Archives For Healthcare

Our Nation’s IQ???

August 21, 2014

2014-08-03_08-55-51“In schools they have what they call intelligence tests. Well if nations held ‘em I don’t believe we would be what you would call a favorite to win.” – Will Rogers, 25 June 1935

I don’t think we would eithter Will.  We would probably be about the same as where we are with our crazy healthcare system. Near the bottom of those that have schools  and hospitals anyway. But there are a few of us who are darn smart and maybe they make up for all the dunces among us…

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The U.S. spends the most of any country on its health care system, and yet it ranked the lowest out of 11 industrialized nations in overall healthcare quality, according to a report published Monday by the Commonwealth Fund.The report, which covered the years 2011-2013, compared more than 80 indicators of U.S. health care spending, quality and performance to the likes of Australia, the United Kingdom, France, Canada, Germany, New Zealand, and Sweden, among other developed nations. The UK, which was ranked highest, blew the U.S. out of the water, despite the fact that the country spends less than half as much on health care per capita $3,406 on average, compared to $8,508 in the U.S.. The U.S. also spends the most on health care as a percentage of GDP 17% than any other nation.

SOURCE: US continues its losing streak in health care quality comparison – Yahoo Finance.

I am about to finish one of the six or so  books I read at the same time; this one about the culture of the United States. It shows numerous places where we are the most creative people on earth. But then comes our ideas of healthcare. We just can’t seem to understand that our current system of taking care of our citizens is a loser and a big waste of money by almost all standards. We spend twice as much as anyone but get so little for our dollars.

It seems idiotic but it seems we are opposed to doing what has proven to work. Why,  because much of the rest of the world already has it figured out and therefore the solution would not be an “American idea”? We need to get over the idea of shunning anything not invented here and simply go with what works. We need to be as much pragmatists as we at least used to be inventive.

We need to get over the idea that somehow anything socialist is un-American.  We presently allow our government to handle our healthcare needs for about half of us but going all the way seems to be a big problem. Perhaps the most socialist healthcare system in the world is from Britain and of course from the above graphic we learn that they also provide the best care by most standards.

A person working sixty hours a week at a minimum wage job will earn about $21,000.  But according to the above they would likely spend about half that amount just for their family’s health insurance! I know I seem to harp on this topic often and that is because it is an obvious solution that is for some reason vastly ignored by so many of us. We need to take a big bite out of the humility apple and learn what the rest of the world can teach us.

 

 

 

On top of that, higher-income taxpayers could see their itemized deductions and personal exemptions phased out and pay higher capital gains taxes — 20 percent for some taxpayers. And there are new taxes for them to help pay for health care reform.

There are different income thresholds for each of these new taxes.

An additional 0.9 percent Medicare tax, for example, kicks in on earnings over $250,000 for married couples filing jointly and $200,000 for singles and heads of household. Same for a 3.8 percent tax on investment income.

But the phase-out of personal exemptions and deductions doesn’t begin until $300,000 for married couples filing jointly and $250,000 for singles.

Taxpayers will still be able to deduct their medical expenses, but it will be more difficult for many to qualify. The threshold for deducting medical expenses now stands at 10 percent of adjusted gross income, up from 7.5 percent. There’s an exception, though, for those older than 65. For them, the old rate is grandfathered in until 2017.

SOURCE: Tax code changes will hit high-income Americans hardest | PBS NewsHour.

It is good to hear that at least some things are changing when it comes to asking the wealthy to pony up a little more of their mammoth discretionary income for the good of the country and for the basic welfare of its citizens. While these gains (you probably say loses if you are on the receiving end) are notable they is still a long way to go in this area…

The Irony Of It All…

November 1, 2013

Medicare CardI have been kind of watching the preliminaries for this latest “super committee” forming in Washington to come to some sort of budget deal and I am not impressed. On the one hand my Republican friends often scream that Medicare doesn’t pay enough for the services rendered. That doctors are dropping out of the system due to not making enough money. And then comes the first salvo of this latest round of budgeting. The first thing the GOP comes up with is cuts to Medicare??

I know that many on that side of the aisle are for a total defunding of Medicare and instead just giving seniors a small voucher and then put them out into the private insurance system to fend for themselves. So, maybe this all makes sense from a higher level than I realize. Cut Medicare so that it becomes so underfunded that no doctor will accept patients from that system. David Stockman who was Reagan’s budget director called that “Starving the beast”. That is continue to cut taxes (income) until the government is drowning in deficits. In that regard the GOP has been somewhat successful lately.

I am still on the fence as to whether the GOP will go the way of the Whig party. If they actually do attempt to “privatize” Social Security I think there will be enough of us seniors to insure that they disappear from the landscape. Those Tea Party folks just don’t seem to want anyone to have affordable healthcare; that is except those in the 1%.  Their latest hit against the Affordable Care Act is that with so many new people being able to see a doctor that some physician groups are saying they must limit their patient contact to no more than 15 minutes to keep up with the case loads. They say that is proof that Obamacare will wreck our healthcare in this country. It never seems to occur to them that they need to try to figure out a way to increase our doctors and nurses to meet the load. Maybe a good start would be to help medical students with the bone crushing debt many have when they finally become practicing doctors. These Tea Party folks are just “anti-” to the bone.

But getting back to the budgeting process, We have not actually had a budget from the folks in Washington in over five years. This year both the House and the Senate created bills but then failed to come together for the reconciliation process because the House GOP speaker would not allow it to happen.  With that in mind I don’t see much hope for this latest committee to accomplish much.

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SurgeonA central reason U.S. health care spending is so high is because hospitals and doctors charge more for their services and there’s little transparency about why. There is no uniformity to the system, in which public and private insurers have separate, unrelated contracts with hospitals and doctors. The result is a tangled, confusing and largely secretive collection of forces driving health care prices higher and higher.

This isn’t possible in many other countries either because governments set prices for health care services or broker negotiations between coalitions of insurers and providers. Known as “all-payer rate setting,” insurers in these systems band together to negotiate as groups. In contrast, U.S. insurers closely guard the secrecy of their contracted prices with health care providers and negotiate individually. This is why a hospital hosting five patients for knee replacements might get paid five different amounts for the surgeries.

Source: Why Our Health Care Lets Prices Run Wild | TIME.com.

There seems to be so many possible solutions to reigning in our ever-increasing healthcare costs if only those in congress would be brave enough to actually try a few. Instead they seem intent on just complaining about the situation. That’s easy, solving it is where the work begins and I am convinced that those yahoos inside the beltway are just too lazy to do the work to actually affect the problem.

After putting in quite a bit of study in this area I have come to believe that the above quote gets to the heart of the problem.  Like everything else in life if something is totally unregulated and uncontrolled it tends to move to an extreme.  I will admit that there are many doctors who are the exception to this statement but overall doctor’s pay is out of control.  When they believe that they are justified in charging me thousands of dollars for an hour of their time they need to be taught otherwise.

The way that hospitals set their rates is simply insanity. It has nothing to do with the actual cost of the service but more to do with getting the most possible. I love the quote above that “the result is a tangled, confusing and largely secretive collection of forces driving health care prices higher and higher”. As long as all of these price setting schemes are held behind closed doors our costs will inevitably grow higher and higher.  Why can’t we understand that simple fact.

Even a simple solution such as allowing Social Security to bargain for lower drug prices has been deemed not allowed by many of the so-called leaders in our government. Until we can finally realize that at some level of regulation is necessary in order to contain our healthcare dollars we will continue to complain about costs but fail to do any real action to contain them. The rest of the world discovered these solutions years ago, when will we ever catch up with them?

But I’m just a simple guy so what do I know…..

SurgeonA hospital in Livingston, N.J., charged $70,712 on average to implant a pacemaker, while a hospital in nearby Rahway, N.J., charged $101,945.In Saint Augustine, Fla., one hospital typically billed nearly $40,000 to remove a gallbladder using minimally invasive surgery, while one in Orange Park, Fla., charged $91,000.

In one hospital in Dallas, the average bill for treating simple pneumonia was $14,610, while another there charged over $38,000…

Source: Hospital Billing Varies Wildly, U.S. Data Shows – NYTimes.com.

I must admit that I have been lazy in regard to studying and reporting on how hospitals are at least partially responsible for the runaway medical costs in our country…..

You might think that just because a hospital charges an amount for a procedure that they actually receive that payment. Fortunately that is not the case for single payer systems like Medicare, Medicaid, and veterans.  The article goes on to say:

Medicare does not actually pay the amount a hospital charges but instead uses a system of standardized payments to reimburse hospitals for treating specific conditions. Private insurers do not pay the full charge either, but negotiate payments with hospitals for specific treatments. Since many patients are covered by Medicare or have private insurance, they are not directly affected by what hospitals charge.

Experts say it is likely that the people who can afford it least — those with little or no insurance — are getting hit with extremely high hospitals bills that may bear little connection to the cost of treatment.

Now that I have been on Medicare for a couple of years now I have been exposed to these extreme differences.  I recently had an endoscopy for an esophagus problem and when I got the paperwork from Medicare I could see that the medical facility charged about $3,500 for the fifteen minute procedure but Medicare approved less than $700 of which they paid 80% and my Medigap coverage paid the other 20%.  Since I was on Medicare and knew that they paid the same to all facilities I did not shop around for the different costs for the procedure but if I had I probably would have encountered differences like shown in the article above.

If like so many on the radical right seem to wish, I had not had Medicare I’m sure I would have been billed and expected to pay the full amount. The sad fact about it is that those who can afford it the least are the ones who actually are charged the most simply because they have no power behind them.

The rest of the developed world is for the most part on a single payer system similar to Medicare. I know that the most famous doctors tend to migrate to the U.S. because of our extreme compensations but even that fact does not give us superior care to most other countries. In fact even with our ultra-expensive way of doing healthcare many other countries are ahead of us when it come to living longer and healthier. When will we ever learn this very basic fact??

I get the feeling that if lawn mowing services were run by hospital administrators I would be charged  $1,000 for every time they mowed my lawn. Too bad someone can’t come up with DIY pace makers.

Source: Are you getting overcharged by your hospital? Time to become a Smart patient | VentureBeat.

Time Cover  MedicalIf you’re a patient represented by Medicare or Medicaid, you’re well served because these programs have significant market muscle: They negotiate prices below what it costs to treat patients. …..

With few exceptions, private insurers tend to be relatively weak when bargaining with hospitals, so that hospitals can extract from them prices substantially in excess of the full cost of treating privately insured patients, with profit margins sometimes in excess of 20 percent.

Finally, uninsured patients — also called “self-pay” patients — have effectively no market power at all vis-à-vis hospitals, especially when they are seriously ill and in acute need of care. Therefore, in principle, they can be charged the highly inflated list prices in the hospitals’ chargemasters, an industry term for the large list of all charges for services and materials. These prices tend to be more than twice as high as those paid by private insurers.

A fellow blogger clued me in on this report about why our medical bills are so high. I now have an electronic copy of this Time issue and plan to do several posts on it in the coming weeks.  We have a major problem with out present healthcare system. We are currently spending twice as much as any other country in the world on our healthcare and actually more unhealthy and dying earlier than most.

It seems that most in Washington, especially the conservatives, want to solve our problem by denying care to those who can’t afford to pay the full bills. They want to reduce coverage for those on Medicare and Medicaid and want to repeal Obamacare; they say that will fix our problems.  That and suggesting that people die early if possible. The Time article above shows us a very different scenario of the causes for our exorbitant spending.

I certainly hope that the results of this study are taken to heart by our legislatures. But since the article basically puts much of the blame on our hospitals and caregivers I doubt it will get much response from them.  The medical lobbies in this country are among the strongest around; they spend millions every year to keep these sort of reports in the background of life.

The quote above is the crux of the problems that are further explained in the article.  The guy that can afford it the least is the one to bear the brunt of hospital overcharges as they have no market power. While Medicare and Medicaid patients are “well served” as the quote says there are still many ways to reduce costs even further. The most obvious one that the Republicans in Washington so object to is the ability of that system to bargain with the drug manufacturers for reduced rates. That seems a no-brainer to me. It would reduce costs in those systems by several billion dollars every year.  It is indeed a low hanging fruit in healthcare containment that has been left untouched because of lobbying power.

Somehow or another we need to convince our lawmakers and regulators to start looking at cost containment instead of service denial.  I will be posting several more times about what this article found on “why medical bills are killing us”. I hope you will be as astounded by the facts as I am and possibly spurred to some sort of action.

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Source: Paul Ryan’s new Medicare plan could be tip of the iceberg (+video) – CSMonitor.com.

A parallel factor is rising income. As a society grows richer, it tends to spend more of its income on health care. Add in demographics (an aging population) and a lack of competition among health-care providers in many markets, and you have a recipe for more people to consume more health-care services at higher prices.

For once I am not going to comment on Mr. Ryan’s seemingly enthusiasm to balance his budget on the backs of the poor while asking for increases in our bloated military budgets and more tax breaks for the rich. That continues to be insane to me but is not the focus of this particular post.  Instead this post is about fixing Medicare and Medicaid. The quote above is at the end of this news article but says much about how some view the problem of spending our healthcare dollars.

The quoted argument seems to say that we choose to go to doctors because we can.  I don’t know about you but I don’t sit down in the morning and try to decide whether I will go to the mall, the park, or to the doctor that day.  I go to the doctor when I am sick or have what I think might be a serious medical problem. I don’t use doctors as a form of entertainment! Yeah, I know about the hypochondriacs out there but I hope they are a very small group.

Of course the quote also deems that the lack of competition is the cause for increasing prices for healthcare.  We just don’t have enough McDoctors and McHospitals around yet I guess.  Maybe I am naive about all of this but I kind of  believe that competition is more of a cause than a solution.  When Hospital “A” gets the latest multi-million dollar piece of medical equipment then Hospital “B” has to get it too so they can compete.  It doesn’t matter that one machine could provide all the tests needed by the community. It doesn’t matter that hospitals will use the machines where they really aren’t necessary because they have them.

If we really want to get our healthcare costs down we need to do what the rest of the world already knows and that is a single payer regulated system.  We spend more than twice as much as everyone else and actually live shorter and less healthy lives. It continues to amaze me how we in the U.S. fail to understand this very basic approach to healthcare.

Just Bill Being Bill….

September 6, 2012

Source: Fact check: Bill Clinton at the DNC – USATODAY.com.

CHARLOTTE, N.C. – Former president Bill Clinton’s stem-winding nomination speech was a fact-checker’s nightmare: lots of effort required to run down his many statistics and factual claims, producing little for us to write about.

Republicans will find plenty of Clinton’s scorching opinions objectionable. But with few exceptions, we found his stats checked out.

The worst we could fault him for was a suggestion that President Obama’s Affordable Care Act was responsible for bringing down the rate of increase in health care spending, when the fact is that the law’s main provisions have yet to take effect.

I must admit that I have always enjoyed listening to Mr. Clinton’s speeches. He just has a way with finding just the right words for every story.  If someone had just super-glued his zipper on that fateful day of his “improper relationship” there would be little to fault him with during his presidency. After all he was the only president in 50 years to have a surplus budget. I’m sure if any of my radical right friends dared to listen to his speech last night they are probably still uncontrollably wincing.

During his speech he step-by-step dismantled every argument against President Obama found in the many vitriol comments given at the RNC last week. About the only thing the fact-checker could find in it was that maybe he gave too much credit to Obamacare in causing the healthcare declining costs last year.  I know the Republicans gave the Affordable Care Act (ACA) the name Obamacare as a slam but it is now being commonly used as showing an achievement for the president.

If there is anyone who still is on the fence in this election I would strongly advise them to get a copy of this speech and read it. It was a forty-five minute speech given in the typical “Now listen this is important…” Bill Clinton mode. I would attempt to put down some of the most memorable things here but there are just too many to keep below my self-imposed five-hundred or so word limit for blog posts.

The one thing in the speech that I will mention is his comment that during his lifetime he has never seen such hatred displayed toward a president. That is the most distressful part of the Tea Party version of politics to me. We had some very good friends in the past who are now spewing this hatred. To see the anger and hate in their eyes when they talk about the President of the United States is truly scary to me. But maybe the scariest part of this is that they are doing it in church related functions such as Bible study classes. I seem to remember Jesus telling us to love our enemies. My past friends seem to have forgotten that phrase as well as so many other found in their bibles!

But what do I know…