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