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How to Bring the Big Health Insurers to Their Knees

Now that the midterm elections have passed, it’s time for Americans’ favorite fall pastime: shopping for health insurance. It’s open enrollment time for the Affordable Care Act. By now almost everyone scoffs at the term “affordable care” because health insurance is no longer affordable and care seems to be lacking as patients have to compete with computers for their doctors’ attention.

There was a time when doctors knew their patients more intimately. From grandparents’ ailments to children’s checkups, the same physician was there for the bulk of a family’s life. And the family paid this doctor directly, be it in cash or on the barter system—chickens, pigs, cakes, what have you. There were no copays. The doctor managed his own offices, typically with a competent nurse and possibly an additional assistant to help schedule appointments.

But with the proliferation of managed care in the late ’80s, patients as well as doctors have slowly ceded control over their health care to insurance companies. For years now, this reality has been accepted because the changes were implemented subtly. Then one day Americans woke up and realized they no longer controlled their health care at all, forced instead to bow to the edicts issued by Big Insurance.

Health care spending in the United States weighs in at a staggering $3.5 trillion. That’s nearly 18 percent of the American economy. Beyond the government players who manage Medicaid and Medicare, the four big insurance companies—United Healthcare, Anthem/Blue Cross Blue Shield, Aetna, and Humana—have done very well for themselves of late. On April 1, 2010, their shares were trading between $26.38 and $53.80. April 1, 2010, is significant because the Affordable Care Act was signed into law by President Barack Obama on March 23, 2010. Shares of those same insurance companies were trading between $68.33 and $97.30 per share on January 1, 2014. On November 2, 2018, their shares closed between $198.21 and $323.05 per share, an increase of 500 percent to 850 percent over the last eight years. In the meantime, interference by those companies in the doctor/patient relationship has only increased.

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Americans continue to blindly pay their premiums in the form of payroll deductions for those employed by large companies or monthly checks to the insurance companies if they’re self employed. The average health insurance premium for a family of four is roughly $1,500 with no subsidies. Over 12 months, that makes the average annual total $18,000 plus a $5,000 deductible before insurance will pay. That’s a significant amount of money considering what you get in exchange: doctor’s visits for $20 and specialists for $50.

The way out of this mess is for Americans to remove themselves from the health insurance market altogether—or to participate in other forms of health insurance such as health sharing ministries and short-term insurance plans. Individuals can actually pay a doctor, hospital, or outpatient center for a service performed without filing claims or getting pre-approval from a clerk in a cubicle. There are primary care physicians across the country embracing this new way of providing health care (notice I did not say health insurance). The new way is called Direct Primary Care. Direct Primary Care physicians are focused on the patient. They can sometimes take as much as an hour to perform a comprehensive assessment and they’re available after hours and on weekends.

“Heresy,” some will say, “totally irresponsible.” But you don’t have be a math genius to see how much health care you can purchase with the $23,000 referenced earlier. The average office visit to a primary care doctor ranges from $75 to $150. As you get older, your doctor may order routine laboratory tests, just to see if there’s anything out of the ordinary, a blood count, metabolic panel if you’re at risk for diabetes, a hemoglobin A1C, and cholesterol. These blood tests, if purchased on the open market, cost between $80 and $100. Hemoglobin A1c kits to test for diabetes (and monitor those already diagnosed) can be purchased from Amazon for $40 and shipped to your home. If you’re a woman and you need that mammogram, you can get one for $181. Gentlemen, for $200 you can have your annual physical, and ladies, your price is $400, including the mammogram. This is what you should be paying for a year’s worth of preventative health care.

But what about emergency room visits? For starters, try using a local Urgent Care, which are open until late in the evenings if not all night. An X-ray with an office visit usually costs less than $500. The lesser the problem the lesser the cost. If you do have to go to an emergency room, be prepared for the hospital’s charges. If you’re knowledgeable about what resources are available to you, you can negotiate them with the hospital.

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Like Dr. Kevin Wacasey, M.D. says in his book Healthcareonomics 101, “it isn’t the cost of healthcare that’s outrageous, it’s the charges.” Hospitals negotiate their agreements with insurance companies based on the chargemaster list. Think of that as the full sticker price on a new car plus 20 percent. But you’ll never know what those negotiated rates are because neither party is compelled to release them.

With a little research from companies like MDSave.com and NewChoiceHealth.com, the consumer can know prices for nearly every type of intervention or procedure. Anything from blood tests to angioplasty to knee replacement can be found there along with physicians and hospital networks that are willing to accept it. Consumers can usually find a participating provider within 200 miles from home. This new way of thinking about surgeries began with Dr. Kevin Smith and his Surgery Center of Oklahoma in 1998, which displays the prices for the most common surgical procedures right on its website. When prices are available for all to see, other players in the health care process are coerced into keeping prices in line.

Consumers shouldn’t get too caught up in the jargon of politicians and health policy wonks. Health care is available to anyone willing to purchase it and no one can be denied basic emergency care. It is health insurance that has become cost prohibitive and provides no real value except to shareholders. In 2017, there were an estimated 7.5 million people paying insurance premiums without subsidies at an average price of $400 per person (the average premium for a family of four, two adults and two children). Let’s say those 7.5 million people decided health insurance wasn’t worth it and left the insurance market. That would cost health insurance companies $3 billion—that’s “billion” with a B and nine zeros. Withholding that much from a company that earned $201 billion in 2017 just might get someone’s attention.

Right now, “innovation” and “disruption” are the buzzwords of American health care. Maybe the disruption that’s really needed is for the insurance system to lose a large amount of money.

Jennifer Hawkins is a mother, freelance writer, and registered nurse.

35 Comments (Open | Close)

35 Comments To "How to Bring the Big Health Insurers to Their Knees"

#1 Comment By Whine Merchant On December 3, 2018 @ 11:00 pm

Glad to see some creative thinking, so let me add two more suggestions:
Mutual Health Societies, such as existed in the English-speaking world before any insurance companies as we know them today. The first Mutual Provident Society was a life insurance collective begun by a Scottish cleric. Where I now live, in Australia, instead of health insurers luring market investors with figures of their dividend, they lure clients by bragging about the high percentage of each dollar that they return in benefits and low costs of their overhead.

The next suggestion would be DOA on any political agenda: tort reform, to cease windfalls for big legal firms driving the outrageous insurance cover required by America’s hyper-litigious game-show-mentality society. Fat chance of that getting through Congress. Even if Trump never touched the ACA, he could have legislated tort reform if he had any idea of what he was doing in the White House; but no one knew it was so complicated until he came along and told us.

Thank you –

#2 Comment By mojrim On December 4, 2018 @ 1:53 am

This is possibly the dumbest take I’ve ever read on healthcare costs in the US. If it was all just well-baby exams and skinned knees this would work, but that’s a tiny fraction of costs. The majority are things far outside any individual’s ability to pay for no matter how deep the cash discount is.

Go home, little over privileged girl. The adults are speaking.

#3 Comment By JR On December 4, 2018 @ 4:48 am

Netherlands paying Euro each adult on average 120 monthly so 1440 yearly. That amounts to Euro 6000 yearly for the 4 person family quoted above paying US$18000 yearly. Dental care is excluded and for hospital care the first Euro 385 are to be paid by the individual. Minor’s below 18 are included as part of the coverage for their parents. So a family with 2 minors pays only Euro 2880 yearly.

So it is quite possible to provide health care insurance at affordable prices.

Direct Health Care as promoted above addresses the problem of a predatory collusion of both insurance industry and health care providers however at the price of not having an insurance spreading the individual risk.

Given the problems of the US health care and insurance industry lobbying politicians “Direct Health Care” may seem the only way out, but that’s only if you accept that your political system is too corrupted and ineffective to actually deal with this problem adequately.

#4 Comment By JonF On December 4, 2018 @ 6:04 am

This is nonsense on stilts. The a out to for Congress to get real, and President Trump to remember his campaign promise, and enact true universal, and affordable, coverage. We know this can be done because every other advanced and even somewhat advanced nation on Earth has done that.

#5 Comment By upstate On December 4, 2018 @ 7:09 am

There’s an easier faster way that’s been shown to work even better. It’s called single payer.

#6 Comment By EliteCommInc. On December 4, 2018 @ 8:11 am

Given the healthcare mess that consumes my every waking moment (there’s nothing I trust about healthcare or insurance at the moment). Ranks about the same place as lawyers — both professions I actually used to admire.

I appreciate this article.

#7 Comment By Stavros On December 4, 2018 @ 8:24 am

This article is astonishingly off-base, blaming insurers for what most academics conclude is a provider and pharma pricing problem in an price-and-quality opaque, non-competitive market. It also assumes that health care consumers are rational players in an open-price market, neither of which is the case. When I fell off a ladder and broke my left leg, the last thing I thought of was “which hospital provides the lowest cost, acceptable care?” I relied on my insurer for their negotiating power when I was taken in shock to the local ER and orthopedic facility. Sure enough, when the bills finally showed up, the Chargemaster price was almost $30,000 and the negotiated insurer payments were less than $14,000 with my share a small fraction according to our policy co-pays and deductibles. Absent that insurer’s market power to negotiate prices with the providers, I would have been charged the full amount less any small discount the hospital and the physicians might have kindly granted due to individual pay.
These thoughts are reinforced by the experience of CalPERS in their move to “reference pricing” which in essence says to the market, “we will pay no more than the least amount necessary to secure facilities within a reasonable drive for our members.” They moved California pricing for major procedures such as knee replacements from a range of $6,000 to $130,000 down to an average of around $7,500, an illustration of the value of insurer market power.
Short-term policies and “health care associations” are not a solution to these problems. Many consumers will be rudely shocked when they discover that neither will pay for major procedures. If your premature newborn ends up in the NICU, watch the “family values” of your religious health “insurance” association vaporize under the costs.
Indeed, what this country needs is larger, more market-dominant insurers who are finally able to dictate to providers what their health consumer market will pay. Most insurers do not presently have such power, thanks in part to massive hospital consolidation. If it takes “Medicare for all” in some form even if only the ability to buy in, so be it. We simply cannot cede to providers all pricing power in an opaque, non-rational health care market.

#8 Comment By Kent On December 4, 2018 @ 8:37 am

“And the family paid this doctor directly, be it in cash or on the barter system—chickens, pigs, cakes, what have you.”

This was maybe up until around the late 1930’s, not the 1980’s.

“But with the proliferation of managed care in the late ’80s, patients as well as doctors have slowly ceded control over their health care to insurance companies.”

And this was in an effort to contain already rapidly rising healthcare costs.

We have a health insurance industry for 3 reasons:

1. Healthcare is not a natural competitive capitalist industry. The system is setup so that the patient can’t know the real costs. So the insurance industry steps in to set prices. It is a “Free Market” not a competitive capitalist market.

2. The knowledge difference between the patient and doctor is too high for patients to make informed decisions. So the insurance industry steps in to make sure the doctor is making reasonable care decisions.

3. This is America. We hate the government. So we have the private sector do what other countries have the government do.

And the private sectors goal is to maximize revenue and minimize expenses. So of course health insurance is wildly expensive. It is what we want and what we have voted for over decades.

Besides, everything you said works fine, but it doesn’t cover hospitalization costs for major issues. Cancer or a bad car accident can cost you a million dollars. In the end, it will cost you your life if you can’t pay up, and most can’t.

Now, those issues may cost the hospital $20,000. But we believe in a free market. The hospital can exercise its liberty to charge what it will. You can exercise your liberty to die, even if you could have come up with the $20k. Pricing differentials are bad for any business.

#9 Comment By madge On December 4, 2018 @ 8:48 am

“With a little research from companies like MDSave.com and NewChoiceHealth.com, the consumer can know prices for nearly every type of intervention or procedure. Anything from blood tests to angioplasty to knee replacement can be found there along with physicians and hospital networks that are willing to accept it.”

So.. I’ve followed the author’s sage advice and checked for the price of a knee replacement surgery on MDSave.com. The national average for that surgery is $55,000. That comes out to what, 5,000 chickens or so I should deliver the surgeon?

Seriously, why publish this insane drivel?

#10 Comment By Frank D On December 4, 2018 @ 9:01 am

Who is going to drive 200 miles to see a doctor? Did the author figure in the costs of traveling 200 miles to see a doctor? I’ve gone to those Urgent Care type offices too. Guess what? They sent me to an emergency room anyway. So I ended up paying twice which didn’t save any money.
And I doubt that those do it yourself medical test kits would convince any doctor that you have accurately diagnosed yourself. They are going to order those very same tests and you will get charged for them too.
At least she didn’t allude to doing your own in-home surgical procedures as a cost saving measure.

#11 Comment By JeffK On December 4, 2018 @ 9:12 am

All well and good until faced with a catastrophic illness requiring a lot of medical services. Very few people can come up with the $50K plus for that type of service.

But I agree with the concept.

Trouble is, when it’s an emergency situation, nobody shops for care. The nearest emergency room, with outrageous charges, is where they go.

I think moving to insurance with catastrophe only coverage may be where we are heading. Low premiums, high deductibles, and you pay for almost everything out of pocket. Or, conversely, traditional insurance, but if you need an expensive transplant or biological chemo, you’re on your own.

Reforming health care costs will require stoic responses. Some people, even those with means, are going to have to accept they, or their parents, or their children, are going to have to die, and unless they can come up with $100K plus, they aren’t going to receive very expensive cutting edge or end of life care.

Making consumers pay for such care will provide incentives to both the consumer and the health care industry. The consumer will choose not to bankrupt themselves for cutting edge therapy that has marginal results (from a ROI perspective), and the medical industry will feel pressure to reduce prices.

And don’t get me started on direct marketing of prescription drugs to patients. Currently Big Pharma spends $5B on direct to consumer marketing, bypassing physicians. That’s nuts. I think their is a 1st Amendment issue with prohibiting it, but that doesn’t mean it should be tax deductible as a business expense. I read somewhere that the US, and New Zealand, are the only countries in the world that allow it. How many viagra commercials does Joe Sixpack need to see?

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To support the article, a friend of mine’s cousin is a UPMC pediatrician. There are lots of Amish around Pittsburgh. When a child needs a medical procedure, the parents, and grandparents come to the hospital and agree on the price. Then grandpa reaches into his pocket and pays cash. No insurance companies, complicated codings, discounts, deductibles, authorizations, denials, appeals, etc. Just cash and service. And they receive big discounts. Maybe that’s the way it should be.

#12 Comment By TomG On December 4, 2018 @ 9:21 am

Great ideas here by Ms. Hawkins. Implied but not directly stated is also the ridiculous Taj-Majal medical complexes that just driving up to one knows they can’t afford even before they check in. Smaller doctor practices and local clinics seem to me to be the most logical step forward. And pay-as-you-go to publicly posted procedure costs would save working families thousands a year. I’m all for it, but then I don’t personally need or even want twenty different specialists billing me into oblivion. Some seem to think they need 15 opinions and twice as many treatments towards their quest for immortality or their hypochondriac big pharma managed care.

#13 Comment By mrscracker On December 4, 2018 @ 9:33 am

My daughter & her family use CMF CURO which is a Catholic medical sharing ministry. They’re expecting their 5th child & have been very pleased with CMF CURO. There are other Christian medical needs sharing networks out there, too :

“Needs are shared monthly within the Samaritan Ministries International community. Sending your monthly share gives you the opportunity to support and pray for your brothers and sisters in Christ. Receiving shares opens you to an experience of trusting in God’s love and providence and receiving spiritual and financial support from the community.

When you receive care, CMF CURO helps you through every step of the process. From working with your medical provider, to submitting your Needs and providing spiritual and emotional support, your whole health care experience is the core of our ministry.

Your CURO Card is exclusively dedicated to paying medical expenses. Set funds aside to for your health care, pay your medical provider, and receive and track shares directly on your CURO Card…”

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#14 Comment By mrscracker On December 4, 2018 @ 10:28 am

JeffK: “To support the article, a friend of mine’s cousin is a UPMC pediatrician. There are lots of Amish around Pittsburgh. When a child needs a medical procedure, the parents, and grandparents come to the hospital and agree on the price. Then grandpa reaches into his pocket and pays cash. No insurance companies, complicated codings, discounts, deductibles, authorizations, denials, appeals, etc. Just cash and service. And they receive big discounts. Maybe that’s the way it should be.”

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That’s how my Mennonite friends do it, too. Additionally, their local church community also assists if costs are above what a family can bear.
And yes, doctors give them deep discounts for paying in cash.

#15 Comment By mrscracker On December 4, 2018 @ 10:37 am

Kent :

And the family paid this doctor directly, be it in cash or on the barter system—chickens, pigs, cakes, what have you.

“This was maybe up until around the late 1930’s, not the 1980’s.”
***************

Right through the 1980’s we paid our country doctor $3.00 per visit including all medications(he dispensed those in his office.) Before he retired the cost of an office visit & meds increased to $5.00.

I’ve also traded home raised hamburger for blood work on at least one occasion.

#16 Comment By mrscracker On December 4, 2018 @ 10:56 am

Frank D says:

“And I doubt that those do it yourself medical test kits would convince any doctor that you have accurately diagnosed yourself. They are going to order those very same tests and you will get charged for them too.”

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I guess it depends on which tests you’re referencing but our midwife did all the blood work/checkups in her home. Pap smears, even if done at home are mailed out to pathology labs, not your physician.
You don’t do the pathology part by yourself. And neither do most doctors.
With advances in technology, there will likely be more ways folks can take responsibility for their health, perform certain screenings at home & free up doctor’s offices.

#17 Comment By Ksw On December 4, 2018 @ 12:38 pm

You should be red faced embarrassed after publishing this kind of nonsense. Please stick to the real world, not a made up fantasy land.

#18 Comment By MM On December 4, 2018 @ 1:32 pm

JonF: “We know this can be done because every other advanced and even somewhat advanced nation on Earth has done that.”

Would you mind providing one international example to follow that would lower the costs but not the quality of care that over 100 million workers in the private health care market currently have in the U.S.?

#19 Comment By I Don’t Matter On December 4, 2018 @ 2:39 pm

“Would you mind providing one international example to follow that would lower the costs but not the quality of care that over 100 million workers in the private health care market currently have in the U.S.?”

You are trolling, right?
Germany. France. Finland. Israel. Holland. Austria. A dozen more.

#20 Comment By creekmama On December 4, 2018 @ 2:56 pm

We have been with our health care cost sharing ministry for several years now and are very satisfied. Our whole family now belongs to a Direct Primary Care practice. It’s only been a few months, but so far so good. We’re getting better care, and I’m less worried about cost.

#21 Comment By JeffK On December 4, 2018 @ 4:59 pm

@MM says:
December 4, 2018 at 1:32 pm

“Would you mind providing one international example to follow that would lower the costs but not the quality of care that over 100 million workers in the private health care market currently have in the U.S.?”

Canada. It doesn’t have 100M population. It has 36M. But close enough for government work.

I have worked for a Canadian company the last 8 years as an independent consultant. I have been back and forth to Canadian clients for the last 3 years. I have discussed the Canadian healthcare system with all types of Canadians. In bars, hotel gyms, and usually airport(bar)s as we sitting waiting for flights. They overwhelmingly support their system, and would not trade it for ours.

But don’t take my word for it.

From a paper by The Wharton School of Pennsylvania: ““We have this discombobulated, fragmented system that leads us to have very high administrative costs, and everything is disconnected. You have to go from one system to another when you go from one provider to another. Some health [information] gets lost with the transfer from one provider to the next. And there’s a private health care system that funds you when you are under 65, and when you’re over 65, you get funded by Medicare. And maybe most of your problems occur when you’re on Medicare, so our private health care system doesn’t have a lot of incentive to keep you healthy when you’re over 65, because they’re not on the hook for it.”

“In one sense, what Americans can learn from Canadians is nothing, because we don’t share the same views of society as they do.”

That pretty much sums it up right there. Canadians are much more egalitarian than we are. Also, their population is very diverse. Go to Montreal or Toronto and it will be obvious.

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Regarding administrative healthcare costs of the US System: “2. A more recent study published in Health Affairs examined data from 2010 and 2011 to determine how administrative costs of U.S. hospitals compared with hospital administrative costs in Canada, England, Scotland, Wales, France, Germany and the Netherlands. It found that 25.3 percent of total U.S. hospital costs went toward administrative expenses. The U.S. had the highest hospital administrative costs, followed by the Netherlands (19.8 percent) and England (15.5 percent). Scotland and Canada had the lowest hospital administrative costs.”

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And that’s just HOSPITAL administrative costs. Let’s not even get into INSURANCE administrative costs, which are not included in hospital costs.

A conclusion from an essay on the subject: “Basing on the above comparisons, it is arguably evident that the multi-payer health care system in the US which is dominated by the private sector is not as effective as the single-payer healthcare system in Canada, which is essentially publicly funded.”

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But, MM, this response isn’t for you. It’s for people with an open mind. I could say the day is 24 hours long, and your rebuttal would be “Ha! You are WRONG! A day is really 24 hours, 0 minutes, 0.0009319 seconds (0.9319 milliseconds). You are wrong because you are OLD. I am right because I live in CA and my vote doesn’t count! And the Democrats did not have a wave election because they only won by 100,000 votes!”

But anyway….. Distinctions without differences. Another example of a logical fallacy.

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#22 Comment By EliteCommInc. On December 4, 2018 @ 5:28 pm

“We know this can be done because every other advanced and even somewhat advanced nation on Earth has done that.”

Name one with the size of the US economy and population. Here’s a peak at France’s issues (referencing only the healthcare issues – not the riots.):

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Touted as the most effective system on the planet it serves a population of 65 million, that is not even half of the US population.

We have wrangled this matter numerous times on this site. And unless We overhaul our entire system by placing heavy required changes in our individual health priorities as a way of life, the idea in my view is just not feasible under the current structure and under the revised structure, insurance companies make a lot less money.

And I think it is incorrect that competition is not possible. when i was finally aware of enough to take become actively involved in my care. It became obvious that shopping around for the right dentist for an affordable price was not possible, but wise. The strangle hold that insurance companies put on who a patient can see really hinders that process.

What the author suggest is correct – the need for more general practitioners to deal with most of the healthcare needs of most people. The tendency to over test, via a vast array of specialists is almost a mandated process now.

I tell who will drive a hundred miles to see a doctor, the same people whi drive 100 miles for specialized care exams and treatments. The same people who can’t afford technically advanced hospitals, exams. I am all for government providing loan relief to medical students in exchange for reduced or static incomes making general practitioners available to more people.

Because the best care is preventative care and that is where the general practitioner has leverage as a personal care giver. And nothing could have been more ground breaking that the broken silence on how we eat — thanks to Dr. Atkins and a host of others who revamping food and health.

#23 Comment By Martin On December 4, 2018 @ 10:12 pm

This is a great article with helpful practical suggestions for containing health care costs. While ditching health insurance may not be desirable for everyone, incentivizing price transparency and sensitivity for non-emergency procedures is possible and desirable. Other worthwhile steps include offering insurance premium discounts for meeting health & fitness targets (blood pressure, BMI, and waist circumference), giving the same tax treatment to employer-provided and marketplace health insurance plans and capping their deductibility, making more people aware of services like mdsave.com which pair well with high-deductible plans and HSAs, and not covering routine physicals and screenings for asymptomatic patients, which are among the easiest procedures to negotiate and pay for directly. The author is careful to speak of direct *primary* care — she’s not suggesting that patients start an auction in the ambulance.

Thanks so much for the helpful ideas in this article.

#24 Comment By john On December 4, 2018 @ 11:06 pm

Medicare is one of those government programs that really work. People under sixty-five should be permitted to buy into Medicare. Then the insurance companies would have to compete with a lower cost provider and either adjust their rates or go out of business. At present, the enormous salaries of the executives and the cost of administration is profound and not a penny of that goes to treat any illness. With the high cost of premiums and the high deductables most people are paying insurance and receiving no benefits. The use of paraprofessionals to being down costs has also decreased the cost to the insurance companies at the expense of patients. The nurse practitioners and physician assistants don’t know what they don’t know. And the old saying is that you see what you know. Would you rather fly with a pilot who had 10,000 hours flight time or one with 500 hours? If your car breaks down do you take it to a certified mechanic or do you take it to Jiffy Lube? If a nurse practitioner or a physician’s assistant can treat your problem then you don’t need to see a medical person in the first place. When I pay I pay to see a real doctor, or why go in the first place? So higher premiums and lower care are what we all face. Direct payment with a catastrophic policy as a backup would even be better. And if you visit a physician get what you came for- a real doctor.

#25 Comment By Anne Mendoza On December 5, 2018 @ 1:15 am

How is it possible to write an intelligent article about reforming the U.S. healthcare market without a single reference to Big Pharma and the other monopoly and pricing cartels which set the costs of healthcare? It isn’t.

Healthcare insurance companies account for roughly 20% of healthcare costs according to most sources. Reducing prices by 20% in no way makes the U.S. healthcare market affordable as any cancer patient will tell you.

I seriously doubt that Ms. Hawkins has ever attempted to negotiate a price for an in-patient procedure at any hospital anywhere in the U.S. If she had, she would not have written such an idiotic article. I also doubt that she has ever attempted to negotiate the price of a therapeutic dose of the Hepatitis C drug ($94,500) with the drug maker. Even at half off, which presupposes the skills of a master negotiator, show me the middle class family that can afford it.

Healthcare in the U.S. is a racket run by rentiers who exploit monopoly pricing power, pricing opacity and asymmetrical buyer/seller knowledge for all it’s worth. Until Big Pharma, pharmacy benefit managers, medical device makers, and hospital consortiums are policed by a bigger player such as the federal government (see Medicare), costs will remain obscene and continue to climb in the private insurance market.

#26 Comment By mrscracker On December 5, 2018 @ 11:33 am

john: “If a nurse practitioner or a physician’s assistant can treat your problem then you don’t need to see a medical person in the first place. When I pay I pay to see a real doctor, or why go in the first place?”

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Any number of things can be taken care of by a nurse practitioner or physician’s assistant. And I’d also add-by a certified nurse midwife. I don’t know about you, but there are a host of skills those professionals are trained for that I lack knowledge of.

I’m only familiar with midwives, but they screen & refer patients to “real doctors” when there’s a reason to. I’m assuming nurse practitioners operate under the same protocol.

Unforeseen circumstances years ago provided me an opportunity to deliver a baby unassisted. Mama & baby did just fine but that doesn’t prove a midwife wasn’t necessary in the first place.

#27 Comment By b. On December 5, 2018 @ 12:17 pm

Next: Direct Primary Retirement.

Disability would work, too.

The same old glibertarian vinegar in new skins?
Really?

#28 Comment By MM On December 5, 2018 @ 6:28 pm

JeffKrank: “But, MM, this response isn’t for you.”

Then you shouldn’t have addressed it to me.

I won’t bother to respond to your argument that the U.S. should copy Canada because you wouldn’t address the points I make, either.

Namely, despite what you claim, the Canadian health care system isn’t single-payer, it’s 70% government subsidized.

And in terms of quality, long-term survival rates for various types of cancer aren’t higher in Canada vs. the U.S.

And the current proposal to let the U.S. government run all health care and abolish the private insurance sector wouldn’t bring costs down.

I deal in dollars and cents, and looked at health care spending in the U.S. From 2000-2016, it grew 80% in real dollars, 2x the rate of inflation. But government spending on health care for the same period grew 3x the rate of inflation. It’s now nearly 50% of all health care spending.

Obamacare was supposed to solve that problem, which was a Big Lie used to sell the program. Obama knew that, and Gruber admitted that.

Now “Medicare For All” is the new solution, the same government program that wastes over $100 million per day.

Sorry, no dice. You guys won’t get another chance to expand the state on this issue. It’s not going to happen.

Give me a better example, like Australia or Japan, and I can agree on certain features. But “Government Runs Everything” isn’t going to happen in America, because it wastes too damn much money as it is…

#29 Comment By MM On December 5, 2018 @ 6:36 pm

JeffKrank: “You are wrong because you are OLD.”

Well, you have displayed rank ignorance on the subject of Social Security, quite a few times, especially your claim that “nobody subsidizes” your SS benefit. Considering how the program is financed, pay-as-you-go by definition, that kind of stupidity speaks for itself.

Whether that has anything to do with the fact that you’re entering your declining years, I’m not sure, but I’ll call a spade a spade when I see it. And you provide plenty of ammunition for that, thanks! 🙂

#30 Comment By JeffK On December 6, 2018 @ 5:44 pm

@MM says:
December 5, 2018 at 6:28 pm

Logical fallacy debate techniques run rampant.

“Namely, despite what you claim, the Canadian health care system isn’t single-payer, it’s 70% government subsidized.” – I never claimed the Canadian health care system was single payer. Strawman logical fallacy debate technique you constantly fall back on.

“And in terms of quality, long-term survival rates for various types of cancer aren’t higher in Canada vs. the U.S.” – Two logical fallacies. Cherry picking regarding cancer cure rates, and I never claimed they cured cancer better (strawman).

“And the current proposal to let the U.S. government run all health care and abolish the private insurance sector wouldn’t bring costs down.” – Neither I, nor the article, proposed abolishing private insurance. Strawman.

Regarding rate of healthcare inflation, healthcare inflation has out-paced nominal inflation for decades. Another logical fallacy. Non sequitur. Literally “It does not follow”.

“Sorry, no dice. You guys won’t get another chance to expand the state on this issue. It’s not going to happen.” – Do you want to bet? Polls show healthcare was the #1 issue with 2018 voters. And CNBC article indicates 70% of Americans, and 52% of Republicans, would vote for it.

[9]

The Republicans did nothing to improve health care for the average American the last 2 years. I suspect they will attempt to impede whatever The Democrats try to do in the next 2 years. So my guess is that healthcare will be the #1 issue i 2020 again, unless Trump gets us into another war or a major recession.

Healthcare is the #1 voter issue in 2018, from Forbes.
[10]

Logical fallacies.
[11]

#31 Comment By JeffK On December 6, 2018 @ 5:52 pm

@MM says:
December 5, 2018 at 6:36 pm

Well, you have displayed rank ignorance on the subject of Social Security, quite a few times, especially your claim that “nobody subsidizes” your SS benefit. Considering how the program is financed, pay-as-you-go by definition, that kind of stupidity speaks for itself.

I stand by my statement nobody subsidizes *MY* social security benefit. I, and my employers (including myself as an employer in my own consultancy) have paid over $250,000 into SS over the last 45 years. And I probably won’t start collecting until 2023, which would give another 5 years for interest to compound if that $250K was in my brokerage account.

And as I recall, given all that money paid in over 45 years, and given the power of compounding, your suggestion that I receive $700/month when I retire 5 years from now, is on it’s face, ludicrous.

You claim to do financial and economic analysis for a living. And you constantly whine about the cost of living in CA.

Many competent economists are thriving in CA.
Why aren’t you? Maybe a bit of self reflection is in order.

#32 Comment By MM On December 6, 2018 @ 10:13 pm

JeffKrank: “I never claimed the Canadian health care system was single payer.”

You literally quoted from an essay that said: “The multi-payer health care system in the U.S. which is dominated by the private sector is not as effective as the single-payer healthcare system in Canada, which is essentially publicly funded.”

You accuse me of committing logical fallacy, but all I did was point out something you claimed that was incorrect.

I will not respond to any more of your arguments here regarding health care, because you just demonstrated, again, that when it comes to discussing serious issues, you’re either a liar or a fool.

“I stand by my statement nobody subsidizes *MY* social security benefit.”

You can continue to stand by a belief that’s totally erroneous, if it helps a progressive hypocrite like you sleep at night.

You lament income inequality and the fact that your taxes aren’t higher, but then deny the fact that the very funding mechanism that makes your Social Security check possible is direct transfers from workers to retirees:

[12]

“Social Security is, and always has been, an inter-generational transfer of wealth. The taxes paid by today’s workers and their employers don’t go into dedicated individual accounts (although 32% of Americans think they do, according to the 2014 Pew Research survey). Nor do Social Security checks represent a return on invested capital, though you might be forgiven for thinking so since the ‘personalized Social Security statements’ that used to be mailed out once a year and now are available online detail your payment history and projected monthly benefits. Rather, the benefits received by today’s retirees are funded by the taxes paid by today’s workers; when those workers retire, their benefits will be paid for by the next generation of workers’ taxes. Your benefit amount is based on your earnings history and age at retirement, not on how much you and your employer paid in Social Security taxes.”

Note that last point. You continue to claim it’s your money that you paid in all those years, but in fact the money you paid into Social Security immediately went out the door in the form of a check to retirees.

Stupid, stupid, stupid, but you’ll never admit it. At this point, you can’t even claim ignorance like those 1/3 of Americans in the Pew survey who just don’t know how it works, because I’ve nailed you to the wall with the basic facts over and over again.

Oh, and I only complain about the cost of living in California because it has causes so many of my fellow citizens to live in poverty, or leave the state. My family’s doing fine, we’re right around median income.

You see, that shows I care and want to find solutions to make their lives better.

You good progressives with all of your stupid social engineering schemes, you just don’t give a damn about poverty, so long as you’re running things.

That’s the cold truth, and your attitude here and in other discussions is absolute proof of that.

You don’t care about poverty, in blue states. What does that say about progressives, I wonder?

🙂

#33 Comment By peterc On December 7, 2018 @ 2:15 pm

The Swiss have an interesting approach:
“Insurers are required to offer this basic insurance to everyone, regardless of age or medical condition. They are not allowed to make a profit off this basic insurance, but can on supplemental plans.”

#34 Comment By JeffK On December 8, 2018 @ 8:17 am

@MM

“You don’t care about poverty, in blue states. What does that say about progressives, I wonder?

🙂”

Another logical fallacy. An unproven allegation, followed by a non-sequitur, yields a faulty conclusion.

For those that aren’t familiar with Logical Fallacies, a pretty good tutorial is linked below. Watch it a few times to easily recognize the flaw in MM’s postings.

#35 Comment By EliteCommInc. On December 12, 2018 @ 10:44 am

The way forward is to re-imagine health care. And that re-imagining does start with a national plan. it starts by assessing and prioritizing needs. And the first need is taking a look at how US citizens manage their individual health maintenance. that includes catastrophic care. Prevention is not only worth a pound of cure, it is financially wise.

The idea of plopping some massive care system based on false comparisons to other countries misses the essentials of long term planning and pilot testing programs to envision what might work. I still think the answer lies in returning to an emphasis on general care.
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Excuse me, on the healthcare debate concerning social security, medicaid and medicare. If the national program now in place mandating that everyone buy health insurance worked, then those programs would be terminated. You could also eliminate the healthcare coverage under social security.