Posted in Access to healthcare, advance-pricing, Consumer-Driven Health Care, Defined Contribution Benefit Plans, Direct-Pay Medicine, Direct-Pay Practice Models, Economic Issues, Free-Market, Health Insurance, Healthcare financing, Independent Physicians, Medical Costs, Medical Practice Models, out-of-pocket costs, Patient Choice, Policy Issues, Price Tansparency, primary care, Quality, Uncategorized

FORBES | Employers Could Slash Their Health Costs Overnight. So, Why Don’t They?

John C. Goodman

“I am often asked if the free market can work in health care. My quick reply is: That is the only thing that works. At least, it is the only thing that works well.

Show me a health care market where there is no Blue Cross, no Medicare and no employer. I’ll bet it’s a market that works a lot like the markets for other goods and services.

In Overcharged: Why Americans Pay Too Much for Health Care (Cato: 2018), law professors Charles Silver and David Hyman make this same point in spades.

After several decades of trying everything from managed care to value-based purchasing, employers need to sit up and take note. The authors say the only thing that really holds down costs is giving money to the employees and letting them buy their own health care. “There is no health care cost crisis in the retail sector,” they write, and there “never has been.”

Atlas MD in Wichita, Kansas, for example, provides just about every service you can get at a primary care doctor’s office for $50 to $75 a month for adults (depending on age) and $10 for a child. Doctors are available by phone or email 24/7. Drugs cost less than what Medicaid pays. Medical tests are cheap.  A cholesterol test is $3, a tiny fraction of the charge that the lab they deal with bills to insurers. An MRI scan costs $400 instead of the typical third party charge of $2,000.

What about expensive hospital care? That too can look like retail medicine if you know where to look. The Surgery Center of Oklahoma (SOC), founded by Drs. Keith Smith and Steve Lantier, posts prices for 112 common surgical procedures. They deal mostly in cash and they don’t take Medicare or Medicaid or negotiate prices with insurance companies. One of SOC’s competitors is Integris Baptist Medical Center in Oklahoma City. The contrast couldn’t be starker, as the authors note:

Integris charged $33,505 for a complex bilateral sinus procedure, which helps patients with chronic nasal infections. This bill covered only hospitalization; the fees for the surgeon and the anesthesiologist were extra. At SOC, the all-inclusive price for the same operation is $5,885. Not surprisingly, Integris’s bill was loaded with overcharges, including $360 for a steroid available at wholesale for just 75 cents, and $630 for three doses of a pain killer called fentanyl citrate, which altogether cost the hospital about $1.50.”

New developments in retail medicine are almost always the product of entrepreneurial thinking. Sometimes the entrepreneurs are medical doctors. Sometimes they are business types with a strong interest in eliminating the many inefficiencies in traditional health care.”

Source: Employers Could Slash Their Health Costs Overnight. So, Why Don’t They?

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, Defined Contribution Benefit Plans, Economic Issues, Employee Benefits, Employer Mandate, Employer-Sponsored Health Plans, Government Regulations, Health Insurance, Health Reimbursement Arrangement (HRA), Healthcare financing, Individual Market, Individual ObamaCare Market, Individual Underwriting Standards, Medical Costs, News From Washington, Patient Choice, Policy Issues, Portable Insurance, Pre-existing Conditions, The Triple Aim, Uncategorized

Donald Trump Takes A Big Step Toward Personal And Portable Health Insurance

READ THIS ARTICLE below if you want to understand the degree to which this ruling is an important step for healthcare reform.

But as John C. Goodman points out, administrative ruling can only go so far without being codified by legislative action.

Some believe the Individual Market is too weak to revive, given the hit it took as as result of the ACA.

I am optimistic that this ruling to utilize HRA is this manner will be a “shot in the arm” and revitalize the market again.

This hopefully highlights the benefits, and spurs popularity, of a defined contribution approach as a means to purchase health insurance.

Anything that makes us less dependent on ESI and gives more portability & options, freeing the labor market from job-lock is a good thing. -Forum for Healthcare Freedom

John C. Goodman

https://www.forbes.com/sites/johngoodman/2019/06/18/donald-trump-takes-a-big-step-toward-personal-and-portable-health-insurance/

Posted in Access to healthcare, Accountable Care Organizations, Affordable Care Act (ObamaCare), Economic Issues, Government Regulations, Healthcare financing, Independent Physicians, Medical Costs, Medical Practice Models, Medicare, News From Washington, DC & Related Shenanigans, Organizational structure, Patient Choice, Patient-centered Care, Policy Issues, Price Tansparency, Reforming Medicare, third-party payments, Uncategorized

How The Trump Administration Is Reforming Medicare | Health Affairs

“This 124-page document challenges a premise behind 50 years of thinking in health policy circles: that our most serious problems in health care arise because of flaws in the private sector. Most problems arise because of government failure, not market failure, the document declares, and it goes into great detail on how to correct the policy errors.

Trump policy toward health care appears to be based on the idea of promoting choice, competition, and the role of market prices. In Medicare, so far that means liberating telemedicine and accountable care organizations (ACOs), ending payment incentives that are driving doctors to become hospital employees, promoting hospital price transparency, reducing regulatory paperwork, and creating more transparency in the market for prescription drugs.”

https://www.healthaffairs.org/do/10.1377/hblog20190501.529581/full/

Posted in Access to healthcare, Consumer-Driven Health Care, CPT billing, Direct-Pay Medicine, Direct-Pay Practice Models, Doctor-Patient Relationship, Economic Issues, Employer-Sponsored Health Plans, Government Regulations, Health Reimbursement Arrangement (HRA), Health Savings Accounts (HSA's), Healthcare financing, Individual Market, Large group insurance market, Medicaid, Medical Costs, Medical Practice Models, Medicare, Patient Choice, Patient-centered Care, Policy Issues, Portable Insurance, primary care, Protocols, Reforming Medicaid, Reforming Medicare, Tax Policy, Technology, third-party payments, Uncategorized

Trump’s New Vision for Health Care

Hats off to John C. Goodman again! His work in leading the effort for market-based healthcare reform over the past 4 decades, and highlighting the government’s role in the dysfunctional mess we labor in, is second to none.

This Forbes article lays out a most concise and accurate rendering of what healthcare has become and why…and what to do about it.

If you’re tired of the hearing healthcare pundits wax feverishly about their favorite villains and how more regulations are the answer; or if you’re just a novice starting to explore the Healthcare conundrum, Dr. Goodman’s work is required reading. I recommend starting here and then circling back to some of his earlier work. The book “PRICELESS” is a recommended next step!

https://www.forbes.com/sites/johngoodman/2019/01/14/trumps-new-vision-for-health-care/

Posted in Access to healthcare, Accountable Care Organizations, Affordable Care Act (ObamaCare), Consumer-Driven Health Care, Crony Capitalism, Doctor shortage, Economic Issues, Employer-Sponsored Health Plans, Evidence-based Medicine, Free-Market, Government Regulations, Health Insurance, Healthcare financing, Independent Physicians, Individual Market, Individual Underwriting Standards, Influence peddling, Large group insurance market, Medical Costs, Medical Practice Models, Medicare, Organizational structure, Patient Choice, Patient Safety, Policy Issues, Price Tansparency, Protocols, State Medical Boards, third-party payments, Uncategorized

Save Us From The Health Care Reformers: They’re The Problem, Not The Solution

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John C. Goodman

Dr. Goodman’s article is a fantastic foray into the dark history organized medicine, culminating with a brutally honest assessment of the cartel that resulted. He gives a great preview of the good stuff in Greg Scandlen’s new book, Myth Busters: Why Health Reform Always Goes Awry, summarizing the oft-repeated myths we hear about healthcare economics thrown around like dogma.

Source: Save Us From The Health Care Reformers: They’re The Problem, Not The Solution

Posted in Access to healthcare, Affordable Care Act (ObamaCare), Deductibles, Economic Issues, Health Insurance, Health Savings Accounts (HSA's), Healthcare financing, Medical Costs, out-of-pocket costs, Patient Choice, Policy Issues, Tax Policy, Uncategorized

A New Approach To High Deductibles

John C. Goodman

Is this a good deal? If you are a high-income individual with a lot more than $10,000 in the bank, this product may not be for you. But if you tend to live paycheck-to-paycheck and have trouble saving for medical expenses, insuring against your deductible may make more sense than trying to fund it with a savings account.

Health Matching Services is a very innovative firm, but it has to struggle with tax laws and regulatory regimes that look like they were designed with no thought at all. And of course, the ridiculously high deductibles offered by primary insurers are the perverse result of Obamacare.

In a rational world, the tax law would provide a level playing field for premium payments and deposits to medical savings accounts. Competition in a secondary insurance market would provide consumers with many choices. For example, some might prefer to self-insure for the first $3,000 and buy the kind of secondary insurance described above for the remaining $7,000 gap.

Who knows? But for the perverse incentives of Obamacare and other insurance regulations, primary insurers might offer these choices. A secondary market for health insurance might not even be necessary.

Source: A New Approach To High Deductibles

Posted in Access to healthcare, Affordable Care Act (ObamaCare), Consumer-Driven Health Care, Economic Issues, Free-Market, Government Regulations, Government Spending, Health Insurance, Healthcare financing, Insurance subsidies, Leadership, Medicaid, Medicaid Expansion, Medical Costs, Medicare, Organizational structure, Patient Choice, Policy Issues, Reforming Medicare, Subsidies, Tax Policy, Uncategorized

Republican Health Care Fiasco, Part II

John C. Goodman

“Only a few years ago, the party was united behind three reforms that are consistent with individual empowerment and limited government: (1) a universal health refund that transfers all government tax and spending subsidies to ordinary citizens each year with no strings attached other than the requirement that it be used for health care, (2) a flexible Health Savings Account that allows people to manage some of their own health care dollars and (3) pre-existing condition protection for people who lose their insurance because of government policies.

For well over a decade House Speaker Paul Ryan (R-WI) was a steadfast supporter of all three ideas, including replacing tax and spending subsidies for health care and health insurance with a universal tax credit. John McCain ran on these ideas in the 2008 election. The legislative embodiment of McCain’s plan was the Patients Choice Act, which Ryan cosponsored in 2009 along with Devin Nunes (R– CA) in the House and Tom Coburn (R–OK) and Richard Burr (R–NC) in the Senate.”

“The American Health Care Act (AHCA), proposed by the House leadership, was not about health care. It was about taxes. Over and over, Ryan said he needed to do health reform before tax reform. In particular, he said he needed to reduce Obamacare taxes by $1 trillion and to reduce spending by more than $1 trillion.

As noted, a tax cut tied to health care is part of good health reform. But the Ryan tax cut wasn’t tied to health care. It consisted of repealing the very revenues that were funding Obamacare. (See below.)  Since the tax cut took money out of the system, the spending cuts paired with it also removed money from the system.”

Source: Republican Health Care Fiasco, Part II