Discussions on Healthcare Topics
Every week my mailbox fills up with articles. Some of which I subscribe too and pay for and others which are freebies. The freebies are slowly disappearing. The first article is an old one and has been on AB before and discussed by Maggie Mahar. Atul asks if healthcare is a right. Maggie and Shadowfax (an ER doctor) would argue it is more a moral obligation. That discussion can be found here: Is Health Care a Right? – The Health Care Blog. Further on down, you will find discussion by Kip Sullivan and how Medicare Advantage is being over paid.
Is Health Care a Right? | The New Yorker, Atul Gawande, September 25, 2017
It is a long read. However, it is also worth your time to read it.
Is health care a right? The United States remains the only developed country in the world unable to come to agreement on an answer. Earlier this year, I was visiting Athens, Ohio, the town in the Appalachian foothills where I grew up. The battle over whether to repeal, replace, or repair the Affordable Care Act raged then, as it continues to rage now. So I began asking people whether they thought that health care was a right. The responses were always interesting.
Factoid:
Smallpox epidemics came with a mortality rate of thirty per cent or higher, and wiped out upward of five per cent of the population of cities like Boston and New York. Jefferson read Jenner’s report and arranged for the vaccination of two hundred relatives, neighbors, and slaves at Monticello. The President soon became vaccination’s pre-ëminent American champion.
It later was the country’s first health-care entitlement for the general population. And its passage wasn’t in the least controversial as was Covid inoculation.
xpostfactoid: New Jersey launches year-round marketplace enrollment at incomes below 200% FPL
New Jersey has gone the feds one better, today announcing year-round enrollment on GetCoveredNJ, the state exchange, for enrollees with income up to 200% FPL ($25,760 annually for an individual; $53,000 for a family of four).
How COVID-19 can harm pregnancy and reproductive health (nationalgeographic.com)
Estimates for the number of people who develop long COVID—a suite of lingering symptoms—range from 10 percent to as high as 50 percent of cases. That means tens of millions of people around the world continue to wrestle with the viral aftermath. The conditions range from frustrating to downright debilitating.
Costs Soaring for Ground Ambulance Transport | MedPage Today
The average allowed in-network amount for advanced life support (ALS) emergency ground ambulance transport rose 56%, from $486 in 2017 to $758 in 2020, according to a white paper from the non-profit FAIR Health.
The increase was part of a general rise in costs (not including mileage fees) for both ALS and basic life support (BLS) emergency ground ambulance transport during the period, the report stated, and included upticks in average allowed amounts for privately insured patients — the total fee negotiated between an insurance plan and a provider for an in-network service — and average billed charges, or the amount charged to a patient who is uninsured or obtaining an out-of-network service.
Hospitals are snapping up physicians: Who wins? (beckersasc.com)
COVID-19 spurred a sharp increase in mergers and acquisitions, accelerating a trend of consolidation. By the end of 2020, nearly 70 percent of physicians were reporting being employment by hospitals or corporations.
This will limit where you can go for healthcar,
Hong Kong orders compulsory Covid tests for all its citizens – BBC News
Hong Kong’s government has ordered the compulsory testing of all of its 7.5 million citizens as the city battles surging coronavirus infections. China’s policy is to try to eradicate infection through early testing, detailed contact tracing and strict quarantine and travel restrictions.
Another Risk in Overturning Roe | The New Yorker
“potential ramifications are obvious. The majority of people who get abortions are already mothers, and seventy-five per cent live near or below the federal poverty line. It is the least advantaged of this disadvantaged group who will be unable to cobble together the time, money, and child care required to travel across state lines to determine their own reproductive futures. Some will be able to self-administer abortions through telemedicine and mail-order pills—a safe and increasingly common method for early pregnancies. “
Beware: Our N95 Supply Chain Is Fragile | MedPage Today
The availability of N95 respirators, a critical piece of personal protective equipment (PPE), has been a top concern throughout the pandemic as COVID-19 surges exposed an international supply chain unable to react quickly to heightened demand. Recent developments around N95s provide the latest example of the need to create a more resilient and sustainable supply chain.
Large Employers Are Suiting Up to Fix Healthcare | MedPage Today
Both doctors and hospitals are completely dependent on the financial margin derived from commercial insurance. RAND studies show that on average, private purchasers are paying approximately two and a half times more than Medicare rates for hospital care (even more relative to Medicare for hospital outpatient services).
Millions of Children May Lose Medicaid: What Can Be Done to Help Prevent Them From Becoming Uninsured? – Center For Children and Families (georgetown.edu)
About half of children in the United States (40 million) are now insured through Medicaid or the Children’s Health Insurance Program (CHIP) –– the vast majority in Medicaid. These children have had stability in their Medicaid coverage during the COVID-19 public health emergency due to a continuous coverage requirement, but this protection is likely to expire sometime in 2022 –– perhaps as soon as April. States will have to recheck eligibility for everyone enrolled in Medicaid including children. During this unprecedented event, we estimate that at least 6.7 million children are likely to lose their Medicaid coverage and are at considerable risk for becoming uninsured for some period of time.
Editorial Note: Almost 7 million children will lose Medicaid coverage due to a failure to extend it in the Senate. Below are issues which are examples of Medicine taking advantage of their position.
Medicare Advantage Overpayments, An unsustainable future; Minnesota Physician, Kip Sullivan, JD
Congress didn’t know about the overpayments? Beginning in 1980, analysts inside and outside the federal government regularly published research demonstrating that Medicare was overpaying HMOs. Note that the phrase fee-for-service (FFS) refers to the traditional Medicare program in which doctors and hospitals are paid a fee only after they render a service. In contrast, Medicare Advantage insurance companies are paid a lump sum per enrollee in advance. In a 1995 report to Congress entitled “Growing Enrollment Adds Urgency to Fixing HMO Payment Problem,” the US General Accounting Office (GAO) stated, “Medicare has paid HMOs more than it would have paid for the same patients’ care by fee-for-service providers.”
These 4 physicians have a $35.8 billion combined net worth (beckersasc.com)
Physician-founders of biotech companies and a large hospital chain rank among the most prosperous billionaires in the U.S.
The following four physicians have a combined net worth of $35.8 billion, according to the Bloomberg Billionaires Index and Forbes:
1. Thomas Frist, MD. Co-founder of HCA Healthcare, a Nashville, Tenn.-based hospital chain: $21.6 billion
2. Patrick Soon-Shiong, MD. Inventor of cancer drug Abraxane: $9.82 billion
3. Phillip Frost, MD. Investor and founder of diagnostics company Opko Health: $2.1 billion
4. Leonard Schleifer, MD, PhD. Co-founder and CEO of Regeneron: $2.3 billion
Top ASCs spend more than $1M yearly on management fees: 10 findings (beckersasc.com)
Management structures at ASCs (Ambulatory Surgery Centers) can vary widely in size and complexity, depending on factors including ownership.
Management fees can eat up more than $1 million of an ASC’s annual budget, according to VMG Health’s “Multi-Specialty ASC Benchmarking Study” for 2022. The study found that on average, 4.8 percent of ASC net operating revenue is spent on management fees.
Judge rules against HHS, surprise billing arbitration rule (beckershospitalreview.com)
A federal judge ruled Feb. 23 that the contentious No Surprises Act arbitration process implemented by HHS violated the Administrative Procedure Act, delivering a win to the Texas Medical Association, according to Law360.
The association sued the Biden administration in October 2021 over the surprise billing resolution process, claiming that leadership failed to implement a rule that followed Congress’ vision for the bill.
Diana Fite, MD, immediate past president of the Texas Medical Association, called the ruling “a major victory” for providers and patients.
“This decision is an important step toward restoring the fair and balanced process that Congress enacted to resolve surprise billing disputes between health insurers and physicians,” Dr. Fite said. “The decision will promote patient access to quality care when they need it most and will guard against health insurer business practices that give patients fewer choices of affordable in-network physicians and threaten the sustainability of physician practices.”
America’s Health Insurance Plans — one of the lobbying groups that submitted amicus curiae briefs supporting HHS — said the decision weakens patient protections and enables providers to profit off the arbitration process.
So, what is a right? Since we don’t believe in God anymore and know one knows what He believes anyway, we can’t say “it’s a God-given….er….right.
The simplest way to define a “right” is what we agree to give each other…the reason governments are created. Of course the trouble comes in when a lot of rights we just assumed on the basis of having respected them since before we climbed down from the trees…we forgot to write down, or didn’t know how to write down so clearly that a future “Supreme Court” couldn’t weasel us out of them.
But we can…it’s a democracy after all…go to the polls and try to “enact” “rights” we agree to give each other.
As for medical care, most sane people, if we explained it carefully to them, would agree that we ought to provide each other medical care. And the best way to do that is by government insurance. Since the doctors have to be paid, we have to pay them. And the best way to do that since none of us knows which of us will need medical care….very expensive medical care…is to pay, each of us, for the average cost for all of us. Medicare does this, in a limited way, fairly successfully. Other countries seem to do it better.
As for the people who cheat…I think there may not be enough of them to significantly raise our costs…it’s the doctors and hospitals that do that.. And probably the best way to keep “free riding” under control is old fashioned shaming. Or moral suasion.
But lately, even the Liberals are getting into the “free ride” frame of mind. They imagine a category of people they call “the rich” who “ought” to pay for our health care, and have succeeded to some extent in making them do so. this of course makes “the rich” mad, and being no more decent than “the Left” set about destroying the whole “right” in order to enforce the virtue known as “pay or die.” And the poor simple folk, get confused because they do see, or think they see “free riders” and so think the whole “right” is somehow unfair to them.
etc. good luck with explaining it to them. would help if the Left actually tried…starting by knowing what they were doing.
Coberly:
Your rights shall not infringe upon my rights. Forget those rights points. Moral obligation are a better argument.
We could always dust off ye ole printing press and pay the $billions off in that manner. Why not? We have endless assets and are a sovereign country. We could go a long way before countries refuse to accept our sovereign dollars because they are worthless. Other countries have done it. There is that funny thing(s) called politics and politicians who always seem to muck things up. I guess we could call Republicans MMT proponents. They always blow up the economy with tax cuts which are supposed to have a positive return. It never does. Dems bring the economy back to a semblance of normal.
What baffles me about healthcare is people, economists, single-payer proponents, doctors, etc. are so ready to accept the prices of healthcare. Somewhere and hidden in the price of healthcare is the actual cost of healthcare which should include temporary costs such as R&D. Some things increase in price because of temporary shortage which usually has no impact on the cost of manufacture. Why is that and why are people willing to pay it even with newly minted bills?
Another time on that topic. And the flamers are not to be given consideration for their theories. “And the best way to do that since none of us knows which of us will need medical care . . . very expensive medical care . . . is to pay, each of us, for the average cost for all of us.” Medicare does not pay an average. It pays far less. My Rituxan infusions cost ~$30,000 which includes a chair and a nurse to administer. Medicare pay ~47500.
run
i don’t see where “moral obligation” gets you any further than “we grant each other rights.”
it could be that you know more people than i do who feel moral obligation. i prefer to try to work on the “do unto others” principle. even that, which ought to be a matter of simple reason..”.you respecnt my privacy and i will respect yours” can be a pretty hard sell. on the other hand, “if you do X God will send you to hell” seems to work for some people.
i see no problem with deficit spending for specific purposes calibrated against their potential to run out of control. but you still run up against the politics of who gets what, and the temptation to print a few extra dollars to send yourself to Cancun for a weekend.
as for medicare and average costs: what i was trying to say is add up the cost of all medical care and divide it by the number of people paying for it and set that as your basick “medicare tax” or “premium.” since there are differences in ability to pay, i would pro-rate the tax according to income (i.e. a “flat” tax, like Social Security). Then “the rich” would end up paying, at first look, more than their “fair share.” but since no one knows in advance how much health care they are going to need, the rich should be happy to pay according to ability to pay, and count the “excess” over their probable “needs” as insurance against getting too poor later in life to pay that “fair” share, and the rest of us can be happy that taken together all of us are paying a fair price for the security of knowing we will be taken care of.
one way or another this is the way it works anyway. it’s just that people have never learned to think of it this way. i think it takes a lot of the anxiety, guilt, and envy, that come from the way we do think about it.
but hell, i coldn’t even teach college students that two plus two equals four, so what do i know?