Obamacare- So where have we landed?

Over the past few months, we have been bombarded with conflicting opinions about a number of issues related to Obamacare:

1)     The rollout.

2)     The “fix”, and the new rate of enrollments.

3)     Reduced hours for some.

4)     Some no longer feel the need to work, because insurance can be obtained through the exchanges.

5)     Higher costs for some, lower costs for others.

6)     An apparent slowdown in health care cost increases.

So is it working?

Regardless of the individual cases where a person’s premium might have gone up or down, we have begun the process of ensuring coverage for all.  We are not there yet, but the discussion has changed.

There are many who landed in a good position under the “old model”, where only some received coverage.  When restructuring our system so everyone can be covered, yes, some may have a little less.  But it is simply not morally correct to preserve the positions of those who were privileged enough to have health coverage at the expense of those who still need it.  Is it?  What do you think?

Is it acceptable that those who have health insurance receive “a little less” or pay “a little more” in order to extend health insurance coverage to a large number of additional people? Granted, “a little less” and “a little more” are relative terms.

Is it acceptable that those who have health insurance receive “a little less” or pay “a little more” in order to extend health insurance coverage to a large number of additional people?

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Is “Bending the Health Care Cost Curve” enough, or do we need to do more?

In an opinion in yesterday’s New York Times (November 29, 2013), Paul Krugman shares some optimistic thoughts about the slowing down of the rate of increase in health care inflation.

Let’s look at that sentence more carefully:  slowing- down- the- rate- of- increase.  In my opinion, this does not go nearly far enough.  Every other industry has experienced dramatic change over the past several years.  People have seen their home lose 30% or more of its value.  The replacement cycle on cars and heavy equipment has become dramatically longer.  Deep discounting has become the norm throughout the retail industry.

But all health care can do is slow down the rate of increase?

What concerns me most is that we are about to “bake this number in” to the national budget, permanently, with no end in sight.

While I am a strong supporter of Obamacare, and some number must be budgeted and planned for, what concerns me is the size of the number we are now prepared to take for granted.

It is widely known that the US spends more per-capita on health care than any other country.  By a wide margin.  In fact, the US spends 50% more than the second most expensive country (Switzerland) and two and a half times  what the average OECD country spends.  And we die younger.

So simply “bending the cost curve” is not enough.  We need to radically reduce the overall costs of care by a substantial number.  Like 30%.

If we reduced our per-capita costs by 30%, we would still have the most expensive system in the world.  And we would still die younger.   But maybe the rest of the country would be allowed to move forward as health costs no longer crowded out education, infrastructure and a host of other social programs.

If we reduced our costs by 30%, we would still be 80% more expensive than the OECD average. And we would still die younger.

Now, is 30% the right number?  I cannot say, as no one else can, exactly what the right number is.  But the point I am trying to make is that we need a drastically different dialogue, with a target drastically different than the status quo.  Bending the cost curve is playing around at the edges.  We need a radical fix, a radical reduction in costs, and the will to build and implement such a health care system.

What do you think?

Is “Bending the Health Care Cost Curve” enough, or should we reduce costs more dramatically?

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What should we do about Obamacare?

It has been painfully obvious during October that the HealthCare.gov site is not ready to serve large numbers of applicants.  One common response from supporters is that “Obamacare is more than a website”, which is true.  Getting past the panic and emotional arguments, let’s divide our thinking on the subject into two areas:

  1. How do we get people registered and signed up?
    1. Will the young and healthy sign up?  Why are some plans being cancelled?
  2. How will this all work out long-term?
    1. What happens when there is only 1 insurer in town?
    2. What about networks with restricted choice?

First, how do we get people registered and signed up?

This is actually the smaller question.  The site, along with other, lower tech means of registering (e.g. call centers), will eventually get fixed and people will be able to register through one method or another.  There may be some required policy fixes, such as a delay in imposing penalties, but over time, people will be able to register.  Compared to decades of a system where many had no hope of coverage, ever, even if it takes 1-2 years to get large numbers enrolled, we will land in a better place.

Please do not misunderstand- I am not saying “so what” to the problems, and I am not brushing them aside.  I am simply taking a longer view.

The more interesting question is, how will this work out long-term?”  I am focusing on two issues here, which have the potential to become, or already are serious structural problems within the industry.  These issues are:

  1. What happens when there are only 1 or 2 insurers in town, and prices have remained high?
  2. What about patient choice and the fact that many emerging networks are narrower, leaving out many popular hospitals and physicians?

Let’s discuss each of these in turn:

How do we get people registered and signed up? Will the young and healthy sign up?  And why are some health plans being cancelled?

The phrase “young and healthy” invites us to look at the young and healthy as one monolithic group with similar needs and issues.  The current dialogue masks, however, a major issue- one that half of this group feels very acutely- the prices for policies sold to young men will increase dramatically.  This is due primarily to the fact that men are now required to buy maternity coverage.  Let’s not discuss that men don’t have babies.  The present law has been crafted in a way that defines as “gender discrimination” any scenario other than men being required to buy maternity coverage.

I am not trying to start or continue a gender debate.  I am simply pointing out that asking young men to accept a large price increase because “it is good for everyone else” is asking a lot.  Please do not be surprised when young men decline to accept this dramatic price increase.

A related issue is the cancelling of policies presently in force because they do not meet the “Obamacare Standards”.  Same issue- a policy sold in the past to a young man, and which does not include maternity coverage, is no longer allowed to be sold.

So, taking away their present policy, offering only policies that include maternity coverage at much greater cost, and criminalizing those who do not buy these new policies, is a long term issue that will continue to weigh on the potential success of Obamacare.


What happens when there are only 1 (or 2) insurer(s) in town, and prices have remained high?

This is where the market takes over, and this will take time. Annual cycles.  When health plans in some states see that the neighboring state, or county, has only 1 or 2 health plans, and that prices are high, they will want to enter that market.  In an unrestricted market, large price differences will be evened out through competition.  This is exactly why we have such high prices now- competition has been stifled throughout the industry.

So my belief is that long term, new entrants will cause prices to drop in these areas where there is presently little competition.


What about patient choice and the fact that many emerging networks are narrower, leaving out many popular hospitals and physicians?

This is what will cause the large, “elite” institutions and networks to reduce their prices. 

When we have a situation where “you can go wherever you want, and somebody else will pay”, guess what?  Not only do consumers want to go the hospital of their choice, but that hospital is now incentivized to stand back, saying “that’s not enough money”, and to maintain that position until the payer, whether an insurer or the government, gives in and agrees to the higher prices.

In fact, we see a trend where hospitals are buying up competitors in order to reduce local competition, so the payers have nowhere else to turn, and are forced to pay the higher price. (By the way, these hospitals run very touching ads about how much they care about patients- all while selling the receivables to very aggressive collectors).

Anyway, leaving these hospitals and medical groups out of the network, and making it stick, eventually causes the “elite” institution to reconsider and arrive at a more reasonable price.

Short term, expect much complaining about “limited choice”.  Long term, if we do not give in, we will see prices decline- after all, a hospital cannot survive if they won’t accept patients from Medicare and the major local insurers.

I can’t resist ending with a thought question on this point- If we got to eat wherever we wanted, and somebody else paid, where would we eat?  And what would happen to the prices at those restaurants over time?



For Obamacare to work long term, we must have sensible answers to these structural issues, namely:

-Requiring young men to purchase maternity coverage will prevent many of them from enrolling, and turning them into criminals is not an efficient or effective answer.

-Markets with a small number of insurers must be made accessible to a larger number of insurers in order to create real competition.

-Limited networks must be allowed to remain.  If we bow to political pressure and let the “elite” hospitals and medical groups continue to charge much higher prices, the cost of health care will never become more reasonable.


There’s a lot here- what do you think?


Should men be required to buy maternity coverage?

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What should happen to people who do not buy health insurance as mandated by Obamacare?

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What should we do in markets where there is only one insurer and prices are high?

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What should we do about networks that exclude providers because their prices are too high (limited consumer choice)?

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What should we do to encourage young, healthy males to enroll in Obamacare?

As Obamacare is implemented, there are predictions of significant cost increases for some.  This is driven by several issues, including the enrollment of millions of new insureds, many with conditions that haven’t been treated in a long time (pent-up demand), and the apparent reluctance of young, healthy males to enroll.

Regarding this second point, just what did we expect?

Young, healthy males are effectively being asked to fund a “triple subsidy”:  The healthy subsidize the sick, the young subsidize the old, and according to Kathleen Sebelius, “men will see costs go up, women will see costs go down”.  This is because the policies are being priced without regard to gender.

So is it hard to see why young, healthy males are not attracted to the plan(s)?  They are expected to pay significantly into a system that is designed, and priced, for the benefit of others.

Personally, I do not think that criminalizing them or bankrupting them is the answer.  Before you say “make them pay anyway!”, ask yourself:

1) if you are older, would you be attracted to a product that is designed and priced to cover serious sports injuries? (not golf injuries, but football injuries).

2) if you are sick, would you be attracted to a product designed for the healthy- say, one that charged very high co-pays and co-insurance for surgery?

3) if you are a woman, would you be attracted to a product designed around the needs of men- say, one that did not cover breast cancer?

So what should we do to encourage young, healthy men to enroll?  We might try offering some products that have their needs in mind, such as catastrophic coverage only, or products where maternity and pediatric coverage are optional riders.  Having them in the system at some level is preferable to not having them in the system at all.  And history is full of plans that failed because only the sick enrolled, which drives up the cost.  Do we want a repeat of that?

I am not saying that anyone is good or bad- I am simply saying that we should not be surprised that young, healthy males are rejecting a product that is designed and priced with the needs of others in mind.

What do you think?  If you have another idea, please leave a comment and tell us about it!

What should we do to encourage young, healthy males to enroll in Obamacare?

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Is it time to restrict consumer choice again?

In a recent New York Times article, (“A Health Provider Finds Success in Keeping Hospital Beds Empty”, April 24, 2013), the author discusses an Illinois based Accountable Care Organization that appears to be having some success in reducing health care costs.

The article goes on to describe several methods the ACO is using, such as care coordination and physician report cards.  But the article also questions the sustainability of savings and points to issues outside of the hospital’s or physician’s control.   These challenges include patients seeing “out of network” providers, who may not have an incentive to control costs at all.  In fact, these other providers may still be practicing under the unrestrained fee-for-service model, where providers have many incentives to increase the volume of services provided.  This increased volume, and related increased costs, will be counted against the Accountable Care Organization’s performance numbers and may affect negatively any reward or bonus the ACO may have otherwise earned.

Now this point is not unfair.  Yes, maybe the patient goes out-of-network because the ACO physicians don’t keep convenient hours, or maybe the quality is perceived to be better elsewhere.  But maybe the patient wants to go to the doctor they know, or the one who is closest.  Should the ACO be penalized for this?

So what should we do about this?  Should patient convenience trump other concerns?  Should all of us pay, through increased premiums, so someone else can visit whichever doctor or hospital they want, regardless of costs?  What should we do as a society?

Here are some thoughts:

a)      Should insurers ban out-of-network visits, meaning no coverage for them?

b)      Should out-of-network visits be made financially unattractive, by reducing coverage to something like 50%?

c)       Is it possible to exempt the ACO from the costs of out-of-network care (and if we did that, are we rewarding the ACO whose service is poor or whose hours are inconvenient)?

d)      Is there some other option?

What do you think?

How should the system treat visits to out-of-network providers that threaten the financial performance of Accountable Care Organizations?

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A Comment on the “Time” Article

A recent article in Time Magazine (“Bitter Pill-Why Medical Bills Are Killing Us”, by Steven Brill), did a fine job of thrusting into the spotlight the profiteering behavior of some providers in our health care system.  While the article covered a lot of ground, his discussion of the behavior exhibited by hospitals and hospital systems was particularly interesting.  That is where I will focus.

To summarize, hospitals are wildly inconsistent in what they charge for specific services and service packages.  By packages, I mean the room, the procedure(s), the doctors, and the drugs required to treat you.  The costs are frequently hidden, and if pressed, hospitals will quote from a greatly inflated “charge master”.  One result is “non-profit” institutions that are incredibly profitable, while their patients experience financial devastation.

It almost seems as if the behavior is somewhat predatory (my words).  So what should we do?

Let’s start here- hospitals should be required to post conspicuously a price list for the 100 most common services or service packages.

If you are considering a hospital for an uncomplicated childbirth or a knee arthroscopy or a hernia repair, you should be able to look at a list and see what it costs.  The price should include all services, tests, supplies, labs and doctors expected to be involved. If the hospital chooses to post it’s charge master, fine (as opposed to an insurance rate, which may be prohibited by their contract).  Posting the charge master will allow consumers to compare prices.  Even if you wind up in the hospital because of an emergency, you can transfer to a more reasonably priced facility once the immediate crisis has passed.

Just this would prevent, or at least lessen, some of the financial horror stories described in the article.

So what do you think?

Should hospitals be required to post a price list for the most common service packages?

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Health Reform: Should maternity care and pediatric coverage be considered “essential benefits” for women and men over 55 years old?

Now that health care reform, often called “Obamacare” will be implemented, one key question focuses on what is covered.  The Department of Health and Human Services (HHS) has recently released a list of “essential benefits”, that is, what must be covered by all plans in order to allow consumers to make fair comparisons.

The list is broken down into 10 categories, one of them being maternity coverage and another being pediatric coverage.

For women and men over 55, this might seem unreasonable.  And we are not just talking about the care that first comes to mind- should complications arise, maternity care brings with it care in a neonatal intensive care unit (NICU), the costs of a perinatologist and the costs of a neonatologist, all of which can be very, very expensive.

Then we get to pediatric coverage, which covers care over an 18 year time horizon, also very expensive.

For those over 55, the decision to have a child is exceedingly remote, if not impossible. And this is not a gender issue- it affects both women and men, and turns the concept of health insurance into one of health care subsidies.  One option is that maternity coverage and pediatric coverage be available as a “rider”, meaning available at an additional cost to those who want it.

So here is the question- should people over 55 be required to purchase maternity coverage? And by extension, should childless adults be required to purchase pediatric coverage?  What do you think?

Health Reform: Should maternity care and pediatric coverage be considered an "essential benefit" for women and men over 55 years old?

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Is it a good thing that some states refuse to implement the health care reform law (Obamacare)?

One of the more significant results of President Obama’s reelection is the impact on the health care reform law- his reelection eliminates the threats to repeal the law on “day one”.  However, some states are actively resisting the law’s implementation.

Specifically, one aspect of the law requires states to set up health care exchanges, where individuals could buy insurance at a competitive price (the exchange does not actually provide the insurance, but determines which insurers can participate).  Many states are refusing to set up the exchange.  One notable example is Texas.  Recently, Texas’ governor Rick Perry refused to implement an exchange in his state.

The Federal government will step in and operate the exchange in states that are unwilling or unprepared to implement an exchange on their own.  The deadline for implementation by the states is January 1, 2014.

So here is the question- how do you feel about states that refuse to implement the health care reform law, even after the Supreme Court decision and the reelection of President Obama?

How do you feel about states that refuse to implement the health care reform law even after the election and Supreme Court decision?

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The settlement of the Medicare lawsuit is a great thing!

The settlement last week of a significant lawsuit against Medicare now opens the door to increased treatments and therapies being provided to patients in their homes, and paid for by Medicare.

The specific change anticipated by the lawsuit involves a requirement that patients have some possibility of “improvement” in order for services to be approved for reimbursement by Medicare.  In the future, the possibility of improvement will no longer be a consideration.

This is long overdue and will change the lives of millions of patients and their families.

First, receiving necessary treatment will slow the pace of decline even if the possibility of actual improvement does not exist.  For people experiencing physical or cognitive impairment, receiving therapeutic services or treatments is at the very least compassionate.  It is also financially wise, which brings us to the second major benefit:

Paying for several months or years of therapy for a loved one can be financially devastating for all but the most wealthy families.  As a result, families experience the wrenching decision of paying for care for an elderly parent versus preparing the children for an advanced education.

It is also beneficial to society as a whole, because when our loved one declines to a certain point, we bring them to the emergency room where they are frequently admitted to the hospital, at a much higher cost, much of which may have been completely preventable.

Granted, some fear an explosion in fraud as providers of various skill levels rush in to provide, and bill for services.  Fair point.  But I for one am optimistic that as we move further into the world of information exchange and both electronic and personal health records, that services can be effectively monitored and that the impact of fraud will be far, far less than the benefit to patients, their families and society as a whole.

What do you think?

Is it a good thing that Medicare will pay for home based services without the requirement that the patient have a possibility of improvement?

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Health Care Reform and the Mandatory Purchasing of Insurance

Is it right to require people to purchase health insurance?  I have mixed feelings on the subject.

First, I understand the concept of insurance and of “pooled risk”- the notion that the premiums of those whose homes do not burn will be used to pay for damages to the homes that do burn.  And I understand the need for everyone to participate in order for this system to work at its best.

The part where I struggle is when we are delivered to a voracious, for-profit industry like so many lambs to slaughter.  There should be, at the least, a “reasonably priced”, non-profit option (we can discuss what a reasonable price is separately).

When I discuss this with my friends, they invariably point out that auto insurance is mandatory.  To which I reply, “If one does not wish to pay for auto insurance, there is an alternative- it is called Public Transportation.

What alternative exists in the health insurance discussion?  If we choose to not purchase an overpriced product from a for-profit health system, what alternative do we have?  What happened to the “public option”?

So here is where I end up: if a reasonably priced, non-profit alternative exists, I support mandatory coverage.  But if the only option is to pay into an overpriced, for-profit system, then I do not support mandatory coverage.  What do you think?

What are your feelings about mandatory health insurance coverage?

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Should home health care budgets be increased (supported through legislation and payment), decreased or left alone?

An interesting part of the health care discussion concerns home health care.  It is unquestionably less expensive to treat someone at home, particularly someone who needs a lot of nursing care and assistance with eating/ dressing/ bathing.

However, many states, as the grapple with high Medicaid costs, seem to want to reduce funding for home care.  There is also some fraud in the home care sector, as there is throughout the health care industry.

Reducing or eliminating home care services forces patients to seek more expensive in-patient care in hospitals and nursing homes.  Reducing funds for home care seems to be financially short sighted.  So what should we do?  What do you think?

Should funding for home care be increased, decreased or left alone?

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The 7 Stages of Managing Our Health Information

Why did Google pull the plug on Google Health?  Why is consumer adoption generally low across the entire landscape? In my opinion, the consumer has still not embraced the change required for this to happen.  It will happen.  We’re just not there yet.  To explain this, I offer “The 7 Stages of Managing Our Health Information” (adapted from Elisabeth Kubler-Ross’ “The 7 Stages of Grief”).

Stage 1:  “Wait a minute, I have to pay for that now?”

Stage 2: “I can’t afford all of this! I don’t know what to do! I should have lost weight, quit smoking, taken better care of myself!”

Stage 3: “This is outrageous! Can’t we go back to the old way? It’s the government’s fault!  It’s the insurer’s fault!”

Stage 4: “Oh my God, I am so screwed!  Who is going to help me?”

Stage 5: “Maybe I need to do something about this.”

Stage 6: “I seem to remember something about Online Tools and Resources.”

Stage 7: “OK, I’m signed up now.  Let’s do this!”

Note: Progress through this framework is not smoothly linear.  Some jumping back and forth occurs.

In my opinion, consumers are generally in stages 1 through 3.  The light bulb will go on, and business models will become viable, when a large number of consumers get to stage 5.  As I stated, we as a country are not there yet.  But with the coming changes to Medicare and Medicaid, and the ongoing increases in deductibles, copayments and coinsurance, we soon will be.  Stay tuned.

For two very thoughtful, insightful discussions on why Google pulled the plug, see Missy Krasner’s post at “The Health Care Blog”, and Janice McCallum’s post at “Health Content Advisors”.

Finally, I am interested in what you think about consumer readiness.  Please take the following brief poll, using the “7 stages” framework above.  Select up to 3 answers.

In general, at which stage are most consumers when managing their health information? Select up to 3 answers.

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Would you sacrifice choice this time around?

In the ’80’s and 90’s, when HMOs first became widespread, we all experienced lower costs but less choice- we had to choose from a list of doctors and hospitals, i.e. “in-network providers”.  But costs did stop rising, and in some cases actually fell.

Then came the managed care backlash and insurers allowed a much broader choice of doctors and hospitals.

Health care costs have nearly tripled since 1990 and now, the federal budget and nearly every state budget is threatened by extremely high health care costs.  Of the many methods being used to try to contain costs, limiting consumer choice of providers is once again a common approach.

The way this works in practice is that health plans offer one set of prices for using “in-network providers”.  If we use “out-of-network” providers, the amount we have to pay out of our own pockets is higher.  Sometimes much higher.

Here is the question: How do you feel about having a limited choice of doctors and hospitals in return for lower costs?

Is limiting our choice of doctors and hospitals fair, if costs are significantly lower?

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Should wealthier people receive more and/ or better health care?

As health care costs threaten more and more of our economy, various methods of addressing the challenge have been proposed, the Ryan plan for Medicare being one of the best known.  In this plan, the Medicare system is revised to provide seniors with a fixed voucher to cover insurance premiums purchased through the private sector.  When the voucher is used up, patients will have to pay out of personal funds.

Clearly, the well-off will be able to afford more care after the voucher is gone.  Is this right?

This blogger believes that the quality of some things should vary with wealth:

  • the well-off should drive nicer cars
  • the well-off should wear nicer clothes
  • the well-off should eat at fancier restaurants

But some things should not vary with wealth:

  • fire protection
  • water quality
  • food safety

So here is the question- should the amount and quality of health care a person receives vary with wealth?  What do you think?

Should financially well-off people receive more and/ or better health care than those who are not well-off?

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Health Care for persons in this country illegally.

What should we do about providing health care for people in this country illegally?

On the one hand, persons here illegally may put a strain on the system (I say “may” because ironically, many illegals do pay taxes).

On the other hand, to ignore the health needs of a large group of people has public health implications- diseases may spread within that population and then affect “the rest of us”:

  • tuberculosis
  • HIV
  • flu and related conditions

Also, for the purposes of this question, please assume that “sending all illegals back home” would take years, so we still have to deal with the issue, at least temporarily.

So here is the question- please select only one answer:

Until the day when there are no illegals, should persons in this country illegally have access to the health care system?

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Fourteen Zeroes!

Part 1- the problem.

If you look at our present level of health care spending ($2.6 Trillion), and project it forward, growing at 6% annually for the next 20 years, the total exceeds $100 Trillion.

That’s 14 Zeroes:

  • Just for health care
  • Just in America
  • Just for the next 20 years (if we look at 30 years, the number is over $200 Trillion).

That number is incomprehensible.  Not only is it not sustainable, it is not even possible to finance this number.  Yet, that is the path that we are on.

The present discussion aims to “bend the cost curve” and to somehow shift the burden:

  • Blame the insurers
  • Blame the pharmaceutical companies
  • Reduce provider reimbursement
  • Limit what Medicare pays on behalf of seniors.

Whomever we choose to blame, we are clearly headed for a scenario where we all  work our entire lives just to pay for health care, and when we get old, all of our assets, if there are any left, get paid over to our huge, for-profit health system.

We must fundamentally restructure our health care system, and our expectations of living and of dying, or life will become one long health-care payment treadmill.

Part 2- the discussion.  Please answer the following questions. One answer per question:

What is the responsibility of consumers (the system calls us "patients")?

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What is the responsibility of insurers?

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What is the responsibility of the government?

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What is the responsibility of providers (doctors and hospitals)?

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What is the responsibility of suppliers (pharmaceutical companies and device manufacturers)?

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Now, please consider all of the answers you provided.

What do your answers, taken together, mean for the 14 zeroes in our future?  Something to think about…

Is “bending the health care cost curve” enough, or do we need to do more?

All over the country, people, companies and entire sectors of the economy are experiencing, or will soon experience, drastic cuts.

  • benefits of unionized employees significantly reduced
  • layoffs
  • salary freezes and reductions
  • reductions in state provided services

Yet, in the health care industry, we talk about “bending the cost curve”, which means a reduction in the rate if increase, say, from 6% annual growth to 4% annual growth.

Why is health care exempt from the drastic cuts being made almost everywhere else? (In fact, it is health care costs more than anything else that is forcing states to the brink of bankruptcy).

So is bending the cost curve enough? What do you think?

Is "bending the health care cost curve" enough, or do we need to do more?

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Should physicians have the right to refuse Medicare and Medicaid patients because they are not paid as much as they feel they should be? What options does society have?

This is a tough one…

On the one hand, physicians have to run their practices, which costs money.  They want to live well, as we all do, and that costs money.

On the other hand, they provide a vital service which not just anyone is allowed to provide- so in a way, they are on “protected turf”- protected through licensing and long years of training.

But when physicians refuse to see Medicare or Medicaid patients, those patients have nowhere else to turn.  In fact, the threat of physicians refusing Medicare is often used as a reason not to cut Medicare rates.

This sets up a sort of “health care hostage situation”, where we, as a society, can no longer afford the costs of care, but seem to be powerless to do much about it.

So here is the question.  Actually 2 this time.  What do you think?

In return for the right to practice medicine, should physicians be required to accept at least some Medicare and Medicaid patients?

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As a society, what should we do when physicians refuse to see Medicare and Medicaid patients because the pay isn't high enough, and we have nowhere else to turn? Select up to 3 answers.

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Who owns patient data?

When we visit a doctor, hospital or pharmacy, lots of data is generated:

  • X-rays
  • Lab tests
  • Prescription information
  • Physician notes

That information is exchanged among physicians, hospitals, pharmacists and insurers, all to assist in the care of the patient and to support the billing and payment system.

Yet, there is potential to mis-use this information:

  • Data mining to target potential customers
  • Data used for coverage decisions
  • Data used for research purposes

And further, when a patient moves or simply wants to maintain their own files or health record, they frequently encounter resistance from the doctor or hospital when requesting copies of their record or tests:

  • fees
  • outright refusal
  • “The HIPAA law won’t let me give it to you”

So who owns patient data?

What do you think?

Who owns the data that is generated when an individual visits the doctor, hospital or pharmacy. Check all that apply.

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Should our health care system be a for-profit system?

Some have said it is the profit motive that is at the core of our health system’s problems:

  • Insurers need to provide profits to their shareholders
  • Hospitals and hospital systems need to provide profits to their shareholders
  • Physicians perform tests with their own economic interests in mind
  • Pharmaceutical companies and device manufacturers charge too much

A system that is not designed for profit might look as follows:

  • A single payer health system
  • All hospitals should be not-for-profit
  • All physicians should be employees, and their employers should be not-for profit
  • Pharmaceuticals, devices and supplies should be subject to price regulation

What do you think?  Please select only one response.

Should the profit motive be removed from our health care system?

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