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