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 Uncategorized

Capitalism and Morality

International Liberty

Since libertarians are motivated by the non-aggression principle, it’s easy to understand why they support the capitalist system of voluntary exchange rather than alternative systems based on government coercion.

But there are some who think markets are immoral, and that’s the topic of this book and this related video.

Virgil Henry Storr and Ginny Seung Choi are the authors of Do Markets Corrupt Our Morals, and the Mercatus Center explains the book’s core message.

…people in market societies are wealthier, healthier, happier and better connected than those in societies where markets are more restricted. More provocatively, they explain that successful markets require and produce virtuous participants. Markets serve as moral spaces that both rely on and reward their participants for being virtuous. Rather than harming individuals morally, the market is an arena where individuals are encouraged to be their best moral selves.

And Professor Michael Munger from Duke University

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Posted in Education, outcomes, outcomes measurement, Patient Safety, Policy Issues, Prevention, Protocols, Uncategorized

Are medical errors really the third most common cause of death in the U.S.? (2019 edition) – Science-Based Medicine

The claim that medical errors are the third leading cause of death in the US has always rested on very shaky evidence; yet it’s become common wisdom that is cited as though everyone accepts it. But if estimates of 250,000 to 400,000 deaths due to medical error are way too high, what is the real number? A study published last month suggests that it’s almost certainly a lot lower and has been modestly decreasing since 1990.

https://sciencebasedmedicine.org/are-medical-errors-really-the-third-most-common-cause-of-death-in-the-u-s-2019-edition/

Posted in Uncategorized

The Truth About 22 “Studies” that Claim “Medicare For All” Would Save Money

IP4PI - Independent Physicians for Patient independence

There’s a lot not being revealed in a recent oped in The Hill touting new “evidence” that “Medicare for All” would be a financial boon.

https://thehill.com/blogs/congress-blog/healthcare/484301-22-studies-agree-medicare-for-all-saves-money

For example:

PLOS Survey Is A Selective Review Of Prior Studies From Single Payer Proponents

  • The authors of thePLOS surveyused a flawed and incomplete review process that only included studies supporting implementation of Medicare for All, rather than comprehensively and objectively examining the significant economic impact and other negative tradeoffs of single-payer proposals.
  • The PLOS survey included 22 studies, more than half of which were written by the same four authors, some of which dated back to 1991.
  • The PLOS surveyexcluded35 studies of single payer proposals.

The Nonpartisan Congressional Budget Office (CBO) Found Medicare For All Would Reduce Access To Care And Eliminate Choice For Consumers, While Dramatically Increasing Federal Spending At A Time Of Record Deficits And Debt 

https://americashealthcarefuture.org/new-plos-survey-provides-a-biased-and-flawed-overview-of-medicare-for-all/

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Posted in Uncategorized

Why direct primary care is the future

I project that in a year of quarterly “insured” PCP visits, I’d likely spend over $400 out-of-pocket, whereas with my doctor, I’ll spend over $900.

However, comparing my recent lab work costs, I would have saved about $450 had she drawn the labs for me. Her wholesale prescription service will also save me at least $300 over a year compared to average retail prices. All told, I estimate a net savings of over $400 this year through my DPC membership. The potential for additional savings for other services is significant, particularly as I approach the age for screening colonoscopy – which she has coordinated for around $1,000 for her patients.

In summary, despite a monthly fee, DPC pays for itself (and then some) in many forms of savings and benefit. I believe DPC to be economically superior to the current third-party payer model of medical practice. This is especially true for primary care and non-emergent outpatient medical services – which are arguably the majority of the demand in health care.

I believe that DPC may be medically superior as this model allows physicians the time and flexibility to know their patients and accommodate their needs.

DPC may also be superior from inter-personal, personal satisfaction, and humanistic aspects as the rushed, frustrating (for doctor and patient), insurance-restricted, 10-minute visit is replaced with greater availability, depth, flexibility, frequency and duration of interactions.

Lastly, I consider the non-transparency of pricing in our profession to be a moral affront against the patient-consumer who has little idea of his financial obligation or exposure until after the fact. I can think of no other service or product line with similarly hidden and confusing costs. I have not found my own path to higher moral ground as a physician provider, yet, but I’m pushing us all towards greater awareness of costs and of systemic obstacles to transparency. For myself, as a patient, direct primary care is a great stride forward.

https://www.kevinmd.com/blog/2020/02/why-direct-primary-care-is-the-future.html

Posted in Access to healthcare, Canadian Health System, Economic Issues, Government Regulations, Healthcare financing, Medical Costs, Organizational structure, Policy Issues, Uncategorized

Alberta ends master agreement with doctors, new rules to be in place April 1 | CBC News

HEALTHCARE ECONOMIC REALITY CHECK:

  • Supply is limited (it is a service & commodity that is rendered by others)
  • Demand is inexhaustible (innumerable definitions of healthcare needs and wants)
  • Fixing prices exacerbates shortages (resources flow to where they are valued)

This article instantiates the snares and trappings of gov’t financed systems where gov’t functions as a buyer, payer and regulator!  

In the case of this Alberta Canada conundrum, cutting fees is a surrogate for rationing. It encourages providers to short-cut care by reducing time spent with complex patients.  The dangerous flip side of that ugly coin is that the cuts encourage emphasis on increasing the number of shorter visits.

 

tyler-shandro
Health Minister Tyler Shandro says enforcing new rules on Alberta doctors is necessary to meet budget targets. (Colin Hall/CBC)

Last fall, Premier Jason Kenney’s United Conservatives passed Bill 21, which gives the government the right to unilaterally end the agreement.

A decade ago, Alberta added in an extra fee — called a complex modifier — to recognize that some patients have multiple or complex issues and doctors should be compensated for overly long visits.

If a visit went more than 15 minutes, doctors were able to extend it 10 minutes and bill the province a complex modifier fee of $18, for a total of $59.

As of April 1, the fee will be halved from $18 to $9, for a new total fee of $50.

As of April 1, 2021, the $18 complex modifier will return. But physicians won’t be allowed to bill for it until the 25-minute mark.

Doctors warn of cutting visits

Shandro’s ministry says the change is necessary for two reasons: more time is needed to assess complex patients and the current complex modifier is being abused, with too many doctors billing the $59 right at the 15-minute mark.

At a news conference announcing the changes, Shandro said the modifier was being used for almost 50 per cent of visits.

The Alberta Medical Association, the bargaining arm for doctors, has said extending the length of a visit to 25 minutes would reduce fees by a total of $200 million and devastate many family and rural practices.

The AMA has argued the complex modifiers are not only for exceptional cases and take into account all the work — preparation, follow-up and face-to-face time — needed for patients with complex needs. It also says it keeps those patients out of the hospital.

The issue has riled up some doctors, many of whom have put up signs warning patients they may have to cut future visits short to recoup funds needed to keep their practices going.

https://www.cbc.ca/news/canada/calgary/alberta-government-doctors-pay-ama-agreement-1.5470352