Posted in Access to healthcare, advance-pricing, Economic Issues, Health Insurance, Healthcare financing, Medicaid, Medical Costs, medical inflation, Medical Practice Models, Medicare, out-of-pocket costs, Patient Choice, Price Tansparency, Quality, Uncategorized

G. Keith Smith, M.D. — Health “Coverage” as a Distraction


I think it is good to be alert to any discussions that are “downstream of a flawed premise.” Let me explain.

When I hear, for instance, that the “flat tax” is preferable to the current income tax, I think to myself that this is a discussion of the knife versus the axe, a conversation far downstream of one addressing government spending or the very legitimacy of denying someone their earnings. After all, victims don’t generally care what the mugger does with their money. They just resent being mugged and no discussion about whether the mugger used a knife or a gun will likely provide any solace.

Similarly, I would argue that arguing for everyone to have health “coverage” is far downstream of the more original problem: the cost of healthcare. To provide “coverage” for everyone in the current climate of gross overcharging primarily serves the interests of those who employ the “what can I get away with” method of medical pricing.

The fierce push back against true price transparency by the cronies in the medical industry makes more sense in this context, as price honesty denies them access to everyone’s blank checkbook as the health cronies are well aware.

Supporters of government-guaranteed “coverage” object with the following arguments.

First, coverage is equated with healthcare. While millions of Canadians streaming across the border to secure their health needs could be used to refute the idea that coverage is synonymous with care, this disconnect has become more apparent in this country. Each passing day reveals Medicaid and Medicare “coverage” to be a “black mark,” an actual obstacle to obtaining care, as these government programs and their associated rationing through price controls and hassles are creating the lines the central planners intended. Physicians are either dropping out of these programs altogether or they are limiting their exposure to patients with this “coverage.”

Another objection points to the relief from financial devastation that having “coverage” represents. Keep in mind that not only are well over half of the bankruptcies in this country medically related, but almost three quarters of those filing for medical bankruptcy have insurance. This points powerfully to cost as the root cause of medical economic ills.

Acknowledging this is a slippery slope for the objector, however, for no economic system better provides for resource allocation than the market and the cronies and their government pals know this as well as anyone.

The market is the only source of price deflation with simultaneous improvement in quality. This powerful competitive mechanism has brought affordability to countless products and services in all industries and has begun to bring rationality to health care pricing as more physicians and facilities honestly post their prices for all to see.

Rather than focus on “coverage,” which allows the cronies to continue their financial feeding frenzy, we should remain unalterably focused on cost. The competition unleashed will result in a medical price deflation the likes of which will cause even the most skeptical objector to re-evaluate the role of “coverage” in the provision of payment for health care.

This is no prediction. This is exactly what is happening here in Oklahoma where so many health professionals have embraced the same market discipline every other industry must endure. The reasonable prices and high quality of care, have had such a wide appeal that Oklahoma City has evolved into a medical tourist destination for many patients far from here, while simultaneously bringing savings in the millions of dollars to those who actually pay for healthcare, locally.

This is my answer to another objection from those who claim the inapplicability of market competition to health care.  Whether the focus on “coverage” is a deliberate distraction by the crony propaganda machine or a well-meaning but misguided attempt to provide better access to care, we must keep our eyes on the “price transparency ball.” The Oklahoma market is already harshly judging those attempting to avoid this gaze and I believe this trend will continue as long as we identify, challenge and reject conclusions downstream of their flawed premises.

Posted in Access to healthcare, advance-pricing, Direct-Pay Medicine, Direct-Pay Practice Models, Entrepreneurs, Healthcare financing, Independent Physicians, Medical Costs, Medical Practice Models, out-of-pocket costs, Patient Choice, Patient Safety, Patient-centered Care, Policy Issues, Price Tansparency, Quality, Uncategorized

Transparent Pricing for Medical Emergencies | The Emergency Center

What the status quo apologists and the naysayers said was impossible, is a reality:

Emergency services with transparent pricing and NO surprise bills!

“Always staffed with board-certified physicians, ICU- and ER-trained nurses, X-ray technologists and helpful administrative personnel, The Emergency Center offers the same comprehensive emergency care and treatment as a hospital ER, without the wait. State-of-the-art CT, ultrasound, x-ray, and lab services on-site combined with compassionate care provides an unparalleled patient experience.

The Emergency Center and OnDEC Health have partnered together to offer direct contracts for emergency room visits, urgent and primary care, plus telemedicine. OnDEC Health’s innovative direct contracting opportunities save employers significant dollars on ER claims, while offering their members 24/7, no-wait access to premier concierge style freestanding ERs and more.”

Peyton Vooletich

Director of Business Development

https://www.theemergencycenter.com/fort-worth-er/

Posted in Access to healthcare, advance-pricing, Direct-Pay Medicine, Direct-Pay Practice Models, Entrepreneurs, Healthcare financing, Independent Physicians, Medical Costs, Medical Practice Models, out-of-pocket costs, Patient Choice, Patient Safety, Patient-centered Care, Policy Issues, Price Tansparency, Quality, Uncategorized

Transparent Pricing for Medical Emergencies | The Emergency Center

What the status quo apologists and the naysayers said was impossible, is a reality:

Emergency services with transparent pricing and NO surprise bills!

“Always staffed with board-certified physicians, ICU- and ER-trained nurses, X-ray technologists and helpful administrative personnel, The Emergency Center offers the same comprehensive emergency care and treatment as a hospital ER, without the wait. State-of-the-art CT, ultrasound, x-ray, and lab services on-site combined with compassionate care provides an unparalleled patient experience.

The Emergency Center and OnDEC Health have partnered together to offer direct contracts for emergency room visits, urgent and primary care, plus telemedicine. OnDEC Health’s innovative direct contracting opportunities save employers significant dollars on ER claims, while offering their members 24/7, no-wait access to premier concierge style freestanding ERs and more.”

Peyton Vooletich

Director of Business Development

https://www.theemergencycenter.com/fort-worth-er/

Posted in Access to healthcare, Crony Capitalism, Economic Issues, Healthcare financing, Influence peddling, Medical Costs, Medical Practice Models, Organizational structure, Patient Choice, Patient Safety, Patient-centered Care, Policy Issues, Quality, Uncategorized

Surgeon Sues Orlando Health Over ‘Forced’ Referrals | Medpage Today

Jay Wolfson, PhD, a health policy expert at the University of South Florida in Tampa, said this case “goes to the heart of physician clinical autonomy.”

Hospitals use various methods to ensure that physicians refer patients to its own entities, including non-compete agreements that prohibit doctors from practicing medicine in a set geographic area around their place of employment during their contract, or even after termination.

A 2018 survey of 2,000 doctors in five states found that 45% of primary care physicians were bound by this sort of non-compete agreement, though hospital-based physicians are less likely to be restricted by these clauses.

https://www.medpagetoday.com/special-reports/exclusives/84571

Posted in British National Health Service, Economic Issues, FDA, Health Insurance, Healthcare financing, outcomes, outcomes measurement, Patient Choice, Patient Safety, Policy Issues, Protocols, Quality, Technology, Uncategorized

Should access to life-saving medicines be determined by economic evaluations? | TheHill

“My opportunity finally came. In April 2018, I was one of a few hundred cystic fibrosis patients to dose in a pivotal phase III clinical trial to evaluate a new drug designed to correct CFTR, the dysfunctional protein responsible for CF. The medication, two pills in the morning, and one at night worked almost immediately.

Within a few hours, the viscosity of my usually thick, sticky mucus changed; within a week, the constant cough I had lived with for my entire life nearly vanished, and within a month, my pulmonary function tests skyrocketed. I could finally breathe.

Instead of heading towards end-stage illness, disability income, and an end to my fight with cystic fibrosis, Trikafta, as the drug came to be named, saved my life.

A disturbing trend is washing over the United States, though. Insurers are using economic analyses based on a discriminatory cost-effectiveness metric called Quality-Adjusted Life Years (QALY) as negotiating leverage to limit access to life-changing medications.

A 2018 article in Health Affairs said, “QALY calculations inherently privilege treatments that extend the lives of those who can be restored to perfect health, and disadvantage the many who seek life-extending treatments despite having a disability or chronic condition that is not curable.”

But, QALY is not adequately able to quantify what happened in my own life — my journey from near end-stage illness and no hope for a future to correctly managed CF and entrance into an elite graduate program. Living in a world where I would not have had the chance to dose Trikafta sends a shiver down my spine.

That world, however, has existed in countries where QALY has been used to justify not covering CFTR modulators for people with CF. In the United Kingdom, the National Institute for Health and Care Excellence (NICE) makes QALY calculations to determine which medications are covered by the nation’s National Healthcare Service. In 2016, NICE decided that Orkambi, a previous CFTR modulator iteration, was not cost-effective for its citizens.”

https://thehill.com/opinion/healthcare/477547-should-access-to-life-saving-medicines-be-determined-by-economic

Posted in American Presidents, Disease Prevention, Education, FDA, government incompetence, Government Regulations, Nutrition, outcomes, Patient Choice, Patient Safety, Policy Issues, Prevention, Quality, Uncategorized

Watch “How the Government Made You Fat” on YouTube

Or AKA…

Stay in Your Lane:  Why the government should not parent the citizenry.

Posted in British National Health Service, Disease Prevention, Doctor-Patient Relations, Education, Evidence-based Medicine, Medical conditions and illness, outcomes, outcomes measurement, Patient Compliance, Patient Safety, Patient-centered Care, Prevention, Protocols, Quality, Uncategorized, Unsettled Science

Watch “Evidence Based Medicine Has Been Hijacked by Dr Aseem Malhotra | PHC Conference 2019” on YouTube

Insightful and fascinating glimpse into how medical science has been, and continues to be, distorted by special interests and ideological cabals to the detriment of patients.

Posted in Disease Prevention, Education, Evidence-based Medicine, outcomes, outcomes measurement, Patient Choice, Patient Safety, Patient-centered Care, Prevention, Protocols, Quality, Uncategorized

Dietary carbohydrate restriction as the first approach in diabetes management: Critical review and evidence base – ScienceDirect

The benefits of carbohydrate restriction in diabetes are immediate and well documented. Concerns about the efficacy and safety are long term and conjectural rather than data driven.

Dietary carbohydrate restriction reliably reduces high blood glucose, does not require weight loss (although is still best for weight loss), and leads to the reduction or elimination of medication. It has never shown side effects comparable with those seen in many drugs.

Here we present 12 points of evidence supporting the use of low-carbohydrate diets as the first approach to treating type 2 diabetes and as the most effective adjunct to pharmacology in type 1. They represent the best-documented, least controversial results. The insistence on long-term randomized controlled trials as the only kind of data that will be accepted is without precedent in science.

The seriousness of diabetes requires that we evaluate all of the evidence that is available. The 12 points are sufficiently compelling that we feel that the burden of proof rests with those who are opposed.”

https://www.sciencedirect.com/science/article/pii/S0899900714003323