Category Archives: Health care administrators

Fed Chair Jerome Powell calls out massive US health spending, says Americans are ‘getting nothing’ in return; and What are Pete Buttigieg’s Plan for Health care? More on the Coronavirus and health care costs.

Josepj Zeballos-Roig reported that Federal Reserve Chair Jerome Powell said at a Senate hearing on Wednesday that Americans were “getting nothing” in return for what the US spends on healthcare.

“The outcomes are perfectly average for a first-world nation, but we spend 6% to 7% of GDP more than other countries,” he said. “So, it’s about the delivery. That’s a lot of money that you are effectively spending and getting nothing.”

Studies have indicated that the US spends far more on healthcare than other developed countries, only to achieve worse outcomes.

One study published last year in a medical journal estimated that nearly a quarter of the US’s $3.6 trillion health spending was wasteful.

Why the heck is this true??

The United States is one of the highest spenders on healthcare for its citizens, but it has very little to show for it, Federal Reserve Chairman Jerome Powell said on Wednesday.

Powell made the brutal comments during a Senate Banking Committee hearing on monetary policy.

Republican Sen. Ben Sasse of Nebraska asked the Fed chair to weigh in on the effect of healthcare spending on the economy, and Powell said the US was spending at far higher levels without much to show for it.

The Fed chair added that developed countries had been more successful in delivering quality healthcare for much less to their citizens.

“It’s not that these benefits are fabulously generous — they’re just what people get in Western economies,” Powell said.

It’s not the first time Powell has weighed in on the rising price tag of healthcare in America. In a 2018 interview with Yahoo Finance, he warned that it could hurt the country’s economy in the future.

“It’s no secret: It’s been true for a long time that with our uniquely expensive healthcare delivery system and the aging of our population, we’ve been on an unsustainable fiscal path for a long time,” the Fed chair said.

US health spending grew by 4.6% in 2018, reaching over $3.6 trillion, according to the Centers for Medicare and Medicaid Services. And it has been swelling for decades.

The US spent about $10,000 per person for healthcare in 2017, about twice as much as other developed countries, according to the nonpartisan Kaiser Family Foundation. But it has ranked poorly in health outcomes, particularly on infant mortality and deaths from preventable causes under age 75.

One study published in the Journal of the American Medical Association last year estimated that nearly a quarter of that spending — up to $935 billion a year— was wasteful, with failures of care delivery and coordination eating up most of the nation’s mismanaged health expenditures.

How do we change this and will a government run system solve these problems?

‘A godsend to my old industry’: A former insurance executive says Pete Buttigieg’s healthcare plan would keep huge profits for insurers and bankrupt Americans

I thought that as Pete Buttigieg is surging in the polls that we should look at his health care strategies. Joseph Zeballos-Roig further reported that Wendell Potter, a former insurance executive, ripped into Pete Buttigieg’s health plan in an interview with Business Insider.

Potter said he believes the plan is a “godsend” for the insurance industry and will allow it to maintain its grip over American healthcare.

“They’d be happy as clams on the Pete Buttigieg health plan,” he told Business Insider.

The Buttigieg campaign defended the plan in statement and noted the insurance industry has also spent millions attacking it.

A former insurance executive says Mayor Pete Buttigieg’s proposed healthcare plan would be “a godsend” for insurers and allow it to exert outsize power in the debate around healthcare reform.

Wendell Potter, President of Medicare for All, an advocacy organization, tweeted on Tuesday that Buttigieg’s effort to continue attacking a proposal to insure everyone in the US in the Democratic primary would massively benefit the health industry.

“This will thrill my old pals in the insurance industry, as Pete’s plan preserves the very system that makes them huge profits while bankrupting & killing millions,” Potter wrote.

He resigned from his position as a senior communications executive at Cigna in 2008 and went on to testify against the insurance industry in Congress.

In an interview with Business Insider, the former healthcare executive said he believed Buttigieg’s plan would be a “godsend” for the industry in a system designed to maximize profits at the expense of consumers.

“They’d be happy as clams on the Pete Buttigieg health plan,” he said. “It doesn’t change much.”

Potter criticized a mandate in the proposal compelling people to carry health insurance which could saddle people with multi-thousand-dollar fines at the end of the year, given a provision to cap premiums at 8.5% of income. It resembles the least popular part of the Affordable Care Act that Congress repealed under the 2017 Republican tax law.

The former Cigna executive has sought to generate support for universal healthcare, and met with the Sanders and Warren presidential campaigns. But he doesn’t plan on endorsing a candidate in the competitive primary.

The Buttigieg health plan mirrors the one that former Vice President Joe Biden unveiled last year, another moderate. Both candidates have faced off against Sens. Bernie Sanders and Elizabeth Warren’s support to create a single-payer system in the US, which would cost over $30 trillion over a decade.

Buttigieg’s $1.5 billion health proposal is a middle-of-the-road approach. It would create a government-managed plan for people who want it while allowing others to maintain their private insurance. He’s touted it as a “glide path” towards universal health coverage.

What the heck does that mean?

In a statement to Business Insider, Sean Savett, a spokesperson for the Buttigieg campaign, defended the plan and noted insurers have also spent millions of dollars slamming it.

“Pete’s ‘Medicare for All Who Want It’ plan would make some of the boldest, most progressive changes to our health care system in decades in order to achieve universal coverage for all Americans,” Savett said. “It has also been attacked by the health insurance industry because it would create competition and force insurers to lower costs and improve care or lose customers — so that claim doesn’t hold up.”

In recent months, the health industry has spearheaded a multimillion-dollar effort to throttle proposals for Medicare for All.

It often lumps modest attempts at reform — such as Buttigieg’s plan — alongside universal healthcare and industry groups warn it could lead to a “one size fits all” system with hospital closures and longer wait times to receive medical care.

Still, the effectiveness of a public option depends on its strength. It would likely still shake up the healthcare system and empower the government to negotiate with providers for lower costs.

Larry Levitt, executive vice president for the Kaiser Family Foundation, said to the New York Times last year: “The political appeal of the public option is it preserves the choice of private insurance. But the better it works, then the less likely it is to actually preserve a private insurance market.”

The glaring question continues to be how will the $1.6 billion be paid?

John Legend calls Pete Buttigieg’s ‘Medicare for All Who Want It’ plan a ‘trap’

Further, we had Eliza Relman of the BusinessInsider report that John Legend took issue with former Mayor Pete Buttigieg’s healthcare-reform proposal in a series of tweets on Thursday, saying the 2020 candidate’s plan doesn’t go far enough to protect Americans.

As if John Legend is someone whose evaluation on health care should be valued!

Buttigieg’s “Medicare for All Who Want It” plan would essentially add a public option to Obamacare.

“It’s a trap for progressives to try to talk about healthcare as some sort of free market like they’re talking about TVs or cell phones,” Legend tweeted. “Healthcare is a necessity and there’s very little choice when you’re actually sick. You need treatment and you need it to not bankrupt you.”

Critics of a public option, including those who favor “Medicare for All,” say it wouldn’t adequately rein in healthcare costs and would leave the insurance industry with significant influence over Americans’ healthcare coverage.

John Legend took issue with former Mayor Pete Buttigieg’s healthcare-reform proposal in a series of tweets on Thursday in which he said the 2020 candidate’s plan didn’t go far enough to protect Americans.

“This myth of freedom and choice sounds wonderful til you realize your boss has the freedom and choice to fire you from this union job,” the singer wrote, retweeting Buttigieg’s message promoting his “Medicare for All Who Want It” plan for union workers.

Buttigieg’s plan, like the one proposed by former Vice President Joe Biden, would essentially add a public option to Obamacare, opening up Medicare for those who don’t have or want private insurance. Critics of a public option, including those who favor “Medicare for All,” say it wouldn’t adequately rein in healthcare costs and would leave the insurance industry with significant influence over Americans’ healthcare coverage.

“It’s a trap for progressives to try to talk about healthcare as some sort of free market like they’re talking about TVs or cell phones,” Legend said. “Healthcare is a necessity and there’s very little choice when you’re actually sick. You need treatment and you need it to not bankrupt you.”

He added, “And the so-called ‘market’ for healthcare is so opaque, there are few if any perfectly informed consumers. And no one can predict what healthcare they’ll need in the future.”

Spokespeople for Buttigieg’s campaign didn’t immediately respond to a request for comment.

Health Insurance Premiums Continue to Increase. What Can You Do?

MoneyWise noted that according to the Kaiser Family Foundation’s annual employer benefits survey, the average annual health insurance premium for family coverage for employer-sponsored health plans was over $20,000 in 2019. That’s the first time premiums have reached the milestone. Premiums were 5% higher than the year before.

Meanwhile, a 2018 report from the National Association of Insurance Commissioners noted that the health insurance industry was continuing its “tremendous growth trend,” going from a profit margin of 2.4% in 2017 to 3.3% in 2018.

The numbers haven’t come in yet for 2019, but insurers in 2019 have posted record profits, and many individuals and families have experienced climbing health insurance premiums in recent years.

Why health insurance premiums are climbing

While a number of factors contribute to the rising cost, Melissa Thomasson, department chair and professor of economics at Miami University in Oxford, Ohio, has identified two main reasons for rising health insurance premiums: consolidation and billing.

Consolidation

Thomasson says that the increasing consolidation of health care is the main driver of rising premiums.

“People can look around, and they see physicians’ practices being purchased by hospitals. Well, every time that happens, those bills increase,” Thomasson says.

This is what you likely learned in high school economics class. “When competition is lowered, prices go up,” Thomasson says. “As hospitals merge, they have less competition and more leverage with the insurers, and the discounts get lower. Consolidation forces health care prices to go up.”

Billing

The second factor is “surprise billing,” Thomasson says. Every health care bill may seem like a surprise, given how you often don’t know what you’ll be charged. But Thomasson says that it’s becoming more common for consumers to receive extremely large bills for out-of-network care — even though they thought they were receiving care within their health insurance network.

“It doesn’t always occur to you to ask, ‘How much will it cost for somebody to read that X-ray?’” Thomasson says.

What you can do about rising health insurance premiums

Often, when you ask experts what can be done about rising insurance premiums, the answer is “not much.” But there are a few strategies you can use to try to tame your costs.

Tinker with your health insurance plan

Keep your plan, but talk to your insurance agent or the insurer directly about making changes.

Choosing a higher deductible and higher copays will lower your premium, says Matt Oves, an employee benefits account manager at Sahouri Insurance, an independent insurance brokerage located in Tysons Corner, Virginia.

“If you are healthy and do not anticipate any major health concerns, it may be smart to select a plan with higher deductibles,” Oves says.

However, it may not be a good idea if you often go to the doctor, or you anticipate needing to see a physician frequently in the near future. If you’re paying a smaller monthly premium but you’re shelling out higher copays two or three times a month throughout the year, you might wish you had kept your premium as it was.

Consider a health savings account (HSA) or flexible spending account (FSA)

This is one strategy that I have suggested to my family. Oves suggests taking advantage of an HSA or FSA if you can. Some people with high-deductible health insurance plans, as defined by the government, qualify for health savings accounts. Each year, you decide how much to contribute to your HSA, and that money is usually not subject to federal income tax. If you don’t use the money, it rolls over to the next year. That will help cover out-of-pocket costs. There are also investment options for HSA funds, providing an added bonus to those with high-deductible plans.

Flexible spending accounts are similar to HSAs, but the money doesn’t roll over to the next year and the account is owned by the employer. FSA contributions are deducted from your salary with pre-tax dollars. The employee usually receives a debit card to use for qualified health expenses. If you qualify for both an HSA and an FSA, you’ll likely find more flexibility and benefit from an HSA.

Look into a short-term health insurance plan

Adam Hyers, who owns Hyers and Associates, Inc., an insurance agency in Columbus, Ohio, says that many of his healthy clients have enrolled in short-term insurance plans that can last 12 months or longer.

“These policies now look much like what insurance plans did pre-ACA and can cover the insured for unknown, catastrophic types of issues. In many cases, premiums for short-term plans can be half as much as ACA-type policies,” Hyers says.

However, Hyers cautions, “short-term plans aren’t the solution for everyone as they don’t cover preexisting conditions, but they are a good option for those who just want to cover a bigger event that could happen throughout the year.”

In other words, it’s a stop-gap solution if you need a health plan while you look for a plan you can afford, you’re between jobs or you need coverage in case of an emergency.

Stay healthy

Eating your fruits and vegetables, exercising and not doing unhealthy activities, like smoking, can help lower your insurance costs today and over time. Obesity and other conditions can increase your costs over time. Using your preventative health insurance every once in a while, can help keep your health care costs lower in the future.

“Get routine checkups to catch health problems early and avoid paying for complex surgeries later,” Oves says.

Think of your body as a car. If you never change the oil because it’s expensive, eventually you’ll destroy your engine and be out far more money. If you don’t get an annual physical, you may pay for it later in a big way.

Talk to your representatives

Call your senator. Call your member of Congress. Thomasson recommends this if you’re looking for health care premium relief in the long run. If you feel that the government should be working to bring health care prices to more manageable levels — for you and your employer — then make your voice heard.

Your wages may be paying for insurance premiums

Thomasson notes that if your wages haven’t risen much lately, it may be due to your employer-provided health plan. “If your employer is paying for your higher and higher premiums, then you’re receiving compensation for that. And that’s the raise that your employer can’t give you,” Thomasson says.

There’s the chicken-and-egg irony in all of this. Your health plan is getting more expensive, which keeps your employer from offering you a higher salary, which makes your health plan even harder to pay for.

While it may be challenging to combat rising insurance premiums, knowing your options and taking small actions can help save you money today and in the future. While you may not be able to lower your premium, you can make changes to help offset the costs, or even inspire change in your workplace or community by understanding how insurance premiums work.

And now more on the Corona virus, or COVID-19!

More than 1,700 healthcare workers in Wuhan have gotten the coronavirus. A study found that 29% of infections were in medical staff.

Holly Secon reported that as the new coronavirus, now known as COVID-19, continues to spread, hundreds of healthcare workers are getting sick.

China’s National Health Commission announced Friday that 1,716 health workers had contracted the new virus. Six have died.

One study found that nearly a third of the patients involved were healthcare workers.

Healthcare workers on the front lines of the coronavirus outbreak are getting sick by the hundreds.

China’s National Health Commission said on Friday that 1,716 healthcare workers nationwide had been infected by the virus. Of that total, 87.5% are in the Hubei province, where the outbreak began.

In addition, Chinese authorities confirmed for the first time that six healthcare workers have died. That includes doctor Li Wenliang, who was censored by Chinese authorities after warning colleagues about the new virus.

The South China Morning Post Tuesday that at least 500 healthcare workers in Wuhan hospitals had contracted the virus, and approximately 600 more cases were suspected, but the official numbers reveal that the risk to medical staff is even more dire.

Research published last week in the Journal of the American Medical Association found that of 138 total patients studied, 29% were healthcare workers. In one case, a patient admitted to a hospital in Wuhan infected at least 10 medical workers and four other patients.

Together, these reports highlight a concerning threat both to the individuals working to curb this outbreak and to Wuhan’s already overstressed healthcare system.

Healthcare workers at risk

The coronavirus has infected more than 64,000 people and killed nearly 1,400. It has spread to 25 countries beyond China.

Healthcare workers are particularly vulnerable for a handful of reasons. First, the coronavirus is highly contagious, and medical staff members are exposed to more viral particles than the general public. Second, they’re facing shortages of supplies as the tide of patients rises. Third, a combination of stress and long hours could make their immune systems more vulnerable than normal.

A lack of data and information about the new coronavirus is a fourth challenge. Gastrointestinal symptoms, for example, were not initially recognized as potential early indicators. That’s the reason one Wuhan patient infected 10 medical workers: The person came into the hospital with abdominal issues but was placed in a surgical ward, since the symptoms didn’t match known coronavirus red flags. Four other patients in the ward then caught the virus, too.

The threat to hospital staff isn’t limited to China: Two of four new coronavirus cases in the UK are healthcare workers, officials announced Monday.

“We are now working urgently to identify all patients and other healthcare workers who may have come into close contact, and at this stage we believe this to be a relatively small number,” Yvonne Doyle, medical director of Public Health England, said in a statement.

At the Good Samaritan Hospital in San Jose, California, meanwhile, five employees were sent home and told to self-isolate for about two weeks after they came into contact with a patient later confirmed to have coronavirus.

Infection among healthcare workers has been a problem during outbreaks of other coronaviruses as well, including SARS (severe acute respiratory syndrome) and MERS (Middle East respiratory syndrome). Around 20% of people who got SARS were medical workers. One highly contagious patient — a “super-spreader” — infected 50 doctors and nurses.

“We’ve seen this before with MERS, we’ve seen this before in SARS,” Mike Ryan, the executive director of the World Health Organization’s Health Emergencies Program, said in a press conference on Friday. “If you look at the percentage of overall cases, although it’s a tragic situation for the health workers … it is a lower percentage than has occurred in other coronavirus outbreaks.”

Overwhelmed by the coronavirus outbreak

In Wuhan, where nearly 20,000 cases have been documented, hospitals have reported running out of beds, testing kits, and protective gear.

Chinese authorities sent 10,000 additional medical workers and more protective gear to the hospitals in the city and rapidly built two new hospitals there as well. Hotels, sports centers, exhibition spaces, and other local venues are also serving as temporary treatment centers.

But a doctor at one major hospital in China — who was kept anonymous due to fears about losing his job — told the South China Morning Post that curbing the outbreak and treating patients is exponentially more difficult when healthcare workers are getting sick.

“Just a very rough estimate, 100 nurses and doctors can look after 100 ordinary beds and 16 ICU beds,” he said. “If they are sick, not only do they occupy 100 beds, but the staff taking care of 100 beds are gone. That means a hospital loses the capacity of 200 beds. That is why the authorities have to keep sending medics over to Wuhan, not only because there are not enough beds, but because of a lack of health doctors and nurses to take care of the sick beds.”

Hospitals and healthcare workers in other countries are preparing

In the US, which has confirmed 15 cases, many hospitals are preparing for potential coronavirus cases.

“A lot of our patients are from many different countries and travel,” Kim Leslie, an emergency-department nursing director at Swedish Hospital in Chicago, previously told Business Insider. “The likelihood of us coming across it is high, so we’re trying to have a plan for what to do.”

Health authorities worldwide recommend standard preventative measures for healthcare providers: hand-washing, avoiding touching one’s face, and wearing a surgical mask when around sick patients.

The Central Hospital of Wuhan via Weibo/Reuters

The US Centers for Disease Control and Prevention also recommends that hospital staff put potentially infected patients in an airborne infection isolation room, wear eye protection, and immediately notify the CDC about any person under investigation.

Plus, US hospitals are already facing a bad flu season. At least 22 million people have gotten the flu since October 1, 2019, and 12,000 have died.

“It’s really hard because so much of US screening is relying on travel history, but it shows the importance of following the standard procedure of basic infection control practices,” Saskia Popescu, an epidemiologist specializing in infection prevention, told Business Insider, adding, “if you could put a mask on everyone who had a cough and fever, that would be huge.”

‘I owe the American people an apology’: A former healthcare executive says he’s sorry for devising the biggest argument against Medicare for All and Some Additional Thoughts

Leave a reply

As the politicians are getting ready for the Senate impeachment trial, I realize how much time has been wasted on non-health care, non-immigration, non-education improvement, non-environmental issues. Both parties, Democrats and Republicans have wasted and multiple millions of our taxpayer dollars. Pathetic. These are the people that we voter for to do our bidding…improve our lives. Instead they fight and embarrass all of us. Pathetic!

And again, what about Medicare for All? Zeballos-Roig noted that Wendell Potter, a former health insurance executive and now pro-Medicare for All activist, apologized for his role in designing the biggest argument against industry reform in a New York Times op-ed published Tuesday.

He was referring to the idea of choice, or put another way, the freedom of Americans to pick their own health insurance plans and which doctors they want to see.

The activist called it “a PR concoction,” one filling him with “everlasting regret.”

A former executive at a prominent health insurance company had one thing to say recently: I’m sorry.

Wendell Potter, once a vice president for corporate communications at Cigna and now a pro-universal healthcare activist, laid out his apology in the New York Times on Tuesday for crafting one of the biggest arguments used against the creation of a single-payer system in the United States.

He was referring to the idea of choice, or put another way, the freedom of Americans to pick their own health insurance plans and which doctors they want to see.

It’s a common argument the health industry employs to oppose any attempt to change the system. Most recently, its spearheaded a multimillion-dollar effort to throttle proposals for Medicare for All, which would enroll everyone in the US onto a government insurance plan and virtually eliminate the private insurance sector.

“When the candidates discuss health care, you’re bound to hear some of them talk about consumer ‘choice,'” Potter wrote, referring to the Democratic primary field. “If the nation adopts systemic health reform, this idea goes, it would restrict the ability of Americans to choose their plans or doctors, or have a say in their care.

He called it “a good little talking point,” effective at casting any reform proposal expanding the government’s role in healthcare as drastically damaging.

But Potter said that defense was ultimately “a P.R. concoction,” and one that filled him with “everlasting regret.”

“Those of us in the insurance industry constantly hustled to prevent significant reforms because changes threatened to eat into our companies’ enormous profits,” Potter wrote.

Potter resigned his position at Cigna in 2008. And he testified to Congress a year later about the practices of an industry that “flouts regulations” and “makes promises they have no intention of keeping.” He’s since become a leading reform advocate.

Get this, the activist said in the Times op-ed that healthcare executives were well aware their insurance often severely limited the ability of Americans to personally decide how they accessed and received medical care, unless they wanted to pay huge sums of money out of their own pockets.

Do you all believe this?

“But those of us who held senior positions for the big insurers knew that one of the huge vulnerabilities of the system is its lack of choice,” Potter said. “In the current system, Americans cannot, in fact, pick their own doctors, specialists or hospitals — at least, not without incurring huge ‘out of network’ bills.”

The “choice” talking point, Potter wrote, polled well in focus groups that insurers set up to test their messaging against reform plans, leading them to adopt it.

Now he is shocked to see an argument that he had a hand in engineering used among Democrats battling to claim their party’s nomination to face off against President Trump in the 2020 election — and Potter says the insurers likely see it as a huge victory for them.

“What’s different now is that it’s the Democrats parroting the misleading ‘choice’ talking point — and even using it as a weapon against one another,” Potter wrote. “Back in my days working in insurance P.R., this would have stunned me. It’s why I believe my former colleagues are celebrating today.”

One of the biggest divides among Democratic candidates is on health reform.

The progressive wing of the party, led by Sen. Bernie Sanders, largely supports enacting Medicare for All. So does Sen. Elizabeth Warren, though she’s tempered her rhetoric backing it in the last few months after rolling out her own universal healthcare plan and drawing criticism for its hefty $20.5 trillion price tag.

Moderates like former Vice President Joe Biden and South Bend Mayor Pete Buttigieg are pushing to create an optional government insurance plan for Americans instead. They’ve argued that a single-payer system could kick millions of Americans off their private insurance and restrict their ability to manage their care — echoing the line of attack used by the healthcare industry.

Potter had a warning for voters as they head to the polls in this year’s election.

“My advice to voters is that if politicians tell you they oppose reforming the health care system because they want to preserve your ‘choice’ as a consumer, they don’t know what they’re talking about or they’re willfully ignoring the truth,” Potter wrote in the op-ed. “Either way, the insurance industry is delighted. I would know.”

Humana CEO talks M&A, government-controlled health care

More from another healthcare executive. Reporter Chris Larson noted that Louisville-based Humana Inc. — a giant in the health insurance market — expects its long-term success to be based in providing health services to keep its members from needing more care.

Humana CEO Bruce Broussard said as much — and much more — on Monday in two appearances at the J.P. Morgan Healthcare Conference in San Francisco.

Appearing beside Humana Chief Financial Officer Brian Kane, the duo answered a wide range of questions (which you can hear for yourself here). Below are a few takeaways from their remarks.

Humana’s core business is expected to grow despite market leader status

Administering Medicare Advantage, a privately administered version of the federal health plan Medicare, is at the heart of Humana’s (NYSE: HUM) business: it has about 4.1 million members on individual or group Medicare Advantage plans, according to the company’s latest financial disclosure.

One analysis shows that Humana holds about 18 percent of the Medicare Advantage market, the second largest share in the nation.

Presentation moderator Gary Taylor, a managing director and senior equity analyst with J.P. Morgan, noted that continued growth in a market-leading position is not typical and noted that continued growth in the Medicare Advantage business is possible because more seniors are using it rather than traditional Medicare.

Taylor said that about one-third of Medicare enrollees are on Medicare Advantage plans. Broussard said that he expects that portion to grow to one-half in the next seven to 10 years.

“We’re seeing just both a great consumer attraction, but, more importantly, great health outcomes by being able to serve someone more holistically,” Broussard said.

Broussard added that Humana’s growth in Medicare Advantage depends on brand recognition and customer experience. He added he expects that the company can grow along with the popularity of Medicare Advantage in the Midwest and Texas specifically.

Public policy: Americans want a private option

Some Democratic presidential candidates say they would push for expanded health benefits from the government while others — notably Vermont Senator and presidential hopeful Bernie Sanders — want to see private insurance eliminated altogether. Broussard largely downplayed the likelihood that these proposals would become policy.

He referred to polling, the company’s experience and the increased popularity of Medicare Advantage — a privately administered version of a government health plan — as proof that people want private options in health care.

Humana’s M&A plans will focus on clinical capabilities

Broussard said clinical capabilities were key to the company’s success and later added that its merger and acquisition activity would largely focus on that.

“What we see long term is the ability to compete in this marketplace will be really determined on your clinical capabilities — helping members stay out of the health care system as well as what we’ve done in past in managing costs in the traditional managed care way,” Broussard said.

Broussard added later in the presentation: “As we think about growth, we really think about how do we build the health care services side more. We’ll still buy plans especially on the Medicaid side and the markets that we want to be in. But for the most part, I think our capital deployment is expanding the capabilities we have.”

He added that there are only a few options for additional blockbuster mergers in the health care industry given the current regulatory environment.

Humana was the subject of such a merger a few years ago with Hartford, Connecticut-based Aetna Inc. But that deal fell apart and Aetna has since merged with Woonsocket, Rhode Island-based CVS Health Inc.

Humana was party to a $4.1 billion acquisition that took Louisville-based Kindred Healthcare private and separated Kindred At Home into a standalone entity.

How an insured pro athlete ended up with $250,000 in medical debt

With all the concern regarding patients without health care insurance that there are people with insurance who due to the complexities of the system still end up with huge bills sometimes ending in bankruptcies. In the U.S., going bankrupt because of medical bills and debt is something that doesn’t just happen to the unlucky uninsured, but also to people with insurance.

Though health plans have an “out of pocket max” – the most you’d be required to pay for medical services in a given year – that’s no guarantee that number will ensure a safety net.

This is what pro cyclist Phil Gaimon discovered after a bad crash in Pennsylvania last June that left him with his collarbone, scapula, and right ribs broken. The bills totaled $250,000.

“I have good insurance,” Gaimon told Yahoo Finance. “I pay a lot of money for it. I just haven’t gotten good explanations for any of this.”

Gaimon pays $500 a month for a plan with a $10,000 deductible, and is fighting the bills.

This type of medical debt isn’t uncommon. The Kaiser Family Foundation, a healthcare think tank, has reported that insurance can be incomplete and that the complexity of the system often leaves people seeking treatment in financial hardship. In a survey KFF found that 11% of consumers with medical bill problems have declared bankruptcy, and cited the medical bills as at least a partial contributor. Another report found that medical problems contributed to 66.5% of all bankruptcies. (Currently, there’s some legislation addressing surprise billing issues.)

Gaimon was taken by ambulance to the nearest hospital after his crash. Unfortunately, it turned out to be an out-of-network hospital. Gaimon told Yahoo Finance that he thought it would be okay, because the emergency nature could be seen as an extenuating circumstance. His insurer, Health Net, has an appeals process for situations like that.

Gaimon figured the no-other-option aspect of the situation would solve the problems, and believed it enough to post on Instagram soon after that people should donate to No Kid Hungry, a children’s food insecurity charity, rather than a GoFundMe for his bills.

“I said, ‘Hey, I crashed, what would you donate to my GoFundMe if i didn’t have health insurance? Take that money and give it to this instead,’” said Gaimon. “We raised around $40,000 in 48 hours.”

The $103,000 raised in the next few months would have taken a big chunk out of his medical bills, but Gaimon has no regrets. “Someone out there needs more help than I do,” he said.

Medical bills are fun!

It’s hard to comparison shop when you’re in physical pain

Things may have been easier if it would have been possible for Gaimon to steer the ambulance towards an in-network hospital. But an ambulance isn’t a taxi — it’s a vehicle designed to bring a patient to health care providers in the least amount of time possible.

Also consider that Gaimon, as he put it, was in “various states of consciousness” following his accident — hardly in a position to check which hospitals are in his insurer’s network.

Gaimon may be able to win the appeals process with his insurer for the out-of-network hospital. But that’s just the beginning of his insurance woes.

The cyclist’s scapula break was complex enough to require a special surgeon, and Gaimon said the hospital was unable to find someone capable.

“I was laying in the hospital for three days hitting the morphine,” Gaimon said. Multiple times a potential surgeon would come to examine him only to say that they weren’t up to the task.

After multiple cycles of fasting before a surgery only to be told that the surgeons couldn’t operate, Gaimon took matters into his own hands. Eventually he found a surgeon in New York to do it, and even though it was out-of-network as well, he figured the fact that there was seemingly no other alternative would mean his insurer would cover the surgery.

So the track race didn’t go very well. Broken scapula, collarbone, 5 ribs, and partially collapsed lung. What if I told you that I don’t have health insurance? Would you donate do help me out? How much?

Okay well I do have health insurance and I’m fundamentally alright, so I ask you to take that money and give it to @ChefsCycle @nokidhungry who need it more than I do. I’m in a lot of pain and this is all I can think to cheer me up. Link in profile and updates as I have them. Xo

Six months later, Gaimon finds out that it did not, and is fighting the charges. He’s hired a lawyer to help, as has had mixed results with the system so far.

“No one talks prices until it’s over — that’s the other horrible flaw,” he said.

Gaimon said that he’s numb to things at this point, though he doesn’t know what will happen.

“Ultimately I’m going to have to negotiate with that hospital, or the health insurance will choose to cover,” said Gaimon. “Or they’ll have to sue me and I’ll go bankrupt — the traditional way you deal with medical stuff.”

Gaimon’s sarcasm aside, sky-high health care costs are a central issue in the current presidential election and a frequent talking point for Democratic candidates. In this week’s Democratic debate, Sen. Bernie Sanders highlighted the issue. “You’ve got 500,000 people going bankrupt because they cannot pay their medical bills,” Sanders said. “We’re spending twice as much per capita on health care as do the people of any other country.”

The whole ordeal has shown Gaimon how fragile the healthcare system really is.

“The whole idea that you could be in a car accident and you wake up in a hospital and owe $100,000 — and that could happen to anyone — that’s a ridiculously scary thing,” he said. “I was making no decisions, I was on drugs, and in fetal-position-level pain. Every decision was made to live. And then you emerge and you’re financially ruined.”

Medicare for All? A Public Option? Health Care Terms, Explained

Now, a review of some of the terms that we keep discussing. As I complete a chapter in my new book, I thought that it would worth taking the time to review some of the terms. Yahoo Finance’s Senior writer, Ethan Wolff-Mann reported that if the last few Democratic presidential debates are any guide, tonight’s will likely delve into health care proposals. Do voters know what we’re talking about when we talk about various plans and concepts, including “Medicare for All?” Or any of the other health policy terms that get thrown around?

Pretty much no.

According to one poll from the Kaiser Family Foundation, 87% of Democrats support “Medicare for All,” while 64% of Democrats support “single-payer health care.” Here’s the catch — those two phrases describe almost the same thing. The language in this debate is murky, confusing and hugely consequential. So, we’re laying out some key terms to help you keep up.

Single-payer

This is a kind of health care system where the government provides insurance to everyone. Think about it as if you’re a doctor: a patient comes in, and you treat them. Who’s paying you for that care? Under our current system, it could be a variety of payers: state Medicaid programs, Medicare, or a private insurance company like Aetna or Cigna or Blue Cross and Blue Shield — each with different rates and different services that they cover. Instead, under the single-payer model, there’s just one, single payer: the government.

Medicare for All

If single-payer is fruit, Medicare for All is a banana. In other words, single-payer is a category of coverage, and Medicare for All is a specific proposal, originally written by presidential candidate Sen. Bernie Sanders (as he often reminds us). It envisions the creation of a national health insurance program, with coverage provided to everyone, based on the idea that access to health care is a human right. Private health insurance would mostly go away, and there would be no premiums or cost-sharing for patients.

Important note: it would not actually just expand Medicare as it exists now for all people (as you might guess from the name). Medicare doesn’t cover a whole lot of things that this proposed program would cover, like hearing and vision and dental and long-term care.

Public option

The idea of a “public option” was floated back in 2009 when the Affordable Care Act was being debated. The idea is that along with the private health insurance plans that you might have access to through your employer or through the individual insurance exchanges, there would be an option to buy into a government-run insurance program, like Medicare. Private insurance would still exist, but people could choose to get a government insurance plan instead.

There are many kinds of public option proposals, and different presidential candidates have their own ideas on how it would work, whether it’s lowering the age for Medicare access or creating a new program that’s not Medicare or Medicaid that people could buy into, among others. The idea is that the government might be able to offer a more affordable option for people, which could push down prices in the private insurance world.

Pete Buttigieg’s plan — “Medicare for All Who Want It” — is his version of a public option. And Elizabeth Warren announced November 15 that she’d start with a public option plan before trying to push the country toward Medicare for All.

“Government-run” health care

Many opponents of Medicare for All and other health proposals use the term “government-run” as a dig against them, including President Trump. (Sometimes the term “socialized medicine” is used as well.) In the U.K. and some other places, the government doesn’t just pay people’s health care bills, it also owns hospitals and employs doctors and other providers — that’s a government-run health care system. The single-payer concept being discussed in this country’s presidential campaign would not operate like that — the industry would still be mostly private, but the government would pay the bills. How the government would generate the money to pay those bills is subject to debate.)

Universal coverage

This isn’t a plan, it’s a goal that everyone has health insurance — that health insurance coverage is universal. The Affordable Care Act made a system for states to expand Medicaid and created the individual health insurance exchanges, , both of which significantly cut down on the number of uninsured people, but currently 27 million Americans do not have health insurance, and the rate of people who lack insurance is rising. Most Democratic presidential candidates would like to achieve universal coverage — the debate is about the best approach to get there.

Medicare for All Would Save US Money, New Study Says

Reporter Yuval Rosenberg, The Fiscal Times noted that a Medicare for All system would likely lower health care costs and save the United States money, both in its first year and over time, according to a review of single-payer analyses published this week in the online journal PLOS Medicine. You have to read on to understand the flimsy data and weak argument to try to convince us all to adopt the Medicare for All program, especially those of us who really know the reality of living with a Medicare type of healthcare program and the reality of restrictions in needed care for the patients.

The authors reviewed 18 economic analyses of the cost of 22 national and state-level single-payer proposals over the last 30 years. They found that 19 of the 22 models predicted net savings in the first year and 20 of 22 forecast cost reductions over several years, with the largest of savings simplified billing and negotiated drug prices.

“There is near-consensus in these analyses that single-payer would reduce health expenditures while providing high-quality insurance to all US residents,” the study says. It notes that actual costs would depend on the specifics features and implementation of any plan.

The peer-reviewed study’s lead author, Christopher Cai, a third-year medical student at the University of California, San Francisco, is an executive board member of Students for a National Health Program, a group that supports a single-payer system.

Questions about methodology: “This might be the worst ‘academic’ study I’ve ever read,” tweeted Marc Goldwein, head of policy at the Committee for a Responsible Federal Budget. “It’s a glorified lit review of 22 studies – excluding 6 of the most important on the topic and including 11 that are redundant, non-matches, or from the early 90s.” The results would look quite different if the authors had made different choices about what analyses to include in their review.

What other studies have found: Other recent analyses have been far less conclusive about how health care spending might change under a single-payer system. The nonpartisan Congressional Budget Office said last year that total national health care spending under Medicare for All “might be higher or lower than under the current system depending on the key features of the new system, such as the services covered, the provider payment rates, and patient cost-sharing requirements.”

An October analysis by the Urban Institute and the Commonwealth Fund, meanwhile, found that a robust, comprehensive single-payer system would increase national health spending by about $720 billion in its first year, while federal spending on health care would rise by $34 trillion over 10 years. But a less generous single-payer plan would reduce national health spending by about $210 billion in its first year. Remember the costs that Elizabeth Warren spouted?? $52 trillion over a decade! Can we all afford this?

Physicians Get Weed Killer; Administrators Get Miracle-Gro And neither is helping, Obamacare Funding Suggestions, Andrew Lang, Year in Review and Google Searches

Fate of Obamacare uncertain amid tax repeals, lawsuits and Medicare-for-all push consider that Democrats seize on anti-Obamacare ruling to steamroll GOP in 2020

Alice Miranda Ollstein and James Arkin reported that a court ruling last week putting the Affordable Care Act further in jeopardy may provide the opening Democrats have been waiting for to regain the upper hand on health care against Republicans in 2020.

At the most recent Democratic presidential debate, candidates largely avoided discussing the lawsuit or Republicans’ years-long efforts to dismantle Obamacare, and instead continued their intra-party battle over Medicare for All.

But Senate Democrats, Democratic candidates and outside groups backing them immediately jumped on the news of the federal appeals court ruling — blasting out ads and statements reminding voters of Republicans’ votes to repeal the 2010 health care law, support the lawsuit and confirm the judges who may bring about Obamacare’s demise.

“I think it’s an opportunity to reset with the New Year to remind people that there’s a very real threat to tens of millions of Americans,” Sen. Brian Schatz (D-Hawaii) said in an interview. “We Democrats are always striving to improve the system, but, at a minimum, the American people expect us to protect what they already have.”

In 2018, Democrats won the House majority and several governorships largely on a message of protecting Obamacare and its popular protections for preexisting conditions. This year continued the trend, with Kentucky’s staunchly anti-Obamacare governor, Matt Bevin, losing to Democratic now-Gov. Andy Beshear.

The landscape in 2020 may be more challenging for Democrats than it was in 2018, when Republicans had more recently voted to repeal the Affordable Care Act. Republicans also say they now have more ammunition to push back on Democrats’ arguments with the party’s divisions over single-payer health care, which would replace Obamacare, shaping the presidential race.

Moreover, the appeals court’s ruling — which in all likelihood punted any final disposition on the case until after the 2020 elections — eliminates what some Republicans saw as a nightmare scenario: If the court had embraced a lower court ruling striking down the law in its entirety, it would have put the issue before the Supreme Court during the heat of the election, putting tens of millions of Americans’ health insurance at risk.

Still, Democrats believe they can win the political battle over health care, especially in Senate races. At least a half-dozen GOP senators are up for reelection, and Democrats need to net three seats to win back control of the chamber if they also win back the presidency. Democratic strategists and candidates are eager to run a health care playbook that mirrors that of the party’s House takeover in 2018, and say Republicans are uniquely vulnerable after admitting this year that they have no real plan for dealing with the potential fallout of courts striking down Obamacare.

Within a day of the ruling, the pro-Obamacare advocacy group Protect Our Care cut a national TV and digital ad featuring images of Sens. Susan Collins (R-Maine) and Cory Gardner (R-Colo.), warning that if the lawsuit succeeds, “135 million Americans with preexisting conditions will be stripped of protections, 20 million Americans will lose coverage and costs will go up for millions more.”

Other state-based progressive groups told POLITICO they’re readying their own ads going after individual Senate Republicans over the 5th Circuit’s ruling.

Protect Our Care director Brad Woodhouse predicts that it’s just a preview of the wave of attention the issue will get in the months ahead, as Democratic candidates and outside groups alike hammer the GOP on the threat their lawsuit poses to Obamacare.

“If there is one issue in American politics that is going to flip the Senate from Republican to Democratic in 2020, it’s this issue,” he said. “Our message is simple: President [Donald] Trump and Republicans are in court right now, suing to take away the ACA, take away your health care. And if Cory Gardner or Thom Tillis or any of them don’t think that’s an indefensible position, they should ask the 40-plus House Republicans who lost their seats in 2018.”

More than a dozen Republican state attorneys general, backed by the Trump administration, have been arguing in federal court for more than a year that Congress rendered the entire Affordable Care Act untenable when they voted as part of the 2017 tax bill to drop the penalty for not buying insurance down to zero. A district judge in Texas sided with them last year in a sweeping ruling declaring all of Obamacare unconstitutional.

Last week, an appeals court agreed that the elimination of the penalty made the individual mandate unconstitutional, but sent the case back down to the district court to decide whether any of the law could be separated out and preserved. The move all but guarantees the case won’t reach the Supreme Court until after the election, but it maintains the cloud of uncertainty hanging over the health law that experts say drives up the cost of insurance.

Though no one is in danger of losing their health coverage imminently, Democratic challengers in nearly every Senate battleground race, including Arizona, North Carolina, Maine and Iowa, jumped on the court ruling as an opportunity to attack Republicans on health care.

“Democrats have been in the fight to ensure that people across this country have access to affordable health care,” said Sen. Catherine Cortez Masto of Nevada, the chair of the DSCC. “This opinion does not help the Republicans.”

Sara Gideon, Democrats’ preferred candidate in Maine to take on Collins, called the lawsuit a “direct threat to the protections countless Mainers and Americans depend on. She has been reminding voters that Collins’ vote on the 2017 tax reform law triggered the ACA lawsuit in the first place, and she voted to confirm one of the 5th Circuit judges that recently sided with the Trump administration’s arguments against the law.

Unlike the vast majority of her GOP colleagues in the upper chamber, Collins has spoken up against the lawsuit. She has written multiple times to Attorney General Bill Bar, urging him to defend the ACA in court. Collins told POLITICO the day after the ruling that it was “significant” that the 5th Circuit judges were clearly “very uneasy with the thought of striking down the entire law” and instead sent the case back down to the lower court for reconsideration. Collins’ campaign spokesman both emphasized that she believes the government should defend the law and criticized Democrats for defending the unpopular individual mandate.

Tillis, the vulnerable North Carolina senator, said the lawsuit gave Republicans “breathing room” to find a viable replacement for Obamacare and attempted to flip the attack on Democrats by tying them to their presidential contenders.

“I think the fact that they all raised their hands and said we need Medicare for All is also raising their hands and saying the Affordable Care Act has failed,” Tillis said.

Though most of the 2020 presidential candidates have come out against Medicare for All, and more Democratic voters favor a choice between private insurance and a public option, the single-payer debate has given Republicans a potent line of attack that they’re turning to more than ever in the wake of the court’s ruling.

“Obamacare failed to lower health care costs for millions of Americans, and now Democrats want a complete government takeover of our health care system,” said Jesse Hunt, a spokesman for the National Republican Senatorial Committee. “They spent all of 2019 defending their socialist plan to eliminate employer-based health care coverage, and those problems will not subside anytime soon.”

The effectiveness of the GOP attacks will depend largely on the Democratic nominee for president — if it is someone who backs Medicare for All, it will be much more difficult for Senate candidates who don’t support the policy to separate themselves from it. But Democratic activists say they’re confident the GOP’s actions in court will sway voters more than their claims about Medicare for All.

“We can prepare for and counter those attacks by reminding voters that [Republicans are] fighting actively to take health care away,” said Kelly Dietrich, the founder and CEO of the National Democratic Training Committee, which coached more than 17,000 candidates for federal and state office in 2019. “Republicans’ ability to use fear as a tool to win elections should never be underestimated. But the antidote is to fight back just as hard.”

Year in Review: Lots of talk, not a lot of action in healthcare politics

Rachel Cohrs noted that lawmakers and regulators talked big on tackling high drug prices and surprise medical bills in 2019, but agreement on the bipartisan policies remained elusive. Some healthcare policy could be attached to a potential budget deal in December, but it is still unclear whether lawmakers will resolve funding disputes by the end of the year.

Despite major bipartisan legislative packages spearheaded by senior Senate Republican leaders, disputes over details and intense lobbying efforts have so far stalled progress in Congress. Drug makers are fighting a provision in the Senate Finance Committee’s drug pricing bill that would require them to pay back Medicare for drug price hikes faster than inflation, and providers and insurers are warring over how out-of-network medical bills should be handled.

Competing approaches to address surprise medical billing came to a head in December when a bipartisan, bicameral compromise proposal on addressing surprise medical bills emerged, but a key Senate Democrat involved in the negotiations had not signed on as of press time. Despite provider-friendly tweaks, providers still oppose the legislation and it is unclear whether House and Senate leadership have an appetite to include it in must-pass legislation.

Health reform 3.0: Early in the year, Senate health committee Chair Lamar Alexander and ranking Democrat Patty Murray released a wide-ranging plan to lower costs that addresses surprise medical bills; contract reform provisions; cost transparency; and boosting generic competition for Rx drugs. The year ended with a bipartisan, bicameral bill emerging, but at deadline it lacked Murray’s endorsement.

Reducing drug prices: Addressing drug prices was the other issue that dominated the policy landscape. Competing plans emerged, and the House passed a bill in mid-December on a party-line vote.

Grinding to a halt: House Speaker Nancy Pelosi announced a formal impeachment inquiry into President Donald Trump, which soured the prospects of a grand bargain between Trump and Pelosi on drug pricing and complicated the timeline for passing major healthcare policy.

Drug pricing was also a top priority for the Trump administration, but several marquee policy ideas have been stopped by the courts, abandoned, or are forthcoming. The White House decided to retract a prominent initiative that would have required insurers to pass manufacturer rebates directly to patients at the pharmacy counter, and a rule that would have compelled drug makers to include list prices in television advertisements is tied up in court. House Democrats passed a partisan government drug price negotiation bill, but it almost certainly will not become law.

The administration could at any time release a regulation outlining a process to allow states to import prescription drugs from Canada or move forward with a demonstration that would tie payments for physician-administered drugs in Medicare to international drug prices, but it has not yet acted on either proposal.

The 10 most-searched questions on health Reported by Sandee LaMotte of CNN

There were more questions that had people Googling in 2019.

The full list of the most-searched health questions in the United States this year also included questions about the flu, kidney stones and human papillomavirus or HPV:

How to lower blood pressure
What is keto?
How to get rid of hiccups
How long does the flu last?
What causes hiccups?
What causes kidney stones?
What is HPV?
How to lower cholesterol
How many calories should I eat a day?
How long does alcohol stay in your system?

NYU started to answer one of the big questions in the design of a fair healthcare system when they decided to declare their medical school tuition free. If all medical schools were tuition free the graduating doctors wouldn’t have the huge debt and they could have the opportunities to chose primary care and provide care to underserved rural and poorer communities.

One step at a time and maybe next year Congress can really improve the health care system of our U.S.A.

And to all you interested readers out there Happy New Year! Maybe those in control will start the process of improving the delivery of affordable health care to all and not worry about their future political aspirations. What a change that would be!

Musings of a Doc with an MBA

Business strategy and healthcare