Category: Affordable Care Act

A Pharmaceutical CEO That Gets It!

9/28/2018

Well, one pharmaceutical CEO gets it! I was emboldened to read David A. Ricks', CEO of Eli Lilly and Co., editorial. He points out that regardless of Apple, Amazon and other tech companies’ entry into healthcare, there remains one huge barrier: the outdated U.S. health care system.

You repeatedly hear me saying how we all made this mess – and we can all fix it.

Ricks adds to that by pointing out that the foundation of America’s health care system was designed 50 years ago to treat mostly acute episodes of illness inside brick-and-mortar facilities with lots of people, lots and lots of paper, and very little technology.

This is no longer our objective when, today, Ricks states our primary challenge is to help people live independently with mostly chronic illnesses over a long period. I would add to that our actual goal should be prevention since the majority of those chronic illnesses could be completely alleviated with a proactive wellness model instead of even continuing a “sick” model. (And how about pharmaceutical cures rather than lifetime drug regimens Mr. Ricks?)

And yet, as Ricks, points out, “We continue to pursue this task with the same high-cost, high-touch tools that were built in a different era for a different job.”

The result of this mismatch is unsustainable, skyrocketing health care spending. Thirty years from now, Alzheimer’s alone will require more Medicare and Medicaid spending than the entire 2019 U.S. military budget. We will hit a wall.

Ricks says that digital technology, when combined with pharmaceutical technology, will be crucial in reducing the massive cost of health care, yet it isn’t enough – we must have an efficient network that can unleash the power of today’s technology.

According to Ricks, we must do three things: digitize everything, empower consumers, and pay for value.

Digitize Everything

Digital technology already has an information superhighway to act as the foundation of that efficient network. An online retailer can reach people literally worldwide with just a website – compared to the few hundred thousand dollars for a brick-and-mortar store that reaches only one community.

We must develop common standards and patient privacy protections – and I would add greatly improve cyber security and enforcement – that allow data to flow through our health care system freely and safely. Medicare can also help by reimbursing at higher rates for products and services that combine digital, medical, and pharmaceutical technologies.

Empower Consumers

Ricks agrees with what I said in my book Bill Please: Consumers Driving Health Care, and what Regina Herzlinger, the mother of consumer-driven health care, stated in her book, Who Killed Health Care? America’s $2 Trillion Medical Problem – and the Consumer-Driven Cure, that in nearly every industry, consumers are the catalysts for reducing costs and improving quality. We also all agree that this hasn’t happened yet in health care – because, as I’m always stating, it is opaque and nearly impossible to get meaningful cost and quality information before receiving treatment.

Ricks uses the same example as Herzlinger and I – “When you buy a car, you don’t care what the manufacturer paid for each of the 30,000 parts in it. You care what the price of the whole is, and how well it functions, before you drive it off the lot. We need that kind of transparency in health care, to enable consumers to make more informed decisions and to encourage health care companies to meet consumers’ expectations.”

Pay for Value

Ricks and I diverge a bit here. Just as I believe we must go further than continuing a “sick” model, I believe we must go further than the value-based care model Ricks supports. We must go all the way to a well-being model. I also believe that Concierge Medicine is the payment model that makes the most sense in implementing a well-being model, with health insurers only needing to provide catastrophic insurance. Providers' greatest revenue incentive, then, is to keep their patients healthy from the get-go. This also means, of course, that medical school curriculum needs a complete overhaul to equip providers to accomplish this. Being a doctor would need to be much more than slice and dice, even though we still need them to know these skills as well – assisted by robots, of course. :o)

What if every employer contracted directly with Concierge Medicine Programs then offering their employees catastrophic health insurance as well as supplemental gap insurance?

Summary

I wholeheartedly agree with Ricks that the greatest barrier to the system we want – and deserve – is the system we have, and that, “To realize the transformative potential of the digital revolution in our health care system, we need to change [reinvent] it.”

Source: David A. Ricks, August 27, 2018 “Eli Lilly CEO: Why Consumers Are Key to Bringing Down Health Care Costs” Fortune retrieved 9-28-18 from: http://fortune.com/2018/08/27/eli-lilly-health-care-pharmaceuticals/

Medicare For All? Be Very Careful What You Wish For...

7/30/2018

A new analysis states that Bernie Sander’s Medicare For All idea would cost $34.7 trillion dollars over 10 years. Ummm… We’re complaining about spending $3 trillion a year on health care right now? Beyond the sticker shock of that number, there is the most fundamental fact that government, which in our “of the people, for the people, and by the people” democracy is supposed to be made up of citizens taking turns at serving as public servants, was never designed to run businesses, let alone take over a broken health care system. How does that make any sense?

To me, government is a revolving group of citizens who are our neighbors elected and tasked with collecting our taxes, then listening to us on how we believe those taxes should best be spent on things like safe infrastructure and law enforcement, as well as lawmaking based on our feedback. If I had my way, government wouldn’t be involved in anything else. Education, health care and all of the other things government is getting involved in would be required to run as lean and mean as our main street small businesses have to. (And those main street small business owners, by the way, would be my choice to represent me in Washington D. C. every time.)

It is almost as if we’ve become weary, so Medicare For All is starting to sound like an easy way out of the mess we’ve all had a hand in creating when it comes to our U.S. health care system. Believe me, after living in countries that took that “easy” way out, it is a train wreck, so be very careful what you wish for. I don’t know quite how rosy pictures are painted of those countries’ health care systems – but I do know firsthand that those stories are not true.

This is no time to give up. This is no time to give in. We’ve made this mess – together we can fix it. The first step is transparency. There are reports that consumers are not shopping as we expected they would as soon as they had skin in the game in the form of high deductibles. They, instead are just not going, or still doing what their doctor tells them instead of checking prices. Why are we surprised at this?

When prices are opaque and providers aren’t straightforward, oh, and big pharma is playing games with discounts, what do we expect? We haven’t yet even come close to achieving transparency in health care and are nowhere yet near the level of transparency we often take for granted in other industries. We must keep pushing for complete transparency, requiring pricing information to be in easy-to-understand English (and whatever other languages we speak). We must keep pushing for accountability. We must keep pushing for affordability. No more shell games.

In addition, we need to realize that along with this transparency, accountability and affordability, the administrative costs that have been estimated to be as high as 30% of that $3.3 trillion a year we are currently spending ought to also be slashed.

We also need to shift our entire health care system to a “well” rather than a “sick “paradigm. We need to figure out how to keep well, which is enormously less expensive than waiting until we are sick to seek care. Every moving part of our health care system ought to first be focused on “well,” how to achieve and maintain “well.” If our health care providers were paid to keep us “well,” and they were financially penalized, as were we, because we certainly must take responsibility in making the right choices to stay “well,” when we become sick, then we would be looking at an entirely different health care system.

As far as employer-sponsored health care, everyone in America, individuals purchasing health plans as well as small businesses, ought to be able to access the same incentives large employers do through volume-buying, and either take away the tax-incentives, or give them to all. But that means health care prices would have to be realistic and affordable in the first place. Health insurance, after all, reflects those prices.

Association Plans are a good idea in theory, but without dedicated management who know what they are doing, and appropriate checks and balances, Association Plans in the past ended up like the Obamacare Co-ops - heavy on ideals and light on business acumen ending up bankrupt or corrupt. And, they shouldn’t be controlled by government in any way, but by economies of scale and free market principles.

Finally, health insurers need to be put in their rightful place – simply as third party payers. No one in the health care system we all want and deserve ought to be practicing medicine without a license. The focus needs to move back to doctor and patient, with health insurance being a convenient way to pay for health care.

In fact, imagine if health insurers actually disappeared for a full year, just went on vacation, then it would be providers and patients figuring out quickly how to work together. Transparency, accountability and affordability would be an immediate result – or providers would go out of business! No more hiding behind health insurers. No more health insurers practicing medicine without a license. Patients would be getting the care they need at prices they could afford.

Don’t give in. Don’t give up. Keep letting your representatives in Washington, your health insurance agents, and your health care providers know what you want and need. This is no time to faint. This is no time to look at Medicare For All as an easy way out. We can do this!

Legal Teeth? 20 States Sue To Abolish ACA

2/28/2018

While Trump announces his intent to indirectly dismantle the Affordable Care Act, piece by piece, the GOP's success in repealing the ACA's individual mandate may have actually achieved the law's demise, if 20 Republican states succeed in their lawsuit announced yesterday.

Their argument, standing on the 2012 decision by the Supreme Court defining the ACA as a tax penalty enabling it to continue, is that under that definition the ACA cannot stand without the individual mandate. I'm not a lawyer, but they appear to be logically correct. It will be interesting to see the legal maneuvering. Of course, it will also be interesting to see America's response.

But, unraveling this national health care law wouldn't be a first in the history of our country. As presented in my book, Bill Please: Consumers Driving Health Care, every previous national health care law that was passed was then dismantled in a similar fashion in short order by the opposition.

The Federal government first inserted itself in national health care beginning clear back in 1798 passing the Act for the Relief of Sick and Disabled Seamen, creating the Marine Hospital Service which later became the Public Health Service.

The United States has witnessed 220 years now of what we continue to see today regarding health care legislation. Do we finally have the ability to stand back and recognize this futile cycle? Can we stand back and see that when we as consumers yell at our representatives in Washington to "do something," can we see that they do "something" hoping to please us and get reelected, but that, after 220 years, it is not what needs to be done?

You see, we as consumers are the ones that must do something, the something that will fix our health care system - take control. We do so by requiring the same transparency, accountability and affordability we do from any other industry hoping to earn our business. And our health insurance? If we interacted with the health care industry directly as if we didn't have any insurance, this ship would be righted immediately.

Don't give away your power. No one ought to be practicing medicine without a license, including governments or insurance companies. The only ones licensed to practice medicine are physicians who you must partner with to achieve and maintain your health. Don't settle for less. Ask a lot of questions and require answers. Ask for quotes for everything and hold providers to it, just as you do in any other purchase. After all, your health is more important than any other purchase - it is the most important investment you can make.

Doing SOMETHING About Health Care - Bezos, Buffet & Dimon

1/31/2018

Is our wait finally over? Well, with yesterday's announcement from Amazon, Berkshire Hathaway and JP Morgan Chase that they are collaborating to do something about health care, the consumer-driven initiatives, in addition to all of the innovation happening on the fringes of the industry, whether the current players like it or not - has me hopeful that the status quo is truly no longer an option.

Bezos, Buffett & Dimon have not given details, but all of the employers, who provide 178 million Americans, 55% of the U.S. population, access to health care via their employer plans, spending over $672 billion of the $3.6 trillion U.S. health care bill, changing horses in the middle of the stream could make a huge impact.

Could their partnership provide the leadership and national cohesion needed for all employers to make positive change? Could be.

To be fair, a lot of employers have been trying to make change for a lot of years, and have made a difference for their own organization's cost savings, and every little bit helps, but nothing has yet made a course-changing, national impact on heath care costs for all of us, which is what needs to happen.

It's like trying to crack a nut. The nut has to be turned in the nutcracker several times, and receive pressure on all sides before it finally cracks wide open. Consumer-driven initiatives, like high-deductible health plans, which force consumers to shop and pay the kind of attention they do with other purchases, and force all of the current health care players to step out of behind insurance and deal directly with consumers to get paid, is applying pressure on one side. Innovation and the entry of entrepreneurs with refreshing new perspectives, putting more and more of health care control in the hands of consumers, is applying pressure on another side. Now, with this new pressure from three of the largest employers in the country - yes, I am hopeful!

Perhaps we can stop playing the political shell game - or, at least ignore it - to get something actually accomplished around the real issue. I say shell game because focusing on health insurance is also continuing to hide behind insurance and is a diversion. Insurance has never been the crux of the problem - not to deny a housecleaning is certainly in order in health insurance just as it is for the rest of the health care industry - no one ought to be practicing medicine without a license.

Costs. Are. The. Problem.

Individual Mandate Repeal an ACA Spoiler?

12/29/2017

Well, the GOP managed to slip a repeal of the ACA's individual mandate into their new tax law. But will it topple the ACA apple cart?

I doubt it.

Why?

Because the individual mandate, designed to "require" young, healthy Americans to buy health insurance never worked. The young, healthy millennials I spoke to just did the math - 5% of their income or a minimum of $695, whichever is lower - and compared that to hundreds of dollars a month to buy insurance they may not use? They just paid the penalty. Or they didn't.

Fact is, the IRS had no real way to enforce the individual mandate. The IRS can’t bill people that didn’t buy health insurance. It can’t garnish their wages, threaten tax evasion charges or report them to the credit bureaus. All it can do is deduct the fine from their tax return. If they have the right amount withdrawn, they won't get a tax refund to deduct the penalty from.

The fear that only those who need health insurance will buy health insurance was already happening.

But let's talk about the real problem here.

An opaque, inefficient health care system with skyrocketing, unsustainable costs.

Health insurance, while not lily-white in their dealings, has nothing to do with this real problem and fretting over young, healthy people buying health insurance will not fix the real problem.

We need a transparent, accountable, affordable health care system.

As I've said before, if health insurance and the government, who are both practicing medicine without a license, stepped aside, and it was just consumers and providers, health care would get fixed in a jiffy!

Gee. How about health insurance companies and the government pitching in with a clear focus on empowering consumers, then staying out of the way!

We've still got a long way to go. I know you're weary - and so am I. But we've got to keep stating that we want consumer-driven health care - now.

Bipartisan Two Year Deal...?

10/17/2017

Yeah, I just wrote the last post - and bam, Congress got something done - for now. A two year bipartisan deal to pay the cost sharing reduction subsidies. Don't know if it will pass through the full Congress. Trump supports it - for now. He still has his sights set on a full repeal and replace, though, tweaking the Graham-Cassidy-Heller-Johnson bill. And the saga continues... .

Meanwhile, emphasize to your public servants in Washington anything they decide to do needs to empower consumers to drive health care... .

If Congress Can't Get 'Er Done, Play Cowboy...Wait A Minute...

10/17/2017

Is anyone else having Deja Vu? It seems to me that Trump has just done what the GOP was criticizing Obama for - unilateral (and illegal?) decision making on health care, slinging that pen on those executive orders like there's no tomorrow.

I seem to recall the GOP suing the Obama Administration for cost sharing reduction subsidies without appropriation approval through Congress - and winning (which was in appeal), because that is not how our government is set up. Appropriations of our tax dollars are supposed to go through the legislative process - one of the differences between a democracy and a dictatorship.

Trump's announcement last Friday that he has signed an executive order to not pay those cost sharing reduction subsidies to insurers, stating his administration is heeding the advice of the Justice Department, may stick, even in light of the lawsuits that are racking up. There is the sticky point that the insurers were promised those payments by a former administration, and changing horses in the middle of the stream may still end up in legal quick sand, but there also is a legal standing.

Now Trump's other health care related executive orders - selling insurance across state lines and the right to purchase health care plans through formed associations, with some other items added in - the jury is still out.

What can you do? I sound like a broken record, I know - but we deserve transparent, affordable, accessible, high quality health care in America, and until we are dealing with those issues, we won't get it. Tell your public servants in Washington that we need consumer-driven health care.

I realize I'm in health insurance, but just imagine what would happen if there were no more health insurance and no more employer health care benefits and no government practicing medicine without a license. Wham! It's all gone. What would happen? We would immediately have affordable health care because it would be back to the providers and the patients - us. Providers, pharmaceuticals, and everyone else in the health care industry could no longer hide behind insurers or employers or the government - they would immediately have to figure out how to provide us with their services at prices we could afford.

Now, I realize health insurance serves an important purpose, but you see my point. Maybe I, health insurance, the government, and employee health benefits need to take a year-long vacation. When we come back, rested and refreshed, bet you the health care industry has figured out how to do or die. Bet you consumers then have the transparency and the quality competitive choices they need to shop effectively for the health care that is right for them.

I repeat - tell your public servants in Washington that we need consumer-driven health care - everyone except doctors need to stop practicing medicine without a license - and they need to put their eye on the right ball - health care transparency, affordability, accessibility, and quality.

Oh, and there's no room for loner cowboys. This is a democracy, for the people and by the people. We want our democratic system honored, respected, and intact. We elected all of you - not just one of you. Stop acting like Washington is a sandbox. Grow up and get 'er done - together.

The GOP Majority's Deadline to Repeal & Replace the ACA Just 9 Days Away...

9/21/2017

If the GOP wishes to repeal and replace the ACA with just their majority under the rules of the Reconciliation Act - their time is quickly running out. On September 30th that option expires.

GOP Senators Graham (R-SC), Cassidy (R-LA) and Heller (R-NV) are the main sponsors of what looks to be the GOP's last hope, which pushes block grants and health care decision-making to the states. See a major point comparison with their bill and the ACA here.

Don't forget to contact your representatives and let them know, as a consumer, you want control to achieve transparency, accountability and affordability in America's health care once and for all.

Have the GOP Given Up on ACA Repeal and Replace?

8/28/2017

Shortly after John McCain decided the fate of the GOP Senator's last health care bill intended to repeal and replace the ACA with his thumbs down a month ago today, GOP senators Lindsey Graham (R-SC), Bill Cassidy (R-LA) and Dean Heller (R-NV) were in Trump's office sketching the outline of yet another try. Running any attempts through the Reconciliation Act, which would only require GOP votes, is a moving window. We'll see how it goes... .

Meanwhile, consumers need to continue to contact their representatives and tell them that only consumer-driven health care can achieve the transparent, accountable, affordable health care we deserve.

...And Here Is The Latest Version of the Senate Health Care Bill...

7/13/2017

Read the latest version of the Senate Health Care Bill below - and the saga continues - meanwhile, let your representatives know only consumers driving health care will transform our U.S. health care system into what we all need and deserve.