Archive for the ‘health insurance companies’ category

Elizabeth’s Pickel

October 18, 2019

Senator Elizabeth Warren has drawn some criticism for her performance at this week’s Democrat Debate.  The criticism centers on Warren dodging the answer to the question “will taxes increase for middle class families if Medicare For All is adopted.  There are many answers Warren could have given but none that fit the frame work of a televised debate with 11 other hopefuls.  Here’s Warren’s problem.

The most fundamental question should be “is healthcare a right” or “is healthcare a privilege”?

If healthcare is a privilege, then the path forward leads to “the best healthcare money can buy”.  If someone has the money, they can have access to the best healthcare available in the US.  If someone does not have the money, then the healthcare available is to be found in whatever safety net programs Employers and Congress enact or at the Emergency Room.

If on the other hand one believes healthcare is a right, then the question arises what is the best method to deliver healthcare.  And here begins the pickle.  Healthcare is not free and must be paid for.  And, healthcare will cost middle class Americans more next year regardless of whether there is a “Medicare For All” option or not.  

So how should Warren have answered the question?

How about, “I don’t know but I am sure asking if taxes are going up is the wrong question.  Income taxes could increase but middle class Americans’ healthcare costs might go down”.  “Here’s why.  Medicare For All is an aspirational proposal whose goal is to provide healthcare to all American residents at existing quality levels or better and at steadily reducing costs.  Under Medicare for All, there should be no exclusions for pre-existing conditions or life time monetary limits on benefits.” 

And why not, all other modern industrialized countries provide their residents basic healthcare with health outcomes equal to or better than the US, and experience a national expenditure that is one half what we spend in the US, so why can’t the US do the same?”

Warren could have said, “And even if there are reasons we can’t achieve a 50% reduction (and still provide equal or better care), there is a lot of room to cover the costs of the 20% of Americans under or uninsured.”

These “best in class” healthcare delivery systems which cost about one half what the US pays have (1) a far greater emphasis on preventive health care, (2) negotiate healthcare providers costs nationally, and (3) offset much of the actual healthcare costs with a consumption based tax (VAT) which involves all of its residents in sharing the healthcare cost burden.   

Finally, Senator Warren might have said, “healthcare costs are bankrupting America.  Over two dozen other countries have found ways to deliver equal or better healthcare outcomes at one half the total amount the US spends.  Why can’t we do the same.  If you do not think healthcare should be a right (which of course must be paid for), I can only say I sincerely disagree with your view.  If you hold this view and are relaxed because you receive your healthcare insurance from your employer, I have bad news for you.  Global competitive market pressures are slowly making your employer uncompetitive and over the coming years more and more companies will be ending healthcare coverage.

So the wiser goal is not just insuring all Americans, but rather insuring all Americans at a cost approaching one half of what we are paying today insuring 80% of Americans.

Healthcare All Over Again?

March 29, 2019

Like a flash brush fire, the subject of US healthcare has blazed anew.  Dumbing the complex healthcare situation down, the President and loyal Republicans are chanting for the ACA’s elimination and good things will follow.  The President has promised the best healthcare ever, one with “pre-existing” coverage and no individual mandate.  Of course the President wants first the ACA repealed, or ruled un-Constitutional in the courts, and then… “trust me”… the GOP will introduce a beautiful new healthcare bill.  Hmmm.

The silver lining of this “bad dream again” issue is that there are compelling reasons to reopen the healthcare “can of worms” again.  The ACA represented an honorable, ethical, and moral effort to improve upon what existed in 2008 and provide access to basic healthcare for all Americans.  Republicans tell us that ACA is not so. 

The inconvenient truth about US healthcare (the current ACA or the version before ACA) is that

  • healthcare spending per capita is twice that of other developed countries,
  • does not still cover everyone (estimated 20 million more however), and
  • mediocre healthcare outcomes compared to many other countries.  (Healthcare available through institutions such as the Mayo Clinic, Johns Hopkins, Cleveland Clinic and most major University teaching hospitals are as good as there are in the world but those located in the suburbs, depressed inner city areas, and the rural areas across the country are not delivering on the highest standards. And, not to be overlooked, US healthcare is not affordable or not available to too many Americans.)

Affordability, and availability rise above the partisan solutions such as “Medicare For All”, “the replace of Repeal and Replace”, and “keep government out on my healthcare”.  There is no known credible reasons to justify current US healthcare cost and outcomes. 

  • Drug prices are non-negotiable for Medicare.  How is that possible? 
  • A growing number of Americans are learning that they can buy prescription drugs in Mexico or Canada the exact same medications they currently purchase in the US for substantially less.  Why would the Government not demand the best global price? 
  • Republicans have embraced private sector solutions built around private healthcare insurance. Let the insurance companies police costs, the GOP says.
  • Insurance is based upon pooling risks. .  So how can the GOP fight to eliminate the individual mandate? Without the individual mandate the insurance revenue pool will shrink.  In addition, individuals without insurance will go to Emergency Rooms where they will, by law receive treatment.   In essence, no individual mandate means a free pass for those who do not wish to buy insurance, cost everyone more, and makes everyone else a sucker.  How does this make sense? 
  • Estimates put US healthcare spending at 18% of the approximate US $20 trillion GDP (almost $4 trillion).  If the actual spending was on a parr with 20 other major world countries, there could  be $1-2 trillion savings each year extra for investment in infrastructure or paying off the national debt.  What are Republicans thinking?

President Trump and Republicans are disingenuous about healthcare reform.  Democrat candidates who are singularly focused on insuring everyone and overlooking the inexplicable cost differences with other modern countries are destined to make the GDP cost even larger.  The US deficit can not be reduced or brought under control without first dealing with healthcare costs.  Even more dangerous, in the world of income inequality, unless basic healthcare is made affordable for all, there is destine to be social upheaval.

Medicare For All

January 30, 2019

As the 2020 Presidential Campaign season begins to bud early, a few candidates are stepping forward testing the publics reaction to them.  Elizabeth Warren and Kamala Harris have amped their entries with the battle cry “Medicare For All”.  Two unannounced candidates, Howard Schultz and Michael Bloomberg, have dismissed “Medicare For All” as too expensive.  No surprise then that Schultz and Bloomberg position themselves as “centrists”,  Hmmm.

T0 be successful, the accepted theory seems to be the Democrat candidacy must be more than simply “anti-Trump”.  Democrats must be for something, not just against the current President.  Hmmm.

Healthcare is, for sure, a mess and capitalism is stinking up the house.  Morally, it would seem unconscionable that any reputable healthcare insurer could put forth the notion of “pre-existing condition” as grounds for not insuring someone. And the well worn line of “don’t put the government between you and your doctor” seems ridiculous if the other options is putting the insurance company between you and your doctor.  What are people thinking?

The public’s demand for transparency of medical costs touches on another evil.  Hospitals are unable (and unwilling) to put numbers on the table.  Hospitals claim that there are insurance company discounts which means the patient never would pay the hospital full charge (if the hospitals knew what their costs were).  Drug companies use the same thinking to justify their greedy price increases.

What cannot be denied, however, is that Americans spend, without universal coverage, more than twice as much as anyone else in the world.  And if anyone googles healthcare, one can quickly determine that in comparison to other first world countries, Americans pays twice as much and receives only mediocre healthcare outcomes.  (Of course those Americans who utilize the Mayo Clinic or similar world class health care center, pay the high prices but do receive outstanding medical care.  These world class medical facilities serve only a small slice of Americans).

Schultz and Bloomberg’s “Medicare For All is too expensive” reaction may be missing a point.  Health care today is already too expensive for the average American.  Harris and Warren’s off the cuff reply that the rich will have too pay is just as out of touch with reality.  In fact taxing the wealthy is sure fired way to stimulate even higher healthcare costs.  (Free enterprise just loves situations where there is a payer.)

Healthcare systems found in Japan, Canada, Germany, or France, for example, emphasize preventive care, cost controls, and largely a national sales tax to fund the healthcare system, not taxes on a single segment of society.  The national sales tax (value added tax) coupled with negotiated health care services and drug costs keeps “cost control” front and center, and reminds everyone that healthcare is not free.

The 2020 campaign season does not get into full swing until later in 2019.  Hopefully by that time the candidates will have sharpened their stump speeches and gotten real about what’s possible.   

Beautiful Healthcare

October 8, 2017

The Tweet-meister has once again promised Americans “beautiful” healthcare, without the “high premiums” some individual insurance seekers are experiencing. What magic does President Trump have in mind? Do you think he will embrace Medicare for all? Do you think he will recommend the US adopt a single payer system like Australia, Canada, or most of Europe?

Unlikely.

To date, the GOP has been serious about controlling cost exposure for those in the single payer market. Shamefully, the Republicans have chosen various forms of “less coverage”, “fewer insured”, and outright mistruths to portray their proposal as providing “beautiful” healthcare coverage. Why?

Opposition towards the Affordable Care Act (Obamacare) has been mainly a partisan political event. Republicans have never been serious about maintaining (or increasing) the basic healthcare insured rolls. Republicans have eyed the single payer (largely individual owner proprietorships) who could be counted upon to vote Republican.  The rest of Americans were far less important.

The GOP has lamented rising rates and declining insurance company participation in certain markets. Behind these crocodile tears, however, has been (you select which one), either (1) a basic ignorance of how any insurance market works, or (2) a cruel belief that those added by Obamacare were mostly lazy Americans unwilling to do what it takes to work hard.

Why would insurance companies keep raising rates in many markets? Does anyone connect that people who were sick and now have insurance might just be using it?

Does anyone think that many who otherwise reneged on paying doctors and hospitals previously (and by the way, those costs were written off by everyone else paying through insurance), and were now enrolled in Obamacare, were not going to use healthcare?

There have been some commonsense proposals, short of single payer, such as putting all single individuals seeking insurance into a group composed of all other single individual Americans (forming groups like employers do). The idea is that insurance companies could then set rates based upon this much large pool.

This approach might stabilize insurance markets but over all there is no way this proposal will lower healthcare spending. People who are sick or have experienced healthcare coverage for the first time with Obamacare will still get sick and will still want to use healthcare services.

The tweet-meistre might do well if he asked questions about how to lower healthcare costs without reducing coverage or those covered.

Such a line of questioning will invariably lead to where costs are generated, namely doctors, hospitals, and drug companies. This healthcare industry is like no other in the modern world and represents 1/6th of the US economy. If in some magical way, President Trump decreed that the US should adopt a healthcare model like Germany or France, where healthcare spending is about 1/2 that of the US (with equal or superior healthcare outcomes), it would require years to transition to that model without bankrupting many doctors, hospitals, and drug companies, not to mention healthcare insurance companies.

All I can say is that after such a transition, healthcare would be “beautiful” for the average American.

Obamacare’s 9 Lives

September 26, 2017

With Senator Susan Collins’ thumb down, it appears the Affordable Care Act (Obamacare) will live to die another day. This is a victory for decency to be sure, but fiscally US healthcare remains a uncertainty. What does this say about those who govern?

Senator Rand Paul said the GOP bill (Graham-Cassidy) was too much like the Affordable Care Act (too much entitlement), and he said he would not vote for it. Senator John McCain told Senate Republicans to use a bi-partisan approach when Congress deals with 1/6th of the economy. Republicans did not, and McCain said no thanks.  And, Susan Collins announced her “no” following the release of the CBO score indicating millions of Americans would lose coverage with Graham-Cassidy. Others such as Senators Cruz and Murkowski were rumored as “no” but have not spoken out.

The general theme of Republican opposition has been exploding cost. Republicans seem concerned that the Federal Government will pump billions into healthcare and that amount will not be enough as healthcare cost will increase each year. A subset of these fiscal worriers sees Medicaid expansion as the culprit and have selected block grants to States as a way to cap the Federal Government’s financial obligation.  Both of these concerns are reasonable but is it reasonable to take healthcare away from some in order to keep the Federal cost down? Hmmm.

Senator Bernie Sanders has seized this opportunity to hype “Medicare for all”, a single payer system, as the best way to fix Obamacare. OMG, here comes socialism Republicans are crying out.

What an opportunity for someone to articulate in a calm voice that the rest of the modern world provides basic healthcare to all their residents at 1/2 or less what it costs America and these other countries have excellent (better than the US) health outcomes.

If Republicans were really serious about the fiscal aspects of Obamacare, one would think that adopting a healthcare system similar to France, Germany, or Switzerland’s would make sense. Unfortunately, these universal, single payer systems cut out insurance company profits and in turn campaign donations to politicians.
Hmmm.

There might be a tendency to take a deep breath that Obamacare has survived again.  Obamacare’s nine lives are not a forever thing.

Republican’s disregard about pre-existing conditions and even whether everyone, regardless of means, should have access to basis healthcare pose a menace to most Americans.

One might think that faced with a ground swell for Universal, single payer, Republicans might see Obamacare as a preferred alternative.

Repeal And Replace II

September 21, 2017

Republican Senators are marching, somewhat like lemmings, towards a cliff over which they are likely to plunge. The Graham-Cassidy proposal is craftily constructed healthcare (not) bill. As previous GOP attempts, this repeal and replace version eliminates the individual mandate, frees employers from the requirement to provide their workers healthcare insurance, and frees businesses and the wealthy from certain Obamacare related taxes.

Graham-Cassidy also shamelessly bribes the 50 States with a promise of a block grant which can be spent as the States see fit thanks to large cuts to Medicaid.

For some States, Medicaid cuts are unwelcome since when they do the math, these States realize they will receive less money than with Obamacare. For other States, especially those who did not expand Medicaid under Obamacare, Graham-Cassidy looks like new found money.

The vote scheduled for next week represents a wholesale capitulation by Republican Senators to big money interests. The vote is expected to be held without the daylight of any public hearings and without knowledge of the CBO review, both steps Senate Republicans had vowed to provide just months ago.

There is, however, no reason to expect the CBO score to indicate less Americans will lose coverage than in previous GOP attempts.  One must wonder why the GOP insist upon retracing its already discredited path.

At risk once again are the most vulnerable, the poor, those with pre-existing conditions, and the suddenly unemployed. Most Americans gain healthcare coverage through employer provided insurance and will not feel the impact of any “repeal and replace’ legislation (until such time as it becomes fashionable for employers to decline to offer coverage at all). The wealthy, if required, could pay for healthcare personally, and while no one likes paying for anything, healthcare insurance cost for the wealthy represents a tiny percent of their disposable income.

One is tempted to blame President Trump and assign this shameful legislation to him. Wrong.

From all reports the President has tissue paper thick knowledge of healthcare and has applied his learnings to Graham-Cassidy.

There is no doubt the President will praise the bill if the Senate finds the 50 votes necessary for passage (President knows about winning). There is also no doubt that were Graham-Cassidy to become law and the public become disenchanted with GOP governance, President Trump will then disown the legislation and blame the Senate.

When People Think Differently

August 8, 2017

The idea of “universal, single payer” healthcare seems so obvious as both the most efficient and least costly method of delivering a nation’s basic healthcare, it seems incredible that there are so many Americans who do not embrace this notion. Why would that be?

Fewer and fewer Americans remember the time before the wide spread availability of insurance company provided healthcare. Yet the US system of “for profit” healthcare insurers is a relatively recent happening. Following WWII, employers began offering health insurance as an employee benefit designed to retain employees in a period of relatively full employment. Health insurance as a benefit caught on and employers have found it difficult to retain workers without offering health insurance. Hmmm.

Also escaping most Americans knowledge is the cottage industry which is necessary to support the multitudes of healthcare insurers. Healthcare service providers (doctors, hospitals and drug companies for example) must carefully keep track of each patient and how much service that patient has consumers, report those services using each insurers different set of codes on each insurers specific form, and then argue with each of these insurers to insure they receive reimbursement for the services already provided. This entails millions of more healthcare workers who do not themselves provide healthcare. Hmmm.

More than two dozen other modern countries (like Germany, France, England, Japan, and Canada) utilize a single payer, universal healthcare service delivery system. These countries all offer “best in class” healthcare services at about one half the total cost experienced in the US. These countries also report excellent healthcare outcomes and boast longer life expectancies than the US. Oh, and these countries provide this healthcare to all residents. Hmmm.

So, why would anyone not be in favor of universal healthcare?

In the US there are many who decry the idea of universal healthcare. They predict unacceptably long wait times to see a doctor or receive treatments. They ask the question “if healthcare is so good in other countries, why do people from Canada travel to the US for medical care?”, and “Why should we put the government between you and your doctor?”, the ask.

The politics of healthcare is even more fascinating and not easy to understand. Progressives are for a universal system and conservatives are not. Conservatives point to Progressive’s record of entitlements and using taxes to fund the cost. Conservatives see creeping socialism behind the call for universal healthcare and the resulting dependency of Americans to look for government to solve all their problems. And worse, universal healthcare will bloat the government making what is already (in their opinion) too big, even bigger. And even worse, conservatives don’t want their tax dollars going to pay for healthcare for someone else. Hmmm.

Hmmm. What could be simpler. Big government, less choice, poorer quality, and offering out of control cost increases, conservatives claim.

Why do conservatives think that way when there are so many examples around the world that prove otherwise? Why don’t conservatives recognize that some Americans already have “universal healthcare”. These Americans, of course, are over 65 and are enrolled in Medicare.

Is this a subject of “the glass is half empty, or half full”? Do progressives and conservatives see the same problem (basic healthcare available to all Americans) or do they see different solutions to different problems (basic right versus small government with low taxes)?

If Americans see the same problem, conservatives may still view the delivery of basic healthcare too difficult a task for “American thinking” and from their perspective, a universal healthcare system must inevitably end up with poorer healthcare and higher costs. Progressives could, alternatively, see no problem too great for Government to solve and therefore discount totally conservatives’ warnings.

The recent Congressional fight over repeal and replace for Obamacare should make conservatives take notice. The conservative sponsored alternatives largely failed because they offered less coverage for the poor, those with pre-existing conditions, and the elderly.   Voters representing those groups made their views known. Progressives and conservatives would be wise to heed this warning.

Healthcare is not free and does require funding. Most other countries employ a “prevention” oriented healthcare philosophy, inhibitions towards uncontrolled price increases, and utilize a consumption tax (value added tax) to fund healthcare along with modest co-pay requirements.

Obamacare could be a starting point were Republicans to acknowledge that Obamacare was based upon Romneycare (Massachusetts) and that was based on a proposal from the conservative Heritage Foundation think tank.

If conservatives can’t agree with progressives on what the problem really is, voters make make the choice for them. The 2016 Presidential elections was a clear sign that the electorate was dissatisfied with both parties and threw its support to a total outsider.

What will voters do next time?