Insurance

October 15, 2019

In U.S. health care, experts assail $1 trillion-plus in waste, fraud and abuse

Politicians almost by reflex decry the skyrocketing cost of U.S. health care by blaming much of it on waste, fraud, abuse. They, alas, really may be on to something, newly published research shows.

Health care experts, including a medical leader of health insurer Humana, “combed through 54 studies and reports published since 2012 that estimated the waste or savings from changes in practice and policy,” leading them to some jaw-dropping calculations about how well spent is the $3.5 trillion or so that Americans drop on health care, the New York Times reported.

Answer: Really badly. The researchers, in their published work, estimated that 20%-25% of American health care spending is wasteful. That turns into giant sums, fast, as the newspaper reported, including:

October 3, 2019

Health insurance? It’s now about the price of a new car each year.

by Patrick A. Malone

Millions of Americans may sigh at Bertha, Barney, or Betty, or whatever they’ve nicknamed the beat-up family vehicle parked out front: “Wouldn’t it be great, if only we could afford a nicer, newer model?”

A big obstacle to that wish, however, may be the increasingly costly and unaffordable health insurance they get at their workplace. New research finds that the annual premium for family coverage — forked over mostly by companies but also by workers — now averages $20,576, according to an annual survey by the nonprofit, independent Kaiser Family Foundation.

Drew Altman, chief executive of the group, commented to the Wall Street Journal about the spiking burden of workplace coverage: “It’s a milestone. It’s the cost of buying an economy car, just buying it every year.”

September 29, 2019

Is Sanders’ plan to erase $81 billion in U.S. medical debt really all that crazy?

by Patrick A. Malone

Critics have attacked Sen. Bernie Sanders for his proposal to wipe out $81 billion in medical debt, including by changing rules around debt collection and bankruptcy. He also called for “replacing the giant credit reporting agencies with a ‘public credit registry’ that would ignore medical debt when calculating credit scores,” reported the New York Times.

Well, there he goes again, with interesting but hard to execute ideas, critics replied to Sanders’ medical debt idea, dissecting it to pieces.

But dig into some of the news articles and important realities flare up. Even his critics concede that medical debt has become a nightmare for too many Americans, contributing in unacceptable fashion to family stress and anxiety and, more importantly, adding to the nightmare of medical bankruptcy.

September 26, 2019

While it’s still warm and sunny, saunter in for that annual flu shot

by Patrick A. Malone

The weather may be sunny and temperate, the seasonal foliage a slowly changing delight to behold. But the savvy are prepping for sterner days ahead. It’s that time of year when doctors and public health officials urge us all to get that annual flu shot.

It’s never easy to forecast the severity with which influenza will sweep the country. But early indications — including a child’s death already attributed to the illness — suggest this may be a bad year for the bug.

Don’t downplay the harms of this all-too-common sickness: The federal Centers for Disease Control and Prevention estimates that there were as many as 43 million flu illnesses in this nation in the 2018-19 season, with more than 20 million cases serious enough to cause patients to seek medical care. The CDC says there were as many as 647,000 hospitalizations and up to 61,200 flu-related deaths. That toll included more than 100 children killed by flu.

September 18, 2019

There hospitals go again: UVA Health backpedals on draconian debt collection

by Patrick A. Malone

Is a public pillorying the only way to stop big hospitals from pursuing patients for medical debt with the zeal of demons from the underworld?

The University of Virginia Health System — an enterprise that racked up an $87 million operating profit on revenue of $1.7 billion in the fiscal year ending in June and that holds stocks, bonds and other investments worth about $1 billion — has become the latest institution to get a journalistic blaming and shaming for extreme debt collection practices that would make proud Inspector Javert in Les Miserables.

The independent, nonpartisan Kaiser Health News Service and the Washington Post deserve credit for their investigation into UVA avariciousness. As KHN reported of the state operation:

September 17, 2019

With GOP still tearing at ACA, uninsured rate rises for first time in decade

by Patrick A. Malone

The Grand Old Party may have just won the dictionary definition of a Pyrrhic Victory. That’s because Republicans’ decade-long assault on the Affordable Care Act his finally showing predictable results, with the share of Americans lacking health insurance increasing for the first time in 10 years.

The rate and number of people without health insurance increased from 7.9%, or 25.6 million, in 2017 to 8.5%, or 27.5 million, in 2018, officials reported.

The nation’s children got a kick in the face, too, with almost half a million more youngsters uninsured in 2018 versus 2017 — a decline attributable mostly to a reduction in the number of kids covered by safety net programs like Medicaid and the Children’s Health Insurance Program aka CHIP.

August 30, 2019

When young adults outgrow their pediatricians, tough life lessons may follow

by Patrick A. Malone

Moms and dads, please don’t gawk at the college-aged and older men and women parked in the pastel-colored, animal-themed pediatrician’s waiting room. Sure, they stick out among the runny-nosed, bawling babies and wiggly little children. But these older patients are part of a reported trend that says a lot about contemporary health care and the current difficulties of growing up.

As Caren Chesler reported in the Washington Post, a popular and important aspect of the Affordable Care Act allows parents to keep their sons and daughters on their health insurance plans up to age 26. That has proved a boon for those in the Millennial and Generation Z age groups, providing parent-supported health coverage to more than 2 million young adults between 2010 and 2014 alone.

But along with health insurance from the ‘rents, many young adults also have kept their medical care givers, chiefly their beloved pediatricians. These specialists in some cases have treated them almost from birth. They know well their patients and their medical conditions. This can be important, Chesler reported:

August 28, 2019

U.S. task force refines guidelines for women’s genetic cancer screening

by Patrick A. Malone

Many more women would benefit if their doctors took time to put them through a relatively easy screening using readily available questionnaires to determine if they might need further specialist assessment and a medical test for a genetic mutation linked to breast and other forms of cancer.

Women, however, should not routinely be subjected to the assessment, counseling, and testing for the BRCA 1 and BRCA 2 mutation, the influential U.S. Preventive Services Task Force has recommended, based on its blue-chip review of medical evidence. The task force gave the broad, routine approach its D grade, as in it should not be done.

The panel gave the careful and appropriate BRCA screenings its “B” grade, meaning they have moderate to significant benefits. The screening by primary care doctors is best suited for women with “a personal or family history of breast, ovarian, tubal, or peritoneal cancer or who have an ancestry associated with breast cancer susceptibility 1 and 2 (BRCA1/2) gene mutations.”

August 26, 2019

Americans spend billions on illicit and recreational drugs. Their toll is rising.

by Patrick A. Malone

All drugs carry costs, risks, and harms as well as benefits. Illegal ones too. Americans can’t escape the toll of harm as they use and abuse recreational and illicit substances, recent news reports show.

With the long Labor Day weekend upcoming — the traditional summer’s end, with gatherings of friends and families for outdoor barbecues, relaxing, fun, and potentially drinking and use of marijuana or more — it may be worth taking note of some indicators of the serious problems associated with substance abuse:

The nonprofit, independent RAND Corp. reported that its studies suggest that American drug users spent an estimated $150 billion on cocaine, heroin, marijuana, and methamphetamine in 2016 alone. The marijuana market is now roughly the size of the cocaine and methamphetamine markets combined, and the size of the retail heroin market is now closer to the size of the marijuana market than it is to the other drugs. Further, after plunging from 2006 to 2010, cocaine consumption’s decline slowed by 2015. Results suggest there were 2.4 million individuals who used cocaine on four or more days in the past month in 2015 and 2016. Results also suggest that consumption grew in 2016 among a stable number of users as price per pure gram declined. And heroin consumption increased 10% per year between 2010 and 2016. The introduction of fentanyl into heroin markets has increased the risk of using heroin. From 2010 to 2016, the number of individuals who used marijuana in the past month increased nearly 30%, from 25 million to 32 million. RAND experts estimate a 24% increase in marijuana spending over the same period, from $42 billion to $52 billion.

August 13, 2019

Would workers really be sad if health insurers didn’t grab a third of their pay?

by Patrick A. Malone

With the 2020 presidential campaign obsessing early about health insurance rather than costly health care overall, voters may wish to reframe their thinking about coverage and candidates’ views on making it affordable. Their chief query may need to be this: Just how much of the vig should the bagman take?

That may be a blunt a way to put it, but is the vernacular of the criminal “protection” racket all that out of place here? Michael Hiltzik, a financial columnist for the Los Angeles Times, makes pretty much the same argument, that the bagman’s share ought to be zero. Why not get rid of health insurers, he asks in a bit of evidence-based hyperbole? He finds the companies don’t fulfill much of a public mission, save, as a former insurance executive describes it, to make themselves money and to persuade all of us that they are essential. Indeed, as Hiltzik sees it, insurers are not just a rip-off but a failure in their own terms:

“Let’s start by examining what the insurers say are their positive contributions to healthcare. They claim to promote ‘consumer choice,’ simplify ‘the health care experience for individuals and families,’ address ‘the burden of chronic disease,’ and harness ‘data and technology to drive quality, efficiency, and consumer satisfaction.’ (These claims all come from the website of the industry’s lobbying organization, America’s Health Insurance Plans (AHIP). They’ve achieved none of these goals. The increasingly prevalent mode of health coverage in the group and individual markets is the narrow network, which shrinks the roster of doctors and hospitals available to enrollees without heavy surcharges. The hoops that customers and providers often must jump through to get claims paid impose costly complexity on the system, not simplicity. Programs to manage chronic diseases remain rare, and the real threat to patients with those conditions was lack of access to insurance (until the Affordable Care Act made such exclusion illegal). Private insurers don’t do nearly as well as Medicare in holding down costs, in part because the more they pay hospitals and doctors, the more they can charge in premiums and the more money flows to their bottom lines. They haven’t shown notable skill in managing chronic diseases or bringing pro-consumer innovations to the table.”