The Politics of Health Care

[Crafty_Dog]

Thank you.

Those are some smart people, it will be interesting to see if they come up with something intelligent and reality based.

[ccp]

*******Annals of Internal Medicine Logo

Starving the Hungry Tapeworm: How Businessmen May Reform Health Care Cost

Laurence F. McMahon Jr., MD, MPH; Vineet Chopra, MD, MSc

In 2016, U.S. health care spending reached $3.3 trillion, a figure representing 17.9% of the nation's gross domestic product. Sadly, the skyrocketing cost of health care is not headline news. Rather, as aptly summarized by Warren Buffett, “The ballooning costs of health care act as a hungry tapeworm on the American economy” (1). Like a tapeworm, our health care cost problem degrades the overall vitality of our economy. Therefore, news that the CEOs of Amazon, Berkshire Hathaway, and JPMorgan Chase are coming together to combat health care cost has been met with anticipation and skepticism (1): anticipation—because these business giants may help solve what ails our health system—but also skepticism—because what do highly successful entrepreneurs, investment bankers, and money managers know about health care? Could blindness to the usual approaches to reducing health care cost be a strength?
After all, it's not as if health care costs have been ignored. The health system has been subjected to several innovations focused on decreasing the cost of care. We have seen the rise of HMOs (now ACOs [accountable care organizations]) with incentives for health systems to lower cost and improve outcomes. Likewise, efforts have been undertaken to identify and target patients who receive costly—and sometimes unnecessary—interventions. Even changing how we pay for services, from diagnosis-related groups to resource-based relative value systems for hospital and physician payment, has not bent the cost curve. Furthermore, studies, including a recent analysis by the Congressional Budget Office, have highlighted how all these approaches have failed (2, 3).
In contrast, a principal strength of the collaboration among Buffett, Jeff Bezos, and Jamie Dimon is that these 3 highly successful businessmen operate outside the health care delivery structure. Thus, their decisions do not come with the inherent conflict of those who are subject to the results of those decisions. We do not yet know what tactic they will use to address health costs. On one hand, they may wield their collective influence or market power merely to gain discounts for their employees or to promote products they wish to develop. If they do so, they will only become part of the problem, because obtaining price discounts is rampant, from Medicaid to Blue Cross plans. Fortunately, reports suggest that this will not be the case; rather, the new partnership will not seek to profit from health care, as many others have done (4). What, then, might their approach look like?
Health care expenses may be quantified simply by multiplying the cost of a service by its volume. To decrease health care cost, one has to decrease the price of a service, the volume of the service, or both. Thus, regardless of the approach, the end result must affect price or volume (3). We anticipate that these industry leaders will use a business strategy to address this deceptively simple equation. One such method might be Six Sigma (5).
In brief, Six Sigma is a structured, stepwise approach to improve a process: define, measure, analyze, improve, and control. The first step is to define the structure of the health care cost problem. In doing so, several truths are revealed, one of which is that cost is not evenly distributed. For example, we learn that 5% of patients consume 50% of health care cost (6). The second step in Six Sigma is measurement. During this phase, we learn that patients individually are not the problem. In fact, efforts concentrating on individual patients to control cost have never succeeded. Rather, “high-cost” patients are consumers of high-cost services (such as major surgery, cancer treatment, and trauma care). The third step, analysis, focuses on quantifying the value of a service. For example, for some patients, a service may be life saving (for example, a cardiac stent for a patient with acute myocardial infarction). In contrast, for patients with stable angina, the same procedure has substantially less clinical value. Any businessperson would recognize that paying the same for these services with disparate clinical value makes little sense. We expect this will be a key change in the next phase, improvement. We believe that these business pioneers will push for either a decrease in specific services or “repricing” of services that are of low clinical value.
After all, this approach mirrors the structure commonly seen in the consumer marketplace and is most familiar to these business leaders. The creation of a market structure built around relative clinical value has the net effect of both directly affecting the price component of the health care cost equation and, by lowering the price point, sending a signal to decrease the volume of the service. To follow through with the cardiac stent example, the price of the less efficacious use of the service in patients with stable angina would be set lower than its most efficacious use in the setting of acute myocardial infarction. Thus, hospitals and health systems would focus on redirecting resources to higher-margin activities and not invest where they lose payment. In the final Six Sigma step, control, we expect an emphasis on ensuring that the price and volume of low–clinical value services do not increase to offset the price-based savings. Such control will probably require a multifaceted approach, including interfacing with Medicare and private payers to promote similar messages.
How may these changes be executed through a Six Sigma–like process? We expect that these corporate leaders will turn to disruptive technologies to help keep costs low. Just like Amazon dabbled with drones to lower package delivery costs and JPMorgan Chase revolutionized banking through apps, many processes in health care are ripe for innovation. For example, annual health checks (which are controversial given their dubious value) (7) might be automated through publicly available health kiosks that measure blood pressure and blood sugar, and then dispense medications or make referrals if warranted. This is hardly science fiction. Indeed, technology-heavy kiosks that do all this and more are currently available (. Likewise, virtual consultation with physicians (through an Uber for Doctors–like app) might improve access and wait times while reducing costs—doing to health care facilities what Uber did to taxis. In addition, gaming strategies to promote healthier eating and living (á la Pokémon, which already has been shown to improve activity among sedentary populations) (9) are just a few examples of changes that may be emphasized by these visionaries. Of importance, all these concepts will focus on controlling (and reducing) health care costs—bending the supply-and-demand curve that currently relies on large hospitals and health systems.
Business leaders of the caliber of Bezos, Buffett, and Dimon, who are not steeped in the biases of health care pundits, can provide a fresh look at our cost problem. We believe their use of a business approach will ultimately lead to the repricing of much of what we do in health care. Just as an item with a 1-star rating on Amazon or a poorly performing mortgage product from JPMorgan Chase is quickly removed or repriced, so too could such a business value system change the health care cost problem. Although Medicare is moving to a “value-based” payment system, the pace of that movement is too timid and slow. Moreover, the current political climate (and that of Medicare itself) guarantees incremental not revolutionary progress. The business focus has fewer constraints and has the necessary bottom-line paradigm to be effective. If we do not focus on prices and value (10), we will not be able to starve our hungry tapeworm—and that, quite simply, is bad medicine.
References

Wingfield K, Thomas K, Abelson R. Amazon, Berkshire Hathaway and JPMorgan team up to try to disrupt health care. The New York Times. 30 January 2018. Accessed at www.nytimes.com/2018/01/30/technology/amazon-berkshire-hathaway-jpmorgan-health-care.html on 8 February 2018.
McWilliamsJMChernewMELandonBEMedicare ACO program savings not tied to preventable hospitalizations or concentrated among high-risk patients., Health Aff (Millwood), 2017, vol. 36 (pg. 2085-93)CrossRefPubMed
McMahonLFJrChopraVHealth care cost and value: the way forward., JAMA, 2012, vol. 307 (pg. 671-2)CrossRefPubMed
Bomey N. How Amazon, JPMorgan, Berkshire could transform American health care. USA Today. 25 February 2018. Accessed at www.usatoday.com/story/money/2018/02/25/amazon-jpmorgan-berkshire-health-care/350625002 on 18 April 2018.
de MastJLokkerbolJAn analysis of the Six Sigma DMAIC method from the perspective of problem solving., Int J Prod Econ, 2012, vol. 139 (pg. 604-14)
CrossRef
MitchellEConcentration of Health Expenditures in the U.S. Civilian Noninstitutionalized Population, 2014. Statistical Brief no. 497. Medical Expenditure Panel Survey.RockvilleAgency for Healthcare Research and Quality, 2016
Society of General Internal Medicine. Choosing Wisely: general health checks for asymptomatic adults. 2017. Accessed at www.choosingwisely.org/clinician-lists/society-general-internal-medicine-general-health-checks-for-asymptomatic-adults on 20 April 2018.
Wicklund E. Potential for healthcare kiosks in improving care delivery. mHealth Intelligence. 2018. Accessed at https://mhealthintelligence.com/features/potential-for-healthcare-kiosks-in-improving-care-delivery on 20 April 2018.
BarkleyJELeppAGlickmanEL“Pokémon Go!” may promote walking, discourage sedentary behavior in college students., Games Health J, 2017, vol. 6 (pg. 165-70)CrossRefPubMed
PapanicolasIWoskieLRJhaAKHealth care spending in the United States and other high-income countries., JAMA, 2018, vol. 319 (pg. 1024-39)CrossRefPubMed

[Crafty_Dog]

Not sure that I am persuaded here, but certainly quite relevant:

Trump’s Drug Price Bust
HHS follows the Obama method: set policy first, find statute later.
188 Comments
By The Editorial Board
Oct. 18, 2018 7:24 p.m. ET
Trump’s Drug Price Bust
Photo: David Goldman/Associated Press

One thing Americans rightly hate about health care is that no one knows the true price of a service. How much did your last X-ray cost? Why are you suddenly paying more for a statin? The Trump Administration tried to address this frustration this week with a new rule requiring price disclosure on prescription drugs, but its cure is worse than the problem.
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Health and Human Services has proposed a regulation that will force pharmaceutical companies to include the list price of a drug in television advertisements, and the rule applies to any drug paid for by Medicaid and Medicare that runs more than $35 a month. HHS says this is no different from forcing companies to disclose medical side effects and warnings, nothing but sensible transparency that might shame companies into lowering list prices.

This is misleading political advertising. Almost no one pays the “list” price at the pharmacy after insurance and discounts. Nearly nine in 10 prescriptions are generic, an identical version of the product that is a fraction of the cost. A unit of generic Prilosec costs about eight cents versus $3.31 for the branded heartburn medicine. Medicaid patients have co-pays as low as a couple bucks, though they won’t know that from watching an ad that says the medicine costs $50 or $200 a month.

The more important problems are legal. One sleight of hand is that HHS is promulgating the rule through the Centers for Medicare and Medicaid Services, not the Food and Drug Administration, which regulates safety and efficacy disclosures in drug advertisements.
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HHS openly concedes in the rule that “Congress has not explicitly provided HHS with authority to compel the disclosure of list prices to the public.” But it invokes sections of the Social Security Act that direct the agency to operate Medicaid and Medicare programs efficiently. That looks like a throwback to the Obama years: Select a desired policy and then hunt for a broad statute to justify it.

Pharmaceutical companies will almost certainly challenge the rule as compelled speech that violates the First Amendment, and they’re right to do so. Courts must apply the highest standard of review (“strict scrutiny”) on measures that burden content and speaker. This regulation singles out pharmaceutical companies for punishment, but not, say, hospitals. The price details hardly meet the legal exception for purely factual and noncontroversial information, especially given that HHS’s expressed motive is to embarrass companies into lowering their prices.

By the way, the pharmaceutical trade group PhRMA said this week that its member companies will voluntarily include in ads directions to a website where consumers can find what they’re likely to pay. Details include: list price, out-of-pocket costs and information about financial assistance programs.

HHS Secretary Alex Azar called this “a small step in the right direction,” but he is deploying his own rule anyway. That’s a tip that this is more of a political exercise than a good faith effort to offer customers information.

Another clue: HHS says that “we anticipate” the rule’s enforcement mechanism will be private lawsuits alleging unfair competition from misleading advertising. As if blowing money on lawsuits that enrich trial lawyers will lower drug prices.

More broadly, drug costs are roughly 14% of health spending but absorb about 99% of public attention. Much of the debate is driven by an increasingly bitter fight between pharmaceutical manufacturers and supply-chain negotiators known as pharmacy benefit managers. If this continues, the losers may be the rest of us.

Pharmaceutical companies are annoyed that the middlemen drive steep rebates and pocket some of the difference. The benefit managers complain that pharmaceutical companies are villains with huge profit margins. Congrats, you’re both wrong.

Benefit managers have in many cases put downward pressure on prices by negotiating bulk discounts as in any other business. Express Scripts reports that per person prescription drug spending grew a mere 1.5% for commercial plans in 2017. As for pharmaceutical companies, they need high profit margins as a return on capital in a business where most innovations fail. Between 1998 and 2014, some 167 lung cancer drugs failed in trials. Only 10 made it to market.

The Trump Administration is waddling into this debate so it can appear to be doing something—anything—about drug prices. Yet the White House’s policy blueprint offered many worthier ideas: cracking down on anti-competitive behavior from drug companies; reforming a dysfunctional Medicaid price system, and more. Those reforms are better than its simplistic and probably illegal attack on Big Pharma’s advertising.

Appeared in the October 19, 2018, print edition.

[ccp]

To my knowledge pharm companies don't advertise generics
they advertised patented drugs that cost a bundle
and to simply show the cost to the patient is misleading
as the insurance if it covers or medicare could be paying a huge amount

so the above article is misleading too.

[Crafty_Dog]

Newt knows how to win-- too bad the Patricians of the Stupid Party do not.

A Proposed Republican Pledge on Health Care
Originally published at Fox News

The 2018 midterm elections are less than two weeks away, and many polls show there is a sizable bloc of independent voters who have not yet made up their minds. At the same time, health care remains the number one issue for the American people.  The best way for Republicans to earn the votes of these undecided voters – and honor commitments to the Republicans who already support them – is to clearly articulate how they would fix our broken health care system.

This is an example of what that plan should be:

Republicans are Creating a Better Health System and Pledge to Do More

Republican Principles for America’s Health and Health Care System

•   We believe every American should have the opportunity to live a long and healthy life, supported by a health system that is simple to use, innovative, and affordable.
•   We believe that every American should have his or her choice of doctors and insurance that meet his or her specific needs.
•   We believe the health system should be transparent about health care costs and quality of treatments options and that this information should be available to every American in a simple, understandable way so patients can make better decisions about their own health.
•   We believe in protecting patients with pre-existing conditions so that they can obtain affordable health insurance coverage.
•   We believe in the importance of American medical innovation that leads to breakthroughs that dramatically improve health outcomes while significantly lowering costs.
•   We believe that the doctor-patient relationship is at the center of an effective health system, and it should not be disrupted by micromanagement from public and private bureaucracies.
•   We believe American seniors have earned their health care benefits; and that they, their families, and their doctors should make their own medical decisions – not unelected government boards, bureaucrats, or private third-party payers and middlemen.
•   We believe in a competitive health care market where private sector innovation works to strengthen public programs. One-size-fits-all government-controlled health care interferes with doctor-patient relationships, kneecaps new medical breakthroughs, provides less access to treatments, and leads to long wait times for critical care.
•   We believe that the current health care system in America is far too expensive. While it is very good at treating people when they become sick, it is much less effective at helping Americans remain healthy – which is equally as important.
•   We believe the goal of health reform should be to build on what’s working and fix what’s not. Destroying what’s good about our health system in an attempt to fix what’s bad is not an acceptable step toward a better future.

Republican Accomplishments in Improving America’s Health and Health Care System

Consistent with these principles, Republicans have taken several steps to improve the simplicity and affordability of America’s health and health care system. So far, the Trump administration and the Republican-led Congress have:

•   Passed legislation to eliminate the Obamacare individual mandate penalty.
•   Passed legislation to end pharmacy “gag” clauses so patients can find the lowest prices for drugs.
•   Passed Right-To-Try legislation.
•   Passed $6 billion dollars in new funding to fight the opioid epidemic.
•   Passed the historic VA Mission Act, which replaced the troubled Veterans Choice Program and passed the VA Accountability and Whistleblower Protection Act to make sure VA employees are held accountable for bad behavior and bad service.
•   The Trump administration is providing more affordable health care options for Americans through association health plans and short-term limited-duration plans.
•   In the first year of the Trump administration, the Food and Drug Administration approved more affordable generic drugs than ever before in history. Thanks to its efforts, many drug companies are freezing or reversing planned price increases.
•   The Trump administration reformed the Medicare program to stop many hospitals from overcharging seniors on their drugs – saving seniors hundreds of millions of dollars this year alone.
•   The Trump administration cut high-dose opioid prescriptions by 16 percent during its first year in office. This year, President Trump signed the SUPPORT for Patients and Communities Act to direct even more resources to fighting addiction and crack down on dangerous synthetic drugs that are killing tens of thousands of Americans a year.
•   Under the Trump administration, the VA expanded telehealth services, walk-in clinics, same-day urgent primary and mental health care, and launched the promised 24-hour White House VA Hotline.

The Republican Promises for Additional Improvements to America’s Health and Health Care System

If the American people re-elect Republicans to a majority in the House and Senate, we pledge to enact a series of practical and specific changes, based on what works in the public and private sectors, to build a better health system. This system will keep people healthy and provide effective treatments and economic security for those who get sick. These legislative changes will:

1. Protect patients with pre-existing conditions with an alternative approach to the Washington-knows-best method of Obamacare, which doubled premiums in the individual marketplace. We will do so by committing the resources necessary for states to try new approaches, like high risk pools and reinsurance, so everyone – regardless of medical history – has access to affordable insurance.

2. Further reduce the cost of prescription drugs by requiring additional transparency and accountability across the entire prescription drug supply chain (from manufacturers, to pharmacy benefit managers, to health insurers); making sure patients receive the benefits of drug manufacturer discounts and rebates; changing FDA rules to accelerate the release of new and generic drugs to market; and creating incentives to give more patients affordable access to new, highly-effective treatments that cure diseases and save money over time but have large up-front costs that create short-term challenges for public and private payers.

3. Lower premiums for individuals and small businesses by eliminating the health insurance tax; reducing Washington mandates that limit choices and drive up the cost of insurance; allowing the self-employed and small businesses to band together to purchase insurance so that they can have the same negotiating power as big businesses; and making it easier for smaller companies to self-insure.

4. Strengthen Medicare by protecting Medicare Part D patients from excessive out-of-pocket costs for drugs; protecting the market competition model of Medicare Part D, which has kept premiums low for seniors; eliminating unelected boards and bureaucrats that have decisions over treatments; and protecting Medicare as a program for seniors by opposing government-run health care, which would strain resources and limit availability and access to health services.

5. Maximize medical innovation by fully funding National Institutes of Health research that leads to new cures and treatments; creating incentives for private sector research dollars to flow into national health priorities, such as Alzheimer’s disease; repealing the medical device tax; reforming the FDA to give patients access to breakthrough treatments faster and at lower costs; and applying pressure on foreign countries to pay their fair shares for U.S.-developed drugs.

6. Make health care simpler by passing additional legislation to make the price and quality of health care providers visible and useful to patients; insist on patient rights to ownership and portability of their medical records; liberate primary care physicians to practice their craft with minimal interference from government and insurer bureaucracies – including expanding patient access to direct primary care options; and reduce or modify federal mandates, which increase administrative overhead, incentivize waste, and interfere with the kind of doctor-patient relationship that keeps people healthy for the long term.

7. Fight the opioid crisis by reducing the use of opioids to treat pain; enhancing border security to stop the flow of deadly fentanyl into our communities; investing in research to create non-addictive painkillers; and improving access to evidence-based treatment – including medication-assisted treatment.

8. Address the underlying costs of health care by focusing on treating chronic disease; shifting to payment models based on value and long-term health outcomes; passing medical liability reform to reduce unnecessary and duplicative testing; fighting health care fraud through public and private investment in information technology that the credit card industry uses successfully; and emphasizing public investment in improving the social determinants of health status, such as access to public transportation, affordable housing, and healthy food options.

This is the type of contract on health Republicans should be willing to sign – and deliver – to the American people so that we can all live longer, healthier, more productive, and more enjoyable lives.

Your Friend,
Newt
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[ccp]

rather then just health care:

https://www.usatoday.com/story/news/nation-now/2018/10/29/same-sex-couple-carries-same-baby-ivf-fertility-treatment-first/1804554002/

[Crafty_Dog]

Trump’s Health-Care Progress
The Administration is improving the individual market by expanding insurance choices.
85 Comments
By The Editorial Board
Nov. 4, 2018 5:41 p.m. ET

Americans say health care is a leading concern in Tuesday’s election, and voters say they trust Democrats over Republicans by double-digit margins. Yet the Trump Administration has put together an impressive suite of reforms that allow consumers more freedom and personal choice, not that you’ll read about it anywhere else.

Last month the Trump Administration rolled out a rule on health-reimbursement arrangements that would allow employers to offer workers tax-exempt dollars to buy insurance in the individual market. The Obama Administration banned this via regulation as part of the Affordable Care Act.

The Administration’s thinking is that these arrangements will be most attractive to small firms that lack the economies of scale that make offering insurance affordable. About 30% of workers at firms with three to 24 employees are covered by employer health benefits, down from 44% in 2010, according to Kaiser Family Foundation data. Eight in 10 companies with fewer than 200 employees offer only one plan.

Health reimbursements would be a cheap and easy option for, say, startups. This is also a way to offer more individuals the tax break on health care that employer insurance receives. Ending this economic distortion for everyone would be preferable, but equal treatment is a step forward.
***

The reflexive response from Democrats is that this is another effort to undermine the Affordable Care Act, but they need a new script. The rule will draw more young and healthy workers into the individual market, which currently skews toward the sick or those poor enough to be eligible for tax-credit subsidies. Reimbursements should make the ObamaCare exchanges more stable, which is what Democrats claim to want.

The rule includes guardrails to prevent employers from dumping sick employees onto the exchanges, and to prevent a person from getting both employer contributions and public subsidies. The Administration expects that some 800,000 employers will provide reimbursement arrangements to more than 10 million employees. Some three million will have been buying coverage on the individual market, meaning the rule should save the fisc money on increasingly expensive tax credits.

By failing to repeal ObamaCare, Republicans can’t address all of its dysfunctions. But at the margin by expanding choices they are making the individual market better, not worse, even as Democrats accuse them of sabotaging ObamaCare. Other new Trump options include short-term plans and association health plans. And unlike ObamaCare, the government isn’t coercing you to buy these products.
Trump’s Health-Care Progress
Photo: iStock/Getty Images

Speaking of association plans, the returns are coming in on the Democratic claim that allowing employers to band together to offer coverage is “junk insurance.” The plans are still nascent, but look at what the Las Vegas Metro Chamber of Commerce is offering: nine plan choices; dental, vision and life coverage available; pre-existing conditions covered; and more, with premium rates locked in for two years.

This is no surprise. The selling point of association plans is that businesses can pool risk and cut overhead costs. Businesses want to offer generous coverage that helps to attract workers in a tight labor market.

There may also be more relief ahead with the recent announcement that Health and Human Services rescinded a 2015 guidance for Section 1332 waivers. This is the Affordable Care Act’s waiver process for states to opt out of parts of the law. But Democrats designed the waivers to ensure that only progressive fantasies like single payer in Vermont could win approval. The Obama crowd then restricted the statute further in regulation.

The law stipulates that waivers must show the state plan provides coverage that is at least comprehensive and at least as affordable to comparable number of residents. Oh, and make it budget neutral.

The Trump Administration will interpret this in more rational ways, versus Obama guidance that applied the standards down to how plans would affect subpopulations in the state. The guidance was so prescriptive that most states didn’t bother coming up with ideas. The question now is how many enterprising Governors will decide they can do better than the status quo even within the restrictions.
***

You haven’t heard about all this because Democrats want to define the election as a choice between them and Republicans who supposedly want to deny insurance to people with lung cancer. But political control of health insurance is not the only way to care for the sick. The GOP tends to favor block grants for high-risk pools that subsidize those who need help paying for expensive treatments.

ObamaCare set up an interim high-risk pool to cover anyone with pre-existing conditions who had been denied coverage, at least until the exchanges went live. Peak enrollment: 115,000, even as Democrats claim now that 130 million people have pre-existing conditions and are at risk from Republican policy.

The GOP’s incremental progress on health-care freedom would have been hard to imagine a year ago when it failed to repeal and replace ObamaCare. Repeal is still desirable given the law’s fundamental flaws. But the Administration is working within the law’s limits to allow as much freedom as possible. If these products prove to be popular, Democrats may find it harder to eliminate the choices to stand up single payer

[Crafty_Dog]

Lan

https://www.breitbart.com/politics/2018/11/02/winning-land-o-lakes-offers-health-plans-nearly-50-cheaper-than-obamacare/?fbclid=IwAR08n9HsOnpLfrjYCCeg1ePZy-udNX59MuZnbSBfP2AkMwYxzp5h_xcXfRM

[Crafty_Dog]

Texas ObamaCare Blunder
A judge’s ruling will be overturned and could backfire on Republicans.
138 Comments
By The Editorial Board
Dec. 16, 2018 4:40 p.m. ET
Texas Attorney General Ken Paxton
Texas Attorney General Ken Paxton Photo: Tony Gutierrez/Associated Press

No one opposes ObamaCare more than we do, and Democrats are now confirming that it was designed as a way-station to government-run health care. But a federal judge’s ruling Friday that the law is unconstitutional is likely to be overturned on appeal and may boomerang politically on Republicans.

Judge Reed O’Connor ruled for some 20 state plaintiffs that the Affordable Care Act’s individual mandate is no longer legal because Republicans repealed its financial penalty as part of the 2017 tax reform. Recall that Chief Justice John Roberts joined four Justices to say ObamaCare’s mandate was illegal as a command to individuals to buy insurance under the Commerce Clause. “The Framers gave Congress the power to regulate commerce, not to compel it,” he wrote.

Yet the Chief famously salvaged ObamaCare by unilaterally rewriting the mandate to be a “tax” that was within Congress’s power. Never mind that Democrats had expressly said the penalty was not a tax. Majority Leader Roberts declared it to be so.

Enter Texas Attorney General Ken Paxton, who argues in Texas v. U.S. that since Congress has repealed the mandate, the tax is no longer a tax, and ObamaCare is thus illegal. Judge O’Connor agreed with that logic, and he went further in ruling that since Congress said the mandate is crucial to the structure of ObamaCare, then all of ObamaCare must fall along with the mandate.

We’ll admit to a certain satisfaction in seeing the Chief Justice hoist on his own logic. But his ruling in NFIB v. Sebelius was in 2012 and there is more at issue legally now than the “tax” issue in that opinion. One legal complication is that Congress in 2017 repealed the financial part of the individual mandate, not the structure of the mandate itself. Republicans used budget rules to pass tax reform so they couldn’t repeal the mandate’s express language.

The Affordable Care Act has also been up and running since 2014, which means so-called reliance interests come into play when considering a precedent. Millions of people now rely on ObamaCare’s subsidies and rules, which argues against judges repealing the law by fiat.

Judge O’Connor breezes past this like a liberal Ninth Circuit appeals judge handling a Donald Trump appeal. He’s right that Democrats claimed the individual mandate was essential to the Affordable Care Act. But when Congress killed the financial penalty in 2017 it left the rest of ObamaCare intact. When judging congressional intent, a judge must account for the amending Congress as well as the original Congress.

In any case, the Supreme Court’s “severability” doctrine calls for restraint in declaring an entire law illegal merely because one part of it is. Our guess is that even the right-leaning Fifth Circuit Court of Appeals judges will overturn Judge O’Connor on this point.

As for the politics, Democrats claim to be alarmed by the ruling but the truth is they’re elated. They want to use it to further pound Republicans for denying health insurance for pre-existing conditions if the law is overturned. Democrats campaigned across the country against Mr. Paxton’s lawsuit to gain House and Senate seats in November, and they will now press votes in Congress so they can compound the gains in 2020.

President Trump hailed the ruling in a tweet, but he has never understood the Affordable Care Act. His Administration has done good work revising regulations to reduce health-care costs and increase access, but the risk is that the lawsuit will cause Republicans in Congress to panic politically and strike a deal with Democrats that reinforces ObamaCare. This is what happens when conservatives fall into the liberal trap of thinking they can use the courts to achieve policy goals that need to be won in Congress.

[DougMacG]

"The Affordable Care Act has also been up and running since 2014, which means so-called reliance interests come into play when considering a precedent. Millions of people now rely on ObamaCare’s subsidies and rules, which argues against judges repealing the law by fiat."

With all due respect, I say ... bull sh*t.  They have this completely upside down.

How about the precedent that the federal government does not have this power and the Framers never envisioned it.

The mandate can no longer be deemed a tax no matter how you stretch it.

The "precedent" was that Obamacare was constitutional only because of the tax. The Court has never upheld the power of the federal government to mandate a private purchase.  Where in the constitution is that power granted? The legislative branch knew that full well when they repealed the tax.  No Democrats supported the repeal.  The intent and effect of repeal of the penalty was to repeal the entire law - by taking literally what the Chief Justice of the Supreme Court wrote when he cast the deciding vote in that case sending it back to the legislative branch for action, or inaction.  Taking literally what the Supreme Court wrote is what they are supposed to do!  It took 5 years and 3 election cycles but this was the legislative response to the guidance given by the Court.

The Supreme Court now has two choices as I see it.  Stay consistent with their previous action which means strike the whole law down, or they can contort like a pretzel, again, go against their own previous ruling and rule against the new will of the people expressed through their legislative representatives who responded to the previous ruling  by repealing the relatively small tax upon which the constitutionality of the whole mess rested.

The mandate is constitutionally defective, unconstitutional.  It was ruled constitutional only if deemed a tax.  THAT is the precedent.  See Robert in Sebelius.  They didn't have a 5th vote then without that and they didn't likely gain one since, though we don't know the Gorsuch or Kavanaugh view on this yet.  

The law is a whole made up of interrelated parts.  The risk pools for example don't work without the mandate.  The law stands or folds as a whole, not a menu of parts for the Court to legislate from.

Major legislation often includes what’s known as a “severability clause,” to prevent courts from invalidating entire laws when they find that small sections of those laws violate the Constitution.  The ACA does not include such a clause.
https://talkingpointsmemo.com/dc/the-glitch-that-allows-the-supreme-court-to-throw-out-all-of-obamacare

They could no longer fix that alleged defect when discovered because they lost the 60 vote majority in the Senate after the special election in Massachusetts.  In July 2009 Al Franken finished his stealing of the 60th Senate seat making Obamacare possible without a single Republican vote.  One month later Ted Kennedy died and Republican Scott Brown won that  seat BECAUSE of Obamacare.  In 2010 Republicans won the House.  In 2014 the Senate and in 2016 the White House.

The tricks supporters used to deem this passed and contortions used to rule it constitutional with one so-called conservative vote have now come back to bite the supporters and the legislation.

The original legislation came from only one party.  The repeal came from only the other party after power had switched in the ensuing elections.  Now the federal government is divided.  They can either enact new legislation or a legislative fix that is bipartisan or they can send it back to the states [where it belongs].

Passing all-encompassing federal legislation that changes the private lives and private decisions of everyone in the country and expands the power and reach of government is hard - JUST LIKE THE FRAMERS INTENDED.  

[Crafty_Dog]

https://www.nationalreview.com/2019/02/bernie-sanders-health-care-rhetoric-rights/?fbclid=IwAR1MLhCEWuyRB3hX2j2oxRNPS6a147rh_vZebAG_fLZk-LWAysgymUT5C38

[G M]

https://www.nationalreview.com/2019/02/bernie-sanders-health-care-rhetoric-rights/?fbclid=IwAR1MLhCEWuyRB3hX2j2oxRNPS6a147rh_vZebAG_fLZk-LWAysgymUT5C38

In the 1850s, the southern dems had a right to cotton.

[Crafty_Dog]

https://www.westernjournal.com/hermancain/policy-change-trump-doj-now-asking-supreme-court-throw-obamacare-entirely/?utm_source=push&utm_medium=westernjournalism&utm_content=2019-03-26&utm_campaign=manualpost

[DougMacG]

White House working on secret healthcare plan with three conservative think tanks

https://www.washingtonexaminer.com/news/white-house-working-on-secret-healthcare-plan-with-three-conservative-think-tanks?utm_source=Examiner%20Today_04/01/2019&utm_medium=email&utm_campaign=WEX_Examiner%20Today

"The analyst said the administration has been “having conversations” on healthcare policy and has reached out to numerous think tanks, including the Heritage Foundation, the Mercatus Center, and the Hoover Institute."
--------------------------------------------------

My fingers are crossed.  The next Trump or Republican proposal needs to be acceptable politically, functionally and doesn't unnecessarily or egregiously violate the principles of free market economics.

BTW, the Obamacare people should have consulted with these three groups too.

[Crafty_Dog]

A trial balloon I heard this morning is to "Leave it to the laboratory of democracy-- the fifty States-- to find a way including for preexisting conditions with the Feds giving block grants."

[DougMacG]

Credit John Hinderaker for writing what I was thinking about Mick Jagger's health care.  With US healthcare the worst in the world according to the Left and the National Health Service in Britain the leader in national healthcare, how come people who have choice keep coming here?

https://www.powerlineblog.com/archives/2019/04/annals-of-government-medicine-27.php

[DougMacG]

Oct 2018 Survey:
https://www.studyfinds.org/survey-half-doctors-consider-leaving-medicine-insurance-company-headaches/
https://aimedalliance.org/wp-content/uploads/2018/10/Aimed-Alliance-Primary-Care-Survey-Report.pdf

[DougMacG]

https://www.medicareinteractive.org/get-answers/medicare-basics/medicare-coverage-overview/differences-between-medicare-and-medicaid
-------------------------------------------------------------

When Bernie and the gang talk about "Medicare for all", can we just start calling it Medicaid for all?

Medicare as I understand it is a program where they take from your paycheck all your working life in order to pay for healthcare when you are older, over 65.

WE ALREADY HAVE MEDICARE FOR ALL.  To repeat, it is the program where you pay in and then collect.

What Bernie et al is saying is, 'elect me and someone else will pay for your healthcare'.  To the poor that means free sh*t; to the taxpayers that means beware!  In government-speak, the program where you collect without paying in is called Medicaid.  The poor in America have had free healthcare since 1965.  What the Left is saying is, let's make this program available to all.

Just posted on Cog Diss of the Left thread is a New Yorker article.  On healthcare they point out that the ACA, a so-called subsidized market-based approach "leaves Americans paying more for worse coverage than any other advanced nation."  Next paragraph begins, "supporters of the A.C.A. would contest this characterization."  But there are no supporters of the ACA.  The right wants it gone, the left wants it gone and the center doesn't like it either.

"Medicare for all" is not a proposal because it is not Medicare and no one proposing has accurately forecasted the cost or proposed how to pay for it.

If socialized medicine is a better economic system than market economics, charge people for their share of it.  Charge all the able-bodied people their full cost of it, and even that doesn't pay for it because half the people currently pay in nothing.
 
The "explicit implication" that someone else will pay for it is bullsh*t rubbish.  Raising tax rates further only on the rich does not bring in more dollars at all and most certainly doesn't bring in additional tens of trillions of dollars. 

We know that having government run something makes it more expensive and less efficient, cf. everything they have touched so far.  If you switch to government healthcare, you will pay all your healthcare dollars to the government instead of to your provider AND your taxes will go up to help cover the one or two hundred million who will not be paying their fair share.  Only then can you enjoy the 270 day wait times they have in Canada and the quality of heart care that drove the Rolling Stones to the USA.

Candidate Barack Obama was shown that raising rates on capital does not increase tax revenue and he famously responded he would do it anyway out of "fairness".
https://taxfoundation.org/obama-and-gibson-capital-gains-tax-exchange/

Unlimited free healthcare for all would more than double the current cost of the federal government, cost more than $4 trillion per year and escalate rapidly.  Symbolic rate increases that don't bring in more revenue doesn't get you there.  "Static" increases that don't accurately measure the revenue degradation of changed behavior caused by greater disincentives to produce and report income do not get you there.  Frankly nothing gets you there short of closing up all other government spending and shifting it to healthcare.  We could have no defense, no payments on the debt, no social security, no food stamps, no court system, no executive or legislative branches, no EPA, and it still wouldn't get you there because you would have no IRS and no enforcement, no prison system to lock up the non-payers.

The Left lives in a dream world and most of us don't share their dream.

And they lie.  They tell us we should all be able to have the healthcare of the rich and then they offer us all the healthcare of the poor.

[Crafty_Dog]

The articulation of the reality that what is being proposed is Medicaid for All and why that difference matters is a matter of tremendous importance.

[ccp]

now coming North

expect the political correct not medically correct comments from them:

https://www.delawareonline.com/story/news/health/2019/04/23/remember-kissing-bug-cdc-confirms-one-found-delaware/3548857002/

[Crafty_Dog]

Interesting point, but I am unable to see the article.  Any other citation?

[ccp]

With regards to truvada , one could argue people are dying because it's cost  too high , but really it is that  they continue to have unprotected sex indiscriminately.

truvada allows people to have sex with hiv + people and not get it. 

https://www.yahoo.com/news/aoc-asks-pharma-ceo-why-171300682.html

we can't even cure the common cold but we are close to curing HIV , and it can be kept  at bay.
so it is not like no one is doing anything AOC . 

Maybe she should work for 74 K not 174K

[Crafty_Dog]

https://issuesinsights.com/2019/06/04/586-billion-later-health-care-in-bigger-state-of-crisis-thanks-obama/?fbclid=IwAR3xPnFCbGApoVrE6upzOV1I6AQIGdW0kgPkB3UMtHgTJ0fJKrc-NcFCqVI

[ccp]

https://www.huffpost.com/entry/medicare-for-all-poll-democrats_n_5d08264de4b0886dd15db364?guccounter=1&guce_referrer=aHR0cHM6Ly93d3cuaHVmZnBvc3QuY29tLw&guce_referrer_sig=AQAAADmW1PJjngfg-biVDmh6BWXEVoYO_485zyULM1xhCIYxwWfcdrIM_E24PF7Nxselzz1kN0DkbEbGH87pD6tzxnR-kK6Tn7WRPIkgsuFgyvwKGRhTAD4-UzW_29w5laT3dc1-dVS0fD64H1Wx2_Ps06efVn4BQtcSFipbJ82nVzeC

actually it is really very simple
everyone is forced into a government led bureaucracy that controls 1/7 more of the economy and dictates what health care we get or don't gt
and those who make money pay more into it and those that don't will get it for free courtesy of taxpayers

it will expand the Democrats control over all of us and reduce our freedom of choice to none.
unless like in Britain where the super rich can get pay for outside care.

End of story
Complicated - no not really

[DougMacG]

"Democratic Voters Don’t Actually Understand ‘Medicare For All,’ New Report Says?

No they don't.  If the media polling companies were honest and sought clarity they would ask it more this way:

1) Do you favor banning all private health care and trust everyone's health care to the government?

2)  Do you want the healthcare system here that they have in Venezuela where all healthcare is free and provided by the government but they can't give you as much as a band aid because the system is bankrupt?

3)  Do you favor banning the entire private sector in all industries and turning everything over to the government?

If you answered no to any of these, vote 'R'.

[ccp]

up front for basic tests:

https://www.yahoo.com/finance/news/trump-order-seeks-disclosure-hospital-142157856.html

Seems like good idea to me but the anti Trump media is pointing out insurers and hospitals are skeptical and mostly not for it.


Suddenly the news media is on the side of hospitals and insurers    rather then patients

That said I am not sure it will make any difference in costs at all.

Patients I have found do not care what the cost of anything is as long as someone else or the insurance cover it.

I recall telling patients about scams to have them driven to distant hospitals to have procedure done that could have easily been done nearby within their network.

Doctors did this so they could charge several multiples for the same service
Patients respond every freakin time =>  so what do I care the insurance covered it.

So it will only make a dent if the patient gets the bill is the bottom line.

[Crafty_Dog]

a) Do large deductibles motivate patients still in the deductible zone?

b) Would non-motivation be solved by Dr. Carson's HSA proposal?

[DougMacG]

a) Do large deductibles motivate patients still in the deductible zone?

b) Would non-motivation be solved by Dr. Carson's HSA proposal?

From my point of view, yes and yes, those are both important steps in moving away from third-party pay to a market system.  Everyone should pay the part they can afford out of their own pocket, and as we get more prosperous that should be a larger and larger share of healthcare instead of the other way around as it has been. Then insurance or catastrophic insurance can cover the unexpected or the unaffordable. Government needs to pay less and less, not more and more.

The problem with the large deductibles now is that the price of what you are paying out of your pocket has been driven out of sight by the system of third party and government pay. It is not just the high deductible but what we need is the mindset for most people their health care, like food, clothing, shelter, transportation, entertainment, is among the things you pay for out of your pocket and treat them with that kind of care and choice.

When only a very few are paying out of pocket, the pricing gets based on the government and insurance third party system.

Senator Phil Gramm said, give me 3rd party pay at the grocery store and I'd eat more steak and so would my dog. But that misses half of it. The stake would no longer be 10 or $20 a pound it might be a hundred or $1,000 a pound because no one cares what it costs.

[ccp]

https://www.nytimes.com/2019/07/08/health/drug-prices-tv-ads-trump.html

[Crafty_Dog]

On Drug Prices, Trump Should Heed Reagan’s Advice: “Bold Colors” not “Pale Pastels”

In Friday's column, I explained why the President and Republicans are on their way to a stunning victory in 2020. I predicted that a big factor in this victory will be the clear juxtaposition between the President’s methodical, step-by-step approach to lower health care costs with more transparency, choice, and accountability and the Democrats’ calls for radical change that would throw people off of their private insurance and replace it with a government-run monopoly.

In today’s column, I want to sound a warning about how things could go wrong, particularly when it comes to the President’s efforts to lower prescription drug prices.

Until a few days ago, I would have argued confidently that the President and Republicans were well situated to win on the issue of drug prices in 2020.

A record number of generic drugs were approved by the FDA in 2017, saving consumers nearly $16 billion with lower priced alternatives. The Republican Congress also passed, and the President signed, a bill lifting the pharmacy “gag clauses” that prevented pharmacists from informing patients if they could pay less for a medicine by paying cash instead of going through insurance (some generic drugs are so cheap that they can cost less than a co-pay).

This early progress has led to a stunning result: for the first time in nearly 50 years, the consumer price index for prescription drugs is falling.

With a proof of concept that increasing transparency and consumer choice can lower drug costs, the President and Republicans could point to even bigger reforms being developed using the same strategies. This record of results using common sense, market-oriented reforms would provide a positive contrast with the Democrats’ calls for big government price controls that would lead to rationing of care and fewer medical breakthroughs like gene therapy, which would both cure diseases and create an economic boom in America (click here to learn more).


Unfortunately, the administration's efforts have hit several roadblocks in recent days. Worse, it appears some in the administration are abandoning market-oriented reforms that are working in favor of a more left-wing approach which would be a disaster.

Last week, a judge ruled that the administration could not require the prices of prescription drugs to be disclosed in direct-to-consumer advertising. This was a blow to efforts to use transparency and market forces to put downward pressure on drug prices.

Worse, the administration announced that due in part to misguided budgetary concerns, it was dropping its development of a rule in Medicare Part D to require all discounts and rebates given to pharmacy benefit managers (PBMs) to be passed directly to patients at the pharmacy counter.

This decision is incomprehensible. As I have explained before, this reform would have removed a huge incentive for drug manufacturers to constantly raise their prices in order to provide bigger discounts to PBMs. It is also a reform which would save seniors money in their out-of-pocket costs, making it easier for patients to follow their drug regimes, improving their health. Coupled with the fact that seniors would have started saving money in 2020, an election year, the decision to abandon the rule is both bad medicine and bad politics.

In an even more worrying development, reports are that some in the administration are considering embracing Nancy Pelosi’s plan to impose price controls on drugs in Medicare by tying the rate of drug price increases to inflation. Unlike the rebate rule, using price controls to standardize the rate of price increases won’t reduce the amount seniors pay for their drugs. In fact, drug manufacturers will likely respond by increasing their initial prices. In addition, in Pelosi’s plan, the penalty for raising prices faster than inflation is a tax, which would go to the federal treasury, not to seniors. So instead of reducing seniors’ drug costs, Pelosi’s plan would grow government.

The danger President Trump is in is best summed up by this headline: ‘Trump leaning on Sanders-style ideas to save his drug plan’.

President Trump should heed Ronald Reagan’s advice for conservatives: raise a banner of “bold colors,” no “pale pastels.”
Embracing watered-down, left-wing ideas to get something done on drug prices will not help American patients, who will face rationing and be robbed of future medical breakthroughs made possible through the free market, and it certainly won’t help politically in 2020. The Democratic nominee for president will always be able to go further to the left than a Republican president offering “pale pastels” of liberal ideas.

Instead, President Trump should stick to “bold colors.” He should announce that the rebate rule will be implemented as scheduled; fight for more transparency in drug prices in the courts; and make clear that while he is open to bipartisan legislation on drug prices, he is not going to adopt price controls that would ruin the innovation base making the drug breakthroughs possible in the first place.

Combined with President Trump’s other positive reforms in health care, this would be a “bold colors” health care platform that would win in 2020.

Your Friend,
Newt

P.S. There’s another potential solution to America’s health care crisis. I’ve been working passionately for years to advance it, and I believe we’ve finally reached a tipping point. It has to do with a miraculous scientific breakthrough that could save and improve lives, as well as the finances of our country. I’ll be discussing all the behind-the-scenes details during The 2019 American Health & Wealth Summit Thursday, July 18th at 1pm ET. It'll be online and is free to attend - click here now to register.

[ccp]

100 yrs after discovery:

https://www.vox.com/science-and-health/2019/4/10/18302238/insulin-walmart-relion

and their prices seem to be in tandem.

[DougMacG]

 Hospitals would have to disclose the discounted prices they negotiate with insurance companies under a Trump administration rule that could upend the $1 trillion hospital industry by revealing rates long guarded as trade secrets. Hospitals that fail to share the discounted prices in an online form could be fined up to $300 a day, according to the proposal. The price-disclosure requirements would cover all the more than 6,000 hospitals that accept Medicare, as well as some others, and is likely to face fierce industry opposition.
https://www.wsj.com/articles/trump-proposes-forcing-hospitals-to-disclose-discount-rates-negotiated-with-insurers-11564431303?mod=itp_wsj&mod=&mod=djemITP_h

   Winning.

[ccp]

https://fortune.com/longform/medical-records/

[ccp]

https://www.yahoo.com/news/diabetic-27-dies-taking-cheaper-113810916.html

the story is not complete
not clear how someone who used insulin his entire life would die from a different brand or type exactly

that said there is price fixing
oh yeah the insulin makers may not get together in a back room and agree to all sell at a similar price

they just do it .

no doubt about it.
as for why this guy did not have other insurance
or exactly what happened I dunno.

[Crafty_Dog]

https://www.marketwatch.com/story/the-us-can-slash-health-care-costs-75-with-2-fundamental-changes-and-without-medicare-for-all-2019-08-15?fbclid=IwAR1ZJxuQIreQ9WQfph15w6K9ULaS03c5rYG1xWsEAm5G2vYrS36X6J4LJzY

[ccp]

blasting medical community for under prescribing pain medicines circa 2003

fast forward to now:
regulators now watching every single prescription for pain meds and law firms suing pharmaceutical companies

https://academicworks.cuny.edu/cgi/viewcontent.cgi?article=1147&context=clr

[ccp]

https://pjmedia.com/trending/trumps-sudden-e-cig-crack-down-raises-questions-did-melania-catch-barron-vaping/

good political move . - Donald is protecting our children and should put smiles on all the suburban babes.

That said I think vaping is good for people who cannot otherwise quit cigarettes though I don't like the flavored shtick

The epidemic of teens using it for fun social reasons and to be cool is not good
at all.

However why ban vapes but not cigarettes?
And suddenly CBD and marijuana is ok?

No real consistency in policy .

 

[ccp]

https://www.wsj.com/articles/take-two-aspirin-and-call-me-by-my-pronouns-11568325291

The above is the reason I no longer a member of the American College of Physicians after over 30 yrs for the past ~ 2 yrs
I am tired of reading and hearing about gun control, women make 5 % less than men in healthcare
abortion access BCP access  crazy definitions of gender ,  woke this woke that , climate change affecting menstrual cycles male erectile function and everything any researcher can dream of to make money publish BS  and the increasing numbers of woke  foreigners, females etc
some of whom seem to think all this is necessary
forcing it down the communication outlets to an every increasing degree.

I can turn on MSLSD to here the same dogma.
I don't need to pay for membership for more of the same.
I can get education updates for free without it.

[DougMacG]

“Finland's government resigns over failed healthcare reform - BBC News”
https://www.bbc.com/news/world-europe-47496326

Finland's entire government has resigned over its failure to achieve a key policy goal on social welfare and healthcare reform.

[Too bad our liberals don't have  this level of integrity.]

As an increasing number of people live longer in retirement, the cost of providing pension and healthcare benefits can rise. Those increased costs are paid for by taxes collected from of the working-age population – who make up a smaller percentage of the population than in decades past.

Mr Sipila's government also famously experimented with a guaranteed minimum income scheme – giving €560 (£480) a month to 2,000 unemployed people as a basic income with no conditions attached.  Initial results suggested the pilot scheme left people happier, but still unemployed.

[ccp]

 "Initial results suggested the pilot scheme left people happier, but still unemployed"

so that is how the Scandinavians become so happy!   

the Dems want to make our unemployed even happier to be # one in the world.

[ccp]

too complicated for me to understand and I don't know the numbers to crunch
but here is a summary :

https://www.conservativereview.com/news/house-republicans-release-health-care-plan-aims-finally-end-insurance-nightmare/

Hopefully this gives Pres Trump something to run with ........
if anyone could promote it he is the man.

I can just imagine Fareeeeed Zakaria is already (with Sanjay) looking for ways to tear this apart to please the Big Zucker.

[G M]

https://wilderwealthywise.com/free-speech-not-if-you-want-healthcare/

Good thing that couldn't happen here!

[Crafty_Dog]

https://www.marketwatch.com/story/the-us-can-slash-health-care-costs-75-with-2-fundamental-changes-and-without-medicare-for-all-2019-08-15?fbclid=IwAR2U68z6A5Jo6nIwhvvIAzgMtfI-0qqeW702tTb1AF4UlZJaWVZsm_aZ7bo

[DougMacG]

https://www.marketwatch.com/story/the-us-can-slash-health-care-costs-75-with-2-fundamental-changes-and-without-medicare-for-all-2019-08-15?fbclid=IwAR2U68z6A5Jo6nIwhvvIAzgMtfI-0qqeW702tTb1AF4UlZJaWVZsm_aZ7bo

Great ideas.

[Crafty_Dog]

Yes they are; very much like Dr. Ben Carson's IIRC.

[Crafty_Dog]

Trump Administration Releases Transparency Rule in Hospital Pricing
Plans to propose similar requirement for insurers; legal challenges are likely

Prices charged for health-care procedures such as magnetic-resonance imaging vary widely. PHOTO: KEITH SRAKOCIC/ASSOCIATED PRESS
By Stephanie Armour
Updated Nov. 15, 2019 2:52 pm ET
Hospitals and insurers would be forced to disclose their secret negotiated rates for the first time under a far-reaching plan released Friday by the Trump administration.

Administration officials said the final rule will compel hospitals in 2021 to publicize the rates they negotiate with individual insurers for all services, including drugs, supplies, facility fees and care by doctors who work for the facility.

The administration proposed extending the disclosure requirement to the $670 billion health-insurance industry. Insurance companies and group health plans that cover employees would have to disclose negotiated rates, as well as previously paid rates for out-of-network treatment, in file formats that are computer-searchable, officials said.

The insurers, including Anthem Inc. and Cigna Corp. , would have to provide a transparency tool to give cost information to consumers in advance, senior administration officials said.

The requirements are more far-reaching than many industry leaders had expected and could upend commercial health-care markets, which are rife with complex systems of hidden charges and secret discounts. The price-disclosure initiative has become a cornerstone of the president’s 2020 re-election health strategy, despite threats of legal action from the industry.

“Right now, there is too much arbitrage in the system,” a senior administration official said in an interview Thursday with The Wall Street Journal. “There are a ton of vested interests who will oppose this. We expect to get sued. We’re really goring people’s oxes.”

SHARE YOUR THOUGHTS
How could information from insurers and hospitals be helpful to you if this plan goes into effect? Join the conversation below.

Hospitals and insurers typically treat specific prices for medical services as closely held secrets, with contracts between the insurers and hospital systems generally bound by confidentiality agreements. Policy makers, employers and patients are often unable to see clearly which hospital systems and doctor practices are driving high costs.

The proposal covering insurers is the newest part of the price-disclosure initiative, and it would include the private-employer market, where about 158 million people get their health insurance. Insurers and group health plans would have to put the negotiated rates into a file that third-party developers could incorporate into shopping tools.

Insurers would also have to create a web-based tool for beneficiaries that discloses the list price, the negotiated rate, cost sharing and the amount left on a plan deductible, as well as allowable out-of-network rates, officials said. There will be a 60-day public comment period on the proposal.

The requirements for the negotiated-rate file could cost insurers an estimated $200 million to build based on projections in the proposal.

Other costs include an estimated $64 million to $161 million for three years to implement and maintain posting about cost sharing.

The proposal also states that “price transparency may have the opposite effect because in some markets where pricing is very transparent, pricing can narrow and average costs can increase.”

Studies show consumers are often required to pay more out of pocket when they don’t have the price information they need to comparison shop. Employer health-plan deductibles are outpacing wage growth and have risen to an average $1,655 for a single plan, according to a September survey by the Kaiser Family Foundation. Workers on average pay $6,015 toward the cost of their coverage.

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Drug pricing is complicated and secretive. WSJ explains how the flow of money, drugs and rebates behind the scenes may drive up the price of prescription medicine for consumers. Illustration: Mallory Brangan
On the final rule covering hospitals, facilities will have two obligations. First, they will have to provide insurer-specific negotiated rates in a computer-readable file.

Second, hospitals will have to post negotiated charges online for 300 specific services for which patients typically shop around. Seventy of those services, including vaginal birth, colonoscopy and joint-replacement surgery, are stipulated in the rule, according to senior administration officials. Hospitals can select the other 230 services they post online.

Hospitals face fines of up to $300 a day if they don’t comply with sharing negotiated rates.

The requirements would cost hospitals more than $23 million annually in 2016 dollars, according to an estimate in the rule. Annual costs range from $38.7 million to $39.4 million in 2019 dollars.

Taken together, the price-disclosure initiatives could reshape the $3.5 trillion health-care industry.

Prices charged for health care vary widely depending on whether a provider is in or out of the patient’s insurance network and on the insurer’s undisclosed price agreements with hospitals. A magnetic resonance image of the lower back costs $141 at an imaging center in Jefferson, La., but $7,646 at a hospital in Torrance, Calif., according to data from Clear Health Costs, which publishes information on health costs.

Hospitals, insurers and others in the industry have spent the past nine months since the idea was floated by the White House denouncing the proposal and gearing up for a pitched legal battle.

The industry is also likely to argue in any legal challenge that negotiated rates are proprietary and include confidential contractual agreements. Industry groups have also said the proposal runs counter to the First Amendment.

Pharmaceutical companies prevailed with a similar argument when the Trump administration said they had to disclose list prices for drugs in television ads. A federal judge in July ruled that the requirement overstepped regulatory authority.

“It’s actually worse than we expected,” said Tom Nickels, executive vice president of the American Hospital Association. “They have additional requirements. It’s additional data that I don’t know is particularly helpful for consumers.”

If rates are public, health-care companies say, some hospital systems might push for payment rates that match their crosstown rivals’.

MORE ON HEALTH POLICY
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FDA Expected to Ban Flavored E-Cigarettes Except Tobacco, Menthol November 5, 2019
Proponents of the proposal argue it would bring costs down. Out-of-network doctors could try to compete with in-network negotiated rates. Health systems that charge higher negotiated rates could lose business if they don’t match competitors’ rates or justify the reasons for their steeper costs. And employers could press their insurers to include hospitals with lower negotiated rates in their networks.

Employers and patients are often unable to see which hospital systems and doctor’s offices are driving prices upward. Some health-care economists argue that the secrecy is a factor in why the U.S. spends more per resident on health care than any other developed nation.

The administration’s vision is to arm patients with information needed to make health-care decisions much like shopping for other consumer services. Rates potentially could be posted on public websites, where consumers would check the negotiated price of a service before they pick a provider.

The White House push on price disclosure comes as President Trump seeks to close the gap with Democrats, who hold an advantage on health care in public polling.

“You’ll see some results that are incredible in terms of costs coming down,” Mr. Trump said Friday, adding, “We’re taking on the insurance companies and the special interests.”

Mr. Trump has stated that under his health-care plan, Americans will get better care at a lower cost than they currently pay. About three in 10 adults are very or somewhat confident that the president will deliver on his promise, while 62% say they aren’t too confident or not at all confident, according to an October poll by the Kaiser Family Foundation.

The White House is prepared to defend the rule and the proposal covering insurers from lawsuits, a senior administration official said. Officials said authority for the requirements stems from the Public Health Service Act.

“You’ll be able to negotiate all over the place,” Mr. Trump said in an October speech in Florida. “And you’ll be able to pick everything you want, from the hospital to the doctor. And it’s going to save you a tremendous amount of money.”

Write to Stephanie Armour at stephanie.armour@wsj.com

[Crafty_Dog]

https://www.wsj.com/articles/hospitals-turn-to-courts-as-lobbying-fails-to-block-price-transparency-proposal-11575551412?fbclid=IwAR2ghXAhPq161SFzi92lozlq1jdaSR6XZt4b1dUMYOUdTBVvQ7uMIxGF9kk

[Crafty_Dog]

https://www.facebook.com/SurgeryCenterOK/?hc_location=ufi

[DougMacG]

https://www.thetimes.co.uk/article/cancer-patient-delays-worst-on-record-hospital-shortages-5wntk7qbr

“Cancer patients face record wait.”

Cancer patients are being forced to endure the worst waiting times since records began, official figures reveal.
***
In total, 168,390 patients were not seen or treated within the specified times. The figure is up 24% on the same period in 2018-19. Staff shortages, lack of equipment and beds filled by patients needing social care were to blame.
***
In September, 76.9% of patients with suspected cancer began treatment within two months of an urgent referral from a GP.

“Urgent” isn’t what it once was. Delays in obtaining treatment often lead to poor outcomes:

Last year, for the first time, the NHS carried out more than 2m checks. It says cancer survival is at an all-time high, yet Britain is near the bottom of international league tables for cancer survival and is lagging years behind some countries for some types of the disease.
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I wondered if these problems are limited to the UK.  Switching to Canada:

https://nationalpost.com/news/canada/canada-ranks-low-in-international-comparison-of-patient-wait-times-report
Canada’s health-care wait times get failing grade in survey of 11 industrialized countries

https://www.ctoam.com/precision-oncology/why-we-exist/standard-treatment/treatment/wait-times-in-canada/
Wait Times for Cancer Treatment in Canada
Long wait times are part of the problem, with Canada having the "the highest proportion of patients with long delays to see specialists." (56% of patients wait more than four weeks; the international average is 36%.) Needing to wait this long for diagnosis and treatment results in many cancer patients not getting the treatment they need in time.

[DougMacG]

The low point for support for private health care on the Gallup time line happens to be the day Democrats took the House.



54% prefer private system; 42% support government-run system
Two-thirds of Democrats favor a government-run system

Independents have been closely divided in recent years, but in 2019 tilt more toward a private (50%) than a government-run (45%) system.

https://news.gallup.com/poll/268985/americans-favor-private-healthcare-system.aspx
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Too bad we don't have a private health care system for people to evaluate.