Posted in Free Society, Government Regulations, Liberty, Philosophy, Policy Issues, Representative Republic vs. Democracy, Rule of Law, U.S. Constitution, U.S. Security, Uncategorized

The True Story of the Reichstag Fire and the Nazi Rise to Power | History | Smithsonian Magazine

You may want to read the Smithsonian piece about the Reichstag Fire first, then consider it in light of the political events of the past year 4 years.

Here’s an excerpt:

“In January 1933, Hindenburg reluctantly appointed Hitler as chancellor on the advice of Franz von Papen, a disgruntled former chancellor who believed the conservative bourgeois parties should ally with the Nazis to keep the Communists out of power. March 5 was set as the date for another series of Reichstag elections in hopes that one party might finally achieve the majority.

Meanwhile, the Nazis seized even more power, infiltrating the police and empowering ordinary party members as law enforcement officers. On February 22, Hitler used his powers as chancellor to enroll 50,000 Nazi SA men (also known as stormtroopers) as auxiliary police. Two days later, Hermann Göring, Minister of the Interior and one of Hitler’s closest compatriots, ordered a raid on Communist headquarters. Following the raid, the Nazis announced (falsely) that they’d found evidence of seditious material. They claimed the Communists were planning to attack public buildings.

On the night of February 27, around 9:00, pedestrians near the Reichstag heard the sound of breaking glass. Soon after, flames erupted from the building. It took fire engines hours to quell the fire, which destroyed the debating chamber and the Reichstag’s gilded cupola, ultimately causing over $1 million in damage. Police arrested an unemployed Dutch construction worker named Marinus van der Lubbe on the scene. The young man was found outside the building with firelighters in his possession and was panting and sweaty.

“This is a God-given signal,” Hitler told von Papen when they arrived on the scene. “If this fire, as I believe, is the work of the Communists, then we must crush out this murderous pest with an iron fist.”

A few hours later, on February 28, Hindenburg invoked Article 48 and the cabinet drew up the “Decree of the Reich President for the Protection of the People and State.” The act abolished freedom of speech, assembly, privacy and the press; legalized phone tapping and interception of correspondence; and suspended the autonomy of federated states, like Bavaria. That night around 4,000 people were arrested, imprisoned and tortured by the SA. Although the Communist party had won 17 percent of the Reichstag elections in November 1932, and the German people elected 81 Communist deputies in the March 5 elections, many were detained indefinitely after the fire. Their empty seats left the Nazis largely free to do as they wished.”

As you read THE SMITHSONIAN article, think about the convenient political alignment of ANTIFA & BLM with previously centrist Democrats. Consider how the FBI, under the Obama administration, spied on the Trump campaign as a predicate to construct a false narrative that Trump solicited Russian election interference (i.e. the Democrat funded, opposition research Steele dossier, etc). Recall the FBI sting of General Flynn where even the facts called for halting the investigation; yet hand written notes from those pushing the investigation spoke of the importance of “getting him to lie”. Or the heavily armed FBI assault team raid on elderly Roger Stone’s home home at 4 AM for allegedly making false statements to Congress and witness interference. Recall the January 2021 incident at the Capital where barricades were abandoned by police allowing easy passage of peaceful and not-so-peaceful protesters and subsequent accusations of seditious activity of Trump and any known sympathizer.  Reflect on the lopsided 17:1 ratio of left-leaning to conservative leaning professors that dominate the humanities departments of our universities. Or that over 90% of political contributions from teacher’s unions historically go to Democrat candidates and progressive legislation.

It seems obvious to me that the threat to our democracy doesn’t come from concerns of seditious activity on the right or unfounded fears of Trump refusing to leave the White House. The political lessons in the aftermath of the Reichstag Fire teach us that the threat comes from the radical left’s crackdown on free speech where any opinions not deemed mainstream are equated with subversion & violence; and a coercive political media-driven assault on our liberties and the protections outlined in the Constitution. Ask yourself if the experiment in representative republic self-governance called the United States of America can survive with one party rule.

The NAZI party rose to power by a carefully orchestrated & choreographed manipulation of public opinion against their political opponents, led by a compliant and often complicit media.  Considering the disastrous consequences to individual liberty, be it from the Statism of the radical left or the Autocratic Fascism of the far right, the left’s political tactics and agenda should set off alarm bells in our collective heads.  

https://www.smithsonianmag.com/history/true-story-reichstag-fire-and-nazis-rise-power-180962240/

Posted in big government, CDC, Dependency, Education, Government Regulations, Liberty, Organizational structure, Patient Choice, Patient Safety, Philosophy, Policy Issues, Prevention, Protocols, Rule of Law, Uncategorized

The CDC Perspective on COVID Shielding Approaches and Green Zones: A Humanitarian Oxymoron?

Manitoba Metis Federation minister of energy and infrastructure minister Jack Park hosts a video tour of a 96-room camp the federation is setting up for people who may need to isolate or quarantine if the coronavirus hits a high number of people. (Screenshot)

 

The comments below are in response to a CDC article entitled, Operational Considerations for Humanitarian Settings. As citizens with sovereign rights, we need to be aware of the “operational considerations” being discussed by policymakers & influencers, because there is not ONE reference to, or acknowledgement of, the individual right of self-determination or rights of families to make decisions for themselves.

Leave it to the public health theorists, who truly believe it’s their job to war-game these scenarios (and then make our decisions for us) to miss the obvious.

Like, for instance, the fact that things rarely turn out optimally.  Their planning should not only acknowledge that reality, but the ACTUAL final plan should assume bad stuff happens and reflect that reality in its design.

But alas, that’s not what we get with Green Zone Shielding Approach to those at high risk for COVID19.

As a person with common sense and a hopeful future, you would not store kindling in same box as flammable accelerants. Nor, would you stow all weapons & ammunition in same cache; or invest all funds in the same asset class.  No, you wouldn’t protect your precious resources that way; you would minimize your risk by using strategies designed to diversify, shield, obscure your cargo from theft, devaluation or damage.

To be fair, the CDC acknowledges…“Inadvertent introduction of the virus into a green zone may result in rapid transmission among the most vulnerable populations the approach is trying to protect.”  They seem confident that careful central planning can mitigate that risk.

So here’s an excerpt from a CDC article about humanitarian issues pertaining to shielding approaches for those at high-risk for COVID. The article’s stated purpose was to give the CDC’s perspective on and challenges to…“implementing the shielding approach in humanitarian settings as outlined in guidance documents focused on camps, displaced populations and low-resource settings.”1,2 

It goes on to state, “High-risk individuals would be temporarily relocated to safe or “green zones” established at the household, neighborhood, camp/sector or community level…”

  • “Neighbors “swap” households to accommodate high-risk individuals.”
  • “A group of shelters such as schools, community buildings within a camp/sector (max 50 high-risk individuals per single green zone) where high-risk individuals are physically isolated together.”
  • “No movement into or outside the green zone.”

Other considerations:

  • “Plan for an extended duration of implementation time, at least 6 months.”
  • “Ensure safe and protective environments for all individuals, including minors and individuals who require additional care whether they are in the green zone or remain in a household after the primary caregiver or income provider has moved to the green zone.”

Note the focus on “camps, displaced populations and low resource settings.” No one should be comfortable with the historical images conjured up by that quote. Need I say more?

In the summary section, the CDC authors admit the shielding approach is “ambitious” but offer no proof of concept. 

Specifically they state, “The shielding approach is an ambitious undertaking, which may prove effective in preventing COVID-19 infection among high-risk populations if well managed. While the premise is based on mitigation strategies used in the United Kingdom,24,25 there is no empirical evidence whether this approach will increase, decrease or have no effect on morbidity and mortality during the COVID-19 epidemic in various humanitarian settings.”

What could possibly go wrong?

Interim Operational Considerations for Implementing the Shielding Approach to Prevent COVID-19 Infections in Humanitarian Settings | CDC

Posted in Economic Issues, Education, emotional intelligence, Free Society, Free-Market, Liberty, Philosophy, Policy Issues, Representative Republic vs. Democracy, Rule of Law, U.S. Constitution, Uncategorized

Audio Blog Episode 3: James Keena, author of 2084: American Apocalypse

 

Posted in Access to healthcare, Disease Prevention, Economic Issues, Education, Evidence-based Medicine, Free Society, Government Regulations, Job loss, Leadership, Liberty, Organizational structure, outcomes measurement, Patient Safety, Policy Issues, Uncategorized

COVID Data and Governors’ Authority: Beyond Phase 1

By Robert Nelson, MD

The 14th Amendment to the U.S. Constitution states, in part, that…

“No State shall make or enforce any law which shall abridge the privileges or immunities of citizens of the United States; nor shall any State deprive any person of life, liberty, or property, without due process of law; nor deny to any person within its jurisdiction the equal protection of the laws.”

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Every state has its own criteria for declaring a public health crisis. The the Model State Emergency Health Powers Act that was was floated following 9-11, proposed a model legislation designed to update protocols among the states to account for bio-weapons and infectious agents; and to standardize the approach among the States. There were many concerns about infringement on civil liberties and over-reach abuse from Governors. But even though it never became law, most states already had similar, albeit outdated, protocols allowing their executive branch to declare health emergencies. These states’ laws currently on the books give governors the authority to varying degrees to deprive people of use of property (business closures, etc…), prohibit peaceful assembly of groups (religious gatherings, weddings, family events, etc…) and even confine citizens to their homes during times of public health emergencies (enforceable with fines or imprisonment) all without due process of law, if certain thresholds are met; and by extension of logic, those emergency measures may continue if those same threshold criteria remain operational.

Even if we set aside the contradictions between the 14th Amendment and the power granted to States’ Governors under EHPA-like laws — given the substantial knowledge amassed about the risk of COVID-19 infections, we must question whether the criteria for sustaining a “public health emergency” still meets operational thresholds.

Based on definitions in the original model state Emergency Health Powers Act, the original cases of human-to-human COVID-19 infections certainly met the criteria for “new…infectious agent” and initial reports out of Europe and Asia justified viewing the threat as having high potential for “…a large number of deaths…” and “…widespread exposure to an infectious or toxic agent that poses a significant risk of substantial future harm to a large number of persons…”

There was reasonable agreement among many experts, and based on the death and devastation we saw in Italy, that COVID-19 cases could overwhelm the hospital systems’ ability to provide care for the sickest patients. This was a valid concern and represented an unacceptable risk if the calculus was accurate. Most agree, the initial reaction to temporarily shut down normal societal operations was justified.

But data coming mainly in March and April strongly suggested the initially justified fear was over-stated. And despite evidence that predictive models repeatedly over-estimated cases and fatalities, even with distancing measured factored in, many Governors have not taken their foot off the regulatory gas peddle or seriously thought of changing directions even though the evidence shows that most people are not at high risk.

So given the criteria required for declaring a public health emergency detailed above, and in light of drop in case load and data showing a much lower over-all fatality rate than originally estimated, are we still at risk for…”a high probability of a large number of deaths, a large number of serious or long-term disabilities, or widespread exposure to an infectious or toxic agent that poses a significant risk of substantial future harm to a large number of persons.”(?)

According to the facts, the answer is “NO.” Here’s a summary of supportive data:

  • COVID-19 appears to have a very high infectivity, which means it spreads horizontally (not just close household contacts) within a population very quickly. It likely spreads quicker and easier than Influenza, which is highly contagious. It is very hard to effectively stop the spread as data from New York indicates.
  • Aggregate data from around the world and compiled by many government agencies indicates that over 80% of cases are very mild with virtually complete recovery.
  • Anywhere from 15 – 40% may be asymptomatic
  • A look at the New York data, undeniably the epicenter in the U.S., shows…
    • risk of death in people 18 – 45 to be about 0.01% or 10 per 100,000
    • For people under age 18 years, the death rate approaches zero
    • Two-thirds of fatal cases occurred in patients over 70 years of age
      • More than 90% of those fatal cases had underlying serious illnesses
    • Even for people ages 65 to 74, only 1.7 percent were hospitalized
    • For those who don’t have serious underlying medical illness, the chance of dying from COVID-19 is very small, regardless of age and especially if under 50
    • Nearly 25% of NYC residents tested show antibody to COVID, so real number of cases could be at least 12x more than the number of confirmed cases meaning that the true case fatality rate is much lower than we thought initially
  • Herd immunity helps act a human shield, or firewall so to speak, to protect those at risk by simply cutting down on the chance they will come in contact with someone who is infected. In the absence of a vaccine, herd immunity is the best way to protect the vulnerable and thus cut down the death rate.
  • In April, approximately 1,200 patients were surveyed from 113 New York hospitals over a three-day period and 66% of those admitted with COVID-19 infections were sheltering at home; most were over 51 years old, retired or unemployed; and 96% of the surveyed patients had co-morbidities, which means nearly all had another chronic medical condition prior to catching coronavirus.
  • “Authors of a new study conducted by researchers at the World Health Organization and Stanford University say there is no evidence of increased transmission of COVID-19 in Wisconsin following the state’s April 7 primary election.
  • The State of Georgia’s “shelter-at-home” order expired on April 30 and many businesses were permitted to re-open on April 24 providing they observed distancing guidelines and gloves and masks where appropriate. Between April 14 – 27th, the average daily death rate was 37. From 4/28 – 5/11, there were 29 reported deaths per day on average. There were 1,500 patients hospitalized with COVID on May 1, compared to 1,133 on May 11.
  • Sweden mandated very few closings and relied on voluntary compliance with distancing measures, allowing businesses and most schools to remain open throughout the pandemic. It’s death toll was somewhat higher and its Nordic neighbors who utilized mandatory shut-downs but Sweden’s death rate was lower than many western European countries such as Spain, France, Belgium and Great Britain which utilized very strictly enforced lock-down measures. And despite Sweden’s liberal approach, its healthcare system was never over-ran like in Italy.

Let’s summarize what we know.

There is no clear correlation to when various States went into lock-down and the time to peak or the magnitude of cases or deaths per 100,000. There is a similar non-correlation between countries across the same metrics.

Prevalence studies indicate number of infected people is MUCH higher than most realized suggesting COVID-19 is highly contagious yet very mild in vast majority of people. This also suggests restrictive lock-downs are minimally effective. A higher prevalence indicates a much lower case fatality rate than was originally published.

Herd immunity is vital to protecting the vulnerable. Prolonged distancing slows the herd immunity, which is likely to be the quickest and safest way to protect those most at risk.

Opening the economy gradually will be important to support the efforts of our communities to continue vigilant case monitoring and appropriate care for severe cases.

The goal of not overwhelming healthcare resources was successful. But many of those who had legitimate concerns which triggered an emergency declaration have failed to critically evaluate new data, and worse still, they have failed to fully come to grips with the consequences of keeping society and their economies locked-down.

The ability of millions of citizens to earn a living and provide for their families and keep businesses afloat (and the jobs that accompany those businesses) was/is severely compromised by overly aggressive, often coercive and sometimes punitive restrictions on basic freedoms. The negative fallout from the lock-down of 2020 will continue to pile up long after the risk from the virus has been forgotten. More people may end up being harmed by the disruptions in healthcare delivery and the loss of “non-essential” jobs, than were saved by trying to prevent the spread of a COVID-19. Ironically, the reaction to the threat of the virus could result in our self-inflicted death unless we learn to live with it.

Posted in Access to healthcare, Disease Prevention, Economic Issues, Education, Evidence-based Medicine, Government Regulations, Leadership, outcomes measurement, Patient Safety, Policy Issues, Prevention, Uncategorized

The Herd Protects Its Weakest from Predators…Be the Herd.

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Hint: The lions keep coming back when there are weak or exposed zebras.

by Robert Nelson, MD

It’s not an over-statement to assert that our strategy, thus far, for combating the novel coronavirus (COVID-19) has focused on preventing its spread through a variety of social distancing measures; such as shelter-at-home, work-from-home, closing large venues, prohibiting gatherings of 10 or more people, and numerous other variations of distancing.  This is in addition to identifying and protecting the most vulnerable from falling prey to complications thereof.  But the latter recommendations, although well known and often repeated, seem to have taken a back seat to a myriad of politically and socially controversial policies which have brought our collective economic and social engine to a grinding halt.

Here is the logic. By stopping the spread, then fewer contract the illness, then fewer get sick and fewer die. Who can argue with that? It all sounds perfectly reasonable. And even more reasonable if you’re fortunate enough to still be getting a pay check.

But what if containment strategies, relying on wide-spread comprehensive distancing protocols, simply delay the total number of cases and spread out the number of deaths?  There is ample evidence (data-driven, empiric and observational) to suggest that social distancing is far from an ideal strategy.

Distancing, in any viral pandemic, would certainly slow the spread of the contagion; and distancing was the basis of our initial response plan, the goal of which was to “flatten-the-curve.”  There was reasonable agreement among many experts, and based on the death and devastation we saw in Italy, that COVID cases could overwhelm the hospital systems’ ability to provide care for the sickest patients.  This was a valid concern and represented an unacceptable risk if the calculus was accurate.

But the objective was never to halt the virus. This distinction is crucial since it appears we’ve conflated distancing to include an implicit bias that it will get rid of the virus and make us all safer. Neither is likely to be true.

The goal of not overwhelming healthcare resources was met. But the fear that transformed a targeted strategy into a mantra was too hard to resist for policy makers and politicians whose instinct (or what some would call mandate) is to DO SOMETHING even if doing less is a better choice. And that same fear was soon found to be overstated.  And yet despite evidence that predictive models repeatedly over-estimated cases and fatalities even with distancing measured factored in, many have not taken their foot off the regulatory gas peddle or seriously thought of changing directions even though the evidence shows that most people are not at high risk.

This disconnect and failure to pivot, unfortunately, is more ideological than it is epistemological.  You only have to look at the accusations and insults hurled by proponents of one strategy at the proponents of another; the lack of civil discourse and failure to acknowledgement that we all want the same good outcomes, shows us how easy it is to be pulled into our ideological corners.  The data should drive the policy; not the other way around.

The implications that the real Case Fatality Rate (infection mortality rate) is likely to be much lower than we realized is vital information that should allow us to pivot very quickly. We have lost precious time arguing over the benefits of distancing and testing supplies and whether the President actually believes we should inject disinfectants.  We should have been devising reverse lock-down strategies designed to actually prevent death; death from the virus and death from other causes including unemployment and all manner of social depravity and the illnesses that come with it.

So, can a strategy based primarily on distancing accomplish the goals we all want without unacceptable human collateral damage? And is that strategy even plausible based on the behavior of contagious respiratory viruses, and specifically based what we know about SARS-CoV-2 (COVID-19)?  And furthermore, will it accomplish the goal of diminishing deaths?

To better answer those questions, let’s examine what we know about the behavior of this virus, much of it revealed fairly early in the lock-down and some of it we knew even before the lock-down began.

  • COVID-19 appears to have a very high infectivity, which means it spreads horizontally (not just close household contacts) within a population very quickly. It likely spreads quicker and easier than Influenza, which is highly contagious.
  • Aggregate data from around the world and compiled by many government agencies indicates that over 80% of cases are very mild with virtually complete recovery.
  • Anywhere from 15 – 40% may be asymptomatic
  • A look at the New York data, undeniably the epicenter in the U.S., shows…
    • risk of death in people 18 – 45 to be about 0.01% or 10 per 100,000
    • For people under age 18 years, the death rate approaches zero
    • Two-thirds of fatal cases occurred in patients over 70 years of age
      • More than 90% of those fatal cases had underlying serious illnesses
    • Even for people ages 65 to 74, only 1.7 percent were hospitalized
    • For those who don’t have serious underlying medical illness, the chance of dying from COVID-19 is very small, regardless of age and especially if under 50
    • Nearly 25% of NYC residents tested show antibody to COVID, so real number of cases could be at least 12x more than the number of confirmed cases meaning that the true case fatality rate is much lower than we thought initially
  • Herd immunity helps act a human shield, or firewall so to speak, to protect those at risk by simply cutting down on the chance they will come in contact with someone who is infected.  In the absence of a vaccine, herd immunity is the best way to protect the vulnerable and thus cut down the death rate.

Sequencing and staging a return to work & life normalcy based on risk assessment, rather than waiting on achieving some arbitrary drop in cases or death rate (which is a function of current testing limitations) is a solution which can cut down on unnecessary deaths and avoid collateral human suffering across other important dimensions.

We can start by identifying the intersections of various Venn diagrams where low risk people can return to the most essential work; and likewise identify lower risk environments where less scrutiny about risk is needed.

Interventions such as N-95 or even regular surgical masks can be used in selected situations as needed.  Staggering shifts and segregating open offices with cubicles or using room dividers can possibly minimize exposure in the workplace for those at risk.

Of course, the basics of hand-washing and proper respiratory “hygiene” are assumed to be at the forefront of any strategies.

These strategies should be done simultaneously with vigilant surveillance for new cases so appropriate measures (testing, observation, isolation or contact tracing) can be initiated.

And those at highest risk could work if they can do it safely; or they can work from home if they can for as long as possible.

Last, but certainly not least, -given that nursing home COVID cases have accounted for a disproportionate percentage of deaths- we need to segregate infected patients/residents from non-infected and have stringent protective measure for those caring for these at-risk people, just as if they were in a hospital.

If we want to get our world back, we have to get back in the world  (paraphrased from David Katz, MD)

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, 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 trap!  The same financial tool we rely on to pay our healthcare providers also contributes to runaway costs; making us 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.