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.


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.