Category Archives: healthcare as financial problem

Election 2020: What Exactly Is Joe Biden’s Healthcare Plan? And Really, Telehealth to Care for Our Patients?

So, first I wanted to relate an experience, which exemplifies the failure of telehealth, or maybe the failure of healthcare workers who are taking advantage of the “new” health care system of patient care.

Consider the case a two weeks ago. As I was about to operate on a cancer surgery patient, I was asked to evaluate a patient healthcare conundrum. One of our nurse teammate’s husband was sick and no one knew what was the problem. He had lost 23 pounds over 3 ½ weeks, was dehydrated, appetite, sore throat, weak and needed to go to the emergency room multiple times for intravenous fluids. Each time he was told that they were very sorry but they had no idea what the problem was.

His Primary care physician would not see him in person, and he had another telehealth visit, which he was charged for and was prescribed an antibiotic with no improvement.

I asked if he had a COVID test which he did and it was negative.

I then asked if I could examine him or if she had any pictures. She had pictures, with no skin rashes except I noticed something interesting on the intraoral pictures, which showed left sided ulcers on his cheeks, left lateral posterior tongue and palate, again-only on the left side.

I asked if this was true in that the ulcers were only on one side of his mouth? When his wife responded with a yes to the question I then responded that he had intraoral shingles involving the nerve to the tongue, cheek, palate ( glossophyngeal nerve ) and sometimes also affected additional nearby cranial nerve, which is probably why he was having some of his stomach problem. She thought that was interesting and wanted to know what to do since he was about to have some gallbladder studies.

I outlined a treatment plan and low and behold he is getting better. My question is why didn’t anyone in the doc’s office or ER never complete a thorough physical exam? Oh, wait- how does one do a complete physical exam through the telehealth system? What about heart or lung disease patients, how does a nurse or physician listen to their heart or lungs, etc?? Are we physicians forgetting our teachings and training regarding the proper approach to physical diagnosis?

And now what about Biden’s proposal for health care?

Leigh Page pointed out that physicians — like all Americans — are trying to size up Joe Biden’s healthcare agenda, which the Democratic presidential nominee has outlined in speeches and on his official website.

Many healthcare professionals, patients, and voters of all political stripes think our current healthcare system is broken and in need of change, but they don’t agree on how it should change. In Part I of this article, we take a look at Biden’s proposals for changing the US healthcare system. Then, we include comments and analysis from physicians on both sides of the fence regarding the pros and cons of these proposed healthcare measures.

Part 1: An Overview of Biden’s Proposed Healthcare Plan

Biden’s proposed healthcare plan has many features. The main thrust is to expand access to healthcare and increase federal subsidies for health coverage.

If elected, “I’ll put your family first,” he said in a speech in June. “That will begin the dramatic expansion of health coverage and bold steps to lower healthcare costs.” He said he favored a plan that “lowers healthcare costs, gets us universal coverage quickly, when Americans desperately need it now.”

Below are Biden’s major proposals. They are followed by Part 2, which assesses the proposals on the basis of comments by doctors from across the political spectrum.

Biden Says We Should Restore the ACA

At a debate of the Democrat presidential candidates in June 2019, Biden argued that the best way to expand coverage is “to build on what we did during the Obama administration,” rather than create a whole new healthcare system, as many other Democratic candidates for president were proposing.

“I’m proud of the Affordable Care Act,” he said a year later in his June 2020 speech. “In addition to helping people with preexisting conditions, this is the law that delivered vital coverage for 20 million Americans who did not have health insurance.”

At the heart of the ACA are the health insurance marketplaces, where people can buy individual insurance that is often federally subsidized. Buyers select coverage at different levels ― Gold, Silver, and Bronze. Those willing to pay higher premiums for a Gold plan don’t have high deductibles, as they would with the Silver and Bronze plans.

Currently, federal subsidies are based on premiums on the Silver level, where premiums are lower but deductibles are higher than with the Gold plan. Biden would shift the subsidies to the Gold plan, where they would be more generous, because subsidies are pegged to the premiums.

In addition, Biden would remove the current limit on subsidies, under which only people with incomes less than 400% of the federal poverty level qualify for them. “Many families making more than 400% of the federal poverty level (about $50,000 for a single person and $100,000 for a family of four), and thus not qualifying for financial assistance, still struggle to afford health insurance,” the Biden for President website states.

Under the Biden plan, there would still be a limit on insurance payments as a percentage of income, but that percentage would drop, meaning that more people would qualify. Currently, the level is 9.86% or more of a person’s income; Biden would lower that level to 8.5%.

“We’re going to lower premiums for people buying coverage on their own by guaranteeing that no American ever has to spend more than 8.5% of their income on health insurance, and that number would be lower for lower-income people,” Biden said in the June speech.

Add a Public Option, but Not Medicare for All

In the primary, Biden parted company from rivals who backed Medicare for All, a single-payer health system that would make the government pay for everyone’s healthcare. “I understand the appeal of Medicare for All,” he said in a video released by his campaign. “But folks supporting it should be clear that it means getting rid of Obamacare, and I’m not for that.” But he nor anyone else who supported Obamacare has come up with a way to finance this type of healthcare system.

However, Biden embraced a “public option” that would allow people to buy into or be subsidized into “a Medicare-like” plan. It is unclear how similar the public option would be to regular Medicare coverage, but the Biden campaign has made it clear that it would not take funds from the Medicare trust fund, which is expected to start losing funds by 2026.

The more than 150 million Americans who have employer-sponsored insurance could keep it, but they could still buy into the public option if they wanted to. In addition, the public option would automatically enroll ― at no cost to them ― some 4.8 million low-income Americans who were excluded from the ACA’s Medicaid expansion when many states chose to opt out of the Medicaid expansion.

In addition, the 37 states that participate in expanded Medicaid could switch coverage to the new public option, provided that they continue to pay their current share of the costs. (In June, Oklahoma became the 37th state to allow the expansion, following the results of a ballot measure.)

“We need a public option now more than ever, especially when more than 20 million people are unemployed,” Biden said in the June speech. “That public option will allow every American, regardless of their employment status, the choice to get a Medicare-like plan.”

Lower the Medicare Age

In spring 2020, Biden proposed lowering the age to qualify for Medicare from 65 to 60. This provision is not included among the official policies listed on the Biden for President website, but it has been cited by many, including the Biden-Sanders Unity Task Force.

This provision would bring almost 23 million people into Medicare, including 13.4 million from employer-sponsored coverage, according to one analysis. It’s not clear whether these people would buy into Medicare or simply be covered. Their care would not be paid for by the Medicare Trust Fund but would use tax dollars instead. Oh, finally, we find out that our taxes would go up. How much is the problem as we consider all the other programs that Biden and Harris have promoted.

Provide Relief in the Covid-19 Pandemic

Biden would cover the cost of COVID-19 testing and the cost of health coverage for people laid off during the pandemic.

“Testing unequivocally saves lives, and widespread testing is the key to opening our economy again,” Biden said in his June speech. “To fix the economy, we have to get control over the virus.”

Prescription Drug Reform

Biden would repeal a Bush-era exception that bars the Medicare program from negotiating prescription drug prices for the Part D prescription drug benefit. “There’s no justification for this except the power of prescription drug lobbying,” the Biden for President website states.

In addition, Biden’s prescription drug reform plan would do the following:

• Limit launch prices for drugs. The administration would establish an independent review board that would assess the value of new drugs and would have the power to set limits on their prices. Such drugs are “being abusively priced by manufacturers,” the Biden for President site says.

• Limit price increases to inflation. As a condition of participation in government programs, drug prices could not rise more than the general inflation rate. Biden would impose a tax penalty on drug makers whose prices surpassed inflation.

• Allow consumers to buy prescription drugs from other countries. Biden would allow consumers to import prescription drugs from other countries, provided the US Department of Health and Human Services certifies that those drugs are safe.

• Stop tax breaks for pharma ads: Biden would drop drug makers’ tax breaks for advertising, which amounted to $6 billion in 2016.

Stop Surprise Billing

Biden proposes to stop surprise billing, which occurs when patients receive care from a doctor or hospital that is not in their insurer’s network. In these situations, patients can be surprised with very high bills because no payment limit has been negotiated by the insurer.

Twenty-eight states have enacted consumer protections to address surprise medical billing, but Congress has not passed such a measure. One proposed solution is to require payers to pay for out-of-network services on the basis of a benchmark, such as the average Medicare rate for that service in a specific geographic area.

Closely Monitor Healthcare Mergers

Biden would take a more active stance in enforcing antitrust laws against mergers in the healthcare industry.

“The concentration of market power in the hands of a few corporations is occurring throughout our health care system, and this lack of competition is driving up prices for consumers,” the Biden for President website states.

Overhaul Long-term Care

Biden’s latest plan calls for a $775 billion overhaul of the nation’s caregiving infrastructure. Biden says he would help create new jobs, improve working conditions, and invest in new models of long-term care outside of traditional nursing homes.

Restore Funding for Planned Parenthood

Biden would reissue guidance barring states from refusing Medicaid funding for Planned Parenthood and other providers that refer for abortions or that provide related information, according to the Biden for President website. This action would reverse a Trump administration rule.

Boost Community Health Centers

Biden promises to double federal funding for community health centers, such as federally qualified health centers, that provide care to underserved populations.

Support Mental Health Parity

Biden says he supports mental health parity and would enforce the federal mental health parity law and expand funding for mental health services.

Part 2: Physicians’ Opinions on Biden’s Healthcare Plans: Pro and Con

Biden’s plans to expand coverage are at the heart of his healthcare platform, and many see these as the most controversial part of his legislative agenda.

Biden’s Medicare expansion is not Medicare for All, but it can be seen as “Medicare for all who want it.” Potentially, millions of people could enter Medicare or something like Medicare. If the Medicare eligibility age is dropped to 60, people could switch from their employer-sponsored plans, many of which have high deductibles. In addition, poor people who have no coverage because their states opted out of the Medicaid expansion would be included.

The possibility of such a mass movement to government-run healthcare alarms many people. “Biden’s proposals look moderate, but it is basically Medicare for All in sheep’s clothing,” said Cesar De Leon, DO, a family physician in Naples, Florida, and past president of the county’s medical society.

Reimbursements for Doctors Could Fall- No, Will Fall!

A shift of millions of people into Medicare would likely mean lower reimbursements for doctors. For example, the 13.4 million people aged 60 to 65 who would switch from employer-sponsored coverage to Medicare would be leaving some of the best-paying insurance plans, and their physicians would then be reimbursed at Medicare rates.

“Biden’s plan would lower payments to already cash-strapped doctors and hospitals, who have already seen a significant decrease in reimbursement over the past decade,” De Leon said. “He is trying to win the support of low-income voters by giving them lower healthcare prices, which doctors and hospitals would have to absorb.

“Yes, the US healthcare system is dysfunctional,” De Leon added, “but the basic system needs to be fixed before it is expanded to new groups of people.”

The American Association of Neurological Surgeons/Congress of Neurological Surgeons warns against Biden’s proposed government-run system. “We support expanding health insurance coverage, but the expansion should build on the existing employer-based system,” said Katie O. Orrico, director of the group’s Washington office. “We have consistently opposed a public option or Medicare for All.

“Shifting more Americans into government-sponsored healthcare will inevitably result in lower payments for physicians’ services,” Orrico added. “Reimbursement rates from Medicare, Medicaid, and many ACA exchange plans already do not adequately cover the costs of running a medical practice.”

Prospect of Higher Taxes- Absolutely, grab your wallets and your retirement funds!!

Paying for ambitious reforms means raising taxes. Biden’s plan would not make the Medicare trust fund pay for the expansions and would to some extent rely on payments from new beneficiaries. However, many new beneficiaries, such as people older than 60 and the poor, would be covered by tax dollars.

Altogether, Biden’s plan is expected to cost the federal government $800 billion over the next 10 years. To pay for it, Biden proposes reversing President Trump’s tax cuts, which disproportionately helped high earners, and eliminating capital gains tax loopholes for the wealthy.

“Rather than tax the average American, the Democrats will try to redistribute wealth,” De Leon said.

“The elephant in the room is that taxes would have to be raised to pay for all these programs,” said Gary Price, MD, president of the Physicians Foundation. Because no one likes higher taxes, he says, architects of the Biden plan would try to find ways to save money, such as tamping down reimbursements for physicians, to try to avoid a public backlash against the reforms.

“Physicians’ great fear is that efforts to keep taxes from getting too high will result in cutting physician reimbursement,” he said.

Impact of COVID-19

Perhaps an even larger barrier to Biden’s health reforms comes from the COVID-19 crisis, which didn’t exist last year, when health reform was the central issue in the presidential primary that pitted Biden against Vermont Senator Bernie Sanders, the chief proponent of Medicare for All.

“The top two issues on voters’ minds right now are the pandemic and the economy,” said Daniel Derksen, MD, a family physician who is professor of public health policy at the University of Arizona in Tucson. “Any other concerns are pushed down the list.”

The COVID-19 crisis is forcing the federal government to spend trillions of dollars to help businesses and individuals who have lost income because of the crisis. Will there be enough money left over to fund an ambitious set of health reforms?

“It’s not a good time to start reforms,” warned Kevin Campbell, MD, a cardiologist in Raleigh, North Carolina. “Given the current pressures that COVID-19 has placed on physicians, healthcare systems, and hospitals, I don’t believe that we can achieve meaningful change in the near term.”

However, supporters of Biden’s reforms think that now, during the COVID-19 crisis, is precisely the right time to enact healthcare reform. When millions of Americans lost their jobs because of the pandemic, they also lost their insurance coverage.

“COVID-19 has made Biden’s healthcare agenda all the more relevant and necessary,” said Don Berwick, MD, who led the Center for Medicare & Medicaid Services (CMS) under President Obama. “The COVID-19 recession has made people more aware of how vulnerable their coverage is.”

Orrico at the neurosurgeons group acknowledges this point. “The COVID-19 pandemic has exposed some cracks in the US healthcare system,” she said. “Whether this will lead to new reforms is hard to say, but policymakers will likely take a closer look at issues related to unemployment, health insurance coverage, and healthcare costs due to the COVID-19 emergency.”

Many Physicians Want Major Reform

Although many doctors are skeptical of reform, others are impatient for reform to come and support Biden’s agenda ― especially its goal to expand coverage.

“Joe Biden’s goal is to get everyone covered,” said Alice Chen, MD, an internist who is a leader of Doctors for Biden, an independent group that is not part of the Biden campaign. “What brings Democrats together is that they are united in the belief that healthcare is a right.”

In January, the American College of Physicians (ACP) endorsed both Medicare for All and the public option. The US healthcare system “is ill and needs a bold new prescription,” the ACP stated.

The medical profession, once mostly Republican, now has more Democrats. In 2016, 35% of physicians identified themselves as Democrats, 27% as Republicans, and 36% as independents.

Many of the doctors behind reform appear to be younger physicians who are employed by large organizations. They are passionate about reforming the healthcare system, and as employees of large organizations, they would not be directly affected if reimbursements fell to Medicare levels ― although their institutions might subsequently have to adjust their salaries downward.

Chen, for example, is a young physician who says she has taken leave from her work as adjunct assistant clinical professor of medicine at the University of California, Los Angeles, to raise her young children.

She is the former executive director of Doctors for America, a movement of thousands of physicians and medical students “to bring their patients’ experiences to policymakers.”

“Doctors feel that they are unseen and unheard, that they often feel frankly used by large health systems and by insurance companies,” Chen said. “Biden wants to hear from them.”

Many idealistic young physicians look to health system leaders like Berwick. “I believe this nation needs to get universal coverage as fast as we can, and Biden’s policies present a path to get there,” the former CMS director said. “This would be done chiefly through Biden’s public option and his plans to expand coverage in states that have not adopted the ACA Medicaid expansion.”

But what about the potential effect of lowering reimbursement rates for doctors? “The exact rates will have to be worked out,” Berwick said, “but it’s not just about who pays physicians, it’s about how physicians get paid.” He thinks the current fee-for-service system needs to be replaced by a value-based payment system such as capitation, shared savings, and bundled payments.

The Biden-Sanders Task Force

Berwick was a member of the Biden-Sanders Unity Task Force, which brings together supporters of Biden and Sanders to create a shared platform for the Biden campaign.

The task force issued a report in early July that recommended a variety of healthcare reforms in addition to expanding access to care. One of them was to find ways to address the social determinants of health, such as housing, hunger, transportation, and pollution, which can harm health outcomes.

Chen specifically cites this provision. “We need to focus on the social determinants of heath and try to encourage better health,” she said. “I remember as a doctor advising a patient who was a young mother with several small children that she needed to exercise more. She asked me, ‘When am I supposed to exercise, and who will watch my kids?’ I realized the predicament that she was in.”

Price is also glad to see the provision in Biden’s plan. “Social determinants of health has been a key focus of the Physicians Foundation,” he said. “To my knowledge, this is the first time that a political candidate’s healthcare policy has included this point.

“Physicians are not in control of the social determinants of health, even though they affect their reimbursements,” he said. Under Medicare’s Merit-based Incentive Payment System, for example, doctors are penalized when their patients don’t meet certain health standards, such as when diabetes patients can’t get their A1C levels under control, he says.

However, Price fears that Biden, in his efforts to make peace with Sanders supporters, may have to some degree abandoned his moderate stance on health reform.

Is the Nation Ready for Another Health Reform Battle?

Clearly, many Democrats are ready to reform the system, but is the nation ready? “Are American voters ready for another major, Democratic-led health reform initiative?” asked Patricia Salber, MD, an internist and healthcare consultant who runs a blog called The Doctor Weighs In.

“I’ve been around long enough to remember the fight over President Clinton’s health plan and then President Obama’s plan,” she said. Each time, she says, there seemed to be a great deal of momentum, and then there was a backlash. “If Biden is elected, I hope we don’t have to go through the same thing all over again,” Salber said.

Derksen believes Biden’s proposed healthcare reforms could come close to rivaling President Obama’s Affordable Care Act in ambition, cost, and controversy.

He shares Biden’s goal of extending coverage to all ― including paying the cost of covering low-income people. But the result is that “Biden’s agenda is going to be a ‘heavy lift,’ as they say in Washington,” he said. “He has some very ambitious plans to expand access to care.”

Derksen speaks from experience. He helped draft part of the ACA as a health policy fellow in Capitol Hill in 2009. Then in 2011, he was in charge of setting up the ACA’s insurance marketplace for the state of New Mexico.

Now Biden wants to begin a second wave of health reform. But Derksen thinks this second wave of reform could encounter opposition as formidable as those Obama faced.

“Assuming that Biden is elected, it would be tough to get this agenda passed ― even if he had solid Democratic majorities in both the House and Senate,” said Derksen,

According to polls by the Kaiser Family Foundation (KFF), 53% of Americans like the ACA, while 37% dislike it ― a split that has been relatively stable for the past 2 years, since the failed GOP effort to repeal the law.

In that KFF poll, the public option fared better ― 68% of Americans support the public option, including 42% of Republicans. These numbers help explain why the Biden campaign moved beyond its support of the ACA to embrace the public option as well.

Even when Democrats gain control of all the levers of power, as they did in 2009, they still have a very difficult time passing an ambitious healthcare reform bill. Derksen remembers how tough it was to get that massive bill through Congress.

The House bill’s public option might have prevailed in a reconciliation process between the two bills, but that process was cut short when Sen. Ted Kennedy died and Senate Democrats lost their filibuster-proof majority. The bill squeaked through as the Senate version, without the public option.

The ACA Has Survived-But at What Cost?

The ACA is much more complex piece of legislation than the public option.

“The ACA has survived for a decade, despite all efforts to dismantle it,” Salber said. “Biden wants to restore a law that the Republicans have been chipping away at. The Republicans eliminated the penalty for not having coverage. Think about it, a penalty of zero is not much of a deterrent.”

It was the loss of the ACA penalty in tax year 2019 that, paradoxically, formed the legal basis for the latest challenge of the ACA before the Supreme Court, in a suit brought by the Trump administration and 18 Republican state attorneys general.

The Supreme Court will make its ruling after the election, but Salber thinks the suit itself will boost both Biden and the ACA in the campaign. “I think most people are tired of all the attempts to repeal the ACA,” she said.

“The public now thinks of the US healthcare system as pathetically broken,” she added. “It used to be that Americans would say we have the best healthcare system in the world. I don’t hear that much anymore.”

Physicians who oppose the ACA hold exactly the opposite view. “Our healthcare system is in shambles after the Obamacare fiasco,” Campbell said. “Even if Biden has a Democrat-controlled House and Senate, I still don’t think that there would be enough votes to pass sweeping changes to healthcare.”

Biden Could Choose Issues Other Than Expanding Access

There are plenty of proposals in the Biden healthcare plan that don’t involve remaking the healthcare system.

These include making COVID-19 testing free, providing extra funding for community health centers, and stopping surprise billing. Proposals such as stepping up antitrust enforcement against mergers would involve administrative rather than Congressional action.

Some of these other proposals could be quite expensive, such as overhauling long-term care and paying for health insurance for laid-off workers. And another proposal ― limiting the prices of pharmaceuticals ― could be almost as contentious as expanding coverage.

“This proposal has been talked about for many years, but it has always met with strong resistance from drug makers,” said Robert Pearl, MD, former CEO of the Permanente Medical Group and now a faculty member at Stanford School of Medicine and Graduate School of Business.

Pearl thinks the first item in Biden’s drug plan ― to repeal a ban against Medicare negotiating drug prices with drug makers ― would meet with Congressional resistance, owing to heavy lobbying and campaign contributions by the drug companies.

In addition, Pearl thinks Biden’s plans to limit drug prices ― barring drug makers from raising their prices above the general inflation rate and limiting the launch prices for many drugs ― enter uncharted legal waters and could end up in the courts.

Even Without Reform, Expect Lower Reimbursements

Although many doctors are concerned that Biden’s healthcare reforms would reduce reimbursements, Pearl thinks reimbursements will decline even without reforms, owing in part to the COVID-19 pandemic.

Employer-based health insurance has been the bedrock of the US healthcare system, but Pearl says many employers have long wanted to get rid of this obligation. Increasingly, they are pushing costs onto the employee by raising deductibles and through premium sharing.

Now, with the pandemic, employers are struggling just to stay in business, and health insurance has truly become a financial burden, he says. In addition, states will be unable to balance their budgets and will try to reduce their Medicaid obligations.

“Before COVID-19 hit, healthcare spending was supposed to grow by 5% a year, but that won’t happen for some time into the future,” Pearl said. “The COVID economic crisis is likely to continue for quite some time, forcing physicians to either accept much lower payments or find better ways to provide care.”

Like Berwick, Pearl believes healthcare will have to move to value-based payments. “Instead of producing more services, doctors will have to preserve resources, which is value-based healthcare,” he said. The primary form of value-based reimbursement, Pearl thinks, will be capitation, in which physicians agree to quality and service guarantees.

Even steadfast opponents of many of Biden’s reforms foresee value-based payments taking off. “Certainly, there are ways to improve the current healthcare system, such as moving to value-based care,” said Orrico at the neurosurgeons’ group.

In short, a wide swath of observers agree that doctors are facing major changes in the payment and delivery of healthcare, regardless of whether Biden is elected and succeeds with his health agenda.

Notice that no one has mentioned tort reform in healthcare. Why Not???????

Surprise medical bills, coronavirus and bad insurance: 3 arguments for Medicare for All’ Really?

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As we saw Wednesday the WHO declared the Corona Virus/COID-19 a pandemic. We also heard the President role out plans for travel restrictions, increased testings and economic assistance. But what really gets me angry is that the Democrats in Congress are still making this a political battleground. Shame on them all! This is not the time for partisan politics so that they can embarrass the President and get their wishes and show the evilness of the political hate out there. Grow up Congress and let’s all get in on this battle to keep us all healthy and limit the death toll!! Philip Verhoef of USA Today reported that Congress is grappling with the problem of surprise medical bills, but will its Band-Aid approaches make a difference? As a physician, I’m trained to look beyond superficial symptoms to diagnose the underlying ailment. When patients pay thousands of dollars each year for “good” private insurance, how does a health care system allow them to walk away from a single hospital visit with debilitating medical debt? These concerns have become even more pressing with the spread of the new coronavirus and the costs associated with prevention, testing and treatment.

Most Americans assume that a commercial insurance card in their wallet protects them from unexpected medical bills. They pay their premiums and deductibles, scour the pages of insurance fine print and keep up with the revolving door of “in-network” doctors and hospitals.

However, going to the “in-network” hospital is no guarantee that the emergency room doctor, radiologist or anesthesiologist will be “in-network.” Today, many hospitals no longer directly employ physicians but instead contract with physician staffing firms such as TeamHealth, which employs more than 16,000 clinicians at 3,300 medical facilities.

Caught unaware in a medical crisis

These agencies are extremely profitable, which is why private equity firms are so hungry to buy them. Contract physicians operate outside of insurance coverage agreements — they’re not part of any “network” — and can act like free agents, billing patients directly for services not covered by insurance, called “balance billing.”

What does this mean for patients? Imagine you’re having a heart attack and call 911. Paramedics transport you to the nearest emergency room, which may or may not be in your insurer’s network. And because that hospital — or the ER doctor on duty — does not have a contractual relationship with your insurer, they can essentially name their price and “balance bill” you for the amount the insurance company won’t cover.

Here in Hawaii, many critically ill patients must use air ambulances for transportation from their home island to one that can provide emergency specialty services. For one of my patients, an air ambulance was a life-or-death necessity but deemed “out of network” by their insurance. Weeks later, the family received a balance bill for more than $25,000. They were forced to file bankruptcy and then enroll in Medicaid to cover subsequent health care costs — all with an insurance card in their wallet.

If this hasn’t happened to you, it’s just a matter of time. Over 40% of privately insured patients face surprise medical bills after visiting emergency rooms or getting admitted to hospitals. These bills punch a major hole in most family budgets: The average surprise hospital bill is $628 for emergency care and $2,040 for inpatient admission. That’s on top of the more than $20,000 families pay in premiums and deductibles each year just for the insurance policy.

If faced with a surprise $500 medical bill, half of Americans would either have to borrow money, go into debt or wouldn’t be able to pay it at all. Medical bills are a key contributor in two-thirds of personal bankruptcies, and yet the vast majority of households filing for medical bankruptcy have insurance.

Medicare for All is the only solution-Really??

What is the value of commercial insurance if it can’t protect us from financial ruin?

Lawmakers are considering a number of policies that would prohibit balance billing, cap the amount patients pay at out-of-network facilities and implement baseball-style arbitration when providers and insurance companies can’t agree on a payment. But surprise bills are not the real problem — they are merely one symptom of a dysfunctional system based on private insurance. And insurance companies only turn a profit by restricting patient choice, denying claims and passing costs onto enrollees.

The only policy that can end this scourge for good is single-payer Medicare for All, which would cover everyone in the nation for all medically necessary care. Medicare for All would eliminate out-of-network bills, because every doctor and hospital would be covered. Patients would never see a medical bill again, because Medicare for All would pay doctors and hospitals directly, with no deductibles, co-pays or insurance paperwork to get in the way.

Right now the current Medicare system is covering the costs of coronavirus testing, protecting patients just as it was designed to do. This health emergency is another argument for expanding such protections to all Americans.

Working in various hospitals across the country, I have met so many patients who delay or avoid needed care for fear of surprise bills and financial catastrophe. That’s risky for them and, in the face of a threat like coronavirus, for all of us. It doesn’t have to be this way. As a doctor, I prescribe Medicare for All.

We are forgetting the huge cost of Medicare for All and the ineffectiveness and short comings of Medicare for All , which I have attempted to point out these last few weeks. Doesn’t any one read my posts?

America’s Health System Will Likely Make the Coronavirus Outbreak Worse

Abigail Abrams noted that as government officials race to limit the spread of the new coronavirus, fundamental elements of the U.S. health care system—deductibles, networks, and a complicated insurance bureaucracy—that already make it tough for many Americans to afford medical care under normal conditions will likely make the outbreak worse.

More than 140 cases of the coronavirus have been confirmed in the United States so far, according to a Johns Hopkins University tracker. But as the CDC makes the test for the virus more widely available, the structure of the U.S. health care system is complicating the response.

For one, people must actually choose to get tested—a potentially expensive prospect for millions of Americans. While the government will cover the cost of testing for Medicaid and Medicare patients, and for tests administered at federal, state and local public health labs, it’s unclear how much patients will be charged for testing at academic or commercial facilities, or whether those facilities must be in patients’ insurance networks. Just recently, a Miami man received a $3,270.75 bill after going to the hospital feeling sick following a work trip to China. (He tested positive for the seasonal flu, so did not have the new coronavirus, and was sent home to recover.)

Those who test positive for COVID-19 possibly face an even more financially harrowing path forward. Seeking out appropriate medical care or submitting to quarantines—critical in preventing the virus from spreading further—both come with potentially astronomical price tags in the U.S. Last month, a Pennsylvania man received $3,918 in bills after being released from a mandatory U.S. government quarantine after he and his daughter were evacuated from China. (Both the Miami and Pennsylvania patients saw their bills decrease after journalists reported on them, but they still owe thousands.)

More than 27 million Americans currently do not have health insurance of any kind, and even more are underinsured. But those who do have adequate health insurance are hardly out of the woods. Many current health plans feature massive deductibles—the amount you have to spend each year before your insurance kicks in. In 2019, 82% of workers with health insurance through their employer had an annual deductible, up from 63% a decade ago, according to a report from the Kaiser Family Foundation. The average deductible for a single person with employer insurance has increased 162% in that time, from $533 in 2009 to $1,396 last year.

More than one quarter of employees, and nearly half of those at small companies, have an annual deductible of at least $2,000. Those who are covered by Obamacare marketplace plans face an even bigger hurdle: the average deductible for an individual bronze plan last year was $5,861, according to Health Pocket, a site that helps consumers shop for health insurance.

For many Americans, paying down an unexpected bill of that size is almost unthinkable. Nearly 40% of U.S. adults say they wouldn’t be able to cover a $400 emergency with cash, savings or a credit card they could easily pay off, according to the Federal Reserve.

Research has shown that even in non-outbreak situations, high deductibles lead people to reduce their spending on health care and delay treatment or prescription drugs, which can pose particularly tough problems for patients with chronic illness or diseases that need early detection. The timing of the new coronavirus at the beginning of the year makes the outlook even worse: because most deductibles reset each January, millions of Americans will be paying thousands out of pocket before their insurance companies pay a cent.

“Most likely most people haven’t started paying down their deductible,” explains Adrianna McIntyre, a health policy researcher at Harvard. “For care they seek, unless it’s covered as zero dollar coverage before the deductible, they could be on the hook for the full cost of their visit, the diagnostic testing and other costs related to seeking care or diagnosis of coronavirus.”

Half of Americans report that they or a family member have put off care in the past because they couldn’t afford it. Others have gone without care because they couldn’t find an in-network provider, or couldn’t determine how much care would cost in advance, so decided not to risk seeking medical attention.

“When patients try to go to a doctor or hospital, they often don’t know how much it’s going to cost, so they get a bill that’s way more than expected,” says Christopher Whaley, a health economist at the RAND Corporation. “On a normal basis, that’s chaotic and challenging for patients. But when you add on top this situation where you have a potential pandemic, then that’s even worse.”

In the face of that kind of uncertainty, many patients may simply decide not to go to the doctor, he added, which is “exactly the opposite of what we want to happen in this type of situation.”

Public health experts and Democrats have also criticized the Trump administration’s decision to allow people to sidestep the Affordable Care Act’s rules and buy limited, short-term health insurance coverage. Such “junk plans,” said Senator Patty Murray, speaking at a Senate Health, Education, Labor and Pensions Committee hearing on Wednesday, are not required to cover diagnostic tests or vaccines.

The Trump administration’s embrace of such barebones plans “makes it much harder for people to get the care they need to keep this crisis under control,” she said. A large group of health, law and other experts also released a letter this week urging policymakers to “ensure comprehensive and affordable access to testing, including for the uninsured.”

Insurance industry trade group America’s Health Insurance Plans issued guidance on the coronavirus last week, but it did not recommend that insurance companies eliminate out-of-pocket costs related to the virus. It said insurers would be working with the CDC and “carefully monitoring the situation” to determine “whether policy changes are needed to ensure that people get essential care.”

New York Governor Andrew Cuomo issued a directive on Monday requiring New York health insurers to waive cost sharing for testing of the coronavirus, including emergency room, urgent care and office visits. This could help New Yorkers who receive coverage through Medicaid and other state-regulated plans, but it won’t apply to the majority of employer-based health insurance, which is regulated by the federal government. Other states have similar limitations on the insurance plans they can regulate, according to McIntyre.

The federal government, on the other hand, could step in. The Trump Administration is considering using a national disaster recovery program to reimburse hospitals and doctors for treating uninsured COVID-19 patients. And even Republicans, who have traditionally opposed health care paid for by the government, are warming to the idea. “You can look at it as socialized medicine,” Florida Rep. Ted Yoho, who has vocally opposed the Affordable Care Act, told HuffPost this week. “But in the face of an outbreak, a pandemic, what’s your options?”

But even if the federal government takes steps to eliminate deductibles or other cost-sharing related to the coronavirus, experts say that Americans should brace themselves for long wait times to see providers, or for having to see doctors who are out-of-network, due to the limited capacity of providers and hospitals.

Those who don’t need to be treated at a hospital may still be impacted. The CDC has recommended that people maintain a supply of necessary medications in case they are quarantined, for example. But many insurance companies do not allow patients to refill prescriptions until they are almost out. The CDC also recommends that people to stay home from work if they experience symptoms of respiratory illness, but a lack of federally mandated sick leave makes it impossible for many workers to afford to take time off.

These consequences of the country’s fragmented health care system become more visible in times of stress, says Whaley. “In a pandemic type situation, that’s harmful both for patients,” he says, “and also for the members of society.

”Coronavirus: US ‘past the point of containment’ in battle to stop outbreak spreading

Tim Wyatt reported that America is “past the point of containment” in its battle against the coronavirus, senior health officials have admitted.

There are now more than 550 confirmed cases of the virus in the United States and at least 22 deaths linked to the outbreak.

Now, the government’s strategy had to change from trying to hold the virus at bay to actively seeking to minimise its impact and slow its spread, experts said.

Speaking on US television, the former commissioner of the Food and Drug Administration Dr Scott Gottlieb, said everything had changed.

“We’re past the point of containment. We have to implement broad mitigation strategies. The next two weeks are really going to change the complexion in this country.

“We’ll get through this, but it’s going to be a hard period. We’re looking at two months, probably, of difficulty.”

A similar message came from the Surgeon General Jerome Adams who warned it was time to consider cancelling large gatherings, including sporting events, and closing schools.

Each community might take a different approach to mitigating Covid-19, but inaction was not longer an option he cautioned while speaking to CNN. “Communities need to have that conversation and prepare for more cases so we can prevent more deaths,” he said.

Those in the most at-risk groups, including the elderly or unwell, should refrain from spending time in confined spaces with large numbers of the public, Dr Adams added.“Average age of death for people from coronavirus is 80. Average age of people who need medical attention is age 60. “We want people who are older, people who have medical conditions, to take steps to protect themselves, including avoiding crowded spaces, including thinking very carefully about whether or not now is the time to get on that cruise ship, whether now is the time to take that long haul flight,” he said.

Dr Anthony Fauci, the director of the National Institute of Allergy and Infectious Diseases, echoed this advice. “If you are an elderly person with an underlying condition, if you get infected, the risk of getting into trouble is considerable,” he told NBC.“So it’s our responsibility to protect the vulnerable. When I say protect, I mean right now. Not wait until things get worse. Say no large crowds, no long trips. And above all, don’t get on a cruise ship.”

A swathe of conferences, including many tech-focused events in California, have already been cancelled over fears flying in thousands of delegates from across the country and world would exacerbate the spread of Covid-19. Some schools in the US are already closing, with major sporting events such as the Indian Wells tennis tournament being cancelled.

The comments from senior Trump administration health officials marks a shift from an earlier tone of calm. Several people, including the president, had sought to downplay fears about the coronavirus, insisting it probably would not turn into a full-blown epidemic in America.

Dr Fauci even suggested limited lockdowns could be imposed on regions or towns where a serious outbreak occurs, saying the government was ready to take “whatever action is appropriate” to try and mitigate the crisis.’We’re gearing up for something extremely significant’:

Top hospitals across the US told us how they’re preparing for the coronavirus outbreak

Lydia Ramsey and Zachary Tracer reviewed the U.S. hospitals preparation for this pandemic. Hospitals around the US are preparing for the novel coronavirus outbreak, which has sickened more than 200 people in the US and 100,000 worldwide.

They want to make sure workers and equipment are ready to go in the event of a worst-case scenario. “We’ve not yet seen an epidemic or pandemic in our lifetimes of this size and scope,” said Becca Bartles, the executive director of infectious disease prevention at Providence St. Joseph Health System. “We’re gearing up for something extremely significant.”

When the first case of novel coronavirus showed up in the US in January, Becca Bartles was ready for it.

As the executive director of infectious disease prevention at Providence St. Joseph Health System, she had been preparing for years. Bartles helps prepare Providence, which runs 51 hospitals across the West Coast, for potential outbreaks by keeping an eye out for new pathogens that could hit the communities the health system serves.

“We’ve not yet seen an epidemic or pandemic in our lifetimes of this size and scope,” Bartles said. “We’re gearing up for something extremely significant.”

Hospitals and healthcare workers are already starting to feel the effects of the coronavirus outbreak as it hits communities around the US. The US has reported more than 200 cases of the novel coronavirus, which causes the disease known as COVID-19. More than 100,000 people have come down the virus worldwide, mainly in China.

And they’re preparing for the outbreak to get worse. Some of the hospitals Bartles works with are in the Seattle area and are already treating coronavirus patients. She said the virus is positioned to be the biggest outbreaks we’ve seen in recent US history.

‘It will stretch our capacity to provide healthcare overall in the US’

“I don’t think we can appreciate, based on what we’ve seen in our lifetimes, how big that’s going to be,” Bartles said. “That does cause me significant concern.” “It will stretch our capacity to provide healthcare overall in the US,” she added.

According to the US Centers for Disease Control and Prevention, reported symptoms related to the novel coronavirus include fever, cough, and shortness of breath, appearing within 14 days of exposure to the virus.

In a presentation hosted by the American Hospital Association, which represents thousands of hospitals and health systems, one expert projected there could be as many as 96 million cases in the US, 4.8 million hospitalizations, and 480,000 deaths associated with the novel coronavirus. The American Hospital Association said the webinar reflects the views of the experts who spoke on it, not its own.

Preparing for the worst

Health systems like Providence perform drills and trainings in anticipation of outbreaks like the novel coronavirus. The goal is to make sure employees, especially those working in the emergency department or who might care for critically ill patients, are trained correctly and have the right protective equipment.

And they’re ramping those up now. In Philadelphia, Jefferson Health has been conducting extra protective-equipment trainings, focused on intensive care unit clinicians who might treat people with the coronavirus.

The 14-hospital system also started a coronavirus task force this week and is readying its outbreak plans. The idea is to prepare for a worst-case scenario.

“We’re saying, look, let’s plan as if there’s going to be a lot of cases, it’s going to be overwhelming to our hospital,” said Dr. Edward Jasper, an emergency medicine physician who leads the task force. “We don’t think that’s going to happen. And then whatever else comes, it’s going to be nothing compared to that. So we’re prepared.”

For now, Jasper said he’s not expecting the worst. “We watch it so closely and right now it’s not triggering keeping me awake at night,” he said.

At Providence, Bartles said leaders within the organization are now meeting multiple times a day to discuss issues like making sure the hospitals have enough supplies on hand, especially protective equipment for those working in emergency departments.

The goal of the meetings is also to inform other hospitals across Providence’s network of what’s going on in Washington, which has been hit hard with the virus.

How the largest health system in New York is preparing

The senior leadership at New York’s Northwell Health System, which operates 23 hospitals, has been meeting continuously for the last several weeks, chief quality officer Dr. Mark Jarrett told Business Insider. The discussions cover what happens if one individual comes in with symptoms all the way to a pandemic.

Northwell’s relying on some of the preparation it did in advance of the SARS epidemic in 2003, and its response to the H1N1, or Swine Flu pandemic in 2009. But, Jarrett said, the hospital has changed a lot since then. Northwell, New York’s largest health system by revenue and the state’s largest private employer, has been steadily moving more of its services outside the four walls of a hospital.

That means the health system will have to account for patients showing up for care in places other than the main hospital in a community — places like urgent care centers and primary care clinics.

Readying hospitals for a surge of patients

Should the outbreak intensify, hospitals are grappling with how to prepare for the surge in coronavirus patients while also keeping other patients safe. At first, hospitals will isolate patients with the coronavirus, but if lots of patients come down with the virus, hospitals will probably put them in rooms together, said Kelly Zabriskie, Jefferson’s director of infection prevention.

Dr. Kathleen Jordan, a vice president at CommonSpirit Health, a 142-hospital health system and chief medical officer at the system’s Saint Francis Memorial Hospital, told Business Insider that the health system is having conversations about what might happen if they’re confronted with an influx of patients.

That might include setting up tents, building out larger emergency rooms or adding more beds for patients who need to stay at the hospital. For now, the health system has a few cases of the novel coronavirus under investigation. Eventually, hospitals might have to consider reducing or pausing elective procedures to make room for the surge in patients, Northwell’s Jarrett said. Hospitals are also thinking about staff being out, either due to the virus itself, or in the event that they have to care for their family.

Northwell on Tuesday told its employees that it’s restricting travel for business both internationally and domestically through the end of March. That’s a move other hospitals are making as well. “These updated travel guidelines are designed to help us remain in good physical health so we can most effectively care for the patients and families we serve,” Northwell said in an email to employees.

But you shouldn’t rush to the emergency room if you start having flu symptoms. Bartles said the plan is to focus on following CDC recommendations. As the virus continues to spread in communities, it will be harder to distinguish what might be flu from coronavirus.

Jan Emerson-Shea, a spokeswoman for the California Hospital Association, said hospitals are encouraging patients to call ahead or use an online doctor visit, rather than show up to an emergency room with potential coronavirus. That can help prevent them from infecting others, and let hospitals focus their resources on the most serious cases.

And lastly, few have mentioned that in China they are already taking down some of the temporary housing for the quarantined patients as the infection rate decreases. Important to note as we prepare for the worst!

And next week we should discuss the economic issues resulting from the pandemic!

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.

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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.”

Red and Blue America see eye-to-eye on one issue: the nation’s health care system needs fixing and What is Missing in Medicare for All and What is Stressing Us All?

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USA TODAY’s Jayne O’Donnell noted that Health care is one of the most divisive issues of the 2020 presidential campaign, with candidates disparaging insurers and polarizing labels creating deep divisions even among Democrats. But remove the buzzwords from the policies, and voters who will decide the election aren’t so far apart in their own positions, new research shows. But remember what I have been questioning for the last at least 6 months- with all the concern why hasn’t neither the Republicans nor the Democrats have done anything when they had control, i.e. had the majorities in the House or the Senate? And will Mike Bloomberg come to the Democrats’ recur and solve everyones’ problems?

Regardless of party affiliation, nearly everyone wants to see the nation’s health care system improved, and a majority want big changes. That includes people for whom the system is working well, and those who may be political opposites.

That’s the big picture finding of a new Public Agenda/USA TODAY/Ipsos survey of Americans’ attitudes on health care. The survey is part of the Hidden Common Ground 2020 Initiative, which seeks to explore areas of agreement on major issues facing the nation.

The nationally representative survey of 1,020 adult Americans 18 years and older was conducted December 19-26, 2019. It has a margin of error of plus or minus 3.3 percentage points.

The survey removed politically charged language such as “Medicare for All” and “Obamacare” and simply explained the basics of health care approaches in an effort to capture voters’ true opinions.

“There’s the making of a public conversation about this and it does not need to be around ideology,” said Will Friedman, president of Public Agenda, a nonpartisan, nonprofit research and public engagement organization. “People just aren’t so set on what they want.”

The sharpest divides were on the size of government and taxes.

In general, Democrats were more comfortable with a larger role for the federal government, such as the single-payer government insurance program also called Medicare for All, or a public option.

Instead of saying “public option” though, pollsters asked respondents how strongly they agreed with the concept of a new federal health insurance program that gives people a new choice beyond the current private insurance market.

Any adult could buy into the program on a sliding scale, they were told, and 48% were in favor. A survey released last week by the nonpartisan Kaiser Family Foundation found similar support, with the same percentage of Americans favoring such an option.

When described in general terms, 46% of respondents said they would support market-based plans and 45% could back Medicare for All-type plans.

Five goals were rated by more than 90% of those surveyedas very or somewhat important: making health care more affordable for ordinary Americans; lowering the cost of prescription drugs; making sure people with preexisting medical conditions can get affordable health insurance; covering long-term care for the elderly and disabled; and making sure all communities have access to enough doctors and hospitals.

So why the gridlock?

“There are these sort of flashpoints with politicized terminology that send people to their partisan corners,” said former Vermont Gov. Jim Douglas, a Republican who is on the board of the bipartisan, nonprofit United States of Care. “If we avoid them, we’re going to be more successful.”

John Greifzu, a survey respondent and school janitor in Fulton, Illinois, used to be a Democrat and “almost middle of the road.” Now, after being a single father of three children until his recent marriage, health insurance costs have made him distrust his party.

His wife is “paying an arm and a leg” — up to a third of a paycheck — for “bottom of the barrel” insurance that comes with a $2,000 deductible through her retail job. And even on the Medicaid plans that cover his children, there are things that aren’t covered, he said.

Greifzu watched his insurance costs rise as it became offered to the unemployed.

“I work hard for what I’ve got,” said Greifzu. “I’m not going to give up more money for people who don’t do anything.”

Emily Barson, United States of Care’s executive director, said the survey “validates our worldview … that people agree more than the current political rhetoric would have you believe.”

It also shows success at the state level is particularly promising, Barson added.

Before the midterm congressional elections, some Republican members of Congress avoided unscripted town halls with voters as concerns rose about the fate of the Affordable Care Act and protections for people with preexisting conditions. In states, Douglas said governors and state officials can’t avoid voters — or each other.

State officials need to get elected too, but “more importantly, we (states) have to balance our budgets every year,” said Douglas, now a political science professor at Middlebury College.

Friedman noted, however, that voters made it clear in their responses that they don’t want policymakers to leave health care issues to the states. When queried on the specifics, respondents said they didn’t want moving from state to state to make health care any more complicated.

“In terms of the overarching solution, the public would like to see it solved nationally,” he said.

Larry Levitt, senior vice president at the Kaiser Family Foundation, said most of all it’s clear voters want something done about the prices they pay.

“Americans across the political spectrum desperately want relief from health care costs,” Levitt said, “and at some point they’re going to hold political leaders to account for not delivering.”

Obamacare, Medicare and more

The findings from the Public Agenda/USA TODAY/Ipsos poll are part of an election-year project by USA TODAY and Public Agenda. The Hidden Common Ground initiative explores areas of agreement on major issues facing the nation.

The survey of 1,020 adult Americans 18 years and older was taken December 19-26, 2019. It has a margin of error of plus or minus 5.7 percentage points for Democrats, plus or minus 6.2 percentage points for Republicans and plus or minus 5.7 percentage points for independents.

The Hidden Common Ground project is supported by the John S. and James L. Knight Foundation, the Charles Koch Foundation and the Rockefeller Brothers Fund. The Kettering Foundation serves as a research partner to the Hidden Common Ground initiative.

Cost of health care, lack of data security stress us out. It’s time to claim our rights.

USA TODAY opinion contributor, Jane Sarasohn-Kahn reported that Americans are stressed out about health care.

Whether it concerns costs, access to treatment or ability to navigate the system, the American Psychological Association, in its 2019 Stress in America survey, found that 69% of people in the United States say health care is a major source of stress in their life.

We’re also stressed about privacy and data security. We live with a patchwork quilt of laws but no overarching protection that allows us to control our personal information.

As Americans, we need to demand our health citizenship. What does this mean? That people claim health care and data privacy as civil rights.

Polls show that most Americans, from top income earners to people living with much less, believe that it’s unfair for wealthier people to have access to better health care.

In an election year where there seems to be little consensus, two issues on which most American voters agree is the need to lower prescription drugs costs and to protect patients with preexisting conditions. These are priorities that cross party lines in 2020.

What’s driving this cross-party consensus? It’s the reality of patients spending increasingly higher amounts of household income on high-deductible health plans, medical services and prescription drugs. Forcing patients to have more financial “skin in the game” has led millions of Americans to forgo care altogether or to self-ration care by not getting recommended tests and not filling prescriptions.

The second driver for the declaration of health citizenship is the urgent need to protect our personal health information.

In 1996, when the Health Insurance Portability and Accountability Act was enacted, the introduction of the iPhone was 11 years away. The internet was dial up to AOL, CompuServe and Prodigy. And per-capita spending on health care averaged $3,759 (in 2018, it was $11,172).

Health care in 2020 is digitally based, with most physicians and hospitals in America using electronic health records and providers conducting care online via web-based services. Health care is quickly moving to the home, to our cars and even inside our bodies with implants. Wearable technology, remote health monitoring and mobile apps increasingly support our self-care and shared-care with clinicians.

Our health data is vulnerable

Those interactions create new data points. So do daily interactions with our phones and retail purchases. That information, when mashed up with our health care data, can be used to predict our health status, identify emergent conditions like a heart attack or stroke, and customize medications for patients.

But the data generated by our daily lives, outside of HIPAA-covered entities such as doctors, hospitals and pharmacies, is not for the most part covered by existing laws. We are exposed to third-party brokers who monetize our data without telling us how it’s used and without sharing the revenue they make from our personal information.

Universal care is basic right

What would a new era of health citizenship look like? Every American would be covered by a health plan — however we fashion it.

Universal health care, American-style, could come in many forms, including through proposals under debate during the election cycle. All residents in our peer nations in the Organization for Economic Cooperation and Development enjoy some form of health care plan. Most of these countries spend less on health care per person and realize better health outcomes.

One reason is that those nations spend more per person on social factors that help determine a person’s health.

Education, for example, is a major predictor of people’s health. Sir Angus Deaton and Anne Case’s research into the “deaths of despair” in America identified lack of education as a risk factor. Lawmakers need to “bake” health into food and agriculture, transportation, housing and education policies to improve the health of all Americans regardless of income or education levels.

We also need to help people understand the growing role of data in everyday life. Virtually everyone leaves digital dust in the use of mobile phones, credit cards and online transactions. Our peers in Europe enjoy the privacy protection afforded by the General Data Protection Regulation, which defends the “right to be forgotten.” In the United States, we lack laws that sufficiently protect our personal data.

Voting is part of health citizenship, too. The Stress in America survey cited the 2020 presidential election as a major source of Americans’ stress. Let’s make the act of voting a part of our pursuit of good health’

Medicare for All is really missing the point’: Experts say program needs work

Ken Alltucker of USA TODAY, reported that when Robert Davis’ prescription medication money ran out weeks ago, he began rationing a life-sustaining $292,000-per-year drug he takes to treat his cystic fibrosis.

Tuesday, the suburban Houston man and father of two got a lifeline in the mail: a free 30-day supply of a newer, even more expensive triple-combination drug with an annual cost of $311,000.

The drug will bring him relief over the next month, but he’s uncertain what will happen next. Although the 50-year-old has Medicare prescription drug coverage, he can’t afford copays for it or other drugs he must take to stay healthy as he battles the life-shortening lung disorder.

Davis is among millions of Americans with chronic disease who struggle to pay medical bills even with robust Medicare benefits. More than one in three Medicare recipients with a serious illness say they spend all of their savings to pay for health care. And nearly one in four have been pressured by bill collectors, according to a study supported by the Commonwealth Fund.

As Democratic presidential candidates Elizabeth Warren, Bernie Sanders and others tout “Medicare for All” to change the nation’s expensive and inequitable health care system, some advocates warn the Medicare program is far from perfect for the elderly and disabled enrolled in it.

The word “Medicare” was mentioned 17 times during Wednesday night’s debate in the context of a national health plan or a public option people could purchase. However, there’s been little to no discussion among the candidates in debates about the actual status of the health program that covers about 60 million Americans.Ad

One in two Democrats and Democrat-leaning independents want to hear more about how candidates’ plans would affect seniors on Medicare, making it the top health-related concern they’d like candidates to discuss, according to a Kaiser Family Foundation poll released Wednesday.

“We fear the debate about ‘Medicare for All’ is really missing the point,” says Judith Stein, director of the Center for Medicare Advocacy. “What most people don’t know is the current Medicare program has a lot of problems with it. We need to improve Medicare before it becomes a vehicle for a broad group of people.”

Medicare for All faces broad political challenges. About 53% support a national Medicare for All plan, but that support drops below 50% with more details about paying taxes to support a single-payer system, according to the Kaiser poll.

Nearly two in three moderate voters in Michigan, Minnesota, Pennsylvania and Wisconsin are skeptical of a plan to use Medicare as a vehicle for comprehensive health coverage, another Kaiser and Cook Political Report poll released this month shows. A group funded by pharmaceutical companies, health insurers and hospitals has lobbied against Medicare for All, and a survey released by HealthSavings Administrators reported participating employers oppose the plan.

This month, Warren released more details about her health plan, calling for a public option within the first 100 days of her presidency. She said it was not a retreat from Medicare for All, even as a Des Moines Register/CNN/Mediacom Iowa Poll showed her support in Iowa dropped to 16%.

Stephen Zuckerman is a health economist and co-director of the Urban Institute Health Policy Center. He says the Medicare for All proposals expand coverage beyond what Medicare beneficiaries get.

“If you hear about Medicare for All, you might think it’s the current Medicare program for all people,” Zuckerman said. “But that’s not what the Medicare for All proposals are presenting. They are looking at plans that are far more generous, in terms of the benefits they cover and to some extent the cost sharing.”

The fundamental promise of Medicare for All builds on a public program that works well for adults over 65 and people who are unable to work because of disability. Although Medicare rates high in satisfaction among most who have it, a portion of people who need frequent, expensive care struggle financially.

The Commonwealth Fund-supported survey of 742 Medicare beneficiaries reported 53% of those with “serious illness” had a problem paying a medical bill. The study defined serious illness as one requiring two or more hospital stays and three or more doctor visits over three years.

Among these seriously ill patients, the most common financial hardship involved medication. Nearly one in three people reported a serious problem paying for prescriptions. People had problems paying hospital, ambulance and emergency room bills, according to the survey.

Eric Schneider, a Commonwealth Fund senior vice president for policy and research, says the survey’s findings show seriously ill Medicare recipients face “significant financial exposure.

“The expectation is that people would be relatively well-covered under Medicare,” Schneider says. “We’re seeing it has gaps and holes, particularly considering the level of poverty many elderly still live in.”

‘More illness, more sickness’

Davis, the Houston-area man, has rationed expensive but critical modulator drugs, which seek to improve lung function by targeting defects caused by genetic mutations.

When he ran out of the drug Symdeko last November, he coughed up blood, had digestive problems and was hospitalized for a week. This month, he took half the amount he was prescribed, hoping he’d have enough pills to last through the year.

“It alters my breathing a lot,” Davis says. “I’m more congested. I start slowing down, more illness, more sickness.”

Davis has Medicare prescription coverage, but he couldn’t afford Symdeko’s $1,200 monthly copay. He needs to pay an additional $600 each month for a less expensive drug, pulmozyme, which breaks down and clears mucus from his lungs. The medication he takes is critical to keep his lungs functioning and to limit infections.

A private foundation offers copay assistance up to $15,000 each year, a threshold Davis reached this month. Like a year ago, as rent, food and utility bills took most of his disability income, the math didn’t work. He could no longer afford drugs when the foundation’s annual help ran out.

A 30-day supply of the newer drug, Trikafta, was provided by the drug’s manufacturer free of charge. Davis worries he will run into the same problem when he’s again forced to cover a copay he can’t afford.

His Medicare coverage is sufficient for doctor visits and hospital stays, but he says drug costs for cystic fibrosis patients are “out of control.”

“Research is expensive – I understand that,” Davis says. “They are making lifesaving drugs that very few cystic fibrosis patients can afford and that a lot of insurance plans will balk at.”

Vertex Pharmaceuticals, the company that makes Symdeko and Trikafta, says the drugs’ list prices are appropriate.

“Our CF medicines are the first and only medicines to treat the underlying cause of this devastating disease and the price of our medicines reflect the significant value they bring to patients,” the company says in a statement.

Vertex provides financial assistance to patients such as Davis who need the company’s medications.

“Our highest priority is making sure patients who need our medicines can get them,” the company says. “Every patient situation is different, and our (patient-assistance) team works individually with patients who are enrolled in the program to evaluate their specific situations and determine what assistance options are available.”

‘Public Medicare plan is withering’

Advocates such as Stein want presidential candidates to address Medicare’s coverage gaps and other challenges mill

ions of beneficiaries face.

The Commonwealth Fund survey did not report whether participants had traditional Medicare plans or Medicare Advantage plans, which are administered by private insurance companies such as Aetna or UnitedHealthcare. The report did not ask participants whether they had supplemental insurance, which covers out-of-pocket medical expenses not capped by Medicare.

People on Medicare typically have robust coverage for hospital stays and doctor charges. But even with “Part D” prescription drug coverage, Davis and others who must take expensive drugs are responsible for copays.

“What is happening is the public Medicare program is withering,” Stein says. “The private, more expensive, less valuable Medicare Advantage program is being pumped up.”

More than one-third of Americans choose private Medicare plans, which entice consumers through add-on services such as vision and dental coverage and perks such as gym memberships. A survey commissioned by the Better Medicare Alliance, which is backed by the private insurance industry, reported 94% of people in private Medicare plans are satisfied with their coverage.

Private Medicare plans restrict the network of available doctors, hospitals and specialists people can see. Traditional Medicare plans allow people to see any doctor or hospital that takes Medicare.

Stein says tailored networks can be problematic for seniors who travel out of state and encounter a medical emergency.

She says private plans frequently change doctors and hospital networks from year to year. Such frequent network changes can surprise Medicare recipients and force them to switch doctors.

“There’s too much confusion, too little standardization,” Stein says. “The inability, when you are really ill or injured, to get the care where you want it and from whom you want it, I think that is completely lost in the discussion.”

This month, President Donald Trump signed an executive order “protecting and improving” Medicare, but some worry it could push more consumers into private plans and lead to more expensive medical bills. Among other things, the order calls for Medicare to pay rates closer to those paid by private insurers. Medicare typically pays doctors less than what private commercial plans pay.

The federal rules based on the executive order haven’t been finalized, so it’s unclear how it might be implemented.

The executive order “doesn’t seem all that well thought out,” Zuckerman says. Raising Medicare’s payment rates to be on par with private insurance would make the program more expensive and potentially financially vulnerable, he says.

“Public opinion wants to see that program preserved,” Zuckerman says. “At a minimum, I don’t think anyone wants to see Medicare contract.”

US health care system causing ‘moral injury’ among doctors, nurses

Megan Henney of FOX Business noted that the emphasis on speed and money — rather than patient care — in emergency medicine is leading to mass exasperation and burnout among clinicians across the country.

According to a new report published by Kaiser Health News, a model of emergency care is forcing doctors to practice “fast and loose medicine,” including excessive testing that leaves patients burdened with hefty medical bills; prioritizing speed at the cost of quality care and overcrowding in hospitals, among other issues.

“The health system is not set up to help patients,” Dr. Nick Sawyer, an assistant professor of emergency medicine at the University of California-Davis, told Kaiser Health. “It’s set up to make money.”

In October, a 312-page report published by the National Academy of Medicine, a non-profit organization based in Washington, D.C., found that up to half of all clinicians have reported “substantial” feelings of burnout, including exhaustion, high depersonalization and a low sense of personal accomplishment.

Physician burnout can result in increased risk to patients, malpractice claims, clinician absenteeism, high employee turnover and overall reduced productivity. In addition to posing a threat to the safety of patients and physicians, burnout carries a hefty economic cost: A previous study published in June by the Annals of Internal Medicine estimated that physician burnout costs the U.S. economy roughly $4.6 billion per year, or $7,600 per physician per year.

Physicians suffering from burnout are at least twice as likely to report that they’ve made a major medical error in the last three months, compared to their colleagues, and they’re also more likely to be involved in a malpractice litigation suit, the report found. Each year, about 2,400 physicians leave the workforce — and the No. 1 factor is burnout.

The authors of the report, who spent 18 months studying research on burnout, found that between 35 and 54 percent of nurses and doctors experience burnout. Among medical students and residents, the percentage is as high as 60 percent.

“There is a serious problem of burnout among health care professionals in this country, with consequences for both clinicians and patients, health care organizations and society,” the report said.

But the issue in emergency medicine goes beyond burnout. A 2018 report published by Drs. Wendy Dean and Simon Talbot found that physicians are facing a “profound and unrecognized threat” to their well-being: moral injury.

The term “moral injury” was first used to describe soldiers’ response to war and is frequently diagnosed as post-traumatic stress. It represents “perpetrating, failing to prevent, bearing witness to, or learning about acts that transgress deeply held moral beliefs and expectations.”

At the crux of moral injury in physicians is their inability to consistently meet patient’s needs, a symptom of a health-care environment that’s increasingly focused on maximizing profit that leaves clinicians trapped between navigating an ethical path or “making a profit from people at their sickest and most vulnerable.”

“The moral injury of health care is not the offense of killing another human in the context of war,” Dean and Talbot wrote. “It is being unable to provide high-quality care and healing in the context of health care.”

In the one year since they published their paper, Dean and Talbot sparked an international conversation among health care professionals about the moral foundations of medicine, receiving a flood of responses.

“All of us who work in health care share, at least in the abstract, a single mission: to promote health and take care of the ill and injured. That’s what we’re trained to do,” they wrote. “But the business of health care — the gigantic system of administrative machinery in which health care is delivered, documented, and reimbursed — keeps us from pursuing that mission without anguish or conflict.”

And as I am watching the New Hampshire Primary results I am amazed that Bernie is heading the Dems, as they are saying, based on his push for Medicare for All. Just a flawed proposal and evidently there are many that believe this Socialist. I am truly worried.

My Millennial Doctor Peers Think They’re Walking Into a Crisis Regarding Health Care, Doctors Need to Understand Health Care and Buttagieg’s Health Care Plan, Corona Virus and Kobe.

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Dr. Daniel E. Choi announced that ”Hey man, just wanted you to be one of the first to know that I put in my 90-day resignation notice at the hospital. Planning to pursue exec MBA…”

I did a double take at this shocking text from an orthopedic surgery colleague who was also a close friend. What? He was quitting?

We had just slaved through 5 years of orthopedic surgery residency, 1 year of fellowship, and just passed our oral boards. We were now supposed to be living the dream. All of that delayed gratification: throwing away our 20s holed up in the library, taking call endlessly on weekends and holidays. We did it for the ultimate privilege of being attending surgeons for our patients one day.

I called him right away and he confirmed my suspicions about why he quit. As an employed physician in a hospital system, he felt that he was sadly just becoming a cog in the machine, a “provider” generating relative value units. Administrators who had never done a day of residency or even stepped foot in his clinic wanted to provide “guidance” on how he should practice medicine. Overall, he felt that medicine was a sinking ship on which doctors were losing autonomy quickly and that this was a path leading straight to burnout.

I felt I had to let the Twitterverse know.

This tweet went viral and it was clear that I was on to something. I had struck a nerve with many of my physician colleagues. Surprisingly, many physicians empathized with my friend and didn’t blame him for looking elsewhere in finding a fulfilling career. Some physicians even thought he was doing the right thing.

I was getting really curious. I followed up with a Twitter poll: “Physicians, are you actively making plans for early retirement or considering how to possibly exit medicine in the near future?” Sixty-five percent of physicians who replied were considering an early exit from medicine.

This poll result was consistent with my own observation that early retirement online physician groups are burgeoning. Physician Side Gigs on Facebook, which seeks to help “physicians interested in pursuing opportunities outside of traditional clinical medicine…as a way to supplement or even replace their clinical income,” has over 50,000 members. Another Facebook group, Physicians on FIRE, aims to help physicians reach “Financial Independence. Retire Early” and has over 4000 members.

It is difficult to determine whether these physicians seeking early retirement are just wishfully complaining or actually planning an exit strategy. Many physicians answering the Twitter poll clarified that they loved treating and helping their patients but that the system had just become too difficult to deal with. Did this many physicians really want to leave the practice of medicine? What does that mean for our impending physician shortage? Why do so many of us feel the urge to get out?

Many discussions with disenchanted physicians ensued after that poll. In these discussions, I have found several common reasons that have pushed my colleagues to leave medicine.

Devaluation of Physicians on All Fronts

Devaluation appears to be happening on many fronts, according to my discussions with doctors online. There is the use of the term “provider” to replace “physician,” which more of us are finding offensive.

Mid-level providers who are cheaper for health systems to hire are replacing physicians. Reimbursements from commercial payers are declining. Health policy “experts” unfairly blame rising healthcare costs on physicians and have pushed legislators to find ways to lower physician compensation further. There are fewer physician meeting spaces in hospitals, such as doctors’ lounges or physician dining rooms, which used to serve as important spaces for physicians to commiserate and collaborate.

Overall, I sense great disappointment and anger among physicians about what many perceive to be increasing disregard for the tremendous amount of sacrifice physicians have made to complete their training. Physicians increasingly regret all of that time away from family or dropping their personal interests and hobbies during medical school and residency.Most shocking to me, however, is that physicians who speak out about such devaluation are often labeled “greedy doctors” by health policy “experts,” the press, and even fellow physicians (usually in the later stages of their career).

Loss of Autonomy and Independent Physician Opportunities

Personally, I’ve always wanted to be my own boss and I knew fairly early on in training that I wanted to enter private practice. I thought private practice would allow me to insulate myself from many of the forces that pushed my orthopedic surgery colleague to quit.

Mine is not the popular path, however, as the number of millennial physicians who are entering private practice has rapidly declined over the past decade. According to Medscape’s Residents Salary & Debt Report 2019, 22% of residents say they anticipate becoming either a practice owner or partner. According to a survey by the Physicians Foundation and Merritt Hawkins, only 31.4% of physicians identified as independent practice owners or partners in 2018. In 2012, independent physicians made up 48.5% of all doctors.

The survey even revealed that 58% of doctors do not think that hospital employment is a positive trend and concluded that “many physicians are dubious about the employed practice model even though they have chosen to participate in it, perhaps fearing that employment by hospitals will lead to a loss of clinical and administrative autonomy.”

I used to wonder why more of my millennial physician colleagues did not choose private practice as a career path and why so many were choosing hospital-based employment. A line I saw on Twitter sums it up: “Private practice is no longer about profitability. It’s about financial sustainability.” With greater consolidation within healthcare, independent doctors have lost much of their leverage when trying to negotiate fair rates with commercial payers.

In addition, the costs of purchasing an electronic health record and running a staff to deal with authorization and billing issues have made private practice extremely difficult. If more private practice opportunities existed, I am sure that my millennial colleagues would absolutely take them to maintain their independence. However, such independent practice opportunities continue to diminish, and millennial physicians may be pressured to take the only available positions: hospital employment with possible restrictions on autonomy.

Is Your Career Worth Your Own Life?

On average, one doctor a day in the United States ends his or her own life. Physicians commit suicide at a rate twice that of the general population, and over 1 million patients will lose their doctors to suicide every year. Pamela Wible, MD, who studied 1363 physician suicides, points out that “assembly-line medicine kills doctors” and that “pressure from insurance companies and government mandates further crush the souls of these talented people who just want to help their patients.”

Just a couple of months ago, my fellowship director forwarded me an email about a young orthopedic surgeon who had committed suicide, Thomas Fishler. He was known to be a brilliant surgeon whom colleagues and patients loved, and is survived by his young daughter. My fellowship director included in his email, “I know you have an awareness of the risks that those in our profession often face.”

Many physicians are crying for help and nobody is listening. Some sadly feel that the only way out is to end their lives.

Physician suicide is heartbreaking and screams crisis. What is driving brilliant doctors to the edge? I believe it’s further evidence of compounding external pressures that are making the practice of medicine increasingly intolerable. Many physicians are crying for help and nobody is listening. Some sadly feel that the only way out is to end their lives.

I get chills as I push the thought quickly out of my mind: Am I being subjected to this risk? All physicians have their tough days but I have never been anywhere close to being suicidal. But seriously—is it really worth it if I am at even a small risk of becoming that miserable?

Is There an Impending Crisis?

The average millennial physician completes training, looks around, and sees his or her profession in complete shambles. Burnout is rampant. Doctors are committing suicide daily. Many seem to be miserable over their lack of autonomy and loss of standing. The physician starts to take a hard look at the career they are about to embark on and begins to have serious doubts. Then the physician remembers that student loan debt. The average medical student loan debt in 2018, according to AAMC , was $198,000. There’s really no way out at this point; even if your job is going to make you miserable, you are going to push through because you’re on the hook.

And this is where I start to get seriously worried. We will have an entire generation of graduating physicians who will be subjected to forces that have never been present in medicine before. And these forces are actively causing distress and misery among some of my colleagues.

I know that my millennial colleagues have tremendous resilience and grit, as every generation of physicians has in the past. But how long will they put their heads down and fight against these ominous forces before they decide that they’ve had enough and jump ship just like my orthopedic colleague did?

Hope in Advocacy to Avert Crisis

Don’t get me wrong—practicing medicine is still the greatest privilege, and I know that every one of my millennial physician colleagues loves their patients dearly. I am honored that my patients entrust me to take away their pain and suffering in the operating room. I’ve studied and trained for 14 years to become an attending orthopedic spine surgeon; I’m not giving up this privilege that easily. And neither are most millennial physicians.

Millennials may be viewed as entitled, but many of us see that as “ comfort in advocating for themselves and questioning the status quo.” I believe that millennial physicians will not quietly accept the current state of affairs.

I see many impassioned millennial physician advocates becoming active in organizations like the Medical Society of the State of New York or the American Medical Association. These organizations already do excellent advocacy work, and I predict that millennial physicians will become a powerful force within such organizations to protect their profession. Through a unified voice, organized medicine is truly our strongest hope in enacting systemic changes that can prevent further physician demoralization and burnout.

We’re not giving up just yet. The crisis can be averted. Our patients and profession depend on it.

America’s healthiest and unhealthiest states

Cortney Moore noted that when it comes down to the popular saying that “health is wealth,” the states that have high revenue streams and median household incomes also have populations that are wellness-focused. Particularly, the states with the healthiest people are concentrated in the northern half of the U.S. and West Coast, according to America’s Health Rankings annual report conducted by the United Health Foundation.

The United Health Foundation analyzed the 50 states on five core categories, including model behaviors, community and environmental factors, public policies for health care and preventative care, clinical care and the overall health outcomes that result from the previous four.

America’s Health Rankings used a composite index of over 30 metrics to create its annual snapshot of statewide healthy populations, which ultimately helped the organization determine the healthiest to the unhealthiest.

Moreover, the report cited the World Health Organization’s definition of health as “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity,” in addition to individual genetic predispositions to disease.

The healthiest state is Vermont, which has moved up from 20th place in 1990 to first place in 2019, according to America’s Health Rankings data. In the past 15 years, the state has decreased its air pollution by 47 percent – with fine particles per cubic meter going down from 9.7 to 5.1 micrograms. Additionally, Vermont’s disparity in health status decreased from 49 percent to 17.4 percent in the past year. Other strengths the report noted include low incidences of chlamydia, violent crime and the percentage of uninsured residents.

For the 2019 fiscal year, with the exception to the month of December (which data has yet to be released for at the time of publication), the state of Vermont made over $955 million in revenue from general funds, according to the Agency of Administration. More than $113 million came from health care taxes and assessments that were collected between January 2019 and November 2019.

The median household income in Vermont is $60,076, according to data from the U.S. Census Bureau, which is close to the national median of $61,937. Moreover, average employee health care premium contributions for a family in the state is said to be $4,996, according to independent researchers at the Commonwealth Fund.

When it comes down to those who have government-funded health insurance plans, the Centers for Medicare and Medicaid Services do not have up-to-date figures since it is collected on a quinquennial basis. However, the agency found that Vermont reported a little over $5.7 million in 2015 for health care expenditures, as noted in an infographic by the Kaiser Family Foundation.

Outside the Green Mountain State, the other states that rounded out America’s Health Rankings top 10 are Massachusetts, Hawaii, Connecticut, Utah, New Hampshire, Minnesota, New Jersey, Washington and Colorado.

The unhealthiest state is Mississippi, which has maintained close to 50th place from 1990 to 2019, according to America’s Health Rankings data. Since 1993, low birthweight in Mississippi increased from 9.6 percent to 21 percent of live births. In the past five years, premature death increased by seven percent from 10,354 to 11,043 years lost to people who died before age 75. Premature mortality has increased on a national scale in addition to diabetes and obesity. Other challenges the report noted include a high cardiovascular death rate and percentage of children in poverty.

For the fiscal year of 2019, the state of Mississippi made $166 million in revenue collections, according to the Mississippi Legislative Budget Office, which surpassed the state’s estimate by $30.5 million.

The median household income in Mississippi is $43,567, according to data from the U.S. Census, which is $18,370 less than the national median. Average employee health care premium contributions for a family in the state is $5,133, according to the Commonwealth Fund, which is only $137 more than the premiums employees in Vermont are paying. But, when coupled with Mississippi’s lower median income, the cost of health coverage is substantial.

Mississippi also surpassed Vermont in spending on government-funded health insurance plans. The Centers for Medicare and Medicaid Services found that Mississippi reported over $21.5 million in 2015 for health care expenditures.

The other states that rounded out America’s Health Rankings bottom 10 were primarily in the South, including, South Carolina, Kentucky, Tennessee, West Virginia, Oklahoma, Alabama, Arkansas and Louisiana. Indiana was the only Midwestern state to land on the lower one-fifth of the unhealthiest states list.

On a national scale, American health is a mixed bag. Since 2012, smoking among adults has decreased from 24 percent to 16.1 percent, however, obesity among adults increased to 30.9 percent from 11 percent while diabetes among adults increased to 15 percent from 9.5 percent.

In the past three years, drug-related deaths have increased by 37 percent from 14 to 19.2 deaths per 100,000 people. When compared to America’s Health Rankings data from 2007, that is a 104 percent increase.

Environmental conditions have improved as air pollution decreased by 36 percent since 2003 and violent crime decreased by 50 percent since 1993. In the past four years, frequent mental distress increased from 11 percent to 13 percent, which has resulted in an increase of mental health providers, according to the report.

Infant mortality has decreased by 43 percent from 10.2 to 5.8 deaths per 1,000 live births in the past 29 years. However, low birth weight has increased by four percent from eight to 8.3 percent in the past three years, which also happens to be a 19 percent increase from 1993.

The average American spends more than $11,000 per year on health care and accounted for 17.7 percent of the U.S. GDP, according to estimates from the Centers for Medicare and Medicaid Services. With spending projected to grow at an average rate of 5.5 percent per year, the U.S. will reach nearly $6 trillion in health care spending by 2027.

Buttigieg’s health care plan would save money while Warren and Sanders plans would cost trillions, analysis finds

Associate Editor Adriana Belmont reported that Health care has been a contentious topic among the Democratic presidential candidates: Sens. Bernie Sanders (I-VT) and Elizabeth Warren (D-MA) support Medicare for All while Mayor Pete Buttigieg (D-IN) and former Vice President Joe Biden offer alternatives to universal health care.

A new analysis from the Committee for a Responsible Federal Budget (CRFB) took a look at the different plans and found that while each proposal would reduce the number of uninsured Americans, the least costly would be Buttigieg’s plan.

“Mayor Buttigieg’s plan would reduce deficits by $450 billion,” according to CFRB, adding that the policy would also “increase gross spending by $2.85 trillion, reduce costs by $1.2 trillion, and raise $2.1 trillion through direct and additional offsets.”

Through Buttigieg’s Medicare for All Who Want It plan, everyone would automatically be involved in universal health care coverage for those who are eligible. The policy would also expand premium subsidies for low-income individuals, cap out-of-pocket costs for seniors on Medicare, and limit what health care providers change for out-of-network care at double what Medicare pays for the same service. At the same time, those who still want to stay on private insurance can do so.

“This is how public alternatives work,” Buttigieg said. “They create a public alternative that the private sector is then forced to compete with.

CRFB estimated that the Indiana mayor’s plan would reduce the number of uninsured by between 20 to 30 million “by improving affordability and implementing auto-enrollment as well as retroactively enrolling and charging premiums to those who lack coverage.”

‘Building on Obamacare’

Joe Biden’s health care plan, described as “building on Obamacare,” has an estimated gross cost of $2.25 trillion and would add $800 billion to deficits over 10 years. The CRFB also found that “it would reduce costs by $450 billion” and “raise $1 trillion through direct and additional offsets.”

Biden’s plan would reduce the number of uninsured by 15 to 20 million Americans and reduce national health expenditures by 1%.

Some of his biggest revenue drivers in his plan include coverage expansion revenue feedback, which would create a public option, and end deductibility of prescription drug advertising. Additionally, his capital gains tax and “tax at death” would generate $550 billion.

‘Federal health expenditures would increase somewhat more’

Sen. Sanders, one of the original proponents of Medicare for All, has a plan that’s projected to add $13.4 trillion to deficits over a decade at a gross cost of $30.6 trillion. It would also raise $12.5 trillion in revenue through direct offsets and raise another $3 trillion through additional offsets.

His proposals to eliminate medical debt would cost $100 billion and would raise $1.7 trillion by reducing the costs of prescription drugs. To generate more money for the plan, Sanders would establish a 4% income surtax (projected to raise $4 trillion) and 7.5% employer payroll tax (estimated $4 trillion added). One significant cost in his plan, though, is offering universal long-term care — which would cost $29 trillion.

“The reality is that Medicare for All will save American families thousands of dollars a year because they will no longer be paying premiums, deductibles and co-payments to greedy private health insurance companies,” Warren Gunnels, senior advisor for the Sanders campaign, told Yahoo Finance in a statement.

“If every major country on earth can guarantee health care to all and achieve better health outcomes, while spending substantially less per capita than we do, it is absurd for anyone to suggest that the United States of America cannot do the same.”

Overall, between 2021 to 2030, the CFRB estimated that Sanders’ plan would increase national health expenditures by 6%, “meaning that federal health expenditures would increase somewhat more than non-federal health spending would fall.”

‘Magical math’ or ‘the biggest middle class tax cut ever’?

Sen. Warren’s plan closely resembles Sanders’ in terms of cost. She stated her plan would cost $20.5 trillion in federal spending over a decade. CFRB found that the plan “would add $6.1 trillion to deficits over ten years under our central estimate.”

Experts disagree over the cost of Warren’s numbers, with one calling it “magical math” and another referring to Warren’s plan as “the biggest middle class tax cut ever.”

According to CRFB, the plan would increase gross spending by $31.75 trillion, reduce costs by $4.7 trillion, raise $14.2 trillion in revenue through direct offsets, and raise another $6.75 trillion through additional offsets. Her health care plan is estimated to increase costs by about 3%, but “the magnitude of these increases would decline over time.”

A major way to fund the plan would be through tax reform. By essentially eliminating tax breaks with private health insurers and requiring employers to contribute to her Medicare for All, she’s projected to generate an estimated $14.2 trillion. Other means of generating revenue for her plan include her wealth tax and a tax on bonds, stocks, and derivatives.

Both the Warren and Sanders plans would reduce the number of uninsured Americans by 30 to 35 million and “nearly eliminate” average premiums and out-of-pocket costs.

Patients can’t afford for doctors to misunderstand the healthcare business

Caroline Yao reported that When I was in medical school, my teachers started a lot of their stories with the same phrase:

“Back in my day, I still helped patients who couldn’t pay.”

“Back in my day, we didn’t have 100 checklists.”

“Back in my day, I didn’t need permission from insurance companies to do my job.”

“Back in my day, a yelp review couldn’t ruin my reputation.”

It happened so often that I wondered if I had shown up to the medical profession 30 years too late. Had I signed up for a sham fairytale?

I had thought doctors were autonomous, benevolent masters with kind voices and encyclopedic knowledge. After entering the field, I’ve found most young doctors struggle to balance convention versus empowerment, and doing good versus doing well. Doctors are the ugly stepchild of healthcare reform; too privileged to warrant help, but too powerless to do our jobs better.

I performed more than 2,500 surgeries during my residency training, and I am embarrassed to say that I do not know what a single one of my patients paid for their operations.

I later learned at the public hospital, surgeons were reimbursed $35 for each emergency appendectomy performed. Where did all that money go? Why didn’t the doctors question the system, or try to regain some control?

The provider will see you now

Somewhere along the way, my title as a doctor has been reduced to “provider,” and my worth dictated by administrators, insurance companies—and the government. The Hippocratic Oath I earnestly recited upon starting medical school is challenged everyday by a system of perverse incentives, where hospitals are paid more for treating the sick than keeping the patient well.

In 2013, 87% of graduating doctors felt uncomfortable with their knowledge of the business of medicine; 81% felt they lacked an understanding of healthcare legislation.

Is the answer that doctors should participate more in determining patient fees and reimbursement schedules? History shows that when doctors controlled payments more directly, graduated systems based on ability to pay were subtle but more ubiquitous. In the era of Aristotle, wealthy physicians did not accept payment, while poorer ones requested them. When 9th-century physician and scholoar Ishaq bin Ali al-Ruhawi wrote the first book of medical ethics, he described physicians as business owners who provided free services during times of patronage from caliphs and sultans. Throughout medieval Europe and during the Ottaman Empire, doctors treated the poor with the help of subsidies from royal courts and churches. Notable physicians such as Sir William Osler, legendary French surgeon and anatomist Guillaume Dupuytren, and physician and founder of Dickinson College, Benjamin Rush also charged rich and poor patients based on a self-made sliding scale.

Today, governments, universities, religious groups, and philanthropists are essentially modern-day barons who fund healthcare for the indigent through public hospitals, grants, and charitable work.

In the US, some physicians are granted partial and full student debt forgiveness from the government for working in underserved or rural communities. However, the majority of physicians who volunteer at free clinics, teaching hospitals, charities, or medical missions often do so only because their practice is flexible or lucrative enough to allow them both time away from paying jobs and the financial means to offer free services.

While physicians in private practice have autonomy over who they treat and how much they charge, physicians who work in hospital systems are more and more removed from managing the whole patient.

In 1983, 76% of doctors owned their own practice versus only 47% in 2016. Young physicians today are fundamentally unaware of the business side of medicine, and that’s bad news for everyone. As is the fact that medical students and residents are consistently and idealistically mentored to ignore the costs of materials and treatments we recommend.

We are taught to deliver care based on strict scientific evidence: the “gold standard” of care. Said gold standard, however, does not account for price, diminishing returns, convenience, or pain. The treatment that works best for a lab rat in a cage does not always translate to the most appropriate care for a person who has far more complex needs.

The cost of your health

A more pragmatic physician understands that patients who are underinsured, uninsured, or improperly educated will often forgo procedures, clinic visits, and medications when those interventions are too expensive or inconvenient.

Cost-conscious surgeons know that using instruments to tie stitches instead of hand-tying stitches can often result in a 10-fold cost savings without sacrificing quality.

I did not know how prohibitively expensive everyday surgical consumables cost until I went on humanitarian missions abroad and worked with surgical teams that could not afford these luxuries. I learned that hemostatic fabric we used like disposable napkins in the US cost $40 for a post-it sized square. A five-inch silicone band-aid costs $20. Bioengineered skin substitutes cost $10,000 for a palm-sized sheet.

My lack of price-awareness is fairly common. Many doctors have stopped accounting for the cost portion of a cost-benefit analysis.

And where doctors have leaned away from understanding cost, others have stepped in. Hospital administrators, governments, and insurance companies now manage the costs of healthcare. Correspondingly, physician compensation is estimated to be under 10% of total US national healthcare spending today. Overhead, administration, ancillary staff, malpractice insurance, and pharmaceuticals account for the majority of costs. For an appendectomy and associated care in 2018, the Medicare allowable compensation for a surgeon’s work is $394; meanwhile, healthcare watchdog organizations quote $13,000 as the fair price for hospitals to charge a patient and US hospitals bill an average of $31,000.

Most surgeons working in large hospitals are unaware of these numbers. They are therefore unable to tell patients how much they will be billed for a given operation. A surgeon in the 1830s in the company of the likes of Dr. Dupuytren would know these numbers.

Patients are often dismayed or surprised that their doctor cannot earnestly explain the cost-benefits of different treatments. A 2013 survey by the Journal of the American Medical Association found that 87% of graduating doctors felt uncomfortable with their knowledge of the business of medicine and 81% felt they lacked an understanding of healthcare legislation. As surgeons, we have slowly let ourselves become exclusively technicians. Just like Aristotle and Plato said.

By turning our noses up at the business of medicine, we have lost ownership over our patients, and the agency to advocate for them. As Osler said, “The good physician treats the disease. The great physician treats the patient who has the disease.”

We as physicians and surgeons need to recover our identity and learn the business skills that our teachers have forgotten, but our forefathers stood up for.

As China’s Coronavirus Cases Rise, U.S. Agencies Map Out Domestic Containment Plans

Richard Harris reported that China has reported a large surge of cases of the novel coronavirus — upping its count from under 3,000 to over 4,500 as of Tuesday morning. More than 100 deaths have been reported. It is spreading rapidly in many provinces, and sporadic cases have now been reported in 18 other locations outside of China, including Australia, France and Canada.

In the United States, the case count remains at five — all people who had recently returned from Wuhan, China. And at a news conference Tuesday, top U.S. health officials reiterated that the disease — while serious — is not currently a threat to ordinary Americans.

“At this point, Americans should not worry for their own safety,” said Alex Azar, health and human services secretary, at the press briefing Tuesday.

While risk to most Americans remains low, Dr. Nancy Messonnier, the director of the National Center for Immunization and Respiratory Diseases at the Centers for Disease Control and Prevention, noted that “risk is dependent on exposure” and that health care workers or others who know they have been in contact with a person exposed to the virus should take precautions.

The federal government continues to adjust its approach to preventing the disease from taking hold in the U.S. On Monday night, the CDC and the State Department announced that a travel advisory recommending that Americans avoid travel to China when at all possible.

Airport screening is also being expanded from five airports to 20, with the goal of screening all passengers returning from China and letting people know what they should do if they fall ill after they get home.

The CDC is conducting contact investigations of people known to have been in contact with the five patients with confirmed infections, monitoring them for symptoms and testing them if concerning symptoms emerge.

Officials at the CDC are eager to get into China in order to help scientists there answer key questions — such as whether the virus can spread from people who don’t show any symptoms of illness. Azar said at the news conference that he had been pressing his counterpart in China for permission to send investigators.

That plea has been answered, at least to a certain extent. On Tuesday, the World Health Organization announced that it had the green light to send outside experts to China. It was not immediately clear whether that will include scientists from the CDC.

Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, explained that federal agencies are taking a three-pronged approach to respond to the novel coronavirus: developing and improving diagnostic tests, investigating experimental antiviral drugs, and working to develop a vaccine.

He said if it turns out that the virus can spread from someone who is not showing any symptoms, there would be some changes in the public health response. Similar coronaviruses from past outbreaks — severe acute respiratory syndrome and Middle East respiratory syndrome — did not spread in the absence of symptoms, but that doesn’t mean the new one will behave the same way. Viruses such as measles and influenza can be spread from people who aren’t showing signs of disease.

“Even if there is some asymptomatic transmission, in all the history of respiratory-borne viruses of any type, asymptomatic transmission has never been the driver of outbreaks,” Fauci said. “The driver of outbreaks has always been a symptomatic person.”

And lastly condolences go out to the Bryant family and the other members of the helicopter crash in southern California. Kobe will be sure missed but loss of kids really upsets a father like me the most!

‘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

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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?

Drug prices rise 5.8% on average in 2020, Obamacare and True Economics and the opinions of Delaney!

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The Holidays are finally over and Rudolf was just arrested for assaulting his teammate reindeers for calling him names and laughing at him. Was this a hate crime??? Oh, how sensitive these days!! Poor, poor Rudolf!

As I was picking up a prescription today I was reminded of this article, one copy sent to me by a friend, I then went to pay for the prescription with my GoodRx card though which I was given an 80% discount. This brings up the question how will we all be able to pay for the future drugs with their outrageous prices?

It also brings up the question, how do organizations like GoodRx and Singlecare give people the discount. And what is the true value of prescription drugs and what prices should be charged in order for the always-profitable pharmaceutical companies to make an acceptable profit and what is an acceptable profit?

Consider this report published in MarketWatch by Jared S. Hopkins.

Pharmaceutical companies started 2020 by raising the price of hundreds of drugs, according to a new analysis, though the increases are relatively modest this year as scrutiny grows from patients, lawmakers and health plans.

Pfizer Inc. led the way, including increasing prices by over 9% on more than 40 products. The drug industry traditionally sets prices for its therapies at the start of the year and again in the middle of the year.

More than 60 drugmakers raised prices in the U.S. on Wednesday, according to an analysis from Rx Savings Solutions, which sells software to help employers and health plans choose the least-expensive medicines. The average increase was 5.8%, according to the analysis, including increases on different doses for the same drug.

The average is just below that of a year ago, when more than 50 companies raised the prices on hundreds of drugs by an average of more than 6%, according to the analysis.

Pfizer said that 27% of the drugs Pfizer sells in the U.S. will increase in price by an average of 5.6%. More than 90 of the New York-based company’s products rose in price, according to the Rx Savings Solutions analysis. Among them are Ibrance, which sold nearly $3.7 billion globally through the first nine months last year, and rheumatoid arthritis therapy Xeljanz.

A Pfizer spokeswoman said that nearly half of its drugs whose prices went up are sterile injectables, which are typically administered in hospitals, and the majority of those increases amount to less than $1 per product dose.

Pfizer’s largest percent increases, 15%, are on its heparin products, which are generic blood thinners typically administered in hospitals.

Pfizer said the heparin increases are to help offset a 50% increase in the cost of raw materials and expand capacity to meet market demand. The company said it is monitoring the global heparin supply, which has been challenged by the impact of African swine flu in China, as the drug is derived from pig products and disruption could lead to a shortage. Pfizer said that its U.S. heparin supply is not sourced from China.

Overall, the increases by drugmakers Wednesday affect “list prices,” which are set by manufacturers, although most patients don’t pay these prices, which don’t take into account rebates, discounts and insurance payments. Drugmakers have said prices are increased in conjunction with rebates they give to pharmacy-benefit managers, or PBMs, in order to be placed on the lists of covered drugs known as formularies.

In fact, drugmakers have said that their net prices have declined because of large rebates to PBMs, which negotiate prices in secret with their clients, such as employers and labor unions.

Pfizer said its price increases will be offset by higher rebates paid to insurers and middlemen. The company said the net effect on revenue growth in 2020 will be 0%, which is the same percentage expected for 2019. The company said the average net price of its drugs declined by 1% in 2018.

In 2018, Pfizer was assailed by President Trump after the company raised the prices on some 40 drugs. Pfizer temporarily rolled back the increases, but raised prices again later.

In Washington, Republicans and Democrats in the U.S. Congress have drawn up proposals for lowering drug costs, while the Trump administration recently introduced a plan for importing drugs from Canada.

“Prices go up but demand remains the same,” said Michael Rea, CEO of Rx Savings Solutions. Clients of the Overland Park, Kan., company include Target Corp. and Quest Diagnostics Inc. “Without the appropriate checks and balances in place, this is a runaway train. Consumers, employers and health plans ultimately pay the very steep price.”

While some increases in his firm’s analysis were steep, most product prices rose by less than 9%.

AbbVie Inc. raised the price of rheumatoid arthritis treatment Humira, the world’s top-selling drug, by 7.4%, according to the analysis. Through the first nine months of 2019, Humira sales totaled nearly $11 billion.

AbbVie didn’t respond to a request for comment.

GlaxoSmithKline PLC raised the prices on more than two dozen different therapies, although none by more than by 5%. That includes its shingles vaccine, Shingrix, which sold about $1.7 billion globally in the first nine months of 2019.

A Glaxo spokeswoman confirmed the increases and said net prices for its U.S. products fell about 3.4% on average annually the past five years.

Other major companies that raised prices included generic drugmaker Teva Pharmaceutical Industries Ltd., which raised the price of more than two dozen products, but none by more than 6.4%, according to the analysis. Sanofi S.A. raised prices on some of their therapies, but none by more than 5%, while Biogen Inc. took increases that didn’t exceed 6%, including on multiple-sclerosis therapy Tecfidera.

Teva didn’t respond to requests for comment.

A Sanofi spokeswoman confirmed the increases and said that the changes are consistent with its pledge to ensure price increases don’t exceed medical inflation. A Biogen spokesman confirmed the price changes and said adjustments are made to products for which it continues to invest in research, and otherwise increases follow inflation.

In addition to Pfizer’s increases on heparin, companies increased prices for several therapies by more than 10%, according to the analysis.

Cotempla XR-ODT, which is approved in the U.S. to treat attention-deficit hyperactivity disorder in children between 6 and 17 years old, increased by more than 13% to $420 for a month supply. The therapy is sold by Neos Therapeutics Inc., based in Grand Prairie, Texas.

Representatives for Neos didn’t respond to requests for comment.

Democrats ask U.S. Supreme Court to save Obamacare

Lawrence Hurley of Reuters reported that the Democratic-controlled U.S. House of Representatives and 20 Democratic-led states asked the Supreme Court on Friday to declare that the landmark Obamacare healthcare law does not violate the U.S. Constitution as lower courts have found in a lawsuit brought by Republican-led states.

The House and the states, including New York and California, want the Supreme Court to hear their appeals of a Dec. 18 ruling by the New Orleans-based 5th U.S. Circuit Court of Appeals that deemed the 2010 law’s “individual mandate” that required people to obtain health insurance unconstitutional.

The petitions asked the Supreme Court, which has a 5-4 conservative majority, to hear the case quickly and issue a definitive ruling on the law, formally called the Affordable Care Act, by the end of June.

Texas and 17 other conservative states – backed by President Donald Trump’s administration – filed a lawsuit challenging the law, which was signed by Democratic former President Barack Obama in 2010 over strenuous Republican opposition. A district court judge in Texas in 2018 found the entire law unconstitutional.

“The Affordable Care Act has been the law of the land for a decade now and despite efforts by President Trump, his administration and congressional Republicans to take us backwards, we will not strip health coverage away from millions of Americans,” New York Attorney General Letitia James said.

Obamacare, considered Obama’s signature domestic policy achievement, has helped roughly 20 million Americans obtain medical insurance either through government programs or through policies from private insurers made available in Obamacare marketplaces. Republican opponents have called it an unwarranted government intervention in health insurance markets.

Congressional Republicans tried and failed numerous times to repeal Obamacare. Trump’s administration has taken several actions to undermine it.

In 2012, the Supreme Court narrowly upheld most Obamacare provisions including the individual mandate, which required people to obtain insurance or pay a financial penalty. The court defined this penalty as a tax and thus found the law permissible under the Constitution’s provision empowering Congress to levy taxes.

In 2017, Trump signed into law tax legislation passed by a Republican-led Congress that eliminated the individual mandate’s financial penalty. That law means the individual mandate can no longer be interpreted as a tax provision and therefore violates the Constitution, the 5th Circuit concluded.

In striking down the individual mandate, the 5th Circuit avoided answering the key question of whether the rest of the law can remain in place or must be struck down, instead sending the case back to a district court judge for further analysis.

That means the fate of Obamacare remains in limbo. The fact that the litigation is still ongoing may make the Supreme Court, which already has a series of major cases to decide in the coming months, less likely to intervene at this stage.

John Delaney: On health care, bold vision with pragmatism is what America needs

Pulitzer prize winning editor, Art Cullen noted that in living rooms and coffee shops across all of Iowa’s 99 counties, I am forever reminded that health care is the paramount issue facing Americans. Our current system is deeply broken, and our country needs a bold vision and a pragmatic approach for improving health care. In many ways, a candidate’s approach to health care defines their governing and leadership style. It answers important questions about their values, vision, pragmatism and management style.

The Democratic Party should have as its true north universal access — where every American has health care coverage as a right of citizenship. We should support plans that encourage innovation — curing diseases like cancer and Alzheimer’s — and that create a framework for getting costs under control. My Better Care Plan uniquely achieves all of these goals.

Universal access needs to be realistic

Currently, only three candidates have detailed plans for universal access — Sens. Elizabeth Warren and Bernie Sanders and I. Universal access is the right answer, both morally and economically. The plans advocated by Warren and Sanders, however, call for an extreme “single-payer” system, where the government is the only provider of coverage.

Aside from the extraordinary practical, fiscal and political issues associated with eliminating and replacing over 180 million private insurance plans, a single-payer system will massively underfund the health care system. Today, government reimbursement is dramatically less than reimbursements paid by insurance companies. Making the government the only payer in health care would underfund hospitals, particularly in rural America, resulting in hospital closures, practitioners closing up shop, and a reduction of investment in innovation.

On the other hand, most other candidates are advocating for a “public option” as our way forward. This is a modest proposal, insufficient for the challenges of our broken health care system. A public option is simply another insurer that is government-run. It will have co-payments, deductibles, and premiums. And it relies on people choosing to sign up. While it would provide more options than are currently available in the marketplace, undoubtedly helping many, it would not address the tragedy of the uninsured in our country.

Under BetterCare we achieve the ambition of universal coverage without the negatives of a single-payer system.

Under BetterCare, Medicare is left alone, because it works, and every American from birth to 65 (seniors are on Medicare) is auto-enrolled in a free federal health care plan that covers basic health care needs. This ensures every American has health care coverage. But unlike the single-payer Medicare for All, Americans could still choose private insurance. They could “opt out” of the BetterCare plan and buy private insurance or receive insurance from their employer. If they “opt out” they would receive a health care tax credit to offset the cost of health care they purchase or that their employer provides.

Alternatively, they could use the BetterCare plan and enhance it with supplemental plans, similar to how Medicare beneficiaries acquire supplemental plans. BetterCare is like Medicare. It provides guaranteed coverage but allows our seniors to have supplemental plans or “opt out” and accept a Medicare Advantage Plan.

BetterCare is similar to the plans of most developed nations that have universal coverage. As Art Cullen wrote, it provides “universal coverage while not eliminating private insurance.” By providing universal access, choice, protecting provider reimbursements, and encouraging innovation, BetterCare is bold, ambitious, practical and a political winner. Importantly, it can be fully paid for by applying the Obamacare subsidies and current federal and state Medicaid payments and by eliminating the corporate deductibility of health care.

It is bold, yet practical, and reflective of my approach to governing. As a former entrepreneur, CEO of two public companies and member of Congress, I bring a unique approach and real leadership experience, which is why I respectfully ask for your support.

Use Simple Economics to Contain Health Care Costs

Gary Shilling wrote for Bloomberg and makes so much sense when he looked at health care costs in terms of simple economics. (Bloomberg Opinion) — Spending on U.S. health care is out of control, expanding steadily from 5% of GDP in 1960 to 18% in 2018. There are, however, ways to curb the explosion in costs from both the demand and the supply side.

Health care costs per capita in the U.S. are almost double those of other developed countries, but life expectancy is lower than many, even South Korea, according to the CIA and Eurostat. Without restraint, costs will accelerate as more and more postwar babies age. The nonpartisan Congressional Budget Office projects Medicare spending alone will leap from 3% of GDP to 8% by 2090.

Medical costs are understandably high since the system is designed to be the most expensive possible for four distinct reasons. First, with the constantly improving but increasingly expensive modern technology, the best is none too good when your life or mine is at stake. Also, few patients have the knowledge to decide whether a recommended procedure will be medically much-less cost-effective. The medical delivery system encourages a gulf between the providers who supposedly know what’s needed and their patients who don’t.

Second, patients are quite insensitive to costs since their employers or governments pay most health care bills. And those who are privately insured want to get their money’s worth from their premiums, especially since Obamacare does not allow insurers to set premiums on a health risk basis.

Third, the pay-for-service system encourages medical providers to over-service. After my dermatologist burned off the pre-cancerous growths on my face, he wanted me back in two weeks to be sure, but also to bill another office visit.

Finally, domestic training programs and facilities for medical personnel are inadequate. As a result, many MD residents and nurses come from abroad, while medical schools of dubious quality in the Caribbean train U.S.-born physicians.

To control costs on the demand side, use the appeal of money. The importance of their health to most Americans means they will spend proportionally more on medical services than other goods and services, but they’ll think twice if it’s money they otherwise can keep. Increasing deductibles and co-payments are moving in that direction. In 1999, employees on average paid $1,500, or 22%, of $6,700 in family health coverage premiums, according to the Kaiser Family Foundation. The total rose to $26,600 in 2019, but employees’ share has climbed to $6,000, or 29%.

Medical savings accounts also make patients more aware of costs. Companies give employees a set amount of money and they can keep what they don’t spend on health care.

Accountable Care Organizations, now authorized by Medicare, attack the fee-for-service problem. The medical providers who participate are encouraged to be efficient since they can retain part of any savings due to cost controls as long as they provide excellent care.

To increase the supply of medical personnel, American medical and nursing schools can be expanded with government help. Also, shortening the whole training process would save time and get huge student debts under control. Does a physician need a four-year bachelor’s degree before beginning medical school?

Cartels among hospital medical specialties can be attacked. Now, physicians in, say, the general surgery department limit competition by controlling who has the privileges to use their institution’s facilities.

In another development, the entrepreneurial model of a small group of MDs operating a practice is fading in the face of high costs of medical record-keeping and other regulatory requirements. Over half of physicians now work for hospitals, either on their main campuses or in satellite facilities. This may shift the emphasis of many from money to medicine.

Limiting malpractice insurance premiums, a major outlay for medical providers, can also cut medical costs. Texas placed a $250,000 cap on non-economic damages, i.e., pain and suffering, in 2003. Texas Department of Insurance data reveals that medical malpractice claims, including lawsuits, fell by two-thirds between 2003 and 2011, and the average payout declined 22% to $199,000.

Also, average malpractice insurance premiums plunged 46%, according to the Texas Alliance for Patient Access, a coalition of health care providers and physician liability insurers. And physicians were then attracted to Texas. The Texas Medical Association reports that in the decade since malpractice awards were capped, 3,135 physicians came to the Lone Star State annually, 770 more than the average in the prior nine years.

At present, Americans basically pay the development costs of new drugs while other countries with centralized pharmaceutical-buying skip the expenses of R&D, field trials, etc., and only pay the much-lower marginal cost of production. Allowing Medicare to join Medicaid to negotiate drug prices could reduce costs if foreigners can be convinced to share development costs. Otherwise, new drug development would be curtailed. The Trump administration’s new rules that force health insurers and hospitals to publish their negotiated prices may force costs to the lowest level.

One approach that doesn’t work in easing the burden on consumers of medical costs is increasing overall government subsidies. They tend to be offset by higher costs, much as higher college tuition and fees often dissipate more scholarship aid. Ever notice that the most modern, prosperous institutions in town tend to be hospitals, hugely subsidized by governments?

Health care is critical, but that doesn’t mean its costs aren’t subjected to supply and demand. Then how do we assess the value as well as the costs and cost limitations? Are drug companies as well as insurance companies making way too much in profits by taking advantage of we the honest patients??

There many parts of the eventual answer to our need for a health care program which can service all at reasonable costs and each “part” needs thorough investigation and real solutions and that just addressing only one or two of these “parts” will never be sustainable!!

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

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Last week Suneel Dhand reported that compared to a couple of years ago, very little has changed in the hospital medical community.

In fact, I’m sure the divergence of the curves has only grown bigger, as more and more administrators are added to the ranks of healthcare. Look at what happened in Chicago where one of the fairly large hospitals fired 15 of their physicians and replaced them with 15 nurse practitioners last year, and in Texas 27 pediatricians at a chain of clinics in the Dallas area lost their jobs and were replaced by nurse practitioners.

Quite often in life, the answers to some of the biggest questions we have, are staring us right in the face and incredibly simple. Healthcare can never be fixed unless we radically simplify everything and strip away the unnecessary complexities in our fragmented system. The divergence of the above lines, however, actually represents so much more than just an obnoxious visual. It actually symbolizes what happens when any organization, system, or even country, becomes top-heavy and loses sight of what is happening at the front lines. And in the end, it eventually collapses under its own weight.

When this happens in America, we cannot predict, but consider this: The amount we spend on healthcare would be the 4th largest economy in the world if it stood alone (at $3.5 trillion, only China and Japan have a higher total GDP). With an aging population, increasing chronic comorbidities, and expensive new treatments, if costs are not reined in, healthcare expenditure could account for a third of the entire GDP in about 25 years. A figure that will quite simply destroy the American economy.

It would be one thing if all the administration and bureaucracy was actually resulting in an improved and more efficient healthcare system. But look around you folks. Acute physician shortages now plague every state. Millions of people find it impossible to find a primary care doctor. Certain specialties are now booking out appointments months in advance. ERs and hospitals are overflowing. And in the end, patients are still facing soaring out of pocket expenses.

The last 20 years have witnessed the consolidation and corporatization of the entire U.S. healthcare system. Sold initially as a way to reign in costs, I am yet to see any evidence that it’s done anything other than dramatically increase costs (please feel free to forward me any financial analysis if I’m wrong). And why should that be a surprise to anyone?

I’ll leave you to stare once again at the above graph for a minute or two, and take in a comment that a distinguished physician colleague of mine recently made: “It’s like the physicians have been given weed killer and the administrators have been given Miracle-Gro.”

Affordable Care Act funding in question after health insurance taxes repealed

The Cadillac Tax, Health Insurance Tax and Medical Device Tax were recently repealed, raising questions over how the Affordable Care Act will be funded in the future. Yahoo Finance’s Anjalee Khemlani joins Adam Shapiro, Julie Hyman and Dan Howley during On the Move to break it all down.

Andrew Yang Has The Most Conservative Health Care Plan In The Democratic Primary

Daniel Marans of the Huff Post pointed out that Entrepreneur Andrew Yang has had unexpected staying power in the Democratic presidential primary thanks in part to the enthusiasm for his plan to provide every American with a basic income of $1,000 a month.

But the boldness of his signature idea only serves to underscore the unambitiousness of the health care plan he released earlier this month.

In fact, Yang’s health plan, which he bills as an iteration of the left’s preferred “Medicare for All” policy, is more conservative than proposals introduced by the candidates typically identified as moderate.

Former Vice President Joe Biden, South Bend, Indiana, Mayor Pete Buttigieg and Sen. Amy Klobuchar of Minnesota all at least call for the creation of a public health insurance option that would be available to every American. (Sen. Bernie Sanders of Vermont and Sen. Elizabeth Warren of Massachusetts favor Medicare for All, which would move all Americans on to one government-run insurance plan ― though the two senators disagree on the timeline for implementing the idea.)

In terms of expanding health insurance coverage, Yang says on his website merely that he would “explore” allowing the employees of companies that already provide health insurance the chance to buy into Medicare.

“We need to give more choice to employers and employees in a way that removes barriers for businesses to grow,” Yang writes.

Under Yang’s plan, people employed by businesses that do not provide insurance, or who are self-employed, would continue to purchase coverage on the exchanges created by former President Barack Obama’s Affordable Care Act.

The decision not to focus on expanding coverage distinguishes Yang dramatically from his competitors. And in the foreword to his plan, he explains that that is a deliberate choice, since enacting single-payer health care is “not a realistic strategy.”

“We are spending too much time fighting over the differences between Medicare for All, ‘Medicare for All Who Want It,’ and ACA expansion when we should be focusing on the biggest problems that are driving up costs and taking lives,” he writes. “We need to be laser focused on how to bring the costs of coverage down by solving the root problems plaguing the American healthcare system.”

When asked about how Yang plans to expand health insurance coverage ― 27 million Americans remain entirely uninsured and millions more have insurance that is so threadbare they do not use it ― Yang’s campaign referred HuffPost to his website.

Yang would increase health care access through reforms designed to reduce the health care system’s underlying costs, according to his campaign. On his website, he divides those reforms into six categories: bringing down the cost of prescription drugs through bulk negotiation; investing in waste-saving health care technologies; realigning medical providers’ “incentives” away from waste and abuse; increasing investment in preventive and end-of-life health care; making the provision of health care more “comprehensive”; and reducing the influence of lobbyists on the political system.

Yang implies that his rivals have sacrificed cost control in the name of expanding coverage. But when it comes to the specifics, Yang’s competitors have already gotten behind many of the ideas he is proposing ― and sometimes take them a step further.

For example, Buttigieg has a provision in his health care plan that would prohibit “surprise billing” ― the practice of providing unwitting patients with a large bill after a medical procedure when a doctor who performed it is not in the hospital’s insurance network. Yang does not mention the practice in his health care plan.

One provision of Yang’s plan that genuinely sets him apart is his plan to encourage the replacement of the fee-for-service billing model for doctors with salaries. The latter model is supposed to cut back on duplicative practices and foster more holistic care. Other elements of his plan, such as “incentivizing” gym memberships, healthy eating and bike commuting as a form of preventive health care, have drawn eye rolls from leftists who regard the ideas as paternalistic.

First and foremost, though, many progressives are likely to find fault with Yang’s plan, because they consider his use of the term “Medicare for All” misleading.

For months on the campaign trail, Yang claimed that he supported Medicare for All, though not the provision of Sanders’ bill ― and its companion in the House ― requiring people with private insurance to enroll in an expanded Medicare program.

He even aired a television ad casting his commitment to the policy as a reflection of his experience as the father of a special needs child.

Yang says on his campaign website that he is still firmly committed to the “spirit” of Medicare for All. But now that he has introduced a plan of his own, that claim is harder to defend.

Yet the Yang campaign is plowing full-steam ahead with its appropriation of the term in a new 30-second ad, “Caring.”

“If my husband, Andrew Yang, is president, he’ll fight for Medicare for All with mental health coverage,” Yang’s wife, Evelyn, says in the ad.

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!

US Health-Care Prices Are Off the Charts, Pros and Cons of Public vs Private healthcare and possible Financing of Medicare for All

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After listening to the debates and the House debating and finally voting to approve the Articles of Impeachment I can actually say that I am embarrassed for we Americas and our Country. We all look like such fools! I say this because I have read critically the transcripts of the phone call that President Trump made to the President of Ukraine, listened to the witnesses in the case and have found no credible data to support an Impeachment. But how can one argue with the Hate of the party that lost the 2016 election? But on to discuss additional information on healthcare.

Michael Rainey of the Fuscal Times reported that a CT scan of the abdomen typically costs more than $1,000 in the U.S., but the same procedure in the U.K. costs $470, while in the Netherlands it costs just $140. Those numbers come from a new report, released Tuesday by the Health Care Cost Institute and the International Federation of Health Plans, that compares private insurance health-care prices in the U.S. to those in a sample of other wealthy countries – and finds that the U.S. is just about always the most expensive.

“The median prices paid by private insurance for health care services in the United States was almost always higher than the median prices in the eight other countries included in the iFHP study,” the report says. “Figure 1 [below] shows the prices paid for medical services in each country as a percent of the US price.”

Note that U.S. prices are marked by the red dots. In almost every case, the prices in other countries are just a fraction of the U.S. price. (Avoid getting cataract surgery in New Zealand, apparently.)

The report also looks at drug prices, and finds that with only one exception, prices in the U.S. are the highest in the group. Harvoni, used to treat hepatitis C, costs $4,840 in South Africa and $12,780 in the Netherlands, but it costs more than twice that ($31,620) in the U.S. Similarly, a Humira pen, used to treat arthritis, costs $860 in the U.K., but $4,480 in the U.S.

“Drug prices for most countries were less than half the US price for most of the administered and prescription drugs included in the study,” the report says.

Writing about the report Tuesday, Vox’s Dylan Scott said that high medical prices in the U.S. have many causes, but one in particular stands out: “The US is still the wealthiest country in the world. It’s home to the world’s leading biopharmaceutical industry. It tends to have the most cutting-edge treatments. All this contributes to higher prices here than elsewhere. But one big and unavoidable culprit is the lack of price regulation.”

American health care is a farce

Rick Newman reported that the cost of private health insurance is skyrocketing. Medicare will run short of money soon. About 28 million Americans still lack health insurance.

Are your elected officials on it? NOPE! Why should they be. They get generous coverage through a choice of plans and enjoy taxpayer subsidies covering most of the cost. So they’ve taken care of themselves, which is the only thing that matters in Washington.

Wait, that’s not quite correct. Republicans are also determined to keep hacking away at the Affordable Care Act, now in place for 9 years. A GOP lawsuit—backed by the Trump administration—claims the entire ACA is unconstitutional, because in 2017 Congress repealed the penalty for people who lack insurance. It’s a convoluted argument, yet an appeals court recently upheld part of the case and sent the rest back to a lower-court judge, to assess which other parts of the ACA to kill. The law isn’t dead yet, and it might ultimately survive, but it could take the Supreme Court to rescue the ACA from its third or fourth near-death experience.

So here’s the story: There’s a health care crisis in the United States, with millions of people lacking care and many millions more facing costs that are rising far faster than their incomes. Health care costs are devouring both the family and the federal budget. And many workers stay in jobs they’re not suited for simply for the health benefits. Yet Republicans are trying to take care away from about 18 million Americans, and repeal the ACA’s prohibition against denying coverage to people with preexisting coverage. Their answer to giant problems of access and affordability is to make coverage even harder to obtain and drive up costs even more.

The Democrats have answers! Presidential candidates Bernie Sanders and Elizabeth Warren want to annihilate the private insurance system and create a government program, Medicare for All, which would be 15 times larger than the ACA Republicans hate so much. Sure, that’ll work. In response to obstinate political opposition, peddle a fantasy plan that generates even more furious resistance. And tell voters you refuse to compromise because it’s more important to stand for the right thing than to actually accomplish something that could improve people’s lives.

There are better ideas out there. Democrats such as Joe Biden, Pete Buttigieg and Amy Klobuchar favor enhancements to the ACA and a new public option that would provide coverage to nearly all the uninsured while leaving private insurance in place, for those who want to stick with that. It will never get Republican support, since Republicans favor the law of the jungle over government aid. But a Bidenesque plan could happen in the unlikely event a few reddish states grow momentarily sensible and elect a few pragmatic Democrats, including a majority in both the House and Senate.

If that doesn’t happen, we can look forward to posturing on both sides that will fool some voters into thinking politicians care, without accomplishing anything likely to help. The Trump administration is pushing a new plan that would allow states to import prescription drugs from Canada, which enforces price controls that make drugs cheaper. Great idea, as long as Canada has no problem diverting drugs meant for Canadians back to America, where many of the drugs come from in the first place. Why doesn’t America just impose its own price controls? Because pharmaceutical companies own Senate Majority Leader Mitch McConnell and many other members of Congress, who won’t let it happen. So Trump is hoping more principled Canadian legislators will help Americans gets cheaper drugs made in America by American companies.

At least you’ll be free of all these worries once you turn 65, and Medicare kicks in. Except Medicare is going to run short of money starting in 2026, and will eventually be able to pay only about 77% of its obligations. So here’s the real health care plan: Don’t get sick until you turn 65, and then, get just 77% as sick as you would have otherwise. Or just move to Canada.

Pros and cons of private, public healthcare

A study by Flinders University found that the rising cost of private health cover and public hospital standards raise concerns among heart patients to obtain the best outcomes.

In one of the few direct comparisons, medical researchers in South Australia have analyzed data from pacemaker and defibrillator implant surgeries in all public and private hospitals in New South Wales and Queensland between 2010 and 2015 to make an assessment of medical safety outcomes, including infection levels and mortality.

Overall the outcomes were quite similar, says lead researcher Flinders cardiologist and electrophysiologist Associate Professor Anand Ganesan, who joined other Flinders University and University of Adelaide researchers in a new article just published in the Royal Australasian College of Physicians Internal Medicine Journal.

“There is growing community interest in the value of private health insurance and, to date, there are few head-to-head studies of the outcomes of care in public and private hospitals to compare the same service with adjustments for differences in patient characteristics,” says Associate Professor Ganesan, a Matthew Flinders Research Fellow and National Heart Foundation Future Leader Fellow.

“We believe our results are of community interest for patients to assess the value and benefit of private health insurance, as well as for policymakers who decide on resource allocations between the public and private healthcare systems.”

He stressed that further “head-to-head” studies are needed across all major medical procedures to provide patients and clinicians in both the public and private system with the most up-to-date safety information.

The population level study of pacemaker complications found few key differences in overall major safety issues, although there were slightly higher infection rates in public hospitals but slightly lower acute mortality rates compared to the private hospital system.

This could be connected to the greater number of older, frail patients relying on private health cover—and greater number of people in the public system—although further studies were needed to explain these differences.

Associate Professor Ganesan says more regular comparative assessments of public versus private hospital care quality are very important, particularly for Australian health consumers.

Australia’s hospitals account for more than 40% of healthcare spending with a cumulative cost exceeding $60 billion per annum. Hospital care in Australia is delivered by a combination of 695 public (or 62,000 beds) and 630 private sector hospitals (33,100 beds).

The research paper, “Complications of cardiac implantable electronic device placement in public and private hospitals” has been published in the Internal Medicine Journal.

Budget watchdog group outlines ‘Medicare for All’ financing options

So, one of my oppositions to the program Medicare for All has been the question as to financing the program. The Committee for a Responsible Federal Budget (CRFB) on Monday released a paper providing its preliminary estimates for various ways to finance “Medicare for All,” as the issue of how to pay for such a health plan has taken center stage in the Democratic presidential primary.

“Policymakers have a number of options available to finance the $30 trillion cost of Medicare for All, but each option would come with its own set of trade-offs,” the budget watchdog group wrote.

The issue of how to pay for Medicare for All — single-payer health care that eliminates premiums and deductibles — has become a key discussion topic in the Democratic presidential race.

Sen. Elizabeth Warren (D-Mass.), one of the top tier 2020 hopefuls, recently said that she would release a financing plan for her Medicare for All proposal after being criticized by some of her rivals in the primary race for refusing to give a direct answer about whether she’d raise taxes on the middle class to pay for the massive health care overhaul.

CRFB said most estimates find that implementing Medicare for All would cost the federal government about $30 trillion over 10 years.

“How this cost is financed would have considerable distributional, economic, and policy implications,” the group wrote.

CRFB provided several options that each could raise the revenue needed to pay for Medicare for All. These included a 32 percent payroll tax, a 25 percent surtax on income above the standard-deduction amount, a 42 percent value-added tax, mandatory premiums averaging $7,500 per capita, and more than doubling all individual and corporate tax rates.

The group estimated that Medicare for All could not be fully financed just by raising taxes on the wealthy.

CRFB also estimated that cutting all nonhealth spending by 80 percent, or by more than doubling the national debt, so that it increased to 205 percent of gross domestic product, could finance Medicare for All.

The group said that the financing options it listed could be combined, or that policymakers could reduce the cost of Medicare for All by making it less generous.

“Adopting smaller versions of several policies may prove more viable than adopting any one policy in full,” CRFB wrote.

CRFB said that most of the financing options it listed would on average be more progressive than current law, but most of the financing options would also shrink the economy.

Out-of-pocket costs for Medicare recipients will rise in the New Year

Dennis Thompson reviewed the future costs of Medicare since the Democratic primary discussion seems to point to Medicare or All. He noted that the standard monthly premium for Medicare Part B would rise $9.10, to $144 a month, the U.S. Centers for Medicare and Medicaid Services (CMS) announced.

The annual deductible for Part B also will increase $13 to $198 per year, CMS said.

Both increases are relatively large compared to 2019, when the Part B premium rose $1.50 a month and the deductible $2 for the year.

“This year there’s an unusual tick up in the Part B premium that could be a real concern for people living on a fixed income,” said Tricia Neuman, director of the Henry J. Kaiser Family Foundation’s Program on Medicare Policy.

The Part B premium increase will affect people enrolled in original Medicare as well as those who are covered under Medicare Advantage, said David Lipschutz, associate director of the Center for Medicare Advocacy.

“One thing I definitely wanted to make clear is that the increase in the Part B premium itself also applies to everyone on Medicare Advantage,” he said. “People on Medicare Advantage have to continue to pay the part B premium.”

Some, but not all, Medicare Advantage plans cover the Part B premium as part of their package, Lipschutz added.

The annual inpatient hospital deductible for Medicare Part A is also increasing to $1,408 a year, up $44. In 2019, the increase was $24.

These cost increases will wipe out much of the 1.6% cost-of-living (COLA) increase for Social Security benefits in 2020, CBS News reported. The COLA amounts to about $24 extra a month for the average retiree.

Medicare Part A covers inpatient hospital stays, nursing facility care and some home health care services. Part B covers doctor visits, outpatient hospital treatment, durable medical equipment, and certain home health care and medical services not covered by Part A.

Unless Congress acts, the prescription benefit in Medicare Part D also will start drawing a lot more money out of the pockets of seniors taking pricey drugs, the experts added.

The Affordable Care Act (ACA) included a provision that limited how much a senior with Part D would pay out-of-pocket after reaching a “catastrophic coverage” threshold, Neuman and Lipschutz said.

Once they reach that threshold, seniors pay 5% of their prescription costs. Until then, they pay 25% of the costs for brand-name drugs and 37% of generic drug costs.

But that ACA provision expires this year. When that happens, the catastrophic coverage threshold will jump $1,250, the Kaiser Family Foundation estimates. People will have to pay $6,350 out-of-pocket before reaching the threshold.

“There will be a jump up in the threshold, which means that people with high drug spending will have to pay more before they can get this extra help,” Neuman said.

Both the Senate and the House of Representatives have bills in the works that could address this Part D increase, but it’s hard to predict whether Congress will be able to cooperate on a solution, Neuman and Lipschutz said.

“No matter what your allegiances are, everyone agrees something should be done about the high cost of prescription drugs,” Lipschutz said.

It’s not all bad news, however.

Folks with Medicare Advantage are expected to pay lower premiums, even with the increase in Part B, according to the CMS.

On average, Medicare Advantage premiums are expected be at their lowest in the past 13 years, and 23% lower than in 2018, the CMS said.

Medicare Advantage enrollees also will have more plans to choose from. The Kaiser Family Foundation estimates that the average beneficiary will have access to 28 plans, compared with a low of 18 in 2014.

Original Medicare is the traditional fee-for-service program offered by the federal government, while Medicare Advantage plans are an alternative provided through private insurance companies.

Medicare beneficiaries spent an estimated $5,460 out-of-pocket for health care in 2016, according to the Kaiser Family Foundation. About 58% went to medical and long-term care services, with the remainder spent on premiums for Medicare and supplemental insurance.

So, the ultimate question is :

Equal health care for all: A philosopher’s answer to a political question

The University of Pennsylvania staff asked the question-Should access to health care, especially in life-threatening situations, depend on whether you can afford it? Absolutely not, says Robert C. Hughes, Wharton professor of legal studies and business ethics, who compared health care systems in the U.K., Canada, and Australia. He writes about this question and other issues in a recent paper titled, “Egalitarian Provision of Necessary Medical Treatment.”

Hughes identifies two key features of an egalitarian health care system. First, he argues, it would protect people’s liberty to ensure that access to money does not decide if people get the health care they need. Second, it would promote stability and encourage people to be law abiding. “The central finding of [my research] is that it’s morally necessary to make sure that people’s finances don’t affect their ability to get truly medically necessary treatment,” he says.

Hughes favors universal health care coverage in the U.S. Further, in order to ensure that everybody has access to the medical care they need, he says one option is to eliminate private health insurance for coverage provided under “Medicare for All,” the solution that Democratic presidential candidates Elizabeth Warren and Bernie Sanders have proposed. Hughes explores what legislators, the pharmaceutical industry, and other health care providers could do to ensure a fair health care system where private parties don’t get to decide who is eligible for what treatments.

I mentioned my embarrassment and disappointment in our political system we all have to give thanks for all the good things in our lives. As Christmas approaches we all should reflect on the good in our lives and enjoy the Holiday including family and friends. Merry Christmas, Happy Hanukkah, and Happy Kwanzaa! And I hope Santa leaves coal in all the stockings of our politicians who can’t even do the job that we the voters asked them to do when we voted them in. Oh, how you are making a mockery of the system in the games that you all are playing!

I have been avoiding the discussion regarding single payer system, what it is, how it would work and what are the consequences, etc.? More to come!

A British doctor was treated in an American emergency room and said it revealed how broken US healthcare really is, The Republicans on Healthcare and Obamacare Again!!

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“You should never, ever have to say, ‘I can’t afford this medical treatment I need,'” he said. Really??
He experienced American healthcare firsthand when he went to the emergency room in the US with a bloody finger.
Adam Kay says he never paid a single medical bill in his life — until, while vacationing in the US, he got a piece of glass lodged in his finger.

His finger sprang open, spurting bright red blood in every direction.

“It was really embarrassing. It was like a little fire hose,” the former obstetrician told Insider. “It looked like there’d been some sort of massacre, and the blood was coming, and I couldn’t stop it bleeding.”

That was the day that Kay got a glimpse of just how different the US healthcare system is from the system in his home in the UK, where medical care is taxpayer-funded.

Kay swiftly headed off to the nearest emergency room, travel-insurance card in hand, for care.

“They took my card details and my insurance details,” he recalled. “That was the most important thing. And that was quite weird, because that just doesn’t happen back home.”

Kay, a former National Health Service worker who chronicled his time as a doctor in a bestselling book, “This Is Going to Hurt,” said he took great pride in being a doctor in the NHS — what he called the “closest thing” Brits have to “a national religion.”

One of the biggest differences between the UK and US health systems, he’s noticed, is the pay-as-you-go, employer-bankrolled nature of many American health plans. He said the for-profit US health system undermined the idea that healthcare is a basic human right.

“The NHS was founded on the principle that it’s free at the point of delivery and you’re treated according to clinical need, not ability to pay — whether you live in Windsor Castle or on a bench outside Windsor Station,” Kay wrote in his book. “Other systems around the world might be more efficient, but I’d drag myself out of a coma to argue that none of them is fairer.”

Kay acknowledged that it’s not a perfect system. In recent years, it’s been tough for the NHS to find enough doctors and nurses to go around. With Brexit on the horizon, many doctors are worried that the shortages will only get worse.

Meanwhile, the UK’s Conservative Party, famous for slashing the NHS’s budget in recent years, won an overwhelming majority of parliamentary seats in the country’s general election on Thursday. British Prime Minister Boris Johnson, the Conservative leader, has promised to reverse course and make the national healthcare system the first priority. Even so, he’s proposing to spend less than his left-wing rivals.

Despite issues of cash and people power, the NHS still tends to outperform private care systems in the US. For example, the NHS said that in November, more than 80% of patients who were rushed to the ER were admitted, transferred, or discharged within four hours. In California, the average ER patient can expect to wait more than 5 1/2 before admission. Life expectancy is also shorter in the US by more than two years.

“I feel like America’s been gaslit about what the NHS is,” Kay said. “I speak to hugely intelligent people over here who’ve just been slightly brainwashed into the idea that healthcare is rationed.”

Instead, he said, it’s the US system that has “got this wrong.”

“You’ve got yourself worked up into this lunatic situation where everything’s itemized and everything’s become hyperinflated, because it’s become a marketplace,” Kay said. “I don’t think that should ever play a part in medicine. They’re two separate things. Do what’s best, clinically.”

That was not how Kay’s trip to the ER went.

Money should not dictate best practices in medicine, Kay said- hmmm, and that’s why the most complex, complicated cases in other countries come to the U.S. for treatment!!

After the bleeding stopped, Kay was shocked when his doctor said he’d have to decide what to do based on how much he wanted to spend.

“They said, ‘Normally, because it was a glass injury, we would want to X-ray it, just to make sure that nothing’s got into the joint, but that will be an extra $1,500.’ I’m suddenly thinking, do I really [want this X-ray]? I imagine I’ll get this back from my travel insurance, but if I don’t, that’s a lot of money on my holiday … And then I suddenly thought, no! If I was the doctor back home, I wouldn’t suggest it as an option. I would say, ‘This is best practice.'”

The cost of US healthcare has consistently been at the top of the list of issues Americans are most worried about. Healthcare bills are the most common reason Americans file for bankruptcy protection. In the UK, while people are still concerned about the direction of their national healthcare system, they’re more likely to say their top life worry is a looming Brexit deal, or crime, or maybe the environment.

“You should never have to sell your house ’cause you got ill,” Kay said. “You should never, ever have to say, ‘I can’t afford this medical treatment I need.’ I’ve just grown up in an environment where it’s effectively a human right. You get the healthcare you need.”

Interesting, then who pays the bill and if the government is paying all the bills and if there is no fear of bills and who will pay them the patient can ask for anything to treat them without care as to expense and can go from doc to doc without care as to cost. Not a happy scenario.

A growing number of Republicans say they’re satisfied with US healthcare costs — even as insurance prices have surged 20% in the past year

Joseph Zeballos-Roig noted that a growing number Republicans are satisfied with the cost of healthcare in the United States, according to a new Gallup poll released Wednesday.

The increase comes as another major index from the Labor Department showed average insurance prices spiking 20% over the last year.

The poll noted overall satisfaction with US healthcare costs is the highest since 2009 as just over one in four Americans are content with the healthcare pricing environment — though much of that boost was driven by the uptick in Republican approval.

It suggests that heightened partisanship is swaying Republicans on healthcare just as it has been on the economy, another issue where they are much likelier than Democrats to view the situation more favorably, An growing number of Republicans are satisfied with the cost of healthcare in the United States, according to a new Gallup poll released Wednesday. The increase comes as another major index from the Labor Department showed average insurance prices spiking 20% over the last year.

The Labor Department’s consumer price index, which tracks the average change over time in prices paid for goods and services, said the cost of overall medical care rose 5.1% since Nov. 2018. That measure also incorporates doctors’ visits and hospital services.

The cost of health insurance had the biggest jump over the past year at 20.2%, representing one part of the broader healthcare industry. Other elements such as the price of doctors’ visits and hospital services saw more modest increases at 1.4% and 3.3%, respectively.

By comparison, only 9% of Democrats were satisfied with healthcare costs in the US, according to the Gallup poll.

Still, another recently-released Gallup poll showed both Democrats and Republicans broadly satisfied with what they pay for their own healthcare, though there was a notable dip in Democratic satisfaction and an increase among Republicans.

The cost of healthcare, though, continues to rise in the United States.

That’s led to Democratic primary candidates to propose a variety of methods to reform American healthcare. They range from incrementally shoring up the Affordable Care Act and introducing an optional government insurance plan to enrolling every American into a government-run insurance system.

Trump has repeatedly promised to introduce another plan to replace Obamacare, but he hasn’t done so yet.

House Republicans rolled out their own alternative in October, but it looks a lot like the unpopular “skinny repeal” version that was narrowly defeated by a single Senate vote in 2017. That one has almost no chance of becoming law before the 2020 election as it would have to pass the Democratic-led lower chamber.

Striking down Obamacare would open a path to better, more affordable health care

Realize that I really believe that Obamacare was and still is a well thought out health care system, but my concern is the lack of long term financing of the program, especially in comparison to the new program touted by the Democratic liberals running for president. Now, Thomas Price and Alfredo Ortiz and Opinion contributor noted that The 5th Circuit Court of Appeals in Texas is expected to rule soon on the constitutionality of Obamacare. While its decision will have significant implications for American health care policy, it won’t affect people’s health coverage for at least a couple of years as the appeals process plays out. In the meantime, a ruling striking down Obamacare would give the country the opportunity and the impetus to unite behind a health care reform plan that actually lowers costs, increases choices and improves the doctor-patient relationship.

In 2012, the U.S. Supreme Court ruled that Obamacare was constitutional under the government’s power to tax. However, President Donald Trump’s tax cuts eliminated the tax, more commonly known as the penalty, for not purchasing health insurance. In February 2018, 20 states led by Texas filed suit against the federal government, arguing that Obamacare was no longer constitutional because the tax upon which the law had been based no longer existed. Without this tax, the plaintiffs argued, the law’s individual mandate is nothing more than the unlawful federal compulsion to purchase health insurance.

Last December, a federal judge in Texas agreed with this reasoning and declared Obamacare unconstitutional. But he also issued a stay on his judgment, allowing the law — the Affordable Care Act — to remain while the case is being appealed in order to save Americans potentially needless uncertainty. The case, Texas vs. Azar, was then appealed to the 5th Circuit.

Disgraceful fearmongering

Politicians and commentators claim that this case threatens to eliminate health care coverage for Americans covered by Obamacare. California Attorney General Xavier Becerra, who is leading the appeal, called the lower court ruling “an assault on 133 million Americans with preexisting conditions, on the 20 million Americans who rely on the ACA for health care.” House Democratic Caucus Chairman Hakeem Jeffries claims that the Trump Justice Department is trying to “destroy health care for tens of millions of Americans.”

Sabrina Corlette, co-director of the health care industry-funded Center on Health Insurance Reforms at Georgetown University, warns that if Obamacare is deemed unconstitutional, “the chaos that would ensue is almost impossible to wrap your brain around. The marketplaces would just simply disappear and millions of people would become uninsured overnight, probably leaving hospitals and doctors with millions and millions of dollars in unpaid medical bills. Medicaid expansion would disappear overnight.”

This is fearmongering of disgraceful proportions. In reality, Democrats would appeal a plaintiff’s victory to the Supreme Court. In the meantime, the trial court stay would remain in effect. The earliest the high court would be able to hear the case would be next fall at the start of its next session, barring an expedited Supreme Court timeline. Based on the usual timeline between hearings and rulings, this means the soonest it would issue a final decision would be the spring of 2021. Obamacare health coverage already purchased and planned upon for 2021 would likely continue.

Listen to your doctor: Medicare for All government chokehold would be even worse than private insurance

In the meantime, policymakers and reformers can develop a health care alternative that fixes the many flaws in Obamacare while keeping its protections for those with preexisting conditions. Obamacare has done nothing to control spiraling medical costs and diminishing health care choices for many ordinary Americans. Despite their different reform visions, Republicans and many Democrats are united in their agreement that the country must move on from Obamacare.

‘Medicare for All’ would be worse

Yet the solution proposed by these Democrats — “Medicare for All” — would exacerbate our current cost and choice problems even further. The Mercatus Center of George Mason University estimates that Medicare for All would cost $32 trillion over 10 years. That means one year would amount to more than two-thirds of the entire 2020 federal budget.

The only way government-run health care could attempt to control costs is by rationing care — meaning fewer options, longer wait times and less innovation.

‘Medicare for All’ is unpopular: Democrats could lose to Trump if they abandon Obamacare and private health insurance

A better alternative is the Job Creators Network Foundation’s “Healthcare for You” framework, which prioritizes reform from the bottom up rather than the top down. In practice, this means deregulating insurance markets and allowing state officials to set insurance parameters while maintaining protections for those with preexisting conditions. Instead of the one-size-fits-all health care plans that proliferate today, this reform would unleash a flood of new insurance options — from Cadillac to catastrophic — that patients could tailor to their unique needs.

By also prioritizing direct medical care, transparent prices and expanded tax-free health management accounts (also called health savings accounts), a true health care market would emerge, allowing patients to shop for coverage while prices fell.

A Texas vs. Azar ruling that deems Obamacare unconstitutional will help spur such long-overdue patient-centric health care reforms. It will not immediately remove lifelines for patients, as critics claim.

Sunday Deadline Looms For Affordable Care Act Open Enrollment

Brakkton Booker alerted us all that for millions of Americans, time is running out to sign up for health insurance through the Affordable Care Act’s online marketplace healthcare.gov.

For those who will not receive health coverage beginning Jan. 1, 2020 through an employer or other programs like Medicaid, Medicare or the Children’s Health Insurance Program — commonly referred to as CHIP — the deadline to purchase health insurance is Sunday, Dec. 15.

Health and Human Services Secretary Alex Azar tweeted a reminder: “If you decide that purchasing coverage through healthcare.gov is the right decision for you, make sure you select coverage by this Sunday.”

December 15 is the deadline to shop for 2020 plans.

Costs are down and choices are up for 2020 plans. If you decide that purchasing coverage through

is the right decision for you, make sure you select coverage by this Sunday.

Sign-ups for 2020 coverage in the first six weeks of open enrollment for the ACA, also referred to as Obamacare, are down slightly, trailing last year’s totals by 6%. However, this decline is happening at a slower rate when compared to 2019 coverage sign-ups in the first six weeks. That decline dipped 12%, according to Modern Healthcare.

The publication also notes that the latest numbers “don’t include the millions of people who will be automatically enrolled in coverage at the conclusion of open enrollment.”

NPR’s Health Policy reporter Selena Simmons-Duffin told NPR’s Up First podcast on Saturday that enrollment has been down every year since 2016.

“Last year more than 11 million people enrolled and we’re on track to be slightly behind that this year,” Simmons-Duffin said.

Many experts blame the drop in sign-ups on the Trump administration making sharp reductions in outreach efforts to connect would-be insurance purchasers to available plans.

“One of the actions that President Trump’s administration took to change the [Affordable Care Act] law is to radically cut back the funding to do outreach and to do advertising to let people know that this exists,” Simmons-Duffin said.

Kaiser Health News points out there is typically “a flurry in the last few days before the Dec. 15 deadline” when last-minute participants decide to sign-up.

Some states have seen double-digit declines. In Arizona, for example, enrollments are down 17% from this time a year ago, according to the Arizona Republic. The paper cites “apprehension among some Latino families over enrolling in anything government-related” as one possible cause for the drop off.

Meanwhile, Delaware Public Media reports a 1.7% decline from last year. It adds: “Lagging enrollment comes despite premiums in Delaware dropping for the first time since the ACA became law seven years ago.”

Health officials in California announced Thursday more than 130,000 people signed up for new coverage plans this year — an increase of 16% compared to the open enrollment period last year.

For those who miss the open enrollment sign-up period, not all is lost. The health care law does allow, in specific cases, a special enrollment period where people can sign-up after the open enrollment period ends.

The government lists circumstances including losing health insurance, getting married, moving, having a baby or adopting a child as “life events” that would make applicants eligible.

And the confusion continues with no real solution in the horizon! Let’s get to the discussion that I had promised, what a single-payer system is really all about!

Musings of a Doc with an MBA

Business strategy and healthcare

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