Posted in Access to healthcare, advance-pricing, Affordable Care Act (ObamaCare), CPT billing, Deductibles, Economic Issues, Employer-Sponsored Health Plans, Government Regulations, Health Insurance, Healthcare financing, Medical Costs, medical inflation, out-of-pocket costs, Patient Choice, Policy Issues, Uncategorized

On the Importance of Price Transparency

Dollar-under-magnifying-glass-1024x910On the importance of transparency… may I present exhibit A: https://www.medpagetoday.com/publichealthpolicy/ethics/83459

Pay particular attention to the content of the last paragraph!!! 

“The Affordable Care Act mandates that health insurers cover all federally recommended vaccines…at no charge to patients,…

Kaiser Health News looked at what its own insurance carrier, Cigna, paid for those free flu shots. At the high end, it shelled out $85 for a flu shot given at a Sacramento, California, doctor’s office that was affiliated with Sutter Health, one of the largest hospital chains in the state. Further south, in Long Beach, Cigna paid $48 for a shot.

Prices in the Washington, D.C., area went even lower, to $40 per shot at a CVS in Rockville, Maryland, and to $32 per shot at a CVS in downtown Washington that’s less than 10 miles away from the Rockville location.

Picture1.pngOne expert told KHN that the variation has nothing to do with the cost of the drug, but stems from secret negotiations between health plans and providers. While patients are expected not to care since the shot is free to them, these costs come back to bite in the form of higher premiums — which is one of the major complaints about the ACA.”

Posted in Access to healthcare, Accountable Care Organizations, Affordable Care Act (ObamaCare), American Presidents, Canadian Health System, Direct-Pay Medicine, Economic Issues, Employer-Sponsored Health Plans, Government Regulations, Government Spending, Health Insurance, Healthcare financing, Independent Physicians, Medicaid, Medical Costs, Medical Practice Models, Medicare, News From Washington, out-of-pocket costs, Patient Choice, Policy Issues, Quality, Reforming Medicare, Uncategorized

What You Need To Know About Medicare For All, Part I

A study by Charles Blahousat the Mercatus Center estimates that Medicare for all would cost $32.6 trillion over the next ten years. Other studies have been in the same ballpark and they imply that we would need a 25% payroll tax. And that assumes that doctors and hospitals provide the same amount of care they provide today, even though they would be paid Medicare rates, which are about 40% below what private insurance has been paying. Without those cuts in provider payments, the needed payroll tax would be closer to 30%.

Of course, there would be savings on the other side of the ledger. People would no longer have to pay private insurance premiums and out-of-pocket fees. In fact, for the country as a whole this would largely be a financial wash – a huge substitution of public payment for private payment.

But remember, in today’s world how much you and your employer spend on health care is up to you and your employer. If the cost is too high, you can choose to jettison benefits of marginal value and be more choosey about the doctors and hospitals in your plan’s network. You could also take advantage of medical tourism (traveling to other cities where the costs are lower and the quality is higher) and phone, email and other telemedical innovations described above. The premiums you pay today are voluntary and (absent Obamacare mandates) what you buy with those premiums is a choice you and your employer are free to make.

With Medicare for all, you would have virtually no say in how costs are controlled other than the fact that you would be one of several hundred million potential voters.

Remember also that there is a reason why Obamacare is such a mess. The Democrats in Congress convened special interests around a figurative table – the drug companies, the insurance companies, the doctors, the hospitals, the device manufacturers, big business, big labor, etc. – and gave each a piece of the Obamacare pie in order to buy their political support.

As we show below, every single issue Obamacare had to contend with would be front and center in any plan to replace Obamacare with Medicare for all. So, the Democrats who gave us the last health care reform would be dealing with the same issues and the same special interests the second time around.

It takes a great deal of faith to believe there would be much improvement.

https://www.forbes.com/sites/johngoodman/2018/09/07/what-you-need-to-know-about-medicare-for-all-part-i/

Posted in Access to healthcare, Affordable Care Act (ObamaCare), American Presidents, Economic Issues, Employee Benefits, Essential Benefits under the ACA, Government Regulations, Health Insurance, Healthcare financing, Individual Market, Individual ObamaCare Market, Individual Underwriting Standards, Insurance subsidies, Medical Costs, News From Washington, Patient Choice, Policy Issues, Pre-existing Conditions, Uncategorized, Uninsured

Obamacare is now optional

Michael F. Cannon
Michael F. Cannon

“Wednesday’s rule reinstates and even expands the consumer protections Obama curtailed. It allows short-term plans to last 12 months, and allows insurers to offer them with renewal guarantees.

You read that right. Democrats curtailed consumer protections; Republicans are expanding them.

The policy change also promises more secure coverage for the sick. It frees consumers to avoid Obamacare’s price controls, which are eroding coverage for the sick. Instead, consumers can purchase consecutive short-term plans, tied together with renewal guarantees that protect them from medical underwriting when they fall ill.

Renewal guarantees can even protect some 200 million consumers with employer-based coverage, or no health insurance, from medical underwriting — for just one-tenth the cost of Obamacare plans.

When Congress passed Obamacare, insurers had just begun selling renewal guarantees as a standalone product. These policies gave purchasers the right to enroll in a health insurance plan whenever they wanted, at healthy-person premiums, no matter how sick they got in the meantime, and cost roughly 90 percent less than the average Obamacare premium. Twenty-five states approved this marvelous innovation for sale before Obama unilaterally banned it. Wednesday’s rule makes this and further innovations possible again.”

https://www.washingtonexaminer.com/opinion/obamacare-is-now-optional

Posted in Access to healthcare, Affordable Care Act (ObamaCare), Direct-Pay Practice Models, Employee Benefits, Employer Mandate, Employer-Sponsored Health Plans, Essential Benefits under the ACA, Health Insurance, Health Reimbursement Arrangement (HRA), Health Savings Accounts (HSA's), Healthcare financing, Individual Mandate, Policy Issues, Tax Policy, Uncategorized

Healthcare: What to Watch For

“…it is important for employers to be fully aware of what the regulations may impact them to safeguard against inadvertently putting themselves, or their employees, in an untenable situation.

It is important for an employer looking to offer an unconventional or untraditional benefit package to speak with an independent health plan attorney or CPA (not employed by the agency selling the program) regarding potential liability and compliance with federal and state laws regarding employer sponsored health plans.

Can your employee afford to reimburse the IRS for taxes not collected on an inappropriately structured HSA? Can your business afford a fine of $100 per day per employee for every day that the unqualified arrangement was offered? These are just some of the potential liabilities.”

http://ushealthmedia.com/healthcare-what-to-watch-for/

Posted in Economic Issues, Government Regulations, Influence peddling, Medical Costs, medical inflation, Organizational structure, Policy Issues, Price Tansparency, Uncategorized

Government-Enabled Kickbacks Escalate Medical Prices, Worsen Shortages, Stifle Innovation | PressReleasePoint


While there are more than 600 GPOs in various industries, only a few GPOs dominate the medical market,” Dr. Singleton writes. “The current fee structure raises an obvious conflict of interest: … since vendors pay the fees as a percentage of the product cost, the higher the price, the higher the GPOs’ fees.”

http://www.pressreleasepoint.com/government-enabled-kickbacks-escalate-medical-prices-worsen-shortages-stifle-innovation

Posted in Access to healthcare, Affordable Care Act (ObamaCare), DC & Related Shenanigans, Economic Issues, Government Regulations, Government Spending, Healthcare financing, Medical Costs, medical inflation, Medicare, News From Washington, out-of-pocket costs, Policy Issues, Reforming Medicare, Uncategorized

Best Kept Secret In Washington DC: The Future Of Medicare – Forbes

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John C. Goodman

The fact that Medicare has been put on a sound financially footing – for the first time in its history – has never appeared in any official government announcement. Ditto for the fact that the disabled and the elderly may bear a heavy cost along the way.

These facts have not been in the headlines of any major newspaper. They have not been addressed in any news article. To my knowledge they have never been discussed in any opinion editorial. Even more surprising, they are repeatedly ignored by scholars and in scholarly reports at think tanks around the country (other than my own).

Eerie as it may seem, the entire country has been acting as though these incredible public policy changes have never occurred.

Here is a third thing l bet you don’t know. Although Republicans have criticized the “Obama cuts in Medicare spending” as threatening access to care for the elderly, the GOP alternative essentially does exactly the same thing.

What no one bothered to discuss was the much bigger budget story: an enormous reduction in future Medicare spending and its impact on the health and financial well-being of the 54 million people in Medicare.

Here is a bit more detail.

Source: Best Kept Secret In Washington DC: The Future Of Medicare – Forbes