Health Care Reform

June 24, 2019

With 2020 race kicking into next gear, voters have lots to ponder on health care

Starting this week in Miami, 20 Democrats over the course of two nights will try to make the case that they deserve to be elected President. Now what will they and Republicans have to say about health care, which voters have declared a troubling issue that’s on the top of their minds?

In recent weeks, the current administration and members of the GOP could not have made clearer that Medicaid, Medicare, and, of course, the Affordable Care Act will be major matters to tussle over, still. Is health care a fundamental right or a privilege? Should the government assist the poor, working poor, and middle class with more affordable health care? Plenty of recent developments with federal social safety net programs will give politicians much to talk with voters about, including:

In Arkansas, a GOP-embraced notion — that the elderly, disabled, chronically ill, and children, as well as others who get health care help through the federal Medicaid program also should work for their benefits or prove they cannot work — has flopped, as opponents warned it would. Instead, Harvard researchers found that Draconian measures requiring Medicaid recipients to repeatedly prove they could not work, were seeking employment, or had some kind of jobs “caused thousands of poor adults to lose coverage without any evidence the target population gained jobs,” the Kaiser Health News service reported. KHN’s article said, “the Harvard study is the first to provide evidence that the [Medicaid policy] change left [program participants] uninsured and did not promote employment. The results, based on a telephone survey of about 3,000 low-income adults in Arkansas, concluded that the law befuddled enrollees and that its mandatory reporting requirements led many to unnecessarily lose coverage.”

June 11, 2019

Faith-based charity as the answer to crushing medical debt? Only in America.

by Patrick A. Malone

Praise be: Churches nationwide are leaping in with their congregations’ blessing and financial support, putting up small sums to buy up and wipe out one of the huge shames of the American health care system: patients’ medical debt.

The faithful work with RIP Medical Debt, a nonprofit organization based in Rye, N.Y., that provides the know-how to many kinds of donors to help eliminate bills that can crush patients and their loved ones for a lifetime, the Kaiser Health News service reported. Roxie Hammill wrote how this all works in modern medicine:

May 16, 2019

Hospitals rip employer health plans with prices up to 3 times what Uncle Sam pays

by Patrick A. Malone

Big businesses, which beat on their employees to be more cost-conscious, efficient, and productive, may need to take a page out of their own books if they hope to better control the soaring health care costs that they’re also shoving off onto their workers.

That’s a key takeaway from new research by the independent, nonprofit RAND Corporation into prices paid in 25 states to 70 hospital systems by job-provided health insurers in 2017. They provide coverage for most Americans, more than 180 million of us, and RAND found that private employer-sponsored health plans paid hospitals on average twice or even three times as much as Uncle Sam did through the Medicare program for the same services at the same hospitals.

Hospitals bellyache about tight-fisted Medicare prices that Uncle Sam can negotiate due to big dollars and huge number of patients covered under its senior health care plan. Although hospitals call the government-negotiated prices too low and an unfair benchmark, they provide realistic insights into hospitals’ bottom-line charges in what is one of the biggest areas of Americans’ health care costs. As RAND researcher Christopher Whaley told Modern Healthcare, an industry-covering news organization:

May 10, 2019

Modern medicine may be great at making money but not at making sense

by Patrick A. Malone

Spending’s askew when billions go for unproven surgical robots while lack of affordable care leads thousands of poor, black, and brown patients to need diabetic amputations

If U.S. health care leaders look ahead to 2020 and wonder why their sector of the economy will be one of the key concerns of presidential candidates and voters, they can only blame themselves for allowing the public to conclude that the industry’s big money and big profit drives have gone haywire.

How unbalanced have the nation’s health care priorities become that, on the one hand, surgeons and hospitals keep pushing to spend billions of dollars more for robotic surgeries that doctors themselves are doubting, while, on the other hand, researchers blame economic and racial disparities for playing a big role in requiring tens of thousands of patients — especially those who are black and brown and poor — to undergo diabetic amputations?

April 17, 2019

Cost of medical billing soars to half a trillion dollars—and half may be wasted

by Patrick A. Malone

When patients battle with the desperate extremes of a disease like a fast-spreading cancer, it isn’t just the radiation and chemo therapies that sap their spirits, there’s a demoralizing runner-up concern: The constant battling with doctors, hospitals, and insurers over medical bills.

Medical billing and insurance-related costs are so over the top that they pile up a half-trillion-dollars a year in burdensome administrative costs — half of which is excessive and wasteful, according to new research from the Center for American Progress, a left-leaning think tank.

The center reviewed past studies of administrative costs in U.S. health care, seeking to address criticisms of their methods and conclusions. Still, the new findings raise points that may stagger patients, policy makers, and politicians, say Emily Gee, a health economist for the group, and Topher Spiro, its vice president for Health Policy and a senior economic fellow.

April 7, 2019

Politicians disconnect from good sense, even as U.S. health care worries soar

by Patrick A. Malone

When it comes to something as crucial as health care, let’s keep it simple: Americans deserve better than this …

Can President Trump keep up his barrage of counter-factual assertions and political reverses on federal help for those needing health insurance, a key part of the Affordable Care Act? After resurrecting in federal courts the decade-long debacle of Republican efforts to kill Obamacare—including its protections for preexisting conditions—Trump flipped yet again. He heard an earful from party leaders that they have no way to cover tens of millions who would lose their health insurance if the ACA gets tossed out by courts, and he apparently awoke to the reality that the GOP can’t eliminate the law when Democrats control the House. So, the president then insisted that the GOP, after failing to do so for years, would present a better alternative and enact it, repealing Obamacare, too—at some time after the 2020 elections. If Republicans win back the House, keep control of the Senate, and he is reelected.
Even as the president asserted the GOP’s superiority in health care policy, the Los Angeles Times and the Philadelphia Inquire reported that a key element of Trumpcare is bringing back consumer nightmares. Patients initially might like the short-term health insurance plans the administration has pushed as an ACA alternative. Officials have relaxed rules on them so they can last longer than the few months permitted under Obamacare. The plans may carry lower monthly premiums. But they come with skimpy benefits. Which consumers are rediscovering. They’re getting sick and hoping to rely on short-term policies, only to find they owe doctors and hospitals thousands of dollars—but their insurance won’t help them with a penny.

April 4, 2019

As GOP keeps slashing at health coverage, big strains of caregiving ignored

by Patrick A. Malone

Americans have real reason to fear a health care catastrophe: If loved ones suffer major injury or illness, who will feed, bathe, and care for them 24/7 after they get out of the hospital and recuperate at home? Who will take time off from work to set up and take them to unending and long medical appointments? Who will wait for and get all the pills and devices they need?

The nation has been locked in a decade-long battle over health insurance that helps cover medical costs, but caregiving, a crucial part of the social safety net, gets short shrift, writes Aaron E. Carroll, a professor of pediatrics and health research and policy expert at Indiana University School of Medicine. As Carroll noted in a timely and personal column for the New York Times “Upshot” feature:

Americans spend so much time debating so many aspects of health care, including insurance and access. Almost none of that covers the actual impossibility and hardship faced by the many millions of friends and family members who are caregivers. It’s hugely disrupting and expensive. There’s no system for it. It’s a gaping hole.

March 25, 2019

Electronic records mess threatens patient safety, investigation finds

by Patrick A. Malone

Tempting though it may be to dismiss doctors’ howls about electronic health records—maybe they’re Luddites or they’re just another group of high-paid workers beefing about their job tools—the persistent and significant nightmare of the complicated computer systems has been this: Do they harm patient care?

The answer now may be: Yes, billions of taxpayer and private dollars spent on EHRs may be reducing patient safety.

That’s the finding of the independent, nonpartisan Kaiser Health News Service, based on its extensive investigation in partnership with Fortune Magazine. The two media operations reported that:

February 27, 2019

Brokers pocket big bonuses for boosting cost of workplace health insurance

by Patrick A. Malone

As tens of millions of Americans struggle with workplace medical insurance that provides them with little benefit when they most need it, consumers may wonder just how naïve their employers may be in overlooking industry SPIFFs, SPIVs, and other little-discussed payments that jack up costs and may reduce benefits.

Before any confusion arises, don’t think about health insurance in high-minded terms, and, instead, as just another business transaction — maybe what occurs at the cheesy used car dealership in the neighborhood (ala actor Danny DeVito in “Matilda,” as shown above). There, customers have gotten savvy about bonuses (Sales Promotion Incentive Funds or Sales Promotion Incentives) ladled on salesmen to get them to move vehicles out of showrooms, asap.

Pro Publica, a Pulitzer Prize-winning investigative site, deserves credit for digging in to the medical insurance business to show how similar incentive programs proliferate in brokerages that purportedly help companies of all sizes figure how to cover their employees’ health needs.

February 19, 2019

Americans rely on health coverage from work. It’s not getting the job done.

by Patrick A. Malone

Republicans got their heads handed to them in the midterms because they bungled a decade of efforts to eliminate public options on health insurance, the House minority leader has conceded. But he and other lawmakers, as well as corporate bosses, may face greater political fallout for failing to deal with a bigger health coverage nightmare for Americans: workplace insurance plans.

More than half of Americans 65 or younger — 150 million-plus — get employer health insurance, while just a quarter of us buy plans on individual markets or get covered by Medicaid, reported the nonpartisan, respected Commonwealth Fund.

Republicans, in control of the House and Senate and now the White House, have ripped at the Affordable Care Act since its passage — although Obamacare has expanded and improved options for those uncovered on the job, including protections for preexisting conditions. Lawmakers in the meantime largely have left alone employer plans.