Category Archives: Health Economics

American Healthcare isn’t About Care. Hint: Deep Throat’s Tip to Woodstein

But the hospital never sent her bills to Medicaid, which would have paid for the care in full, and the hospital refused requests to do so. Instead, it pursued an amount five times higher from Ms. Smith directly by placing a lien on her accident settlement.”

“Parkview is among scores of wealthy hospitals that have quietly used century-old hospital lien laws to increase revenue, often at the expense of low-income people like Ms. Smith. By using liens — a claim on an asset, such as a home or a settlement payment, to make sure someone repays a debt — hospitals can collect on money that otherwise would have gone to the patient to compensate for pain and suffering.”

Medicynical Note: No surprises here, to understand the core values of American healthcare providers just follow the money and observe the trickery used to maximize revenue……which of course discourages service. Charging the least able to pay the most is a long-standing American hospital tradition.

Trump’s Pre-existing Illness NON-PROMISE

“The Trump administration touched off another politically charged battle over the future of Obamacare with its latest maneuver to dismantle the law amid a pandemic — a move that Democrats immediately weaponized for competitive campaigns this fall and few Republicans defended.”

“The 82-page brief filed late Thursday to the Supreme Court in a high-profile case brought by GOP state attorneys general undercuts President Trump’s repeated pledges to ensure coverage for people with preexisting conditions as his administration and the broader Republican Party seek to wipe away that protection.”

“Trump vowed as recently as last weekend, at a campaign rally in Tulsa, that he would “always protect patients with preexisting conditions, always, always.” But his own administration’s position in court is that the 2010 Affordable Care Act’s individual mandate is unconstitutional, and therefore so is the entire law — even its most popular provisions, such as coverage for those with preexisting conditions.”

Medicynical Note:  And now the fine print on Trump’s pre-existing illness non-guarantee. 

Trump’s promise to protect patients with pre-existing illnesses does not guarantee affordable pricing.  Insurers can and will charge people with pre-existing problems more, much much more. 

And if the patient can’t afford the insurers price for coverage,  republicans then usually propose to put them into high risk pools and charge for subsidized insurance based on income (an ability to pay test).  The problems with such pools is that they are underfunded (run out of funds to pay for care) and still too expensive for most people to afford.

The president’s promise also does nothing to limit deductibles and co-pays for people with pre-existing illnesses.  And these extra charges can also be based on  income and assets. 

Remember Trump is a health care ignoramus.  He knows nothing about health insurance or funding it.  He really can’t be bothered with details and has no understanding that health insurers  have primary fiduciary responsibility to stock holders not patients.  They really have limited to no interest in caring for very sick people. 

It’s a fact that Medicare was first established for that very reason.  Insurers didn’t want to provide coverage for the elderly, after all they might be sick.  As a group they have too many pre-existing illnesses. 

Maybe in a more rational time we’ll come to conclude that Medicare type insurance makes the most sense for everyone in the only industrialized country in the world which has no national health care scheme.  Maybe, who knows?  VOTE

Relief for Corporations, of Course. People? Let Them Eat Cake

Our feckless president and his Republican Party controlled Senate propose using tax funds to rescue corporations and fashions a rescue that cuts out the lowest earners from financial support. It gets even worse..

“But he also injected new uncertainty into the government’s response, suggesting it was not his responsibility to meet the needs of health care workers on the front lines of combating the disease. A day after he said he would use the Defense Production Act — a Korean War-era law that allows presidents to force American industry to ramp up production of critical equipment and supplies — Mr. Trump told reporters that he would rather rely on states to deliver equipment to health care workers.” (Emphasis medicynic)

“On Capitol Hill, Republicans presented a bill that would offer bridge loans of up to $10 million each to small businesses, extend hundreds of billions of dollars in loans to large corporations in distressed industries and send checks as large as $1,200 per adult to individuals earning less than $99,000 per year. The payments would phase in for earners up to $75,000 — meaning lower earners would get smaller checks — and then phase out again at $99,000. Those who did not earn enough to pay income tax would receive much less: $600.”

“The Senate bill also includes a raft of temporary changes to the tax code that would reduce the tax liability of large corporations, many of them overriding provisions in the 2017 tax overhaul that were meant to raise revenue to offset corporate rate cuts.”

Medicynical note: Where to start. In the chaos of the Trump administration we learn that our leader doesn’t think it his responsibility to assure access to competent care and testing. Where I live the PeaceHealth hospital (a several state multi hospital organization ) is reporting shortages of all types of medical materials as well as test kits. The staff feels extremely vulnerable because of the lack of preparation. This is a microcosm of the nationwide situation. Remember Trump gutted the government’s ability to anticipate and plan for a pandemic after his election. What’s happening was predicted but our guy knew better (sic) he is reaping at the expense of citizens lives and fortunes what he has sowed.

The Senate plan pointedly gives little financial support to the poorest in our society while proposing yet another large tax cut for corporations. The last tax cut, you recall doubled, the federal deficit. Trump, meanwhile, says he’s going to cut social security Medicare and Medicaid because of the large government deficits from his tax cuts to corporations and wealthy. Chutzpah combined with chaos.

So corporations under Trump receive bailouts from tax payer funds from which they want to be excused from paying. While in effect taxing the sick and elderly by cutting their Social Security and access to health care. America, something terrible is happening and his name is……..Trump.

Read Between the lines (Trump vs the Science….again)

Today Anthony Fauci of the NIH said the following about the Coronavirus regarding recommendations to the elderly chronicaly ill. 

“You don’t want to go to war with a president,” he said. “But you got to walk the fine balance of making sure you continue to tell the truth.”

FoxNewsSunday

@FoxNewsSunday

Doctor Anthony Fauci talks about staying away from political spin when addressing the American public about the risks of the coronavirus.

Embedded video

Medicynical Note:  What’s going on here?  Think there might be a conflict between the scientists and the politican?  Trump has called global warming a hoax and recently called the Coronavirus worldwide epidemic bordering on pandemic a hoax as well.  Think he has your best interests in mind?

It’s the Money $tupid– the busine$$ of dialy$i$

The Dialysis Duopoly Spends $100 Million to Protect Profits in California https://prospect.org/article/dialysis-duopoly-spends-100-million-protect-profits-california

“With Medicare for All being discussed in national circles, the situation with the dialysis providers is instructive. Faced with a single-payer system with lower reimbursement rates for their service, the dialysis industry bankrolled a charity to shift people into private insurance and jack up the cost. We don’t know what loopholes might enter the picture under Medicare for All, but the dialysis duopoly scam bears watching as a potential tactic. It speaks to how resourceful medical providers might be in their vigorous opposition to single-payer, and why politicians need to be mindful of their power.”

““I feel like it’s an unfair business practice all of us are paying for,” said Wood, who’s hopeful the bill will pass. “For me the bigger part of this is that, we’re trying to make sure we get access to care for as many people as possible, you can’t do that if you can’t contain costs.””

Medicynical note: In medicine as in other capitalistic enterprises the goal is to become a monopoly, gouge your customers and then fight like mad to protect your profits. Patient care. Access? Good outcomes? Value. All are nice goals but not a really the primary aim of the endeavor. It’s $ucce$$ is mea$ured by other parameter$$$$$.

Privatization….Doesn’t Work Without Regulation

“Beginning in 1996, the military launched the largest-ever corporate takeover of U.S. federal housing, shifting ownership of more than 200,000 family housing units on bases to private real estate developers and property managers under 50-year contracts.”

Great Moments in American Medicine: Snake Bite $142,000

Overcharging is the rule in the U.S.

The average list price for CroFab is $3,198 per vial, according to the health care information tech company Connecture. Manufacturing costs, product improvements and research all factor into the drug’s price, said Chris Sampson, spokesman for BTG. ”

“A Mexican version of snake antivenin can cost roughly $200. But it couldn’t be sold in the U.S. (More about that in a moment.)”

And

“In Oakley’s case, St. Vincent Evansville hospital charged $16,989.25 for each unit of CroFab, according to the facility’s bill. That’s more than five times higher than the average list price.”

“WellRithms analyzed Oakley’s bill from St. Vincent Evansville at Kaiser Health News’ request and found providers generally accept $16,159.70 for all four vials of the drug.”

Read the article for more.

Medicynical note: The U.S. overcharging for healthcare services seems to be more the rule rather than the exception, particularly for those in life threatening situations. If the patient is insured they will most often get a significant discount rate that cuts the bill dramatically. Ironically if a person has no insurance, hospitals and other providers bill the full amount…… to the most vulnerable patients

United Healthcare…..in it for the money

Not a big surprise

For those who thought insurance companies are in it to provide excellent healthcare……you were wrong.

“US Chief Magistrate Judge Joseph Spero issued his decision Tuesday against United Behavioral Health, a unit of UnitedHealthcare, saying the insurer created internal policies that effectively discriminated against those seeking mental health and substance abuse treatment.”

“”It is well-established that effective treatment of mental health and substance use disorders includes treatment aimed at preventing relapse or deterioration of the patient’s condition and maintaining the patient’s level of functioning. UBH Guidelines deviate from that standard,” Spero said”

Medicynical notes: Given a choice between enhanced profits or funding excellent care, the private insurer’s policy was programmed to choose the former. After all it’s their their fiduciary responsibility.

Pizza and Prescriptions.

We’ve talked about doctors receiving honoraria and other payments from drug companies to influence their choice of treatments.  Always quite righteously physician groups have responded to such allegations with drivel about their professionalism and their over riding concern for their patients.  That works up to a point but in our culture money talks.

This puts such arguments to rest:

As little as one free meal from a drug company can influence which medicines doctors prescribe for Medicare patients, according to a study using Medicare records and recently released data from the health care law’s Open Payments program.

More here.

Medicynical Note:  For the almost 50 years that I’ve been a physician drug companies have vied for face time with physicians.  Some of it is fairly legitimate education on new better drugs but most is simply  a sales pitch to get the doc to change his/her prescribing habits, almost always with limited benefit and  increased cost.  Various incentives are provided to get this access–cash payments, meals, faux jobs, deals on medications given directly to patients.  It all works and it all costs the system integrity and cash. 

But hey that’s the way America works. Check out the gun lobby and the recent assault weapons votes.  Money buys access and influence.  Doctors are not immune. 

Your Money or Your Life: America’s Health Care Disaster

It used to be financial planning was a field which provided assistance for the golden years (retirement),  In the U.S. financial planning is necessary for patients to get their health care.  Our amazingly inefficiency expensive (most in the world) health care non-system is now providing such planning to patients to “help” finance their care.  Something is terribly wrong here.

His doctor had prescribed the cancer drug Gleevec, but Steiner’s insurance refused to cover its $3,500 monthly cost. Steiner, a warehouse manager for a publisher of Bible-themed literature, and his wife, Brenda, a part-time nurse, made just $30,000 a year. No way could they afford the drug on their own.

“We still had six kids at home — how were we going to come up with that kind of money?” Steiner said. “We couldn’t re-mortgage the house, because it had already been re-mortgaged. I wouldn’t have been able to take the medication. We would have had to just trust in the Lord.”

It was a scary brush with “financial toxicity,” as researchers call the mix of economic stress, anxiety and depression cancer patients often endure. But then Steiner was assigned to Dan Sherman, an oncology social worker at Mercy Health Lacks Cancer Center who within days got a free supply of Gleevec from the manufacturer. He also made sure it was delivered promptly. The package arrived at Steiner’s home on Christmas Eve, his 46th birthday.

In the eight years since, Steiner has faced a series of medical and financial reversals, and each time Sherman has done as much as any doctor to keep Steiner going — scrambling to get the treatment he needed without sending his family into bankruptcy. “He keeps throwing me life rafts before I sink,” Steiner said.

Read the entire article.

Medicynical Note:  Health care in the U.S. is a special type of hell if you are not independently wealthy.  Something like 60% of bankruptcies in our country are related to medical expenses and it appears from the above article that the first goal of our non-system is to spend all the patient’s savings and then offer assistance.

Our insurance companies’ main goal is to assure profits to share holders, hospitals have a multilevel billing system which ironically bills most those without insurance coverage and least able to pay;  our drug companies think nothing of gouging patients to pad their bottom line, because they can (pretty sadistic); and our medical practitioners often are on their receiving end of payments from technology providers to get them to use the company’s product.  Care of patient is not the primary concern of many in our health care industry.

There are bright spots.  People working to help patient’s figure out the non-system; primary care types working very hard for relatively (compared to some medical specialties) low salaries; our nursing and medical support colleagues who work face to face with patients helping with their care and problems, medical and otherwise.  

The Affordable Care Act is a good first step but more needs to be done.