was not racial, it is being called out as racial by the mainstream media . This probably suits the lobbyists, because if the debate is about racism, one cannot have a genuine discussion about Healthcare Reform.
Racism strikes both ways. Samantha Bee came out with a "fuck you white people" message right after the election. Jon Stewart, without whom she probably wouldn't have her own show, pointed out that it was simply economics, like the healthcare insurance premium increase , that brought Donald Trump to power. Interestingly enough, James Carville made the same argument when Bill Clinton beat George Bush, but when Hillary Clinton lost, Carville was quick to blame Russia. These delusions on the Left are letting the Right mobilize stronger than ever before. And all of this takes away from the Healthcare Debate.
In an attempt to blame Trump's Election on white racism, rather than basic economics, numerous outlets simply fell flat. For instance, Eric Sasson writes : white men went 63 percent for Trump versus 31 percent for Clinton, and white women went 53-43 percent. Among college-educated whites, only 39 percent of men and 51 percent of women voted for Clinton What's more, these people hadn't suffered under Obama; they'd thrived. The kind of change Trump was espousing wasn't supposed to connect with this group.
Did this group thrive? The collegiate debt went from $600 billion to $1.4 trillion under Obama's Administration, while the health insurance increased from $13,000 to $18,000 per family . This is thriving? Was the author experimenting with medical marijuana when said article was written? Nevertheless, the parade of insanity continued, with Salon assuring us that it was blatant racism that gave us Trump . The Root, which also claimed that Russians attempted to hack election machines, pointed out that Russia exploited America's racism , and thus Trump won the election. Washington Post claimed that racism motivated white people more than authoritarianism . Comedian Bill Maher tried to sway the discussion back to economics, by pointing out that outrage over Pocahontas or Halloween should not stop the Democrats from working for the working man . Sadly, Maher and Stewart are in the minority, and instead of a Healthcare Debate, the US is now stuck in a debate over racism, which isn't even three-fifths as effective. Meanwhile the US continues to waste almost a trillion dollars on healthcare .
Who Benefits?
Let's start with the banks. Medical students graduate with an average of $416,216 in student debt . The average interest rate on said loan is seven percent. Roughly 20,055 students go through this program, per year . Presuming a twenty year loan, the banks are looking at about $7.185 billion in interest payments. It really is a small fraction of the cost. Prescription drug prices are another story. In 2014, Medicare spent $112 billion on medicine for the elderly . Oh la la! Cha-ching. I would not be surprised if at least half of that was wasted on drug price inflation. You know the health insurance companies? It's a great time to be one, since profits are booming – to the tune of $18 billion in projected revenue for 2017.
Of course the system itself is quite wasteful, with needless hours spent on paperwork, claim verification, contractual review, etc, etc, etc. Humana's revenue was $54.4 billion , Aetna's was $63.2 billion , Anthem's was $85 billion , Cigna's was $39.7 billion , and UnitedHealth's was $184.8 billion . Those are just the top five companies. None of them ia a mom-and-pop shop or small business store. Do any of these insurers support Obamacare? Even if they do, it is without much enthusiasm . They are leaving, and leaving quite quickly. Thirty-one percent of American counties will have just one healthcare insurer . Welcome to a monopoly that is artificially creating itself. And despite the waste, 28.2 million Americans remain uninsured . Mission accomplished!
Who else benefits? Those who hire illegal immigrants instead of American workers, since illegal immigrants cost the United States roughly $25 billion in Healthcare spending . Meanwhile those who hire them can avoid certain types of taxes and not have to cover their Healthcare; communism for the rich, capitalism for the rest of us. Of course that is just a rough estimate, since this spending is also quite hard to track.
The Future
The problem with changing Healthcare is that too many people have their hands in the proverbial pie. There is not a single lever of power that isn't affected by Healthcare, and most of the levers that are affected, benefit quite a bit. Insurance companies will fight to the death, because Universal Healthcare will be their death knell. Banks will defend it, because who doesn't want to make billions from student loans? Medical schools too – since it lets them charge higher and higher tuition. Pharmaceutical companies can use the increase in Healthcare expenditure to justify their own price hikes, even though a major reason for those price hikes is artificial patent based monopoly.
What is an artificial monopoly? In my opinion, it's when a patent is utilized to prevent competitors from manufacturing the same exact drug. In less than a decade, the price of Epi-Pen soared from $103.50 to $608.61. When asked the justify said increase, one of the reasons provided by the CEO was that the price went up because we were making investment; as I said, about $1 billion over the last decade that we invested in the product that we could reach physicians and educate legislatures. "Reaching" doctors and legislators; I wonder, how was said "education funding" spent? According to US News, a website that is extremely credible when it comes to internal decision making within the United States, drug companies have long courted doctors with gifts , from speaking and consulting fees to educational materials to food and drink. But while most doctors do not believe these gifts influence their decisions about which drugs to prescribe, a new study found the gifts actually can make a difference – something patient advocates have voiced concern about in the past. Do you feel educated? Would you feel more educated if I paid you a $150,000 consulting fee? What about $400,000? What? It's just consulting; no corruption here!
Everyone knows that this is going on. But there is not going to be change. Why not? The same reason that there was not change with Harvey Weinstein, until Taylor Swift came along. Remember how I said that almost everyone has their hands in the Healthcare Pie? It was not much different with Weinstein. Scott Rosenberg explained why it took so long for people to speak out against Harvey , and the reasons were numerous. First, Harvey gave many people their start in Hollywood, and treated all of his friends like royalty. That drastically increased their loyalty. Second, he ushered the Golden Age of the 1990s, with movies like Pulp Fiction, Shakespeare in Love, Clerks, Swingers, Scream, Good Will Hunting, English Patient, Life is Beautiful – the man could make phenomenal movies. Third, even if one was willing to go against his own friends, workers, mass media, and so on, there was no one to tell. There was no place to speak out. Fourth, some of the victims took hefty settlements.
That fourth reason enabled mass media to portray rape victims as gold diggers. Rape Culture is alive and well. In California, a Judge gave minimal sentencing to a convicted rapist , because he was afraid a harsher sentence would damage the rapist's mental psyche for life. Uh dude, from one Californian to another, he, uh, raped. His mental psyche is already damaged; for life. That's the kind of pressure that Rose McGowan had to deal with. She had a little kerfuffle with Amazon , and she thinks it was partially because of Harvey Weinstein. How many times had the word "socialism" been thrown around to describe Universal Healthcare? Switzerland has it – are they Socialist?
Enter Taylor Swift . In order to destroy allegations that women are filing sexual harassment claims as gold diggers, she sued her alleged sexual assaulter for a buck; one dollar. She won. Swift stated that the lawsuit was to serve as an example to other women who may resist publicly reliving similar outrageous and humiliating acts. On top of that, Weinstein was no longer as popular as he used to be, and an avenue to tell the story, an outlet was created. The additional prevalence of the internet caused the stories of Weinstein's sexual abuse to leak. Within a month, the giant fell.
Something similar is needed to change Healthcare in America. But until that comes along, racism will increase, the cost of Healthcare will rise, emergency room costs will most likely double every ten years, and the future remains bleak. As if that was not enough, more and more upper class Americans, (like yours truly,) are seeking treatment abroad. It cost me less money to lose five weeks of wages, spend three weeks partying in Eastern Europe, (Prague to be more specific,) after my two weeks of treatment, buy a roundtrip plane ticket, and stay in a five star, all-inclusive hotel, than the cost of the same treatment in the US. If anyone wants to utilize this as a startup – let me know!
Of course its effects on Healthcare will hurt, since it is a huge chunk of business that will be traveling across the Atlantic. But what can be done to stop it? One cannot stop Americans from traveling to other countries. One cannot force the poor to work for free. Perhaps this is the change that is needed to make those who benefit from the Healthcare Waste realize that this cannot continue. Perhaps not. What we do know, is that Obamacare insured the poor, at the expense of the middle class . And that is regarded as a failure in America.
Northern Star , November 27, 2017 at 3:12 pmAs for Obongo Care ??:ucgsblog , November 28, 2017 at 3:58 pm"In trying to show that he was successfully managing the Obamacare rollout, the president last week staged a high-profile White House meeting with private health insurance executives -- aka Obamacare's middlemen. The spectacle of a president begging these middlemen for help was a reminder that Obamacare did not limit the power of the insurance companies as a single-payer system would.
****The new law instead cemented the industry's profit-extracting role in the larger health system -- and it still leaves millions without insurance."*** (THAT is the Achille's lower torso of the ACA)https://www.healthcare-now.org/blog/single-payer-healthcare-vs-obamacare/
Exactly! That's why I stated that they're now oligapolizing the market, and will slowly start to increase their insurance rates and profits once again.Northern Star , November 27, 2017 at 3:23 pm"Prince Harry..Do you take this American mulatto negress -aka raghead untermensch-as your lawfully wedded royal wife?*Northern Star , November 27, 2017 at 3:52 pm
http://www.newsweek.com/prince-harrys-worst-moments-meghan-markle-rogue-723177
https://www.sbs.com.au/guide/sites/sbs.com.au.guide/files/styles/body_image/public/nazi.jpg?itok=q1oxMi44&mtime=1503879842Ummm Advice to Meghan .make sure the honeymoon motorcade stays clear of tunnels in Paris
or elsewhere!!!Appurtenant to many of the issues raised in Mark's post:Patient Observer , November 27, 2017 at 5:17 pmhttp://www.wsws.org/en/articles/2017/11/27/pers-n27.html
(Socialist or not..the WSWS writers continue to state that which NEEDS to be hammered home)
"The vast wealth of the financial oligarchy, expressed in their ownership of massive corporations, must be seized and expropriated, while the complex technologies, supply chains, and advanced transportation systems must be integrated in an organized, planned manner to harness the anarchic force of the world economy and eliminate material scarcity.
Amazon is a prime example. Its supply lines and delivery systems could distribute goods across the world, bringing water, food, and medicine from each producer according to his or her ability, to each consumer according to his or her need.
The massively sophisticated computational power used by the technology companies to censor and blacklist political opposition could instead be used for logistical analysis to conduct rescue and rebuilding missions in disaster zones like Houston and Puerto Rico. Drones used in the battlefield could be scrapped and rebuilt to distribute supplies for building schools, museums, libraries, and theaters, and for making Internet service available at no cost for the entire world.
The ruling class and all of the institutions of the political establishment stand inexorably in the way of efforts to expropriate their wealth. What is required is to mobilize the working class in a political struggle against the state and the socio-economic system on which it is based, through the fight for socialism.
Eric London "Particularly for American Stooges:
Advanced technology is helpful but not essential for a humane and just society. Its what we believe and feel that matters. FWIW, I like socialism on a national/international level and individual accountability on a personal level.saskydisc , November 27, 2017 at 4:04 pmWhile general medical care is single payer in Canada, dental services are not. For major work on teeth, it is cheaper to fly to Mexico. The downside is for Mexicans -- such practices will drive the costs up in Mexico.Patient Observer , November 27, 2017 at 5:12 pmMark, today's posting provided is a nice change of pace to a topic of local impact (for me at least). UGC presented a good overview peppered with supporting data.marknesop , November 28, 2017 at 12:10 amIn an earlier career incarnation, I worked as a systems analyst involved with development of online systems for state social services. Data showed that our systems were able to administer a comprehensive health care program for social services recipients for about 3-4% of the cost of services. Private medical insurance providers required approximately 20% of the cost of services to provide similar services. Yet, private providers were supposedly driven by invisible market forces to maximum efficiency. BS. In fact, they are driven by greed and they found it much easier to maximize profits by colluding with politicians and health care providers. That is the trouble with free markets – its just so damn easy to cheat and cheaters are never in short supply.
One more thing, prescription drugs costs may exceed $600 billion in the US by 2021:
That would be nearly $2,000 per year for every American!
If a tiny fraction of that amount were spent on prevention, education, improved diets and other similar initiatives, the population ought to be healthier and richer. But, greed overpowers the public good every time. The US health care system is a criminal enterprise in my opinion. The good that it does is grossly outweighed by greed and exploitation of human suffering.
I believe the author is also a systems analyst, so you are thinking along similar lines.ucgsblog , November 28, 2017 at 4:05 pmI agree with that. Plus, it seems like they have an entire staff dedicated to giving their "customer" the run around. A friend of mine had to deal with several different departments regarding his healthcare bill. The billing office told him that they only deal with billing questions, and that for explanations for the bill, he should call the doctor's office. The doctor's office told him to call the hospital, since that's where the service took place. The hospital told him to call his primary doctor, who sent him there, and his primary doctor referred him back to the specialist, where he was referred back to the billing department, which promptly told him that they're closing for the day, since he spent 6 hours being transferred from one department to the next.anon@gmail.com , November 27, 2017 at 6:02 pmI find it terribly silly that we should even consider med student's debt as an excuse. First, American doctors are the best paid professionals in the country. Internists make a median 190 thousand a year, and they are among the worst paid specialties. I cannot possibly see the problem with paying your income for 5 years, knowing that you get access to a caste that will allow you make good money into your eighties.ucgsblog , November 28, 2017 at 4:08 pmSecond, the debt is not that high as you claim. Harvard Medical School tuition is 64 thousand. You can rent across the street with 20 thousand a year – I currently live there.
Third, med students know all this. The reason why they borrow far more is because they know they can afford it. I went to med school somewhere in a developing world. We shared toilets in the dorm. As a matter of fact, most under-30s in Boston live in shared accommodation. The outliers? Med students. Even the lowly Tufts and BU students that I met own cars and live by themselves, mainly in new buildings across the street from their hospitals.
Every time I go to the doctors, I am thinking how I am going to sue their asses if they make a mistake.
It's not an excuse. It's a bill. When you rent an apartment, did you know that most landlords also factor in the property tax when figuring out what your rent payment should be? Similarly, the interest payments on the doctoral students' loans are passed off to the consumer, and that is yet another reason why Healthcare is so expensive. That's why I think that medical school should be free for those students who promise to charge their patients no more than x amount of money.kirill , November 27, 2017 at 8:38 pmInteresting article. Looks like the rot in the US is terminal. But Canada and its "socialized" medicine is not far behind. Operating an emergency ward with only one doctor doing the rounds at the rest of the hospital during the night is absurd. But that is what major Canadian hospitals do. Don't bother going to emergency at 2 am unless you are literally dying. Wait until 7 am when the day day crew arrives and you can actually receive treatment.Ryan Ward , November 28, 2017 at 3:19 amThe problem in Canada, as in the USA, is overpaid doctors and not enough of them (because they are overpaid). Instead of paying a doctor $300,000 per year or more, the system needs to have 3 or more doctors earning $100,000 per year. Then there is no excuse about being overworked and "requiring" a high compensation. Big incomes attract crooks and not talent. If you want to be a doctor then you should do 5 years of low income work abroad or at home. That would weed out a lot of the $$$ in the eyeballs leeches. A nasty side effect of having overpaid doctors and living adjacent to the US, is that they act like a mafia and extort the government by threatening to leave to the USA. I say that the Canadian provinces should make all medical students sign binding contracts to pay the cost difference between their Canadian medical education and the equivalent in the USA if they decide to run off to America.
At the undergraduate level, the physics courses with the highest enrollment are aimed at streams going into medicine. There are hordes of money maker wannabes trying to make it big in medicine. But they are all nearly weeded out and never graduate from medical school. So the system maintains the fake doctor shortage and racket level salaries. On top of this, hospitals pay a 300% markup for basic supplies (gauze, syringes, etc). It is actually possible for private individuals to pay the nominal price so this is not just a theory. Clearly, there is no effort to control costs by hospital administrations since basic economics would imply that hospitals would pay less than individuals for these items due to the volume of sales involved. At the end of the day North American public medicine is a non-market bloating itself into oblivion since the taxpayer will always pay whatever is desired. That is, the spineless politicians will never crack the whip.
This is part of the problem in Canada. One way to help deal with it in my view, beyond simply cutting doctors' fees (which any government with the political will to do so can do) is to simply make it easier for International Medical Graduates to get licensed in Canada. Canada has legions of immigrants (and could have pretty much however many more it likes) with full medical qualifications who would be thrilled to work for much less than the current pay rates. It's a scandal how many qualified doctors we have in Canada driving taxis rather than practicing medicine. If we just took advantage of the human resources we already have, we could easily say to doctors who threaten to leave for the US, "Fine, go. We've got 10 guys from India lined up to do your job." This isn't to say that doctors shouldn't be very well-paid. Anyone who has ever known someone in med school knows it's hell. But doctors would be very well-paid at half the rates they're getting now.marknesop , November 28, 2017 at 10:32 amAnother part of the problem is an over-reliance on hospitals. There are a lot of people in the hospitals more in "holding" than anything else, because there's no space in the proper facilities for them (The book "Chronic Condition" talks about this). The problem with this is that the cost per day to keep someone in the hospital is much higher than in other kinds of facilities. This is an entirely unnecessary loss.
For all that though, the Canadian system is leaps and bounds better than the American. We spend a vastly smaller percentage of our GDP on health care, and in return achieve higher health outcomes, as measured by the WHO. If we were willing to spend the kind of money the Americans do on health care, we could have patients sleeping in golden beds even with the structural flaws of our current system. That's worth constantly remembering, because some of the proposals for health reform floating around now lean in the direction of privatization, and we've seen where that road leads.
Before he retired from politics, Keith Martin was my MLA, and he was also a qualified MD. He used to rail against the convoluted process for certification in medicine in Canada, while others complained that we were subject to an influx of doctor-immigrants from India because Canada required less time spent in medical school than India does. I never checked the veracity of that, although we do have quite a few Indian doctors. My own doctor – in the military, and still now since he is in private practice – is a South African, and he explained that he had gone in for the military (although he was always a civilian, some military doctors are military members as well but most are not) because the hoop-jumping process to be certified for private practice in Canada with foreign qualifications was just too onerous.Jen , November 27, 2017 at 11:15 pmUnsurprisingly, I completely agree on the subject of privatization, because it always leads to an emphasis on profit and cost-cutting. I don't know why some people can't see that.
Thanks very much UCG, for your article. Very interesting reading for us Australians as the Federal Government eventually wants to shove us kicking and screaming into a US-style privatised healthcare insurance model.Fern , November 28, 2017 at 7:02 amFunnily enough I'm currently considering changing my private health insurer. I'm with Medibank Private at present but considering maybe going with a smaller non-profit health fund like Australian Unity or Phoenix Health Fund.
I was just about to post along the lines of "I don't know if Jen has experienced this in Australia but here in the UK ." so I'll finish the thought. In the UK, successive governments, not just Conservative ones, have been trying to dismantle the NHS and move us to the American system. It is pure ideology – no amount of the very abundant evidence of the inefficiencies of the US system, its waste etc makes any dint in the enthusiasm of those pressing for change.ucgsblog , November 28, 2017 at 4:17 pmThank you Jen! My advice: don't let the Government cajole you into wasting your money on Corporate Greed. Share the article with your fellow Australians, if you must, but don't let our wasteful system be replicated. Interestingly enough, one of my friends, Lytburger, send me a meme right after Ukraine adopted America's Healthcare System, it said: "ISIS refused to take responsibility for Ukraine's Healthcare Reform!" I'd be happy to provide other data or answer questions about the Healthcare System here.James lake , November 28, 2017 at 12:21 amAs for insurance, I'm not sure if Australia has the in-network and out-of-network rules. Does it? Whatever insurance you get, make sure that it has good coverage. If you own a home in the US, and you end up in a hospital's emergency room that's not covered by your insurance, the hospital can take your house under certain circumstances. Ironically, even the Government cannot. All of my real property is in various Trust Accounts, just in case, and I make sure that I have insurance where all major hospitals are in-network and that's the best I can do.
This is s very interesting insight into healcare in the USA. The cost is shocking. I live in the UK and the healthcare system is paid for from taxation. When it was established over 70 years ago it's. The health service would be available to all and financed entirely from taxation, which meant that people paid into it according to their means. It was the best thing in my view that government has ever done. Good healthcare should be available to all and not dependent on peoples ability to pay.marknesop , November 28, 2017 at 10:25 amHowever there always a private healthcare system that ran alongside it
And over the years it had been unpicked as successive governments have tried to privatise it. Claiming they will save the taxpayer money
– opticians and dentistry have become part private after 18 if you are employed.
Which many people do not mind.
-Elderly care was also privatised as it's the most expensive
-care for the disabled also is a issue for local councils
-Mental health became care in the community – society's problem!
Privatisation has meant profits for businesses, poor services to vulnerable groups.
And yet still more and more taxation is needed for the NHS!
The issue of more money was even part of the Brexit debate as it was stated that leaving the EU would mean more money for the NHS which people are proud of.
There was a quote I was thinking of using in the lead-in, but decided in the end not to since I didn't want to have too many and it might have become confusing. It related that you would get the best medical care of your lifetime – after you died, when they were rushing to save your organs, for transplant. Obviously this would not be true if you were not an organ donor (at least in this country) or died as the result of general wasting away so that you had nothing left which would be particularly coveted. But this is a major issue in medicine in some countries and there have been various lurid tales of bodies being robbed of their organs without family permission, bodies of Ukrainian soldiers harvested of their organs and rackets in third-world countries where the poor or helpless are robbed of organs while they are alive. From my standpoint, since I haven't done much research on it, I have seen little proof of any of them despite plenty of allegation, but it is easy to understand that traffic in organs to those who will pay anything to live a little longer would be tremendously profitable, and the potential for disproportionate profit seldom fails to draw the unscrupulous.Patient Observer , November 28, 2017 at 12:49 pmAs I alluded in the lead-in, Canada has what is sometimes described as 'socialized medicine' and alternatively as 'two-tier healthcare' although I have never seen any real substantiation for the latter charge. My mom had an operation for colon cancer some time back, and she paid nothing for the hospitalization or the operation. My father-in-law is scheduled for the same operation as soon as he gets his blood-sugar low enough, and he already had one for a hernia and removal of internal scar tissue from an old injury – again, we paid nothing. He had a nurse come here for a couple of months, once a week, to change his dressing (because the incision would was very slow to heal because he is diabetic – nothing. That's all great, from my point of view, and I've paid into it all my life without ever using it because I was covered by the government under federal guidelines while I served in the military, although I was a cheap patient because I never had to be hospitalized for anything and was almost never even sick enough not to come to work. But the great drawback to it, as I said, is the backlog which might mean you have to wait too long for an operation. And in my small practical experience – the two cases I have just mentioned – both were scheduled for surgery within a month of diagnosis. So perhaps the long wait is for particular operations such as heart or brain surgery.
The Albanian Kosovo Liberation Army harvested organs from captured Serb civilians and soldiers:et Al , November 28, 2017 at 1:32 amhttps://thebloodyellowhouse.wordpress.com/
In December 14th 2010, Dick Marty, Rapporteur of EU Commission pass for adoption to the Council of Europe a report on allegations of inhuman treatment of people and illicit trafficking in human organs in Kosovo organized by KLA leader and Kosovo Prime minister Hashim Thaçi . An official report accusing Kosovo's prime minister of links to a "mafia-like" network that killed captives in order to sell their organs on the black market was yesterday endorsed by a Council of Europe committee.
Bold text emphasis added.
Nothing came of the charges that I am aware of and it is business as usual with Kosovo and Albania.
Per Wikipedia:
The Washington Times reported that the KLA was financing its activities by trafficking the illegal drugs of heroin and cocaine into western Europe.[16]
A report to the Council of Europe, written by Dick Marty, issued on 15 December 2010[23] states that Hacim Thaçi was the leader of the "Drenica Group" in charge of trafficking organs taken from Serbian prisoners.
On 17 February 2008, Kosovo declared its independence from Serbia. Thaçi became Prime Minister of the newly independent state.
So, there you have it – the war criminal, drug runner, murderer and organ thief/butcher became the PM of Kosovo, a nation created and nurtured by NATO with a nod and a wink from the EU. Simply disgusting but typical treatment for Serbia by the fascist/racist and genocidally inclined West.
Thank you very much for a very interesting article UCG! Quite the horror story. I've heard quite a few about the US over the years from people I know too. I think one of the BBC's former America correspondent gave an interview to the Beeb as he was leaving America a few years back (MAtt Frei?) and was asked what were the best and worst things about living there. The worst was certainly healthcare.yalensis , November 28, 2017 at 3:21 amI've also read that healthcare costs for the self-employed, independents, freelancers can also be crushing in the land of the free where everyone can become rich. Has this changed? I would have thought that those were the ideal Americans, making it off their own back, but apparently not.
There's also another issue that is not addressed: an ageing population. This is a very current theme and it is now not at all unusual for people to live another 30 odd years after retirement. Now how on earth will such people manage their healthcare for such a period? Will they have to hock absolutely everything they have? America is already at war with itself (hence the utmost need to for foreign enemies), but nothing is getting done. Just more of the same. Meanwhile the Brits are trying to copy the US through stealth privatization of their health system. It might work as well as privatizing its rail service
Thanks for an interesting post, UCG. Hopefully this will stimulate some ideas on how to fix the American healthcare system, which seems to be badly broken.Patient Observer , November 28, 2017 at 4:34 amBroken for us but working perfectly for Big Pharma and insurance companies. That is a fundamental reason why it will be extremely difficult to "fix" because it ain't broken as a money making machine.yalensis , November 28, 2017 at 1:25 pmTrue. And the insurance companies, in particular, have been really raking it in, especially with Obamacare and the various Medicare Advantage options.Ryan Ward , November 28, 2017 at 3:40 amWith health care in general, there's a bit of a trade-off. The most cost-efficient systems, like the system in Sweden for example, are fairly regimented and don't leave much room for individual choice (unless someone pays out of pocket for treatment completely outside the public system). On the other hand, systems that give people a little more choice, like the system in Germany, tend to be a little on the pricey side. I think, given American political culture, something along the lines of the German model is much more likely to attract widespread public support. In any case, it's still cheaper than the American system, and achieves some of the best results in the world. https://en.wikipedia.org/wiki/Healthcare_in_Germany
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Nov 15, 2017 | www.nakedcapitalism.com
Alex Azar: Can There Be Uglier Scenarios than the Revolving Door? Posted on November 15, 2017 by Lambert Strether By Lambert Strether
Clearly, Alex Azar, nominated yesterday for the position of Secretary of Health and Human Services by the Trump Administration, exemplifies the case of the "revolving door," through which Flexians slither on their way to (or from) positions of public trust. Roy Poses ( cross-posted at NC ) wrote, when Azar was only Acting Secretary:
Last week we noted that Mr Trump famously promised to “drain the swamp” in Washington. Last week, despite his previous pledges to not appoint lobbyists to powerful positions, he appointed a lobbyist to be acting DHHS Secretary. This week he is apparently strongly considering Mr Alex Azar, a pharmaceutical executive to be permanent DHHS Secretary, even though the FDA, part of DHHS, has direct regulatory authority over the pharmaceutical industry, and many other DHHS policies strongly affect the pharmaceutical industry. (By the way, Mr Azar was also in charge of one lobbying effort.)
So should Mr Azar be confirmed as Secretary of DHHS, the fox guarding the hen house appears to be a reasonable analogy.
Moreover, several serious legal cases involving bad behavior by his company, and multiple other instances of apparently unethical behavior occurred on Mr Azar’s watch at Eli Lilly. So the fox might be not the most reputable member of the species.
So you know the drill…. The revolving door is a species of conflict of interest . Worse, some experts have suggested that the revolving door is in fact corruption. As we noted here , the experts from the distinguished European anti-corruption group U4 wrote ,
The literature makes clear that the revolving door process is a source of valuable political connections for private firms. But it generates corruption risks and has strong distortionary effects on the economy , especially when this power is concentrated within a few firms.
The ongoing parade of people transiting the revolving door from industry to the Trump administration once again suggests how the revolving door may enable certain of those with private vested interests to have excess influence, way beyond that of ordinary citizens, on how the government works, and that the country is still increasingly being run by a cozy group of insiders with ties to both government and industry. This has been termed crony capitalism.
Poses is, of course, correct. (Personally, I've contained my aghastitude on Azar, because I remember quite well how Liz Fowler transitioned from Wellpoint to being Max Baucus's chief of staff when ObamaCare was being drafted to a job in Big Pharma , and I remember quite well the deal with Big Pharma Obama cut, which eliminated the public option , not that the public option was anything other than a decreasingly gaudy "progressive" bauble in the first place.)
In this post, I'd like to add two additional factors to our consideration of Azar. The first: Democrat credentialism makes it hard for them to oppose Azar. The second: The real damage Azar could do is on the regulatory side.[1]
First, Democrat credentialism. Here is one effusive encomium on Azar. From USA Today, "Who is Alex Azar? Former drugmaker CEO and HHS official nominated to head agency" :
"I am glad to hear that you have worked hard, and brought fair-minded legal analysis to the department," Democratic Sen. Max Baucus said at Azar's last confirmation hearing.
And:
Andy Slavitt, who ran the Affordable Care Act and the Centers for Medicare & Medicaid Services during the Obama administration, said he has reason to hope Azar would be a good secretary.
"He is familiar with the high quality of the HHS staff, has real-world experience enough to be pragmatic, and will hopefully avoid repeating the mistakes of his predecessor," Slavitt said.
So, if Democrats are saying Azar is "fair-minded" and "pragmatic" -- and heaven forfend that the word "corruption"[2] even be mentioned -- how do they oppose him, even he's viscerally opposed to everything Democrats supposedly stand for? (Democrats do this with judicial nominations, too.) Azar may be a fox, alright, but the chickens he's supposedly guarding are all clucking about how impeccable his qualifications are!
Second, let's briefly look at Azar's bio. Let me excerpt salient detail from USA Today :
1. Azar clerked for Supreme Court Justice Antonin Scalia .
2. Azar went to work for his mentor, Ken Starr , who was heading the independent counsel investigation into Bill and Hillary Clinton's Whitewater land deal.
3. Azar had a significant role in another major political controversy when the outcome of the 2000 presidential election hinged on a recount in Florida . Azar was on the Bush team of lawyers whose side ultimately prevailed [3]
For any Democrat with a memory, that bio provokes one of those "You shall know them by the trail of the dead" moments. And then there's this:
When Leavitt replaced Thompson in 2005 and Azar became his deputy, Leavitt delegated a lot of the rule-making process to Azar.
So, a liberal Democrat might classify Azar as a smooth-talking reactionary thug with a terrible record and the most vile mentors imaginable, and on top of it all, he's an effective bureaucratic fixer. What could the Trump Administration possibly see in such a person? Former (Republican) HHS Secretary Mike Leavitt explains:
"Understanding the administrative rule process in the circumstance we're in today could be extraordinarily important because a lot of the change in the health care system, given the fact that they've not succeeded legislatively, could come administratively."
We outlined the administration strategy on health care in "Trump Adminstration Doubles Down on Efforts to Crapify the Entire Health Care System (Unless You're Rich, of Course)" . There are three prongs:
1) Administratively, send ObamaCare into a death spiral by sabotaging it
2) Legislatively, gut Medicaid as part of the "tax refom" package in Congress
3) Through executive order, eliminate "essential health benefits" through "association health plans"
As a sidebar, it's interesting to see that although this do-list is strategically and ideologically coherent -- basically, your ability to access health care will be directly dependent on your ability to pay -- it's institutionally incoherent, a bizarre contraption screwed together out of legislation, regulations, and an Executive order. Of course, this incoherence mirrors to Rube Goldberg structure of ObamaCare itself, itself a bizarre contraption, especially when compared to the simple, rugged, and proven single payer system. ( Everything Obama did with regulations and executive orders, Trump can undo, with new regulations and new executive orders . We might compare ObamaCare to a child born with no immune system, that could only have survived within the liberal bubble within which it was created; in the real world, it's not surprising that it's succumbing to opportunistic infections.[2])
On #1, The administration has, despite its best efforts, not achieved a controlled flight into terrain with ObamaCare; enrollment is up. On #2, the administration and its Congressional allies are still dickering with tax reform. And on #3 . That looks looks like a job for Alex Azar, since both essential health benefits and association health plans are significantly affected by regulation.
So, yes, there are worse scenarios than the revolving door; it's what you leave behind you as the door revolves that matters. It would be lovely if there were a good old-fashioned confirmation battle over Azar, but, as I've pointed out, the Democrats have tied their own hands. Ideally, the Democrats would junk the Rube Goldberg device that is ObamaCare, rendering all of Azar's regulatory expertise null and void, but that doesn't seem likely, given that they seem to be doing everything possible to avoid serious discussion of policy in 2018 and 2020.
NOTES
[1] I'm leaving aside what will no doubt be the 2018 or even 2020 issue of drug prices, since for me that's subsumed under the issue of single payer. If we look only at Azar's history in business, real price decreases seem unlikely. Business Insider :
Over the 10-year period when Azar was at Lilly, the price of insulin notched a three-fold increase. It wasn't just Lilly's insulin product, called Humalog. The price of a rival made by Novo Nordisk has also climbed, with the two rising in such lockstep that you can barely see both trend lines below.
The gains came despite the fact that the insulin, which as a medication has an almost-century-long history, hasn't really changed since it was first approved.
Nice business to be in, eh? Here's that chart:
It's almost like Lilly (Azar's firm) and Novo Nordisk are working together, isn't it?
[2] Anyhow, as of the 2016 Clinton campaign , the Democrat standard -- not that of Poses, nor mine -- is that if there's no quid pro quo, there's no corruption.
[3] And, curiously, "[HHS head Tommy] Thompson said HHS was in the eye of the storm after the 2001 terrorist attacks, and Azar had an important role in responding to the resulting public health challenges, as well as the subsequent anthrax attacks "
MedicalQuack , November 15, 2017 at 10:31 am
diptherio , November 15, 2017 at 11:25 amOh please, stop quoting Andy Slavitt, the United Healthcare Ingenix algo man. That guy is the biggest crook that made his money early on with RX discounts with his company that he and Senator Warren's daughter, Amelia sold to United Healthcare. He's out there trying to do his own reputation restore routine. Go back to 2009 and read about the short paying of MDs by Ingenix, which is now Optum Insights, he was the CEO and remember it was just around 3 years ago or so he sat there quarterly with United CEO Hemsley at those quarterly meetings. Look him up, wants 40k to speak and he puts the perception out there he does this for free, not so.
a different chris , November 15, 2017 at 2:01 pmI think you're missing the context. Lambert is quoting him by way of showing that the sleazy establishment types are just fine with him. Thanks for the extra background on that particular swamp-dweller, though.
petal , November 15, 2017 at 12:52 pmNot just the context, it's a quote in a quote. Does make me think Slavitt must be a real piece of work to send MQ so far off his rails
sgt_doom , November 15, 2017 at 1:21 pmAlex Azar is a Dartmouth grad (Gov't & Economics '88) just like Jeff Immelt (Applied Math & Economics '78). So much damage to society from such a small department!
Jen , November 15, 2017 at 7:56 pmNice one, petal !!!
Really, all I need to know about the Trumpster Administration:
From Rothschild to . . . .
https://en.wikipedia.org/wiki/Wilbur_Ross
Since 2014, Ross has been the vice-chairman of the board of Bank of Cyprus PCL, the largest bank in Cyprus.
He served under U.S. President Bill Clinton on the board of the U.S.-Russia Investment Fund. Later, under New York City Mayor Rudy Giuliani, Ross served as the Mayor's privatization advisor.
jo6pac , November 15, 2017 at 2:13 pmOr from a "small liberal arts college" (which is a university in all but name, because alumni).
Tim Geitner ('82 – Goverment)
Hank Paulson ('68 – English)Alfred , November 15, 2017 at 2:53 pmWell it's never ending game in the beltway and we serfs aren't in it.
https://consortiumnews.com/2017/11/15/trump-adds-to-washingtons-swamp/
I don't believe that the President's "swamp" ever consisted of crooked officials, lobbyists, and cronies I think it has always consisted of those regulators who tried sincerely to defend public interests.
It was in the sticky work of those good bureaucrats that the projects of capitalists and speculators bogged down. It is against their efforts that the pickup-driving cohort of Trump_vs_deep_state (with their Gadsden flag decals) relentlessly rails.
Trump has made much progress in draining the regulatory swamp (if indeed that is the right way to identify it), and no doubt will make considerably more as time wears on, leaving America high and dry. The kind of prevaricator Trump is may simply be the one who fails to define his terms.
Henry Moon Pie , November 15, 2017 at 4:13 pm
I think we've moved past the revolving door. We hear members of the United States Senate publicly voice their concerns about what will happen if they fail to do their employers' bidding (and I'm not talking about "the public" here). In the bureaucracy, political appointees keep accruing more and more power even as they make it clearer and clearer that they work for "the donors" and not the people. Nowhere is this more true than the locus through which passes most of the money: the Pentagon. The fact that these beribboned heroes are, in fact, setting war policy on their own makes the knowledge that they serve Raytheon and Exxon rather than Americans very, very troubling.
I suspect Azar's perception is that he is just moving from one post to another within the same company.
Watt4Bob , November 15, 2017 at 5:28 pm
Larry , November 15, 2017 at 8:01 pmPerfect cartoon over at Truthout
I'm amazed there is enough private security available on this planet to keep these guys safe.
Big pharma indeed has so much defense from the supposed left. It combines their faith in technological progress, elite institutions, and tugs on the heart strings with technology that can save people from a fate of ill health or premature death. Of course, the aspect of the laws being written to line the pockets of corrupt executives is glossed over. While drug prices and medical costs spiral ever higher, our overall longevity and national health in the US declines. That speaks volumes about what Democrats really care about.