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Tag: cost of healthcare

Health-Law Suit Hints at Republican Divide

After President Obama’s Affordable Care Act was enacted in 2010, Republicans at both the state and federal levels seemed to speak with one voice in flatly rejecting it.

But in subsequent years, though most Republican governors remained critical of the health care law, nine accepted a central but optional element, expanding Medicaid programs to cover many more low-income residents of their states. At least four others, urged on by hospitals and business groups, will try to do so this year.

And now, briefs filed last month in support of a major legal challenge to the law — King v. Burwell, which is now before the Supreme Court — are raising new questions about divisions within the Republican Party over the law.

Such filings, known as amicus briefs, allow interested parties to weigh in on either side of a case. Nearly two dozen briefs were filed on behalf of the plaintiffs in the King case, which the court will hear on March 4, but relatively few Republican state officials signed on.

The case focuses on the federal subsidies that help Americans buy insurance through marketplaces established under the law. The plaintiffs say the law’s wording allows subsidies only in states that created their own marketplaces. But the Obama administration argues that Congress intended to make the subsidies, which are considered crucial to helping millions enroll in coverage, available in all states, including those that rely on the federally run marketplace.

Six Republican state attorneys general — in Alabama, Georgia, Nebraska, Oklahoma, South Carolina and West Virginia — filed a brief agreeing that subsidies were illegal if distributed through the federal marketplace. “Those were the states that expressed an interest in joining,” said Aaron Cooper, a spokesman for Attorney General Scott Pruitt of Oklahoma, who led the effort.

Read the full article here.

Contact Steven G. Cosby, MHSA with questions or to request more information and to schedule a healthcare plan evaluation, savings analysis or group plan solution for your company.

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Obamacare is A Disaster: Here’s What ’60 Minutes’ Didn’t Tell You.

60 Minutes on Sunday ran an eye-raising exposé of the health law’s many shortcomings — or as correspondent Lesley Stahl called the segment, “What Obamacare Doesn’t Do.”

Unfortunately, when it came to telling a complete story about the Affordable Care Act, there was a lot that 60 Minutes itself didn’t do.

That’s too bad, because the incredibly popular and venerable news magazine is a force for steering national conversation. And 60 Minutes acknowledged that the ACA has accomplished some good, like help 10 million uninsured Americans get access to care.

Here were six of my biggest sticking points with 60 Minutes — and an argument for how they could’ve presented them instead.

Too many issues, not enough time made for muddled storytelling.

Rather than dwell on positives like the nation’s historically low uninsured rate, 60 Minutes made the decision to focus on one author who thinks that Obamacare is an “outrage”: Steven Brill, a lawyer who’s written a book called “America’s Bitter Pill,” which traces the creation of the Affordable Care Act.

That’s a fair decision, because Brill does have useful insights to offer. His well-written book attacks the perverse incentives in the U.S. health care system, and tries to figure out why prices are so darn high. And like experts who eagerly anticipated Sunday’s episode, I believe it’s always useful to shine a spotlight on health care’s inherent problems.

But the story that 60 Minutes chose to tell was misleading. The program didn’t offer context for Brill’s arguments, or touch on the ways that the Affordable Care Act is working. Just like Brill’s other interviews and articles, it again confused the important nuance of hospital charges versus hospital costs.

And Stahl jammed in so many other hot-button issues — from hospital executive compensation to how drug prices are negotiated and even why some American patients have to pay full “charges” — that her 13-minute segment was ultimately all over the place.

Read the full article here.

Dissecting Obamacare

The following is a script of “Obamacare” which aired on Jan. 11, 2015. Lesley Stahl is the correspondent. Rich Bonin, producer.

This month marks one year since health insurance coverage under the Affordable Care Act began, and from the president’s point of view: so far, so good. More than 10 million Americans who didn’t have health insurance before have signed up. But congressional Republicans are gunning for Obamacare. Even if they can’t outright repeal it, they want an overhaul.

And with the debate just getting underway, author Steven Brill, who has spent the past two years immersing himself in the subject, has come out with a new book, “America’s Bitter Pill,” that takes a comprehensive look at what the new law does and doesn’t do. Brill argues that Obamacare is the product of what he calls an “orgy of lobbying” and backroom deals in which just about everyone with a stake in the $3-trillion-a-year health industry came out ahead – except the taxpayers.

Steven Brill: Good news: More people are gonna get health care. Bad news: We have no way in the world that we’re gonna be able to pay for it.
Steven Brill says that the outrage is what the Affordable Care Act doesn’t do.

Steven Brill: It doesn’t do anything on medical malpractice reform. It doesn’t do anything to control drug prices. It doesn’t do anything to control hospital profits.

Lesley Stahl: So all the cost controlling side of this just went by the wayside?

Steven Brill: 99 percent of it.

Brill learned that when it came to controlling costs, the White House was told up front–

Steven Brill: If you go after costs, you’re never going to get anything passed because the lobbyists will just not allow it to be passed.

Lesley Stahl: So let’s go through what each entity won.

Steven Brill: The drug companies they were going to get $200-plus billion worth of new customers able to pay for drugs. They were going to avoid the calamity of the real reforms that they were worried about: price controls generally.

Lesley Stahl: Canada.

Steven Brill: You and I being able to buy drugs from Canada. That would have cost them hundreds of billions.

The hospital lobby did agree to cuts in how much the federal government compensates them for Medicare patients, but Brill says overall the trade off in new paying patients would more than make up for that. And the hospitals managed to keep other cost controls completely off the table, allowing them to charge whatever they can get for hospital stays and greatly mark up drug and test prices.

In writing his book, Brill wanted to find out how hospitals jack up those prices. He found the answer in the Recchi family of Lancaster, Ohio. Their experience, both before and after Obamacare kicked in, shows all the things Brill says the law should’ve dealt with — like highly inflated hospital charges — but didn’t.

Sean Recchi: I just want to get healthy and that’s what I told ’em.

Their story begins in 2012 when Sean Recchi – then 42, father of two – was diagnosed with cancer, stage 4 non-Hodgkin’s lymphoma.

Sean Recchi: I have two young children. You know, I wanna see ’em get married. I wanna see my grandchildren. You know. Too early.

Stephanie was determined to get him to MD Anderson in Houston, one of the premier non-profit cancer centers in the country. But because their health insurance policy was so limited, they had to pay upfront: first $48,900 for the evaluation…then more for the actual treatment.

Stephanie Recchi: And they told me that we would have to give them another $35,000 to get him, to get chemo.

Lesley Stahl: Did you have the money?

Stephanie Recchi: I didn’t. My mother did.

Lesley Stahl: Your mother had to give you the money?

Stephanie Recchi: Yes. I just kept thinking in the back of my mind, there’s a mistake and we’ll work it out. I just have to get him there and I have to get him better. That was my main concern.

When Sean was sick, they felt vulnerable and scared. Like most people in that kind of crisis, they never once asked what any specific item or test cost. When they got the bill, they gave it to Steven Brill, who found charges he couldn’t believe.

Steven Brill: The first thing I saw in the bill was a generic Tylenol for $1.50. Now that’s not–

Lesley Stahl: One pill?

Steven Brill: One pill. You can buy 100 generic Tylenols for the same $1.50. So that’s 1,000 percent mark-up. But who cares, it’s just $1.50. As you start going down the bill, they had something like $15,000 worth of blood tests that Medicare would’ve paid a few hundred dollars for.

The charges add up – over the single-spaced 18 pages of the bill. Independent hospital economists say these are all greatly inflated over their actual costs:

Like a PET scan for $5,453 – a 400 percent mark up.

Three CT scans for $9,685 – an 1,100 percent mark up.

The charge for his room was $10,746 for six days. That comes to $1,791 a day.

Steven Brill: You and I need to get into this business. It’s a really good– They call it nonprofit, but it’s a good business.

The single largest charge was for his cancer drug, Rituxan: for one dose, the hospital billed him $13,702.

Steven Brill: The hospital paid $3,500 for that drug. OK?

Lesley Stahl: How many times – that’s for–

Steven Brill: That’s a 400 percent mark up.

Lesley Stahl: This is a nonprofit hospital. What does nonprofit mean?

Steven Brill: It means they don’t pay taxes, that’s the first thing it means.

Lesley Stahl: They don’t pay any taxes?

Steven Brill: They’ve created in health care an alternate universe economy, where everybody except the doctors and the nurses, makes a ton of money. And nobody is holding them accountable and Obamacare does zero to change any of that.

MD Anderson declined to appear on camera but sent us a letter defending the prices it charges patients, saying, the costs reflect in part “using and maintaining expensive, state-of-the-art medical equipment… [and] research to develop new and better treatments.”

But Brill says hospitals get some federal aid for new technology and says in general large nonprofit hospitals are thriving businesses. He suggested we go to Pittsburgh. Once a steel city, today Pittsburgh’s biggest business is a hospital complex, the University of Pittsburgh Medical Center. Its CEO, Jeffrey Romoff, showed us the view from his office.

Read the full article here.

Contact Steven G. Cosby, MHSA with questions or to request more information and to schedule a healthcare plan evaluation, savings analysis or group plan solution for your company.

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Discussions With Your Physician Article Series: : Surgeries You May Be Better Off Without

The process by which medical procedures become established medical practice makes the drug-approval process look good. Before the FDA will approve a new drug, the pharmaceutical company must demonstrate that it does something better than the competition’s, inspiring a lot of statistical ingenuity.

“We have a saying in research medicine,” Roberts says. “If you torture the data long enough, it will confess to anything.”) But a new medical device has to clear a lower regulatory bar – only that it’s not dangerous – before it can be introduced to the public. The procedure itself is rarely systematically evaluated: A few influential doctors bring out something new, it catches on, and in a few years we have procedures like cardiac stenting to reduce heart attack risk or spinal-fusion surgery to relieve back pain that become institutional cash cows with little scientific evidence that they work as advertised.

Once a procedure becomes established, it’s protected by a phalanx of moneyed interests. In How We Do Harm, Brawley recounts the tale of a fledgling federal agency, now called the Agency for Healthcare Research and Quality, which was created to review how well common medical treatments actually work. In 1995 it reported that the research on spinal-fusion surgery for back pain was unequivocal: It produced results that were no better or not much better than doing nothing. Outraged, the North American Spine Society convinced a group of Republican congressmen that the agency was wasting taxpayer money on shoddy research. After nearly losing its funding, the agency limped away from the inquisition with a 21 percent budget cut. “The self-serving surgeons were saying the hell with what the science says,” Brawley wrote, “and everyone else was apathetic or worse.”

Read the full report here.

It’s important to keep in mind that while we criticize and critique our health care system, we should not minimize the value of the persons who have dedicated themselves to the study of medicine. When we or one of our love ones are sick we are often beholden to the artful and skilled physician. However, as a patient or concerned loved-one asking good questions should always be encouraged.

The Men’s Health article Surgeries You May Be Better Off Without is worthy of your review.

Contact Steven G. Cosby, MHSA with questions or to request more information and to schedule a healthcare plan evaluation, savings analysis or group plan solution for your company.

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The Single-Payer Health Insurance Plan Fails in Vermont

For 25 years I’ve been saying that I wished a little state like Vermont would implement a single-payer Canadian-style health insurance system––”Medicare For All.” My argument has always been that such a small and limited experiment would give us the opportunity to see the ideological arguments for such a system play out in the face of fiscal reality and the stakeholders fighting it out in the political arena over who would get the money. The rest of the country would be able to learn a lot from it.

I have always thought that this debate will never be settled until a state gives it a shot and everybody witnesses the result.

So, I was excited to see that Vermont, of all places, was indeed going to give it a shot when they passed Act 48 back in 2011. It was no longer a theory, a state was really going to do it––”Medicare For All.”

Until last month.

Turns out reality crashed head-on with ideology a lot quicker than even I expected it to.

Vermont’s governor pulled the plug on his plan because the state couldn’t afford it.

Read the full article here.

Contact Steven G. Cosby, MHSA with questions or to request more information and to schedule a healthcare plan evaluation, savings analysis or group plan solution for your company.

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