Doctors expect a super high salary. Pharmaceutical companies the same. We should be outraged that these people demand such profits. We should protest. Yet we are okay paying a full time teacher 32,000 a year. Our thinking is screwed up.
5
Why can't Medicare negotiate drug prices? Oh how silly--of course Congress forbids it to protect the public.
4
Great article - it is sort of insidious how we got here, with so many fingers in so many pies. I'm just finishing the 400+ page new book by Elisabeth Rosenthal, MD - Am American Sickness: How Healthcare Became Big Business and How You Can Take It Back. From large hospitals gobbling up small ones to the most expensive pharmaceutical charges in the world, she lays out the problems and then provides solutions. Not gonna be easy. Her ten "economic rules of the dysfunctional medical market" are worth the price of the book! I wish every member of Congress would read this. My son is planning to move to Canada to pursue his graduate degree in chemistry - not necessarily because our president is a crazy man, but because our healthcare system is INSANE.
2
The title you chose for this editorial is disgusting in its arrogance - along with much of the content.
Who Needs Congress for healthcare? You imply that the answer is no one. But even you acknowledge that at least the 40% of Americans are not covered through employment. Congress needs to define health care legislation for them, if no one else.
Even for the small minority of people with excellent coverage through employer plans need, Congress needs to define laws about pre-existing conditions and many other serious issues that even supposedly "excellent" coverage leaves unaddressed because it keeps employees tied to their current jobs and insurance.
Employers are biased and think only of their own selfish interest -- much like former and current members of Congress such as yourself.
But healthcare needs to be fair for everyone.
Who Needs Congress for healthcare? You imply that the answer is no one. But even you acknowledge that at least the 40% of Americans are not covered through employment. Congress needs to define health care legislation for them, if no one else.
Even for the small minority of people with excellent coverage through employer plans need, Congress needs to define laws about pre-existing conditions and many other serious issues that even supposedly "excellent" coverage leaves unaddressed because it keeps employees tied to their current jobs and insurance.
Employers are biased and think only of their own selfish interest -- much like former and current members of Congress such as yourself.
But healthcare needs to be fair for everyone.
3
Pathetic. Saving lives isn't a priority. The priority is wheeling and dealing to secure the lowest cost. The priority should be a health care system that doesn't stress out families. That would be a goal worth pursuing.
The US economic system places profit first. And the insurance companies remain the death panels.
We cannot solve the problems with health care until our mission statement places people first before profit.
The US economic system places profit first. And the insurance companies remain the death panels.
We cannot solve the problems with health care until our mission statement places people first before profit.
3
Right on, Mr Andrews!!! We all know that Congress follows so thank you for leading!!! Somebody's got to do it.
2
It's not the whole explanation for our high medical insurance costs, but the fact that we have chosen to divide ourselves into thousands of small risk pools elevates the actuarial risk for everyone. Large groups of insured function most efficiently, and they have the leverage needed to lower prices, yet we insist on dicing up most insurance marketplaces into groups too small to function. The fact that many rural areas have only one insurer is not a failure of the marketplace. It is the marketplace informing us that the sizes of those areas' risk pools can only accommodate one insurer. Forcing more than one entity into those markets would mean actuarial suicide for all of them. It's not lack of competition. The competitions have taken place. The victors have emerged.
5
The only way to make health care affordable is to all but take the profit out. That is why business interests in Congress refuse to consider national health.
for once, it would be nice if our government did something for the people who make up this nation and grant authority to congress to give everybody health care and let the giant medical-industrial complex go fallow.
for once, it would be nice if our government did something for the people who make up this nation and grant authority to congress to give everybody health care and let the giant medical-industrial complex go fallow.
2
"The only way to make health care affordable is to all but take the profit out."
The first way to make health care affordable is to end the individual and employer mandates. The second way is to get government out of trying to manage one-sixth of the economy.
The first way to make health care affordable is to end the individual and employer mandates. The second way is to get government out of trying to manage one-sixth of the economy.
Wouldn't a single payer system representing 325 million Americans be much simpler and have more bargaining power, just saying.
20
Medical prices are controlled in various ways in the rest of the developed world. In Japan, the land of $100 melons and tiny $10,000 per month apartments, all medical care prices are listed in a book, thicker than the Manhattan telephone directory. The prices set in the book are usually less than a third of those in the USA. An MRI that costs $1,200 in the USA costs $88 in Japan. Japanese insurance companies are private as are most doctors. Japan spends less than a third per capita on medical care than America.
However, the Japanese are greater consumers of medical care than Americans. They visit doctors and hospitals more often, have much more diagnostic tests such as MRIs. They also have better health outcomes as measured by all metrics such as life expectancy. They also wait less for treatment than Americans do as Japanese doctors work much longer hours for their much lower incomes.
Japan's explicit price controls are roughly emulated in other countries via the use monopsonistic systems. Monopsony, meaning "single buyer" is the flip side of monopoly. A monopolist sets prices above free market equilibrium. A monopsonist sets prices below free market equilibrium. It does not matter if there is an actual single payer or many buyers (or payers) whose prices are set by the government or by insurance companies in collusion with each other.
More competition among sellers generally leads to lower prices. However, more competition ..."
http://seekingalpha.com/article/1647632
However, the Japanese are greater consumers of medical care than Americans. They visit doctors and hospitals more often, have much more diagnostic tests such as MRIs. They also have better health outcomes as measured by all metrics such as life expectancy. They also wait less for treatment than Americans do as Japanese doctors work much longer hours for their much lower incomes.
Japan's explicit price controls are roughly emulated in other countries via the use monopsonistic systems. Monopsony, meaning "single buyer" is the flip side of monopoly. A monopolist sets prices above free market equilibrium. A monopsonist sets prices below free market equilibrium. It does not matter if there is an actual single payer or many buyers (or payers) whose prices are set by the government or by insurance companies in collusion with each other.
More competition among sellers generally leads to lower prices. However, more competition ..."
http://seekingalpha.com/article/1647632
1
the health care system in the US is not based on a free market system. instead it is composed of government sanctioned interlocking monopolies granted to doctors, pharmaceuticals, insurance companies, and medical degree granting universities in this country. these industries have a monopoly on both the supply of medical services and the supply of labor that produces those services. as such the health care marked is an uncontrolled engine for price inflation. until we recognize that health care in this country is an unregulated monopoly market we are never going to get control of health care costs.
13
The USA is the last holdout with market-priced medical care not only because of any inherent conservative or free market ideology. Rather, as the wealthiest nation that ever existed we are the last ones who can afford it. Switzerland was one of the last advanced economies to abandon market-priced medical care. It is arguably a greater bastion of conservatism than the USA. Switzerland's women were not granted the right to vote until 1971.
The reason that no nation, including the wealthiest can allow markets to set the prices of medical care indefinitely is that demand for medical care is inelastic. Demand for a good or service is inelastic if a percentage increase in price results in a smaller percentage decrease in the quantity demanded. Basic economics tells us that sellers facing inelastic demand will continuously raise prices until prices reach the elastic portion of the demand curve. Consequently in every developed country in the world, all goods or services with inelastic demand have their prices regulated by government. Medical care in the USA being the only exception.
Health care is one of the very few things for which the sellers face inelastic demand. The prices of all other goods and services facing inelastic demand in the USA are regulated by government. Retail electricity service providers face inelastic demand. Consequently, their prices are strictly controlled by all governments worldwide, including the USA..."
http://seekingalpha.com/article/1647632
The reason that no nation, including the wealthiest can allow markets to set the prices of medical care indefinitely is that demand for medical care is inelastic. Demand for a good or service is inelastic if a percentage increase in price results in a smaller percentage decrease in the quantity demanded. Basic economics tells us that sellers facing inelastic demand will continuously raise prices until prices reach the elastic portion of the demand curve. Consequently in every developed country in the world, all goods or services with inelastic demand have their prices regulated by government. Medical care in the USA being the only exception.
Health care is one of the very few things for which the sellers face inelastic demand. The prices of all other goods and services facing inelastic demand in the USA are regulated by government. Retail electricity service providers face inelastic demand. Consequently, their prices are strictly controlled by all governments worldwide, including the USA..."
http://seekingalpha.com/article/1647632
Let's be clear most of the talk really refers to health care but the issue discussed is really insurance, the price of which reflects health care costs..
Health care costs in the us are twice anywhere else and the national statistics are mediocre. Does this suggest a problem?
I assume the author knows the latest recommendations about low back pain. And life style changes. An do a lot for diabetes.
About 5years ago the IOM issued a report that one third of the money spent is wasted. They offered suggestions for. This.
Another cause for excess costs is patient demands. Many MRIs are unnecessary, patients ask for them at thousand of dollars each.
Price industry and others can do what the government can't, say no.
Health care costs in the us are twice anywhere else and the national statistics are mediocre. Does this suggest a problem?
I assume the author knows the latest recommendations about low back pain. And life style changes. An do a lot for diabetes.
About 5years ago the IOM issued a report that one third of the money spent is wasted. They offered suggestions for. This.
Another cause for excess costs is patient demands. Many MRIs are unnecessary, patients ask for them at thousand of dollars each.
Price industry and others can do what the government can't, say no.
4
There will never be a fair, affordable health care system until the profit motive is removed. That sounds socialist and perhaps it is. Medical professionals that have dedicated their lives to helping their fellow man certainly deserve to be generously compensated and pharmaceutical companies that develop life saving and life enhancing drugs also should be well rewarded. However, the system we have is unsustainable and almost criminally unjust. A classic example is the opioid crisis. In pursuit of obscene profits big pharma corrupted research, bribed doctors and precipitated the addiction and deaths of tens of thousands of their fellow Americans. Finally they are being called into account, https://www.cnbc.com/2017/03/28/senate-committee-opens-probe-of-five-big..., but that's no comfort to the grieving families and the people whose lives are wrecked as a result. We simply must find a way to balance compensation for medical professionals with quality health care for ALL of our citizens.
12
Big data and corporate solutions ie marketplace beliefs, does the author mean transparency, will lead nowhere for the average healthcare cosumer. The one factor above all that ensures healthcare is health insurance (NEJM 2017). Without universal coverage at the outset, everything else is a false promise. Mr Andrews spend time in a clinic serving poor people and try a little empathy.
9
I guess firms reducing their costs is useful. Even more useful would be a safety net and urban design that prevents the need to use health care. Yet again, we have local optimization in silos treating symptoms rather than treating causes and really reducing costs.
3
I don't have the answer for sure, but glad to see the authors take a stab at providing health care at a reasonable cost. I'm also glad to see the reference to Health Care rather than Health Insurance. Health Insurance is an oxymoron. ACA cannot function as a service subject to the free market, because insurance companies cannot use actuarial principles to assess risk. Mandatory car insurance works because everybody is supposed to have it, and the ACA mandates that. However, insurance companies can assess what type of risk you are as a driver, and if you have DUI's or speeding tickets (we'll call them 'pre-existing conditions'), then you're a higher risk, so you pay more. Not so with the ACA, they have to insure everybody regardless. Life insurance companies for years have practiced risk mitigation, so if you are young and healthy, don't hang glide, don't jump out of perfectly good aircraft flying at 14,000 feet just for fun, don't smoke etc. ('pre-existing conditions'), you get a low rate. If you're old and have health issues, smoke, heart disease, history of breast cancer in the family, etc. (we'll again call them 'pre-existing conditions'), you pay more for insurance, or in some cases, you cannot get insurance at all.
So let's provide Health Care for all. I'm all for it. But let's once and for all disabuse ourselves of the notion that we can and should be providing 'Health Insurance' for all, because there is no way that can be done via the free market.
So let's provide Health Care for all. I'm all for it. But let's once and for all disabuse ourselves of the notion that we can and should be providing 'Health Insurance' for all, because there is no way that can be done via the free market.
7
I interviewed 50 doctors in my book, "I Have Been Talking with Your Doctor: Fifty doctors talk about the healthcare crisis and the doctor patient relationship." When are we going to start listening to them? They talk about what it is like on the ground trying to provide healthcare. They spoke about it from every angle imaginable. How can we have effective and quality healthcare reform without listening to them?
4
A threatened bottom line is always a good reason for close examination of expenses, and these companies are doing what government is rarely capable of doing: finding workable solutions to health care issues. But regardless of how diverse their industries and how numerous the businesses, only government is able to provide national insurance. As a tax, like income or property, and at least as important, but costing much less than as available from private insurance companies.
3
"That results in lower prices for the same medicines and allows the alliance members to achieve considerable savings."
How nice for the alliance members. But my math tells me that the 57 percent that might benefit from the reforms is still a long way from 100 percent. The rest of the un- or under-insured population should just eat cake. Big corporate America is still looking to help its own bottom line. Wedded to the market solution, everybody else suffers the ongoing rise in costs.
It's nice that people keep trying to make it work, but until we get to single payer, things will just get worse.
How nice for the alliance members. But my math tells me that the 57 percent that might benefit from the reforms is still a long way from 100 percent. The rest of the un- or under-insured population should just eat cake. Big corporate America is still looking to help its own bottom line. Wedded to the market solution, everybody else suffers the ongoing rise in costs.
It's nice that people keep trying to make it work, but until we get to single payer, things will just get worse.
10
Nothing changes until health care is disconnected from employment.
17
Here's a simple way to get the healthcare system on the right track. I call it the MRI act. Every hospital and every MRI provider must provide the cost of the procedure. This is very important because most people face deductibles that cost several thousand dollars (and with Obamacare, $7,500 deductibles are common). And the price of and MRI can be $1,500 in one city, and $6,000 in another city.
Until basic healthcare procedures are priced, the mess we are in will get worse and worse.
Until basic healthcare procedures are priced, the mess we are in will get worse and worse.
6
When a friend asked why a non-scheduled MRI was performed, the Nurse answered "We have to pay for this machine somehow". Case closed.
5
Let’s see: the 41 companies spend $25B (I assume each year) for 6M employees & retirees. We are not given the total annual drug expenditures, but $200M/year in savings is about $35/year per member, & is only about 0.8% of the total health annual health costs. Looks to me like you’re probably still getting fleeced by the health insurers.
In the bigger picture, if this big healthcare alliance can’t do better than this against the insurers, then what chance do small businesses and individuals have? To be fair, more details would be helpful, but as an argument for one approach to dealing with health insurance costs, it only shows how continuing this path is, in the end, a waste of more time & money.
It’s hard to figure why big business does not support single-payer, if only to get out of the health insurance business & save both money & resources. That they have not suggests that they see health insurance as a recruitment & retention tool, but under single-payer they could still offer to pay the premium for the employee. The health insurance industry could sell secondary or supplementary policies; this is where they should properly compete with each other. If big business lobbyists pushed for single-payer, that would send a strong message to Congress from a group they are likely to listen to.
In the bigger picture, if this big healthcare alliance can’t do better than this against the insurers, then what chance do small businesses and individuals have? To be fair, more details would be helpful, but as an argument for one approach to dealing with health insurance costs, it only shows how continuing this path is, in the end, a waste of more time & money.
It’s hard to figure why big business does not support single-payer, if only to get out of the health insurance business & save both money & resources. That they have not suggests that they see health insurance as a recruitment & retention tool, but under single-payer they could still offer to pay the premium for the employee. The health insurance industry could sell secondary or supplementary policies; this is where they should properly compete with each other. If big business lobbyists pushed for single-payer, that would send a strong message to Congress from a group they are likely to listen to.
47
single payer would mean big corporations would need to pay the health care costs of all their customers, including their low income customers. the only way to raise the revenue is a VAT that collects taxes no matter what from businesses big and small, highly profitable and those treading water. that means the prices of the goods and services will be higher. that will force them to force all employers to pay higher wages, or their prices will be too high and their sales will go down.
the US is the only nation without a VAT that provides the funding for universal health care and other programs ensuring business customers have money to buy what businesses sell.
the US is the only nation without a VAT that provides the funding for universal health care and other programs ensuring business customers have money to buy what businesses sell.
The mere mention of a VAT is to the only time the GOP suddenly cares about the poor.
In the USA we have attempted to deal with the combination of inelastic demand and unregulated medical care prices in various ways. One method of keeping medical care expense as a percent of GDP to "only" double that of other developed countries was to have a significant portion of the population uninsured and denied medical care in some circumstances. . The existence of large numbers of uninsured (conscripts in the war against rising medical costs) did moderate the growth in health care costs.
As long as medical prices are set by market forces, the inelasticity of demand will force market prices inexorably higher. In a "mixed system" with both free-market and controlled health care prices like the USA, prices inexorably are driven upwards to the market level as long as demand is inelastic. Prices such as payments from Medicare that are "controlled" have to be increased continuously with legislation such as the "doctor-fix" to stay competitive with market prices. Medical prices can only be effectively controlled either by direct price controls as in Japan or with systems where everyone gets care for "free" from the government. In those countries only the extremely wealthy can chose not to use the government paid health services that they have already paid for with their taxes and patronize the market-priced sector. In those countries, forgoing the government priced system is not an option for almost all doctors, as it is in the USA..."
http://seekingalpha.com/article/1647632
As long as medical prices are set by market forces, the inelasticity of demand will force market prices inexorably higher. In a "mixed system" with both free-market and controlled health care prices like the USA, prices inexorably are driven upwards to the market level as long as demand is inelastic. Prices such as payments from Medicare that are "controlled" have to be increased continuously with legislation such as the "doctor-fix" to stay competitive with market prices. Medical prices can only be effectively controlled either by direct price controls as in Japan or with systems where everyone gets care for "free" from the government. In those countries only the extremely wealthy can chose not to use the government paid health services that they have already paid for with their taxes and patronize the market-priced sector. In those countries, forgoing the government priced system is not an option for almost all doctors, as it is in the USA..."
http://seekingalpha.com/article/1647632
5
Access to health care - a matter of life and death - should not depend on one's employment, or work status. Combined with the failure to provide a public-option and the continual attacks (now with threats to cut off subsidies) on Obamacare exchanges for individuals who are not so "fortunate" as to have health benefits from employers (more than 50% of employers no longer provide health benefits), it renders workers to indentured serfs, fearful to antagonize a boss by asking for a raise, or leaving a job to start one's own business, or escaping an abusive boss or spouse.
14
It's time to decouple health coverage and employment. Close the gigantic loophole that lets these companies pay no taxes on these billions they spend for employee coverage. Recognize that health care for all is a public good, like education - businesses know it's a productivity issue. We should ALL be funding it, we should ALL be getting it. And the government should be doing the cost/quality effort just like these companies (actually, it's already happening for Medicare, hence the star ratings).
Business is acting because government is not. Why isn't government acting? Because we are squeamish in this country about helping each other except in disasters. We can go a long way toward avoiding public health disasters if we just keep every one healthy or managing their conditions. At the end of the day, it's good economics, and it's humane. Why isn't that good enough reason to have Medicare for All?
Business is acting because government is not. Why isn't government acting? Because we are squeamish in this country about helping each other except in disasters. We can go a long way toward avoiding public health disasters if we just keep every one healthy or managing their conditions. At the end of the day, it's good economics, and it's humane. Why isn't that good enough reason to have Medicare for All?
17
The article states: "The members of the alliance spend $25 billion on health care...." it is not evident from the article but, presumably, that is an annual amount.
Further on the article says that drug reforms are projected to save participating companies at least $600 million over three years----. Well, by my calculations $200 million cost savings on $25 billion is 0.8% or eight tenths of one percent.
Surely this alliance represents a start, but nothing like the potential savings that could be achieved with Medicare-For-All. The alliance should use this as a measuring stick for success. How much savings is theoretically possible with Medicare-for-All? Well, about 7% of GDP which translates into $1 Trillion annually, or about 30% of our country's overall health care related expenditures.
Further on the article says that drug reforms are projected to save participating companies at least $600 million over three years----. Well, by my calculations $200 million cost savings on $25 billion is 0.8% or eight tenths of one percent.
Surely this alliance represents a start, but nothing like the potential savings that could be achieved with Medicare-For-All. The alliance should use this as a measuring stick for success. How much savings is theoretically possible with Medicare-for-All? Well, about 7% of GDP which translates into $1 Trillion annually, or about 30% of our country's overall health care related expenditures.
5
So what happens to the rest of the employees whose firms are too small to be included? Does this plan for an exclusive few damage what happens to those outside of it with higher prices, no available care and location issues? This is why government gets involved because so many get left out of the "exclusive" club of the bigger, more powerful companies.
4
Actually, what we need is to unhook coverage from employers. These companies pay no taxes on those billions they spend on employee care. That will raise revenue to fund Medicare for All AND an agency (ideally CMS, if it can) that will do what these guys are doing on the quality and cost front - for ALL of us. No more "exclusive few."
9
Wow, a fact based approach to lowering medical care costs and achieving better outcomes! How astonishing in the era of the alternate fact. Actually determining where the money goes and what are the outcomes for medical care and looking for ways to improve competition in the medical care industry are great starts by the companies involved to eventually lower their costs for employee medical insurance. Good luck to you.
3
Actually, this has been going on for years, driven by both employers and public and private health plans. The news is the scale.
3
Private sector companies aren't the only entities facing healthcare costs which have skyrocketed into the stratosphere. States are also struggling to reduce costs, improve access and outcomes and they too could join together to form healthcare cooperatives /cartels.
What if California, Oregon, Washington, Nevada and New Mexico formed a unified state level single payer healthcare/dental care system which they offered to independent consultants, small businesses and other citizens who are not covered by an large corporate employer based health insurance in their respective states? States, not the federal government are the primary regulators of healthcare service providers and insurers. This would allow each state to tailor their healthcare insurance regimes within a broad and unified framework while sharing administrative overhead and leveraging risk pooling. States with more rural citizens would benefit from the pricing of services available to more densely populated urban areas.
What if California, Oregon, Washington, Nevada and New Mexico formed a unified state level single payer healthcare/dental care system which they offered to independent consultants, small businesses and other citizens who are not covered by an large corporate employer based health insurance in their respective states? States, not the federal government are the primary regulators of healthcare service providers and insurers. This would allow each state to tailor their healthcare insurance regimes within a broad and unified framework while sharing administrative overhead and leveraging risk pooling. States with more rural citizens would benefit from the pricing of services available to more densely populated urban areas.
8
fantastic idea! Sort of a "Grown-up States Coalition."
The Northeast states and the Upper Midwest states could do the same thing.
Each of these groupings is larger than some countries that have successful single-payer systems.
The Northeast states and the Upper Midwest states could do the same thing.
Each of these groupings is larger than some countries that have successful single-payer systems.
3
The Insurance industry has set up contracts with providers (hospitals, doctors, Etc) with contract pricing by procedure codes. This is a poor way to decide what a provider should get paid. If a region of states could set up a non-profit company that negotiates a set of fees for all patients, not by procedure, it would drive down costs.
1
The HTA does not address the most pressing problem with PBMs and prescription cost. The number one problem - What is the cost of the prescriptions? Only the PBMs know and they won't reveal it. They make money off of the "spread" (the difference between what they pay the pharmacy and what they charge the plan).
How can Mr. Andrews know what the savings will be for the members of the HTA If the cost of the drugs is unknown?
The HTA is now going to have access the Caremark's and Optum's pricing structure? What does that mean? Structure?
The problem is a lack of transparency. If they don't know the cost (and Caremark and Optum will never tell them) they cannot promise savings.
The HTA is just another entity making money off of the only unregulated segment of healthcare (it is perfectly legal).
Ask Mr. Andrews how he gets paid. Once the HTA supposedly provides these savings, do they continue to make money off of their constituency? Of course, they do; lots of money. Membership fees and ongoing service fees.
There is no need for another middleman that claims they can provide huge savings. Imagine how much savings can be negotiated if the HTA threatened to leave it's PBM because they know what they should be paying and they have negotiated a set fee with another PBM. A novel idea - A PBM that discloses the true cost of the drugs and passes all fees and benefits back to the plan, just like the PBMs did when they first started in the 1960s.
How can Mr. Andrews know what the savings will be for the members of the HTA If the cost of the drugs is unknown?
The HTA is now going to have access the Caremark's and Optum's pricing structure? What does that mean? Structure?
The problem is a lack of transparency. If they don't know the cost (and Caremark and Optum will never tell them) they cannot promise savings.
The HTA is just another entity making money off of the only unregulated segment of healthcare (it is perfectly legal).
Ask Mr. Andrews how he gets paid. Once the HTA supposedly provides these savings, do they continue to make money off of their constituency? Of course, they do; lots of money. Membership fees and ongoing service fees.
There is no need for another middleman that claims they can provide huge savings. Imagine how much savings can be negotiated if the HTA threatened to leave it's PBM because they know what they should be paying and they have negotiated a set fee with another PBM. A novel idea - A PBM that discloses the true cost of the drugs and passes all fees and benefits back to the plan, just like the PBMs did when they first started in the 1960s.
1
So, you'll save $600M over 3 years compared to $75B of costs? That's 0.8%. That's pretty close to NOTHING. That's not a solution.
Companies are still trying to operate within a broker system. The fact that you're partnered with Optum, a division of UHC, one of the largest insurance companies speaks volumes. They're not interested in reducing your costs in a meaningful way because that takes money out of their pockets. If they were interested, they would have done it already! They have more buying power than you...
Move hospitals to exclusively non-profit or public ownership. Standardize prices and abolish health insurance networks.
Healthcare shouldn't
Companies are still trying to operate within a broker system. The fact that you're partnered with Optum, a division of UHC, one of the largest insurance companies speaks volumes. They're not interested in reducing your costs in a meaningful way because that takes money out of their pockets. If they were interested, they would have done it already! They have more buying power than you...
Move hospitals to exclusively non-profit or public ownership. Standardize prices and abolish health insurance networks.
Healthcare shouldn't
9
Exactly Mark! The only ones who benefit are the PBMs. The so called HTA results in a lot of money for the HTA and deflects the real problem of the PBMs and their lack of transparency.
4
Notice: at no point did the author discuss health insurance premiums. Politicians on both sides (including the "single payer" crowd) have all but stopped talking about cost of health care. This is why this is a viable solution. It addresses the cost AND efficacy of care and even investigates the cost of specific care. Health insurance premiums (including under a single payer system) are just about arguing over who pays. The heart of the conversation is in improving what gets paid for and what is expected as a result (better health).
That is why the ACA does not have full throated defenders. It just moved money around- in many positive ways- but did very little to make the pot of money affordable. Add that to the divisions it created (how many are in the individual market or Medicaid versus everyone else). Major missed opportunity.
All four of those costly conditions are largely preventable. Step one: improve care and accountability. Step two: work to keep them from happening.
Good business people care about costs, but they care about results far more. This approach provides more ability to solve the problem than legislation ever could. When they are not handed legal framework that defines how you must act, people will generally seek to make things work better. Very exciting.
That is why the ACA does not have full throated defenders. It just moved money around- in many positive ways- but did very little to make the pot of money affordable. Add that to the divisions it created (how many are in the individual market or Medicaid versus everyone else). Major missed opportunity.
All four of those costly conditions are largely preventable. Step one: improve care and accountability. Step two: work to keep them from happening.
Good business people care about costs, but they care about results far more. This approach provides more ability to solve the problem than legislation ever could. When they are not handed legal framework that defines how you must act, people will generally seek to make things work better. Very exciting.
In theory, this pricing power is supposed to be the advantage that large insurers already have.
1
Will these programs relieve us for paying twice as much per capita for health care as other countries and getting outcomes almost as good? Who gets the money?
7
Wow, BIG corporations "unionizing" so they can negotiate a better deal for themselves! Whodathunkit!
Why doesn't each corporation just ask nicely for a better deal. I'm sure the healthcare companies have their best interests at heart and will give them the best deal they can. No need for all this "unionizing." If these BIG Corporations join forces and get a better deal, it just hurts everyone else!
Oh, the irony.
Why doesn't each corporation just ask nicely for a better deal. I'm sure the healthcare companies have their best interests at heart and will give them the best deal they can. No need for all this "unionizing." If these BIG Corporations join forces and get a better deal, it just hurts everyone else!
Oh, the irony.
8
Good thing you've done, similar to the Federal Employees Health Benefits. NOW, how do OTHER employees receive similar benefits?
5
What is not addressed in this commentary is prevention, inasmuch as the majority of our healthcare costs come from preventable diseases. A good place to start is in the workplace, since we spend a large proportion of our lives at work. Truly enlightened employers are embracing the concept of Total Worker Health (TWH) developed by the National Institute for Occupational Safety and Health (https://www.cdc.gov/niosh/twh/default.html). From NIOSH, "TWH is a holistic approach to worker well-being. It acknowledges risk factors related to work that contribute to health problems previously considered unrelated to work. The TWH approach seeks to improve well-being in the American workforce for the benefit of workers, employers, and the nation by protecting safety and enhancing health and productivity." We need to take a more wholistic approach towards the lives of working Americans if we hope to reduce the costs of healthcare.
2
If you've gotten a letter or a robocall reminding you to get a mammogram or colonoscopy, that's your health plan investing in prevention. If you have a chronic condition like diabetes, and you get reminders for vision test, kidney check and A1C screening, that's your health plan investing in prevention. If your health plan gives a discount for joining a gym, that's your health plan investing in prevention.
2
Arguing that the “private sector isn’t waiting for health care reform” Robert Andrews makes the case that 57 per cent of Americans get their health insurance through their employers and that reforms achieved by the Health Transformation Alliance for their employees can save money for the 21 companies that have joined together to negotiate lower drug costs and to encourage competition among hospitals and doctors in major cities. So four million Americans who work for companies in the Alliance (out of the 126 million people with health insurance from their employers) may get a better deal. What about those others who have insurance from cities and states or from universities or unions?
Richard Gottfried’s bill—the 2017 New York State Health Act passed overwhelmingly in the Assembly and short one vote in the Senate—guarantees healthcare for all New York residents and cuts administrative costs to 2%. But it pays for those savings with a progressive tax depending on income. Under private insurance in those 21 companies, a secretary contributes as much for healthcare as the CEO: hardly an equitable solution and hardly an answer for those not in employer healthcare. The Transformation Alliance seems indifferent to the fate of others not employed by participating companies.
Richard Gottfried’s bill—the 2017 New York State Health Act passed overwhelmingly in the Assembly and short one vote in the Senate—guarantees healthcare for all New York residents and cuts administrative costs to 2%. But it pays for those savings with a progressive tax depending on income. Under private insurance in those 21 companies, a secretary contributes as much for healthcare as the CEO: hardly an equitable solution and hardly an answer for those not in employer healthcare. The Transformation Alliance seems indifferent to the fate of others not employed by participating companies.
8
What needs to be added to the ways to cut costs is the use of "evidence-based" medicine. That is, scientific results demobstrating that medical procedures are effective. For example, most surgical interventions for back pain are ineffective while low-cost physical therapy is. There are additional millions of dollars that can be saved while simultaneously improving the quality of life for patients by providing health care of proven effectiveness.
Ok. Finally someone has informed us: the ideal benchmark of " affordable healthcare" according to our government is 10% of a family's income.
Who knew what we, the government, insurance industry care providers should be budgeting?
Who knew what we, the government, insurance industry care providers should be budgeting?
4
Mr Andrews seems to be advocating a non-governmental, single-payer system without coming out and directly saying it. This is a provocative piece that I'm sure will be talked about widely. Utilizing the strength and influence of industry and business might be exactly what health care needs. However, corporations (and he does seem to be lumping all "big-business" together here) are also partially responsible for driving the costs up. Would this system be non-profit? Would any business agree to a system that might decrease their overall profits?
How would it deal with pre-existing conditions? Could you keep it if you changed jobs? The devil is in the details - and in the 30-year-old, unemployed, diabetic.
How would it deal with pre-existing conditions? Could you keep it if you changed jobs? The devil is in the details - and in the 30-year-old, unemployed, diabetic.
3
Remember that employer based insurance is based on working full time. Being able to work 32 hours per week or more is a pretty good underwriting filter that screens out many people who have an expensive chronic condition.
4
Congress has been responsible for outrageons prescription drug prices since it prohibited Medicare from negotiating those prices. More recently, deals between insurance companies and pharmaceutical companies have prevented the use of generics, insurance companies covering only the original drugs whose patents long ago ran out, but not cheaper generics. Result? You may not be able to get the perfectly good generic and end up paying much more than what you'd pay if you could get the generic. We certainly need Congress to fix these problems, but a better Congress than we've got.
9
Between the lobbyists and private political funding, any change appears dismal. No I meant to say impossible for Congress. Why do you think a one payer source has NEVER been approved. The ACA as rendered was unrecognizable because of this overwhelming need to make for profit medical plan. It certainly would never refer to what we have as health care.....
2
See what you can achieve when you join a union!
11
Or on making war, apparently. We have conceded the imperial presidency to the most malignant occupier of that office.
1
BRAVO!!!! And about time too! I hope other giant private corporations get on board and join with you. This is an investment in America and Americans and you recognize that.
Thank you for caring about your employees, it is a refreshing change from Trump, McConnell, Ryan and the like who are almost profane in their callousness toward Americans and their healthcare needs and costs.
They are in Congress to serve their country and its people, yet they cannot rise above their personal political agenda and personal greed to honor their oath of office. They are a disgrace and Trump, even today, is attacking his own man or McConnell because the Trump legislation to repeal Obamacare is not passing muster with the majority of Americans who are not millionaires or billionaires.
Trump is not wired or programmed to care about others, so he doesn't. Evidently, some of his Cabinet appointees have the same disorder.
Thank you for caring about your employees, it is a refreshing change from Trump, McConnell, Ryan and the like who are almost profane in their callousness toward Americans and their healthcare needs and costs.
They are in Congress to serve their country and its people, yet they cannot rise above their personal political agenda and personal greed to honor their oath of office. They are a disgrace and Trump, even today, is attacking his own man or McConnell because the Trump legislation to repeal Obamacare is not passing muster with the majority of Americans who are not millionaires or billionaires.
Trump is not wired or programmed to care about others, so he doesn't. Evidently, some of his Cabinet appointees have the same disorder.
3
Best results for hernia repair is in Canada.
1
Those illnesses all are more common in obese patients.
More importantly, the health care arena needs more true competition... at the consumer level. I have private, employer-paid insurance and my insurance company has various (and inconsistent) ways to 'direct' you to certain providers; however it's usually a 3rd party that's evaluated where you can get an x-ray or other test cheaper. I'm fine with that- but if it's a critical surgery, I want to know outcomes, not just price. I am sick of spending many hours over multiple days trying to find out what my out-of-pocket cost is going to be for something like a cortisone injection- common treatment for back problems/sciatica. Neither my provider nor the health insurance company is obligated to make this easy. Call the insurance company, they need to know the codes. Call the doctor's office and admin staff says 'it depends.' They may or may not be willing to track the doctor or paperwork to find out. Give the codes to the insurance company, and you find you don't have them all.... I'm billed for four different 'items' when receiving an injection that takes 10 minutes. Some contract Ts and Cs don't have to be disclosed at all. This would be criminal price-fixing in any other industry. Make pricing and outcomes transparent to patients, and you will see more self-correction in the marketplace- because this sure isn't capitalism.
5
Just, give me a break. We do need congress. What about everyone who doesn't work for that handful of companies? Self-employed entrepreneurs? Smith's cashiers? What about those employees who are having other procedures, not within the band of the "common", or have medical conditions that do not allow then to "use the hospital" with better results? Frankly, this just perpetuates, unequal, unfair healthcare as we know it. We need Congress. Congress, step up!
7
Susan is SO right about this. The corporate-advantaged health insurance system is completely unfair for the rest of us.
2
What? competition? Why is access to health care still a mess?
I thought the cost curve was bent, big pharma was cut to size, the evil insurance companies and hospitals were regulated to submission.
Govt thinks throwing $ at problems will solve them.
It remains the govt added huge numbers to the demand without changing the supply.
Insurance or no, finding healthcare is next to impossible.
I thought the cost curve was bent, big pharma was cut to size, the evil insurance companies and hospitals were regulated to submission.
Govt thinks throwing $ at problems will solve them.
It remains the govt added huge numbers to the demand without changing the supply.
Insurance or no, finding healthcare is next to impossible.
3
Get the fraud out of Medicare and Medicaid!!
1
I can already hear the frantic GOP screaming that this plan, which seems to be working is cheating the American worker from "choosing" his hospital and doctor! Still think that the idea of single payer is the simplest, most honest, least expensive and most productive way to go. Except we are so locked in "American Exceptionalism" that we can't seem to embrace a plan that has been proven to work for millions in other First World Countries.
3
Your efforts are to be applauded however there is much more savings to be had by changing some of the rules of the game. You should have read the recent NYT article on insurers forcing subscribers to purchase brand name (instead of generic) drugs.
3
Another set of statistics from the HTA: "...while the market basket of general costs of living has risen by 41%, employer benefit costs have risen by 191%, and employee costs have risen by 213%."
2
It appears that the US is following Winston Churchill's observation that Americans will eventually do the right thing but only after exhausting all other possibilities and have applied it to healthcare. But they are not there yet, agonizing over single payer, the system employed at lower cost with better outcomes in every developed country. What a waste of lives and money.
7
Finally, the real market force fights back against the fake market force run by GOP. Enough was enough. Business cares about bottom line but politicians only worries about their next election. Speaking of middleman, politicians and their ally lobbyists are the biggest middlemen. Actually, government was never the problem. Politicians were.
I will go one-step further by saying politicians are products of the political system. With the design, I see no hope!
I will go one-step further by saying politicians are products of the political system. With the design, I see no hope!
2
They NOT really doing much of anything since they're still in data gathering mode.
Some days, I really wish you could edit a forum submission after you've sent it.
Some days, I really wish you could edit a forum submission after you've sent it.
1
Shocking! The NY Times publishes an opinion piece--which suggests there is a better way--than allowing a central government to dispense health care? How did this get by the socialists on the Editorial Board?
The HTA is just another middleman. What is the cost? They are using Caremark and Optum as their PBM. Those two companies are part of the problem. How much does it cost to join the HTA? How much does it cost to use their services?
They charge a membership fee and a fee per member for any other services.
Transparency is the answer. The HTA does not provide any transparency for their members if they continue to use two of the least transparent PBMs in the marketplace.
They charge a membership fee and a fee per member for any other services.
Transparency is the answer. The HTA does not provide any transparency for their members if they continue to use two of the least transparent PBMs in the marketplace.
1
Congress fiddles while America burns!
How many more sleepless nights will those of us in the 43%, who DON'T have the luxury of big business working on our behalf, have to endure? If I hear one more politician on either side of the aisle lament about small business, I'm going to lose my mind!
As a 56 year old small business owner, I have not slept in weeks over this! Do they even know they are dealing with real people who have real worries? Hearing Trump carelessly say, "Let it fail and then we'll see a deal" says to me he is so far removed from the reality SO MANY of us face - we are one illness away from losing everything we ever worked for. SHAME!!! SHAME!! SHAME!! on ALL of you!
How many more sleepless nights will those of us in the 43%, who DON'T have the luxury of big business working on our behalf, have to endure? If I hear one more politician on either side of the aisle lament about small business, I'm going to lose my mind!
As a 56 year old small business owner, I have not slept in weeks over this! Do they even know they are dealing with real people who have real worries? Hearing Trump carelessly say, "Let it fail and then we'll see a deal" says to me he is so far removed from the reality SO MANY of us face - we are one illness away from losing everything we ever worked for. SHAME!!! SHAME!! SHAME!! on ALL of you!
7
Has any one described what health care consists of?
We need single payer health care (not health INSURANCE). This should be the litmus test for all candidates seeking office. "Do you believe Americans should have health care as a human right?". Every civilized country has manged to do this except us. And we are to believe this guy? http://www.nj.com/politics/index.ssf/2012/09/post_5.html
6
workers of the world, unite, Comrade
1
I am curious why single payer would not be the best option for American business. Perhaps they just see it as a political non-starter and are thus taking care of business themselves, or have other reasons? Regardless I'm pleased to hear about HTA as a resource to learn more.
2
All good. But when companies get to decide what treatment you need we have a different problem. Single payer is what we want. As a patient I want input into that system because no one cares more about my health than I do.
2
You think the government is going to look out for your interests?
What did the government do for the American Indian?
What they did to the them will happen to you.
What did the government do for the American Indian?
What they did to the them will happen to you.
"...we’re troubled by the number of middlemen who drive up the price of care".
Then why not support single payer and get rid of the lecherous private insurers?
Then why not support single payer and get rid of the lecherous private insurers?
10
And those of us who buy (non-subsizied) coverage through the exchanges--how will this save us money?
2
Just wait until Amazon offers health insurance
The days of the traditiona health insurance companies are numbered
The days of the traditiona health insurance companies are numbered
2
Why should my employer provide my health insurance? It makes no sense, but Americans are ok with it. How nice it would be to leave a job without concern for losing insurance.
In California we came close to single payer but it was killed by a Democrat, Assembly speaker Anthony Rendon.
California is controlled by Democrats and we can't get it done here.
We're so backward in the good ole USA.
In California we came close to single payer but it was killed by a Democrat, Assembly speaker Anthony Rendon.
California is controlled by Democrats and we can't get it done here.
We're so backward in the good ole USA.
3
Single payer committed suicide by not including anything close to a reasonable funding plan. Democrats totally control government in California, but the nurses association put out a terrible piece of legislation.
Andrews is a pretty smooth lobbyist. I wonder how his insurance companiew would deal with insuring people with pre-existing conditions and expensive end of life conditions, absent any government mandates.
2
many ideas worth further consideration here. The shocking statistic for me is that we spend $5 billion (20%) for new knees and hips, and to deal with back pain and diabetes! Soapbox alert: please consider a plant-based diet. Veggies, fruit and whole grains, or surgery?
Uh-Oh. Once big Pharma, big Med, and all those in the middle swimming in the money they rake off the system get an inkling this may threaten their profit bonanza, they will siphon some of that dough off to their lobbyists and the politicians to make sure laws get changed to prevent them doing what they are doing. That's already happened several times with efforts like this. Running a small business and being prevented from meaningfully participating in any business alliance similar to what they describe, I wish them luck, but think the effort will be doomed by the politics. I don't think anyone is in doubt the entire health care system could be better, cheaper, faster, but the citizens who can be bothered to exercise their franchise keep electing representatives who get them hot and bothered about other things. Those voters simply have no clue how they are being harmed while being slowly made poorer, sicker, and less able to lead productive lives. Keep electing the bozos, America (with apologies to Bozo the clown), you have no idea just how much more the cons can rip from you. The best trick the GOP had was to throw millions of your fellow citizens over the rail. You'd go over the rail too but there's too much money to be made off you making sure you take a long, long time to suffer and die in a system that's broken on purpose. Sweet!
3
With the lack of action and effort, in the last 8 years, the question of "Who Needs Congress?" is pertinent. They have certainly not demonstrated their usefulness or skill. Maybe we don't need them, or the cheater-in-chief, either. I think we should stop paying them. How 'bout it?
1
This article demonstrates what the government could do if they got over themselves and leveraged their power in service to their contstituents.
Wake up congress!
Wake up congress!
3
Interesting concept. PBM's have earned every bit of the increasing scorn that is being heaped upon them. My son's medication costs $224.00 per month if I go through insurance. It costs $114.00 per month if I don't go through insurance. There is something seriously wrong with this picture......
7
What a puff piece. Not one iota of fact throughout. Wishes, shoulda, woulda, coulda. If the Andrew alliance was a success it would have been named public enemy #1 by the insurance lobby. It's not.
4
How about "examining trends" in management compensation?! Putting an end to outrageous salaries, bonuses & golden parachutes would save billions.
4
Where Congress could provide enormous help is in the area of tort reform. Such reform would reduce the exorbitant cost of defensive medicine health care providers order to defend themselves against the ambulance chasing, blood-sucking lawyers.
But lawyers have bribed (excuse me, provided political donations) to both parties forever. Neither party seems willing to sacrifice the gravity train of cash coming their way. There is certainly a better way to protect patients from medical errors and mistakes than lining the pockets of lawyers.
But lawyers have bribed (excuse me, provided political donations) to both parties forever. Neither party seems willing to sacrifice the gravity train of cash coming their way. There is certainly a better way to protect patients from medical errors and mistakes than lining the pockets of lawyers.
How would these methods for the big corporations come to someday help smaller-profit, mid-size, and smaller-nationwide corporate businesses be able to afford health care, too?
I think we should increase wages so that more people can afford their own health care and give all but the largest of corporations a corporate-competitive-adjustment tax break based on their labor costs to encourage even more in wages and more business health care coverage.
A $10 Minimum Wage for small-businesses (Trump’s proposed wage); $12 for mid-sized businesses (Clinton’s proposed wage) and $14 for the biggest corporate sized businesses (close to Sanders proposed wage).
To balance wages among the workers more fairly, we could give a payroll tax cut to those making the $10 and $12 wage so that their take-home pay would be close to the take-home pay of workers making the $14.
To encourage and sustain pension and profit-sharing plans to pay for the biggest corporations lower-wage workers and their retired workers instead of Medicaid, the government could allow those corporations that offer such plans to pay the mid-size $12 wage instead of the $14.
I think we should increase wages so that more people can afford their own health care and give all but the largest of corporations a corporate-competitive-adjustment tax break based on their labor costs to encourage even more in wages and more business health care coverage.
A $10 Minimum Wage for small-businesses (Trump’s proposed wage); $12 for mid-sized businesses (Clinton’s proposed wage) and $14 for the biggest corporate sized businesses (close to Sanders proposed wage).
To balance wages among the workers more fairly, we could give a payroll tax cut to those making the $10 and $12 wage so that their take-home pay would be close to the take-home pay of workers making the $14.
To encourage and sustain pension and profit-sharing plans to pay for the biggest corporations lower-wage workers and their retired workers instead of Medicaid, the government could allow those corporations that offer such plans to pay the mid-size $12 wage instead of the $14.
This is absolutely great news. While Republicans rally against Government interference at every level, they have offered very few market-based ideas that would actually work without Government interference or assistance. If they really do believe in providing solutions to actually help Americans, rather than simply regurgitate talking points given to them by their donors, encouraging institutions like the Health Transformation Alliance, maybe encouraging more companies to join this institution or for other groups to form their own, is the right direction to take.
You can always count on Americans to do the right thing - after they've tried everything else. Winston Churchill
it's time for Single Payer
it's time for Single Payer
8
no it isn't: that'd be 1 more wrong thing, even worse.
I can see you have never been put in a position where you're going to lose your house because of medical bills.
Not only doesn't it feel good, it makes you even more sick.
Not only doesn't it feel good, it makes you even more sick.
Healthcare may be the only area where I agree with Reagan...government can't solve the problem, IT IS the problem. Government, that is, our Representatives and Senators, local and national, are in the pockets of the insurance companies, big pharma and large healthcare providers. Costs will not come down by fiat even if there was motivation to do it. Health Transformation Alliance is a good start although as has been pointed out, it doesn't impact a large base, but it may prove a concept that could be applied on a larger scale. We need to try something.
1
Please explain --- What is the relationship of their corporations to their h/c systems in the dozens of nations with generations of universal h/c? With either with single payer or with insurance mandates with govt negotiating costs.
What are the advantages for employers and citizens when private business is not involved in health care?
The US media isn't giving Americans this factual data from abroad. The media is avoiding it's duty to compare/contrast the evidence. Citizens and lawmakers from other countries should be interviewed on how they pay for and use health care. Our media and politicians must stop avoiding this enormous source of practical data.
What are the advantages for employers and citizens when private business is not involved in health care?
The US media isn't giving Americans this factual data from abroad. The media is avoiding it's duty to compare/contrast the evidence. Citizens and lawmakers from other countries should be interviewed on how they pay for and use health care. Our media and politicians must stop avoiding this enormous source of practical data.
2
Thanks for this informative article and bringing to light the Health Transformation Alliance. Great reporting!
1
This is so very encouraging. I still think it would even be better as Medicare for all, but especially retaining the comparisons of providers to promote competition and improvements in quality outcomes. This group should consider including dental care by dental therapists in their health care plans.
3
That’s nice. Is this wonderful, improved health care portable? What about small business and its employees? The growing number of contract workers? Those employees who get locked in by the pre-existing conditions of a family member and get exploited financially because of that? Unable to leave and with no leverage to continue to get pay raises and advancement? What about start ups and entrepreneurial activity without which a vital economy is not possible?
As it is, those Americans with health care from large employers, including government, are beyond caring about what is happening in terms of health care policy. Until of course they are downsized, their jobs are outsourced or suddenly changed to contractor status.
We need a health care system that meets the requirements of our modern economy -- not just some tweaking that pretends the most important economic and workplace changes of the last half century haven’t happened.
As it is, those Americans with health care from large employers, including government, are beyond caring about what is happening in terms of health care policy. Until of course they are downsized, their jobs are outsourced or suddenly changed to contractor status.
We need a health care system that meets the requirements of our modern economy -- not just some tweaking that pretends the most important economic and workplace changes of the last half century haven’t happened.
4
I'm currently unemployed but because I'm single and made over a paltry sum of money I'm required to pay full price for a health insurance policy on the NY exchange that has a high deductible, copays, will definitely chew up more than 9.7% of my gross income and my net income and yet nothing has been done by either party to address this and other issues that all Americans who are not rich face.
Being insured doesn't assure one that bankruptcy from needing to pay the deductibles, the copays, etc., won't occur. Being insured doesn't guarantee access to health care when and where it's needed. All it means that we can pay the premium. Yet now, when we see doctors or go to the hospital for care we have to sign agreements stating that we will pay whatever insurance doesn't cover. Our for profit, fee for service wealth care system is failing us because no matter how we're insured we're losing.
We need what other countries have been able to do for their citizens: universal access to medical care, all medical care, no matter how much we earn, our employment status, or where we are when we need care. Health care is a right in other countries. They don't have luxury hospitals. But no one has to worry about medical bankruptcy. Only in America is it a luxury and that says something very sad about our politics and our wealth care industry.
Being insured doesn't assure one that bankruptcy from needing to pay the deductibles, the copays, etc., won't occur. Being insured doesn't guarantee access to health care when and where it's needed. All it means that we can pay the premium. Yet now, when we see doctors or go to the hospital for care we have to sign agreements stating that we will pay whatever insurance doesn't cover. Our for profit, fee for service wealth care system is failing us because no matter how we're insured we're losing.
We need what other countries have been able to do for their citizens: universal access to medical care, all medical care, no matter how much we earn, our employment status, or where we are when we need care. Health care is a right in other countries. They don't have luxury hospitals. But no one has to worry about medical bankruptcy. Only in America is it a luxury and that says something very sad about our politics and our wealth care industry.
7
How can top Republican leadership and the rest of the Republican elected not know that repealing all of the Affordable Care Act would include repealing the ACA’s required 50% discount from drug manufacturers purchased through the Medicare Part D prescription plan?
It appeared to me, that the Democratic Congress and the Obama Administration did not require that discount for generic drugs, as well as brand-name drugs, maybe as a way to encourage drug corporations to make more money off of pushing their generics, which is also cheaper for Medicare.
Since States have always worked with the health industry to accept a smaller percentage of payment for health service prices paid for by State managed Medicaid and to write-off the rest; what does the GOP think is wrong with the ACA requiring that discount for Medicare? (Maybe it is because the discount is law; where it is non-negotiable, and GOP leadership sees it as an overreach; I don’t know, have they ever said?)
It appeared to me, that the Democratic Congress and the Obama Administration did not require that discount for generic drugs, as well as brand-name drugs, maybe as a way to encourage drug corporations to make more money off of pushing their generics, which is also cheaper for Medicare.
Since States have always worked with the health industry to accept a smaller percentage of payment for health service prices paid for by State managed Medicaid and to write-off the rest; what does the GOP think is wrong with the ACA requiring that discount for Medicare? (Maybe it is because the discount is law; where it is non-negotiable, and GOP leadership sees it as an overreach; I don’t know, have they ever said?)
The one REAL way to get rid of all the middlemen driving up the cost of healthcare for everyone and to control prescription medicine costs is simple.
It is called single price anti-trust enforcement!
Require a single price for any health care services or drug company sales, perhaps with quantity discounts, fully disclosed, to all buyers - pharmacies, PBMs, hospitals, distributors, employers, patients, insurance companies, the government, everyone. No hidden rebates, no secret price negotiations, but full disclosure and transparency. Works for the airlines, works for buying milk from Kroger, works for walking in to any other store or service provider with prices listed for all.
It is called single price anti-trust enforcement!
Require a single price for any health care services or drug company sales, perhaps with quantity discounts, fully disclosed, to all buyers - pharmacies, PBMs, hospitals, distributors, employers, patients, insurance companies, the government, everyone. No hidden rebates, no secret price negotiations, but full disclosure and transparency. Works for the airlines, works for buying milk from Kroger, works for walking in to any other store or service provider with prices listed for all.
3
It would seem to me that if we required a system with one price the health care industry would be able to fleece our system if the government was legally required to pay any price they ask for.
Don't we need a free enterprise market so that health care companies would compete for business off of the 'lowest' price? (How do they manage that over in Europe; or is their corruption between the government and the health industry over there?)
Don't we need a free enterprise market so that health care companies would compete for business off of the 'lowest' price? (How do they manage that over in Europe; or is their corruption between the government and the health industry over there?)
Couldn't agree with you more my friend.
1
NOT any price they care to charge, one price for all for the same good and service. They would still have to compete, change prices, negotiate, etc., but whatever price they charged to one buyer they would charge to all. That is pretty much how commerce works, at least when anti trust and such work. You can charge whatever you want for rent for an apartment, but you cannot charge one rent for a tall guy, one other price for a woman of color, a third price for someone from Texas, etc. One price for everyone. Like Wal-Mart.
HTA provides us (consumers of medical services) with a template as follows: 1. organize. 2. assess what is going on physically. 3. Identify resources. 4. negotiate. This is key to understanding HOW to reform healthcare. HTA is having success because it is negotiating from a very strong position of collectivist groups and needs assessment. This gives them the platform to negotiate with pharma and physicians. The question remains whether this could be used outside of employer-based programs. It might be worth the time and effort to try it as a pilot program in other venues.
2
Having worked for one of these corporations, I can assure you this effort isn't driven by altruism- it's more money to the bottom line for the benefit of shareholders. We started with a half-dozen plan choices, and you could choose what fit your needs. Premiums were subsidized and deductibles/co-pays were reasonable. By the time I left, there was no insurance for retirees; one medical and one drug plan to 'choose' from; and employees' share of premiums had gone up substantially. I now have 'private' insurance with another employer. Deductibles are really high and co-pays have gone the way of the horse and carriage. After we meet our individual deductibles, we pay 20% of the bill. Yet we can never find out what that cost is going to be until after the fact.
4
This effort is laudable. However, a hidden risk must be identified and mitigated, and that is the effect these efforts will have on the uninsured or privately insured. The health care industrial complex sees the game as zero sum. If they make less money in one sector, they've got to make it up in another. The only successful way to bring down healthcare for all is for these kinds of efforts to be coordinated across ALL delivery and payment systems.
5
800 billion in administrative costs could be saved with single payer.
Billions on drug regulations
Trillions on stoping unnecessary procedures and imaging
Advertise each and every hospital and providers costs so patients can shop around
A small 3-5% payroll tax increase to pay for single payer would save families thousands that they now pay.
17 Trillion from private pay transferred to single pay is possible if we shut the private for profits down.
Yes do the math and we can afford single pay like the rest of the world.
Billions on drug regulations
Trillions on stoping unnecessary procedures and imaging
Advertise each and every hospital and providers costs so patients can shop around
A small 3-5% payroll tax increase to pay for single payer would save families thousands that they now pay.
17 Trillion from private pay transferred to single pay is possible if we shut the private for profits down.
Yes do the math and we can afford single pay like the rest of the world.
8
Uhhhh.... how about the 43 percent, i.e. the rest of us in real small businesses or any place else that can't afford or won't afford health insurance benefits?
2
As a former member of congress, the author has been able to make the transition to the private sector and has the advantage of knowing the system from the inside. Granted the ideas presented are innivative and can result in cost saving for those businesses. The larger and more serious issues relate to the healthcare industry as it is has been allowed to exist in this country. These ideas only illustrate how very much we need in congress dedicated individuals committed to representing all the people and enacting solutions for them. Instead we have too many self perpetuating idealogues who see as their main occupation doing the bidding of their wealthy backers so they can remain in office. I do often wonder why there is so much opposition to improving the healthcare of Americans, it seems like a good economic move in the long run.
6
Others have already said it, but I'm going to repeat it: Why haven't American companies argued the loudest for some form of single-payer? Surely they recognize the inherent advantage their foreign competition has when foreign companies don't have to worry about providing insurance for their employees? And why would any company want to spend so much time and money on administering insurance benefits when their business focus should be about making a better widget?
8
Obama and Democrats determined that a healthcare premium that drains 9.7% of income is affordable? Are you kiddng me? That is NOT affordable. And that 9.7% is before federal and state taxes are gouged from one's paycheck. This is the type of Obama/Pelosi thinking that cost Democrats the Presidency, Congress, the Judiciary, a solid majority of the governerships, and thousands of seats in state legislatures.
11
The alternative was lifetime limits and underwriting for pre-existing conditions, resulting in millions of people not being able to get coverage. Society decided this wasn't acceptable, which is why the Obamacare protections went into effect. The Republicans haven't done much to undo these due to the repercussions they will face at the polls if they do...indicating they were a good (ie popular) idea despite the cost.
The high cost of health care in this country is the problem, and it is a bipartisan problem. 17% of GDP and rising, and per capita costs 2x that of any other developed country on the planet. And by the way, we are the only developed country that does not have some sort of universal coverage system. Do you think there just might be a correlation?
2
Man, I totally agree, but at the same time . . . Has no one paid for their own health insurance in America over the last 40 years besides the self-employed? The constant upset people have at their sticker costs of SUBSIDIZED Obamacare which are three times lower than I've paid for my unsubsidized care over the last 15 years - well, it's a wakeup call.
1
Recently I had cataract and Glucoma surgery. The surgery took ~15 minutes on each eye. A total for 30 minutes. Surgeon charges were: $18,792. Medicare allowed and the doctor was paid $4,294. Anthesthesia chargers were: $980. Medicare allowed and anthestheologist was paid: $274. The surgery center charges were: $18,982. Medicare allowed and the Surgery Center was paid: $4,183.
For a surgical procedure that took 30 minutes or less. Total all charges were: $38,264. Total Medicare allowed and paid: $8,810.
Patients were lined up and wheeled in and out of multiple surgery rooms all day for these procedures.
How do doctors and hospitals come up with their fantastic charges? The surgeon and surgery center made tens of thousands of dollars - in just one day - just on Medicare allowed charges.
No one but the super wealthy can afford medical care in America. We need to get back to a time when doctors went into the practice of medicine because it was their calling to care for people and not just to make money.
For a surgical procedure that took 30 minutes or less. Total all charges were: $38,264. Total Medicare allowed and paid: $8,810.
Patients were lined up and wheeled in and out of multiple surgery rooms all day for these procedures.
How do doctors and hospitals come up with their fantastic charges? The surgeon and surgery center made tens of thousands of dollars - in just one day - just on Medicare allowed charges.
No one but the super wealthy can afford medical care in America. We need to get back to a time when doctors went into the practice of medicine because it was their calling to care for people and not just to make money.
9
there is some thing called CHARGEMASTER !! read THE BITTER PILL - Times magazine issues dedicated to health care costs a few yrs ago
1
Being a physician is like any other job. No profit, no mission.
1
Should be required reading for everyone in Congress engaged in this issue. I'd suggest that Trump read it, but I doubt he'd have the patience; nor understand the content.
Kudos to Mr. Andrews and the Health Transformation Alliance. Saving hundreds of millions of dollars in prescription drug costs for over 6 million insured lives is no small feat. Imagine the savings to taxpayers if this approach was applied to the 50 million plus enrollees in Medicare and Medicaid, let alone if everyone was covered under a single payer system. Unfortunately, Congress IS required to make that happen. Remember that in 2018 and beyond.
6
Here's a sickness care cost stat I've never forgotten. About a decade back, I was researching type two diabetes mellitus extensively for a family member in the UK, population about 60 million.
In the UK, ten years ago, total national sickness care cost of T2DM was one million pounds sterling an hour.
USA today, population more than 300 million, so more than five times that of UK, unit costs of sickness care much higher, do the arithmetic ...
In my view, national sickness costs per hour for major illnesses may be easier to grasp, may drive home harder, may create a more vivid picture, than the many billions spent annually that are such big numbers they can be hard to grasp.
In the UK, ten years ago, total national sickness care cost of T2DM was one million pounds sterling an hour.
USA today, population more than 300 million, so more than five times that of UK, unit costs of sickness care much higher, do the arithmetic ...
In my view, national sickness costs per hour for major illnesses may be easier to grasp, may drive home harder, may create a more vivid picture, than the many billions spent annually that are such big numbers they can be hard to grasp.
2
Every little bit helps. Being a heavily medicated 80 year-old on Medicare, I continue to hope (and pray) for common sense and fairness and logic to step in and do their jobs. Big Pharma is not God.
4
Been there. Done that.
Some one has to step up and provide people with healthcare solutions. I am happy to hear of this trend. Even if such moves will not solve the nation's healthcare problem, at least some will benefit from this approach.
In the Senate, 49 GOP senators voted in favor of a bill that many of them decried as seriously flawed and which they hoped in their heart of hearts would never become law. Thank God Senator McCain stepped in to criticize Senate Leader McConnell's abandonment of regular order and to vote against this abysmal bill.
What unenlightened behavior among the majority of GOP members of what was once the world's most august deliberative body.
In the Senate, 49 GOP senators voted in favor of a bill that many of them decried as seriously flawed and which they hoped in their heart of hearts would never become law. Thank God Senator McCain stepped in to criticize Senate Leader McConnell's abandonment of regular order and to vote against this abysmal bill.
What unenlightened behavior among the majority of GOP members of what was once the world's most august deliberative body.
5
I am thankful to see an action challenging the control of the strongest monopolies of medicine. We have to reduce costs which means the monopolies in medicine will have to give up the present profit margins they now enjoy. We have to look at ourselves .... what kind of country makes billions of dollars off of its sick people. That is one significant reason why medicine costs so much more in our country.
6
The concept of medical insurance is cruel and unusual punishment for those who have medical problems, even from accidents. Used to be (before ACA, aka ObamaCare) that those for-profit insurance companies had cadres of employees whose sole purpose in life was to deny coverage on claims. They were measured by the number of claims denied, resulting in horrible abuse and death.
It's long past time to expunge the concept of health insurance. The ACA merely tries to give health insurance to more people. The emphasis should be on health CARE, not insurance.
Medicare for all!
It's long past time to expunge the concept of health insurance. The ACA merely tries to give health insurance to more people. The emphasis should be on health CARE, not insurance.
Medicare for all!
12
You forgot to mention that the so called "free market" Republicans made it impossible to negotiate better drug prices for Medicare. You kind of wonder who these politicians are working for and that these tax paid government politicians are just protecting the interest of special interest.
11
You are motivated by a government that doesn't care and an insurance industry who's profits are in controlling distribution, not providing health care. It's a shame and pox on all our houses that Congress fiddles while we all go down in flames. The right wing will tout is as proof that private sector results are better. But it appears that you are doing this because Congress refuses to, not because they can't.
8
Good luck with your "competing network" designed to direct covered employees and dependents to the most competitive providers. In many metro areas one large health system cartel controls more than 70% of total health spend in the region. Why do US employers tolerate a non-competitive health system that costs so much more than in other developed countries and which delivers so much less in outcomes and value? Why do US employers tolerate paying much more than Medicare for the same procedure (often 50-100% more)? The only solution to a non-competitive health provider delivery system is a sole payer system that enforces price controls and ties health system cartels' capital and operating budgets to the reality of fixed pricing, as opposed to today's world where the cartels can charge stupid US employers much higher prices than paid by Medicare and Medicaid. So much for smart HR officers and "transformation".
10
This is a stop gap or work-around due to our government's lack of will to solve this problem. As a single farmer, I am completely left out -- as many other self-employed people are --from these benefits.
4
This is so smart, especially the drug cost aspect. Drug prices are ridiculous, in part because drug companies spend so much money on advertising. Maybe this approach to health care will come to be the norm and will help to improve all current plans, even Medicare, and Medicaid.
4
The for-profit healthcare system is what needs to go.
7
Only fools would trust leaving the fox in the henhouse unattended. The only people who should make a reasonable living from human suffering are those directly involved in alleviating suffering; every one else with their finger in the pie are just people with their finger in a pie. The people who allowed insurance companies to have a major role in health care over decades made a huge mistake in policy determination. The only skills required in health care are the professional skills of doctors and their skilled staff supported by a paper shuffling staff familiar with a common language of medicine. All others are fly by night institutions that wormed their way into health care at the beginning and now occupy a position where they call all of the shots connected with sick people and they not, the direct providers, add nothing but huge expense to health care.
8
Bravo! and about time. NJ
1
On health care, who needs greedy, inhuman, incompetent, callous, corrupt cynical, cruel, crony, capitalist, corporate, plutocrat oligarchs?
Private profit driven corporate America made the health care mess that preceded the ACA. And the ACA is the conservative Republican Heritage Foundation free market 'solution' to the failed Hillary Clinton Administration health care reform effort.
We all have the pre-existing use by mortality date that will end our lives when where and how they are supposed to. Access to affordable quality healthcare is a universal humble humane empathetic human right.
No normal human being facing a chronic or life threatening illness is focused on cost benefit analysis in their selection of medical options. Nor do they care about private profit beneficial for health care industry shareholders and managers. Nor do they have any meaningful medical expertise. We seek to lessen our pain or a cure or longer life no matter the costs.
Single-payer healthcare yesterday, today and tomorrow.
Private profit driven corporate America made the health care mess that preceded the ACA. And the ACA is the conservative Republican Heritage Foundation free market 'solution' to the failed Hillary Clinton Administration health care reform effort.
We all have the pre-existing use by mortality date that will end our lives when where and how they are supposed to. Access to affordable quality healthcare is a universal humble humane empathetic human right.
No normal human being facing a chronic or life threatening illness is focused on cost benefit analysis in their selection of medical options. Nor do they care about private profit beneficial for health care industry shareholders and managers. Nor do they have any meaningful medical expertise. We seek to lessen our pain or a cure or longer life no matter the costs.
Single-payer healthcare yesterday, today and tomorrow.
8
this remark is the very definition of anoesis.
As long as health care is operated as a for-profit business, all the tweaks and adjustments to the system are going to go primarily to the benefit of the business owners. Every single person in America needs health care, it will always be possible to find some who have benefitted from whatever new schemes the bean counters have come up with, but corporate America is never going to come up with a reasonable way to deal with people who need health care and can't pay retail prices. It is ridiculous to keep entertaining this idea.
5
Why isn't industry lobbying for single payer? Why aren't small businesses lobbying as well? Why isn't all of America?
Except for those who have been brainwashed into thinking single payer is "socialism."
Bernie Sanders needs to disappear from the scene if single payer is ever to be supported and become the law of the land. As long as he's the only one touting it, everyone else will be against.
Except for those who have been brainwashed into thinking single payer is "socialism."
Bernie Sanders needs to disappear from the scene if single payer is ever to be supported and become the law of the land. As long as he's the only one touting it, everyone else will be against.
Good luck with your efforts. At least you're doing something positive (and rational). Let's hope Congress (the Republicans) doesn't make it illegal for you to negotiate prices.
"Health Insurance" is an oxymoron. Insurance by definition is a business to assess risk and charge premiums accordingly. To understand, take a simple analogy. Life Insurance. Its premiums are risk based - e.g. your smoking habits, weight, blood sugar, blood pressure and your health history.
Health "insurance" premiums cannot take into account any of the real risk.
So let us call it - "Health Service Contract".
I have not understood why large employers have not banded together and created a jointly owned Health Service Company for their employees. It makes perfect business sense.
Health "insurance" premiums cannot take into account any of the real risk.
So let us call it - "Health Service Contract".
I have not understood why large employers have not banded together and created a jointly owned Health Service Company for their employees. It makes perfect business sense.
I never thought I would live in a day where my health and those of family and friends would evolve into such a profit making commodity.
The health of the citizens of our nation has no face to those entities making profits, not a one. It is greed that leads the parade because most individuals still live by the motto, "those that die with the most toys wins".
The health of the citizens of our nation has no face to those entities making profits, not a one. It is greed that leads the parade because most individuals still live by the motto, "those that die with the most toys wins".
3
Medicare-for-all as a single payer option, while not perfect, is better than any other idea on the table.
I'm a Medicaid physician - my patients are too poor to pay for anything. I am flat-out perplexed by the marketers who come peddling their wares to my office. One company is driving hard to sell "genetic testing" that purports to show which medication is "best" for any given patient. Even ignoring the obvious fact that the company's rep vastly overstates the utility of this test, why would I order an expensive lab eval to assess the utility of a $4 prescription? Another rep is peddling a new med that costs $10,000/month.
What is most surprising isn't the frank mercantile greed at play, it's the way these carnival barkers are trained to counter a doctor's disinterest by subtle character assassination. "We're just asking you to think of your patient," one cries. "Just please keep an open mind for your patient's best interest," exhorts another. Oh please, these reps and their home office overseers wouldn't speak to one of my patients on the street, let alone shake their hands. Go away.
Then, I can educate my patients on the dishonesty of televised drug commercials...it never ends. When we excuse this cancerous commercialism from medicine, we'll go a long way towards cost containment.
I'm a Medicaid physician - my patients are too poor to pay for anything. I am flat-out perplexed by the marketers who come peddling their wares to my office. One company is driving hard to sell "genetic testing" that purports to show which medication is "best" for any given patient. Even ignoring the obvious fact that the company's rep vastly overstates the utility of this test, why would I order an expensive lab eval to assess the utility of a $4 prescription? Another rep is peddling a new med that costs $10,000/month.
What is most surprising isn't the frank mercantile greed at play, it's the way these carnival barkers are trained to counter a doctor's disinterest by subtle character assassination. "We're just asking you to think of your patient," one cries. "Just please keep an open mind for your patient's best interest," exhorts another. Oh please, these reps and their home office overseers wouldn't speak to one of my patients on the street, let alone shake their hands. Go away.
Then, I can educate my patients on the dishonesty of televised drug commercials...it never ends. When we excuse this cancerous commercialism from medicine, we'll go a long way towards cost containment.
6
So spot on. Please continue to educate your patients that anything being 'sold' too hard deserves a second and third look. It's a shame we can't go back to the days when drug advertising was banned. How much money do these companies have to throw around? Enough to use the most expensive medium- mass market TV- to pitch cancer treatments that are so arcane that the number of people they apply to could certainly be educated more efficiently in other ways. Every time I hear technical descriptions of a drug's patient profile that contains language that no one but a medical professional would understand... I realize the drug companies have money to burn.
Forgive my cynicism when it comes to major corporations providing solutions to problems suffered by their workers and/or the public at large. Verizon and American Express did not become fabulously wealthy companies with fabulously wealthy upper management types because of their altruism.
Conservatives still love to howl with delight when that old Reagan line of "The most terrifying words in the English language are: I'm from the government and I'm here to help" is brought up.
Others of us have lived long enough to understand that the most terrifyingly pathetic words in the American lexicon are: I'm from big business and I'm hear to help.
Conservatives still love to howl with delight when that old Reagan line of "The most terrifying words in the English language are: I'm from the government and I'm here to help" is brought up.
Others of us have lived long enough to understand that the most terrifyingly pathetic words in the American lexicon are: I'm from big business and I'm hear to help.
4
Leadership
Allowing the marketplace is a very Republican idea!
Why couldn't Mitch figure out the power of cooperation.
Allowing the marketplace is a very Republican idea!
Why couldn't Mitch figure out the power of cooperation.
That's all fine for companies and employee insurance pools,but but what about everyone else dependent on one of the public pools? Will drug companies and other providers just try and push more of their excessive profit taking to the public sector? We need Republican and Democratic elected officials to wean themselves from medical industry money and do something. Start with no more advertising on television for perscription drugs as a way to lower costs. Release more patents on life-saving drugs. Fund more research that produces cost controlled drugs...Acting like big corporations making deals among themselves is some meaningful change is really kind of pathetic.
Why does the Republican Party drag its feet in fashioning real reforms in health care delivery and pricing? Simple...campaign contributions from Big Pharma...Congress is for sale to those with the most to give. The Republicans and the for profit healthcare industry are engaged in a mutually parasitic relationship behind which they hide in murky 'ideology' that masks the fact that millions suffer and die to preserve the profit margins for the immensely influential industry we call BIG PHARMA but also the physician run business enterprises best denoted as corporate medicine. "Follow the money" clarifies the motivational nexus of this atrocity. Millions suffer and die bereft of competent medical care while corporate barons and associated medical delivery systems benefit from high prices that fill the pockets of some but not all health care providers. "Follow the money" to see who benefits and who dies. Cynical calculations will unveil the real motives behind the failure to install a single payer system.
2
It's lovely that those companies are reducing their health care costs. For those who have the privilege of working for or being a retiree from one of those companies I'm sure it will be a great benefit. But it does nothing for the rest of us.
What many people don't understand is that in the capitalist system businesses want to cut costs not to lower prices or increase wages, but to increase profits. Prices and wages are set by the markets -- by what consumers are willing to spend for particular products or services, and what workers are willing to accept in return for their labor. So if a company's expenses go down -- be it through raw material, health care costs, or taxes, it doesn't mean they will lower prices or increase wages. The first beneficiaries will be the stockholders.
And, if these companies are successful in negotiating significantly lower costs, then care providers will look to other sources to maintain their profits. So, the result of these wealthy corporations lowering their health care costs (so as to increase their own profits) could be an increase in health care costs for everyone else.
There are various solutions to this mess, but the key is to take profiteering out of health care. If we don't want a British-style national health system, it can be done by regulating the profits health care companies can make (or making them non-profit entities), and establishing a government-run, single-payer insurance system.
What many people don't understand is that in the capitalist system businesses want to cut costs not to lower prices or increase wages, but to increase profits. Prices and wages are set by the markets -- by what consumers are willing to spend for particular products or services, and what workers are willing to accept in return for their labor. So if a company's expenses go down -- be it through raw material, health care costs, or taxes, it doesn't mean they will lower prices or increase wages. The first beneficiaries will be the stockholders.
And, if these companies are successful in negotiating significantly lower costs, then care providers will look to other sources to maintain their profits. So, the result of these wealthy corporations lowering their health care costs (so as to increase their own profits) could be an increase in health care costs for everyone else.
There are various solutions to this mess, but the key is to take profiteering out of health care. If we don't want a British-style national health system, it can be done by regulating the profits health care companies can make (or making them non-profit entities), and establishing a government-run, single-payer insurance system.
8
I like the idea of more competition. One large entity controlling the system will also be inefficient with standards eroding. What happened to anti-trust laws? They don't seem to affect the healthcare sector. Why?
1
The amount of padding in both the $ amounts of the bill and the number of procedures performed is a huge part of the problem. For example, Medicare authorizes an annual wellness checkup. Besides the $400 charge for the extended appointment, there were $100 for "advance planning". (Advice: "download and fill out the form available on line") and for nutrition counseling (not even discussed during appointment); $60 each for hearing test (machine set set wrong volume and didn't identify my hearing loss) and for 2 minute read-the-chart eye test. The annual checkup is valuable - has identified thyroid problem and prediabeties. But the bill padding is an outrage and is an embedded part of the medical industrial complex.
7
That's interesting. I have had this "wellness" checkup every year for several years, but it has never included even a rudimentary vision or hearing check.
In general, I agree with you on the high charges, but 1) this is the sticker price, not what you or Medicare actually pay, and 2) if you think these charges are high, go the Emergency Department or have surgery at your local hospital. Primary care physicians often prevent a lot of more costly health care (as you correctly identified), but are the lowest paid physicians in our health care system. Preventive care done well can save many dollars and, more importantly, identify serious illness before it threatens your life and well being, but in our system is not financially rewarded. (I am speaking from direct experience as a former primary care physician.)
1
Lower prices for the members of the Health Transformation Alliance will translate into higher prices for the rest of us -- particularly those of us forced to buy the astronomically priced insurance (and inadequate) available on the exchanges. The only way to make health care truly affordable for all Americans is to enable us all to be members of the same "alliance" -- a single negotiating entity with which providers and drug manufacturers must make a deal or go out of business. Congressman Andrews is half right: "Private sector health care must change." It must "change" by becoming publicly funded.
7
"... we gain more access to drug companies’ pricing structures, strengthening our position in cost negotiations."
Exactly what Congress prohibited Medicare from doing when it passed the Medicare Part D prescription drug insurance.
Exactly what Congress prohibited Medicare from doing when it passed the Medicare Part D prescription drug insurance.
10
Wasn't that restriction to last for 5 years....and by then the GOP controlled power and naturally the interests of people took a back seat to corporate profits;.
I applaud the effort, but the need remains for a medicare for all system that will take the burden off of businesses and citizens. The complicated for profit system we have now is ripe with greed and inefficent allowing for corruption and poor health care for our most vulnerable.
8
A move in the right direction, toward universal coverage , with some degree of choice and competition to optimize the cost/quality ratio. Similar to the Netherlands.
7
Comparing a small uniform well educated, bicycle riding population to the USA is nonsense. BUT, we could model our wellness thinking to be similar to the Netherlands.
Negotiating to bring drug prices down. Reducing premium costs by smarter data driven delivery of service, if only more companies would join us, etc etc etc. I am not against this kind of alternative thinking and action, but it has all been said before. The positive economics of "single payer" make your case, but really you are making the case for single payer. Where are insurance companies in your concept? Are you really proposing to eliminate those middlemen you have magically discovered? Is this still a profit driven venture? I am just not convinced.
5
Here's what I don't understand about pro-business Republicans. Wouldn't the members of this Health Transformation Alliance be more profitable if it did not have health care on it's balance sheets. If they're spending $25B on health care that's $25B less to hire people, re-invest in their company or even just put in their pocket. Why aren't they leading the way for single payer health care?
50
Isn't this just another example of the power of money? Big corporations can combine their power to lower their costs. Good for them. What about everyone else? Guess who makes up for those "savings"? Everyone else. That is exactly why Government Has to be involved!! Big business should be demanding government take these necessary actions, not dealing in their own self interest.
14
Important steps by private industry. But each of these steps is smaller than what Obamacare either aims at, or in the case of readmission rates, improves. Also, it is obvious that the benefits of these private initiatives will only go to those who are already better-off.
A public-run system would be far more capable of controlling costs and improving care than even the best private system. The question is how to get there.
A public-run system would be far more capable of controlling costs and improving care than even the best private system. The question is how to get there.
16
Never count on the private sector to do anything except increase executive pay, that's all they care about.
10
Among many other everyday subjects, most - if not all - members of Congress have never been poor. Have never had to worry about becoming ill and not being able to afford either doctor visits or medications. How can any one of them, or all of them for that matter, claim to know how to write legislation which will affect mostly poor people and blue collar workers? They have never "walked a mile" in the shoes of a poor person. It is similar to our president and nuclear war - he has never spent one second in a war or in the military, yet he seems intent to start a nuclear war. What have we done to ourselves, America??????
16
The fact that $600 million (over 3 years, yet ; and for large companies, yet ) is meaningful money tells us that executive salaries over, say 20 million, are costing the American economy and its participants a lot.
Starting, but not ending with, Big Pharma.
Starting, but not ending with, Big Pharma.
16
I am not "for" those huge salaries, but this is the USA & that is what the market bears. Those salaries are a mere drop in the bucket compared to the overall costs. Perspective, please.
Where is the relief for contract work, part time work at 2 or more jobs, single head of household who opt out of insurance to pay for food and shelter? Cost of medical care, for all of us, is too high. Diabetes Type 1 demands shots of insulin every day for life. At this time there is no cure. But cost of insulin and blood testing supplies continue to rise. Employers please continue doing the work for your employees, but those who are not full time employees will continue to pick up those rechanneled income flows to insurance companies for medical daily needs and procedures.
15
"We and our employees spend more than $5 billion each year on four procedures and ailments: knee replacements, hip replacements, back pain and diabetes."
Most of these ailments are associated with or excerbated by obesity. This is the reason that Obama focused on wellness under the ACA. The only solution to the massive costs of healthcare is a single payer system. Just the stress of worrying about healthcare, adds to illness. I gave up a few years ago and returned to Canada. The peace of mind alone is priceless.
Most of these ailments are associated with or excerbated by obesity. This is the reason that Obama focused on wellness under the ACA. The only solution to the massive costs of healthcare is a single payer system. Just the stress of worrying about healthcare, adds to illness. I gave up a few years ago and returned to Canada. The peace of mind alone is priceless.
12
CT scans, MRIs, and cancer tumor genetic testing are all examples of newer medical technology that are now routine. Prior to their invention, these were obviously not then an expense. We must resign ourselves to increased costs as more things are invented unless we want to forego progress.
Great for corporations. I'm self-employed. When Obamacare became effective, I doubled my deductible just to keep my premium the same. Since then, my premium has also doubled. Except for our annual physicals, my wife and I are $$34,000 away from the health insurer using any of its money to pay for our care. (If we meet our deductible, which was once in 17 years, the first money the insurer uses is the money we already paid them.) None of this has to do with our health "experience." We are in fine health (and work hard to keep it that way). The increases are strictly due to the decision of (exclusively)Democrats to "spread" the financial responsibility for other persons' health expenses over the pool of insureds, rather than over the tax-paying populace. I don't like the latter, but I really don't like the former.
1
Sorry buddy, we are ALL in this together. We pay for each other! Single Payer is the only way to go. Heartless, libertarian solutions are not effective; it leaves too many people out. Remember, millions of your fellow Americans work very hard, 2-3 low wage jobs where they don't get insurance; they too need--and deserve access to affordable care as do you and your wife.
2
You seem to imply that your and your wife's good health is due to your hard work. Congratulations on making good lifestyle choices. But surely you realize that your good health won't last and that much of your wellness is beyond your control. Accidents happen to even the most cautious, disease strikes even the most virtuous. Spreading risk is the basis of ALL insurance. I never let my children play with matches and never installed my own wiring, and never had a house fire. (But I could have had a gas explosion caused by faulty gas lines outside of my control). Yet I paid for homeowner's insurance with its spread-risk rates. The same with auto insurance. I've never had an accident yet I pay every year. Why should health insurance rates be based on current wellness or lifestyle?
1
Your high costs are the result of many factors, including a risk pool that is too small and too sick, health insurers that are for-profit businesses, and inadequate control over costs. As the author illustrates, a larger risk pool has the economic leverage to reduce costs across the board. You are making an excellent argument in favor of universal, single payer health care.
2
The problem with this laudable program is that it only provides healthcare for 4 million employees (and their families?) whereas the US has over 326 million people (and unknown numbers of illegal aliens). It is a pilot program at best, and of course, when someone leaves one of these participating companies they lose their healthcare. In addition, since the cost of this program is not taxed to the recipient, and is a deductible expense to the corporation or the recipient, it is partly financed by the federal government. Nevertheless, this is is a good start toward a properly working healthcare system.
5
This article is long overdue, for the past 7 years congress and the media have focused on the ideology driven ACA. Both have ignored the rest of our health insurance system which relies on employers. As the author points out that system is also unsustainable. It also suppresses wages, employers cannot provide expensive and give raises at the same time.
4
Tell me, in these large companies, do they not pay employees for sick leave, vacation time, or personnel time? Isn't this cost tax deductable? But to not pay for health care is self defeating!! Maybe in the near future when the labor market is tighter, applicants again will choose to go to firms which have benefits for them. I was also under the impression the firms working under goverment contracts did give their folks health care, I agree that the 50 size number may be too low. But OBAMA care give many workers the freedom to change jobs, if needed,without being under the yoke of their employer.
1
Expand Medicare by lowering the enrollment age by 10 years for the next six years thereby enabling the for profit healthcare industry to change their business model or go out of business. The industry will experience a nice slow death, just like the public.
11
If my employer is essentially also my insurance company, can I now be fired if I develop a debilitating illness like cancer or type-1 diabetes?
10
Right now, they're really doing much of anything towards reducing costs. They're still in data gathering mode.
In the end, whether people like it or not, the only true way to make this work is to have someone with a big enough stick to dictate costs terms to providers. This can only come from the federal government, which also would mean a single payer system. Anything else would create the same problem we're seeing today, especially in the long term.
In the end, whether people like it or not, the only true way to make this work is to have someone with a big enough stick to dictate costs terms to providers. This can only come from the federal government, which also would mean a single payer system. Anything else would create the same problem we're seeing today, especially in the long term.
15
Sadly, the 'big-enough stick' belongs to Congress; we don't have a functioning Congress that cares about the people of this country. The Congress works for the corporate interests that brung 'em. Unless that changes, what leverage do we have re: private insurance? Voting for populist politicians who don't take money from corporate interests is a start. Most Americans don't appear to make the connection between unaffordable health care and the corporate owned Congress. They'd rather condemn and feel disdain for their (poorer) fellow Americans, for having access to care. Sane, thinking Americans must fiercely advocate for Single Payer until it happens! Perhaps one state at a time. California legislature, are you listening to us??!!!
While the actions of this Health Transformation Alliance may benefit its own corporate members, what good is it for everyone else? It accounts for only 6 million employees out of 127 million full time workers in the U.S. What about the rest of the 326 million people who don't work for these huge corporations?
This highlights one of the biggest problems with the U.S. health care "system": disparities in the availability and cost of health care coverage, determined by place of employment. It is an entirely irrational and patently inequitable way to make such determinations. Only the largest corporations have the market power to effectively negotiate with insurers and providers, leaving everybody else out in the cold. The health care industry does not meet the definition of a free market, and free market "solutions" cannot fix it.
The data analysis and bargaining power being touted by the Alliance can be very beneficial to its members. Imagine how this could work if it included everyone, not just employees of huge corporations. Interestingly, a very popular program has been successfully using such methods for decades: Medicare. And Medicare does it at a fraction of the administrative cost. Expanding this to cover everyone is the logically obvious solution. We need to stop labeling such a plan as politically infeasible, stop allowing the rigidly heads-in-the-sand, Ayn Rand-loving, "conservative" ideologues to dominate the conversation, and point out their obvious logical flaws.
This highlights one of the biggest problems with the U.S. health care "system": disparities in the availability and cost of health care coverage, determined by place of employment. It is an entirely irrational and patently inequitable way to make such determinations. Only the largest corporations have the market power to effectively negotiate with insurers and providers, leaving everybody else out in the cold. The health care industry does not meet the definition of a free market, and free market "solutions" cannot fix it.
The data analysis and bargaining power being touted by the Alliance can be very beneficial to its members. Imagine how this could work if it included everyone, not just employees of huge corporations. Interestingly, a very popular program has been successfully using such methods for decades: Medicare. And Medicare does it at a fraction of the administrative cost. Expanding this to cover everyone is the logically obvious solution. We need to stop labeling such a plan as politically infeasible, stop allowing the rigidly heads-in-the-sand, Ayn Rand-loving, "conservative" ideologues to dominate the conversation, and point out their obvious logical flaws.
16
Please tell me how many people were insured under the "old insurance company" monopoly system before the ACA was in exsistance and which looks like it will come back!!!
1
One thing demonstrated by this article is a rudimentary understanding of data and how it may be misused. The authors use an example to suggest that differing recovery/relapse rates between hospitals is due to differences in quality of care. That interpretation is overly simplistic even for a former congressman - the size of the sample, the nature of the population and the likelihood that one hospital might get more complicated cases all confound the example used in the article. Regarding middlemen -only someone from DC would fail to understand that middlemen exist by subtracting value from the supply chain. There is no evidence they enhance efficiency or access and most data suggests otherwise.
10
Putting some of the numbers together it seems that the companies represented in this piece spent $5 billion (out of the total healthcare cost of $25 billion) on only 4 things. knee replacements, hip replacements, back pain and diabetes. I've never seen these numbers before. That's 20% of the total cost on a handful of ailments.
And it's interesting to examine these ailments in particular. Joint replacements are a relatively new procedure and, in many cases, these patients could lead meaningful (although limited) lives without them. Back pain may be the rabbit hole of healthcare where expensive and complicated procedures are prescribed regularly with results that are often no different from cheaper, less invasive treatment or no treatment at all. And Diabetes rates in the US are relatively high and largely attributable to lifestyle habits such as diet and exercise.
I point these out without a particular agenda in mind but as insight for the frequent comparisons to many European countries and their healthcare systems. If you travel in Europe you see many more people walking with canes for example indicating that perhaps their approach to treating joint and back pain might be different. And European countries face much lower instances of diabetes. There's a notion that European style socialized medicine could be applied to the US in some sort of plug-and-play fashion. This is some evidence that the implications would not be so simple.
And it's interesting to examine these ailments in particular. Joint replacements are a relatively new procedure and, in many cases, these patients could lead meaningful (although limited) lives without them. Back pain may be the rabbit hole of healthcare where expensive and complicated procedures are prescribed regularly with results that are often no different from cheaper, less invasive treatment or no treatment at all. And Diabetes rates in the US are relatively high and largely attributable to lifestyle habits such as diet and exercise.
I point these out without a particular agenda in mind but as insight for the frequent comparisons to many European countries and their healthcare systems. If you travel in Europe you see many more people walking with canes for example indicating that perhaps their approach to treating joint and back pain might be different. And European countries face much lower instances of diabetes. There's a notion that European style socialized medicine could be applied to the US in some sort of plug-and-play fashion. This is some evidence that the implications would not be so simple.
3
The "four most common procedures" tells me that a large proportion of workers are older, which is good news for us older people. Eliminating the middlemen is a wise move. This sounds like a fine beginning. Now, get Congress to pay attention.
2
Forgive me if I am skeptical. Companies had decades to "band together" for the benefit of their employees. Who is even an employee now? Gig jobs, layoffs, temp work, employees deliberately kept out of qualifying positions.
Stop thinking we are fooled by "market solutions".
Stop thinking we are fooled by "market solutions".
8
While you are on task, consider and try to find out why these are such common aliments: "knee replacements, hip replacements, back pain and diabetes". Your op-ed indicates this is 20% of health insurance costs at the companies in the alliance. The best cost savings, and the best results, would be to assist people in preventing these problems or intervening earlier with less drastic procedures. All four of these conditions are in some ways amenable to diet and exercise as preventative measures.
10
It appears that caring about not only the bottom line, but also about retaining healthy and productive employees, in a type of, how should I say, socialist arrangement, can be effective in increasing the possibility of affordable health care. Homework, hard work, cooperation in what might be even competing companies and a continuing effort for the good of the population is needed and is essential in creating a healthy work environment. An effort that the Republican members of Congress put toward worsening and actually degrading the health of the American workforce, much of it under the auspices and guidance and approval of Dr. Price and the current occupant of the oval office and the 19th hole. Reach your own conclusions about the 2018 elections.
4
Not much here on "eliminating the middleman." I'd be interested to know if the companies in the Alliance are self insured, which means the cost savings go to them first, their employees second and only to the extent they are passed along.
In other scenarios, we have the business of insurance companies and agents. The revenue to them is gigantic; but what do we get for that? What value do they add?
In other scenarios, we have the business of insurance companies and agents. The revenue to them is gigantic; but what do we get for that? What value do they add?
8
They are undoubtedly self-insured, as they are very large companies. There is no point in such large companies buying insurance.
1
I am happy to hear that companies are getting together to solve healthcare issues. They might also consider the following: back problems and knee problems are often caused by conditions at work. To reduce these problems take a look at how your employees spend a day at work. Some carry heavy loads without protection. Many work overtime and rarely take time for vacations. Many go to work sick because of nonexistent sick leave. Most sit at their desks all day, afraid to get up to stretch or walk around a bit. Some have cafeterias that sell horrible food, which contributes to health problems. The responsibility does not lie solely with the company, but when companies have wellness committees that help employees, that could transfer to a change of habit at home. Everyone benefits when we lift up each other.
3
There are several problem with this approach. It has been tried before (look up Arizona COalition for Cost-Effective Quality Health Care). Experience shows that (1) employees not covered by these employers and employers not in this Alliance experience price increases as health care firms try to maintain their profits (2) those not covered by Medicare, Medicaid or employer-based coverage - the uninsured and those who purchase insurance in the individual market - face increasing financial barriers to care (3) health care providers, pharmaceutical companies and prescription benefit managers threaten such alliances with anti-trust action, calling such alliances as monopsonists, (4) health care providers form their own counter-alliances, consolidating countervailing power and (5) this does nothing for the cost or quality of health care in rural areas - this is a solution for those whom live in large urban areas.
This has been tried before, and turns the health care market into a small number of massive buyers and sellers. Those not part of these giants get squeezed.
This has been tried before, and turns the health care market into a small number of massive buyers and sellers. Those not part of these giants get squeezed.
7
We've heard this story before. HMO's were supposed to be the magic innovation that would bring costs under control. The small effect they had at first petered out. The world-wide experience is perfectly clear - government must take a strong role in determining prices. Individual health care consumers have no effective price-shopping power, and the somewhat greater power of employers and HMO's etc. has just not done the job either. Government must be the collective bargainer for healthcare consumers. The effective parts of Obamacare have been the extension of Medicare, the requirement to cover pre-existing conditions and subsidies in the exchanges, and definitely not the "free-market" exchanges themselves. Those who do not get subsidies still must pay extremely high prices in the exhanges, which continue to rise.
Some party, presumably Democrats, must give up the pretense that "free markets" can be a major part of solution to providing universal healthcare.
Some party, presumably Democrats, must give up the pretense that "free markets" can be a major part of solution to providing universal healthcare.
10
"Laboratories of democracy" is a phrase popularized by U.S. Supreme Court Justice Louis Brandeis in New State Ice Co. v. Liebmann to describe how a "state may, if its citizens choose, serve as a laboratory; and try novel social and economic experiments without risk to the rest of the country."
In our modern economy of huge corporations, evidently they can do what states have done. Good, at least good that someone is doing it.
I do wonder if it is healthy for our democracy that such state-like power is in the hands of HR departments of major corporations. It is better that someone do it than nobody do it at all. Our states are failing us as much as our Feds.
Politicians won't act because they are owned by their donors, yet the corporate world does act, at least for itself. That is not exactly good government, but it is a (mangled) form of democracy.
In our modern economy of huge corporations, evidently they can do what states have done. Good, at least good that someone is doing it.
I do wonder if it is healthy for our democracy that such state-like power is in the hands of HR departments of major corporations. It is better that someone do it than nobody do it at all. Our states are failing us as much as our Feds.
Politicians won't act because they are owned by their donors, yet the corporate world does act, at least for itself. That is not exactly good government, but it is a (mangled) form of democracy.
2
This attempt by private companies to control the cost of healthcare highlights an important truth that is rarely mentioned: health insurance and healthcare costs were rising before there was an A.C.A. and the private insurance sector was failing before the A.C.A. and is continuing to fail.
Insurance companies did not resist the A.C.A. when Obama proposed it because the private employer based insurance system was failing even back then. The A.C.A. provided the insurance companies with a pool of new customers and an injection of federal money and was as much a bail out of insurance companies as it is a blessing for the previously uninsured and the privately unnsurable people with preexisting conditions and expensive chronic medical conditions.
Private health insurance is a luxury that we can no longer afford. Every other advanced country in the world has long since figured that out. It is time we acknowledged the obvious and worked on establishing a viable single payer plan.
Insurance companies did not resist the A.C.A. when Obama proposed it because the private employer based insurance system was failing even back then. The A.C.A. provided the insurance companies with a pool of new customers and an injection of federal money and was as much a bail out of insurance companies as it is a blessing for the previously uninsured and the privately unnsurable people with preexisting conditions and expensive chronic medical conditions.
Private health insurance is a luxury that we can no longer afford. Every other advanced country in the world has long since figured that out. It is time we acknowledged the obvious and worked on establishing a viable single payer plan.
16
" For example, if data tell us that 50 percent of patients who visit a particular hospital suffer a relapse for a particular medical condition while only 25 percent of patients who visit a crosstown hospital have a relapse for the same illness, we want our employees to know that — and if possible, to use the hospital with the better results. The data can save lives."
If you died, you're probably not going to have a relapse. If you have cancer or other chronic conditions, it's very possible that a facility that extends lives will have a higher readmission rate for the same illness. Some of your employees might want to know which facility has a longer term survival rate with the same condition, not the readmission rate?
There are people with late stage cancers who survive for years who are readmitted all the time. That may well having "relapses" and readmissions because they are getting more aggressive treatment and having better long term results.
The status quo clearly unsustainable. We must be careful when cost containment is the only goal in health care. Corporate alliances are a good idea for cost containment but I would not trust them to improve health outcomes when their goal is simply cost containment.
The reality is we need universal coverage and we need a commitment to funding it. Cost containment for corporate insurance, like public insurance is important. It's not the goal of quality health care.
If you died, you're probably not going to have a relapse. If you have cancer or other chronic conditions, it's very possible that a facility that extends lives will have a higher readmission rate for the same illness. Some of your employees might want to know which facility has a longer term survival rate with the same condition, not the readmission rate?
There are people with late stage cancers who survive for years who are readmitted all the time. That may well having "relapses" and readmissions because they are getting more aggressive treatment and having better long term results.
The status quo clearly unsustainable. We must be careful when cost containment is the only goal in health care. Corporate alliances are a good idea for cost containment but I would not trust them to improve health outcomes when their goal is simply cost containment.
The reality is we need universal coverage and we need a commitment to funding it. Cost containment for corporate insurance, like public insurance is important. It's not the goal of quality health care.
6
Mortality isn't just about percentages. Uninsured patients or those with less coverage seek care later. The lack of interpretive services for language in some populations can be a barrier. Limited access to a primary care physician in rural areas can influence out come.
There are more than just financial barriers to good patient care. Single payer can give financial access. However, the system needs to address issues like supporting programs to help med students become family doctors. Support for teaching hospitals, out reach programs, and comprehensive social services are other areas that could help.
There are more than just financial barriers to good patient care. Single payer can give financial access. However, the system needs to address issues like supporting programs to help med students become family doctors. Support for teaching hospitals, out reach programs, and comprehensive social services are other areas that could help.
2
"... if data tell us that 50 percent of patients who visit a particular hospital suffer a relapse for a particular medical condition while only 25 percent of patients who visit a crosstown hospital have a relapse for the same illness, we want our employees to know that — and if possible, to use the hospital with the better results."
I hope the data is also used to help the hospital with the poorer results to figure out what to change to improve their results.
I hope the data is also used to help the hospital with the poorer results to figure out what to change to improve their results.
That's great. More data, better results, more savings. An informative article. But another one whose primary subject is cost-benefit analysis. Somewhere in here, and in many others like it, the human body and humanistic solutions are lost in the data. That in itself is unhealthful.
Not a word here about perhaps the most efficient and effective cost controls there are. Namely, preventive care. And what forms preventive care can take. For instance, we are what we eat. Food is a primary driver of health, both good and bad. The piece specifies diabetes as one of the most costly maladies to treat. Diabetes is a malfunction of the liver and blood and has very serious complications. A main cause? Eating disorder, a poor diet and a sedentary life style, among other factors. It's logical: to deter diabetes, encourage better food education and choices and much more activity. There, I have just greatly reduced the costs of diabetes. Is that in this article? I missed it. The same would apply to heart disease, and albeit perhaps less, to matters of bone health. Humans have an inherent, biological need for activity. We are much healthier with it than without it. I paraphrase: use it--wisely but consistently--or lose it. James Brown sang it: get up offa that thing.
The costs of pharmaceuticals and prescriptions? Do those costs include the endless flood of tv and newspaper ads? Of needing one prescription to offset the effects of another? Of big pharma jamming doctors to jam us?
Not a word here about perhaps the most efficient and effective cost controls there are. Namely, preventive care. And what forms preventive care can take. For instance, we are what we eat. Food is a primary driver of health, both good and bad. The piece specifies diabetes as one of the most costly maladies to treat. Diabetes is a malfunction of the liver and blood and has very serious complications. A main cause? Eating disorder, a poor diet and a sedentary life style, among other factors. It's logical: to deter diabetes, encourage better food education and choices and much more activity. There, I have just greatly reduced the costs of diabetes. Is that in this article? I missed it. The same would apply to heart disease, and albeit perhaps less, to matters of bone health. Humans have an inherent, biological need for activity. We are much healthier with it than without it. I paraphrase: use it--wisely but consistently--or lose it. James Brown sang it: get up offa that thing.
The costs of pharmaceuticals and prescriptions? Do those costs include the endless flood of tv and newspaper ads? Of needing one prescription to offset the effects of another? Of big pharma jamming doctors to jam us?
3
If you think this is effective, just think of the savings possible if the government would negotiate prices.
7
“We and our employees spend more than $5 billion each year on four procedures and ailments: knee replacements, hip replacements, back pain and diabetes. These common problems account for 20 percent of the money our companies spend on treatment.”
Comments: Expensive knee and hip replacements are over-sold (sell aggressively, as by using high-pressure merchandising techniques) by the medical profession. Knee, hip, and back pain and diabetes should first be treated with dietary changes, weight reduction, and exercise programs
Comments: Expensive knee and hip replacements are over-sold (sell aggressively, as by using high-pressure merchandising techniques) by the medical profession. Knee, hip, and back pain and diabetes should first be treated with dietary changes, weight reduction, and exercise programs
3
Unfortunately, these treatments work best long before the symptoms become so severe as to require expensive procedures.
I have a worn-out knee meniscus, four degenerated lumbar discs, and a bone spur on my heel. Simply walking three miles over hilly terrain five or more days a week keeps these under control. I also put heel lifts in my shoes to alleviate strain on my Achilles tendon. To avoid diabetes, I have a whole plant-based diet. My sister is six years younger and has severe diabetes. It's not a matter of genetics.
Modest exercise and diet can control a great many medical problems. Note that my knee is worn out because I spent decades running for health. Walking is better!
I have a worn-out knee meniscus, four degenerated lumbar discs, and a bone spur on my heel. Simply walking three miles over hilly terrain five or more days a week keeps these under control. I also put heel lifts in my shoes to alleviate strain on my Achilles tendon. To avoid diabetes, I have a whole plant-based diet. My sister is six years younger and has severe diabetes. It's not a matter of genetics.
Modest exercise and diet can control a great many medical problems. Note that my knee is worn out because I spent decades running for health. Walking is better!
2
One of the main drivers in hip replacement is undiagnosed or diagnosed hip displaysia in mainly active, healthy woman between the ages of 45 -65.
I am a very healthy (otherwise) 61 year old woman who fits in this category of hip replacement candidate. I have always eaten a healthy diet, been very active and am at the low end of the BMI charts. Before you go generalizing I suggest you get so facts to back up what you're saying.
I am a very healthy (otherwise) 61 year old woman who fits in this category of hip replacement candidate. I have always eaten a healthy diet, been very active and am at the low end of the BMI charts. Before you go generalizing I suggest you get so facts to back up what you're saying.
The best guess is that 10% of all total hip replacements in the United States is because of hip dysplasia. This means that approximately 35,000 total hip replacements each year in the USA are because of hip dysplasia. Early detection can prevent some total hip replacements through modern techniques of hip preservation surgery
http://hipdysplasia.org/adult-hip-dysplasia/faq/#2
http://hipdysplasia.org/adult-hip-dysplasia/faq/#2
Here is a simple solution to what appears to be a complex problem. Employers, presently providing employees with health insurance, should give these employees pay raises with the money saved if the federal and state governments provide single payer health insurance (Medicare for everyone) or use this saved money to pay the increases in the present Medicare payroll tax, deductions that will happen when a single payer health coverage becomes law.
1
Data on the outcomes and costs of hospitals, medical groups and doctors should be made readily available. It could then be used by consumber organization or government agencies it to rate them. These ratings would allow us to made informed decisions as to where to go for medical services and which to avoid. It would also put competitive pressure on those medical organizations with lower ratings to do better.
Medicare provides me with incredible coverage in the best hospital in the West. Due to my nonprofit Medicare Advantage program, I have no copays, even for specialists. It's time to institute Medicare for all. You can phase it in. You can offer it on every exchange. Now, that's competition.
Way too many people do not work for big corporations. Let's get profitability out of the health equation.
Way too many people do not work for big corporations. Let's get profitability out of the health equation.
8
Exactly the right approach. While it's necessary to be focused on cost, especially since our costs tops all others, a focus on quality is long over due and the cry by congressmen about not being able to afford Medicare for all, is ludicrous. We have the means, but not the will.
"The Health Transformation Alliance [is] troubled by the number of middlemen who drive up the price of care, and by the soaring costs of prescription drugs."
Is the HTA abandoning a central tenet of GOP free-market fundamentalism? Everyone knows a market becomes more efficient when pricing is opaque and when that market is dominated by a few too-big-to-fail quasi-monopolies--monopolies within which profits are taken by many individuals at many levels of non-productive activity.
That is the central tenet taught in Free-Market Fundamentalism 101.
Is the HTA abandoning a central tenet of GOP free-market fundamentalism? Everyone knows a market becomes more efficient when pricing is opaque and when that market is dominated by a few too-big-to-fail quasi-monopolies--monopolies within which profits are taken by many individuals at many levels of non-productive activity.
That is the central tenet taught in Free-Market Fundamentalism 101.
1
This system probably will achieve some savings around the edges, but because it fails to attack the problem at its core, those savings will likely be modest and ephemeral. So long as private for-profit insurance companies remain the vehicle for payments, we will continue to see 30% siphoned off in the form of administrative bloat, managing (and denying) claims, paying legions of administrative workers to push paper (or electrons). So long as doctors continue to run offices staffed by large numbers of insurance billing staff, and stock equipment and material that could be used more efficiently at a central clinic, we will see costs rise as doctors increase charges to cover expenses. So long as every community hospital continues to yearn for the latest technology, rather that sharing and distributing need, we will see overuse, and higher costs. In short, so long as every corner of medicine remains a profit center, we will not break the back of ruinous medical cost increases.
1
You left out the most important one: so long as we finance our health care system with fee-for-service payments to doctors and hospitals that disporportionately reward the most expensive and invasive procedures--with little regard for efficacy or long term effects, we are doomed to increasing costs and decreasing health in our population.
1
Health care needs to be untethered from employment. We need to utilize these cost control methods across the board. It would save money and supply better outcomes.If everyone was in we could negotiate from a position of strength. In other words, Medicare for all.
2
There is a very simple part of the health care enigma that has the potential as least-cost and best-outcome. Strongly induce individuals to become healthy: better diet, two hours per week of walking or similar and kill the sugar intake.
Besides their many ailments, most Americans have more weight on themselves than their grandparents ever had. It is not as simple as less weight but neither is it as complicated as landing a rocket on an island in the ocean.
Besides their many ailments, most Americans have more weight on themselves than their grandparents ever had. It is not as simple as less weight but neither is it as complicated as landing a rocket on an island in the ocean.
1
Hurray for the companies, I guess. My own employer, a mid-sized private university, is unlikely to participate and costs on its program have risen, not outrageously but steadily. Were I in the University of Texas system it would be otherwise. But isn't this how the mess began? Many Americans do not work work for huge corporations and getting affordable coverage for all, not just for some fortunate employees of some private enterprises, was the goal of the ACA. Who needs Congress? The answer is the people of the United States, to act to act for the people as a whole, on a matter not just of benefit but of necessity in a way that no lesser entity, public or private, possibly can do. Didn't the first Republican president say something at Gettysburg about government "for the people?"
6
The Affordable Care Act was about insurance; mandatory insurance, insurance pools, mandatory coverages for preexisting conditions and for children into their twenties. It only dealt with affordability indirectly. The healthcare legislation proposed by the House and Senate removed coverage to the neediest Americans and similarly did nothing about affordability of healthcare.
One wonders whether Congress will ever really try to do what private parties with bargaining power (i.e. insurance companies who contract with hospitals and doctors) do privately now to manage costs.
Personally I think that the best way for government to make health care affordable, apart from a single payer system, is to make the market work better by requiring hospitals and doctors to disclose costs of procedures, medications, etc. up front and publically so that consumers can make informed decisions. That remains the greatest impediment to market driven cost containment.
One wonders whether Congress will ever really try to do what private parties with bargaining power (i.e. insurance companies who contract with hospitals and doctors) do privately now to manage costs.
Personally I think that the best way for government to make health care affordable, apart from a single payer system, is to make the market work better by requiring hospitals and doctors to disclose costs of procedures, medications, etc. up front and publically so that consumers can make informed decisions. That remains the greatest impediment to market driven cost containment.
1
employers and individuals should be allowed to buy into Medicare. Here is a secret no one knows. It costs less to insure an average 40 year old than a healthy 65 year. that explains why we have we have expensive private insurance today with multi million dollars pay packages for health insurance execs.
For those without enough money put them into Medicaid. Have a tax to pay for Medicaid.
For companies that think they can do better let them do their own insurance.
Want cheap drugs go global and buy in the global economy.
For those without enough money put them into Medicaid. Have a tax to pay for Medicaid.
For companies that think they can do better let them do their own insurance.
Want cheap drugs go global and buy in the global economy.
3
Wow!
Also, a single payer system would reduce complexity and overhead costs.
Also, a single payer system would reduce complexity and overhead costs.
10
The employer plan I have from Emory Healthcare has overhead costs of only 7%. It is the individual policies that have high overhead, not insurance provided by large employers. And the ACA restricts the overhead in the individual market on the exchanges to 20%.
I need Congress. All Americans who pay for health care premiums individually do. Everybody that thinks that health care is for all and not for a few need Congress to do its job.
9
I want to know what the author and his business community has to say about the doctor shortage, which is suppose to critically worsen over the next 5 years, and the law of supply and demand? Do they know of any instance in the history of the world where the law of decreasing supply (physicians) and increasing demand (patient needs) hasn't eventually kicked in? Doctors are becoming a rare commodity, and replacing physicians with much lesser trained non-physician providers is a recipe for disaster. As we doctors become more in demand, and our finite numbers continue to decrease, guess what happens to our value?
3
Whenever we took about Europe we never mention that they have a much higher percentage of primary care doctors to patients. Obviously the supply helps reduce cost.
the reimbursement for gerontologist and primary care physicians is very low. We have limited spots in US medical schools and high costs. We have a shortage of both. That's why insuring another 20 million people didn't reduce emergency care and won't. It actually increases it. Without more doctors, you can't cover more people.
You can have a capitalist system, socialist system or communist system. The laws of supply and demand still apply.
the reimbursement for gerontologist and primary care physicians is very low. We have limited spots in US medical schools and high costs. We have a shortage of both. That's why insuring another 20 million people didn't reduce emergency care and won't. It actually increases it. Without more doctors, you can't cover more people.
You can have a capitalist system, socialist system or communist system. The laws of supply and demand still apply.
"The doctor says he's coming, but you got to pay in cash"
I applaud your efforts to make a broken system work a little better.
4
The incentives with this project are still all wrong. The Health Transformation Alliance appears to be primarily about reducing costs in order to save corporations money. It's about "getting better value." However, the insurance companies are still there. Copays, deductibles, co-insurance is still there. Cost shifting back to the consumer is still there. If you have ever worked for a large corporation you know they don't have your best interest at heart. Bring on Single Payer.
9
Interesting. Hopefully a regular update using real data will be made available to the public. You should meet with a large group of congresspeople.
5
Republicans should call the democrats' bluff and produce a plain bill with a fully government controlled single payer system, just to get it scored by the sainted CBO.
The costs will be in the trillions.
The costs will be in the trillions.
7
It could happen if the Republican bill will ban the government from negotiation with health providers. Interesting, how other countries manage to have a single-payer system and yet have lower health cost.
7
Of course you would no longer have to pay for ur insurance. So as long as my taxes didnt go up 20k as a result, which is the current approximate after tax cost of my current insurance, seems like a pretty good deal. Further the current population receiving single payer is the sickest part of the population and yet there insurance has not bankrupted the nation. All other western nations have it and most are doing well economically how do u explain?
3
Over enough years, all health care systems apart from Republican "benign neglect {a/k/a "let them die") will cost trillions.
The questions are:
1. What quality of healthcare is being delivered?
(Currently, Medicare, Veterans hospitals, the programs for federal employees, and Cadillac policies provided by unions and Fortune 500 corporations provide very good and often excellent care. Medicaid provides mediocre care. The less expensive policies sold to individuals and small business generally provide poor health care.)
2. Who pays?
Currently, customers pay for employer-based insurance coverage (with the cost built into pricing), taxpayers pay for Medicaid, and beneficiaries pay for Medicare. Single-payer could be funded in any of these a variety of other ways. Single payer would have the important economic benefit of relieving employers of the expense and burden, which often makes American companies less competitive than companies in countries with national health care funded by general tax revenues (such as Canada).
3. How much is lost on waste, corruption and profiteering?
More than 90% of Medicare and Medicaid "revenues" go to actual care, but in at least one year almost 9% was estimated to have been lost on fraudulent claims. Until passage of the ACA, less than 50% of private insurers revenues went to actual care, with the rest being direct to administrative costs, marketing and profits. Their losses from waste and fraud are not published.
The questions are:
1. What quality of healthcare is being delivered?
(Currently, Medicare, Veterans hospitals, the programs for federal employees, and Cadillac policies provided by unions and Fortune 500 corporations provide very good and often excellent care. Medicaid provides mediocre care. The less expensive policies sold to individuals and small business generally provide poor health care.)
2. Who pays?
Currently, customers pay for employer-based insurance coverage (with the cost built into pricing), taxpayers pay for Medicaid, and beneficiaries pay for Medicare. Single-payer could be funded in any of these a variety of other ways. Single payer would have the important economic benefit of relieving employers of the expense and burden, which often makes American companies less competitive than companies in countries with national health care funded by general tax revenues (such as Canada).
3. How much is lost on waste, corruption and profiteering?
More than 90% of Medicare and Medicaid "revenues" go to actual care, but in at least one year almost 9% was estimated to have been lost on fraudulent claims. Until passage of the ACA, less than 50% of private insurers revenues went to actual care, with the rest being direct to administrative costs, marketing and profits. Their losses from waste and fraud are not published.
Make lawmakers pay for their own insurance. On the individual market. Next question.
7
most of them have lots on money and it wouldn't be a concern
Early stage entrepreneurs need Congress to provide them health insurance because insurance companies only work with groups of several employees.
3
So banding together into a larger group not only gives financial leverage to reduce costs, it also provides data that leads to better-informed care choices.
Hmmm... so maybe the more people in the pool, the better the data? A really big pool would give the kind of big data businesses rely on for quality decision-making.
A really big pool, of say, 300 million people, an entire nation's worth. Maybe that's the pool we should be jumping into.
Hmmm... so maybe the more people in the pool, the better the data? A really big pool would give the kind of big data businesses rely on for quality decision-making.
A really big pool, of say, 300 million people, an entire nation's worth. Maybe that's the pool we should be jumping into.
82
So glad I am on Medicare soon.
69
As I've been saying for the last 5 years..."Who thought I'd be looking forward to getting older?!" Only 2 1/2 more years to go for me...if Medicare still exists and functions well, but what about my children and other people who are well under 65? Remember the idea of raising the medicare eligibility age?
In today's world, Mr. Andrews needs to look at the trees, not just the forest. Many human beings are either self employed or employed in the "gig" economy and are not offered health insurance by a company that employs them. That is the trend - and it's going up fast.
Single payer is the only fair and humane way to go. Agreed - let the government employees including the congress people be forced to go on the open market and purchase individual insurance and see what it's like.
In today's world, Mr. Andrews needs to look at the trees, not just the forest. Many human beings are either self employed or employed in the "gig" economy and are not offered health insurance by a company that employs them. That is the trend - and it's going up fast.
Single payer is the only fair and humane way to go. Agreed - let the government employees including the congress people be forced to go on the open market and purchase individual insurance and see what it's like.
2
Tom Price is working behind the scenes to dismantle parts of Medicare while we are preoccupied with Russian and North Korea. Hopefully it will be there when you need it!
You'll soon wish that Medicare Part D would control drug costs. Part D is currently a give-away to the drug compamnies. We pay a growing % of our Medicare for Part D alone. Which is insane.
This is very laudable, but with 370 million Americans needing health care, can this really solve that problem just at the local level? If Medicare was allowed to negotiate drug prices, for example, it would affect the market throughout. Maybe, just maybe, some Republicans will see this as a model, but there has been no evidence that they take evidence seriously, particularly when it means their donors (i.e. big Pharma) will take a hit.
8
As so many people have pointed out, this coalition of companies can accomplish increasingly higher quality at increasingly reasonable cost the more people are under its umbrella.... the logic points to the simplest and best answer, single payer.
13
I've read about the health transformation alliance. It's great what they're doing to avoid getting shafted by 'pharmacy benefit manager' - the shadowy organizations that negotiate discounts with drug companies but then keep a big chunk of the discounts for themselves. But is it enough??
5
Who needs congress? Anybody who doesn't have the protections being developed by these corporations. I applaud them for doing what they can, but how about using their lobbying power to affect those changes in laws that benefit everyone. It's a zero sum game with insurers, so every dollar they save drives up the cost for everyone else.
9
It is the middle man/insurance companies with the unnecessary overload of insurance administration and billing that builds in ever escalating costs to our healthcare system. Countries around the world, with national healthcare, don't pay out the many millions for endless coding and billing that wastes the time of medical providers and escalates the cost to the public. Cancer treatments & other chronic diseases, along with elderly healthcare, are benefiting from new research and treatment but huge costs that come with it are a burden. If we first get the politics out of the issue, we can see our way to getting this under control and trying a new and much better way to provide healthcare for us all.
7
Unfortunately, just as quickly as this employer group learns to cut some costs, the medical industry will just as quickly learn how to make up that revenue by shifting the billing to other tests and procedures, or just add new administrative fees an individual seeking care will not be able to avoid (admission fees, multiple doctors popping in to read a patient's chart who provide no meaningful care to the patient). Every dollar we currently spend on health care and health insurance is somebody's income and they will defend it vigorously.
7
The one REAL way to get rid of all the middlemen driving up the cost of healthcare for everyone and to control prescription medicine costs is simple.
It is called single-payer universal healthcare for all!
When are the American people going to DEMAND this from their Senators, Representatives, and federal government?
****A Connecticut physician
It is called single-payer universal healthcare for all!
When are the American people going to DEMAND this from their Senators, Representatives, and federal government?
****A Connecticut physician
331
Universal coverage is the goal. There are many ways to get there. The two best healthcare systems in the world by most metrics are Australia and the Netherlands. Australia is single payer its even called Medicare. The Netherlands uses private insurance and regulations.
Many of us are 'demanding' it. All of my doctors seem to support it. But you may have noticed that so many things that a solid majority of Americans seem to want never make it into the debate, let alone legislation. I'm guessing that's thanks to 'big healthcare' lobbying money that gets people elected; gerrymandered political districts and an electoral college that now seems destined to deliver minority rule.
In the meantime, every healthcare patient should demand transparency and up-front information on costs before they commit to anything non-emergency. Since I have a very large deductible; and I pay 20% of the costs once that's met, I believe I have that right.
In the meantime, every healthcare patient should demand transparency and up-front information on costs before they commit to anything non-emergency. Since I have a very large deductible; and I pay 20% of the costs once that's met, I believe I have that right.
1
They are being whined and dined by industry moguls and the very rich to whom the idea of universal access to decent medical care at a reasonable price is an anathema and a direct threat to their economic status. Hence the whining and the dining: the whine is because they might have to pay more taxes and the dining is to distract the politicians from paying attention to constituents very real needs for access to health care when and where the need occurs.
In America only little people can't afford health care.
In America only little people can't afford health care.
1
I just retired but what I found out with my company medical and many other big companies is when they start a program to reduce costs, it is to reduce their costs, not the employee.
My premiums went up before I retired and the spouses of married employees were shafted big time.
My premiums went up before I retired and the spouses of married employees were shafted big time.
4
For profit insurance companies should have never been involved in healthcare.
Look at the stock price of Human or UnitedHealth Group. These companies are profiting by shifting costs to patients and reducing payouts to providers. Many employer based plans, Not AFFORDABLE CARE ACT PLANS have $50.00 copays for office visits and $2,000.00 annual deductibles for IN NETWORK services. This is how the insurance plans churn out profits, by NOT PAYING for health care. They make the patients pay more and more and they slash their fees for common procedures. Look at your statements and you will see what the insurance allows, what the patient responsibility is and what the insurance actually paid.
In many cases the patient pays more than the multi $Billion insurance company.
It is time for Medicare to be offered to all and to let the big insurers compete with Medicare.
Look at the stock price of Human or UnitedHealth Group. These companies are profiting by shifting costs to patients and reducing payouts to providers. Many employer based plans, Not AFFORDABLE CARE ACT PLANS have $50.00 copays for office visits and $2,000.00 annual deductibles for IN NETWORK services. This is how the insurance plans churn out profits, by NOT PAYING for health care. They make the patients pay more and more and they slash their fees for common procedures. Look at your statements and you will see what the insurance allows, what the patient responsibility is and what the insurance actually paid.
In many cases the patient pays more than the multi $Billion insurance company.
It is time for Medicare to be offered to all and to let the big insurers compete with Medicare.
10
This article essentially invalidates the Republicans claim that giving individuals more choices will solve the cost issue. When even very large corporations need to band together what can a single person do?
7
Imagine a world where companies can unload the burden of providing medical insurance to their employees. How much would they save that could be used to pay their employees more, focus their capital on things that improve their businesses, stop the unending cycle of Open Enrollment distractions year after year? Imagine a world where an employer is not discounted as a viable option for an applicant just because they are too small to be able to offer 'fringe benefits' (an outdated concept from world war 2). Imagine a world where insurance companies are not skimming a good 20% of the dollars spent on healthcare. I can imagine this. I don't understand why Americans are so resistant to the model that works for every other major country. We will continue to fail in making healthcare affordable and available until we come to our senses and accept we've been doing it wrong all along.
10
" we’re troubled by the number of middlemen who drive up the price of care"
No kidding! This is why the VA, Medicare and Medicaid provide better service than the private insurance companies.
No kidding! This is why the VA, Medicare and Medicaid provide better service than the private insurance companies.
7
Well, middlemen driving up costs. How usual in our free market economy. Isn't it the lure of profit? Why wouldn't a savvy business person not develop a business plan that places him/her in such a position? To be able to insert yourself in a moneymaking position in a large market with little or no effort expended is the American way, isn't it?
I wonder to what extent those four major procedures and ailments are largely due to our biggest epidemic: obesity. A truly comprehensive health-care plan must also be a nutrition plan, beginning in early childhood.
3
The less muddle and meddle of Congress and the Federal government into our affairs, the better for all of us.
Their standardized testing madness in K12 education is another example of counter-productive policies and regs.
Government social support programs have destroyed the initiative of almost 100 million people who choose not to work, as they no longer need to. Yes, take care of those who can't work, but stop enabling those who can.
Congress keeps spending our money on whatever it takes to keep us beholden and them in office.
Their standardized testing madness in K12 education is another example of counter-productive policies and regs.
Government social support programs have destroyed the initiative of almost 100 million people who choose not to work, as they no longer need to. Yes, take care of those who can't work, but stop enabling those who can.
Congress keeps spending our money on whatever it takes to keep us beholden and them in office.
2
The percentage of people in the workforce has hardly budged since the government started keeping records. It's down slightly from its recent peak for complicated reasons, partly demographic. But it's patently untrue that 100 million people choose not to work, or that their initiative has been sapped. That's just bunk.
Single-payer healthcare -- technically, monopsony -- would save they country $1 trillion annually in wasted expenditure. Insurance profits eliminated, drug prices controlled, device and procedure costs standardized, profitable but needless testing curtailed. No co-pays, no claim denials, no negotiations.
We know it works. It works in 22 other industrialized nations. We have Medicare as a working example, one that could be strengthened and improved.
Every year, 50,000 Americans die of untreated treatable illness. How many more would you add to their number in the name of privatized medicine? Why not surrender ideology to common sense, for the common good?
Single-payer healthcare -- technically, monopsony -- would save they country $1 trillion annually in wasted expenditure. Insurance profits eliminated, drug prices controlled, device and procedure costs standardized, profitable but needless testing curtailed. No co-pays, no claim denials, no negotiations.
We know it works. It works in 22 other industrialized nations. We have Medicare as a working example, one that could be strengthened and improved.
Every year, 50,000 Americans die of untreated treatable illness. How many more would you add to their number in the name of privatized medicine? Why not surrender ideology to common sense, for the common good?
5
Companies can only do a certain amount. The government is critical and successful. Medicare has the ability to significantly reduce the cost. An uncomplicated joint replacement and two day stay in the hospital can cost over $120,000. Medicare only pays about one tenth of that. The patient is left wit a payment of one tenth of what Medicare pays. Backup insurance pays that if the patient has it. While a good percentage of us will fall under the knife one day, almost all of us buy medicines. Prescription medicine have to be seen as part of health care and a very expensive part. While we have been taught that generic drugs are supposed to be cheaper, some insurance companies are requiring more expensive non generic drug. They carry a larger copay. Some medications are being sold with only a thirty day supply, making the copay triple. For instance, some insurance companies will only pay for thirty day supply of prenatal vitamins. The copay is about $10. each thirty days. Patients can go to over the counter vitamins and buy a three month supply for not much more than a ten day supply if they use insurance. The cost of generic prescriptions has soared, A pill used for intestinal viruses in April of 2010 cost 0.06 a pill, cost $4 a pill in October. Today's cost is about $150 a pill, wholesale. In Europe the same pill cost $0.02 a pill. That is just one medication. The government needs to step in. So far no matter which party is in charg,e they have done nothing.
5
Some of us do appreciate your efforts on our behalf, given the ridiculous cost of 'doing business' for health care. Trouble is, health care for profit is not the right model; remember, before the Obamacare rules, that healthcare insurance companies did exclude from coverage pre-existing conditions, as a matter of course? Terrible, right? We can, and must, do better. It doesn't matter that for certain disease, and/or procedure, these United States may excel...but for the average 'Joe', it is a disgrace in access and cost and quality. Too bad Congress is derelict, as part of government, in providing what it is supposed to do, serve it's constituents, all and everyone, as best as possible, establishing the rules of the game. But a private system independent of sensible governmental regulation is prone to a rising inequality, and it's inequities (or should we say 'iniquities'?). It behooves us to get together and start being rational about a highly emotional issue affecting our lives, blood and treasure, find answers to benefit the majorities...instead of the lucky few.
This is a useful effort if for no other reason than that it highlights where the real cost problem lies in the US healthcare system. Namely the provision of care in the form of services and drugs.
1
There are many things that can be done in the private for profit health care system, other than doing the easy, more efficient, and much cheaper way of simply going to a Single Payer system.
~ Expand the pool ( republicans went to court\and succeeded to do everything possible to reduce the pool\cut off medicaid expansion so that more people are bearing the costs
~ Negotiate drug prices
~ Illuminate actual heath care costs and put pressure to reduce them
The overall market is in continuous flux because insurance companies say there is no stability. ( republicans want this and continue with every effort to enhance it )
The answers are there ~ just a matter of doing them
~ Expand the pool ( republicans went to court\and succeeded to do everything possible to reduce the pool\cut off medicaid expansion so that more people are bearing the costs
~ Negotiate drug prices
~ Illuminate actual heath care costs and put pressure to reduce them
The overall market is in continuous flux because insurance companies say there is no stability. ( republicans want this and continue with every effort to enhance it )
The answers are there ~ just a matter of doing them
5
If you take the article to its logical conclusion, the more people you have enrolled in a program the more leverage you have with healthcare providers. This can also eliminate most of the middlemen who drive up costs. This argues for a single payer system.
A side note. As union participation has declined, more healthcare costs are being shifted from the employer to employees.
A side note. As union participation has declined, more healthcare costs are being shifted from the employer to employees.
7
I wonder if the benefits achieved by a group representing six million workers and retirees might be even greater if a group were to represent all 325 million Americans and be authorized to negotiate for better and cheaper health care for all. As long as this health care question remains a political question, we may never find out the answer.
5
Providing data to patients and doctors so they are enabled to make better decisions is a good thing. Using such data to impose decisions by a third party may not be.
A patient and doctor should both want the best outcome for a surgery, and having efficacy data for hospitals is a good thing. Forcing a decision on a patient and doctor may not be.
A patient and doctor should both want the best outcome for a surgery, and having efficacy data for hospitals is a good thing. Forcing a decision on a patient and doctor may not be.
1
Employer provided health insurance, along with the non-taxation of the benefit, is the biggest political obstacle to a unified public health care system.
5
Great! How can I with no insurance get access to the same prices and quality? Clearly this is market failure.
The role of government is to effect policies which create fair and efficient markets.
Right now, ideologies, labeling and manufactured outrage distract the voter while the system and unscrupulous folks pick their pockets.
The role of government is to effect policies which create fair and efficient markets.
Right now, ideologies, labeling and manufactured outrage distract the voter while the system and unscrupulous folks pick their pockets.
7
Medicare. Pick one. "Those" should be the "choices" available in the healthcare insurance marketplace.
The monies paid by employers and employees for healthcare coverage, if paid instead into Medicare from day one of a person's work career, would cover costs. Period. The only "IF" being, if the United States survives the current occupant of the White House.
The monies paid by employers and employees for healthcare coverage, if paid instead into Medicare from day one of a person's work career, would cover costs. Period. The only "IF" being, if the United States survives the current occupant of the White House.
13
This is a step in the right direction and more companies should do this. Unfortunately, this consortium, while stronger than being alone, is not as strong as the entire country and the benefits will be limited almost exclusively to its members.
Citing the article, we are already in a bad place:
"The United States government defines health care as “affordable” if it costs less than 9.7 percent of a household’s income".
Average total premium for single coverage is $5,884 and for family coverage it is $16,351 according to zanebenefits.com.
By that math, the average single would have to earn $60,660 while the average family would have to earn $168,567 for healthcare to be "affordable".
The median income in the US is about $51,000.
Worse still, the national minimum wage at $7.25 translates to $15,080 pre-tax income if one works a 40 hour work week.
In other words, the average single coverage consumes 39% of the minimum wage salary and over 11% of the median income. Family coverage : 108% and 32%, respectively.
One estimate pegs the current system costing $49 trillion over the next decade compared to $32 trillion under single payer....with everyone being covered under the latter while over 20 million not being covered under the former....
From a total societal perspective, single payer is the best solution.
What exactly is the value add of the insurance company?
Citing the article, we are already in a bad place:
"The United States government defines health care as “affordable” if it costs less than 9.7 percent of a household’s income".
Average total premium for single coverage is $5,884 and for family coverage it is $16,351 according to zanebenefits.com.
By that math, the average single would have to earn $60,660 while the average family would have to earn $168,567 for healthcare to be "affordable".
The median income in the US is about $51,000.
Worse still, the national minimum wage at $7.25 translates to $15,080 pre-tax income if one works a 40 hour work week.
In other words, the average single coverage consumes 39% of the minimum wage salary and over 11% of the median income. Family coverage : 108% and 32%, respectively.
One estimate pegs the current system costing $49 trillion over the next decade compared to $32 trillion under single payer....with everyone being covered under the latter while over 20 million not being covered under the former....
From a total societal perspective, single payer is the best solution.
What exactly is the value add of the insurance company?
42
I applaud the companies that can band together and affect meaningful change, but most of us don't have the ability to leverage plans like theirs. The editorial simply feeds the narrative we're better off alone. Individuals and small companies cannot band together except through government programs like Medicare that I entered last month. We're better off banding together as a nation and essentially becoming self insured, so every American knows their medical needs will be covered and more importantly paid by Medicare. It's not complicated.
14
I totally agree!! Medicare already exists! It is already in place but just needs expanding BUT negotiating drug costs should be done as it is in Europe on a national basis. The same drugs I get in Italy for no cost cost in the USA as much as 20 times more. This is absurd!
1
Who needs congress? How about everyone not fortunate enough to have a job with good benefits and a large, well-funded network of analysts and negotiators to do this on their behalf?
38
Love it! Corporations that destroyed unions, Unionized to save $$ on the health care expense for their employees. Rand Paul suggested similar efforts for self-employed individuals to get together to bargain for better rates. He went on to note that the employees of GM have great rates. Yes, GM employees have a Union. Of course, the noted libertarian is anti-union to the core.
25
Providing basic health coverage through a "medicare for all" program providing funding and administration in the public domain will benefit all Americans and provide even lower costs to companies and employees with company plans than the program described in this article. I'm not even sure why employers need to be involved with providing basic health coverage. The Conyers/Sanders "Medicare for All" program provide for private sector delivery of medical services though to my mind medical groups, hospitals and other provider organizations should be organized as not-for-profits. Providers must befairly compensated, however their should be no "profit" inuring to professional or health care facilities organizations. Let's get back to medicine as a profession not a business. Health products, including pharma should be competitively priced.
In addition to administering Medicare and Medicaid programs the government has vast experience in administering procurement in both defense and non-defense acquisition of goods and services at all levels of complexity and scope. There is a pool of knowledge in these government programs that should be applied to administering basic health care coverage. Let's take advantage of that background and skill set which already successfully exists in government programs, including medical care, for the benefit of all Americans.
Why do we insist on pandering to a "profit driven" medical coverage system. We need "Medicare for All" now.
In addition to administering Medicare and Medicaid programs the government has vast experience in administering procurement in both defense and non-defense acquisition of goods and services at all levels of complexity and scope. There is a pool of knowledge in these government programs that should be applied to administering basic health care coverage. Let's take advantage of that background and skill set which already successfully exists in government programs, including medical care, for the benefit of all Americans.
Why do we insist on pandering to a "profit driven" medical coverage system. We need "Medicare for All" now.
24
Thank you. We have the means, but lack the will. Perhaps these excruciating exertions around healthcare -- or their absence -- will move the US healthcare system forward to a more equitable system where people are not billing codes to be manipulated for profits. Hospital systems copy-cat one another's costs for procedures, driving prices up across the board.
The compensation of healthcare CEO's should give all of us pause. Corporate America's winner-take-all alpha people should have no credibility in a sector where ethical considerations and the duty to care should prevail.
The compensation of healthcare CEO's should give all of us pause. Corporate America's winner-take-all alpha people should have no credibility in a sector where ethical considerations and the duty to care should prevail.
2
You speak as an outsider with little knowledge. Medicaid & the VA have been disasters, Medicare and Medicaid are on a timeline to insolvency. In Europe, Canada, and Massachusetts, healthcare is breaking the bank (Singapore & Switzerland are better). Yes insurance & pharmaceutical companies & physician/hospital prices went wild for a while, but all are beginning to reign in. WHERE is the money being spent? PATIENTS need to change their behavior: hi cholesterol, diabetes, open heart surgery, angioplasty are 95% PREVENTABLE, like many other conditions. HRS, MD, FACC
So-called "reference pricing" can be a useful tool to control cost and quality of care. This has been used in the California employees retirement benefits program. You start with the best negotiated price for a procedure at an organization with documented high quality outcomes.....let's say a total knee replacement for $30,000 dollars....and that becomes the "reference price." If an employee decides to go to another hospital where the price for that knee is $50,000, the employee must pay the difference between the reference price and the charged price. For many elective procedures, behavior and choices have been demonstrated to change quickly when the patient has incentive to shop for value.
3
It is commendable that some companies are looking for ways to bring down health care costs. But let us not forget their main aim is to have more profit, not necessarily better patient health care. That said, it sounds to me as if they have modeled their approach on Medicare.
This is another argument for Single payer system or Medicare for all.
Perhaps they can share their findings with the Congress and the Senate, thereby saving our overworked Congress and Senate a lot of work that they really do not want to do anyway.
This is another argument for Single payer system or Medicare for all.
Perhaps they can share their findings with the Congress and the Senate, thereby saving our overworked Congress and Senate a lot of work that they really do not want to do anyway.
17
One thing you didn't mention is the money wasted in piecemeal billing. My insurance recently announced a flat rate for hip and knee replacements at a prominent orthopedic hospital, instead of pages of charges for everything from anesthesiologist, to knee parts to x-rays, band-aids, physical therapy, etc. etc.
It's like buying a car where you pay separately for the wheels, engine, ...
It's like buying a car where you pay separately for the wheels, engine, ...
14
Our hospital is making process improvements aimed at the effectiveness of healthcare we provide, but this is done in the context of rules laid down by the ACA and the expansion of medicaid eligibility. Ad hoc corporate efforts (including my own hospital's) are interesting, but we really need to accomplish a formalized system of care delivery - population-based medicine that exists elsewhere in the world, but not here in the USA. We need an orchestra, not a jazz ensemble. To get there we will need a Federal initiative - we need a conductor.
11
Avik Roy - Testimony before the House Ways & Means Committee April 14, 2016. “Health care tax policy: The central flaw in our health care system”
“The CBO’s budget outlook that the entirety of the growth in federal spending over the next several decades is driven by two factors: growth in health care spending and interest on the federal debt”
“Today the value of the employer tax exclusion in terms of federal state and local income taxes, and federal taxes exceeds 500 billion dollars a year. That is a greater sum than what federal, state, and local governments spend on Medicaid each tear”
Worker’s that receive employer health insurance (ESI) do not have to pay income or payroll taxes on the premiums and employer’s contribution. A person in the 39% tax bracket, a dollar in health insurance is worth a lot more that a dollar in wages. Republican opponents of health tax reform argue that ESI is the bulwark against single-payor HC. No mention of ESI reform during the HC debate
“The CBO’s budget outlook that the entirety of the growth in federal spending over the next several decades is driven by two factors: growth in health care spending and interest on the federal debt”
“Today the value of the employer tax exclusion in terms of federal state and local income taxes, and federal taxes exceeds 500 billion dollars a year. That is a greater sum than what federal, state, and local governments spend on Medicaid each tear”
Worker’s that receive employer health insurance (ESI) do not have to pay income or payroll taxes on the premiums and employer’s contribution. A person in the 39% tax bracket, a dollar in health insurance is worth a lot more that a dollar in wages. Republican opponents of health tax reform argue that ESI is the bulwark against single-payor HC. No mention of ESI reform during the HC debate
3
This all sounds smooth, but it lacks facts required to assess this organization's approach to healthcare. The paragraph on prescription drugs, for example, includes many words but little concrete information: "That results in lower prices for the same medicines ...." The "same medicines" as what? The author doesn't say. Pharmacy benefit managers, for another example, are middlemen, contractors who handle beneficiaries' access to medication for a fee. How does that fee affect the cost of drugs? What was the change in business practices the author touts? Where's the data on results? He doesn't show any. This is classic marketing-speak. Without the details, readers can't evaluate the potential impact of the alliance ideas. I'll remain dubious about how much value this employer group can contribute till it offers more information on its process and outcomes so far.
8
Does the bargaining power of one large group result in savings for them at the expense of all the others? In other words will the group/network reduced costs cause the drug companies to compensate themselves and re-coup their "losses" by overcharging the rest of us?
8
I was so pleased to see a movement that will benefit patient in real time and lower costs.The sheer size of corporations could make a big difference
In real costs.
I was particularly struck by the use of data to make available best outcomes in procedures to patients so that real choice can occur and real savings in prevention of relapse will make a difference in cost.
As a retiree who uses Optum Rx I was happy to see this company featured. I use a fair amt of meds daily and have seen reduction in prices happening over several years.
In real costs.
I was particularly struck by the use of data to make available best outcomes in procedures to patients so that real choice can occur and real savings in prevention of relapse will make a difference in cost.
As a retiree who uses Optum Rx I was happy to see this company featured. I use a fair amt of meds daily and have seen reduction in prices happening over several years.
1
Yet another example of the "revolving door" between government and industry. Capitalism is an amoral system. It is a responsibility of government to provide the ethical framework needed for it to function in a way that ensures the well-being of the public is protected. Expecting corporate America to do do the right thing with respect to healthcare is akin to asking the fox to guard the hen house.
9
Nonsense: this is the USA. Maybe you'd enjoy living in China, or Venezuela, or or other lands of limited opportunities. You have the freedoms and opportunities you have because of what has brought you to this point in time and place: USA capitalism
Capitalism is not an amoral system. We wouldn't have the high standard of living that we have if it weren't for capitalism. Would you prefer to live like a Russian or a Cuban and wait in line for five hours for a loaf of bread? The reason the healthcare system is out of control is because of the government. The people who write the laws are more corrupt than any corporation. The sell out the American people every day. Government is the problem not the solution.
This play puts the cart before the horse. The first priority is to be properly covered. It is, lacking this, that kills people unnecessarily. This is what puts us behind other nations in this regard. This article does not go into detail how this plan is administered, and what it provides. Cost of the actual insurance is what is touted, but we are given no idea of how savings are achieved through deeper details. Further where is the point of service focused? The patient or the companies? Several aspects of assuring affordable access are wanting. The largest group possible that spreads risk, true global negotiations, putting the patient in charge without networks, referrals, etc, and cherry picking of populations(? company sickness profile). This is not a new idea, and it has not shown itself much as a cost reducer or provide wide application.
3
Just get rid of ALL middlemen, including corporations. Take the tax breaks for health "insurance" (it is really insurance, hence the quotes) that corporations get and give them to individuals. A corporate health benefit could consist of contributions to the employee's Health Savings Account. Offer real health insurance that pays for catastrophic things like cancer and heart attacks. Stop thinking that the way we've done things since WWII is the only way (it's not even a smart way). Do you want the same kind of care our veterans get from the government? Do you want your employer determining your medical care, or faceless government bureaucrats? I don't.
8
Who would you rather have determining health care coverage and financing issues: public officials, dedicated to the health and welfare of the citizens, and answerable to them, or employers, dedicated to maximizing profits and answerable to shareholders?
Citizens need Congress to create a non-profit state-by-state single payer plan that will cut costs by 26% right off the top, just by removing profiteers, while adding in endless life-saving and life-enhancing treatments.
That's who needs Congress. The poor for obvious reasons. The wealthy for the enormous taxes they will save.
Of note, in all medicare countries, some private providers hang in to provide additional coverage for items outside of universal single payer. There's nothing wrong with that. It harms no one.
That's who needs Congress. The poor for obvious reasons. The wealthy for the enormous taxes they will save.
Of note, in all medicare countries, some private providers hang in to provide additional coverage for items outside of universal single payer. There's nothing wrong with that. It harms no one.
5
Canada's single payer system doesn't even cover prescription drugs.
1
Canada has a multi-pronged and imperfect, but mostly effective prescription drug cost containment program. There is variation from province to province because price controls are managed not only at the federal but at the province level. There are multiple payers. Drug prices grew at only 5% in the 1990's and have decreased since then.
Yet Americans take trips to Canada to buy their drugs because they are so much more affordable there.
It's no wonder we've lost our innovative edge when so much time and money is spent by CEO's on healthcare. Wouldn't the time be better spent doing the work that the company is charged with doing? Medicare for all would not only take that burden away from the company but would give individuals the freedom to start their own businesses. Too many potential inventors/entrepreneurs stay chained to their current job just for the insurance. It's time for medicare for all.
14
Medicare is VERY limiting and getting moreso. Be careful what you wish for.
1
If this system works so well (which I am not at all convinced is the case: anybody can save 2% by cutting out useful but expensive medications or limiting access), then why not make it available to everyone?
1
Good luck. These companies can reduce their costs, which will then shift to other companies and individual. This will only work for the country as a whole if it becomes the norm for all consumers of healthcare, companies, government, and individuals.
4
'Undistributed middle' logic error in what you say
"We and our employees spend more than $5 billion each year on four procedures and ailments: knee replacements, hip replacements, back pain and diabetes. These common problems account for 20 percent of the money our companies spend on treatment." The analysis not offered with this data is that these procedures are all related to obesity brought on by poor eating habits. If these new initiatives don't stress healthy eating it's just more money thrown on the bonfire.
7
Hold on. If they are also covering and including retirees, then it should be no surprise that joint replacements top the list. You get old; your joints wear out. Rheumatoid arthritis and other causes necessitate the need for hip replacements, not just obesity. A lifetime of running to stay fit will eventually wear down the knee(s). Neither has anything to do with poor eating habits. Don't generalize without concrete statistics.
Hey Jen: you and I are on the same page, see what I similarly wrote above or below. So many $ are spent on largely preventable conditions. It is time to involve patient behavior/support/limitation. Read the work of K Volpp @ U Penn re "carrot and stick" to change patient behavior. There is NO free lunch--as we are seeing. HRS, MD, FACC
Why are these companies not lobbying for medicare for all ? Will access to healthcare become a competitive advantage to large employers in the future, with the self employed and small employers left to poor care and high prices ?
30
So you want the same great care our veterans get from the government?
1
Please develop a pool for small and mid-sized companies. Then another for individuals. People will gladly follow a rational, low-cost plan over a bloated insurance-sponsored plan.
If healthcare can be data-driven, then maybe we can get the people who use - and misuse - it to make the right decisions for reasons other than co-pays whose purpose they don't understand aside from driving their finances into the ground. More importantly, maybe we can apply more direct pressure to the doctors who do not follow best practices or prescribe simply for convenience because a patient keeps badgering until he or she gets a prescription or an MRI or whatever, to behave differently.
As far as getting rid of the middleman, most insurance companies outlived their usefulness years ago when they started laying off risk instead of managing it. The cost penalty that they add into the system is obscene, and the value-per-dollar is most likely negative.
If healthcare can be data-driven, then maybe we can get the people who use - and misuse - it to make the right decisions for reasons other than co-pays whose purpose they don't understand aside from driving their finances into the ground. More importantly, maybe we can apply more direct pressure to the doctors who do not follow best practices or prescribe simply for convenience because a patient keeps badgering until he or she gets a prescription or an MRI or whatever, to behave differently.
As far as getting rid of the middleman, most insurance companies outlived their usefulness years ago when they started laying off risk instead of managing it. The cost penalty that they add into the system is obscene, and the value-per-dollar is most likely negative.
7
Why is it that noone in the news media has asked one senator, congress person or Trump why they don't consider "medicare for all?"
12
Having employees depend upon an employer for health care gives employers way too much power! That employer can determine which health care providers you must use. Would you let your employer dictate which car you drive or where you are allowed to buy a house? Of course not!
Furthermore, if I was an employer, I'd prefer to focus my resources on chip making or car making or whatever my core competency has become. I'd not want to get involved in health insurance.
Now is the time to push for single payer. Just do it!
Furthermore, if I was an employer, I'd prefer to focus my resources on chip making or car making or whatever my core competency has become. I'd not want to get involved in health insurance.
Now is the time to push for single payer. Just do it!
9
You're are stuck in the thinking that we need any kind of middleman. Do you really think the US government would be any better at picking your providers and what procedures and prescriptions you get than an employer? You're just trading one bad middleman for another. I don't want VA style health care!
More uneducated nonsense: just DON'T do it.
"Known as the Health Transformation Alliance, we’re troubled by the number of middlemen who drive up the price of care, and by the soaring costs of prescription drugs."
Ah, yes, middlemen--and lobbyists that keep the cost of healthcare high whenever Congress decides to reform the system. Everybody wants a piece of the healthcare financial healthcare pie.
Many of the strategies Mr. Andrews describes are also used by Medicare: using data to drive coverage decisions and using market clout to drive down costs. Unlike a corporate alliance however, Medicare goes one step further and uses price controls, that vary from region to region, to manage costs. So, for example, that hip replacement? When the orthopedist charges $3000 and your statement says, "Medicare pays $1500" or whatever leaving free market medigap plans to manage the rest?
That shows a power of the purse that commercial plans can't yet employ. With the exception of prescription drugs: cutting drug costs at large self-insured companies is still easier because of George Bush's cave-in to big pharma during the creation of Part D drug programs.
What doesn't get mentioned here are the layers of costs grabbed by insurance companies and their brokers. This isn't a problem in Medicare, which has price controls and uses insurers largely as claims processors. Or the spiraling prices for medical devices that seem to get "improved" every six months.
We have too many "plans" in this country. Medicare for all.
Ah, yes, middlemen--and lobbyists that keep the cost of healthcare high whenever Congress decides to reform the system. Everybody wants a piece of the healthcare financial healthcare pie.
Many of the strategies Mr. Andrews describes are also used by Medicare: using data to drive coverage decisions and using market clout to drive down costs. Unlike a corporate alliance however, Medicare goes one step further and uses price controls, that vary from region to region, to manage costs. So, for example, that hip replacement? When the orthopedist charges $3000 and your statement says, "Medicare pays $1500" or whatever leaving free market medigap plans to manage the rest?
That shows a power of the purse that commercial plans can't yet employ. With the exception of prescription drugs: cutting drug costs at large self-insured companies is still easier because of George Bush's cave-in to big pharma during the creation of Part D drug programs.
What doesn't get mentioned here are the layers of costs grabbed by insurance companies and their brokers. This isn't a problem in Medicare, which has price controls and uses insurers largely as claims processors. Or the spiraling prices for medical devices that seem to get "improved" every six months.
We have too many "plans" in this country. Medicare for all.
89
You will enjoy standing in line or Quing (sp?) up as the English say.
It's very simple offer Medicare for all as an option that people can pay for and let the chips fall where they may regarding the best way to get to affordable, accessible, value based care. This would create the largest cooperative of all. How can that be a bad thing, the infrastructure is in place and with MACRA the quality and value based care movement is well under way. That would solve the "Collapsing" individual market in one fell swoop and payers would need to be even more creative and competitive as they have done successfully with Medicare Advantage.
12
This is what Trump was trying to do by allowing separate people to band together and ins companies to sell across state lines. Medicare is headed to insolvency, better pick a different route
1
Good for them but the effort should be broader. If these companies really want to be part of the solution why is not the data made public? Does this initiative represent savings for a group and the whole is still zero-sum? Are the agreements confidential?
3
Any effort to constrain the cost of healthcare should be applauded. But where is the educational component that addresses the least expensive solution of all - diet? Type 2 Diabetes, for instance, is a lifestyle disease significantly mitigated by a primarily plant-based diet.
4
diet and regular cardiovascular exercise - I have lowered my A1C and/or managed it for years this way.
1
As a vegan I understand it isn't that difficult to go plant based but I realized after more than a 1000 yrs of meat eating the populace is not going to go plant based. If the food producers could take the sugar and preservatives out of the food that would be a start. Health snacks too.
2
This is the correct idea: said as a CARDIOLOGIST with 40 years of experience and proving the point of just that. The need for open heart surgery & angioplasty & relevant testing has essentially been eliminated in this Clinic by addressing the risk factors fully. You might enjoy the 'Preventive Medicine Center's Wellness Protecting Numbers'. One need not be 100% vegan, as 90% (18 of 21 meals a week) of ideally organic unprocessed (prior to cooking) whole foods will do: fitting with our biology (teeth, jaw, salivary gand enzyme for plant food, no fangs or claws, inability to digest rotten meat...). HRS, MD, FACC
Many of the comments below posit that the Op Ed piece is in fact an argument for why we need single payer health care. I agree with this conclusion and there are two things that concern me about implementing a single payer system in the United States.
First, the ease with which special interests are able to gain control of decisions made by Congress. We already see how Congress will not take rational steps to control Big Pharma's gouging of the American people. Perhaps we need to get big money out of politics if we want a health care system that truly serves the American people rather than the health care industrial complex.
Second, the unwillingness of the American people to recognize that rationing is already a part of our health care system, including Medicare and most private insurance, and that it must be a part of any viable single payer system as well. We can't afford to pay for every marginal, unproven, and hugely expensive medical intervention just because of "freedom."
First, the ease with which special interests are able to gain control of decisions made by Congress. We already see how Congress will not take rational steps to control Big Pharma's gouging of the American people. Perhaps we need to get big money out of politics if we want a health care system that truly serves the American people rather than the health care industrial complex.
Second, the unwillingness of the American people to recognize that rationing is already a part of our health care system, including Medicare and most private insurance, and that it must be a part of any viable single payer system as well. We can't afford to pay for every marginal, unproven, and hugely expensive medical intervention just because of "freedom."
27
The impact that any congressional redefinition of the ACA, or even its repeal, would have on corporate America would be secondary to corporate efforts at reform of their own programs anyway. The ACA, and even the various Republican concoctions that so far have failed to get past Congress really mostly affect those who don't HAVE company-provided insurance.
Granted, if Republicans did away with no-pre-existing conditions and minimum standards in policies, that would have an effect on what corporations did, but neither change appears to be viable at present.
Good to know that corporations are looking to reform the healthcare they do offer their employees to better manage costs. Congress couldn't seem to manage that for Americans generally, under Democrats OR (so far) Republicans.
Granted, if Republicans did away with no-pre-existing conditions and minimum standards in policies, that would have an effect on what corporations did, but neither change appears to be viable at present.
Good to know that corporations are looking to reform the healthcare they do offer their employees to better manage costs. Congress couldn't seem to manage that for Americans generally, under Democrats OR (so far) Republicans.
2
Kudos to these companies for seizing the initiative on healthcare. But, as others have commented, this is the best, clearest argument in a while for national healthcare. Your alliance's approach applies fundamental principles of strategy in market systems - balancing the market power and knowledge of buyers and suppliers. That is precisely why the GOP's beloved "market-based" approach will not lead to efficient allocation of healthcare resources - "buyers", meaning individual patients, possess no market knowledge (prices, medical expertise, thorough understanding of procedures and drugs) and are entirely at the mercy of huge suppliers in price negotiations. While your consortium approach addresses both these deficiencies better than each company going it alone, just think how much more efficiency can be gained by scaling this approach through a national healthcare system. The rest of the developed world did so, most decades ago, and are eating our lunch, both in terms of health outcomes and percentage of GDP devoted to healthcare, as a result. But, thank you for your article, for you revealed far more than you probably intended.
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Single payer is not the answer to the problem discussed in this article, which is the absurd cost of healthcare itself. Single payer will eliminate insurance companies from the process and, hopefully, the layer of profits that they skim off the top. Single payer, or any other health insurance reform, does not address the bigger problem of the cost of treatment, which is a much more significant driver of overall costs.
The data being gathered by these companies is invaluable in understanding where healthcare dollars are being spent. We need to shine the light of day on where money is being spent and who is reaping windfall profits before considering single payer. Government should take over this data gathering process as the first step of healthcare reform.
Single payer failed in Vermont because it addressed only the role of private insurers in the system. Having government, vs. private insurers, take over the administrative process of paying healthcare bills was not financially practical because if those bills are absurdly high then the taxes needed to make the system work are also absurdly high and not politically viable.
The data being gathered by these companies is invaluable in understanding where healthcare dollars are being spent. We need to shine the light of day on where money is being spent and who is reaping windfall profits before considering single payer. Government should take over this data gathering process as the first step of healthcare reform.
Single payer failed in Vermont because it addressed only the role of private insurers in the system. Having government, vs. private insurers, take over the administrative process of paying healthcare bills was not financially practical because if those bills are absurdly high then the taxes needed to make the system work are also absurdly high and not politically viable.
2
Single payer is the only instrument to have any leverage in controlling and reining the absurd cost of treatment. To say otherwise is to miss the point of single payer and the reason it is the only solution thus far put forth that addresses cost. Read HR676, it's all there.
6
The reason single payer works in other countries is because the government sets global budgets and it sets price schedules for drugs, devices, and procedures. In the US, CMS is PROHIBITED from using its market power to negotiate lower drug prices. Single payer won't lower prices (and thereby costs) if politicians protect the economic interests of drug companies, hospitals, doctors and other producers of health care (for-profit and not-for-profit). Republicans, and some Democrats, will not let government use its market power to reduce the health care costs. Our government no longer serves the people--it serves the interests of people who have access to Congress to influence legislation.
1
Actually, nobody is making a 'windfall profit'. Instead, millions of people are making a nice living, earning more than in other sectors.
For every dollar of revenue, there is a matching expense. The money that is taken in gets paid out, and you can't say at any point 'this is unreasonable'.
You would have to look at the overall number of people working, the number of services provided, and the salaries paid to see that this is simply more than we can afford. So we have to cut. But where?
For every dollar of revenue, there is a matching expense. The money that is taken in gets paid out, and you can't say at any point 'this is unreasonable'.
You would have to look at the overall number of people working, the number of services provided, and the salaries paid to see that this is simply more than we can afford. So we have to cut. But where?
If $5B is 20% then the total is about $25B. If $600M is saved in 3 years, that's $200M per year. That's 1% - which is not going to do it. We need congress.
7
The seeds of change have always been there. This is an example of one side showing the other side how to effect "national health care". What I do not see yet is a stand 'by the people' to demand exactly what they want and business, industry and government to do it.
As some are saying, now: either make a plan people can accept or step aside. Perhaps health care is not America's priority right now. But if it is, we (the people) should write the plan, not Congress or Watson.
As some are saying, now: either make a plan people can accept or step aside. Perhaps health care is not America's priority right now. But if it is, we (the people) should write the plan, not Congress or Watson.
1
Interesting and informative article.
However, how does this information serve the poor who are not working for one of these countries, those are not working full time, or those who are unemployed?
And it's a known fact that some hospitals (perhaps the ones across town) have better outcomes because they serve a healthier population. Once less healthy persons start using those cross town hospitals, those companies may find the results changing for those hospitals.
However, how does this information serve the poor who are not working for one of these countries, those are not working full time, or those who are unemployed?
And it's a known fact that some hospitals (perhaps the ones across town) have better outcomes because they serve a healthier population. Once less healthy persons start using those cross town hospitals, those companies may find the results changing for those hospitals.
6
I read that groups like the AARP are also considering participation in a network, using the power of their numbers to help the situation. I would be all-in on that plan, hope they do. It would surely beat whatever Paul Ryan and the Freedom Caucus have in mind for retirees.
11
Leaving healthcare to employers is an dereliction of government responsibility. They dress it up as choice and market forces but it is simple laziness or apathy. Time to get a government that is willing to work for us rather that to merely posture and tweet.
8
Here we go again. A bunch of consultants and connected folks out of a job (start with "former" congressman Andrews who makes how much as CEO of the Health Transformation Alliance" ?) convince companies so pony up millions for the latest fad (IBM Watson) to take on the health care system. They, in turn, engage in new "cost saving" deals with the likes of CVS and a few health care systems. Meanwhile, the real "cost control" strategy of corporate American is simply to cap the employer contributions and shift more responsibility to employees--particularly those with families. The one and only strategy Corporate america should endorse for health care is to get out of the business.
28
It warms the very cockles of my heart to realize that the noble and beneficent corporations of AmEx, Verizon, and Macy's suddenly have our welfare in mind when it comes to health-care. Up to now their concern for better employee wages has been bird-bath deep but they now see an opportunity to bypass Congress and privatize and control the health-care for those same employees. Do they ultimately hope to bypass the Federal Food and Drug Administration when deciding on which drugs we can take.
Be careful what you wish for.
Be careful what you wish for.
14
This is not a solution to our national healthcare problem, but rather a cost saving initiative by large employers with a self-motivated interest to reduce employer costs. This does nothing to address US healthcare costs where it is needed most - at the end of one's life. Medicare spends nearly 30% of its money on beneficiaries in the last year of their life. The answer is single payer with the ability of government to negotiate with healthcare providers and pharmaceutical companies.
49
Glad to see I'm not the only one who's not fooled by this. The last thing we need is another private entity(ies) influencing health care coverage with only their financial interests at heart. We already have that: it's called the American health care system, and it's why were in the mess that we're in.
This only means that care will get more expensive for most of us who do NOT work for these few companies.
It "impresses" me daily how stupid and easily duped we Americans are.
This only means that care will get more expensive for most of us who do NOT work for these few companies.
It "impresses" me daily how stupid and easily duped we Americans are.
Yes, this piece looks more like a bill written by a drug lobbyist.
We cannot affect market prices for health services unless the three largest players - Medicare, private employers and government employers - are actively involved in the change.
It is terrific that companies are looking analytically at health costs. I have every faith that they will steer their employees to the hospital with the better outcomes. I also have every faith that they will miss the reason - that the other hospital, a non-profit, accepts the sicker and the poorer and the uninsured or Medicaid patients who have a hard time getting quality care. Eventually, having steered all the paying patients across town the non-profit will go out of business and leave the people they served out in the cold.
And that is why we need Congress.
Companies have to try to find ways to drive down what they are paying. We cannot compete globally dragged down by our health costs, and people cannot afford to be let go from the company plan and face the ticket themselves.
But we need to solve the problem of access and good care for people who are not lucky enough to have someone footing the bill, or are on plans that most of the doctors and hospitals will not accept.
Analyze that with Big Data.
It is terrific that companies are looking analytically at health costs. I have every faith that they will steer their employees to the hospital with the better outcomes. I also have every faith that they will miss the reason - that the other hospital, a non-profit, accepts the sicker and the poorer and the uninsured or Medicaid patients who have a hard time getting quality care. Eventually, having steered all the paying patients across town the non-profit will go out of business and leave the people they served out in the cold.
And that is why we need Congress.
Companies have to try to find ways to drive down what they are paying. We cannot compete globally dragged down by our health costs, and people cannot afford to be let go from the company plan and face the ticket themselves.
But we need to solve the problem of access and good care for people who are not lucky enough to have someone footing the bill, or are on plans that most of the doctors and hospitals will not accept.
Analyze that with Big Data.
35
Banning together to squeeze inefficiencies out of the health delivery system is a good thing. Government should do the same, but members of Congress — in their never-ending quest to protect the profits of their donors — prohibit it.
21
The headline says it all, what I've been saying for years: There should be zero federal government involvement in our healthcare and health insurance systems.
The Feds are involved in welfare programs like Medicaid and programs for our vets like the VA system. That's all they should be involved in.
The Feds are involved in welfare programs like Medicaid and programs for our vets like the VA system. That's all they should be involved in.
1
So you are saying that those who do not work for large corporations and do not qualify for Medicaid should not have affordable health care ?
With luck you too will retire some day. Careful what you wish for.
With luck you too will retire some day. Careful what you wish for.
2
You must either be a veteran, or on Medicaid.
I don't blame corporations for doing this; medical insurance costs must severely affect their bottom line. But what an indictment of our government that it cannot/will not put together a universal healthcare system for all Americans. Our 30+ peers in the Organization of Economically Developed Countries have found a variety of systems for arriving at this system, even our neighbor to the south, Mexico. However, I imagine an influential group of Republicans quietly applauding this corporate effort. There are many conservatives, in the vein of Carl Rove, who believe the only meaningful role for the federal government is to amass a huge and expensive military to protect us. The Democrats are missing in action. The Senate Democrats' recently published platform included no demand for any type of universal healthcare. Oh, do I miss President Sanders.
8
What about hospital chargemaster price gouging?
7
Wonderful program. Does the government in thinking about health care reform have this kind of data?
1
The more involved companies become in health care for their employees, the more likely they are to hire, promote, and fire based on health. Let's not kid ourselves, this isn't about health, it's about profits. Some changes may indeed help workers, but it's also possible that they will just end up footing more of the bill. Isn't that exactly what's happened over the past decade?
51
I have heard this perspective, but as a very small employer I did not find that it matched my experience or what other small companies shared with me. Generally the issue of getting a reliable employee who can do good quality work trumps the costs of health insurance. At the same time, businesses don't want to pay more than they need to secure those good employees. Kudos to these companies for tackling the issues at the level where they can make a difference.
Some good ideas but so many innocent workers, retirees and family are not included and never will be under this type of initiative. It's time for reform for all, something like single payer.
144
Prices that employers pay to get health insurance for their employees have been going up for decades. If they are banding together to do something about it, why now rather than a couple of decades ago.
What we have is competition between the group health insurance providers and the employers who purchase group health insurance. The providers have managed to keep competition among them for employer business from pushing them to lower prices or stop the constant rise of prices. Somehow they have managed, as a group, to make free enterprise fail. The competition that happens is the competition between the employers and the health insurance providers, and the providers have been winning this competition for decades.
If the employers are getting together to reduce the price of the health insurance they buy, it is because the providers of health insurance have found ways to get together and keep prices high. They have structured the marketplace so that prices are much higher than in other countries, and so that employers see no way of providing health care insurance themselves any cheaper than hiring the insurance companies to do it.
The only effective way to restructure the marketplace is by government action, and the private employers would rather be ripped off year after year than see governments strengthened. They know that governments strong enough to hinder the games health insurance companies play could also hinder the games they play.
What we have is competition between the group health insurance providers and the employers who purchase group health insurance. The providers have managed to keep competition among them for employer business from pushing them to lower prices or stop the constant rise of prices. Somehow they have managed, as a group, to make free enterprise fail. The competition that happens is the competition between the employers and the health insurance providers, and the providers have been winning this competition for decades.
If the employers are getting together to reduce the price of the health insurance they buy, it is because the providers of health insurance have found ways to get together and keep prices high. They have structured the marketplace so that prices are much higher than in other countries, and so that employers see no way of providing health care insurance themselves any cheaper than hiring the insurance companies to do it.
The only effective way to restructure the marketplace is by government action, and the private employers would rather be ripped off year after year than see governments strengthened. They know that governments strong enough to hinder the games health insurance companies play could also hinder the games they play.
14
This is all well and good, and I'm glad these companies are finding ways to reduce their costs. But ultimately, it means that costs for people not covered by these companies are going to rise. Just as the uninsured are billed many multiples of the price that insurance companies have negotiated for their members, drug companies, hospitals, and other providers will simply raise their prices on people who don't get their health insurance through their employers, to make up for these cost savings.
As long as the healthcare system is driven by profit for the providers, someone has to pay that profit.
As long as the healthcare system is driven by profit for the providers, someone has to pay that profit.
91
Add to that what Medicare, Medicaid, CHIPS, and others don't reimburse hospitals and doctors. None of these programs pays anything close to 100% of billed charges (on average closer to the 50% to 60% range) and even if one has a supplemental policy total reimbursement never gets close to 100%. So the providers just keep raising their cost of doing business and passing them along which in turn causes insurance companies to raise the monthly premium paid by employers and employees. Other examples of the Health Transformation Alliance have been tried, some with short term moderate success, but it always comes back to the millions of dollars in billed charges that are never paid and the circle just continues. Having worked in a large Catholic Hospital system for 40 years (1970-2010) on the business/administrative side I saw and dealt with this issue every day. The American mind set for true change will be hard to achieve. Good luck Mr. Andrews.
1
So these companies are going to save money on health care for their employees and therefore gain a competitive edge in the marketplace to increase returns to stockholders.
But even if all employers who provide health insurance for their employees join the plan, that leaves out 43% of Americans who do not get health insurance from an employer.
Time for single payer: then imagine how much money corporations will save.
Of course they will have to pay taxes: but I bet it will be less than they pay for health insurance.
But even if all employers who provide health insurance for their employees join the plan, that leaves out 43% of Americans who do not get health insurance from an employer.
Time for single payer: then imagine how much money corporations will save.
Of course they will have to pay taxes: but I bet it will be less than they pay for health insurance.
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This article is the best argument yet for single-payer insurance. A cooperative approach, representing more people, gets better results in terms of insurance costs. This multiplied by the numbers to be represented in a national health system would do even more. That is why most advanced nations, with the exception of our own, have such a system.
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WashPost editorial board says SP is financially insane --
https://www.washingtonpost.com/opinions/single-payer-health-care-would-h...
" .. But the government’s price tag would be astonishing. When Sen. Bernie Sanders (I-Vt.) proposed a “Medicare for all” health plan in his presidential campaign, the .. Urban Institute figured that it would raise government spending by $32 trillion over 10 years, requiring a tax increase so huge that even the democratic socialist Mr. Sanders did not propose anything close to it .."
https://www.washingtonpost.com/opinions/single-payer-health-care-would-h...
" .. But the government’s price tag would be astonishing. When Sen. Bernie Sanders (I-Vt.) proposed a “Medicare for all” health plan in his presidential campaign, the .. Urban Institute figured that it would raise government spending by $32 trillion over 10 years, requiring a tax increase so huge that even the democratic socialist Mr. Sanders did not propose anything close to it .."
The Health Transformation Alliance sounds like a worthwhile endeavor which will lead to better care at lower cost for the people and companies involved. Managing the program will allow them to see how much money is being spent and where it is spent, hopefully reducing unnecessary expenditures and fraud while improving outcomes. If Congress wanted to actually know whether we could provide better care at a reasonable cost it might consider looking at data and expert analysis, instead of relying on slogans and ideological purity. Mitch McConnell's fault was not the failure to enact his repeal and replace. The failure was making promises to the base without having a clue about whether the alternatives being considered would actually help the country. In fact, they never took the time to come up with alternatives, and the people who voted for them did not notice this fact.
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Well, this is very nice. What I don't understand is why industry puts up with the notion that they are responsible for healthcare in the first place. It would be so clearly in their interests to have a single payer system, like medicare, for their workers and remove themselves from the equation. Industry competes with the rest of the world where industry is not shackled with direct healthcare costs. It is a perfect time for industry to step up!
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The answer is ideology. The CEOs of major corporations like GM and Apple went to the same business schools and were indoctrinated with the same anti-government rhetoric and ideology as the insurance company executives. Most of these people all think alike and it's a relatively small group of people. Many know each other personally even. The sociologist C. Wright Mills saw this in the 1950s and it's still true today.
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The answer is that employer provided benefits are not taxed like wage income. This is the cornerstone to our high healthcare costs. But this has been known for decades and yet every year an article like this one shows up and suggests a way forward, but never deals with the root cause.
Because it forces people to work at their pleasure. Many people are afraid to leave jobs because their health care is tied to that job stay in place.
Until, of course, they have "aged out" of the ability to effectively compete in the job marketplace. One of the largest health insurance companies just laid off thousands of older workers, thereby cutting their insurance costs and clearing the way to hire younger staff. They saved by lowering the average health insurance costs for the company, the cost of employing younger talent (yes, those positions shortly started re-posting), and denying a lot of older people the ability to get retiree health care benefits because they were below the age-by-employment-length combination. The unemployed workers are now looking at soaring health care costs and worse benefits through ACA with the same company that just laid them off and an uncertain future because of age discrimination in the marketplace. Did I mention that the CEO stated as much in a company-wide town hall - except omitted that these were forced departures.
Until, of course, they have "aged out" of the ability to effectively compete in the job marketplace. One of the largest health insurance companies just laid off thousands of older workers, thereby cutting their insurance costs and clearing the way to hire younger staff. They saved by lowering the average health insurance costs for the company, the cost of employing younger talent (yes, those positions shortly started re-posting), and denying a lot of older people the ability to get retiree health care benefits because they were below the age-by-employment-length combination. The unemployed workers are now looking at soaring health care costs and worse benefits through ACA with the same company that just laid them off and an uncertain future because of age discrimination in the marketplace. Did I mention that the CEO stated as much in a company-wide town hall - except omitted that these were forced departures.
2
Good to read there adults and companies seeking solutions to prevent healthcare train from derailing. Healthcare costs in the USA driven by the motive that the care received is far superior to any place else in modern countries. We know this is not true.
Doctors , nurses and allied health professionals need to regain control of the hospitals. Recently, news of hospitals going bankrupt or closing for financial reasons most point to mismanagement and in some cases poor quality care. The vast majority of these cases of closure are attributed poor leadership..
Lawyers, accountants and professional managers should not lead hospitals and nor drive healthcare initiatives, persons who are patient centric need to be in control and lead.
Doctors , nurses and allied health professionals need to regain control of the hospitals. Recently, news of hospitals going bankrupt or closing for financial reasons most point to mismanagement and in some cases poor quality care. The vast majority of these cases of closure are attributed poor leadership..
Lawyers, accountants and professional managers should not lead hospitals and nor drive healthcare initiatives, persons who are patient centric need to be in control and lead.
7
The cumbersomeness of medical practice is appalling, especially with chronic conditions which get treated to death, in both senses. I would hope that the trends now beginning to emerge in integrative medicine that go for treating the cause and not just symptom-relief offer a very good hope for improvement, both in treatment and in cost. Some of this depends on foregoing the perception of medicine as a religion whose priest-doctors must be obeyed and the self-enriching propaganda from Big Pharma, and some depends on us as consumers being willing to change our self-indulgent life-styles.
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There is more money to be made treating symptoms, since they continue needing treatment and provide an ongoing revenue stream. Prevention and curing usually do not provide this revenue stream, and so those who live off the stream have an interest in downplaying prevention and cure.
Treating diabetes employs thousands of people and costs billions. Both prevention and cure would decimate the treatment industry. So a sugar tax (part of a prevention program) is fought as government overreach, and research to find cheap or one-time cures is not a good investment (for the same reason that developing a new antibiotic isnt).
Treating diabetes employs thousands of people and costs billions. Both prevention and cure would decimate the treatment industry. So a sugar tax (part of a prevention program) is fought as government overreach, and research to find cheap or one-time cures is not a good investment (for the same reason that developing a new antibiotic isnt).
Capitalism at its best! Profit driven firms banding together to increase their profits, at the expense of other profit driven companies who will see their profits fall unless they can figure out a way to derive more profits. Kudos to the Health Transformation Alliance but common sense overwhelmingly indicates that the United States will do the best job for its citizens by declaring health care a right, paid for with tax revenue (yes, I would be happy to trade premiums for an increase in my tax rate). Jump starting the current employee benefit health insurance industry under Roosevelt was a good and innovative idea in its time, but it is time to move on.
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I agree completely with your comments.. The challenge we have is how to unwind the profit healthcare businesses without causing another unemployment crisis.
The healthcare businesses the USA. Is employ thousands , not even considering the hospital and clinic employees , the Cignas , Blue Cross's etc. employ thousands.
Hospitals and surgeons depend on medical sales representatives for service that in some cases goes beyond just selling or customer service duties.
Med device company execs beholding to their investors are fired if earning targets are not met.
Essentially, it's complicated just on the business side to say the least the political side, our congressional representatives are not likely to cut off the hand that feeds their campaigns.
Acting irresponsibly , will create another unemployment crisis,
What do we do?
Let's get completely transparent on costs, not charges, real cost.
The NYT and LAT needs to develop a open forum to discuss solutions, and fund social media and newsprint out reaches to inform the public.
The current healthcare environment is not sustainable , the few do not want the money train taken away, if we do not start down a corrective , responsible path we will bankrupt our grandkids and their children's financial futures.
The healthcare businesses the USA. Is employ thousands , not even considering the hospital and clinic employees , the Cignas , Blue Cross's etc. employ thousands.
Hospitals and surgeons depend on medical sales representatives for service that in some cases goes beyond just selling or customer service duties.
Med device company execs beholding to their investors are fired if earning targets are not met.
Essentially, it's complicated just on the business side to say the least the political side, our congressional representatives are not likely to cut off the hand that feeds their campaigns.
Acting irresponsibly , will create another unemployment crisis,
What do we do?
Let's get completely transparent on costs, not charges, real cost.
The NYT and LAT needs to develop a open forum to discuss solutions, and fund social media and newsprint out reaches to inform the public.
The current healthcare environment is not sustainable , the few do not want the money train taken away, if we do not start down a corrective , responsible path we will bankrupt our grandkids and their children's financial futures.
2
This is pretty much the same impulse that led to the founding of Blue Cross and Blue Shield plans 90 years ago. It is a wheel worth reinventing, but it does not answer the needs of the non-employed who are not immediate family members of covered individuals. The irony is that if employers banding together can press for price breaks on drugs and devices, why can't the government?
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If employers banding together can press for price breaks on drugs and devices, why havent they done so already. Actually, if they could band together to get meaningful price breaks, they would have been doing it long ago, since these prices have been constantly rising for decades.
Perhaps this is just one more attempt by an indefensible group ripoff to obscure what is really going on and reconcile us to it by creating the appearance that the situation will soon be fixed.
Perhaps this is just one more attempt by an indefensible group ripoff to obscure what is really going on and reconcile us to it by creating the appearance that the situation will soon be fixed.
3
The government (Medicare, Medicaid) here DOES negotiate with providers. It should also negotiate with drug companies. Perhaps Medicare could negotiate together with private companies and insurers, so everyone gets a better deal.
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" .. why can't the government?"
Oh .. because lifetime politicos like Hillary Clinton, John Conyers, and Nancy Pelosi have no grip on reality?
Oh .. because lifetime politicos like Hillary Clinton, John Conyers, and Nancy Pelosi have no grip on reality?
41 companies with around 6m workers and retirees getting together to minimise healthcare costs is supposed to be a good thing as opposed to a government with around 256m people failing to organise a healthcare system because that would be socialised medicine and a bad thing?
Even though the latter would clearly have a better bargaining position and, at least in theory, better motivation and accountability.
The American attitude to healthcare is really difficult to understand from the outside.
Even though the latter would clearly have a better bargaining position and, at least in theory, better motivation and accountability.
The American attitude to healthcare is really difficult to understand from the outside.
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Thanks to effective lobbying by corporate interests, some branches of the government are barred by law from negotiating price breaks. I don't recall if it's Medicare or Medicaid. It is truly a perverse situation.
2
The American aversion to a rational healthcare system is near pathological. Harry Truman first proposed national healthcare, around the same time the UK established the NHS; resistance from powerful interests was quick, coordinated and fierce. And the same pattern repeated over the decades -- until the ACA was passed 60-some years later. It's not perfect but it's a start toward a sensible system of care. I had some experience of the NHS when an elderly relative moved back to the UK. The care she received enhanced not just her physical well-being, but her peace of mind as well. She never could have accessed the same level of care in the USA; she didn't have the money. Most of us here have had no idea how much better things can be, but it looks like we're waking up now as a result of the ACA. I can only hope that continues.
4
With Trump the "efficient businessman" in charge who needs Congress at all?
Congress is just an inefficient and wasteful entity that is not cost effective.
Let's have Trump eliminate Congress, stack the Supreme Court with
ultra conservative Judges and rule by decree after declaring himself Emperor.
That would be the business model Trump is most accustomed to but I
sure hope and pray that is not what Americans really want. Is it?
Congress is just an inefficient and wasteful entity that is not cost effective.
Let's have Trump eliminate Congress, stack the Supreme Court with
ultra conservative Judges and rule by decree after declaring himself Emperor.
That would be the business model Trump is most accustomed to but I
sure hope and pray that is not what Americans really want. Is it?
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