Jan
15

The greatest healthcare system in the world.

No better description of our totally dysfunctional “healthcare” “system” from a good friend and colleague. (this is not my situation)

I thought you might get a kick out of something that happened the other day.  I got a call from the hospital where I’ll be getting treatment over the next few months.  They wanted to let me know that they have an estimate, based on discussions with my medical insurer, as to what my out of pocket costs would be for the treatment that’s so far been prescribed.   After walking me through all the necessary ‘caveats’, the young lady then asked me how I would like to pay my responsible share, which is thousands of dollars.
Here’s how the conversation went:
Hospital Rep (HR):  How would you like to pay these fees that you will be responsible for?
Me:  Are you asking me to tell you that now?
HR:  Yes – we can take a credit card or a check number and routing number right over the phone and get it all taken care of right now.
Me:  But I haven’t even seen the charges or received treatment yet.
HR:  Oh, don’t worry – you’ll receive the treatment and then we can bill you for any other responsible charges
Me:  Is this a joke?  You expect me to pay for something off of a verbal discussion – no documentation, no explanation?
HR:  But I just explained it all to you.
Me:  Ok – let’s try this – how about I go through the treatment, you run the charges through my insurance, and then we can see what my responsible share is?
HR:  We can do that too but we prefer to get confirmation of payment up front.
Me:  So is that required?
HR:  Is what required?
Me:  That I pay upfront, with no documentation or having had the benefit of my insurance actually look at the charges first?
HR:  No, it’s not required, we just prefer it.
Me:  Got it – we’ll do it the old fashioned way.  Send it through insurance and we’ll handle the balance from there.
HR:  We do have payment plans available with no interest.  You could make a payment right now and begin that process right now.
Me:  Will that be available to me after insurance sees the charges?
HR;  Will what be available to you?
Me:  The payment plan option  you just told me about.
HR:  Oh yes.
Me:  Ok – let me try this again – send the charges to my insurance and once they adjudicate the claims I’ll get back to you on any charges I am responsible for.
HR:  Well, we know what your deductible is so why not just pay that amount now?  Again, we can take a credit card or a check number and routing number.
Me:  I feel like I’m in a bad Abbott and Costello routine.
HR:  Who?
Me:  Never mind – let me be blunt – I’m not paying for anything without documentation.  I appreciate you letting me know the estimate but I won’t pay off that either.  If that means you won’t perform the service, I’ll find another provider.
HR:  Oh, of course we’ll provide the service, we just wanted to remove the stress of financial responsibility before the treatment begins.
Me: Well, actually, I think you’ve done just the opposite
HR;  The opposite of what?
Me;  Never mind – I have two questions.  Can I still get treatment without paying any charges before treatment is provided and second, will you bill me after insurance has reviewed and adjudicated the charges.
HR;  Yes we will provide the treatments and yes we will bill you after insurance has handled the
charges.
Me:  Ok -thank you (and I ended the call).

Dec
11

Americans can’t afford healthcare

Gallup just reported a quarter of Americans have put off treatment for serious medical conditions because they can’t afford it.

They can’t afford it because:

  • US physicians make twice what docs in other countries do
  • Drug costs are much higher here than elsewhere
  • Hospitals are making bank
  • Administrative costs are twice what they are in other developed countries.

Data from Commonwealth Fund

Average physician income by specialty from FierceHealthcare.

US life expectancy is now 43rd in the world.

We pay twice as much as other developed countries for healthcare, and our outcomes are measurably worse.

What does this mean for you?

Until and unless we fix healthcare, your family and friends will face increasing costs and declining access; it’s highly likely some aren’t getting the medications, surgeries, tests, or therapies they desperately need.


Nov
12

Haven Healthcare’s next step

Is partnering with two big insurance companies to offer creative plans to two of its owners’ employees.

30,000 JPMorgan workers in Ohio and Arizona covered by Cigna and Aetna will be offered a plan that has no deductibles, with copays ranging from $15 to $110 depending on the service; facility copays will likely be higher.

Amazon’s also offering a Haven Healthcare plan in a handful of states. The giant seller-of-everything also just bought Health Navigator for an undisclosed sum.

From Motley Fool:

it will fold [Health Navigator] into Amazon Care, its new employee healthcare benefit that gives users access to virtual doctors and nurses…Amazon Care users (currently limited to employees in the Seattle area) can fill prescriptions through the e-commerce giant and choose between having them delivered or picked up at a participating pharmacy. By providing healthcare services to its employee base Amazon gets to test the waters and make fixes before the program is offered to a wider market.

Evidently Health Navigator uses an AI-based health bot which helps members diagnose illnesses, determine the right course of care, and then routes the member as appropriate.

While JPMorgan and Berkshire are likely funding Haven to help reduce their healthcare costs, Amazon’s got bigger plans.

With annual revenues around $340 billion, the giant company needs a really, really big market to keep growing. Healthcare is $3.4 trillion, massively screwed up, and just the kind of target Bezos et al need to keep the good times rolling.

What does this mean for you?

If you think Haven won’t succeed, did you ever think you’d be getting your groceries, tools, video, toiletries, prescriptions, car parts, medical devices, batteries, dog food, shoes, and music from an on-line bookseller?


Aug
19

Are health insurers’ profits and costs the problem?

There’s a lot of bleating about the huge profits made by health insurers, with some – including too many who should know better – complaining loud and long. [Insurers and pharma netted about $97 billion last year.]

While some would argue the billions raked in by insurers is far too much, let’s take a step back and look at the big picture.

First, insurers’ profits are a tiny fraction of our $3.6 trillion healthcare spend – as in >1 percent.

Second, healthplan, insurers, and other payers’ total administrative expenses amount to 8.3% of that $3.6 trillion – roughly $300 billion.

Oh, and a big chunk of most health insurers’ business comes from servicing governmental programs.  Example – 58% of United Healthcare’s revenue is from Medicare, Medicaid, and other governmental programs.

Frankly, given commercial insurers’ demonstrated inability to control costs and improve quality, that $30 billion may be too generous by far. But it’s clear the big problem with healthcare costs is not insurer profits or administrative expense.

It’s the underlying prices of healthcare.

What does this mean for you?

It’s not insurer profits.


Apr
10

On the one hand…

We have a healthplan you’ll absolutely love.  Covers EVERYTHING – glasses, hearing aids, nursing home care, doctor visits, hospital care, surgery, drugs – all FREE!

It’s the about-to-be-announced BernieCare 2.0, aka the “Whole Enchilada Plan”. You can go to  any doctor, hospital, acupuncturist, yoga instructor, therapist, or nursing home your heart – or other internal organ – desires. And did I say, it’s all for FREE!

On the other hand, there’s the SkimpyPlan – and as the Brits say, it’s “on offer” today. Well, it was until a Federal Judge ruled it isn’t.

SkimpyPlans cover, well, not much. Especially if you had one of those pre-existing condition things. You know, migraines, high blood pressure, the “C” word, bad knees, anxiety or pretty much anything else. Oh, and the list of doctors and hospitals is, well, “limited”… and they don’t cover drugs, or pregnancy, or, well, lots of things.

But hey! they’re cheap! Affordable even!

Ok, enough with the sarcasm, here’s where this is headed.

For some unfathomable reason Mitch McConnell and the current Administration think these SkimpyPlans are a great response to the not-hated-any-more ACA.  SkimpyPlans are pretty much the only plan offered by the GOP, and they are awful. They are getting hammered in the press as patients find themselves without coverage for needed care, facing tens of thousands in medical bills, stuck fighting faceless bureaucrats in some distant “insurance company” via voice mail.

Sure many are covered by their employers, even that is getting unaffordable for many AND sticking families with big bills. 

Then there’s the While Enchilada Plan – an end to paperwork, doctor shopping, copays and deductibles, and all FREE.

Do you see where this is going?


Nov
13

Tuesday catch-up

It’s been a very very busy time.

First, I’m pretty darn excited to note my alma mater’s football team goes into it’s match with Notre Dame ranked 12th in the nation. As a long-suffering Syracuse alum, this is territory we haven’t seen in decades.

Perhaps we’ll see Chris LeStage’s LSU Tigers in a Bowl Game???

OK, on to work.

The National Work Comp and Disability Conference is fast approaching. You can get a discounted registration here.

A bit further out on the schedule is WCRI’s annual confab – which will be in Phoenix AZ next February 28 – March 1.  You can get the details here. DO NOT WAIT to register; this always fills up so don’t procrastinate.

Next, a best-in-class work comp safety program is the product of a “great team” led by a very experienced and very competent leader. Joe Molloy at Northwell Health is innovative, focused on the right things, and committed to partnering with service suppliers. Joe’s team has reduced lost work days at a giant healthcare system by a third.

More proof of the ongoing effort by health insurers to move the US to single payer…this insidious plan is bearing fruit as we just received new evidence of its effectiveness – Americans don’t like their health insurance.

According to a national survey by ACSI, consumers rank their satisfaction with health insurance as equal to airlines. “Health insurance satisfaction is flat after two years of gains, staying lowest in the Finance/Insurance sector” Ouch.

I find it increasingly likely we’ll have some form of single payer, perhaps Medicaid for all – within a decade.  Health insurers continue to piss off customers on a regular basis, can’t control health care cost increases, and are lousy at branding.

They do have gazillions of dollars which they will spend to kill MFA or any other version of single payer – and they are pretty darn good at the government lobbying thing.

That said, when things can no longer continue, they won’t.

What does this mean for you?

It’s not a question of “if” we end up with single payer, it’s a question of when.


Sep
18

Why a Texas court case is hugely important to you.

You or your spouse may well have a pre-existing health condition, one that, back in the bad-old pre-ACA days would have made it hard if not impossible to get insurance coverage in the individual and small group insurance markets.

Those days may be coming back.

A Texas court case is scaring the bejesus out of many; the Trump Administration and several state attorneys general are suing to overturn provisions of the ACA that require health insurers to cover pre-existing conditions.

If this scares you, you’re not alone. More than half of people polled are afraid their insurance costs will go way up, and 4 out of ten think they may lose insurance coverage if insurers no longer have to cover pre-existing conditions.

An old athletic injury, skin cancer, stomach trouble, anxiety, a heart murmur, migraines, allergies – all those and many more are pre-existing conditions that, if the lawsuit succeeds, would likely prevent you from getting individual insurance coverage for those conditions – if you could get insured at all.

Before the ACA,

  • you couldn’t leave their job to try something new or retire early – a condition known as “job lock”
  • small employers’ costs went up dramatically if workers got sick or had specific conditions because their insurer wanted to dump them.

Under the ACA, insurers must cover pre-existing conditions, and can’t charge individuals, families, or small businesses more based on those pre-ex conditions.

This strikes me as eminently fair; I had cataract surgery and started getting migraines years go, and until the ACA I had no coverage for ANYTHING related to my eyes or brain. That was pretty scary; any medical care related to those rather important organs was money out of our family budget.

Here are some of the conditions that you are insured for under the ACA, conditions that would not be covered if the lawsuit succeeds.

I’m all for freedom and choice and all that stuff.

What I’m vehemently against is stupid public policy that results in you going bankrupt because an insurer won’t cover your pre-existing condition.

For those who claim the “free market” will fix this – you are smoking crack. No insurance company will cover your pre-ex condition – or your spouse’s, or kids’ – unless they are forced to.

What does this mean for you?

If Trump et al win this suit, your freedom to change jobs just disappeared.

 

 

 


Sep
10

Hypocrisy hits new heights.

The same folks who want to cut $537 billion from Medicare are now claiming only they can “protect” Medicare.

Out on the campaign trail, President Trump and Gov Rick Scott (R FL) are claiming “Medicare for All” would somehow harm Medicare, and seniors need to vote for them to preserve Medicare as it is.

In an obvious attempt to scare seniors, Trump et al are asserting that expanding Medicare – the most-liked health coverage in the nation – will somehow result in seniors losing Medicare benefits. They support this assertion with no logic, no coherent argument, no evidence or data, yet there it is.

This from the same folks who, just a couple months ago, wanted to cut seniors’ Medicare benefits. What’s changed?

Elections are coming, that’s what’s changed.

According to Forbes, the GOP is looking for:

$900 million in cuts to rein in Medicare prescription abuses. Another $5 billion is cuts are specified to address high drug prices, while $286 billion in funding will be pared to reduce excessive hospital payments.

Now, there’s an argument to be made that Medicare is not financially sustainable – especially given the huge tax cuts passed by the GOP.  And yes, we need to figure out how we can keep Medicare viable given the drop in federal tax revenue due to the tax cut.

But to turn around and claim that expanding Medicare for All is somehow damaging to a program you’d like to cut by a half-trillion dollars is, well, the height of hypocrisy.

What does this mean for you?

Medicare for All isn’t a threat to Medicare. 


Sep
7

Healthcare costs and wages

The economy is booming, wage growth is not.

Healthcare is the big reason workers aren’t seeing higher wages – instead of spending their dollars on consumer goods, travel, cars and entertainment, workers are paying higher premiums and deductibles.

More than half of all workers have seen no increase in take home pay – ALL of their pay increases have gone to pay for higher health insurance premiums. And that’s before deductibles, copays, and co-insurance.

(graphs from WaPo)

Deductibles are zooming ever higher because high deductibles mean lower premiums. Think of this as cost-shifting to the sick; healthy folks pay lower premiums but if/when you need health care, BOOM!

You first have to pay for that care yourself, before you start getting some help from your healthplan.

This is even more of an issue for folks who work for smaller employers (<200 workers), where the average deductible for individuals (not families) is $2,069.

What does this mean for you?

You have less money in your paycheck because it is going to doctors, hospitals, pharma, device companies, and insurers.

And it’s going to get worse.

 

 


Aug
17

The Opioid Update

72,000 kids, moms, dads, brothers, sisters, best friends died last year from opioid overdoses.

Things are so bad that despite the ever-climbing death toll, news reports announcing the butcher’s bill manage to sound somewhat positive, citing reductions in deaths in a handful of states. Meanwhile, between 2.1 and 4 million Americans suffer from Opioid Abuse Disorder. 

Fentanyl is now the biggest driver, accelerating a years-long upward trend begun by rampant over-prescribing of prescription opioids.

Researchers cite some reasons for optimism; death rates in the west remain pretty flat – likely because the heroin used there is hard to mix with fentanyl…however there’s evidence that the black tar folks are figuring out how to do just that.

Meanwhile, Congress dithers; debating, pontificating, speechifying – and doing precious little.

To date, they’ve allocated a mere billion dollars to the biggest health crisis we’ve seen in decades.

Here in workers’ comp land, CWCI just released an analysis of polypharmacy among work comp patients in California. (Polypharmcy refers to patients getting multiple drugs.)

Two key takeaways:

  • A combination of  opioids, muscle relaxants, and anti-inflammatories was the most common drug cocktail. (opioids combined with muscle relaxants are very, very dangerous)
  • Shockingly, fully one-fifth of patients prescribed 3 or more drugs have back strains without skeletal involvement. Another tenth have various other sprains.  Yup, strains and sprains account for about a third of these patients.

What does this mean for you?

The next time someone protests the UR/IMR process, ask them how many more patients have to die from opioids before they accept that doctors need oversight.