Oh, the games we play when it comes to health care affordability. The winners keep winning, and the losers keep losing because the winners set the rules of the game. Winners (insurers, hospitals, doctors, pharma) win by sharing some information about how to play the game while keeping the most important information hidden. But don’t blame the winners for their success; it wouldn’t be possible without the consent of the losers (individuals, small and large employers, and to a lesser extent, government).

For decades, the losers placed their trust, and dollars, in the hands of the winners, and went about their business. Health care costs were a once-per-year conversation and the goal was to get through it. Meanwhile, for the winners, health care was their business, and they spent every day trying to grow it. Now, we ask, has this unequal relationship reached its tipping point or are we all still all-in?

People like me have been saying for years that health care prices are unsustainable and insurers, hospitals, doctors, and Big Pharma should expect a backlash any day now. Wrong. Any day now has turned into ten years and insurers and hospitals are reporting record profits.

It’s So Hard To Say Goodbye To The Health Care Status Quo

Our relationship with the health care status quo has all the characteristics of an emotionally abusive relationship. The relationship started out well enough. About 100 years ago, Baylor University Medical Center in Texas offered a local teachers’ union a deal for hospital services. “For $6 per year, teachers who subscribed were entitled to a 21-day stay in the hospital, all costs included. But there was a deductible. The “insurance” took effect after a week and covered the full costs of hospitalization.” Soon, millions entered into insurance relationships, as the Blue Cross Plans expanded to other states. Continue Reading...

Tags: health care , health care costs, health care choice

‘Tis the season for articles about charities doing great work for those in need. This is not one of them. The charity I want to discuss does great work, but I want to write about how it could increase its impact if its work was required viewing by all Americans. The charity is Remote Area Medical (RAM); founded by the late, British-born philanthropist and adventurer, Stan Brock.

The first time I heard of RAM was in a 2008 interview with Stan Brock on the 60 Minutes television newsmagazine. Remote Area Medical and its thousands of medical and other professional volunteers, provides free medical, dental, and vision care to people who attend their free “pop-up” medical clinics. Stan Brock started the charity in 1985 to help people in third world countries get needed health care. But on that 2008, 60 minutes program, Stan was being interviewed about RAM clinics in Tennessee, USA.

According to a report in USA Today (2018), the United States is one of the wealthiest countries in the world in terms of gross national income (GNI) and gross domestic product (GDP)—ranked #11 and #2, respectively. America is not a third world country and it’s not remote, but somehow needs the free health care services offered by RAM. How RAM got to America is a story of unaffordable private and public (Medicare and Medicaid) health insurance. A significant number of Americans who receive RAM health care services, have or have access to health insurance but cannot afford the premiums and/or out-of-pocket costs the plans require. And many others do not know how to apply for low-cost or free health care.

Nothing says “failing private health care system” like the buckets of pulled teeth noticeable at any RAM event, or the thousands of people that line up the night before the clinics open in their area, to receive preventative health care. Which leads me to this: what if all Americans had to attend a RAM clinic once per year in exchange for tax-free health insurance premiums (employer group health insurance) and other government-subsidized health care benefits? It’s easy to love your private health insurance, as CNN.com likes to remind Medicare For All supporters. It’s hard to look at buckets of extracted teeth, made necessary because most private medical plans don’t provide preventative dental care. Continue Reading...

Tags: Remote Area Medical, health care , Medicare For All, Stan Brock

Sometimes you just gotta geek out over what’s happening in health care even if its implications are years away.

In 2014, Google CEO, Sergey Brin, complained about “heavily regulated” health care that discouraged health care tech entrepreneurship. Last week Google emerged from secret talks with Ascension health system with a deal (Project Nightingale) to analyze and store health care and administrative data. Meanwhile, Amazon, who never shared Google’s timidity on health care, announced its third major health care venture in the last two years—the Amazon Care app. The rollout of the Amazon Care app for its Seattle-based employees comes after Amazon purchased online pharmacy PillPack in 2018 and teamed with Berkshire Hathaway and JPMorgan Chase to create the healthcare company, Haven. It seems like tech companies have found a remedy for health care’s regulatory headaches, or maybe it’s the chance for health care tech glory that they can’t walk away from.

There’s A Lot of Potential In Health Care Data Tech

It’s not surprising that Google changed its mind and inked a health care data deal. Google so wants to join the list of artificial intelligence (AI) pioneers, and having access to mounds of health care data is the first step to AI glory. Seriously, most health care systems around the world currently have AI projects to analyze health care data and monitor patients. And robotic surgery and robotic-assisted surgery has been a thing for well over a decade. Future AI health care projects may include machines that perform tasks currently done by health care professionals. When you think about it, the idea that if you compile enough data from multiple sources (doctors’ notes, physical exams, diagnostic images, etc.), you can teach a computer to diagnose and treat diseases is pretty cool.

Ascension also has a lot to gain if Google can manipulate the millions of patient data records into an AI system that can diagnose and treat diseases. Imagine the savings hospitals would realize if computers could replace some of the doctors and other health care specialists they would otherwise hire to perform these tasks. And it’s not just the potential savings of using artificial intelligence in health care, AI could reduce health care errors and allow hospitals to serve more patients.

Okay, I’m obviously fascinated by the possibilities of AI in health care. And if big tech can meet the privacy and security standards set by federal laws such as HIPAA, I say bring it on. We’ve already given up a lot of our privacy when it comes to health care. We’re willing to wear activity tracking devices, fill out online health risk assessments, and use telemedicine services all in the hope of improving our health or paying less for health care.

While Individual Privacy Concerns Decreases, Regulators Remain Alert

Ten years ago when I was working in private sector Human Resources benefits departments, health care data privacy was a big deal. Many workers balked at completing health risk assessments (HRA) because they thought their employers would use any “negative” health data from the assessment to fire them. They didn’t like the idea of their employer having such personal data. The Equal Employment Opportunity Commission weighed in on workplace wellness programs that charged higher health insurance plan premiums to workers that refused to complete a health risk assessment. Today, you rarely hear about health risk assessment privacy issues. But that’s not to say that privacy and security are not important in health care. The Health Insurance Portability and Accountability Act of 2003 (aka HIPAA) is a reminder to anyone who has or wants to access health care data of how seriously federal regulators take health care data privacy and security.

Between April 2003 and October 2019, the Department of Health and Human Services (HHS) received nearly 221,000 health privacy complaints. Continue Reading...

Tags: health care , health care privacy, HIPAA, Google, Ascension, HHS

ACA Lowest Cost Health Insurance Plan Option For An Individual - 2020/Virginia



ACA Highest Cost Health Insurance Plan Option For An Individual - 2020/Virginia




The Healthcare.gov enrollment period started a week ago, on November 1. Like millions of people who must pay 100% of the health insurance premium insurers charge, I held my breath and prepared for the worst. Due to technological difficulties, I wasn’t able to log on to the site on the first day. No worries, there are benefits to delaying bad news. One is that you become irrationally optimistic.

Although it’s never happened before, I thought, maybe my individual private health insurance premiums would decrease. There are several reasons why they should.

1. Last month I received a $99 refund, aka, medical loss ratio (MLR) rebate, from Cigna (based on Cigna’s 2018 MLR). The MLR rebate provision of the Affordable Care Act “requires health insurers to pay rebates to policyholders if the insurer fails to spend at least 80% to 85% of total premium revenue on medical claims and health care quality improvement activities (as opposed to administrative and marketing expenses and profits).”
2. Cigna is financially strong. It’s 2019 third-quarter profits and revenues were up at $38.6 billion and $35.8 billion, respectively.
3. The federal government’s Health and Human Services Department reports that health care premiums overall are decreasing in 2020.
4. I’ve never needed medical care in my adult life. I’ve never been ill, injured, pregnant, or taken a prescription drug.
5. I’m currently paying an extortionist, unsubsidized monthly premium for my Cigna EPO health plan (per my monthly email reminder).

Tags: health insurance , obamacare, Affordable Care Act

We’ve all heard the stories of people using Groupon and GoFundMe to help pay for medical care. But about a decade before these companies existed, Human Resources departments worried about the financial strain annual health insurance increases and out-of-pocket medical care costs placed on low-paid workers, in particular. How do you pay for food, rent, and transportation when, in 1999, the average health insurance premium for a single person was $183 per month, and the family premium was $483?

Fast forward to 2019, and the average single and family monthly health insurance premiums (for a PPO plan) are $567 and $1,584, respectively.

Every year, purchasing life’s necessities gets exponentially harder as health care costs eat away at wage increases and savings. Even if you have enough money to cover your basic needs, paying $600 to $1,600 (or half of that if getting an employer and government tax subsidy), makes buying a car or a house, or starting a new business, impossible for millions of people. Other rich countries, and poor countries, too, realize this and have rejected overpriced health care. American employers, on the other hand, accept health insurance and health care increases as common practice.

Make Health Care Affordable For Employees, Not Just Employers

Employers are concerned, and even angry, about the never-ending annual health plan increases their insurers insists they need. They just aren't willing to take a really tough stand on the issue. And what would taking a tough stand on health insurance costs look like for employers? Employers should place price caps on insurance premiums and copays (we really need to eliminate deductible and coinsurance amounts).

When health insurers, hospitals, doctors, and drug makers realize that their biggest cash cow, employers, is no longer willing to pay what's billed, prices will come down. Medicare already says what it’s willing to pay and, to be fair; some employers are experimenting with variations of price caps e.g., (reference-based pricing). But small fry health insurance and health care price capping doesn't trickle down to the employee level, at least not enough to make health care and life’s other wants and needs affordable. Capping health insurance costs might also lead to greater health care price transparency. Do you want more money? Show us why you need it. We know you want it, but do you need it, and how much more? Continue Reading...

Tags: health care , health insurance , price caps

The health care status quo is against ‘one-size-fits-all’ health care. Aside from the fact that people have little to no input into the design of the health plans, ‘choice’ has given us an overpriced and overly complex health care system. Could it be that the reason American health literacy is so low is that there are too many types of health plans? Offering one health plan to everyone would not only improve health literacy (or end the need for it), it would save money.

We’re Health Care Stupid…

Despite the efforts of employee benefits managers, consultants, brokers, communications and health care policy experts, Americans have limited health literacy—“the ability to obtain, process, and understand basic health information and services to make appropriate health decisions.” Surveys show that Americans know a lot less about health insurance than they think they do. A 2016 survey conducted by Policygenius, revealed that 96% of Americans don't understand the terms deductible, coinsurance, copay, and out-of-pocket maximum. A 2019 United Healthcare study, as reported by Motley Fool, showed that 90% did not know the insurance terms: premium, deductible, coinsurance, and out-of-pocket maximum.

It’s hard to make wise health care decisions if you don’t understand basic, cost-related health insurance terms that are part of most private health plans. We could eliminate premiums, deductibles, coinsurance, and copays under our current for-profit health care system. No one has to learn these terms. But instead of removing these terms from their health plans, employers and insurers have added more complexity. So-called health plan design innovations are the latest buzz in employer-sponsored health plans. Centers of excellence, reference-based pricing, high-performance networks, etc.: these cost-containment strategies replaced by one simple reform—one health care plan for everyone.

One Health Plan Is All We Need

Employers have it all wrong when it comes to health plan design. We don’t need a thousand different types of health plans, or health plan design innovations. A thousand different health plans require a thousand different documents that insurers must store in their systems. That equals more time spent doing system administration, and less time evaluating health care quality. If we had just one health plan: Continue Reading...

Tags: health care , health insurance , health care literacy

If you went to school in the 1980s like me, chances are your teachers taught you to dislike Russia and Africa. Maybe it was the stories of extreme poverty, primitive (by middle class American standards) living conditions, and government oppression that fueled your aversion for these countries. Or, maybe our teachers and politicians relied on stereotypes about these countries to make the U.S. look superior to them. Well, I’ve never been one to go along with the herd—I’ve always wanted to visit Russia and South Africa (Africa is a continent, not a single country).
 
In 2016, I visited Russia, and in 2019 I visited South Africa and a few other African countries. St. Petersburg and Moscow, Russia were as cosmopolitan as any American big city, and the rural areas of Russia resembled some rural areas in America. Johannesburg and Cape Town, South Africa also resembled large American cities. There was nothing strange or exotic about Russia or South Africa. They are poor countries compared to the U.S., but unlike the U.S., they, at least in philosophy and on paper, look to provide health care to all of their citizens as a human right.
 
At Least “They"Support Universal Health Care
 
No vacation of mine to a foreign land would be complete without studying its health care system.
 
Russia and South Africa have major issues with health care access and quality. In the early 20th century, Russia provided free health care to all of its citizens, but later national reforms entitled “all Russians to free healthcare with Obligatory Medical Insurance (OMI). Employers contribute around 2-3% of employees wages into a social tax, of which a small proportion is put into a healthcare fund.” (So, not free.) In practice, however, many take out their own private medical insurance, known as Voluntary Health Insurance (VHI).”
 
The South African government, this month, “published a bill outlining a national health insurance program it intends to roll out over the next seven years. Private insurers will be able to continue operating until the system is fully implemented, after which they will only be able to offer coverage for services that complement those available from the state.
 
The current South African health care system includes a public and private system of hospitals and doctors. Funding comes from fees charged for services and government contributions.
 
The Russian health care system consistently ranks at the bottom among developed nations. It’s common to hear tales of drunken doctors, unsanitary conditions, and bureaucratic chaos. Russia’s private (market) health care system also struggles with quality issues. 
 
South Africa’s public health care system suffers from a doctor brain drain (doctors train in South Africa, but leave to work in other countries), and sub par public health facilities.
 
If Only Americans Could Understand Health Care Continue Reading...

Tags: American Health Care, health care

The latest health care news from a RAND Corporation study shows that employers paid hospitals “2.4 times the Medicare rates in 2017.” Another recent headline revealed that private health insurance deductibles increased 150% in ten years (2009 to present). Every day a new headline exposes the dark side of employer-sponsored health insurance. The question is: Will employers take the criticism to heart even if it means no longer offering traditional workplace health insurance?
Stuck In Secrecy
Typically, employers have no idea what hospitals charge for their services. When hospitals agree to join a private health insurer’s network, the two parties negotiate their rates in secret. Neither the hospital nor the insurer shares this information with the groups paying the bills—employers and employees—until the bill is due. For their part, most employers never asked for this pricing information to begin with, and if they did, they still would not receive it. The majority of employers sign group health insurance policies or administrative services only contracts, agreeing that the insurance company does not have to reveal its "negotiated" network rates.
Health care price secrecy is unfair in so many ways. Imagine hospitals charging a different rate for the same service for each plan's network they join. That’s a lot of combinations of health care price secrecy. It can happen. One employer offering three "different" health plans could pay three different rates for the same service, provided by the same hospital. Also, these prices can vary glaringly across the country and in the same geographical area.
Workers Think Employers Are Negotiating Health Care Prices
It would shock most employees to learn that the “negotiating” of health insurance rates between their employer and the health insurance company, does not include a conversation about health care prices. Most employers pay whatever premiums or claims expenses the insurance company tells them to pay, with the promise that what they are paying is a discount. Employers take it on faith that the “discounts” are saving them money, but there’s evidence that’s not the case. Last year Propublica reported on a case where Aetna paid a hospital "more than three times the Medicare rate for (a hip) surgery and more than double the estimate of what other insurance companies would pay for such a procedure" because that was the price it negotiated to pay (in secret) with the hospital. The patient (a former Aetna employee and actuary) protested the price and shared his research with his former employer. Aetna replied, "The payment was appropriate based on the details of the insurance plan." Continue Reading...

Five years ago, the late, famed health care economics scholar, Uwe Reinhardt, wrote the following about what he called "the illogic of employer sponsored health insurance,"

Imagine yourself in a bar where a pickpocket takes money out of your wallet and with it buys you a glass of chardonnay. Although you would have preferred a pinot noir, you decide not to look that gift horse in the mouth and thank the stranger profusely for the kindness, assuming he paid for it. You might feel differently, of course, if you knew that you actually had paid for it yourself.

A New Day Brings New Scrutiny To Workplace Health Plans

Last month, an article by Drew Altman, titled, For low-income people, employer health coverage is worse than ACA, explored workplace health insurance affordability issues for low wage workers and workers with chronic illnesses. Altman writes:

We tend to think of everyone with employer coverage as one big group, but it’s really lower wage workers — and, while it’s a different subject, also people with major illnesses — who take it on the chin in the current private health insurance system. They are also the group with employer coverage who would benefit the most from a Medicare-for-All style plan.

The bottom line: Employer-based coverage is by far the largest source of health insurance, and it now provides the least financial protection for lower income workers who need it most.

Altman gets to the heart of the matter when he writes, "We debate affordability in the ACA marketplaces a lot, but we don’t talk about this far larger problem much, if at all."

A week after Altman's article, a report from The Foundation for Research on Equal Opportunity (FREOPP)—a public policy think tank co-founded by Obamacare critic, Avik Roy, designated employer sponsored health insurance as the worst form of private health insurance in the country in terms of underlying cost, sustainability, freedom of choice, and consumer-driven incentives. Worse than individually purchased health insurance, federal employees health benefits, and Medicare Advantage—the country’s other private health insurance programs.

No More Hiding

Tags: Medicaid For All, universal health care, employer sponsored health insurance

Private health insurers know that someday the inevitable will happen—a significant number of people will refuse or be unable to pay the high health insurance premiums the industry has shamelessly extracted for decades. Insurers also know that all of their “cost-saving” efforts over the years were simply stalling tactics, temporary appeasements to employers (payers) to make them feel like they had some control over their multi-million dollar health plans. Insurers were so confident in their relationships with employers that they even took the name “payers” for themselves. However, lately, large employers have questioned their partnerships with insurers and are taking steps to improve the health care experience for their employees and decrease their health plan budgets. But get this; they’re keeping their private health insurance plans.

Large Employers Are Tinkering With Their Health Plans And Calling It Innovation

If you read about health care even occasionally, you know about the new company, Haven. A venture created by the heads of Amazon, Berkshire Hathaway, and JPMorgan Chase. Large companies that got together to create a health insurance company with the goal of lowering health insurance and health care costs for their employees. The health insurance status quo said, have at it. Private health insurers know better than most what’s required to make health care more affordable—medical care price controls and health care trade-offs. Insurers have perfected the art of managing health care trade-offs—most benefit plan documents contain pages of excluded health care benefits. And since employers aren’t talking about price controls, with the exception of reference based pricing, which is technically a form of price controls but with numbers that are easy to manipulate, insurers aren’t that pressed about this new wave of employer health care “innovation.”


Still, we don’t know what “innovations” to expect from Haven, but based on what I’ve read so far, it involves technology. And Haven’s not the first group of large, wealthy employers exploring how technology can help control health care costs. According to a very informative article in Benefits News, before Haven, there was The Employer Health Innovation Roundtable (EHIR), “a grassroots group made up of nearly 60 of the country’s biggest employers that represent nearly 8 million employees.” This group includes mega companies such as Apple, Target, and Google. Basically, representatives from EHIR watch presentations from health care tech start-ups and decide if they want to pilot the “benefit” at one of their companies and report back its findings to the large group via case study or some other format. Continue Reading...

Tags: health care innovation, health care , health care technology, Haven, EHIR

We expect private health insurers to be anti Medicare For All (M4A). Criticizing M4A proposals is just time and money to them, and they have plenty of both. They have no desire to reduce the cost and complexity of health insurance or health care. Besides, you can’t solve a problem that you do not think exists. Attacking something without coming up with a better solution is easy and unfair, but even these tactics would not work for private health insurers without the support of their major corporate clients. So why do major corporations back the health care status quo, and why do we reward corporations that don’t support affordable health care for all?

It’s A Bro Thing, A Control Thing, And A Money Thing

It was just over one year ago that Amazon, Berkshire Hathaway, and JPMorgan Chase announced their joint health care venture. The three business giants said they were combining forces to “provide low-cost, high quality service from a (health care) company ‘free from profit-making incentives and constraints.” But soon after the announcement one of the Big 3, JPMorgan Chase CEO, Jamie Dimon, promised not to compete with private health insurers and would instead restrict the new venture’s efforts to helping the employees of the three companies. We know why Jamie tried to walk back his threat to upend private health insurance—some of his company’s clients are in the health care industry—but why do other major companies support the industry, and do not publicly support Medicare For All?

I can think of a few reasons.

Despite surveys showing that health care costs are a major concern of all private companies, large companies seem to prefer private health insurance to a government-run or universal system. No major corporation has cut all ties with the health insurance status quo. Instead, corporations work with major health insurers to support each other's profits and shareholder returns at the expense of the country. Also, many leaders of “American industry” believe that they know more about health insurance and health care than health care policy analysts, government officials, and economists. They think the private sector is just generally better at running any business even if it has public policy implications. Continue Reading...

Tags: health insurance , health insurance costs, Tax-exempt health insurance, employer sponsored healthinsurance, Medicare For All

Private health insurance companies excel at making employers believe that their business arrangement is an equal partnership with shared goals based on health care price and value. And insurers know they can rely on the vast majority of their employer clients to accept their prices and contract terms with little or no push back. The administrative advantages of working with private health insurers are well known and appreciated by employers. But it is the insurers’ contractual advantage in having access to key costs information that makes the relationship less than equal or fair. This information, if shared, would weaken health insurers’ ability to charge any price they want for their health plans.

The Public Has A Right To Know What It's Getting For It's Health Care Dollars

The Trump Administration, according to a recent article in the New York Times, said, "it wanted to require public disclosure of the rates doctors and hospitals negotiate with health insurance companies." The operative words here are "wanted to require," this is not a formal proposal, according to reporting in the Wall Street Journal. But just wanting to broach the subject around the transparency of contracted rates between health insurance companies and hospitals and doctors is groundbreaking. After more than half a century of purchasing health insurance, employers never asked, at least to the public's knowledge, for this information, even though they and their employees are the true payers of health care.

As someone who worked in HR benefits departments of private companies and participated in annual health insurance negotiations, I have to admit I never requested information on insurer negotiated discounts with network providers. I wanted to know, but I took for granted that the discounts were significant and that it was in the best interests of the insurer to negotiate a “good deal” with the hospitals and doctors in the plan’s network. I’ll never know if the health insurance companies negotiated in good faith on behalf of my employers, but I have reason to be skeptical.

Private health insurance companies haven't behaved like insurance companies for decades. Self-funding by employers means no risk for the insurer, unless claim costs exceed the insured stop loss limit. And high premiums based on secret negotiated discounts for fully insured health plans ensure profits, not losses for the insurance company. The one health insurance product that may result in a loss for insurers is an individually purchased private health plan, which before Obamacare, was highly restrictive due to preexisting condition exclusions, excluded benefits, and premium costs. Post-Obamacare, sky-high premiums and deductibles for individually purchased health plans greatly reduce insurance company risk of loss.

It’s Not An Equal Relationship

Recent reports about some health insurance brokers and some private health insurance companies reveal that these brokers, often hired by employers, in effect work on behalf of the insurance company. Broker compensation and bonuses come from and are contingent upon selling the health plan to the employer and retaining that employer’s business year after year. Other reports show collusion with hospitals and doctors to set discounts on inflated medical care rates. Still, even large employers haven’t requested the discount information the Trump Administration is contemplating. Instead, they are working with consultants to help them create their own private networks (Amazon, Berkshire Hathaway, and JPMorgan) where they negotiate rates for medical care services directly with hospitals, doctors, and drug manufacturers. Continue Reading...

Tags: health insurance , health insurance rates, health insurance discounts

No one could read the statistics about our broken health care system and walk away thinking it just needs a few tweaks. But that's exactly what the marketing and public relations arms of the health care industry status quo wants us to think. The campaign to push back on Medicare For All (M4A), Medicare Buy-In, and any kind of universal health care program that competes with the for-profit health care system is in full swing. What these ads lack in originality they make up for in gall. But if history is any guide, millions of health care consumers will fall for the health care status quo's economic propaganda.

Health Care Industry Anti-Medicare For All Ads Are Pathetic

Social and other media outlets are currently awash in anti-Medicare For All ads, funded by health care organizations and other businesses.

The Partnership for America's Health Care Future (P4AHCF), recently sent out a tweet warning of a future of high prices, low quality, and fewer health plan choices under Medicare For All. (Someone should tell them that the future is now.)

Between the higher price tag, the lower quality care, and the loss of choice and employer-provided coverage, a “one-size-fits-all health care solution” is hardly a solution at all. Learn more → https://t.co/Z5Z50kYzm0 pic.twitter.com/JEHK0bKqJU

— Partnership for America's Health Care Future (@P4AHCF) February 25, 2019

There’s a fair amount of fear on display these days from some of the most powerful people and institutions on the planet. Trump's afraid of Nancy Pelosi. Billionaires at Davos are afraid of Ocasio-Cortez. Microsoft’s afraid of affordable housing and homeless advocates. And the health care status quo is afraid of losing its ability to charge whatever it wants for its products and services. If history is any indication, this high-powered group of scaredy-cats will ignore their opposers or attempt to appease them with small (in proportion to their total resources) gestures.

Just look at how they've responded so far.

Appease: Trump, unwilling to admit defeat to Nancy Pelosi, agrees to temporarily not get his way.

Ignore: Michael Dell, CEO of Dell Technologies and billionaire attendee at Davos, says voluntary philanthropy is a better solution to inequality than taxing the uber rich. (Like that's worked so far.) He also falsely claimed that increasing rich peoples’ taxes hurts economic growth. Bottom line: Mr. Dell thinks that he knows better than the government how to “fix” inequality.

Appease (with a catch): Microsoft, responds to years’ of criticism for exacerbating the affordable housing crisis in the city of Seattle, by creating a multi-hundred-million-dollar housing loan program, along with a much smaller grant to address homelessness. This is a loans-to-pay-for-future-loans program in lieu of higher taxes; with a much smaller grant program thrown in to make it appear more generous. (Where does this I know how to address housing policy issues better than government attitude come from?)

Appease (latch onto): Health insurers and hospitals, in an attempt to forestall Medicare For All, are rolling out small-scale programs to address social determinants of health—‘the circumstances in which people are born, grow, live, work, and age’ that affects their health status and leads to health inequality. (Marmot, Sir Michael, The Health Gap (The Challenge Of An Unequal World): Bloomsbury Press, 2015). By making a small financial commitment now against health care inequality, which was never a major concern of theirs, health insurers and hospitals, hope the public will ignore their ever-increasing, opaque prices and poor health outcomes, on the part of hospitals and doctors. Continue Reading...

Tags: health inequality, Social determinants of health, health care , Medicare For All

If there’s a new year’s prediction that’s easy to make, it is that health insurance and health care prices will rise. The year 2017 was a hugely profitable one for large health insurers, and as predicted premium prices increased significantly in 2018. In 2018, health insurers again saw significant increases in quarterly profits and, you guessed it, monthly premiums increased in 2019. Annual health insurance premium increases are a trend with no end in sight because, why not. Medical care and pharmaceutical prices also rise each year in our anything goes health care system.

Meanwhile, people who have health insurance don’t want to use it because even with insurance, they may have to pay high medical bills when they receive care. Other people, especially in the individual health insurance market, are going without health insurance. After years of paying thousands of dollars each year in insurance premiums and deductibles, they have nothing else to give. Which makes me wonder: with all the frustration over ever-increasing health insurance and health care prices, will 2019 be the year the health care status quo loses its political and cultural support?

It’s On! (The Health Care Value Debate)

Maybe it's me trying to deal with the anger I feel about the 25% increase in health insurance premiums Cigna gifted me this year, but I’m starting to get a sense that 2019 won’t be business as usual for our greedy health insurance and health care industries. Or maybe it's a number of other signs I’m seeing in the health care reform policy debate:

• The new Democrat-led Congress elected to protect health care access, address health-insurance and health care costs, and explore universal health care options like Medicare-For-All or Buy-In, and Medicaid-For-All or Buy-
• The growing demand for real health care price data and all-payer claims databases by individuals and state governments, respectively
• The consistent reporting of and angry responses to outrageous medical care costs like the $629 Band-Aid, $4,000 surgical screw, and $52,000 per month prescription drug
• The study of health care value both nationally and internationally—what are we getting for the trillions we are spending, and what’s the real cost of innovation

Tags: health care , health insurance premiums

Stress, social isolation, and physical inactivity can affect high status, high-income individuals as well as lower income people. Research shows that where a person lives, their education level, their access to nutritious food, their access to health care, and their personal support system greatly impacts their health outcomes. Addressing these issues is key to improving health and to lowering health care costs. Using this research, federal and state regulators/payers (Medicare and Medicaid), community groups, doctors, hospitals, and health insurance companies have joined together to address the social and environmental factors that lead to poor health outcomes and high health care costs.

Employers that want to offer credible, research-driven wellness benefits should follow the lead of public payers and incorporate socioeconomic screenings and benefits into their wellness programs.

Workplace Wellness Programs—Entrenched and Evolving

According to the Kaiser Family Foundation, 49% (157,381,500) of Americans were covered by employer-sponsored health plans in 2016. In addition to their health insurance coverage, many of these individuals have access to an employer-sponsored wellness program. Despite the growing cynicism about the efficacy of workplace wellness programs, they don’t seem to be going away.

Wellness programs have expanded and evolved from weight loss clubs, health screenings, fitness challenges, and annual flu shots to onsite health clinics, fitness trackers, and financial counseling. So-called innovative wellness programs at top companies like Google, Motley Fool, and Zappos, provide nap rooms, Ping-Pong tables, massages, weekly recess, and other unique perks. But what started as common-sense promotion of healthy behaviors has turned into an unconnected, mix of wellness benefits without thought or impact. However, there may be a way for workplace wellness programs to redeem their legitimacy.

Getting Serious About Workplace Wellness Programs

If workplace wellness wants to return to its serious origins, it should look to the important work taking place in the public health care sector—screening for and addressing social determinants of health (SDOH). The Healthypeople.gov website defines social determinants of health as, “conditions in the environments in which people are born, live, work, learn, play, worship, and age that affect a wide range of health outcomes.” Specifically, SDOH includes factors such as income, education, food, environment, transportation, housing, and race and ethnicity.

Employers may think that confronting socioeconomic issues is an invasion of their employees' privacy, and that this work is best left to public policy experts. This is a legitimate concern; however, as the second largest payer of health care in the country, employers should not wait until government or some other group does the work for them. At a minimum, employers should become familiar with SDOH research, and incorporate socioeconomic screenings and benefits in their health plans and wellness programs.

Private health insurers can serve as a resource for employers that want to address socioeconomic issues through their benefits plans. Insurers (BCBS, UnitedHealthcare, Cigna, and Aetna) have experience creating tools and designing SDOH benefits for their Medicare and Medicaid enrollees. Some SDOH benefits employers should consider including in their health plan or wellness program include: Continue Reading...

Tags: workplace wellness, Social determinants of health

Oscar Health, founded, in 2012, originally set out to develop and sell tech products to established health insurance companies. When that plan did not work, Oscar Health’s founders took the millions of dollars raised from investors and started a health insurance company centered around its custom tech. Six years later, and with a recent $375 million investment from Google’s parent company, Alphabet, Oscar is doubling down on being an health insurance technology company. Or, are they a technology company that sells health insurance? And is Silicon Valley-style tech the missing component in health care reform?

Improving Services And Saving Lives

Oscar’s social media branding approach to health care and real-time data decision tools are a welcome contrast to the everything-but-the-kitchen-sink websites of other health insurers. A system that uses real-time prior authorization for surgeries is a huge improvement over faxing forms and waiting days or weeks for a response from the insurer before you can schedule an appointment. An insurance company that pays claims in real-time, while you’re still at the doctor’s office, is much better than waiting for a bill from the doctor and then waiting for the insurer to pay its portion before you know what you owe.

Innovative technology is good for the health care industry and the trash-talking bros at Oscar (these guys can't get through an interview without a negative comment about their competitors’ antiquated legacy systems) are producing tech that improves the health care experience and has the potential to save lives.

We know that the technology doctors and hospitals use to diagnose and treat patients can save lives, but so can having immediate access to real-time data. A recently reported story on Forbes Online about an Australian cancer patient, Mettaloka Halwala, illustrates how faxing forms can result in medical errors. In Mettaloka’s case, it was a death sentence. Less serious, but still frustrating, administrative errors occur in health care every day. Since 2014, Blue Shield in Los Angeles’s enrollment system, the one used for individual health plan purchasers, has been on the fritz. The enrollment system unexpectedly terminates policies of individuals whose premiums were paid. Customers spend hours on the phone trying to get their insurance coverage reinstated, all while skipping medical appointments and delaying prescription drug refills for days, weeks, and months. Blue Shield in LA’s continual system problems for the most basic of services is one of the worst examples of a major health care industry customer service failure due to inadequate technology.

Big Data, Innovative Tech, And The Human Condition

The rollout of the Affordable Care Act (aka Obamacare) had its technology challenges. But the Act achieved its primary purpose of providing affordable health insurance coverage to the millions of people without coverage. A glitch-free enrollment system, impervious to attack by political rivals, would have been a good start for Obamacare supporters and enrollees, but, what’s more important—affordable coverage or a streamlined health plan enrollment system? The guys at Oscar might think that they are providing both, but are they? Using data analytics, predictive modeling, and artificial intelligence may eventually lead to administrative savings in health care, but other factors can replace those costs. Continue Reading...

Tags: Oscar Health, obamacare, health care technology, Social determinants of health

Employers may be wary of their health insurance partners but they share in an opposition to single-payer health insurance.

You would think that large employers would say to heck with the health insurance and health care status quo. You would think that they have had enough of the annual negotiation performances played by brokers, consultants, and health insurance representatives. You would think this, but you would be wrong. Large employers are generally opponents of a single-payer (e.g., Medicare For All) system that would replace their private group insurance plans. They may not enjoy participating in the ritual pretense of controlling health insurance costs, but they find it preferable to the alternative—losing control of a powerful financial tool.

There are several reasons why big companies and the health care industry do not support Medicare for All or single-payer health insurance.

Large organizations that are not part of the health care industry oppose single-payer because they would no longer be able to use health insurance as a recruitment/retainment tool, or as way of manipulating the total compensation their employees receive. These organizations may also benefit financially from health care industry stocks. And you've got to figure that large corporations don’t want to upset each other because the shoe could easily be on the other foot, so it is best to have each other’s backs.

Health care organizations have even more at stake in the single payer debate. According to a Kaiser Family Foundation report, health care employment accounted for about 9% of all employment in the U.S., in 2017. The industry, with the exception of some groups like Physicians for a National Health Plan (PNHP) and a few others, vehemently opposes single-payer health insurance. The Healthcare Leadership Council, a health care industry lobbying group, lists insurers, hospitals, drug makers, medical device manufacturers, pharmacies, health product distributors, and information technology companies as part of the health care industry. Add to that the thousands of companies and freelancers that support these organizations... The bottom line is that the health care industry employs millions of people, and makes tons of money for Wall Street—a gig they would like to keep.

Small Employers Will Save Us

Health care reform isn’t over. Everyone agrees that health care costs is THE problem we must resolve, and that the solutions proposed by insurers and adopted by private sector organizations large organizations are band aids. So far the reforms taken to make health care more affordable and available involve transferring costs from one group to another. Large organizations can play this shell game better and longer than smaller companies because insurers realize from time to time they have to let the big guys win (or think that they've won). Small employers on the other hand do not have this kind of clout, and usually follow the lead of larger organizations when it comes to plan design, financing, and other health insurance reforms. Continue Reading...

Tags: Medicare For All, Single-payer

The announcement by Amazon's Jeff Bezos, Berkshire Hathaway's Warren Buffett and JPMorgan Chase's Jamie Dimon, about a new health care company they were forming to address rising health care costs, enraged some health insurance companies. Some of these insurers were clients of JPMorgan Chase so Dimon assured them that only employees of the three companies would benefit. But Dimon recently admitted feeling annoyed by the response of the health care companies. He expected "a lot of these people we already do business with to call us up and say, ‘What can we do to help?" He expected a partnership.

So far the public response from big health insurance company CEOs has been diplomatic. Cigna CEO, David Cordani, stated in multiple interviews with the financial press that he sees the venture as "an opportunity." Aetna's CEO, Mark Bertolini, also to the financial press, said, “There is an unmet consumer need in health care." And UnitedHealthcare CEO, David Wichmann, said, "We invite innovation in health care." But Wichmann also said, "Our goal is to help people and make the health system work better for everyone. If Amazon can contribute to that, they should bring it." This refreshingly honest statement from Wichmann and his singling out of Amazon, implies that at least one big insurer considers the new company to be a competitor. But it is the sentiment expressed by outgoing CareFirst BCBS CEO, Chet Burrell, when he said, "What exactly are they going to do differently?" that is mostly likely what the big insurers are all thinking.

With Friends Like These

How long did health insurers think they could hand-deliver products that cut costs by shifting it to employers and their employees? Large employers were early adopters of skin-in-the game cost-cutting strategies like PPO and HDHP plans and know the limits of these schemes. Now, these employers want to see lower health care prices, which means health care insurers have to step up their game. To lower health care prices for their employer groups, insurance companies have to get greater price discounts from hospitals, doctors and pharmacy benefit managers, not just focus on employee behavior. Continue Reading...

Tags: Amazon, Jeff Bezos, Berkshire Hathaway, Warren Buffett, JPMorgan Chase, Jamie Dimon, health care

To shine a spotlight on America's outrageously expensive health care system, two media firms that are great at explaining health care policy, asked individuals to share their medical bills with them. Kaiser Health News (KHN) and National Public Radio's (NPR) "Bill of the Month" series does exactly what its name implies. It takes a medical bill submitted by an individual and dissects it to better understand how, for example, four tiny surgical screws or one extensive urine test can cost as much as a car. Vox Media, the other news organization requesting medical bills, performs a similar review, but for hospital emergency room bills only.

Both the KHN/NPR and Vox projects started in 2018, but stories about inexplicably high medical bills are not new. Major news organizations have been shocking readers with reports of shameless health care price gouging for years. Journalist, Steven Brill's 2013 article, "America's Bitter Pill…" in Time Magazine, grabbed the nation's attention like no other health care price article has before or since. In fact, Brill's blockbuster article likely inspired NPR and Vox's current medical bill review projects, as well as several bestselling books on the subject.

Meanwhile, a similar information campaign about income/wealth inequality is also cause for outrage. But if the response to news about income/wealth inequality is any indication, what can we expect the stories about health care price gouging to accomplish? Remember Occupy Wall Street and Fight For $15—how participants in these movements were mocked as naïve losers out to take from the makers? And how Republican lawmakers enacted tax cuts for corporations and wealthy individuals to punctuate the defeat of these groups? It's not hard to believe that this is the fate of the health care price outrage campaign. For every successful teachers' strike there is an annual health insurance premium increase to gobble up any negotiated benefits increase. Continue Reading...

Tags: Bill of the month, Vox.com, America's Bitter Pill, health care costs, health care cost inequality

Steady, stable, slightly, slowly, low, relatively low, lower-than-usual, all words used in recent national articles to describe projected health insurance premium increases for employer-sponsored health plans. I'm sorry, but these words are way too upbeat for my me. Sure, we need to inform people that they can expect smaller health insurance premium increases than in prior years, but I can do without the cheerful tone extolling high but not as high health insurance premiums for some.

Still, you may be thinking that a slowdown in health insurance premium growth is good news or you may be thinking, what's the harm in saying things are better than usual. Where to start?

First, news of lower than usual health insurance premium increases applies mostly to large employers. Smaller employers will continue to see rate increases in or approaching double digits. Second, these "slight" rate increases are made possible by already overinflated health insurance rates. Individual premiums for some small group health plans can be as high as $700 to $1,000 per month, based on benefits covered and cost-sharing structures (e.g., deductibles, coinsurance and copays). These rates are higher than the exchange rates.

But the number one reason we should not celebrate lower than usual group health insurance premiums is that it gives a false impression that we are controlling health insurance and health care costs. That employer groups have finally figured out how to win at the health care negotiating table. That health insurance companies are more accurately predicting risks and passing on the savings to their employer groups. That workplace health insurance is a bargain and operates like a fine-tuned machine, not in need of reform. That health insurance prices are not something we need to address, at least not right now. Nothing could be further from the truth.

Steady Rates or A Red Flag

There is no reason to believe that health insurance costs are under control or are a minor issue in the whole health care reform debate. The cost of health insurance (and health care) is the debate. Health insurance prices are too high and individuals can't determine the value of their policies.

Also, if health insurance was becoming such a bargain, why don't health insurers share price and discount information with the public or employer groups? If insurers are paying providers four, five or six times the Medicare rate for medical services and receive a 50% discount on less, that's no bargain. And if insurers charge a little less to access these inflated, low discount rates, why give them a pat on the back? Continue Reading...

Tags: health insurance premiums, health insurance rate increases

After weeks of silence, followed by news of Obamacare sabotage, health care reform policy returns to center stage. Last week, Bernie Sanders revealed his Medicare for all plan, and Republican Senators renewed efforts to repeal and replace Obamacare with a plan (Graham-Cassidy-Heller-Johnson (GCHJ) plan) that will leave tens of millions without health insurance. If it seems like American health care reform continues on the road to nowhere, it's because it does.

The Sanders plan is long on moralizing (yes, health care should be a right) and short on concrete ideas to address health care costs. The plan includes all of the usual policy proposals to lower health care costs: administrative simplicity, enhanced negotiating power with prescription drug makers, federal subsidies for health care worker training, incentives for doctors to provide better care, and making rich people and employers pay more of the costs for national health care. The only thing new about the Sanders Medicare for all plan is that now it is official.

The Graham-Cassidy et al plan put out by Republican Senators Bill Cassidy (a doctor), and Lindsey Graham is a lot like other Republican health care reform proposals of late in that it looks to reduce federal funding of health care by replacing current subsidies with smaller block grants. The bill would also reduce the amount of money the federal government gives to states to fund their Medicaid programs. But mostly the bill, if passed, will unabashedly, take health care away from millions who currently have it with no pretense of offering them anything in return. There's more awfulness to read in Cassidy-Graham, but the overarching message is that Americans do not have a right to federally funded health care.

So here we are, again, with two opposing policies on American health care reform. Meanwhile, big pharmaceutical companies continue to introduce drugs approaching or surpassing the half a million-dollar cost mark. Employers persist in maintaining health plans whose costs they cannot manage. Workers' keep on watching health care premiums eat up their small wage increases. Politicians continue to move money around from one powerful health care interest group to another. And Americans continue to fall for the you-can't-put-a-value-on-your-health and the importance of American innovation cons to justify uniquely high-priced American health care.

No Shame In the Health Care Price Game

No one disputes that America has the highest medical care prices in the world. But in typical American fashion, some of us like being at the top of even this list. Defenders of high-cost American health care claim the costs are high because we as a country can afford it, and that that's the price tag for medical and drug innovation. But neither of these claims is necessarily true or right. Tens of millions of Americans cannot afford to pay for health care, and the high price of medical innovation shouldn't go unchallenged.

Last week there was a report about a new cancer drug with a $475,000 price tag. And it seems like just last year we in awe about a new Hepatitis C drugs that cost about $80,000 per patient. Also, just two weeks ago, Texas Medical Center was bragging about its $50 million worth of floodgates protecting it from Hurricane Harvey. Yes, America obviously has a lot of money to invest in medical care, but is it investing it wisely, is the greatest number of people helped by these investments and who gets to make these decisions. Continue Reading...

Tags: Bernie Sanders Medicare for all, Graham-Cassidy plan, obamacare, repeal Obamacare, Medical innovation costs

Don't be fooled. After finally agreeing to pay the August Affordable Care Act (aka Obamacare) cost sharing reduction (CSR) payments to insurers, Trump and corrupt Secretary of Health & Human Services, Tom Price, remain committed to destroying Obamacare. Their goals are to pay less in subsidies that help people purchase individual health insurance plans and pay for medical care, and to scare health insurers away from the exchanges by injecting uncertainty about future subsidy payments.

Unfortunately, and despite the latest CSR payment, Trump and Price's sinister plot to undermine Obamacare is having the intended effect. Because health insurers cannot be certain that this Administration will not stall or stop future subsidy payments, they will increase rates by a higher percentage than they otherwise would have. And when health insurers feel uncertain and are afraid they won't meet their financial objectives, they take it out on everyone. That means health insurance premiums may be higher for everyone next year, even employer-sponsored group health plans.

But that is not all on Trump and Price. Their childish, mean-spirited antics only highlight a fundamental problem with a for-profit, private sector led health insurance industry. You see, American health insurers have always insisted that their profits be assured. Taking a loss in one line of business (selling to individuals) and making it up in another line (employer-sponsored and other group insurance), but still making an overall profit, is viewed as a loss for them. They want all of their lines of business to be profitable all of the time.

Even if Trump and Price admit that the Republican health care reform efforts have failed, that they will now honestly administer the Obamacare law as intended, and promise to make all future CSR payments on time, insurers will still raise rates higher than are needed until they feel comfortable that their profits will continue. How long will they wait until they are comfortable that their profits are not in imminent danger? They will wait as long as they want to, which is forever, and there is nothing we can do about it.

Health Insurers Will Always Inflate Premiums

It is so disingenuous for Obamacare critics to imply that the health insurance market was ok or even better before Obamacare. How they ignore or explain away that purchasing individual health insurance pre-Obamacare was hit or miss or that finding comprehensive and affordable coverage was impossible is beyond my comprehension.

Purchasing individual health insurance pre-Obamacare was a long and difficult experience. First, you had to find a reputable insurer that sold individual plans, and then you had to work with an insurance broker to apply and purchase the policy because you couldn't work directly with the insurer. And that describes the not too bad parts of that old way of purchasing insurance. The fact that tens of millions could not purchase individual health insurance, some because they didn't want to, but many because they were denied or couldn't afford it, tells you everything you need to know about why Obamacare or something like it was bound to happen. Continue Reading...

Tags: CSR, obamacare, Medicaid, health insurance

As Donald Trump puts his limited energy into showing the world that this presidency thing is way beyond his limited abilities, the insufficient patches to the American health care system lumber into another year. More of the same high-cost but accessible health care is a better deal than what Republicans were offering with their American Health Care and Better Care Reconciliation Acts. But for the millions of people not eligible for subsidies and purchasing their health insurance in the non-group market, the failure of both parties to make health insurance more affordable is unacceptable.

Republicans lawmakers are not the only ones that waited seven (7) years to suggest changes to the Affordable Care Act (aka Obamacare), Democrats did too. And, to add insult to injury, they callously repeated that the number of non-subsidy receivers was so low and, if you thought about it, these people could technically afford high-cost insurance. They also promised to eventually come up with a solution to this minor Obamacare problem. Well, after 7.5 years Democrats have yet to propose one suggestion to the non-subsidy problem for the millions stuck with paying 100% of high-cost health insurance. However, strangely, there is a law that was passed by both Republicans and Democrats that could help these individuals, including me, but by design, does not.

Say QSEHRA, QSEHRA

In December 2016, a nearly unanimous Congress passed the 21st Century Cures Act. This Act includes a provision that allows small employers to offer a flexible benefits plan, called a qualified small employer health reimbursement arrangement (QSEHRA), to help their employees pay health insurance premiums and health care expenses with tax-free dollars. One way a QSEHRA works is an employee purchases an individual policy, pays the premium out of their pocket and submits proof of coverage to the employer who has set up the QSEHRA plan. The employer reimburses the employee for the premium, with tax-free dollars, up to a mandated amount. Or, if the employee has coverage through a spouse’s plan, the employee can receive tax-free reimbursement to cover medical expenses. The QSEHRA regulation changed the way health reimbursement accounts were treated under Obamacare as it was designed to help small employers provide premium and health care cost assistance to their workers when providing health insurance was not financially or administratively possible. Continue Reading...

Tags: Better Care Reconciliation Act, American Health Care Act, QSEHRA

Becoming a medical doctor in the U.S. is very hard. It takes years of study. We know this because doctors are great at reminding the rest of us of the costs they incur and sacrifices they make in pursuit of their medical degrees. Also, let’s not forget, because they won’t let us, that doctors help the sick and save lives. Don’t get me wrong; I’m not trying to undervalue the efforts and commitment of doctors. However, I’m also not willing to exclude doctors from criticism for the role they play in our overpriced American health care system.

American doctors have much higher salaries than their equally qualified international peers. At least one justification for the sometimes significant salary differentials is legitimate—medical school and training costs are greater in the U.S. than in other countries. Other justifications such as the U.S. is a wealthy country that can afford to pay its doctor more or that doctors could have chosen even higher paying jobs in other industries are even weaker. No one forces you to become a doctor. And, even if you think medicine is a noble profession, there is no such thing as “nobility pay” in the world of compensation management.

If Medicine Is Noble, Not Every Doctor Is

Medicine and money go hand in hand, and so does greed and self-importance. Some doctors enter the medical profession for noble reasons—they want to alleviate illness and save lives; for others, it is a pathway to wealth and prestige. And no one exemplifies the greedy, egoism of the medical profession like Health & Human Services (HHS) Secretary Tom Price. Now a politician, Price was once an orthopedic surgeon and director of an orthopedic surgery clinic in a wealthy area of Atlanta, GA. Orthopedic surgeons are the highest paid of all medical specialists, with an average salary of nearly half a million dollars a year.

Tom Price was never shy about wanting to become a wealthy doctor. It was his goal. And even after moving into politics as an elected Congressman and now head of HHS, he continues to invest in the health care industry and lies about his corrupt investments in the medical field. Another thing Price never lies he doesn’t lie about is his views that doctors should be left alone to make as much money as they can make. At HHS, Price is looking out for doctors’ pocketbooks. In Price’s world, Medicare payments to doctors rise, quality standards and medical malpractice awards go down, and electronic health records disappear (because who wants to share data with other physicians and invite competition). And that’s not even the worst of Price’s financial activism on behalf of his fellow doctors that don’t want to change but want more money. Price wants to collaborate with doctors in letting them decide how much Medicare (taxpayers) pay for their services.

It Matters Who Becomes A Doctor Continue Reading...

Tags: Tom Price, Medicare, HHS, Doctor's pay

I finally agree with what health care policy writers have been saying for months—An American Medicaid or Medicare For All program may be imminent. I reach this conclusion not because of the recent failure by the Republican-majority Senate to repeal and replace the Affordable Care Act (aka Obamacare), but due to the comments of many doctors following this failure. Medical providers sense the change in attitudes away from a for-profit, insurance company driven health care system, and they want to make sure that their role is safe from public backlash and government changes.

And to make it clear on where they stand on this impending new health care world, they are reviving their objections to the “provider” label. Although decades old, doctors hate the provider label now more than ever. They find the use of the term condescending because it links them with other medical care professionals like nurses and physician assistants—people not at their level of expertise. But the primary reason many doctors dislike being called “providers” is that they see it as a “commoditization of the doctor-patient relationship” and now you’re messing with their money.

Commoditization refers to the process by which goods become so similar that their only distinguishing characteristic becomes price. The development of tablets and smartphones are an example of commoditization. They all have the same or similar features like touch screen and syncing with other devices, etc. And even though I prefer Apple products and give the company credit for pioneering much of the technology now available on other devices, I know that I could accomplish pretty much the same tasks with a non-Apple tablet, phone or computer and at a much lower cost.

Apple is not afraid of commoditization; it expects and thrives in this type of environment. It sees the competition as good for customers because it pushes the company to innovate more. Doctors, on the other hand, hate the idea of commoditized health care. They don’t want to compete on service or price. In fact, the real reason doctors and hospitals don’t want electronic medical records or to publish their prices has nothing to do with costs but because they are afraid a competitor will “steal” their patients if they had access to this data. And, of course, doctors think that their product (health care services) is unique

To date, we have protected doctors and hospitals from real competition and allowed them to charge whatever they want for their services. A Medicaid or Medicare For All single payer health care system that includes electronic medical records and price transparency will force doctors and hospitals to compete on price. This type of system is good for the public because it’s one of the few ways, other than forced price reductions, to make health care affordable. Doctors and hospitals won’t like this more transparent health care system, but who cares; it’s coming, and they know it. Continue Reading...

Tags: Medicaid For All, Medicare For All, Affordable Care Act, obamacare

About every July 4th or after a presidential election writers try to explain the American Identity. Some of them, especially of late, conclude that the American Identity is in crises. America does not know who she is. Others say America knows who she is—she is freedom of speech, religion, and opportunity. America is individualism. If there is an American Identity crisis, it is because we have replaced these freedoms with government interference.

There's no denying American democracy is under attack, but ironically our present debilitating state has crystallized our identity. As the famous quote by Carl Jung, "you are what you do, not what you say you'll do." America is and has always been what it does, not what it says.

America is a place where:

• Slumlords rent substandard, barely habitable housing to the poor because people will pay to live there
• Payday lenders, check-cashing centers and prepaid debit card providers keep the working poor in a cycle of debt offering services traditional banks will not
• Children, under strict rules, receive summer meals from food trucks
• Families wait days to receive free dental care at tent clinics where buckets of pulled teeth pile up
• Hospitals charge the poor and uninsured full price for the same medical care the rich and insured receive at a steep discount
• A cancer-stricken Senator who's been on the receiving but never the giving end of compassion, votes to put in motion a vote that will make health care more expensive for the poor, sick and elderly

Tags: health care , American identity

While the health care reform debate stalls in the Republican-majority Senate, individuals health insurance purchasers like me are left wondering what's next. Will Health and Human Services Secretary (HHS), Tom Price, miraculously develop a base level of professionalism and sense of duty to administer the Affordable Care Act (aka, Obamacare), the law of the land, for now, the way it was intended? Will Republicans restore the funds for the risk corridors so that insurers are certain that the government will cover losses they may incur? Will HHS role out a robust national open enrollment program for the exchanges and will they staff the effort appropriately? Or will the Senate, like the House, find a way to pass their awful health care bill, the Better Care Reconciliation Act (BCRA) before the 2018 Open Enrollment on the Exchanges?

We, I, need answers to these questions soon because the fall health plan open enrollment season is just a few months away. My current health insurer has already sent me a good luck because we won't be here for you next year letter. And health insurance companies need answers to these questions now to make decisions about what, if any, plans they will offer to individual health plan purchasers.

Reason To Be Afraid For The Future Of Individual Health Plans

It's so disheartening to witness long-term Republican lawmakers and the White House react so vindictively to their current legislative debacle. After seven years of ranting about the awfulness of Obamacare and promising a better replacement, they delivered bupkis. But don't expect these guys to hang their heads in shame, that's a completely unfamiliar emotion to them. In fact, they can't even call their failure a failure. This is a line from the official statement put out by the Majority Leader's office on the Obamacare repeal vote.

" Regretfully, it is now apparent that the effort to repeal and replace the failure of Obamacare will not be successful."

In other words, Obamacare, which provided health insurance and health care to millions of people, is a failure but the seven-year long Republican effort that created the unpassable Trumpcare is not. The fact that McConnell refuses to acknowledge that Republicans do not have a better alternative to Obamacare that they are all willing to vote for makes me queasy.

And what's even scarier about the future of the individual health insurance market is that where McConnell leaves off in his hypocrisy and projection, Trump picks up with his mean, hateful, nastiness. Since being elected, (gag) Trump has boasted about letting 'Obamacare explode,’ ‘die on its own,’ or ‘fail,’ as he and his fellow Republican liars and obstructionists do everything they can to undermine the law. He threatened explosion when the House wavered in passing their crappy health care reform bill, the American Health Care Act (AHCA); and now he's threatening the same thing now that the Senate's bill is down and out (for now). I think Trump is dumb enough to try this strategy, and with his devil's helper, HHS Secretary Tom Price, things could spiral out of control quickly for people like me. Continue Reading...

Tags: obamacare, American Health Care Act, Better Care Reconciliation Act

Republican Congressman Mo Brooks of Alabama wants us to "take into account our financial limitations" in providing health care to every American. Some people interpreted his remarks as meaning that we can't afford to provide health care to every American. I want to give Congressman Brooks the benefit of the doubt and assume he meant that not everyone could have unlimited medical care at any price paid for by the government. But I can understand how others would translate his words negatively. Brooks is the same guy who talked about "people who lead good lives" as part of the health care reform debate.

This healthy people lead good lives, sick people lead bad lives is just updated phraseology for the same old moralizing nonsense conservatives use to demonize the poor and revere the rich. This type of thinking is so stupid and inapplicable in the real world. There are millions of healthy people who lead good lives that get sick. My best friend in the world was one of those people. She was active, did yoga regularly, ate organic, had an active social life and had a sharp mind. But one day she was diagnosed with cancer, and I lost her. This is a story repeated many times every day yet we still have jerks like Brooks that would rather use hateful language against the poor than address the unnecessarily high prices charged by hospitals and medical care providers.

You see politicians and doctors want us to believe the problem of unaffordable health care is our fault. If we only lead good, healthy lives, no one would need expensive, government-paid health care, says the politician. If we engaged in healthy behaviors and avoided unhealthy behaviors, we wouldn't suffer from expensive chronic diseases, says the doctor. And these politicians and doctors may have valid points—health care would be less expensive if we all lead healthy lives. But what world do these politicians and doctors live in? Who are these perfect, healthy people who do everything right in life? So instead of promoting this myth of the good, healthy, righteous, never need health care super-human being that does not exist, I wish Congressman Brooks and others like him would join us in the real world. A world where real good people, rich and poor alike get sick, sometimes really sick, and need expensive medical care.

The Alabama Congressman could address the financial limitations of high-cost medical innovations. About how much is too much medical innovation for the nation's pocketbook to cover? He could bring up for conversation why we require American doctors to obtain a Bachelor's degree before starting their medical degree education when many other industrialized nations do not. The cost of a medical education in America is the main justification doctors use for their high salaries. Mr. Brooks could learn more about the impact of socioeconomic factors on a person's health and support public policies to address these issues. He could also say that Americans should not pay hundreds of thousands of dollars for heart attack treatment. But he doesn't focus on any of these issues. Continue Reading...

Tags: health care costs, American Health Care

We are right to mock the hypocrisy of elected Republican officials that criticize the Affordable Care Act (aka Obamacare) for leaving millions of individuals uninsured and doing little to address the high cost of health insurance. Instead of creating policies to address these two Obamacare shortcomings, Republicans decided to exacerbate them by withholding funding to insurance companies that all but ensure that premiums will rise even higher and fewer individuals will have health insurance. We are also right to sneer when conservative intellectuals and Libertarians extol the virtues of a so-called free-market health care system where people are free to buy or not to buy any level of health insurance, and from any location they want. When the reality is that health insurers aren't in the habit of offering a la carte health plans. There's also the issue of opaque pricing with “free market health care.” Another issue with conservative and Libertarian views on health care is that half of the purchasers can buy insurance at a significant discount because of the workplace health insurance premium tax exclusion and the other half have no such benefit.

But at some point, and I think the time is now, Obamacare supporters and proponents of single payer or universal health care will have to realistically and publicly address how their proposed policies will deal with the problems of health care costs and affordability. Unlimited health care at any cost paid for by the government is not a realistic option, and no such system exists anywhere in the world. There are and should be limits on the amount of medical care an individual receives if they are not paying for it or if doctors and hospitals determine additional care would have no meaningful impact.

Our current U.S. health care system already places limits on the amount and form of medical care individuals receive. Sometimes these decisions are based on ability to pay the cost of care, and at other times they are based on medical science. However, this approach of rationing medical care won't be sufficient in a Medicare For All style system. Rationing of medical care will have to be front, and center of any government paid health care system. But that is not to say that people will not have access to care the government won't pay for; they are free to purchase health insurance or health care individually.

Some people may believe that a government codified system of medical care rationing harms the poor and favors the rich. Not necessarily. First, the poor won't likely pay anything for their medical care, and they will have access to preventative and continuous care that should improve their health status. Second, the poor won't have to pay for costly medical innovations, one of the real drivers of outrageous U.S. health care costs, but they will benefit from them. And third, the stigma applied to government-provided health care is diminished and so is the incentive for doctors and hospitals to treat the poor differently.

Okay, But Not Now

Right now proponents of government-paid health care for all our engaged in a battle to keep the poor from losing access to medical care. They may feel that they have to accomplish this goal first before they can start the conversation about their ideal health care system. Meanwhile, opposers of government-based health care use the socialists, communists, and hippie-dippy, out-of-control spending argument to make universal coverage look less attractive than the status quo. And I fear they are winning this argument because of a weak counter-argument of a greedy, evil opposition. Continue Reading...

Tags: obamacare, Medical rationing, libertarians, health care reform

We will never know what the private health insurance market would look like today regarding cost and affordability if the Affordable Care Act (aka Obamacare) never became law. However, there is every reason to believe that premiums would be as high if not higher than they are today and that coverage for many people with pre-existing medical conditions that purchase individual plans would be unaffordable or unavailable. But as we contemplate what would have been we should also dread what will be.

Very soon, Republican elected officials will likely pass a health care bill, or tax bill if you prefer, that will return us to the health insurance status quo, but with a twist. The Affordable Health Care Act (AHCA) passed by the House and the Better Care Reconciliation Act (BCRA) proposed by the Senate make the pre-Obamacare health care status quo look not so bad. The BCRA effectively makes individual health insurance plans worthless.

The Better Care Reconciliation Act allows health insurance companies to get away with paying barely half the cost of medical care while charging individual purchasers more than they currently pay in premiums, copays, deductibles, and coinsurance. These provisions in the bill are not just a case of more money for less coverage; they are an attempt to eliminate the individual market for all but the wealthy. Furthermore, these features of the bill are a way for the government to pay less in premium subsidies because people who can't afford these skimpy plans will drop out of the individual market altogether.

This Law (BCRA) Stinks

When Bill Clinton called Obamacare, "the craziest thing in the world," he was referring to the fact that the law offered no financial help to purchase health insurance for millions of individuals. These are people like me that didn't qualify for Obamacare subsidies, Medicaid, Medicare or the employer health insurance tax exclusion. We have to pay 100% of the cost of our health insurance even though most of us are not wealthy. Meanwhile, Obamacare supporters, especially the ones responsible for administering the ACA, downplayed the size of this group or claimed that they would get around to helping us eventually.

After winning the majority of seats in the House and Senate and electing a Republican president, Republican officials seized on Bill Clinton's statement claiming their health care reform bill would eliminate the craziness. Continue Reading...

Tags: obamacare, American Health Care Act, Better Care Reconciliation Act

Before the passage of the Affordable Care Act (aka Obamacare), America had not had a conversation about health care policy in decades. So it's understandable that many elected officials lacked knowledge about America's health care system and assumed it was performing as intended. From what they understood the health care status quo met the needs of the wealthy, professional and middle classes. And the poor, elderly and veterans had government-provided insurance.

But looks can be deceiving; individuals without any group-provided insurance were left to the mercy of the health insurance market. A market that left over 40 million of them uninsured. Obamacare came along and upset the peace of health care policy reform at the best and worst possible time.

It was the best time for an Obamacare-type law because about 40 million Americans did not have health insurance and Obamacare provided coverage to almost 40% of them. And it was the worst time for an Obamacare-type law because the country was and is so divided on most major public policy issues. Major health care reform was introduced in a politically polarized era that became even more polarized when Trump won the presidential election, and the Republicans won a majority of Senate and House seats.

More Than A House Divided

The Republican/conservative health care policy stance is much more splintered than it is among Democrats/liberals. Democrats want Medicare or Medicaid for All, universal health care or single payer. Or maybe they just want more federal funding for the Obamacare exchanges. It depends on which group of Democrats you ask, but at least they all want a health care reform policy that expands coverage to all Americans, Republicans disagree with Democrats on the very definition of universal access to health care. Remember when the Republican Party stupidly referred to health insurance/care access as "freedom?"

But idiotic catchwords aside, Republicans and conservatives also disagree with each other on the policy goals of health care reform. First, there is Senate Majority Leader, Mitch McConnell's (a real life villain) view that replacing Obamacare is the ultimate policy goal. He couldn't care less about the contents of any health bill and its impact on the public. His only health care reform policy objective is to convince enough Republican senators to pass an Obamacare repeal bill quickly. Continue Reading...

Tags: obamacare, Trump

A recent New York Times article laments the "halfhearted opposition" to the pending passage of the American Health Care Act (AHCA, aka Trumpcare) by powerful groups such as doctors, nurses, hospitals and patient advocates. Health policy experts condemn the "fast-tracking" of the ACHA in the Senate. And the Jeff Sessions' hearings and other Russia collusion noise, crowd out national reporting on the AHCA as the Senate is weeks away from passing their health care reform bill.

The AHCA passed by Congress and currently undergoing revisions in the Senate, rewards the healthy and wealthy and punishes the sick and poor. Some people are appalled and baffled by the impending passage of legislation that brings more inequality into an already unequal system. Isn't it more sensible to provide the most financial assistance to people that need the most health care? Well this is America, where a near majority believes it's okay that the rich can afford better health care than the poor.

The Poor Cost Too Much

Many people think the sick are responsible for their illness(es) due to their engagement in "voluntary health risks" or "changeable behaviors." Never heard these terms before? Me neither. I guess using the term unhealthy lifestyle didn't sufficiently make the point that sickness is a choice, and an expensive one at that.

By some estimates an unhealthy lifestyle cost hundreds of billions of dollars each year in medical care. A recent study contracted by General Electric estimated the cost of cancer care due to an unhealthy lifestyle at around $34 billion per year. Other studies put the annual costs of treating alcohol abuse at an estimated $176 billion, smoking at $137 billion and obesity at $147 billion (2008 number for obesity). These issues—cancer, alcohol abuse, smoking and obesity—costs nearly a half trillion dollars in health care each year.

But cost concerns are not what allow the Republican Congress and Senate to easily take away health insurance from the sick and poor. The truth is that despite the passionate town halls, we don't want the poor to live as long as the wealthy. We would save money if they did not. According to the Congressional Budget Office (CBO) score of the AHCA, that savings is about $3 billion, to start (represents reduction in Social Security payments due to early deaths). Continue Reading...

Tags: AHCA, American Health Care Act, Trumpcare, obamacare

Overpricing and overcharging minorities and the poor in hospital ERs; health care specialists are driving up the cost of care; Mylan is waiting out the outrage over its high-cost Epipen and continuing its price gouging, and major health insurance companies settling multi-million dollar Medicare and Medicaid fraud cases with the government. The American health care system is a disaster and a disgrace. Greed and self-interest are its fuel. It's opaque. It's irredeemable.

And, the Affordable Care Act (aka Obamacare) trying to work with and maintain the American health care system, only highlighted all its ills. But at least the Democrats engaged in a comprehensive and intensive effort to improve one of America's biggest problems. Unfortunately, you can't say the same about the Republicans. From the start, and I'll give them credit for not lying about how vile the process would be, Republicans engaged in health care reform sausage making. Their health care reform plan consists of a three-step sausage making process—gut as much of Obamacare (cut taxes) via reconciliation, eliminate health care reform regulations, pass general health care regulation through the normal legislative process.

And like most sausage making, the Republican health care reform work is occurring out of sight. There are no experts to advise on the combination and impact of different policy options. In fact, Republicans in the Senate decided not to send their reform proposals through committees and instead assigned 13 Senators to review the House bill for further tweaking. This not-at-all discriminating approach to health policy reform all but guarantees an unappetizing product for millions. There should be no expectation of a Senate health care reform bill that is much better than the bill signed by the House. In fact, the Senate bill may be even worse than the House bill.

Initially, House Republicans were transparent about their health care reform bill. They made it clear that the Obamacare repeal law, the American Health Care Act (AHCA) was step one of a 3-step process to replace Obamacare. They collaborated with the Health & Human Services Secretary, Tom Price, to sell the proposed law to the public. And, lastly, they waited for the CBO score before deciding not to vote on the legislation. In the end, transparency was political poison for the House, and they resorted to secret meetings and hiding drafts of the revised proposal. The result was a reform bill that was just as bad as the first one but easier to pass politically. Republican senators have no desire to repeat the mistakes of their House colleagues. There will be no false starts on voting and no or little sharing of policy details before the vote, and there will be a vote and the bill will pass.

A Senate version of the AHCA will look a lot like the House version, but with a longer timeline to implement its awfulness. Expect, Continue Reading...

Tags: Mylan, obamacare, AHCA

Some people think the original sin of health care and health insurance is government regulation and "patches" like Medicare and Medicaid. Other people think the problem originated from a different government sin—the employer health care tax exclusion. This tax break translates into significant money saved for individuals enrolled in employer-provided health plans. Individuals not enrolled in these plans and who purchase health insurance, do not receive these savings.

So which sin should the country address first, health insurance regulations and patches or health insurance costs equity? The easiest issue to address—equalizing or eliminating the special tax treatment of employer-sponsored health insurance plan payments is a good place to start. But our time-strapped Republican-majority Congress decided to spend the majority of its limited attention tinkering with the political and policy challenges of health care regulations. The Congressional health care reform bill, the American Health Care Act (AHCA), does not equalize or eliminate the employer health care tax exclusion but goes very far in changing health insurance regulations.

These proposed regulatory changes will take hundreds of millions of federal dollars out of the health insurance and health care system if they survive the Senate and reconciliation processes and are signed by the President. Potentially, tens of millions may lose their health insurance coverage and access to health care. People opposed to the AHCA are focusing their energies on protesting at congressional town halls, emailing and writing their representatives and educating the public about its possible impact. It's an uphill battle for these protestors to change the course of legislation, which is why I think they may have more luck at addressing the unequal tax treatment of health insurance premiums that exists between employer-sponsored and individually paid private health insurance.

The AHCA, in a very limited way, does address the employer health care tax exclusion by providing tax credits to individuals that purchase health insurance. However, these credits may not equal the value of the exclusion and the health plans available in the individual market do not equal what employers offer. So, at a minimum, protesters should demand that the AHCA equalize the tax treatment of all health insurance plans. But they shouldn't stop there. AHCA opponents may have more success trying to convince employers to stop providing health insurance or provide only supplemental health insurance. Continue Reading...

Tags: AHCA, American Health Care Act, health insurance

After spending years studying the Affordable Care Act (aka Obamacare) and related health care reform proposals, I am on a journey to explore the other side. While I've made a point over the years to read the health care reform opinions of Obamacare opponents, I never took seriously their prescriptions. But with the dreaded feeling that the country is on the path to indefinitely postpone the next level of health care reform, I decided to read and reread the writings of those who think our most recent health care reform efforts were a big mistake.

So this past weekend I read a lot of Michael Cannon articles and blogs. Cannon is the Director of Health Policy Studies at the libertarian Cato Institute and an avowed Obamacare hater. Cannon is famous for his many attempts to sabotage the Obamacare law in its early stages by mounting a legal challenge of the subsidies provided to federal exchange enrollees. He also encouraged states not to create their own exchanges (this approach went hand-in-hand with his legal challenge as to whether the federal government could provide subsidies to non-state exchange enrollees). Of course Cannon does not view his fight against Obamacare as sabotage, and although I think it clearly was, I am setting this aside for now.

Today, I'm more interested in understanding the health care reform viewpoint of single payer and universal health care opponents. But not just any opponent, more specifically, I am interested in comprehending the beliefs of the policy wonks, the die hard free market crusaders that oppose government playing any role in providing or paying for health insurance and health care. Consequently, I am reading the works of Michael Cannon and Ron Paul. Free market conservatives draw many negative conclusions about universal health care, including: Continue Reading...

Tags: obamacare, universal health care

Recently, Congressman Steve Chabot of Cincinnati, Ohio wrote on his blog, "I haven’t seen so much misinformation and hysterics about a piece of legislation in a long, long time—maybe ever" about the passage by the House of the American Health Care Act (AHCA). I guess he was asleep during the passage of the Affordable Care Act (aka Obamacare). But all kidding aside, I strongly suspect that the Senate will continue the House's work to make American health care look more like it did pre-Obamacare. They never thought health care reform was necessary in the first place.

Republicans have the numbers to pass the health care bill they want; still, I can't help but think that a return to the status quo is not in the country's future, at least not long-term. You see, Republicans may think that they are about to accomplish something that's never happened before, taking away a huge federal entitlement program, but not even health insurers are prepared to return to the bad old days. Insurers know they passed the big-changes-are-coming-moment and are in the redefining-and-refining-our-purpose-moment, and if the GOP had consulted them during the health care reform debate, they would know this also.

What Health Insurers See As Their Future

Optimizing value by providing doctors with data analysis services.
Last week Humana's CEO, Roy Beveridge, described the country's third largest health insurer as an IT company focused on data analytics to improve health care value. According to Beveridge, the future of health care may be using data to understand risk better and sharing this data with doctors to improve patient outcomes. Doctors can use this data to determine which patient populations need what care and how often to engage with them.

Focusing in on getting a bigger piece of the (new) pie.
Also, last week, health insurer Aetna, Inc., announced it would pull out of the Obamacare exchanges for next year. In addition, Aetna CEO, Mark Bertolini, reportedly said, the country needs to have a conversation about single-payer health care. However, instead of health insurers competing with the government to offer health insurance, Bertolini envisions health insurers managing the single-payer program for the government, as it does with Medicare and Medicaid.

Enhancing patient access to health care services.
The Blue Cross Blue Shield Association is looking to help the very population the AHCA would possibly harm, the poor and isolated. Recognizing that not everyone has access to reliable transportation to get to non-emergency medical appoints BCBSA is piloting a program to partner with Lyft to provide free rides to its members. Continue Reading...

Tags: obamacare, Single-payer, American Health Care Act, Aetna, Humana, health care data analysis

You chose the wrong job. You're the wrong gender. Your lifestyle choices suck. You should pay for your risks. You're a celebrity and should stay out of the health care debate; also that's not how preexisting condition provisions work. The anti-universal health care set has a rational, in their eyes, retort for every appeal for government-paid health care for all.

Mocking the emotions of Medicare For All supporters is so easy it's been pushed down to the level of millennial reporters. And the formula for attacking their opponents is always the same—a charge of too much emotion and not enough facts. The fact that they know little about how health insurance and risk management works, the history of health insurance plan design and access, and the conflict associated with insurers determining risk while seeking profit is unimportant to them.

There's a wall between supporters of government-sponsored health care and those that oppose it that won't come down with appeals to decency and empathy. Still, a change in public policy is the only solution to addressing health care access and affordability. And while it may appear that policy just tilted for anti-government assisted health care reform with the Republican-majority Congress's vote to make health care less affordable for millions, that may not be a bad thing for two reasons.

One, overall the Affordable Care Act (aka Obamacare) is popular among the majority of Americans despite a vicious sounding minority that demonizes people who need assistance paying for health insurance and health care. If Obamacare "supporters" see the nation returning to pre-Obamacare days when coverage could be denied outright or so expensive as to represent a denial, they may demand to return to the protections offered by Obamacare or even greater protections.

Two, Obamacare supporters should take this as a sign to expand their support for health care reform by supporting policies that may potentially reduce health care costs. Policies that focus on alleviating hunger, especially among children and the elderly, should be at the top of the list. Also, addressing homelessness and mental illness is essential to reducing health care costs. These are issues policy advocates, and elected Democrats should include in any federal budget and hold firm on their passage. Of course, there will be opposition, possibly as strong as is currently for Obamacare, but with proper messaging, voters may come start to realize who want to address their needs and concerns.

Not everyone engages with the health care sector every day or even every year, but hunger, homelessness, mental illness and drug addiction are issues most people encounter regularly. Obamacare proponents have nothing to lose by dissecting and addressing the individual drivers of health care costs; it may even be easier than focusing solely on health insurance, which is too complex for most people to understand. Continue Reading...

Tags: obamacare, Poverty, Medicaid For All

America has always been a nation divided. The country fought over its divisions in a gruesome war, one side lost, and the nation stitched itself together again. But the stitches never healed and America never adopted a unified identity. This lack of identity led to smaller wars, culture wars, including conservative values versus liberal values, and the role of government versus the responsibility of the individual.

And with the election of Donald Trump, America's culture wars has reached fever pitch. So much so that some people believe America is headed for a second Civil War; but if not war, towards defining a new national identity. But don't underestimate America's ability to make minor adjustments and put off making tough decisions. A second American civil war is unlikely, but so is adopting a national identity acceptable to all. More than likely, America will move in the direction of greater universality in some areas because political and social forces at the time pushed us there.

We are currently experiencing a grudging push by some toward universal health care because, despite Trump supporters' hatred of their cultural opposites, many of them need assistance paying for health care. Even conservative columnist, George Will, thinks single payer health care in America is inevitable. This is good news for single payer advocates like me because single payer would improve access to health care. On the other hand, single payer health care will not reduce the cost of health care because America is not ready or willing to address the issues that make American health care so expensive, especially the issue of poverty. Continue Reading...

Tags: obamacare, Poverty, health care reform, American culture

The big health care story last week was Trump threatening, again, to let the Affordable Care Act (aka Obamacare) implode if Democrats did not work with him to pass his health care reform bill. It's a story worth reporting because it clearly shows that Trump just wants to tick health care reform off his to-do list. Something he can brazenly claim is better than Obamacare, even though it won't be, and that he accomplished quickly and through force.

Meanwhile, while Trump was undermining Obamacare with threats, Health & Human Services (HHS) Secretary, the greedy and corrupt, Tom Price, was actively weakening the law. After the Republican health care reform law debacle, Price wasted no time tweaking Obamacare administrative provisions that will most definitely result in fewer people enrolling on the federal exchange. He did this by greatly reducing the annual open enrollment period and placing restrictions on special enrollment periods and requiring documentation for life events such as marriage, birth, and losing workplace health insurance, etc. The new rules also force you to pay the full year's premiums unless you have a life event like new job-based coverage, eligibility for Medicare or Tricare, etc. With this new rule, you cannot stop paying premiums the last few months of the year, as you could under the old Obamacare rules, to save a few bucks. Price and HHS also gave insurers the green light to offer slightly skimpier health plans. Bonus!

But Price's week wasn't done. The former doctor who wants to get rid of Medicare and Medicaid because he believes the reimbursement rates are too low asked doctors for ideas on how they should get paid. Specifically, Price was referring to the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), which replaced the old system of paying doctors for Medicare services. MACRA is an attempt to move away from paying physicians based on the number of patients they see (fee-for-service model) and towards a system based on value and quality of services. Therefore, MACRA also requires reports on quality and pays physicians extra for meeting quality standards.

Price portrays MACRAs quality standards as so burdensome to doctors that they could lead to burnout and more doctors leaving the profession. He doesn't support bundled payments and likely doesn’t support value-based health care at all. He uses his credentials as a former orthopedic surgeon to claim he knows better than anyone that value is hard to define and therefore, unfair to pay doctors according to value-based standards. Continue Reading...

Tags: obamacare, MACRA, Tom Price

It seems everyone working in the health insurance and health care industries feels entitled to large profits. And they will do or not do just about anything to get their share of the multi-trillion dollar a year health care "market." Doctors thumb their noses at "low" Medicare and Medicaid payments, limiting the number of patients in these programs that they will treat. Health insurers balk at insuring the very sick without government subsidies to reduce their financial risk. Pharmaceutical companies threaten to curb drug innovation unless they are allowed to impose astronomical markups on existing products and enjoy long patent periods. And hospitals do whatever the heck they want to make a buck--different prices for the same care with no transparency or explanation. And these are only four of the big players in the health care market; there are many others elbowing for their share.

Under these conditions, American health care reform that tries to lower costs is dead on arrival. The powerful groups benefitting from our overpriced health care system aren't going to accept a pay cut. Some may suggest incentives to get doctors to accept lower reimbursements, like subsidizing their student debt or even reducing the requirements and the number of years it takes to become a doctor. Others may suggest performance bonuses, like the ACA tried.

There are a lot of good sounding suggestions for lowering health care costs, including drug re-importation, universal use of electronic health records, value-based health care pricing, hospital consolidation, competitive bidding for supplies, focus on tertiary care, etc. You name a health care cost cutting idea, and great minds have already penned it.

One health care cost cutting idea receiving more attention is allowing future American doctors to enroll directly into medical school instead of first getting a 4-year undergraduate degree. Medical students and the country would save a lot of money, and their student loan excuse to demand high salaries falls away. Many countries with similar or better health care outcomes require 5-6 years of schooling to become a doctor versus 8 in the U.S. But American doctors won't easily give up the prestige of being a doctor and, therefore, will continue to demand higher salaries. Continue Reading...

Tags: Medicare For All, obamacare, Affordable Care Act

I recently read a comment on social media from a doctor equating accepting Medicare and Medicaid to (a doctor) signing her slavery agreement. And as insulting and inaccurate (slaves didn't sign agreements!) as this statement is, the sentiment is not too far off from what many doctors in America share. Doctors often refer to Medicaid as charity work.

The claim that Medicaid reimbursements do not cover the cost of care is near universal. Some specialists claim they make about $8/hr. treating Medicaid enrollees. Others publish a sampling of their Medicaid reimbursement payments online to show Medicaid paying less than $5 for care billed at $400. Of course, they never share all of the information about a claim, just enough to "prove" their narrative of poverty inducing Medicaid rates.

Meanwhile, physician complaints about Medicaid are the same as the ones they have about private insurance; they just hate Medicaid (and Medicare) more because of the lower reimbursement rates. For all payers, doctors complain about jumping through hoops to get paid, late payments, paperwork, and regulations. Some doctors have also complained about the behavior of Medicaid patients (don't exactly know what they mean by that).

Unfortunately, doctors and hospitals can get away with their Medicaid-rates-are-too-low claims because they are the ones setting the rates. And, as we know, they charge different rates for different groups of patients—Medicare, Medicaid, patients with private health insurance, patients without private health insurance, etc. But these rates aren't related to actual costs because a doctor's time and effort are never measured. So doctors cannot prove Medicaid rates don't cover the cost of their services. Still, that doesn't stop them from demonizing Medicaid, but the reality is that doctors don't like any program or law that controls the fees they can charge or requires them to meet certain standards.

Brief Primer On Medicaid Reimbursement Rates Continue Reading...

Tags: Medicaid, health care reform

Decades ago Dr. Martin Luther King, Jr., spoke about the triple evils in society—poverty, racism and militarism. These three things still exist and continue to feed off of one another, but this week three more evils emerged. Speaker of the House of Representatives, Paul Ryan; Secretary of Health And Human Services (HHS), Tom Price; and Director of the Office of Management And Budget (OMB), Mick Mulvaney recently embarked on a tour to spread Step One of their evil health care plan. Shameless lying about an Obamacare death spiral is to be expected from these three, but the callous response to their health care bill's impact on the elderly and poor is shocking.

With a little preparation, Ryan, Price and Mulvaney hit the media circuit and boy did their true colors shine through. Ryan continued in his persona of the cocky politician staying true to his conservative principles. Price adopted the role of the all-knowing physician giving the uniformed a hard dose of medicine on the evils of government "interference" in health care. And Mulvaney, serving as Trump's representative, is just hard to watch.

Paul Ryan, Champion Of Free-Markets

The one and only good thing about the introduction of the American Health Care Act (AHCA), is that it totally destroyed Paul Ryan's (fabricated) reputation as a brilliant policy wonk. Ryan's contribution to the AHCA is ideological and administrative. Ideologically, Ryan does not believe in taxing rich people and does not like entitlement programs. Consequently, questions about the tax cut for the wealthy and the gutting of Medicaid elicit smirks and God-awful responses from Ryan, including these gems from his interviews with radio host, Hugh Hewitt and Fox News' Tucker Carlson, respectively:

“But we always know, you’re never going to win a coverage beauty contest when it’s free market versus government mandates.” Ryan's response is reminiscent of remarks made by former Louisiana Governor, Bobby Jindal, when he rolled out his Obamacare repeal plan:

"whatever amounts of money conservatives were willing to allocate to address a problem, Democrats would always be willing to spend more, so conservatives cannot get into a bidding war." And, “I think it's a mistake if we measure health care reform in terms of how many people we give cards to.”

But Ryan wasn't done being a jerk, this is what he said when called out by Carlson for eliminating an investment income tax on the richest Americans as part of his reform reconciliation bill, "I'm not that concerned about it because we said we were going to repeal all of the Obamacare taxes and this was one of the Obamacare taxes."

And concerning millions of people potentially losing Medicaid coverage, Ryan has expressed absolute giddiness about the billions of dollars in federal savings and the prospect of de-federalizing Medicaid once and for all.

With Paul Ryan, you get an ideology without a soul.

Tom Price, Preserver of the Doctor-Patient Relationship And Access Proponent Continue Reading...

Tags: health care reform

How bad the American Health Care Act (AHCA), the Republican replacement for the Affordable Care Act (aka, Obamacare), will be for the mentally ill, women, poor people, children, older people, and people needing drug treatment is still unknown. However, everyone expects these groups to receive less financial support in purchasing health insurance and in accessing health care. Meanwhile, the young, healthy and the wealthy have something to smile about if the AHCA becomes law.

But According to Donald Trump, weakening Medicaid and providing skimpier subsidies than Obamacare is just the first step in the rollout of the Republicans' great health care reform plan. For step one of the bill making process, Republicans had to navigate a complicated legislative process called reconciliation, as Paul Ryan likes to remind everyone, including critic, Senator Tom Cotton. So Ryan took this opportunity to do something thoroughly Republican and eliminate the Obamacare-related taxes for the rich and warn the poor that their health care free ride was over.

Don’t Underestimate The Republicans Capacity For Cruelty

After rolling out step one of the American Health Care Act, Republicans in Congress proceeded to make some of the dumbest and most hypocritical remarks in political history. I'm being dramatic but I'm not the only one that attacked Congressman Jason Chaffetz's on Twitter for his dumb iPhone remark, or who was disgusted by Senator Tim Scott's dissing of the Congressional Budget Office (CBO) because he suspects it will reveal the bill as a huge takeaway for the millions who got insurance under Obamacare. And let's just try and forget Paul Ryan's misleading, inaccurate and amateurish PowerPoint presentation where he revealed that he doesn't know the definition of insurance, and his performance on Fox News where he coldly stated that he didn't care about the windfall his bill gives to the rich. Continue Reading...

Tags: American Health Care Act, Paul Ryan, obamacare

Everyone wants to see the Paul Ryan/Tom Price Affordable Care Act (aka Obamacare) replacement bill, even most Republican lawmakers. But Ryan and Price would rather look like a putz than reveal who will be the primary losers under their new plan. They are also afraid that their fellow Republicans will join the media in ripping their plan apart. They have no desire to be once again the objects of a mocking press, Democrats and Obamacare supporters for their inability to present a Republican, majority-supported Obamacare alternative plan.

After embarrassing leaks describing their reform paralysis at the Republican retreat in Philadelphia earlier this year, and the leaked draft that revealed a proposal to base tax credits on age instead of income, Ryan and Price literally went underground (House basement) to reveal their latest proposal to a select group of lawmakers. There's plenty to mock about this childish approach to drafting legislation. But like all things related to Republican health care reform efforts, this latest hide and seek stunt is about politics and not providing affordable health care. Ryan can't keep putting out bad proposals that the rest of the GOP won't support. At least not publicly. He failed in his promise from years ago to lead the effort to draft an Obamacare replacement bill and is now just a mere figurehead of the process. Health care reform is now a Senate and White House effort with Ryan serving as secretary and spokesperson.

And with Senator Mitch McConnell and Secretary Tom Price leading the effort, we can expect more drastic cuts to federal subsidies and fewer people with insurance coverage than if Ryan had pushed through all of his lackluster reform ideas. McConnell has always wanted to push health care reform back to the states via high-risk pools and other disproved policies. But states have made it clear that they need federal government funds and they like the money Obamacare provided. Therefore, I expect the new Republican health care reform bill to grandfather Medicaid expansion for the states that adopted it. And based on past Ryan/Price proposals and the Trump Joint Congressional speech this week, we can easily assume that the crux of the law includes health savings accounts and tax credits that will mostly benefit the well-off, healthy and young Continue Reading...

Tags: obamacare, obamacare alternative, obamacare subsidies, Tom Price, Paul Ryan

Since the presidential election, Trump supporters and non-supporters have accused one another of being Snowflakes, or overly sensitive. However, recently the term Snowflake is used increasingly to describe Trump supporters. Countless articles in liberal and conservative media publications warn about the dangers of referring to all Trump supporters as racists, misogynists or uninformed. They claim that these negative characterizations are starting to backfire and result in Trump supporters clinging to him even more.

And many Trump voters admit that they are completely turned off by liberal attacks and hurtful characterizations. Not surprisingly, Trump non-supporters refuse to alter their depiction of Trump voters. They find their characterization of Trump voters accurate and their feelings not worth protecting given the potential harm a Trump Administration can cause. Add to this war of words the contentious issue of affordable health insurance and health care, and you get a mini battle between people that claim Obamacare helped them versus people who claim it hurt them. Both camps have its share of Snowflakes with the "Help" combatants referring to the "Hurt" combatants as selfish and heartless, and the "Hurt" section referring to the "Help" warriors as smug.

The "Hurt" group desperately wants to explain its objections to government-mandated health insurance. They don't like being forced to pay higher premiums than they otherwise would to subsidize health insurance for people who can't afford it. Some in this group don't want to subsidize anyone's insurance but most object to subsidizing people they characterize as able-bodied adults who made bad life decisions. A typical social media thread between the two groups has traces of the culture war happening between Republicans and Democrats.

(This is a real, abbreviated thread from a health care Facebook group. I purposefully exclude the name of the group and the contributors): Continue Reading...

Tags: obamacare, health insurance , Snowflakes

There's a lot of speculation about which group of Americans will be hurt the most by impending Republican health care reform legislation. People with preexisting conditions may see these exclusions return in some form. People with life-threatening medical conditions requiring expensive medical care may see the return of annual/lifetime limits. Group health plans may see their tax-favored plans altered and made less attractive. And freelancers and entrepreneurs may be forced to return to traditional employment, if available.

Everyone that is not wealthy enough to pay for health insurance or fortunate enough to have someone else pay for it has a reason to be concerned about Republican changes to the Affordable Care Act (aka Obamacare). And that's because health care reform is just an unwanted political exercise to Republicans. Made necessary by a law, that despite its shortcomings had a larger goal of providing affordable, comprehensive health insurance to all Americans.

Things Are Different Now

Oddly, not repealing Obamacare is more popular than the law itself. A lot has changed since the law's inception in 2010. While Republican lawmakers waited and tried to hasten the law's collapse by ending funding for the risk corridor program, something else happened—lives were saved. Cancer diagnoses that would never have occurred did. People with life altering mental illnesses started receiving treatment that allowed them to be more productive. Various artists obtained insurance for the first time in decades. The Obamacare death spiral that House Speaker Paul Ryan was so hoping for and wrongly claims is upon us didn't happen soon enough.

There are just too many Obamacare success stories getting in the way of the GOP narrative that every single component of the law has been a total failure. Not that Republican lawmakers are not trying to continue to push the narrative of Obamacare as the dumbest law ever passed by the government. They've even gone so far as to claim paid protesters are behind the current, vocal swell of support for the law, and are giving shout-outs to their well-funded and well-organized protesters to counter this support. This Retweet from the Heritage Foundation says it all:

KEEP IT UP & THANK YOU! Conservatives Are Flooding Town Halls, Too. I Know, I’m One of Them. https://t.co/YZNoJK0wdC @DailySignal

— Genevieve Wood (@genevievewood) February 16, 2017

It is official, the corrupt and greedy former orthopedic surgeon, Tom Price is the new head of the Department of Health and Human Services (HHS). What changes he will make to the Affordable Care Act (aka Obamacare) weighs heavily on a lot of minds. Will it be a slow dismantling of the law or full replacement? Will he work with House Speaker, Paul Ryan who promises to have a House plan ready in 2017, possibly by the end of the first quarter of the year? At the moment, who knows what he'll do, but expect a lot of noise over the next month from the GOP about their Obamacare replacement plan.

In fact, the show of the Republican's impending replacement plan has already started, with Paul Ryan as its star. First, he hosted a televised town hall in January, trying to convince America that Obamacare was in a death spiral. His criticism of Obamacare continued on the Charlie Rose show, and every other time he is in front of a television camera or reporters microphone. And just this week the American Action Network (AAN), using footage of Paul Ryan and hinting at his BetterWay plan, ran a television ad claiming Republicans have a plan.

After leaks of a clueless GOP grappling with health care reform at the Republican retreat in Philadelphia last month, Paul Ryan is eager to change the narrative. He is building up his party's Obamacare replacement reveal the only way he knows how, by using his star power and telling a bucket full of lies.

Ryan is not as smart as he wants people to think but unfortunately, he has a reputation for being the smart guy that's not afraid of getting into the weeds of policy. He's hoping that his undeserved reputation as technical but empathetic, will allow Republicans to replace Obamacare with less health care coverage. He doesn't frame his proposal as less than Obamacare. Instead, it is referred to as patient-centered and freedom (from costly mandates for coverage you don't need). Continue Reading...

Tags: obamacare, obamacare alternative, Tom Price, Paul Ryan

Last week's Republican House and Senate retreat in Philadelphia revealed what we already knew; they don't have a plan to replace the Affordable Care Act (aka Obamacare). This week there were reports that some Republicans have given up on repeal and replace and want to “fix” Obamacare instead. Also, this week, shady Congressman Tom Price came one step closer to becoming Secretary of Health & Human Services when the Senate Finance Committee approved his nomination without Democratic support.

It's been a frustrating week for Obamacare supporters concerned about the future of health insurance and health care in America. Every statement about health care reform, even if it is a repeat of what's been said before is scrutinized for new meaning. But for now, we are in limbo, and that is not a bad thing. Things could be worse. We should use this time to put forth some ideas on health care reforml.

Obamacare Could Be Better

Everyone agrees that Obamacare plans could be better—more affordable and there should be more of them. Also, there's majority agreement that some provisions of Obamacare are keepers, like no prohibitions on coverage for preexisting conditions, keeping dependent children on employer-provided plans up to age 26, and receiving subsidies to pay for coverage. But these goodies cost money and require trade-offs. So knowing that Republicans would prefer the government get out of the health insurance business, what suggestions would you give them if they were forced to stay in it. Keeping in mind that you can't get everything you want.

Protests are fine, but how can we improve Obamacare when we know universal coverage is out of the cards in this new Republican reality?

First, agree not to turn Medicaid over to the states via block grant or any other program. States may know their constituents better than the federal government, but equality often comes in a distant second to state budget priorities. We can't trust states to cover everyone who needs Medicaid. We also can't trust them to regulate the quality of care Medicaid recipients receive. Medicaid patients wait longer to see a doctor and get a lower quality of care than patients with private insurance.

Instead of Medicaid block grants or any other state-based Medicaid program, the federal government should run the Medicaid program just like it does with Medicare. Everyone gets the same benefits, and medical providers must meet predetermined quality standards in exchange for higher reimbursement levels.

There is no way for the government, federal or state, to get around paying for health care for the poor. States can assist in this effort by addressing the poverty in their communities, but they should stay out of the health care business for the poor. Continue Reading...

Tags: obamacare, obamacare alternative, obamacare subsidies, Medicare, Medicaid

To borrow a line from Hamilton, the musical, [Republicans are having their] "governing is harder moment" with health care reform. Just this week they added two more health care reform proposals (outlines) to the seven they conjured up since 2009. The latest health care proposals are near opposites of each other and include an Affordable Care Act (aka Obamacare) light plan and a worse than before Obamacare plan with no subsidies, or possibly, insurance for the sick and poor.

The Road To Still No Health Care Reform Bill

Whenever Obamacare opponents provide an Obamacare alternative plan, its contents are 90% Obamacare is an abject failure, and 10% (usually a bulleted list), here's my plan. Because the focus is not on reforming America's complex and pricey health care and health insurance sectors, their plans come up short in money, benefits covered and access, when compared to Obamacare. This opposition-focused exercise that Republicans are engaged in has produced nine proposals so far.

• The Obamacare Replacement Act
• Patient Freedom Act
• The American Health Care Reform Act
• The Patient Choice, Affordability, Responsibility, and Empowerment (CARE) Act
• Health Care Choices Act
• A Better Way, To Fix Health Care (Reform Plan)
• The Patients' Choice Act
• Health Care Freedom Act
• Empowering Patients First Act

Tags: obamacare, obamacare alternative, Tom Price

Two days before the U.S. presidential inauguration, Senator Bernie Sanders asked Secretary of Health and Human Services (HHS) nominee, Tom Price, "do you believe that health care is a right of all Americans, whether they are rich or they're poor." Like any worthy opponent, Price would not give a "yes" or "no" answer. Instead, he said, "I look forward to working with you to make certain that every single American has access to the highest quality care that is possible.” Here's how I interpret Price's cold reply:

Americans that can afford to pay for the highest quality health care shall have access to it. Americans that cannot afford the highest quality care shall have access to the level of care what little money they have can provide. A doctor is advocating for levels of care based on ability to pay. Shocker. But not all doctors are like Tom.

The Greedy Dr. Price

Tom Price has an estimated net worth of over $13 million. His HHS nomination hearing is as much about corruption as it is about policy. There are allegations that he purchased health care stocks based on insider information and introduced legislation favorable to a company whose stock he owned. Price claims his stock purchases were legal, and that may be true, but his lack of propriety in making these purchases and their timing, is unsettling but not surprising.

Price's careers as a doctor, State Senator and U.S. Congressman have a common theme—oppose any and all legislation that threatens the paychecks of doctors. He opposed single payer health insurance long before Obamacare when he mobilized other doctors to lobby against Hillarycare. And he has a history of trying to limit, sometimes drastically, the amount patients can receive in malpractice lawsuits. With so much time and effort devoted to pursuing and sustaining wealth for doctors, the confirmation hearing may be uncomfortable, but Tom's been doing this for a long time, and he has an answer for everything.

Tom Wants A Health Care System Made Up Of Individuals

As an entrepreneur with a medical degree whose main purpose in life is to stay rich, we can expect Tom Price to oppose legislation to limit what doctors, hospitals and pharmaceutical and medical device companies can charge for their services and products. For Tom, health care is a commodity, not a right of all Americans. Other things not to get your hopes up about with a Price-led HHS department:

• meaningful health care price transparency
• limits on out-of-pocket health care cost for patients
• the prohibition against balance billing

Tags: Tom Price, universal health care

In his January 6, 2017, interview with Vox.com, President Obama said that one of the great disappointments for him regarding the Affordable Care Act (aka, Obmacare) was the difficulty in getting doctors and hospitals to go paperless. His interviewers, Ezra Klein and Sarah Kliff, expressed surprise that the President chose this as one of the great disappointments of such a controversial law. But I get it.

The U.S. is a world technology leader. Home to the world's largest and richest tech companies like Apple, Microsoft, Intel, Google and Facebook. But whether we are the best in tech is a matter of debate. Some believe Israel is tops in tech, claiming it has the brightest software engineers in the world, responsible for creating the best firewall software and other tech innovations. Still, others give a shout-out to Denmark, Finland, Sweden and Estonia, well known for extending tech to all of its citizens who use it in the everyday lives, even more than Americans.

But despite the great things that other countries are doing with tech, I think it is fair to say that that America has the resources and capability to lead the world in health information IT; if we wanted to. And maybe that is the primary reason that electronic health records (EHRs) are still a hope of Obama's.

What Are EHRs And What Are The Benefits and Challenges Of Using Them

Electronic health records are digital records created on a computing device by doctors and other medical care providers and staff about a patient's treatments and care. They have many potential benefits for patients and doctors, including:

• Less paperwork—won't have to provide the same basic information to every new doctor
• Fewer medical errors—doctors can receive warnings and alerts about allergies and prescribed drugs
• Easier remote access that may also expand the use of telemedicine—patients can communicate with providers online and make appointments
• Better diagnosis—doctors have a more complete and up-to-date picture of a patient's medical status
• Less diagnostic testing—doctors can see previously ordered tests and won't duplicate unless necessary

Tags: Electronic health records, EHRs, obamacare