Posted in American Exceptionalism, Education, Free Society, Liberty, Philosophy, Uncategorized

Implications of the Metaphysical & Rational Basis of Western Civilization

Welcome to Friday’s Philosophical Foray beyond Healthcare.

Exploring the Metaphysical & cognitive origins of Western thought: A unique viewpoint by Professor Jordan Peterson.

Synopsis:

A Self-evident axiomatic principle of the intrinsic value of the individual >>> A proposition of Natural Rights >>> Emergence of social principles & Law based on individual sovereignty & Natural Rights >>> Moving beyond savage tribalism & divine rights >>> Unity based on collective belief in same axiomatic principles >>> Diverse elements find common ground >>> Societies more stable by way of respect for rights & sovereignty >>> Gives people tools to correct corruption & dysfunction in societal hierarchies to avoid deterioration into chaos.

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, Affordable Care Act (ObamaCare), CPT billing, Deductibles, Dependency, Direct-Pay Medicine, Direct-Pay Practice Models, Economic Issues, Employee Benefits, Health Insurance, Healthcare financing, Individual Market, Medical Costs, medical inflation, Medical Practice Models, Organizational structure, outcomes measurement, Patient Choice, Policy Issues, Price Tansparency, Self-Insured Companies, Self-Insured Plans, The Triple Aim, Uncategorized

U.S. Healthcare: A Case Study of What Happens When “Insurance” Supplants Price-Transparent Markets

By Robert Nelson, MD

Our health insurance-based third-party payer protocols have pernicious and nefarious economic consequences on the cost of medical care; and in many ways has diminished access due to regulatory complexities that accompany these interventions.

The undeniable result continues to be a rampant increase in healthcare prices, which is catalyzed by the economic distortions of the 3rd party payer effect and perpetuated by the price-obscuring distortions of the CPT billing cycle.

We have taken the concept of insurance, designed to pay out rare higher-priced claims on unpredictable events, and turned it into a product whose design promotes an incentive for everyone to use it as often as possible.

Insurance is sustainable only when the financial risks of individually rare events are spread over a large population. When it also becomes a funding source for anticipated and affordable events, combined with a perverse incentive to utilize it to the margin, the result is the creation of a perpetual payout fund.

The costs of sustaining this model are never satisfied, being squeezed by patients who are chasing the benefits and providers who chase the billing codes to achieve maximal reimbursement.

As evidence for the negative consequence of misusing insurance as a pass-through system for virtually every healthcare expense (accelerated by passage of the ACA), we can examine the employer-sponsored group market premiums.

From 2007 – 2017 the average premium for family coverage increased by 55% and employee contribution rate as a share of premium cost increased by 74% over the same 10-year period; while median household income went up by only 3%.

To add financial injury to insult, the percentage of employees with an out-of-pocket maximum of greater than $3,000 doubled, going from 30% to 60% of employees.

“Eighty-one percent of covered workers have a general annual deductible for single coverage that must be met before most services are paid for by the plan. Among covered workers with a general annual deductible, the average deductible amount for single coverage is $1,505.” ~KFF.org

Between 2012 – 2017, the percentage of covered workers with a general annual deductible of $1,000 or more for single coverage has grown substantially, increasing from 34% in 2012 to 51% in 2017. Thirty-seven percent of covered workers in small firms are in a plan with a deductible of at least $2,000, compared to 15% for covered workers in large firms.

In the ACA individual market insurance exchanges, single coverage premiums (unsubsidized) increased by 62% and family coverage premiums increased by 75% just since implementation of ObamaCare!

Our third-party payer system has created a dependency paradox!

The same funding method that contributes to runaway costs also causes us to be more dependent on it for access. This guarantees that Healthcare will cost significantly more than the sum of its individual parts, and will continue to escalate faster than our ability to pay for it.

The costs associated with health plan premiums (aka insurance) have become a surrogate for health-care costs.

Now let that sink in!

In what other market does the cost of an insurance product act as substitute for the aggregate cost of the product or services that it insures?

Now apply a similar scenario to the auto insurance market. It doesn’t take much imagination to extrapolate how that would play out. But if you want some help visualizing the scenario, here’s a brief vignette. https://lnkd.in/eUGeCKv

Self-insured employer health plans are in a unique position to break out of this dependency paradox.

By contracting with a Direct Primary Care practice and re-routing subsequent encounters away from the more expensive insurance-based protocols, Self-insured employers can utilize creative plan designs to cut costs and improve employee satisfaction.

Data from the Qliance experience, and supported by other self-insured employer’s experiences, utilization of efficient primary care via the DPC model reduces unnecessary downstream care by approximately 50%, with the resultant aggregate cost savings of nearly 20%.

The caveat being, as we double the number of primary care visits combined with longer visits to adequately address problems, the need for emergent visits, ER visits and specialty intervention drop significantly.

A similar level of savings for direct-pay lab tests was noted in data published in 2014 by CMT journal comparing lab fees charged to a Direct Pay practice by the lab vs. the CPT billed charges by the lab (assuming patient had no coverage or had not met their deductible). For five common blood tests the savings was 89% by not using insurance, with lab billed charges of approximately $782 compared to a direct pay cost of $80. Plum Health, a direct primary care practice in Detroit, shows similarly impressive lab test savings of 87% on six common blood tests; $811 vs $106.

Many Self-insured companies are beginning to discover the value and savings in this approach, while breaking free of the coverage trap and the myth that health insurance equates to health care; and the realization that so-called “access” to inflated pricing and the phony discounts used to fleece the buyer is no longer a conversation they are willing to have.

Posted in Access to healthcare, advance-pricing, Affordable Care Act (ObamaCare), CPT billing, Direct-Pay Medicine, Direct-Pay Practice Models, Economic Issues, Free-Market, Government Regulations, Health Insurance, Healthcare financing, Independent Physicians, Medical Costs, medical inflation, out-of-pocket costs, Patient Choice, Policy Issues, Price Tansparency, Uncategorized

Surprise Medical Bills: We Know the Cure…Few Are Using it

This whole issue of “surprise bills” is a symptom of a more pernicious economic disease which has been driving prices in healthcare for decades; that being, a lack on discoverable, actionable meaningful prices for bundled medical services.

Moreover, the lack of transparent/actionable pricing in healthcare is a derivative of the manner in which we have chosen to code, bill and get paid for medical services.

And most of the legislative and regulatory fixes proposed do NOT correct the core problem.

The corollary being, there are no surprise bills when we use real honest pricing strategies!

Dr. Keith Smith and Dr. Steve Lantier

Case in point…you will never have a surprise bill from Surgery Center Of Oklahoma. They publish easily discoverable all-inclusive prices for their surgical procedures. And, they offer same price to any willing buyer, because they aren’t controlled by network contracts.

Price setting or caps is not the correct response to the problem of this form of price gouging. This knee jerk visceral reaction is shortsighted. Price setting ALWAYS distorts markets in negative ways which are not always apparent; shortages or supply chain inefficiencies/interruptions/gaps are inevitable.

It is NOT the cost of medical care & and pharma that is the problem…It is the simultaneous lack of both transparent & actionable prices, combined with using proprietary contractual formulary agreements as a substitute for honest pricing, which has brought us to this dangerous fiscal precipice. Hiding costs by shifting them or redistributing them is same economically illiterate strategy which brought us Obamacare.

We can do better.

Posted in Access to healthcare, advance-pricing, CPT billing, Direct-Pay Practice Models, Economic Issues, Health Insurance, Healthcare financing, medical inflation, out-of-pocket costs, Policy Issues, Uncategorized

The Sorry State of Healthcare Financing: “But I Didn’t Get the Memo!”

Memo.LumbergYou pull into a Gas Station and discover that there are no prices listed on the pump, just a slot to insert your auto insurance card…only to find out your State Farm policy is not part of the gas station’s network! You just want to fill up and you are willing to pay cash, so you ask the attendant how much it is per gallon.

The response: “We can’t be sure until we know what your out-of-network benefits are… so you’ll need to pay a $200 deposit until the claim cycles through. If the gasoline is less than $200 you’ll get a refund; if more, then you’ll get an additional bill.”

Or you sit down at a Restaurant, open the menu to discover there are NO prices listed…Not only that, but you have to agree to eat the food and pay whatever price your insurance company says you owe!!!

This, my friends, is the sorry state of healthcare economics and a big reason why Healthcare is so expensive…because it isn’t the cost of care that is the problem; it’s the price we are being charged for the privilege of using our insurance!!!

Posted in Crony Capitalism, DC & Related Shenanigans, Economic Issues, Government Regulations, Government Spending, Organizational structure, outcomes, outcomes measurement, Policy Issues, Poverty, Progressivism, Uncategorized, Wealth

Homelessness and the Failure of Urban Renewal | Mises Wire

In the department of economy, an act, a habit, an institution, a law, gives birth not only to an effect, but to a series of effects. Of these effects, the first only is immediate; it manifests itself simultaneously with its cause—it is seen. The others unfold in succession—they are not seen: it is well for us, if they are foreseen. Between a good and a bad economist this constitutes the whole difference—the one takes account of the visible effect; the other takes account both of the effects which are seen, and also of those which it is necessary to foresee. Now this difference is enormous, for it almost always happens that when the immediate consequence is favorable, the ultimate consequences are fatal, and the converse.  ~Frederic Bastiat

The parallels are numerous, and highly revealing, between our attempts to control prices in healthcare over the past 50 years and that of government attempts to solve “urban blight” and improve inner city living conditions.  In his book Myth Busters: Why Healthcare Reform Always Goes Awry, Greg Scandlen does a fantastic job of laying out the case for the negative unintended consequences of central planning in healthcare. https://www.goodreads.com/book/show/34942619-myth-busters

homeless“…Since the Progressive Era, government agencies — from the federal level on down — have been front and center in subsidizing, regulating, and planning city development in ways that have made housing in city centers more sparse and more expensive for households who aren’t part of the hipster-millionaire demographic that so many urban planners and politicians are working hard to attract.

While rising demand for housing in a fixed number of square miles will indeed increase the price of land and housing, various types of government intervention makes housing more expensive than it would otherwise be. And sometimes, through zoning ordinances and other regulations, cities largely outlaw just the sorts of housing that are most needed by low-income residents…

City planners were happy to show off the shiny new projects they had used government money to redevelop. But unseen were the households who simply could not afford units in the new buildings.

After all, the poor that lived in the slums lived there precisely because it was cheap, low-rent housing. Reformers admitted there were no “pat answers” to explain what would become of the displaced families. But few reformers seemed much troubled by it. Then, as now, it may have been what really mattered to reformers was to be able to claim they were doing something.

It turned out that the federal government’s grand plan of leveling flophouses and residential hotels in the name of “beautifying” cities, mostly just resulted in destroying the only housing the very-low-income population could afford. Deprived of their units in the slums, these people ended up living in tent cities and cardboard boxes instead.

Today, little has changed for those with the lowest incomes. The options once available to them in the pre-1950s world are gone, and were never replaced.

Thanks to the persistence of the Progressive mindset in cities, zoning, “redevelopment” and a centralized control of new construction remains the norm. “Density” is the new “congestion” and the attitude of city planners remains the same. They bemoan the lack of affordable housing while also blocking efforts to build more housing. Meanwhile, they tighten controls on modern-day boarding houses and other private-sector attempts to provide low-cost housing…

…Tax Increment Financing (TIF) legislation is geared not toward low-cost housing, but toward new commercial development. Often, that development is built where “unsightly” (but affordable) housing once existed. Its destruction is encouraged by government policy…

Yet, city centers remain the most practical place for very-low-income housing to be built and sustained. This is because the lowest-income households need to be close to the densest areas that sustain mass transit and access to employment. By destroying the urban ecosystem of very-low-income housing, though, governments have left many of these people few options other than living in cars, alleyways, and sidewalks…

…We continue to live with the wreckage of failed urban renewal, and the evidence can be seen in the tent cities and makeshift latrines we now see in public spaces.”

Source: Homelessness and the Failure of Urban Renewal | Mises Wire

Posted in Education, emotional intelligence, Free Society, Government Regulations, Liberty, Philosophy, Policy Issues, Progressivism, Uncategorized

Two Ways Our World Resembles “1984” – Foundation for Economic Education

Welcome to another edition of Friday’s Philosophical Foray beyond Healthcare.  Today’s foray comes to us via a thoughtful article by Jon Miltimore, managing editor at Foundation for Economic Education.

 

“Truth, we see, does not exist in Oceania, the totalitarian nation-state that serves as the setting of 1984. The absence of truth is shown at various times in various ways, but it most famously is depicted when Winston Smith, the book’s protagonist, reflects that it’s only a matter of time before the Party would insist that two plus two makes five.

“It was inevitable that they should make the claim sooner or later: the logic of their position demanded it,” Smith tells us. “Not merely the validity of experience, but the very existence of external reality was tacitly denied by their philosophy. The heresy of heresies was common sense.”

It’s not just that Big Brother is hostile to truth, logic, or facts (though it is). It’s that truth, logic, and facts will at certain times inevitably conflict with its sole goal: control.

This brings us to a second observation about Oceania. It’s a land steeped in politics. It’s force-fed to people. They consume it, whether they wish to or not. It is pumped out of telescreens day and night. It comes from indoctrinated children and neighbors. Some of the people reciting the Party’s cliches believe it, others may not. But there is no escaping the Party’s dogmas.

Politics, few today would deny, saturates most aspects of our lives. It’s in our school systems and collegesFootball gamesblockbuster films, and America’s churches. This was not always the case, and the development is not a healthy one.

And then there is the matter of truth. Last year the Rand Corporation published a report. It essentially said our civilization is suffering from a strange condition: Truth Decay.

Truth Decay is defined as a set of four related trends: increasing disagreement about facts and analytical interpretations of facts and data; a blurring of the line between opinion and fact; an increase in the relative volume, and resulting influence, of opinion and personal experience over fact; and declining trust in formerly respected sources of factual information.

Truth decay might help explain why many people—even intelligent sensible, grounded ones—seem to feel like Alice after she tumbled down the rabbit hole.

“We are living in an era when sanity is controversial and insanity is just another viewpoint,” the economist Thomas Sowell recently stated.

Few Americans today would deny, I think, that truth is under assault. It’s one of the few ideas on which Left and Right can agree. The disagreement arises over who are the greater transgressors of truth.

This is not a trivial matter. As FEE president Lawrence Reed recently observed, truth and freedom are inseparable.

“The first casualty on the slippery slope to tyranny is the truth,” wrote Reed. “If you wish to live in freedom, you must first commit yourself to truth in all things.”

Our future need not be as bleak as that of 1984. The first step to making sure it is not is to reclaim the cherished principle of free speech, and not strictly in a legal sense. Rather, we must remember that the free expression of ideas is essential to and inseparable from the search for truth.

The great American writer Walter Lippmann once explained why freedom of discussion is essential to not just freedom, but truth itself.

“…if we truly wish to understand why freedom is necessary in a civilized society, we must begin by realizing that, because freedom of discussion improves our own opinions, the liberties of other men are our own vital necessity,” wrote Lippman, one of the founding editors of The New Republic. “This is the creative principle of freedom of speech, not that it is a system for the tolerating of error, but that it is a system for finding the truth.”

The truth will not prevail in a world that prevents the conflict of ideas by suppressing speech.

“Freedom is the freedom to say that two plus two makes four,” Winston Smith tells us. “If this is granted, all else follows.”

When I read this line 25 years ago I didn’t understand what Orwell was saying. Now I do.

Source: Two Ways Our World Resembles “1984” – Foundation for Economic Education