Costs are simply too high. The medical industrial complex is just too expensive. Nothing can happen until those costs come down - hospital administrators, CEOs, CFOs, Nurses, Doctors, PAs, medical device manufacturers, pharma, pharma sales reps - everyone. Do medical device sales reps in the UK pull in $250-500K a year? No. Do doctors in Italy make $200-700K a year? No. Do hospital CEOs in Belgium make $750K a year? No.
16
Nah, Price, like most Republican nasties, is a graduate of the Marie Antoinette School of Public Policy where the motto and the policy intertwine as in "let them eat cake", which, as Dickens wrote, translates into "if they are like to die let them get about doing it and decrease the surplus population."
That's ole Doc Self-Dealin Price for ya, a real killer that guy.
That's ole Doc Self-Dealin Price for ya, a real killer that guy.
16
Bringing in Price, is like bringing in a drug cartel to fix our addiction problem.
The man is the heart and soul of the previous de facto criminal (pre ACA) republican plan of don't get sick, be rich and/or don't have a bad life event and put the interest of billionaire HMO and big Phrama execs. over the sick.
This time is difference though. 20 milllion+ people have been insured under ACA and Price knows if he goes back to his previous de facto criminal plan, all hell will break loose.
Bizarrely enough, most Republican loved Medicare which is a single payer system like that in Canada for people over age 65.
These same republicans say to Price, keep your hands off my medicare but get rid of the devil incarnate ACA which goes in the direction of medicare for people under age 65.
Never underestimate the power for people to be their own worst enemy.
The man is the heart and soul of the previous de facto criminal (pre ACA) republican plan of don't get sick, be rich and/or don't have a bad life event and put the interest of billionaire HMO and big Phrama execs. over the sick.
This time is difference though. 20 milllion+ people have been insured under ACA and Price knows if he goes back to his previous de facto criminal plan, all hell will break loose.
Bizarrely enough, most Republican loved Medicare which is a single payer system like that in Canada for people over age 65.
These same republicans say to Price, keep your hands off my medicare but get rid of the devil incarnate ACA which goes in the direction of medicare for people under age 65.
Never underestimate the power for people to be their own worst enemy.
23
The number one thing that has to be done is cut overall costs. As long as actual medical care eats up 20% of the GDP, no scheme of insurance or payment will ever work. We are spending about $10,000 a year on each person for medical care, which means a family of four is $40,000 a year. They can't afford it, they can pay enough tax for the government to be able to afford it, and there is no 'someone else' to tax. The only thing to do is cut costs.
21
Numerous well designed studies from top institutes of health care have shown that expansion of Medicaid and expansion of markets to low income people under ACA has been very cost effective in terms of $$$ saved and improved quality of care and health outcomes. This is no more true than in the few red states that adopted Medicaid expansion.
Why the GOP would want to unravel the system when it is just showing net worth defies logic. They will do so at their peril. It's time for medical professionals to speak up and join the resistance. Follow the lead of scientists and educators.
Why the GOP would want to unravel the system when it is just showing net worth defies logic. They will do so at their peril. It's time for medical professionals to speak up and join the resistance. Follow the lead of scientists and educators.
20
They will--truth is the party of so-called family values, the GOP, is struggling to overcome their distaste for actually providing programs that enhance family life. This is the real truth underlying the difficulty the GOP has in discussing health care. They will, in the end, tell us what we really want is more choices--even if those choices are unaffordable and the uninsured rate once again rises.
11
While I certainly support the idea of a single-payer government run system, it will not happen in the near term 1) because it is not popular with the GOP and a significant % of the citizens; 2) because, unlike other countries when they began such a system, we have a huge insurance industry (free-market companies some privately owned with thousands of employees) which is not easily dismantled under our capitalist system.
That said, an individual mandate is a must. EVERYBODY needs insurance. Insurance is the 'just in case' in life. Just in case we have a car wreck, house fire, theft, or are diagnosed with cancer (which happens even to seemingly healthy 20 year olds). We should let folks out of the mandate (no 'pay a little fine to the IRS') IF and only if there is a waver saying that hospitals do NOT have to offer them "charity care" if they show up at the ER. Too many folks blithely believe they can skip paying their fair share because the hospital "has to" take care of them, if they get sick or hurt. Those who are truly in financial difficulty should get subsidies to help buy a plan or Medicaid for the poor...
Insurance only works when all participate. Although a gov't run system is often referred to as "free" health care for all. It is not. Even then all pay in - only through much higher taxes rather than insurance premiums.
That said, an individual mandate is a must. EVERYBODY needs insurance. Insurance is the 'just in case' in life. Just in case we have a car wreck, house fire, theft, or are diagnosed with cancer (which happens even to seemingly healthy 20 year olds). We should let folks out of the mandate (no 'pay a little fine to the IRS') IF and only if there is a waver saying that hospitals do NOT have to offer them "charity care" if they show up at the ER. Too many folks blithely believe they can skip paying their fair share because the hospital "has to" take care of them, if they get sick or hurt. Those who are truly in financial difficulty should get subsidies to help buy a plan or Medicaid for the poor...
Insurance only works when all participate. Although a gov't run system is often referred to as "free" health care for all. It is not. Even then all pay in - only through much higher taxes rather than insurance premiums.
21
The problem is how high the taxes required would be. Let's say your family makes $100K a year, and currently pays $10000 in Federal income tax, $7500 in FICA, $5000 in state income tax, and $5000 in property tax. Your total direct tax is $27,500. Your employer is also pay $7500 in FICA on your behalf, which is really part of your salary.
Now let's say this family of 3 has to pay its 'fair share' of medical costs. There is currently $2 trillion in medical costs not paid by the government, and about $8 trillion total payroll. So they would have to pay an additional $25,000 in tax just to cover what they use, without subsidizing any poor people. Of course, you could argue that they don't really use $25K worth of medical services a year, and therefore they are subsidizing someone. But using my flat tax model, we'd still have to tax a poor family making $20K a year an additional $5000, so it is really the seriously ill they are subsidizing, not the poor. You might argue that someone in this $100K family might get cancer and run up $10 million in bills, so what they are paying for really is there own care.
But in any case, you can see why single-payer is not on the horizon. The taxes required would be so large no one could pay them, just like they can pay their current insurance premiums and deductibles. The whole system is unaffordable no matter how you finance it.
Now let's say this family of 3 has to pay its 'fair share' of medical costs. There is currently $2 trillion in medical costs not paid by the government, and about $8 trillion total payroll. So they would have to pay an additional $25,000 in tax just to cover what they use, without subsidizing any poor people. Of course, you could argue that they don't really use $25K worth of medical services a year, and therefore they are subsidizing someone. But using my flat tax model, we'd still have to tax a poor family making $20K a year an additional $5000, so it is really the seriously ill they are subsidizing, not the poor. You might argue that someone in this $100K family might get cancer and run up $10 million in bills, so what they are paying for really is there own care.
But in any case, you can see why single-payer is not on the horizon. The taxes required would be so large no one could pay them, just like they can pay their current insurance premiums and deductibles. The whole system is unaffordable no matter how you finance it.
5
Every other industrialized country provides single-payer and uses the gov. to bargain medical costs. We blindly ignore these programs because we wish to make health care a personal expense--despite its drag in our economy throughout the system. But then, the GOP, the party of so-called family values, really doesn't care about families--except for families that are also donors.
21
Health Insurance is an altogether bad idea. It effectively hires a middle man to negotiate with providers to keep prices lower and earn a profit for the service. In practice however, it makes money off suffering and death and posts considerable profits to shareholders. It is a ghoulish industry that makes money by gaming the contract and denying people needed care. It also fails to keep overall medical costs lower, because it is in turn gamed by participating medical providers to pay some providers outrageous demands.
In effect insurance just keeps a small group healthier and a lot of medical practitioners much wealthier.
Insurance has it's place as a supplemental coverage and is used as such in many countries. However general basic care is a right all citizens should be able to rely upon. It is a human right.
In effect insurance just keeps a small group healthier and a lot of medical practitioners much wealthier.
Insurance has it's place as a supplemental coverage and is used as such in many countries. However general basic care is a right all citizens should be able to rely upon. It is a human right.
34
Everybody wants lower cost, better quality and total access. Pick any two. Can't have all 3. The irony of attacking insurance is that's the deep pocket that made specialists like Price rich. Regular folks can't pay their prices.
7
stated another way, you cannot have universal access, cost containment and no rationing. since health care has no end to its depth and breadth (show me a healthy normal person and i will show you someone who has not had enough tests done or diagnoses made) something has to be done to control costs and that something is rationing. in america rationing has been done by cost of insurance/care and denial of coverage for pre-existing conditions (to prevent gaming the system-the original being pregnancy).therefore the discussion should be how to best ration care. No coverage for off label treatment, unproven therapies, elective intervention, costly end of life care, etc. that's the 500 lb. gorilla.
11
Please, NYT, stop referring to "healthy people" in describing insurance customers. They are "currently healthy people" and should buy insurance precisely because there is no guarantee they will stay that way.
41
Affordable Care Act is tax friendly to small business. Distorted, propadandaded, faked news by GOP and DJT as "disaster".
5
I had Obamacare until I turned 65 last month. The ACA allowed me to purchase health insurance for $360/month after a subsidy. Yes, it was effectively a catastrophic plan because of the $6000 annual deductible. However, I got an annual physical and a colonoscopy without cost to me. Luckily I'm healthy and didn't need any other care. Interestingly, my premium was to go down to $240/month this year after subsidy. I support Medicare for all. If we just go ahead and cover everyone, no one will be forced to sign up and no one will be uninsured.
44
Not if the Repubs have their way and voucherize medicare.
11
Offer anyone who does not get employer-based health care insurance, irrespective of age, an option to purchase a Medicare-lite plan: This would be a high-deductible plan, but both the premiums and the deductibles would have means-based adjustments (e.g., premiums = 10 percent of annual income; deductibles cap at 5 percent of annual income). To pay for these, add an extra percent (or two) to the Medicare tax.
14
Cost reduction has to be first in any healthcare plan. Drugs from Canada, tort reform, standardize insurance or single payer to control prices. Sacred cows on right and left have to be beaten back. Funny, a nutcase like Trump may be better positioned to make a difference on this issue.
13
The narrow thinking of american people in regard to healthcare is amazing. This continued confusion between health care and health insurance is hard to understand for a person looking in on America.
Fact - america spends more per GDP on health care than any other country in the world. American does not provide access to health care to all people. How is this possible. Perhaps the middlemen ie insurers, hospitals,medical professionals who are milking the health care cow need to be weaned.
Simple solution, nationalise health care provide access to everyone. those that want more choice or better accommodation etc can pay for it out of the svaings made by not paying insurance.
For a smart country americans can sure be dumb.
Fact - america spends more per GDP on health care than any other country in the world. American does not provide access to health care to all people. How is this possible. Perhaps the middlemen ie insurers, hospitals,medical professionals who are milking the health care cow need to be weaned.
Simple solution, nationalise health care provide access to everyone. those that want more choice or better accommodation etc can pay for it out of the svaings made by not paying insurance.
For a smart country americans can sure be dumb.
39
The basic goal of the Ryan-McConnell Congress is to cut taxes for their corporate sponsors, and this Ryan-McConnell goal supersedes all others, and is the driving force behind repealing Obamacare. So the only real question facing Tom Price is whether he is going along with Ryan-McConnell or not. It's a simple choice, uncomplicated by the merits or demerits of Obamacare, which are irrelevant entirely (for him and for Ryan-McConnell).
17
And, unfortunately, Price has already indicated his bias is towards money, insider trading, and every party except the unfortunate citizen--yet another Trump appointee who wishes to destroy the agency he will head.
10
Whatever this charlatan Price does, it is apparent that he wants to make medical care more profitable for doctors, and let the hindmost take care of themselves.
People are not stupid. If they lose coverage, they will be very upset. Many of the worst off are people who love guns. Imagine some of them losing a child to a disease that they cannot pay to treat. What could possibly go wrong?
People are not stupid. If they lose coverage, they will be very upset. Many of the worst off are people who love guns. Imagine some of them losing a child to a disease that they cannot pay to treat. What could possibly go wrong?
19
It is not only the ten million who have been given subsidized Obamacare policies who will have a say in the wake--good or bad--of its repeal or modification. How many millions of small-business owners are there who must buy unsubsidized Obamacare policies--now bloated with coverages they do not want--without the price-moderating benefit of group rates, whose health insurance rates have gone up by 30% or 50% per year? The effect of the repeal or modification of Obamacare on this latter group will be important because they vote.
2
Dr. Price, I recommend trashing ACA/Obamacare so that those, who voted for trump who can't wait for Obamacare to be destroyed, will learn that it is the same as the Affordable Care Act.
Maybe loss of insurance will be enough to wake up trump supporters.
Maybe loss of insurance will be enough to wake up trump supporters.
22
Destructive health policy is coming with Tom Price as the new HHS Secretary. He & many Republicans strongly oppose Medicare, and we can expect that any GOP replacement plan for Obamacare will cost patients, families, and taxpayers more, and that we will all get less. This is all so foolish since a real solution is single-payer national health insurance.Republicans are blinded by ideology and apparently unaware of the failed policies already proven by the last 25-plus years’ experience, including those of the ACA, much of which are still baked into their supposed “better way.” They seem unaware of recent public polls favoring NHI, regardless of political party.
If Trump follows through on his Paul Ryan- Republican style ACA replacement programs, there will be huge benefits for the very rich. Respected economics correspondent of the Financial Times, Martin Wolf, writes that, “The tax proposals would shower huge benefits on already rich Americans such as Mr Trump,” while leaving others in the lurch, including, of course, his constituency. The immediate reaction of the busines world reveals that Big Insurance, Big Pharma, Wall Street, the military industry, energy industries and other such "wonderful" institutions expect a very bright future"
In a chilling 2009 Politico article, Tom Price, M.D., said "I can attest that nothing has had a greater negative effect on the delivery of health care than the federal government’s intrusion into medicine through Medicare".
If Trump follows through on his Paul Ryan- Republican style ACA replacement programs, there will be huge benefits for the very rich. Respected economics correspondent of the Financial Times, Martin Wolf, writes that, “The tax proposals would shower huge benefits on already rich Americans such as Mr Trump,” while leaving others in the lurch, including, of course, his constituency. The immediate reaction of the busines world reveals that Big Insurance, Big Pharma, Wall Street, the military industry, energy industries and other such "wonderful" institutions expect a very bright future"
In a chilling 2009 Politico article, Tom Price, M.D., said "I can attest that nothing has had a greater negative effect on the delivery of health care than the federal government’s intrusion into medicine through Medicare".
32
Republicans face the uncomfortable reality that while their core principals of free markets and less Gov't interference are applicable to most areas - or at least arguably so - in Healthcare they cannot point to a "free market" system that has been successful in the US or any other developed country. In fact fully Gov't run systems (UK & Canada) spend 60% less than we do and get better results, and patients poll happier (despite some exceptions that people point out - no system is perfect).
As to the mandate - EVERY other developed country insists that everyone is covered and pays in if they have an income. The US is the odd one out and it has cost us dearly in poor health and high insurance costs. If everyone had coverage and paid something in premiums would drop and overall health would improve.
Obamacare increased coverage and reduced cost growth rates and its critics blamed any problem in the h/care system on it when those problems (like high deductibles and narrow networks) would have likely been worse without the law.
Modifying and strengthening the ACA it is the only logical path.
As to the mandate - EVERY other developed country insists that everyone is covered and pays in if they have an income. The US is the odd one out and it has cost us dearly in poor health and high insurance costs. If everyone had coverage and paid something in premiums would drop and overall health would improve.
Obamacare increased coverage and reduced cost growth rates and its critics blamed any problem in the h/care system on it when those problems (like high deductibles and narrow networks) would have likely been worse without the law.
Modifying and strengthening the ACA it is the only logical path.
26
The "core principle" of a "free market" is malarkey. First the only "core principle" of the Ryan-McConnell Congress is lower taxes for the corporate elite. Second, the "free market" is a euphemism for the corporate controlled market.
For more detail, read Robert Reich.
For more detail, read Robert Reich.
29
Tom "Let Me Line My Own Pockets First" Price is a wolf in sheep's clothing. Wearing the mantle of the Medical Man, he is in fact a selfish, egotistical, right wing fanatic, a Libertarian who neither believes in good public health policy (vaccination programs) or the over arching concepts of insurance (the more people enrolled, the lower the price and the better the coverage). The organization he belongs to (AAPS) would dismantle all medical care in this country (Medicare, Medicaid, the VA, the ACA) not specifically private. Every American needs to watch this man like a hawk. He is an evil man in the guise of a friendly local doctor. Beware Beware Beware!
60
I've got to say that among all Trump's cabinet picks Trump scares me the most. And that's really saying something.
3
Dr. Price: while I understand that you come from a group of doctors for whom self enrichment is the goal (and you have personally acted upon this "ideal" several times), please comprehend the following:
Citizens will be rioting in the streets if you take away their health care (women's health care included).
Citizens will be rioting in the streets if you take away their health care (women's health care included).
57
Well, rioting in the streets will just mean some more people will need orthopedic surgery, no?
(This is just a joke I couldn't resist. I actually have no personal opinion about Dr. Price being greedy or not. I am more focused on how the policies put in place work out.)
(This is just a joke I couldn't resist. I actually have no personal opinion about Dr. Price being greedy or not. I am more focused on how the policies put in place work out.)
Dear President Trump and Republicans:
How about, at a minimum, extending Medicare to those over the age of 50? As I know you are aware, your corporate masters have decided that older, more costly employees are best discarded from the American workforce. Not only are they seen as too costly, but are overall less physically attractive and thus less likely to be reemployed. Certainly as a connoisseur of beautiful women, you can understand how tough it is for us older women.
Perhaps you can consult with your special advisor for regulatory affairs , Carl Icahn, on this matter. I believe he can confirm, that ridding corporations of their most experienced staff when they are least likely to be reemployed is definitely pervasive. Believe me, he is the best person to ask and will give you fantastic advice.
If you give this age group health insurance, you may also reap the reward of having many of them simply give up the search for employment. This will improve your unemployment numbers and give you something big league to brag about.
Thank you in advance for your consideration.
How about, at a minimum, extending Medicare to those over the age of 50? As I know you are aware, your corporate masters have decided that older, more costly employees are best discarded from the American workforce. Not only are they seen as too costly, but are overall less physically attractive and thus less likely to be reemployed. Certainly as a connoisseur of beautiful women, you can understand how tough it is for us older women.
Perhaps you can consult with your special advisor for regulatory affairs , Carl Icahn, on this matter. I believe he can confirm, that ridding corporations of their most experienced staff when they are least likely to be reemployed is definitely pervasive. Believe me, he is the best person to ask and will give you fantastic advice.
If you give this age group health insurance, you may also reap the reward of having many of them simply give up the search for employment. This will improve your unemployment numbers and give you something big league to brag about.
Thank you in advance for your consideration.
36
Definitely a good start. Trump might secure a positive legacy--assuming that he doesn't start WWIII--if he got Medicare for all enacted.
11
Sad, but true. Men over 50 have also been road kill on the job search highway for at least the past 20 years. Even the U.S. government replaces skilled workers with younger "interns" making $10 per hour and no benefits. Fat chance Price will try to extend Medicare to us "losers" over 50. After all, we are no use to corporate America and a growing burden to government programs such as Social Security. Killing us off early will free up revenues badly needed to give corporations and the ultra-wealthy big tax cuts.
13
Step #1. Rename the ACA ("Obamacare") Affordacare.
The political football that is Obamacare will become a two-legged dog known as Trumpcare if politicians don't find a way to rip it away from the pundit playground and put it back on a non-partisan track. It never should have been political fodder in the first place. People have suffered and died while our politicians played games. Yes, Congress has blood on its hands. No, you don't seem to mind.
Step #2. Quit, Mr. Price, and convince President Trump to replace you with a Secretary of Patient Advocacy who has no political nor industry ties.
We need someone in the cabinet who actually cares about living, breathing human beings above politics and budget hawking and gamesmanship. (Gauging from #45's other picks, this is a foregone impossibility, but a girl can dream).
Step #3. Convince GOP leadership to show it actually cares about the welfare of the people who elected them (aka didn't buy their way) into office, rather than push "cut 'em off at the knees" block grants in place of Medicaid and trample women's reproductive rights.
The gaping loopholes surrounding the lack of transparency, arbitrary cost structures, improper claim denials, inflated deductibles/premiums/out of pocket costs, medical billing errors, overcharges/fraud and price gouging drug/device costs need to be cemented shut. We've had six long years of a do-nothing Congress. No more!
The political football that is Obamacare will become a two-legged dog known as Trumpcare if politicians don't find a way to rip it away from the pundit playground and put it back on a non-partisan track. It never should have been political fodder in the first place. People have suffered and died while our politicians played games. Yes, Congress has blood on its hands. No, you don't seem to mind.
Step #2. Quit, Mr. Price, and convince President Trump to replace you with a Secretary of Patient Advocacy who has no political nor industry ties.
We need someone in the cabinet who actually cares about living, breathing human beings above politics and budget hawking and gamesmanship. (Gauging from #45's other picks, this is a foregone impossibility, but a girl can dream).
Step #3. Convince GOP leadership to show it actually cares about the welfare of the people who elected them (aka didn't buy their way) into office, rather than push "cut 'em off at the knees" block grants in place of Medicaid and trample women's reproductive rights.
The gaping loopholes surrounding the lack of transparency, arbitrary cost structures, improper claim denials, inflated deductibles/premiums/out of pocket costs, medical billing errors, overcharges/fraud and price gouging drug/device costs need to be cemented shut. We've had six long years of a do-nothing Congress. No more!
36
How about this (and this goes for all the thumb-in-the-eye-of-the-left Trump appointees):
Go out to the country. Talk to the actual public. Call it a listening tour. Hold a series of town halls. In big venues. Yes, they'll be noisy. Want to build credibility with the country, which mostly voted the other way? You gotta do this.
At the same time, have televised meetings with physicians. No, not just device-marketing mostly- nonemergent medical specialties like sports medicine, non-emergent orthopedists and ophthalmologists doing mostly Lasix. Have internists, pediatrians, ER docs, OB, geriatrics. Not chosen by your administration. Young as well as established, urban and rurual. Listen to them!
You might find yourself having a hard look at what your replacement proposal does to people. You might find out things like, one of the reasons behind skyrocketing liability costs pre-ACA was families desperately trying to arrange funds for lifelong care, with capped health care plans and a weakening social safety net. You might learn of the young-invincible 24 year year old who didn't have the maturity to arrange insurance in the allotted two weeks at his workplace then got in a motorcycle accident. Or the one that DID get coverage in a mini med that covers the stuff he thought he might face, only to be diagnosed with a cardiac defect.
Listen and learn, Dr. Price. There's a lot out there other than pushing the devices that companies you've invested in market.
Go out to the country. Talk to the actual public. Call it a listening tour. Hold a series of town halls. In big venues. Yes, they'll be noisy. Want to build credibility with the country, which mostly voted the other way? You gotta do this.
At the same time, have televised meetings with physicians. No, not just device-marketing mostly- nonemergent medical specialties like sports medicine, non-emergent orthopedists and ophthalmologists doing mostly Lasix. Have internists, pediatrians, ER docs, OB, geriatrics. Not chosen by your administration. Young as well as established, urban and rurual. Listen to them!
You might find yourself having a hard look at what your replacement proposal does to people. You might find out things like, one of the reasons behind skyrocketing liability costs pre-ACA was families desperately trying to arrange funds for lifelong care, with capped health care plans and a weakening social safety net. You might learn of the young-invincible 24 year year old who didn't have the maturity to arrange insurance in the allotted two weeks at his workplace then got in a motorcycle accident. Or the one that DID get coverage in a mini med that covers the stuff he thought he might face, only to be diagnosed with a cardiac defect.
Listen and learn, Dr. Price. There's a lot out there other than pushing the devices that companies you've invested in market.
22
The solution is to allow alternative medicine to once again become part of mainstream health care. The existing structure in the United States has pushed alternative treatments out of the way to protect their financial support.
The existing structure doesn't know how to cure cancer, for example, and so the doctors rely on chemotherapy. Cancer is an issue that is out of control, and if the patient heals the issue, the cancer goes away. So, people turn their lives over to the doctors and push away alternatives that have the capacity to heal the patient.
I was a dental hygienist for 27 years and it was my job to take medical histories and then counsel patients on health issues. I made the connection between cancer and life issues, but doctors hate having their patients assume responsibility for their own health care. After all--doctors are credible. how many lives could have been saved over those 27 years if alternative treatments were given the same testing as those treatments supported by the existing structure?
The existing structure doesn't know how to cure cancer, for example, and so the doctors rely on chemotherapy. Cancer is an issue that is out of control, and if the patient heals the issue, the cancer goes away. So, people turn their lives over to the doctors and push away alternatives that have the capacity to heal the patient.
I was a dental hygienist for 27 years and it was my job to take medical histories and then counsel patients on health issues. I made the connection between cancer and life issues, but doctors hate having their patients assume responsibility for their own health care. After all--doctors are credible. how many lives could have been saved over those 27 years if alternative treatments were given the same testing as those treatments supported by the existing structure?
1
Karen, you are speaking of "cancer" as though it is ONE disease rather than the perfect storm of events that occurs when genetics, environment, and behavioral habits all align in one human, who is also a genetic snowflake. This is the reason "cancer" is not cured- it is a moving target. It is not because there are magical alternative therapies out there that doctors are hiding or ignoring. Cancer biology is far more complex than people realize. Most alternative medicine is not backed by credible science I am sorry to say, and it most definitely does not cure cancer (essential oils, cannabis oil, herbal supplements, etc). It does, however, make a nice profit for the snake oil salesmen who peddle it to desperate patients. There just is no magic bullet.
15
Here's a really radical idea: listen to what the patients and the doctors want. Patients are tired of being caught in the middle of the blame game. So are doctors. Make life easier for all of us and institute a universal access single payor health CARE system. It shouldn't be so painful to receive health care when one needs it where one needs it rather than when one can afford it. Other countries have done this. Why can't America?
Doctors might be much happier if they weren't constantly second guessed by the so-called health insurance companies. Patients might do better and go for health care when they need it instead of when they can afford it if they didn't have to worry that they couldn't pay the deductibles, co-pays, or find a doctor that's in the exceedingly narrow networks currently favored by the health insurance industry. Stop short staffing hospitals in terms of nurses. They need breaks and patients sometimes need some human contact. Weed out the doctors who have gone into medicine just to make money: most of them don't truly care about the patient. They care about the money.
And let's make it easier for patients to transfer their records to another doctor or have a specialist send a patient's records back to the primary care physician. Make all electronic health record systems able to communicate with each other. It would end the duplication in tests and other mistakes. If time is money a lot of it is being wasted with these clunky systems.
Doctors might be much happier if they weren't constantly second guessed by the so-called health insurance companies. Patients might do better and go for health care when they need it instead of when they can afford it if they didn't have to worry that they couldn't pay the deductibles, co-pays, or find a doctor that's in the exceedingly narrow networks currently favored by the health insurance industry. Stop short staffing hospitals in terms of nurses. They need breaks and patients sometimes need some human contact. Weed out the doctors who have gone into medicine just to make money: most of them don't truly care about the patient. They care about the money.
And let's make it easier for patients to transfer their records to another doctor or have a specialist send a patient's records back to the primary care physician. Make all electronic health record systems able to communicate with each other. It would end the duplication in tests and other mistakes. If time is money a lot of it is being wasted with these clunky systems.
32
" .. It shouldn't be so painful to receive health care when one needs it where one needs it rather than when one can afford it. Other countries have done this. Why can't America?"
Oh .. because their taxes are much higher? It is a proven fact that their systems are beginning to fail? They don't tolerate illegals and drug addicts, like the USA? They don't tolerate medical-malpractice lawyers?
Oh .. because their taxes are much higher? It is a proven fact that their systems are beginning to fail? They don't tolerate illegals and drug addicts, like the USA? They don't tolerate medical-malpractice lawyers?
1
Another "proven fact" that is neither proven nor a fact. Higher taxes in modern nations? Sure, they are higher. But that's because you don't consider that we spend almost 1/5 of our GDP on health care. That's just hidden taxation, and far higher per capita than the European nations.
15
I point out that Mr. Price's candidate plan that he was working on in Congress, the empowering patients first act of 2015 ( https://www.congress.gov/bill/114th-congress/house-bill/2300 ), has at it's method to attempt to avoid insurance pool death-sprials and the associated incredibly high insurance premiums, the "continuous prior coverage" method. That is, if you have maintained a certain amount of continuous prior major medical coverage prior to applying for new individual insurance, then an insurer can't charge you more, or deny coverage, based on pre-existing conditions (or exclude the conditions from coverage). (No mandates to carry coverage in that system.)
I actually kind of liked that method myself at one time. Bit. the method was tried in a few states, like NY, NJ, and MA (for a few years pre-RomneyCare). It may have worked in the first few years in NY and NJ (mid 90s), but eventually rising general medical costs caused massive death spirals. (Example: to me, in the low-cost-of-living city of Binghamton, NY, in 2009, the lowest cost policy available for ONE individual of any age went to $1100. a month. )
My argument, and my example, are thus the same as that of former health insurance industry head Karen Ignagni that you quote:
'Whenever a state has forced insurers to cover everyone without having a mandate, “there was a death spiral,” she said, in which the prices got so high no one could afford them and the market collapsed.'
I actually kind of liked that method myself at one time. Bit. the method was tried in a few states, like NY, NJ, and MA (for a few years pre-RomneyCare). It may have worked in the first few years in NY and NJ (mid 90s), but eventually rising general medical costs caused massive death spirals. (Example: to me, in the low-cost-of-living city of Binghamton, NY, in 2009, the lowest cost policy available for ONE individual of any age went to $1100. a month. )
My argument, and my example, are thus the same as that of former health insurance industry head Karen Ignagni that you quote:
'Whenever a state has forced insurers to cover everyone without having a mandate, “there was a death spiral,” she said, in which the prices got so high no one could afford them and the market collapsed.'
9
The whole "death spiral" narrative is overblown, by Speaker Ryan and numerous others: http://www.nejm.org/doi/full/10.1056/NEJMp1614545?query=TOC . That recent "New England Journal of Medicine" essay ("Success and Failure in the Insurance Exchanges") concludes:
"Taken together, our estimates demonstrate that the insurers participating in the exchange market in 2017 are systematically different from the firms that have exited it. Furthermore, the dimensions on which they differ, such as experience in pricing premiums and managing risk for low-income populations, may be those most likely to contribute to commercial success in a reformed nongroup market. ... But claims that the failure of certain insurers is evidence of unworkable policies seems misguided. The available data reveal patterns of market entry and exit that are consistent with natural competitive processes separating out firms that are best suited to adapt to a new market. We believe that efforts to reform or replace the ACA should therefore proceed with the knowledge that highly publicized market exits are a poor and probably inaccurate signal of a failing market."
"Taken together, our estimates demonstrate that the insurers participating in the exchange market in 2017 are systematically different from the firms that have exited it. Furthermore, the dimensions on which they differ, such as experience in pricing premiums and managing risk for low-income populations, may be those most likely to contribute to commercial success in a reformed nongroup market. ... But claims that the failure of certain insurers is evidence of unworkable policies seems misguided. The available data reveal patterns of market entry and exit that are consistent with natural competitive processes separating out firms that are best suited to adapt to a new market. We believe that efforts to reform or replace the ACA should therefore proceed with the knowledge that highly publicized market exits are a poor and probably inaccurate signal of a failing market."
2
Since I might be sounding like an insurance industry fan above, let me point out that I'm not, but the particular quote from Ms. Ignagni seems accurate to me.
(On the other hand, to show that we do have to watch out for the insurance industry and other vested interests, let me post a couple of old "Harry and Louise" ads from 1993 https://www.youtube.com/watch?v=buFi54TEL1E
(The context is that the Clinton administration was trying to get its universal health plan, Hillary in charge, enacted. The health insurance industry fooled the less-knowledgeable, more-manipulateable parts of the electorate with these ads, and that was largely responsible for the plan not getting passed.
You might note that the 2nd ad attacks "community rating". This is the component that we now call "not discriminating based on pre-existing conditions".)
(On the other hand, to show that we do have to watch out for the insurance industry and other vested interests, let me post a couple of old "Harry and Louise" ads from 1993 https://www.youtube.com/watch?v=buFi54TEL1E
(The context is that the Clinton administration was trying to get its universal health plan, Hillary in charge, enacted. The health insurance industry fooled the less-knowledgeable, more-manipulateable parts of the electorate with these ads, and that was largely responsible for the plan not getting passed.
You might note that the 2nd ad attacks "community rating". This is the component that we now call "not discriminating based on pre-existing conditions".)
3
JSK: Thanks for the link.
Actually, on "death spirals" when pre-existing-condition screening is not allowed, there is an important distinction: what other regulations are in place. (I.e., as the article, "The health law’s requirement that all Americans obtain health insurance or pay a penalty is very unpopular. But it’s also crucial to an interlocking set of policies devised to keep insurance affordable.")
I think you are asserting that in ObamaCare, WITH the other 2 interlocking pieces (mandates to carry coverage, and full or partial subsidies for lower incomes). the death spiral is overblown.
But I, and the Times article, and Ms. Ignagni, are asserting that w. no pre-ex.-cond.-discrim, WITHOUT the two interlocking pieces, there are death spirals. (That means, some healthy people decide not to carry relatively expensive insurance, they leave the pool, prices go up some, more healthy people leave, prices go up more, and pretty soon its mostly expensive sick people in the pool and prices are really high.)
WITHOUT the 2 interlocking pieces, that is what my Binghamton, NY experience indicated to me, and I think was indicated around the state generally. Also, in MA, which had no-pre-existing-condition screening if you had continuous prior coverage, like NY, just before RomneyCare, the individual coverage policies went from 100,000 people to 50,000--from the death sprial. Then, RomneyCare, with the mandate and subsidies. No spirals; coverage went up from 90% to 97%.
Actually, on "death spirals" when pre-existing-condition screening is not allowed, there is an important distinction: what other regulations are in place. (I.e., as the article, "The health law’s requirement that all Americans obtain health insurance or pay a penalty is very unpopular. But it’s also crucial to an interlocking set of policies devised to keep insurance affordable.")
I think you are asserting that in ObamaCare, WITH the other 2 interlocking pieces (mandates to carry coverage, and full or partial subsidies for lower incomes). the death spiral is overblown.
But I, and the Times article, and Ms. Ignagni, are asserting that w. no pre-ex.-cond.-discrim, WITHOUT the two interlocking pieces, there are death spirals. (That means, some healthy people decide not to carry relatively expensive insurance, they leave the pool, prices go up some, more healthy people leave, prices go up more, and pretty soon its mostly expensive sick people in the pool and prices are really high.)
WITHOUT the 2 interlocking pieces, that is what my Binghamton, NY experience indicated to me, and I think was indicated around the state generally. Also, in MA, which had no-pre-existing-condition screening if you had continuous prior coverage, like NY, just before RomneyCare, the individual coverage policies went from 100,000 people to 50,000--from the death sprial. Then, RomneyCare, with the mandate and subsidies. No spirals; coverage went up from 90% to 97%.
3
The ACA like Romney Care is basically a gift to the healthcare industry that forces the public to pay high prices while doing nothing to control them. We can't have universal access to health care while continuing letting the industry focus on finding ever more expensive drugs and treatments.
The insurance "mandate" has to go along with the practice of charging the uninsured twice as much as the insurance companies for the same treatment. Americans must be allowed to buy their drugs overseas or the drug companies should be charged "antidumping tariffs" on any drugs they sell in the US at prices above those they charge overseas equal to the difference in price. Insurers should be encouraged to find lower cost providers for non emergency treatments even if it means sending the patients overseas. This industry needs competition! Capitalism doesn't work without it.
The insurance "mandate" has to go along with the practice of charging the uninsured twice as much as the insurance companies for the same treatment. Americans must be allowed to buy their drugs overseas or the drug companies should be charged "antidumping tariffs" on any drugs they sell in the US at prices above those they charge overseas equal to the difference in price. Insurers should be encouraged to find lower cost providers for non emergency treatments even if it means sending the patients overseas. This industry needs competition! Capitalism doesn't work without it.
5
The mandate has to go? Do you realize that the US is the only developed country that does not require every citizen to be covered and pay in if they have an income. If everyone in the US payed in what they could premiums would drop and there would be no freeloaders and overall health would improve.
You also mention competition. The UK and Canada have zero competition and they spend 60% less than we do and their patients poll happier with their healthcare and their outcomes (cancer cure rates, life expectancy, infant mortality etc) are as good or better than ours.
Applying simple economics principals demonstrably does not work in healthcare.
You also mention competition. The UK and Canada have zero competition and they spend 60% less than we do and their patients poll happier with their healthcare and their outcomes (cancer cure rates, life expectancy, infant mortality etc) are as good or better than ours.
Applying simple economics principals demonstrably does not work in healthcare.
11
Why not extend the Congress Health Plan that benefit Tom Price and his fellow representants and senators to the American people?
53
Well, the president has a full M.D. staff on call, 24x7. Why can't we have that?
Answer: because there's not a bottomless pit of money.
Answer: because there's not a bottomless pit of money.
3
It's better than what most of us get, other than those fortunate enough to be covered by Medicare, but it's not that terrific:
http://www.insuranceqna.com/health-insurance/president-and-congress-heal...
http://www.insuranceqna.com/health-insurance/president-and-congress-heal...
1
Or you could live up to the Hippocratic Oath and begin the process of moving towards a Single Payer system by expanding Medicare, removing incentives for insurance companies to stay in the business of health and expanding the risk pool to include everyone. You have plenty of successful models to look at around the world. Do No Harm Dr. Price.
48
"Do no harm" would be a good oath of office... no matter what.
2
The Hippocratic Oath may not be the best choice as a model. There will always be some harm--the question is how much and to whom. And can the number of harms be decreased. The "worst case scenario" is blanket repeal. Amending/repairing the plan makes the most sense, no matter partisan promises and assertions often predicated on beliefs that have little to do with problems facing the evolution of our health care system.
As to shortcomings of various physicians' oaths: http://www.todayifoundout.com/index.php/2013/11/doctors-arent-bound-hipp... .
As to shortcomings of various physicians' oaths: http://www.todayifoundout.com/index.php/2013/11/doctors-arent-bound-hipp... .
Madam, please read the newspapers. Vermont and Colorado have rejected the "single-payer" theory as financially bankrupting. As many countries are now finding out, and ordering cutbacks.
Ignoring the reality of math will not make problems go away. Really. Not kidding.
Ignoring the reality of math will not make problems go away. Really. Not kidding.
2
A fix for Obamacare is easy: separate people with heavily subsidized health plans into a pool separate from people who pay for their own insurance.
That's the key difference between Romneycare (which had a separate - and subsidized - pool for people under 300% of poverty) and Obamacare (which insists that the pool is the same). Based on Medicaid numbers alone, people who qualify for Medicare are a lot costlier than people with private insurance plans, which is one reason why Obamacare premiums are higher now than that for comparable corporate plans - and why so many insurance companies court clients outside of exchanges.
That's the key difference between Romneycare (which had a separate - and subsidized - pool for people under 300% of poverty) and Obamacare (which insists that the pool is the same). Based on Medicaid numbers alone, people who qualify for Medicare are a lot costlier than people with private insurance plans, which is one reason why Obamacare premiums are higher now than that for comparable corporate plans - and why so many insurance companies court clients outside of exchanges.
1
High risk pools don't work. They separate the risk pools, forcing those who need the most care to be in a pool where they can hardly spread their risks with others who are also high needs. This relies on subsidies, which are always under political pressure and have been inadequate in the states where this has been tried. So they end up with caps and/or exclusions.
They work for auto insurance, as liability is effectively capped by state insurance requirements and the insured asset has a specific market value, above which there is no further reimbursement as the asset is considered "totaled".
At what value, do you propose a human being be totaled, for a high risk pool to work?
They work for auto insurance, as liability is effectively capped by state insurance requirements and the insured asset has a specific market value, above which there is no further reimbursement as the asset is considered "totaled".
At what value, do you propose a human being be totaled, for a high risk pool to work?
8
I'm not sure at all about separating the subsidized and unsubsidized pools. My tendency is to believe, in fact, that it has the exact opposite of the effect you intend.
Among people getting the subsidies (138% of FPL to 400% of FPL; 100% to 400% of FPL in the 19 states not extending Medicaid), and especially among people getting heavy subsidies covering most of the cost (say to 250% of FPL), there is a tendency for the insurance to be more affordable or almost free, so that I suspect even people not likely to incur medical bills pick it up.
Thus, I suspect lower adverse selection in the subsidized pools. (I admit there is a counter affect of lower income means lower total money to spend on insurance.) Anyway, hopefully some people have looked at the claims experience of the two groups you want to split, and know what the true answer is.
Now, I actually live in MA. Apparently, in MA under RomneyCare, and continuing under state regulation under ObamaCare, small groups and individuals are pooled together. I myself suspect that this, which is not done in general under ObamaCare, might help. (Small groups, being small businesses, have a mix of workers all of whom get the plan so there should be little adverse selection, and this larger group should balance out the adverse selection effect in the smaller individual group.)
I see you live in Canada, where you just don't have to worry about this sort of thing. Bless you for taking the time to try and help us out!
Among people getting the subsidies (138% of FPL to 400% of FPL; 100% to 400% of FPL in the 19 states not extending Medicaid), and especially among people getting heavy subsidies covering most of the cost (say to 250% of FPL), there is a tendency for the insurance to be more affordable or almost free, so that I suspect even people not likely to incur medical bills pick it up.
Thus, I suspect lower adverse selection in the subsidized pools. (I admit there is a counter affect of lower income means lower total money to spend on insurance.) Anyway, hopefully some people have looked at the claims experience of the two groups you want to split, and know what the true answer is.
Now, I actually live in MA. Apparently, in MA under RomneyCare, and continuing under state regulation under ObamaCare, small groups and individuals are pooled together. I myself suspect that this, which is not done in general under ObamaCare, might help. (Small groups, being small businesses, have a mix of workers all of whom get the plan so there should be little adverse selection, and this larger group should balance out the adverse selection effect in the smaller individual group.)
I see you live in Canada, where you just don't have to worry about this sort of thing. Bless you for taking the time to try and help us out!
4
The GOP efforts to give tax benefits to corporations and the wealthy just don't allow them much time to discuss the rest of us--except in terms of how they can verbally disguise their bias towards their donors. From the GOP retreat: Rep. Tom MacArthur (NJ), a participant, sum up the discussion: “We’re telling those people that we’re not going to pull the rug out from under them, and ... we are, in fact, going to pull the rug out from under them.” Their leaked discussion was about how to call a sow's ear disguised as a silk purse ----"bridge, bucket, backpack"--more than a discussion of viable programs.