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Health Care Lights and Sirens
“If we want to make America great again, we’re gonna have to make healthcare well again.” — Katy Talento
Or, we can call it too hard to do, take two aspirin, and call Doctor Ocasio-Cortez in a year.
Katy Talento has talent. However busy you are, do listen to at least the last two minutes and thirty seconds of the Candice Owens Show November 24, 2019 episode, in which Katy Talento gives the Trump Administration’s two-minute pitch on real health care reform. Then go to PatientRightsAdvocate.org to submit a comment into the official federal regulatory comment process—because the Medical Industrial Swamp is loading up the system, once again seeking to stack the deck in their pecuniary and power interests. Would you prefer to read the proposed rule and comment directly in the Federal Register? There is a button to submit formal comments and guidance on that and other forms of commenting, along with the summary and details about the “Transparency in Coverage” proposed rule.
We are told:
To be assured consideration, comments must be received at one of the addresses provided below, no later than 5 p.m. on January 14, 2020.
…Or don’t, and shut up when the left rides single-payer to permanent power. These are the actual stakes, as news any month out of the UK shows.
Paul Ryan and the TruCon Grifters rode the lie “if you elect us we’ll repeal Obamacare” to eight profitable years of power, without the “policy wonks” and “experts” ever actually building support through hearings and placing real replacement solutions on the Senate and President Obama’s desk. Meanwhile, the grossly corrupt medical industry makes Hollywood studio movie accounting look transparent. Taken together, we are sliding towards an electoral majority throwing up their hands and taking the government-run “single-payer” system as the least dreadful option. President Trump, within the limits of his Article II constitutional authority, enhanced by the Congress and the Court ceding so much authority to the permanent bureaucracy, is doing everything he can to save America from that fate.
The latest move is one that strikes ordinary folk, not possessed of advanced “expert” credentials, as eminently sensible. We already are bombarded with the most gruesome details about the possible side effects of drugs. If pill pushers can be made to speak those warnings, as a condition of touting their latest miracle potion, then surely they can be made to fully reveal the real prices. Surely, if you must be given the prices before a meal is set before you, you can expect the real prices for medical services upfront. These proposals have been met with howls of outrage and full-on FUD campaigns (fear, uncertainty, and doubt). Somehow, the great free-market virtue of price transparency as a condition of free exchanges is supposed to not operate in the oh so special environment of Big Healthcare.
President Trump’s administration started down this path while Paul Ryan and crew were still in the majority. If Ryan’s Resistance was too busy with hamstringing and delaying the Great Big Ugly Man to keep almost a decade of pinky-swears, President Trump would be the adult in the room. In May of 2018, Seema Verma took the point:
Americans are active shoppers. Whether purchasing a car, a dishwasher, or a jar of salsa, we rarely buy anything without comparing the price and quality of available options. These days, shoppers have access to a wide array of tools online to inform our quest for value. Our demand for value is the engine that drives competition which, in turn, lowers prices and inspires innovation to improve the quality of the products we purchase.
Yet, when it comes to one of the most important services we receive — our health care — this consumer driven engine sputters.
Some might argue that health care is different. However, recent studies show that giving people tools to shop for health-care services by price reduces their costs without any evidence of a decrease in quality.
Health and Human Services has the lead on the American Patients First initiative, to lower costs to consumers through a wide range of reforms, centered on transparency and reducing the complex system, rigged to the advantage of those with the most well-funded lobbying arms.
For years, American patients have suffered under a drug-pricing system that provides generous incentives for innovation, while too often failing to deliver important medications at an affordable cost. We have access to the greatest medicines in the world, but access is meaningless without affordability.
In January of 2019, President Trump increased pressure, with the new Democratic House majority and increased Republican Senate majority having a chance to do something constructive on an issue both parties had made part of their campaigns. President Trump spoke on healthcare to the American people through live video coverage of a healthcare roundtable:
THE PRESIDENT: […] First time in over 50 years that prescription drug prices have declined — that’s in 2018.
But the seen and unseen costs of healthcare are still taking an enormous toll on millions of American families. And this is something that I inherited; unfortunately, you inherited it, and also the people inherited. And we’re doing a lot about it.
Half of all unpaid bills on consumer credit reports in America are for medical bills. One-fifth of credit reports include a past-due medical bill. And you think of so many other bills, but one-fifth — a big portion of what people are having trouble with right now are medical bills, and we’re doing a lot about that.
Nearly 40 percent of insured adults report receiving a surprise medical bill in the last year. Patients should know that the real price — and what’s going on with the real prices of procedures, because they don’t know. They go in, they have a procedure, and then all of a sudden they can’t afford it. They had no idea it was so bad — of procedures, treatments, and medicines before they receive them. And this is a big shock to a lot of people, patients and others.
When you go to a grocery store, or you go to see a mechanic, you know the prices upfront, and you get a receipt that shows the cost of every item. Every single item. You know exactly what you’re paying. You go and get your car fixed and you say, “How much?” But people don’t do that with the medical to the same extent, and they get some very unpleasant surprises.
And one of the things that happens is when you don’t make a deal upfront, then the doctor, or whoever it may it be, all of a sudden doubles and triples the price, because they figure you don’t care or you’re rich — you have plenty of money; you don’t have to worry about it. And we don’t want that happening.
That’s what we want to do with healthcare so that patients will know exactly what the cost is, what the quality is. And just think of it as a consumer. You’re really a consumer at a very high level, and you can get some great healthcare. We have some plans that are great. but you have to go in and price them.
As Congress, under Speaker Pelosi and Majority Leader McConnell, failed to act for six months, President Trump took the next step under Article II, signing an “Executive Order on Improving Price and Quality Transparency in American Healthcare to Put Patients First.” This executive order set 30/60/90 day deadlines for agencies to initiate the federal rule-making process to realize his stated objectives:
By the authority vested in me as President by the Constitution and the laws of the United States of America, it is hereby ordered as follows:
Section 1. Purpose. My Administration seeks to enhance the ability of patients to choose the healthcare that is best for them. To make fully informed decisions about their healthcare, patients must know the price and quality of a good or service in advance. With the predominant role that third-party payers and Government programs play in the American healthcare system, however, patients often lack both access to useful price and quality information and the incentives to find low-cost, high-quality care. Opaque pricing structures may benefit powerful special interest groups, such as large hospital systems and insurance companies, but they generally leave patients and taxpayers worse off than would a more transparent system.
[…]
Making meaningful price and quality information more broadly available to more Americans will protect patients and increase competition, innovation, and value in the healthcare system.
Sec. 2. Policy. It is the policy of the Federal Government to ensure that patients are engaged with their healthcare decisions and have the information requisite for choosing the healthcare they want and need. The Federal Government aims to eliminate unnecessary barriers to price and quality transparency; to increase the availability of meaningful price and quality information for patients; to enhance patients’ control over their own healthcare resources, including through tax-preferred medical accounts; and to protect patients from surprise medical bills.
As NPR reported, the industry push back was swift and consistent with earlier resistance to change that would force real price competition on Big Medicine:
Push back from various corners of the healthcare industry came quickly, with hospital and health plan lobbying organizations arguing this transparency requirement would have the unintended consequence of pushing prices up, rather than down.
“Publicly disclosing competitively negotiated, proprietary rates will reduce competition and push prices higher — not lower — for consumers, patients, and taxpayers,” said Matt Eyles, CEO of America’s Health Insurance Plans in a statement. He says it will perpetuate “the old days of the American health care system paying for volume over value. We know that is a formula for higher costs and worse care for everyone.”
…
This executive order is the latest in a series of moves from the Trump administration on health care price transparency recently. As NPR reported, just last month the White House announced its legislative priorities for ending surprise medical bills, which included patients receiving a “clear and honest bill upfront” before scheduled care. That same week, HHS announced a final rule requiring drugmakers to display list prices of their drugs in TV ads.
However, several of President Trump’s past health care announcements have gotten tied up before the promises to lower costs could be realized.
For instance, in May 2018, Trump rolled out a Blueprint To Lower Drug Prices which included a variety of proposals intended to reduce pharmaceutical costs to individuals, the industry and the economy as a whole, as NPR reported.
In October of last year, the Centers for Medicare and Medicaid Services proposed an international pricing model for setting what Medicare Part B would pay for certain drugs. This is the closest the Trump administration has come to Trump’s campaign promise to have Medicare negotiate with drug companies.
The proposal was put out for public comment with a December 2018 deadline. Thousands of comments came in, including a lot of pushback from the pharmaceutical industry and the proposed rule has not yet been finalized and it’s not clear it ever will be.
Well, President Trump’s political brand is “promises made, promises kept.” So, he has pushed even harder. Last month, November 2019, in the midst of all the Congressional and Deep State nonsense, the Trump administration pressed forward with the rule-making he had ordered this past summer. Seema Verma advocated for price transparency while warning against the impending disaster of “Medicare for All.” Katy Talento, operated outside the administration in a supporting role, making the argument in plain, persuasive language and urging citizen action. To establish Trump administration credibility for further reforms, the Council of Economic Advisors issued a statement on falling drug prices:
While the media continues to claim prescription drug prices are rising, a recent Council of Economic Advisers (CEA) paper shows the opposite: Under President Trump, prescription drug prices are decreasing at rates not seen since the 1960s.
In the eight years prior to President Trump’s inauguration, prescription drug prices increased by an average of 3.6 percent per year. Fast forward to today, and prescription drug prices have seen year-over-year declines in nine of the last ten months, with a 1.1 percent drop as of the most recent month. In June 2019, the United States saw the largest single-year drop (2.0 percent year-over-year decline) in prescription drug prices since 1967.
President Trump promoted broader healthcare transparency with another event, this time in the Roosevelt Room, in which he led with the great job and economic growth news and rolled into promoting two further actions under his June 2019 executive order [emphasis added]:
So I signed, as you know, an executive order — historic. And we’re requiring price transparency in healthcare, forcing companies to compete for your business. It’s a very important thing that we’ve done here. I don’t think it’ll be covered by you, but it will be in the years to come [aimed at the 90-95% hostile media represented behind the cameras and microphones].
Our goal was to give patients the knowledge they need about the real price of healthcare services. They’ll be able to check them, compare them, go to different locations, so they can shop for the highest-quality care at the lowest cost. And this is about high-quality care. You’re also looking at that. You’re looking at comparisons between talents, which is very important. And then, you’re also looking at cost. And, in some cases, you get the best doctor for the lowest cost. That’s a — that’s a good thing.
Today, I’m proud to announce two new actions implementing that order. First, we are finalizing a rule that will compel hospitals to publish prices publicly online for everyone to see and to compare. So you’re able to go online and compare all of the hospitals and the doctors and the prices, and, I assume, get résumés on doctors and see who you like.
And the good doctors — like, I assume these two guys are fantastic doctors, otherwise you wouldn’t be here. (Laughter.) And the bad doctors, I guess they have to go and hide someplace. I don’t know. Maybe they don’t do so well. I don’t know. But if they’re not good, we — we are more interested in the good ones. It’s called “rewarding talent.”
Second, we’re putting forward a proposed rule to require health insurance providers to disclose their pricing information to consumers. We’re giving American families control of their healthcare decisions. And the freedom to choose that care is right before them on the Internet and elsewhere, but on the Internet. Very, very open. Very transparent. That’s why it’s called transparency.
The alternative is not to continue tinkering around the edges. We could go the National Health Service route and have our elected “representatives” genuflect weekly from the floor of Congress towards NHS and strike supplicant poses for one more GP, one more specialist in their district. See most any Prime Minister’s Question Time, outside of a Brexit showdown session. We would swiftly find ourselves and our loved ones culled out for the greater good of cost savings, as cancer treatment delayed is cancer treatment denied. Just read the London Times:*
Cancer patients are being forced to endure the worst waiting times since records began, official figures reveal.
For all nine NHS cancer targets, between April and September the lowest percentage of patients were treated on time since the standards were introduced a decade ago.
In total, 168,390 patients were not seen or treated within the specified times. The figure is up 24 per cent on the same period in 2018-19. Staff shortages, lack of equipment and beds filled by patients needing social care were to blame.
[…]
Last year, for the first time, the NHS carried out more than 2m checks. It says cancer survival is at an all-time high, yet Britain is near the bottom of international league tables for cancer survival and is lagging years behind some countries for some types of the disease.
Motivated? Go, read, and comment. Or don’t, and don’t complain later. Hugh Hewitt wrote 15 years ago: If It Isn’t Close, They Can’t Cheat. He was writing about elections at every level of government, speaking evergreen truths. The same advice applies to commenting on proposed regulations. There is a small army of professional advocates stuffing the comment box with their clients’ self-interested views. There are far more of us, so if we have an interest and choose to shove our own views into the comment box, there will be much stronger support against hostile judges claiming a rule was not properly promulgated.
Or take two aspirin and call Doctor Ocasio-Cortez in a year.
* Hat tip to John Hinderaker, Power Line Blog, “Annals of Government Medicine.”
Published in Healthcare
It depends on how many bills the patient has accumulated, and also how much the bill is for. I have tried to talk to creditors and been told that “It is not possible for our company to take a mere $ 25 a month as a payment.”
Now if the patient has only that one bill, they can then find out the company will take $ 50 a month. But often a patient has over 14 to 30 individual bills to pay. Even $ 25 a month times 14 would bankrupt most Americans.
There is also a huge problem that when a person has anything at all done medically, they are now assuming vast amounts of possible billing from who knows where. Way back circa 2000, I saw my ENT specialist. I paid him off in two separate payments,as he was fine with doing that. Three years later, while looking for a new car, I found out I had two dings on my credit.
Both were minor amounts, but were majorly delinquent. The bills came from labs that my visit too the ENT guy had entailed.
I had never received any billing from them – at the time, I had moved one mailing address over. (From street number 7 to street number 5.) So much of my mail never got to me as that area of the world employed only Philippinos. (Local postmaster was from the Philippines.)
How can a person pay things they don’t know about? It does prove people should check up on their credit reports all the time.
If you think that the state legislators in most major very corrupt legislatures give one rat’s sweet patoutie about whether or not a policy will cause total bankruptcy to the state, you are not thinking.
Our elected officials are feeding from the trough, and they know how many millions of dollars they and their family members will receive for foregoing the enactment of sensible policies in favor of whatever the Big Industry’s demands via lobbyists happen to be.
I grew up in Chicago in the 1950’s and some of the scandals relating to “bribery and embezzlement” now seem quaint. Aldermen who were discovered to have shoe boxes of quarters and dimes and nickels they swindled out of the parking meters’ major firm. Or sacks of money handed over in back allies of Chi town after dark.
But these days no elected official is worried about mere parking meter change. If you do Big Pharma a favor, your son or daughter-in-law or perhaps even your wife will now get a cushy job, inside-industry, where there is not even a need to show up for work. (“VP Smith works from her home.”) Eighty thousand bucks a year over 20 years is a lot of dough.
These quid pro quo items are no longer even considered “bribery.” Instead they are called “pay to play.” Campaign contributions, another source of in-family enrichment for politicians, is another sore point.
Close. In this situation, the end user (the patient) is twice removed from the vendor (the doctor). The employer is the “customer” of the health insurance company. And the insurance company is the “customer” of the doctor. At least, that is how the money flows, sort of.
If there were a magic wand, I’d wave it and it would be the patient and the doctor, and that’s it. But try selling that to the American people!
This is 100% correct. I think I might be alone in this, but I used to work for an insurance company processing insurance claims. Some has-been doctor or nurse is employed to review claims and determine if what is done is reasonable and what they think it should cost. The provider bills $100 and the reviewer says it should be $80. They are “incentivised” to find cuts. So the next time the provider bills $120 to get $90. The reviewer gets wise and starts allowing less, and the provider keeps billing more. Not a bit of it makes any fiscal sense outside the RGC (Rube-Goldberg Contraption).
I saw open heart surgery bills in the hundreds of thousands of dollars of which the insurance “allowed” $80k and paid $65k.
Interesting. If that information is ever written up, I’d like to read it. (I won’t listen to a 1:23:00 podcast, though.)
I’m responding to your whole comment here…but I don’t want your words to take away from my 500!
It doesn’t really depend on how many bills they have. I have a whole stack of medical bills on my desk right now. Pediatricians. Massage therapy. One from the dentist. And one from when I had my foot x-rayed. Your final statement is the crux “How do you pay something you don’t know about?” But you DO know about it. You went to the doctor. You know you are going to get a bill. You may not know how much, but you know you are going to get one. So you pay attention.
In 2018 I had a pretty significant injury. What followed that injury was a trip to the ER (so a bill from the ambulance, a bill from the ER, a bill from the ER doctor, a bill from the radiologist, and a bill from the imaging center), three surgeries at two different facilities (so surgeon, anesthesiologist, surgery center bills times three), countless trips to two different physical therapists, oh and I had a separate surgeon for my ruptured Achilles from the guy who worked on my hand. Oh and I had to go see my GP, too. So…you know what I did? Because I’m smart and I figure I’m supposed to be responsible for myself? I started keeping track of all my appointments, and the bills. And I cross references my EOBs with my visits so I’d know what was paid and what wasn’t. And what I owed. I knew I’d hit my out of pocket max. And because I was moderately diligent I knew exactly when that happened. So when I had to have a MRI done on my Achilles, and they wanted a down payment of $500, I said “No, I’ve hit my max out of pocket.” “Oh really? You know that? Most people have no idea!”
Why can’t we all do that?
And to Kozak’s point, when the hospital charges $40,000 to use their facility and my surgeon only charged me $2,000, I reviewed that bill and showed it to the surgeon. He was flabbergasted. I said “You should charge more. Not me, of course. Your other patients.”
To @thereticulator , if you check out the right-hand side of the page and below the show notes and citations, there’s a transcript of the podcast (not sure if it’s the whole conversation or just the major parts), see here.
Here’s the bit I referred to in my previous comment–and obviously the rest of the transcript is an interesting read as well.
I have been doing that also. In fact, one bill came that was yet another doctor who supposedly saw my spouse while he was in the hospital back in May. The bill was even more streamlined than all the others. It turned out that it was a scam. Someone, I assume, who does work inside the billing office or who used to, put together a dummy bill, making up a doctor’s name but no one at hospital admin has any knowledge of any dr by that name. So I am not paying it, with a note from hospital admin that it is bogus in case it becomes a nick against my credit .
You’re absolutely right. I was being sloppy and used “providers” as a shorthand for the corporate overlords at hospitals and larger networks who set and negotiate reimbursement prices and determine billing practices.
There’s an important piece missing from your list of market elements: supply, demand, competition, and scarcity. In other words, the fact that in order for markets to work properly, not everyone can get what they want – or even what they (think they) need.
The problem is that we as a populace have collectively decided that we don’t want scarcity to exist in certain major sectors of the health care market. And yes, this includes a majority of Republicans.
It is absolutely impossible to enjoy the simplicity of a market system while simultaneously prohibiting one of the key features of market systems. That doesn’t mean it’s not possible to devise a system more aligned with market principles while still maintaining the guarantees we want to provide. But it sure as hell won’t be simple.
This, in my opinion, is the core delusion underpinning conservative health care discussions.
To build upon my previous comment: one issue that never gets mentioned when conservatives hold up these types of examples is that most of these “free market” clinics/practices operate on the basic principle of “if you can’t afford it, you don’t get it”. I haven’t heard this episode so I can’t comment on it, but every single other example I’ve heard discussed operates on this basic principle.*
It seems incredibly intuitive to me: stop guaranteeing everyone a service and prices for that service will drop enormously. Yet that fact never gets mentioned when conservatives hold up these facilities as positive examples. I have no doubt that most of the beneficial work and billing practices of these clinics would disappear overnight if we suddenly decided that access to their services was “a right” that would be paid for by taxpayers if needed.
*I recognize that many perform some charitable service. But from a society-wide perspective there’s a huge difference between “we’ll provide service at a below-market rate when we can” and “we guarantee that everyone will be served regardless of ability to pay”.
I wouldn’t assume that. Using private healthcare information as part of social engineering scams is a big deal. And “they” can get that from a number of sources. Which is why it is so important for all of to be careful with what we post online about our healthcare activities, and why it is so important to keep close tabs on the stuff.
The website has printed “highlights”, which looks like a smoothed transcript.
Edit:
I was Snirtlered.