• Same story, different day...........year ie more of the same fiat floods the world
  • There are no markets
  • "Spreading the ideas of freedom loving people on matters regarding high finance, politics, constructionist Constitution, and mental masturbation of all types"

Health Care In America

searcher

Mother Lode Found
Mother Lode
Sr Site Supporter
Joined
Mar 31, 2010
Messages
179,264
Likes
43,408
They sold Depression to sell the pill
RT America


Published on May 16, 2018
On this episode of America’s Lawyer, Farron Cousins and Martha Rosenberg discuss how depression was sold as a disease to make money and how many drugs are now affecting the water in the environment.

Brigida Santos talks about a memory loss supplement that was falsely advertised resulting in $3000,000 worth of refunds.

Mollye Barrows discusses Suge Knight’s murder trial and charges against his lawyers for trying to bribe witnesses. [71]
 

searcher

Mother Lode Found
Mother Lode
Sr Site Supporter
Joined
Mar 31, 2010
Messages
179,264
Likes
43,408
California Hospital Giant Sutter Health Target of Anti-Trust Suit, Legislation for High Prices. Will It Set a National Precedent?
Posted on May 18, 2018 by Yves Smith

By Chad Terhune, Kaiser Health News Senior Correspondent, who previously worked for the Los Angeles Times, where he spent four years covering the business of health care. Before the Times, he was an award-winning reporter for The Wall Street Journal and Businessweek. Originally published at Kaiser Health News

Cooking dinner one night in March, Mark Frizzell sliced his pinkie finger while peeling a butternut squash and couldn’t stop the bleeding.
The 51-year-old businessman headed to the emergency room at Sutter Health’s California Pacific Medical Center in San Francisco. Sutter charged $1,555 for the 10 minutes it treated him, including $55 for a gel bandage and $487 for a tetanus shot.

“It was ridiculous,” he said. “Health insurance costs are through the roof because of things like this.”

California Attorney General Xavier Becerra couldn’t agree more. The state’s top cop is suing Sutter, accusing one of the nation’s biggest health systems of systematically overcharging patients and illegally driving out competition in Northern California.

For years, economists and researchers have warned of the dangers posed by large health systems across the country that are gobbling up hospitals, surgery centers and physicians’ offices — enabling them to limit competition and hike prices.

Becerra’s suit amounts to a giant test case with the potential for national repercussions. If California prevails and is able to tame prices at Northern California’s most powerful, dominant health system, regulators and politicians in other states are likely to follow.

“A major court ruling in California could be a deterrent to other hospital systems,” said Ge Bai, an assistant professor at Johns Hopkins University who has researched hospital prices nationwide. “We’re getting to a tipping point where the nation cannot afford these out-of-control prices.”

Reflecting that sense of public desperation, Sutter faces two other major suits — from employers and consumers — which are wending their way through the courts, both alleging anticompetitive conduct and inflated pricing. Meanwhile, California lawmakers are considering a bill that would ban some contracting practices used by large health systems to corner markets.

Sutter, a nonprofit chain, is pushing back hard, denying anticompetitive behavior and accusing Becerra in court papers of a “sweeping and unprecedented effort to intrude into private contracting.” Recognizing the broader implications of the suit, both the American Hospital Association and its California counterpart asked to file amicus briefs in support of Sutter.

In his 49-page complaint, Becerra cited a recent studyfinding that, on average, an inpatient procedure in Northern California costs 70 percent more than one in Southern California. He said there was no justification for that difference and stopped just short of dropping an expletive to make his point.

“This is a big ‘F’ deal,” Becerra declared at his March 30 news conference to unveil the lawsuit. In an interview last week, he said, “We don’t believe it’s fair to allow consolidation to end up artificially driving up prices. … This anticompetitive behavior is not only bad for consumers, it’s bad for the state and for businesses.”

To lessen Sutter’s market power, the state’s lawsuit seeks to force Sutter to negotiate reimbursements separately for each of its hospitals — precluding an “all or nothing” approach — and to bar Sutter employees from sharing the details of those negotiations across its facilities. Becerra said Sutter has required insurers and employers to contract with its facilities systemwide or face “excessively high out-of-network rates.”

Heft In The Marketplace
Overall, Sutter has 24 hospitals, 36 surgery centers and more than 5,500 physicians in its network. The system boasts more than $12 billion in annual revenue and posted net income of $958 million last year.

The company’s heft in the marketplace is one reason why Northern California is the most expensive place in the country to have a baby, according to a 2016 report. A cesarean delivery in Sacramento, where Sutter is based, cost $27,067, nearly double what it costs in Los Angeles and New York City.



For years, doctors and consumers have also accused Sutter of cutting hospital beds and critical services in rural communities to maximize revenue. “Patients are the ones getting hurt,” said Dr. Greg Duncan, an orthopedic surgeon and former board member at Sutter Coast Hospital in Crescent City, Calif.

Sutter says patients across Northern California have plenty of providers to choose from and that it has held its average rate increases to health plans to less than 3 percent annually since 2012. It also says it does not require all facilities to be included in every contract — that insurers have excluded parts of its system from their networks.

As for emergency room patients like Frizzell, Sutter says its charges reflect the cost of maintaining services round-the-clock and that for some patients urgent-care centers are a less costly option.

“The California Attorney General’s lawsuit gets the facts wrong,” Sutter said in a statement. “Our integrated network of high-quality doctors and care centers aims to provide better, more efficient care — and has proven to help lower costs.”

Regulators in other states also have sought to block deals they view as potentially harmful.

In North Carolina, for instance, the state’s attorney general and treasurer both expressed concerns about a proposed merger between the University of North Carolina Health Care system and Charlotte-based Atrium Health. The two dropped their bid in March. The combined system would have had roughly $14 billion in revenue and more than 50 hospitals.



Last year, in Illinois, state and federal officials persuaded a judge to block the merger between Advocate Health Care and NorthShore University HealthSystem. The Federal Trade Commission said the new entity would have had 60 percent market share in Chicago’s northern suburbs. Still, Advocate won approval for a new deal with Wisconsin’s Aurora Health Care last month, creating a system with $11 billion in annual revenue.

Antitrust experts say states can deliver a meaningful counterpunch to health care monopolies, but they warn that these cases aren’t easy to win and it could be too little, too late in some markets.

“How do you unscramble the egg?” said Zack Cooper, an assistant professor of economics and health policy at Yale University. “There aren’t a lot of great solutions.”

A Seven-Year Investigation
California authorities took their time sounding the alarm over Sutter — a fact Sutter is now using against the state in court.

The state attorney general’s office, under the leadership of Democrat Kamala Harris, now a U.S. senator, started investigating Sutter seven years ago with a 2011 subpoena, court documents show. Sutter said the investigation appeared to go dormant in March 2015, just as Harris began ramping up her Senate campaign.

Becerra, a Democrat and former member of Congress, was appointed to replace Harris last year, took over the investigation and sued Sutter on March 29. His aggressive action comes as he prepares for a June 5 primary against three opponents.

Sutter faces a separate class-action suit in San Francisco state court, spearheaded by a health plan covering unionized grocery workers and representing more than 2,000 employer-funded health plans. The plaintiffs are seeking to recoup $700 million for alleged overcharges plus damages of $1.4 billion if Sutter is found liable for antitrust violations. Sutter also has been sued in federal court by five consumers who blame the health system for inflating their insurance premiums and copays. The plaintiffs are seeking class-action status.

San Francisco County Superior Court Judge Curtis E.A. Karnow grantedBecerra’s request to consolidate his case with the grocery workers’ suit, which is slated for trial in June 2019.

The judge sanctioned Sutter in November after finding that Sutter was “grossly reckless” in intentionally destroying 192 boxes of evidence that were relevant to antitrust issues. As a result, Karnow said, he will consider issuing jury instructions that are adverse to Sutter.

In a note to employees, Sutter chief executive Sarah Krevans said she deeply regretted the situation but “mistakes do happen.”

In an April 27 court filing, Sutter’s lawyers criticized the state for piggybacking onto the grocery workers’ case. “The government sat on its hands for seven years, exposing the public to the alleged anticompetitive conduct. … Rather than driving the agenda, the Attorney General seeks to ride coattails.”

Outside court, California legislators are taking aim at “all or nothing” contracting terms used by Sutter and other hospital chains. The proposed law stalled last year amid opposition from the hospital industry. But consumer and labor groups are seeking to revive it this year.

In the meantime, Frizzell said he will probably wind up at one of Sutter’s hospitals again despite his disgust over his ER bill. “Most of the hospitals here are Sutter,” he said. “It’s difficult to avoid them.”

KHN senior correspondent Anna Gorman contributed to this report.


This entry was posted in Banana republic, Free markets and their discontents, Guest Post, Health care, Regulations and regulators on May 18, 2018 by Yves Smith.

https://www.nakedcapitalism.com/201...-prices-will-it-set-a-national-precedent.html
 

searcher

Mother Lode Found
Mother Lode
Sr Site Supporter
Joined
Mar 31, 2010
Messages
179,264
Likes
43,408
Obamacare premiums set to soar in 2019

By Tami Luhby, CNN
1 hr ago

Brace yourselves -- it looks like Obamacare premiums could jump by double digits again next year.

Insurers in several states have requested large rate hikes for 2019, with many pointing to steps taken by President Donald Trump and Republicans in Congress as the main reasons why.

New York insurers want to hike rates by 24%, on average, while carriers in Washington are looking for a 19% average premium increase. In Maryland, CareFirst is asking for an average 18.5% rate bump for its HMO plans and a 91% spike for its PPO policies (which have far fewer enrollees), while Kaiser Permanente wants to boost premiums by more than 37%, on average.

Many insurers cite two key drivers of the increases: Congress' elimination of the penalty for the individual mandate -- which requires nearly all Americans to have coverage or pay up --and the Trump administration's expected expansion of two types of health plans that don't have to adhere to Obamacare's regulations.

"Health insurance providers are now making decisions about market participation and pricing for the 2019 plan year in a market that continues to face uncertainty and instability challenges," America's Health Insurance Plans, an industry group, wrote in a recent report.

RELATED: Obamacare premiums to rise an average of 15% next year, says CBO

Jettisoning the individual mandate penalty is expected to cause premiums to rise by about 10%, the industry group said, citing reports by the Congressional Budget Office and independent actuaries. That's because younger and healthier people will be more likely to forgo insurance since they will no longer have to pay a penalty. Insurers fear they will then be left with sicker and older policyholders, prompting them to request higher rates to cover the anticipated increase in claims.

Also, Trump last year issued an executive order directing federal agencies to make it easier to buy two alternatives to Obamacare plans. One would allow small businesses to band together to buy coverage through association health plans, while the other would let Americans buy short-term coverage that would last less than a year, rather than the current 90-day limit. Both of these types of policies are expected to have lower premiums, but would cover fewer benefits -- making them more attractive to healthier Americans who don't need comprehensive coverage.

Related: Trump officials unveil rule that could chip away at Obamacare

Insurers in remaining states will file proposed rates in coming weeks. Regulators will review the requests and could change them significantly. Premiums will be finalized in September and open enrollment starts November 1.

There are some bright spots in the 2019 Obamacare landscape. Insurers in some states, such as Pennsylvania and Vermont, have requested relatively modest increases. In the Keystone State, insurers are asking for a boost of 4.9% on average. Meanwhile, BlueCross BlueShield of Vermont and MVP Health Care are asking for 7.5% and 10.9% bumps, respectively.

Pennsylvania Insurance Commissioner Jessica Altman attributed the relatively small increase to the state's efforts to maintain enrollment this year after the Trump administration slashed support. Also, the state's individual market remains competitive: Nearly half of counties will have a greater choice of insurers next year, and only eight will have just one carrier, down from 20 this year.

Related: Trump administration unveils alternative to Obamacare

Another plus: Insurers so far haven't pulled out completely from any market in the nation. At various points last year, tens of thousands of Americans in dozens of counties were facing the prospect of having no choice of carriers on their Obamacare exchanges. State regulators, however, were able to convince insurers to offer policies in every county by the time open enrollment began in November.

Also, most Obamacare enrollees won't have to pay more for coverage next year, regardless of how much insurers hike premiums. That's because they receive federal subsidies that limit their rates to less than 10% of their income.

However, the rate hikes will hit the millions of Americans who earn too much for subsidies or who buy individual coverage outside of the Obamacare exchanges.

http://www.msn.com/en-us/news/us/obamacare-premiums-set-to-soar-in-2019/ar-AAyldXN?ocid=ientp
 

Uglytruth

Gold Member
Gold Chaser
Joined
Apr 6, 2011
Messages
5,495
Likes
7,799
Pills just went up 50%.......... I'm so glad it's affordable health care.
They just forgot to mention (if your an illegal)
 

michael59

heads up-butts down
Platinum Bling
Sr Site Supporter
Joined
Apr 1, 2014
Messages
9,186
Likes
5,488
Location
on the low side of corporate Oregon
yepits Trumps fault the Nigerian couldn't fleece this country....

When will brains start exploding from these freaks?

Oh wait! You have to have a brain for it to explode ....
 

goldielox1

Silver Miner
Seeker
Joined
Jun 20, 2013
Messages
1,215
Likes
837
Idiots keep paying these prices for insurance and then wonder why it's so expensive. Eliminate insurance and costs will drop 90%. Ever wonder why hospitals charge you $100 for gauze you can get at the store for 99 cents? It's because the typical American dummy doesn't care how much it costs because "he has insurance covering it". Ever wonder why the "Emergency Room" is full of people with colds, the flu and constipation? Hint: They aren't paying for it. Ever wonder why Americans are so obese yet rather than lose weight beg for more pills to fix their fat sedentary problems? You got it, they aren't paying for it.

Easy solution:

1) Eliminate health insurance
2) People will be much more selective as to when to go to a hospital and be much more price sensitive to which hospitals are charging what
3) People will actually start paying attention to taking care of their weight and health since all costs will be out of pocket.
4) Prices will drop astronomically as hospitals have to compete in a free market for cost conscious business

Easily refuatable objection) I can't plan for emergencies, they just happen:
Answer) Most "emergencies" are preventable e.g. 300 pound man gets a heart attack. Teenager deciding that he will jump his BMX over parked cars. Knowing mom ain't gonna coddle him but rip him a new one will make behavioral adjustments.
 

searcher

Mother Lode Found
Mother Lode
Sr Site Supporter
Joined
Mar 31, 2010
Messages
179,264
Likes
43,408
‘You’ve handed us an issue’: Democrats pounce on Trump administration’s health-care move

Washington Post
Erica Werner and Amy Goldstein
7 hrs ago

The Trump administration’s startling decision to abandon one of the Affordable Care Act’s most popular provisions — protections for people with preexisting medical conditions — put Republicans on the defensive Friday and handed Democrats a potentially potent political message.

Democrats had already made health care a major focus in their campaigns heading into November’s midterm elections, with polls consistently showing it as a top issue among voters. Now, the Justice Department’s stance in a federal-court case in Texas will allow Democrats to argue that Republicans want to deny affordable health coverage to some of the people who need it most.

Late Thursday, the department said the health law’s requirement that most Americans carry insurance will become unconstitutional next year and so will consumer protections forbidding insurers to deny coverage to sick customers or charge them more.

The administration’s legal stance injects profound uncertainty into the political debate and the health-care landscape at a critical moment, just as insurance companies are developing rates for the coming year and as candidates head into a summer campaign season that both parties will try to use to solidify a foothold for their agendas.

The fresh potential that the courts could deliver a significant blow to the ACA arises after a years-long perseverance by Republicans to repeal much of the sprawling 2010 statute ended in failure a year ago, leading GOP attorneys general, governors and the Trump administration to turn to the courts and administrative actions to undermine the law.

Republicans on Capitol Hill had no advance warning that the administration was going to assert that protections for people with preexisting conditions is unconstitutional — a position that defies President Trump’s promises to maintain those protections.

Most Republicans on Friday insisted they continued to support coverage for people with preexisting conditions, such as high blood pressure, diabetes and cancer. The policy, unlike some elements of the Affordable Care Act, has widespread support, affecting approximately 52 million Americans under the age of 65, according to a 2016 analysis by the Kaiser Family Foundation.

Several Republicans expressed bewilderment at the notion that this protection could be declared unconstitutional or overturned. “I certainly do not believe the provision on preexisting conditions is unconstitutional. I don’t even understand what the legal argument would be,” said Rep. Leonard Lance (R-N.J.), one of the most endangered Republican incumbents in the midterms.

“I have always favored coverage for preexisting conditions and will continue to do so,” Lance said, adding he would urge the administration to back off their new legal stance.

But Democrats were already pouncing. “I’m astounded, and it’s not only recklessness on lots of scores in terms of the legal reasoning,” said Rep. Gerald E. Connolly (D-Va.). “But it’s also political malpractice because you’ve handed us an issue we will ride into the sunset.”

Senate Minority Leader Charles E. Schumer (D-N.Y.) released a letter with other top Democratic senators demanding the administration reverse the move, while the Democratic Senatorial Campaign Committee wasted no time blasting out news releases questioning whether Republican candidates agreed with the administration.

Privately, some Republicans involved with midterm races expressed frustration at the move.

“I don’t understand why the White House would do this, and no one is communicating how they want people to navigate this issue,” said one Republican strategist working on Senate races, who demanded anonymity to speak freely. “Preexisting conditions is something everyone agreed we should keep. Picking this fight going into the summer of an election year is mind-boggling.”

In many ways, the political fight over health care during the midterms had started before Thursday night, with Democrats already accusing Republicans of trying to snatch health coverage from American consumers. Republicans, in turn, were focused on calls by liberals such as Sen. Bernard Sanders (I-Vt.) to establish a single-payer health-care system, suggesting that would become the Democrats’ agenda if they were to regain power.

Insurers are now in the midst of deciding whether to participate in the individual marketplaces created under the law in 2019 and, if so, what filing rates with state regulators will be. A central rule of ACA health plans is that they must welcome all customers, healthy and sick, and not charge higher premiums to those with preexisting conditions. The possibility that a Texas judge could, at the administration’s urging, wipe out this rule — with an inevitable appeal to higher courts — introduces a new source of instability that insurers detest.

America’s Health Insurance Plans, the main trade group for the industry, immediately denounced this prospect. “Removing those provisions will result in renewed uncertainty in the individual market, create a patchwork of requirements in the states, cause rates to go even higher for older Americans and sicker patients, and make it challenging to introduce products and rates for 2019,” Matt Eyles, AHIP’s president and CEO, said Friday in a statement.

Eyles said that AHIP plans to file a brief in the case laying out “more detail about the harm that would come to millions of Americans if the request to invalidate the ACA is granted.”

According to health-policy experts, a court ruling in favor of the suing GOP states and the administration would trigger what one called “immediate chaos” in the law’s insurance marketplaces created under the law.

The 2010 law, passed by a Democratic Congress and a signature domestic accomplishment of President Barack Obama, created insurance “exchanges” in every state to sell federally subsidized coverage to individuals who do not have access to affordable health benefits through a job. These marketplaces have had their troubles — with many commercial insurers defecting and prices spiking — but their basic contours have remained intact.

That would immediately change if Judge Reed O’Connor of the U.S. District Court for the Northern District of Texas agrees with the Justice Department argument that the mandates including protections for people with preexisting conditions will become unconstitutional in January, when new tax rules end existing penalties for people who flout the law’s requirement to carry health insurance.

If the judge agrees, “insurers would want to discontinue” health plans that treat healthy and sick customers the same, predicted Larry Levitt, a senior vice president at the Kaiser Family Foundation. This could be tricky, because the ACA’s rules allow health plans to enter or leave a marketplace once a year, in January, which is the only time that rates can change. But the Department of Health and Human Services could, in theory, create exceptions to those rules or rewrite them in way that could upend coverage for some consumers midyear, Levitt said.

In addition, Levitt said, a court ruling that struck down the preexisting conditions protections could cause premium subsidies that the vast majority of ACA customers receive to come unglued. The subsidies for each region within a state are based on a “community rating,” which, in turn, takes into account the cost of covering healthy and sick customers. While the subsidies would not go away, it is unclear how their amount would be determined if insurers could return to the days before the law of charging higher prices to people with previous medical conditions — or refusing to cover them at all.

“This lawsuit is less about altering the law and more about blowing it up,” Levitt said.

Several Republicans said Friday that if the administration did prevail, it would be their responsibility to step in and restore protections for people with preexisting conditions. Yet how they would do so was far from clear, especially given Congress’s inability so far under the administration to pass health-care legislation.

The president last fall ended “cost-sharing reduction payments” to insurers that offset discounts that the law promises to lower-income customers in the out-of-pocket costs for ACA health plans. Health officials halved the sign-up period to buy ACA health plans, cutting from $100 million to $10 million an advertising budget to help encourage consumers to sign up, and slashed funds for grass-roots organizations that helped people enroll.

More recently, the administration is in the midst of rewriting federal rules to make it easier for people to buy two types of insurance that are relatively inexpensive because they bypass the ACA’s requirements for benefits that health plans sold to individuals and small business must include.

erica.werner@washpost.com

amy.goldstein@washpost.com

http://www.msn.com/en-us/news/polit...tion’s-health-care-move/ar-AAypwTy?ocid=ientp
 

searcher

Mother Lode Found
Mother Lode
Sr Site Supporter
Joined
Mar 31, 2010
Messages
179,264
Likes
43,408
House GOP plan would cut Medicare, Medicaid to balance budget

Washington Post
Erica Werner
7 hrs ago

House Republicans released a proposal Tuesday that would balance the budget in nine years — but only by making large cuts to entitlement programs, including Medicare, that President Trump vowed not to touch.

The House Budget Committee is aiming to pass the blueprint this week, but that may be as far as it goes this midterm election year. It is not clear that GOP leaders will put the document on the House floor for a vote, and even if it were to pass the House, the budget would have little impact on actual spending levels.

Nonetheless the budget serves as an expression of Republicans’ priorities at a time of rapidly rising deficits and debt. Although the nation’s growing indebtedness has been exacerbated by the GOP’s own policy decisions — including the new tax law, which most analyses say will add at least $1 trillion to the debt — Republicans on the Budget Committee said they felt a responsibility to put the nation on a sounder fiscal trajectory.

“The time is now for our Congress to step up and confront the biggest challenge to our society,” said House Budget Chairman Steve Womack (R-Ark.). “There is not a bigger enemy on the domestic side than the debt and deficits.”

The Republican budget confronts this enemy by taking a whack at entitlement spending. Lawmakers of both parties agree that spending that is not subject to Congress’s annual appropriations process is becoming unsustainable. But Trump has largely taken it off the table by refusing to touch Medicare or Social Security, and Democrats have little interest in addressing it except as part of a larger deal including tax increases — the sort of “Grand Bargain” that eluded President Barack Obama.

The House Republican budget, titled “A Brighter American Future,” would remake Medicare by giving seniors the option of enrolling in private plans that compete with traditional Medicare, a system of competition designed to keep costs down but dismissed by critics as an effort to privatize the program. Along with other changes, the budget proposes to squeeze $537 billion out of Medicare over the next decade.

The budget would transform Medicaid, the federal-state health-care program for the poor, by limiting per capita payments or allowing states to turn it into a block-grant program — the same approach House Republicans took in their legislation that passed last year to repeal the Affordable Care Act (the repeal effort died in the Senate, but the GOP budget assumes that the repeal takes place). It also proposes adding work requirements for certain adults enrolled in Medicaid. Changes to Medicaid and other health programs would account for $1.5 trillion in savings.

Social Security comes in for more modest cuts of $4 billion over the decade, which the budget projects could be reached by eliminating concurrent receipt of unemployment benefits and Social Security disability insurance.

The budget also proposes a number of other cost-saving measures, some of which could prove unpopular if implemented, such as adding more work requirements for food-stamp and welfare recipients and requiring federal employees — including members of Congress — to contribute more to their retirement plans. It assumes repeal of the Dodd-Frank Act that regulated banks after the financial crisis 10 years ago, something Congress recently rejected in passing a banking bill into law that softened some of the key provisions of Dodd-Frank but left its overall structures intact. And the budget proposes $230 billion in cuts from education and training programs, including consolidating student loan programs and reducing Pell Grant awards.

The budget also relies on rosy economic-growth projections and proposes using a budgetary mechanism to require other congressional committees to come up with a combined $302 billion in unspecified deficit reduction.

Overall, the partisan proposal is reminiscent of the budget released in 2011 by now-House Speaker Paul D. Ryan (R-Wis.), who was then the Budget Committee chairman and advanced a bold proposal attacking entitlements, slashing spending — and creating lines of attack for Democrats once Ryan became Mitt Romney’s vice presidential running mate on the GOP ticket the following year.

Democrats were quick to criticize the GOP proposal while contending that Republicans were opening themselves up to election-year attacks by releasing it at all.

“The 2019 Republican budget scraps any sense of responsibility to the American people and any obligation to being honest,” said Rep. John Yarmuth (Ky.), the top Democrat on the Budget Committee. “Its repeal of the Affordable Care Act and extreme cuts to health care, retirement security, anti-poverty programs, education, infrastructure, and other critical investments are real and will inflict serious harm on American families.”

http://www.msn.com/en-us/news/polit...icaid-to-balance-budget/ar-AAySglD?ocid=ientp
 

searcher

Mother Lode Found
Mother Lode
Sr Site Supporter
Joined
Mar 31, 2010
Messages
179,264
Likes
43,408
GOP governor cuts health care to take anti-abortion stand


By JEFFREY COLLINS, Associated Press
11 hrs ago



COLUMBIA, S.C. — South Carolina Gov. Henry McMaster removed $16 million for health care from the state budget, saying Friday he wanted to make sure no taxpayer money goes to abortion providers.

The Republican governor said he was keeping a promise he made repeatedly as he campaigns for a full term, disagreeing with Democrats and some Republicans who said Planned Parenthood gets less than $100,000 of the money and all of it goes for family planning and not abortion.

"I have stated many times I am opposed to what Planned Parenthood is doing. And the veto I have is the most direct way," McMaster said in a news conference after issuing 42 vetoes worth about $36 million from South Carolina's $8 billion spending plan.

Planned Parenthood said the veto is a "political stunt" and the practical effect will be to remove birth control, testing for sexually transmitted diseases and even cancer screenings for hundreds of thousands of poor women on Medicaid.

"It's clear that the governor is singularly focused on his election bid in November and that is at the expense of South Carolina women. The veto does not 'defund' Planned Parenthood, but it will ensure that South Carolinians who use Medicaid as their primary insurance will be unable to access affordable, basic health care," Planned Parenthood spokeswoman Vicki Ringer said in a statement.

Republicans have been fighting over the "Family Planning" line in the budget for months. McMaster did not veto the entire $34 million in the item, with his office saying eliminating all that money would keep 700,000 women and children from getting prescriptions through Medicaid.

Democrats and some Republicans — even those adamantly against abortions — called removing the money from the budget shortsighted since so little goes to Planned Parenthood in the first place and removing it from the spending plan could mean less money for things like law enforcement or help for families with children with autism.

"You are voting for a budget with an illusion at the expense of a reality," said Rep. Kirkman Finlay, R-Columbia, during last month's debate.
McMaster said he would prefer if the federal government approves his request for a waiver that would allow South Carolina to withhold any public funds from Planned Parenthood, but his office does not know when that might be considered.

Some Republicans threatened to toss out the entire budget because the money remained after a conference committee vote — the House took it out, while the Senate put it back in. But legislators at the time pointed out it will take a two-thirds vote to override the veto. In the Senate 12 Republicans would have to join the 18 Democrats and in the House, 40 Republicans would have to join 44 Democrats if everyone is present to put the money back in the budget.

"I'm sure they should be sustained," McMaster said of his vetoes. "Whether they will be is another question." McMaster said.

Legislative leaders said they were reviewing the vetoes and had not decided when or if they would return to Columbia to consider them.

The governor issued a number of other vetoes, including removing a provision put in the budget that would give priority for foster parents to adopt children away from their biological parents after nine months. McMaster said that kind of abrupt and major policy change should be made through the legislative process and not in the budget.

McMaster also struck out of the budget a line that removed from public view in the spending plan more than $3 billion that colleges and universities collect through fees, grants, athletic ticket sales and other revenue streams. The governor said that money needed to stay in the appropriation process for the benefit of the public and policy makers.
___
Follow Jeffrey Collins on Twitter at https://twitter.com/JSCollinsAP. Read his work at https://apnews.com/search/jeffrey collins .

http://www.msn.com/en-us/news/us/go...ake-anti-abortion-stand/ar-AAzFQZJ?ocid=ientp
 

searcher

Mother Lode Found
Mother Lode
Sr Site Supporter
Joined
Mar 31, 2010
Messages
179,264
Likes
43,408
Trump Freezes Billions In Obamacare Payments, Outraging Insurers

by Tyler Durden
Sun, 07/08/2018 - 09:57


The Trump administration halted billions of dollars in payments to health insurers after the Centers for Medicare and Medicaid Services, the agency that administers programs under Obamacare, announced on Saturday it was freezing payments to insurers that cover sicker patients, saying a federal court ruling ties its hands. The move brought a sharp response from health insurers warning of market disruptions and even higher costs.

The payments are intended to help stabilize health insurance markets by compensating insurers that had sicker, more expensive enrollees in 2017. The government collects the money from health insurers with relatively healthy enrollees, who cost less to insure.

In a Saturday announcement, the CMS said the move was necessary because of a February ruling by a federal court in New Mexico, which found that the federal government was using an inaccurate formula for allocating the payments; it added that the trial court in New Mexico "prevents CMS from making further collections or payments under the risk adjustment program, including amounts for the 2017 benefit year, until the litigation is resolved."

The CMS, which is part of the Department of Health and Human Services, added that the court’s ruling bars the agency from collecting or making payments under the current methodology, which uses a statewide average premium, Bloomberg reported.

We were disappointed by the court’s recent ruling. As a result of this litigation, billions of dollars in risk adjustment payments and collections are now on hold." CMS Administrator Seema Verma said in the agency’s statement.

“CMS has asked the court to reconsider its ruling, and hopes for a prompt resolution that allows CMS to prevent more adverse impacts on Americans who receive their insurance in the individual and small group markets,” Verma said.

The risk adjustment program of the Affordable Care Act redistributes funds from plans with lower-risk enrollees to plans with higher-risk enrollees, helping to ensure that sicker individuals can receive coverage by sharing the cost of covering them. The immediate impact of the decision will be to boost healthcare costs for millions of Americans even higher, unleashing even higher inflation for staples, at a time when the Fed is keeping a close eye on rising costs.

Predictably, advocates of the risk adjustment program, and Obamacare in general, were outraged.

Risk adjustment “has been long supported and embraced by both Republicans and Democrats,” said Scott Serota, president of the Blue Cross Blue Shield Association.

“This action will significantly increase 2019 premiums for millions of individuals and small business owners and could result in far fewer health plan choices,” Serota said in a statement. “It will undermine Americans’ access to affordable coverage, particularly those who need medical care the most.”

The trade group America’s Health Insurance Plans said in an emailed statement that “We are very discouraged by the new market disruption brought about by the decision to freeze risk adjustment payments.” It added that the move comes at a critical time when insurance providers are developing premiums for 2019 and states are reviewing rates.​
“This decision will have serious consequences for millions of consumers who get their coverage through small businesses or buy coverage on their own. It will create more market uncertainty and increase premiums for many health plans -- putting a heavier burden on small businesses and consumers, and reducing coverage options,” AHIP said.​

AHIP urged “a quick resolution is needed to avoid greater harm to the individual and small group markets,” while Serota said CMS “has the legal justification needed to move forward with the payments regardless of the New Mexico ruling, and should do so.”

In addition to raising costs, the announcement may also adversely impact the stock prices of select insurers: according to Bloomberg, the CMS decision will affect publicly traded insurers that have stuck with Obamacare, such as St. Louis-based Centene Corp.

CMS provided a timeline, noting that after the Feb. 28 decision by the New Mexico federal court, it filed a motion for reconsideration, and on June 21 the court held a hearing on it. CMS is waiting for the court’s ruling.

Timeline of Key Events
March 23, 2010 - The Patient Protection and Affordable Care Act (PPACA) is signed into law by President Obama.​
March 11, 2013 - CMS finalizes a risk adjustment methodology for States where HHS operates the program that includes the use of the statewide average premium in order to maintain a budget neutral program.​
July 29, 2016 - New Mexico Health Connections files a complaint in U.S. District Court in New Mexico arguing, among other points, that CMS’s use of the statewide average premium was arbitrary and capricious. Minuteman Health, Inc. files a similar complaint in U.S. District Court in Massachusetts the same day.​
January 30, 2018 – The US District Court for the District of Massachusetts rules for CMS, finding that CMS acted within its authority in promulgating the HHS-operated risk adjustment methodology based on the statewide average premium.​
February 28, 2018 - The US District Court for the District of New Mexico issues a decision invalidating CMS’s use of the statewide average premium in the risk adjustment transfer formula for the 2014-2018 benefit years, pending further explanation of CMS’s reasons for operating the risk adjustment program in a budget neutral manner in those years. Following this decision, CMS files a motion for reconsideration.​
June 21, 2018 - A hearing is held on CMS’s motion for reconsideration.​

The CMS statement said the agency will “provide additional guidance shortly on how it will handle other issues relating to
risk adjustment payments."

Trump’s administration has used its regulatory powers to undermine Obamacare after Congress last year failed to repeal and replace the law. About 20 million Americans have received health insurance coverage through the program.


https://www.zerohedge.com/news/2018...illions-obamacare-payments-outraging-insurers
 

goldielox1

Silver Miner
Seeker
Joined
Jun 20, 2013
Messages
1,215
Likes
837
Just end this unconstitutional behemoth. It required a contitutional amendment to outlaw liquor but it doesn't require one to force socialized federal government health care on everyone?
 

goldielox1

Silver Miner
Seeker
Joined
Jun 20, 2013
Messages
1,215
Likes
837
It's amazing that any one would even argue that higher risk people (pre-existing conditions) wouldn't pay more than low risk healthy people for "insurance". Why is it okay for every other insurance company to price this way: high risk drivers pay more for auto insurance, high risk properties pay more for flood, fire, etc insurance. This monstrosity can't even be called insurance, it's just a socialized program funded by taxes disguised as "premiums". No one offered to "subsidize" (i.e. socialize) my $2000/year auto insurance policy when I was in high school.
 

searcher

Mother Lode Found
Mother Lode
Sr Site Supporter
Joined
Mar 31, 2010
Messages
179,264
Likes
43,408
Trump targets Pfizer and big Pharma for raising costs of prescription drugs after he vowed prices would decrease

  • President Trump tweeted his anger at drug companies for raising costs
  • Bayer, Novartis, and Pfizer all raises rates on some prescription medicines in the last few weeks
  • Trump vowed last month drug costs would go down
  • He has repeatedly attacked drug companies, saying they get 'away with murder'
http://www.dailymail.co.uk/news/art...a-rising-drug-costs-vowed-price-decrease.html
 

searcher

Mother Lode Found
Mother Lode
Sr Site Supporter
Joined
Mar 31, 2010
Messages
179,264
Likes
43,408
A Baby Was Treated With A Nap And A Bottle Of Formula. The Bill Was $18,000.

Posted on July 10, 2018 by Lambert Strether

Lambert here: “Some hospitals are turning this into a cash cow on the backs of patients.” Imagine my surprise.

By Jenny Gold, Kaiser Health News and Sarah Kliff, Vox

On the first morning of Jang Yeo Im’s vacation to San Francisco in 2016, her 8-month-old son, Park Jeong Whan, fell off the bed in the family’s hotel room and hit his head.

There was no blood, but the baby was inconsolable. Jang and her husband worried he might have an injury they couldn’t see, so they called 911, and an ambulance took the family — tourists from South Korea — to Zuckerberg San Francisco General Hospital (SFGH).

The doctors at the hospital quickly determined that baby Jeong Whan was fine — just a little bruising on his nose and forehead. He took a short nap in his mother’s arms, drank some infant formula and was discharged a few hours later with a clean bill of health. The family continued their vacation, and the incident was quickly forgotten.

Two years later, the bill finally arrived at their home: They owed the hospital $18,836 for a visit lasting three hours and 22 minutes, the bulk of which was for a mysterious fee for $15,666 labeled “trauma activation,” also known as “a trauma response fee.”

“It’s a huge amount of money for my family,” said Jang, whose family had travel insurance that would cover only $5,000. “If my baby got special treatment, OK. That would be OK. But he didn’t. So why should I have to pay the bill? They did nothing for my son.”

American hospital bills are today littered with multiplying fees, many of which don’t even exist in other countries: fees for blood draws, fees for checking the blood oxygen level with a skin probe, fees for putting on a cast, minute-by-minute fees for lying in the recovery room.

But perhaps the pinnacle is the “trauma fee,” in part because it often runs more than $10,000 and in part because it seems to be applied so arbitrarily.

A trauma fee is the price a trauma center charges when it activates and assembles a team of medical professionals that can meet a patient with potentially serious injuries in the ER. It is billed on top of the hospital’s emergency room physician charge and procedures, equipment and facility fees.

Emergency room bills collected by Vox and Kaiser Health News show that trauma fees are expensive and vary widely from one hospital to another.

Charges ranged from $1,112 at a hospital in Missouri to $50,659 at a hospital in California, according to Medliminal, a company that helps insurers and employers around the country identify medical billing errors.

“It’s like the Wild West. Any trauma center can decide what their activation fee is,” says Dr. Renee Hsia, director of health policy studies in the emergency medicine department at the University of California-San Francisco.

Hsia is also an emergency medicine doctor at Zuckerberg San Francisco General Hospital, but was not involved in the care of the patients discussed in the story — and spoke about the fees generally.

Comprehensive data from the Health Care Cost Institute shows that the average price that health insurers paid hospitals for trauma response (which is often lower than what the hospital charges) was $3,968 in 2016. But hospitals in the lowest 10 percent of prices received an average of $725 — while hospitals in the most expensive 10 percent were paid $13,525.

Data from Amino, a health cost transparency company, shows the same trend. On average, Medicare pays just $957.50 for the fee.

According to Medicare guidelines, the fee can be charged only when the patient receives at least 30 minutes of critical care provided by a trauma team — but hospitals do not appear to be following that rule when billing non-Medicare patients.

At the turn of the century such fees didn’t even exist.

But today many insurers willingly pay them, albeit at negotiated rates for hospitals in their networks. Six insurers and industry groups declined to discuss the fees, and a spokeswoman for America’s Health Insurance Plans, the industry trade group, said, “We have not seen any concerning trends surrounding trauma center fees.”

Trauma centers argue that these fees are necessary to train and maintain a full roster of trauma doctors, from surgeons to anesthesiologists, on-call and able to respond to medical emergencies at all times.

SFGH spokesman Brent Andrew defended the hospital’s fee of over $15,000 even though the baby didn’t require those services.

”We are the trauma center for a very large, very densely populated area. We deal with so many traumas in this city — car accidents, mass shootings, multiple vehicle collisions,” said Andrew. “It’s expensive to prepare for that.”

At What Cost Trauma?
Experts who’ve studied trauma fees say that at some hospitals there’s little rationale behind how hospitals calculate the charge and when the fee is billed. But, of course, those decisions have tremendous financial implications.

After Alexa Sulvetta, a 30-year-old nurse, broke her ankle while rock climbing at a San Francisco gym in January, she faced an out-of-pocket bill of $31,250 bill.

An ambulance also brought Sulvetta to Zuckerberg San Francisco General Hospital, where, she recalled, “my foot was twisted sideways. I had been given morphine in the ambulance.”

Sulvetta was evaluated by an emergency medicine doctor and sent for emergency surgery. She was discharged the next day.

SFGH also charged Sulvetta a $15,666 trauma response fee, a hefty chunk of her $113,338 bill. Her insurance decided that the hospital fees for the one-day stay were too high, and — after negotiations — agreed to pay only a charge it deemed reasonable. The hospital then went after Sulvetta for $31,250.

“My husband and I were starting to think about buying a house, but we keep putting that off because we might need to use our life savings to pay this bill,” she said.

SFGH spokesman Andrew, meanwhile, said that the hospital is justified in pursuing the bill. “It’s fairly typical for us to pursue patients when there are unpaid balances,” he said. “This is not an uncommon thing.”

‘I Feel Like I Created A Monster’
Trauma response fees were first approved by the National Uniform Billing Committee in January 2002, following a push by a national consulting firm specializing in trauma care. The high costs of staffing a trauma team available at all hours, the firm argued, threatened to shut down trauma centers across the country.

Trauma centers require special certification to provide emergency care for patients suffering very serious injuries above and beyond a regular emergency department.

“We were keeping an ongoing list of trauma centers that were closing all over the country,” said Connie Potter, who was executive director of the firm that succeeded in getting the fee approved. She now consults with hospital trauma centers on how to bill appropriately.

Trauma teams are activated by medics in the field, who radio the hospital to announce they are arriving with a trauma patient. The physician or nurse who receives the call then decides whether a full or partial trauma team is needed, which results in different fees. Potter said that person can also activate the trauma team based on the consultation with the EMTs.

But reports from the field are often fragmentary and there is much discretion in when to alert the trauma team.

An alert means paging a wide range of medical staff to stand at the ready, which may include a trauma surgeon, who may not be in the hospital.

Potter said if the patient arrives and does not require at least 30 minutes of critical care, the trauma center is supposed to downgrade the fee to a regular emergency room visit and bill at a lower rate, but many do not do so.

Hospitals were supposed to come up with the fee for this service by looking at the actual costs of activating the trauma team, and then dividing it over the amount that their patients are likely to pay. Hospitals that see a lot of uninsured and Medicaid patients might charge more to patients with private insurance to make up for possible losses.

But soon, Potter said, some hospitals began abusing the fee by charging an exorbitant amount that seemed to be based on the whims of executives rather than actual costs.

“To a degree, I feel like I created a monster,” Potter said. “Some hospitals are turning this into a cash cow on the backs of patients.”

The $15,666 is San Francisco General’s low-level trauma response fee. The high-level response fee in which the trauma surgeon is called into action is $30,206. The hospital would not provide a breakdown of how these fees are calculated.

Unfortunately, outside of Medicare and state hospitals, regulators have little sway over how much is charged. And at public hospitals, such fees may be a way to balance government budgets. At SFGH, the $30,206 higher-level trauma response fee, which increased by about $2,000 last year, was approved by the San Francisco Board of Supervisors.

An Ibuprofen, Two Medical Staples — And A $26,998 Bill
Some patients question whether their particular cases ought to include a trauma fee at all — and experts think they’re right to do so.

Sam Hausen, 28, was charged a $22,550 trauma response fee for his visit to Queen of the Valley Medical Center in Napa, Calif., in January.

An ambulance brought him to the Level 3 trauma center after a minor motorcycle accident, when he took a turn too quickly and fell from his bike. Records show that he was alert with normal vital signs during the 4-mile ambulance ride, and that the ambulance staff alerted the hospital that the incoming patient had traumatic injuries.

He was at the hospital for only about half an hour for a minor cut on his head, and he didn’t even need X-rays, CAT scans or a blood test.

“The only things I got were ibuprofen, two staples and a saline injection. Those were the only services rendered. I was conscious and lucid for the whole thing,” said Hausen.

But because the ambulance medics called for a trauma team, the total for the visit came to $26,998 — and the vast majority of that was the $22,550 trauma response fee.

Queen of the Valley Medical Center defended the charge. “Trauma team activation does not mean every patient will consult with and/or be cared for by a trauma surgeon,” spokeswoman Vanessa deGier said over email. “The activation engages a team of medical professionals. Which professional assesses and cares for a trauma patient depends on the needs and injury/illness of the patient.”

Guidelines for trauma activation are written broadly on purpose, in order to make sure they don’t miss any emergencies that could otherwise kill patients, said Dr. Daniel Margulies, a trauma surgeon at Cedars-Sinai in Los Angeles and chair of the American College of Surgeons committee on trauma center verification and review. Internal injuries, for example, can be difficult to diagnose at the scene of an accident.

“If you had someone who needed a trauma team and didn’t get called, they could die,” he said.

Medics err on the side of caution when calling in trauma patients to avoid missing a true emergency. To that end, the American College of Surgeons says it is acceptable to “overtriage,” summoning the trauma team for 25-35 percent of patients who don’t end up needing it.

But that logic leaves health consumers like Jang, Sulvetta and Hausen with tens of thousands in potential debt for care they didn’t ask for or need, care that is ordered out of an abundance of caution — a judgment call by an ambulance worker, a triage nurse or a physician — based on scant information received over a phone.

Jeong Whan had fallen 3 feet from a hotel bed onto a carpeted floor when his nervous parents summoned an ambulance. By the time the EMTs arrived, Jeong Whan was “crawling on the bed, not appearing to be in any distress,” according to the ambulance records. The EMTs called SFGH and, after a consultation with a physician, transported Jeong Whan as a trauma patient, likely because of the baby’s young age.

At the hospital, Jeong Whan was evaluated briefly by a triage nurse and sent to an emergency department resuscitation bay.

Jang recalls being greeted by nine or 10 providers at the hospital, but the baby’s medical records from the visit do not mention a trauma team being present, according to Teresa Brown of Medliminal, who reviewed the case.

The baby appeared to have no signs of major injury, and no critical care was required. Five minutes later, the family was transferred to an exam room for observation before being released a few hours later. Brown said she would dispute the $15,666 trauma response fee because the family does not appear to have received 30 minutes of critical care from a trauma team.

Jang currently has a patient advocate working on her behalf to try to negotiate the bill with the hospital. She said she fears that the pending medical debt could prevent her from getting a visa to visit New York and Chicago, which she hopes to do in the next few years.
'
She said her experience with the U.S. health care system and its fees has been shocking. “I like the USA. There are many things to see when traveling,” she said. “But the health care system in USA was very bad.”

This story was produced in collaboration with Vox, which is collecting emergency room bills as part of a year-long project focused on American health care prices.

Kaiser Health News is a nonprofit news service covering health issues. It is an editorially independent program of the Kaiser Family Foundation, which is not affiliated with Kaiser Permanente.

This entry was posted in Health care on July 10, 2018 by Lambert Strether.

https://www.nakedcapitalism.com/2018/07/baby-treated-nap-bottle-formula-bill-18000.html
 

goldielox1

Silver Miner
Seeker
Joined
Jun 20, 2013
Messages
1,215
Likes
837
Welp the moral of the story is quit calling the ambulance for every little nick and cut. And quit visiting the hospital for such minor stupid things. 50 years ago, 99% of these things would have been dad telling the kid "quit crying or I'll give you something to cry about" and that would be the end of it. Hospital ride for a broken ankle? Idiot probably took twice as long to get to the hospital than just having had her friend drive her there in her car. Same with the dumb asian lady. Could have driven junior to the hospital or just look at him crawling around as if nothing was wrong...because nothing was wrong.
 

searcher

Mother Lode Found
Mother Lode
Sr Site Supporter
Joined
Mar 31, 2010
Messages
179,264
Likes
43,408
Big Pharma & The Rise Of Gangster Capitalism


by Tyler Durden
Sat, 07/14/2018 - 16:20


Authored by Charles Hugh Smith via OfTwoMinds blog,

$8 per vial in competing developed-world nations and $38,892 in the U.S. That says it all.



Thanks to decades of gangster films, we all know how gangster capitalism works: the cost of "protection" goes up whenever the gangster wants to increase revenues, any competition is snuffed out, and "customer demand" is jacked up by any means available-- addiction, for example.

This perfectly describes the pharmaceutical industry and every other cartel in America. You might have read about the price increase in Acthar gel, a medication to treat Infantile Spasms. (via J.F., M.D., who alerted me to the repricing of this medication from $40 in 2001 to the current price of $38,892.)

The compound first received approval in 1950, and various branded versions have been approved in recent years. Let's be clear: this medication did not require billions of dollars in research and development, or decades of testing to obtain FDA approval; it's been approved for use for the past 68 years.

Yes, you read that correctly: a medication that's been in use for 68 years went from $40 a dose in 2001 to $38,892 today. Don't you love the pricing? Not a round 38 grand, but $38,892. You gotta love these gangsters!

There's another related term to describe this form of capitalism: racketeering.That's what mobsters do--operate rackets.

The Big Pharma racket enriches a number of gangs practicing gangster capitalism: the drug companies themselves, of course, but some doctors are profiting from the racket, and so are pharmaceutical lobbyists:

Study highlights role of doctor conflicts of interest in Medicare spending on Mallinckrodt drug Acthar Study published in JAMA indicates nearly 90 percent of doctors prescribing HP Acthar Gel took payments from drug's manufacturer.

Here are the money quotes:

In 2014 Mallinckrodt raised the price of Acthar further to $34,000. The Federal Trade Commission and attorneys general from five states sued Mallinckrodt for anti-competitive behavior with regard to the acquisition of Synacthen Depot and the monopolistic pricing of Acthar, and in January 2017 the company settled, agreeing to pay $100 million and to license Synacthen Depot to a competitor.
According to Kaiser Health News, Mallinckrodt responded by increasing its Congressional lobbying to $610,000, and its contributions to Congress members to $44,000, in the first quarter of 2017.
As an off-patent pharmaceutical, a similar drug, differing in formulation, available in Europe, made by a different manufacturer, sells for $8 per vial.


So a medication to treat infants costs $8 per vial in Europe and $38,892 in the U.S. Don't you just love gangster capitalism to death? Because death and suffering is the gangsters' ultimate threat: pay up or die.

Here's another example of Big Pharma gangster capitalism at work: Insulin Drug Price Inflation: Racketeering or Perverse Competition?

Don't you wish you had a racket where you could raise prices by 10% a year like clockwork, or triple the price of your "product" every decade?



Pfizer just raised prices on 100 medications:

The increases are effective as of July 1. In most cases, the increases are just over 9%, which is in line with the annual 10% price hikes adopted by most drug companies. Putting that number in context, core inflation printed at 2% last week.

Here's a chart of the net result of gangster capitalism:



Gangster capitalism is the new model of "growth" in America, the model used by every cartel from higher education to Pentagon contractors. Eliminate actual competition, raise prices in lockstep with other cartel members, lobby the government to pay your extortionist prices, and threaten any resisters with severe consequences.

Try resisting your local government's property tax increases to cover insiders' pensions and healthcare benefits: it's always "for the children," of course, and if you don't pay up, we'll just auction off your house.

There's no difference between that and being told you're gonna be wearing concrete overshoes if you don't comply.

The U.S. economy is nothing more than an exploitive jumble of rackets, insider plundering and gangster capitalism. $8 per vial competing developed-world nations and $38,892 in the U.S. That says it all.

https://www.zerohedge.com/news/2018-07-14/big-pharma-rise-gangster-capitalism
 

goldielox1

Silver Miner
Seeker
Joined
Jun 20, 2013
Messages
1,215
Likes
837
I think it's safe to say that 90% of drugs are quite unnecessary. Let's start with those. e.g. Instead of taking the $250 insulin per week or whatever that dosage is, how about reversing that diabetes that is caused by being overweight? What do you think would happen to the price of insulin if 95% of those that were on it decided that they didn't want to pay $1000's a year and decided to walk 5 days a week (for free) instead? That's just one example. Let's face it Americans are way over-medicated.
 

Area51

Silver Miner
Seeker
Joined
Oct 23, 2012
Messages
1,353
Likes
991
Welp the moral of the story is quit calling the ambulance for every little nick and cut. And quit visiting the hospital for such minor stupid things. 50 years ago, 99% of these things would have been dad telling the kid "quit crying or I'll give you something to cry about" and that would be the end of it. Hospital ride for a broken ankle? Idiot probably took twice as long to get to the hospital than just having had her friend drive her there in her car. Same with the dumb asian lady. Could have driven junior to the hospital or just look at him crawling around as if nothing was wrong...because nothing was wrong.

The woman was charged $113k for surgery to set a broken ankle and you're focused on how she should have taken an Uber to the hospital.

How much of that $113k do you suppose could have been "saved" by avoiding the ambulance ride?

Instead of distracting yourself with asinine minutiae, let's focus on the real issue of for-profit health care.
 

edsl48

Silver Member
Silver Miner
Site Supporter
Joined
Apr 2, 2010
Messages
1,960
Likes
3,255
ANd this is better??????

NHS Waiting-List In England Reaches Longest In 11 Years

New figures released by NHS England today reveal the waiting list to be at its longest since August 2007 having steadily risen over the last few years to 4.1 million people awaiting treatment.

You will find more infographics at Statista
Responding to the figures, Chief Executive and General Secretary of the Royal College of Nursing, Janet Davies, said:
"While he is not personally on the hook today...these figures should leave the new Health Secretary in no doubt as to the scale of the task ahead of him".​
In terms of the action she sees as necessary for the NHS, she added:
"Safe and effective patient care relies on having enough nurses, and the Health Secretary must urgently address the staff shortages that are crippling our healthcare system.”​
As a reminder, in a tweet earlier this year, President Trump wrote:
“The Democrats are pushing for Universal Healthcare while thousands of people are marching in the UK because their system is going broke and not working. Dems want to greatly raise taxes for really bad and non-personal medical care. No thanks!”​
With almost 10% of the UK population in front of you for treatment, he may have a point.
 

goldielox1

Silver Miner
Seeker
Joined
Jun 20, 2013
Messages
1,215
Likes
837
The woman was charged $113k for surgery to set a broken ankle and you're focused on how she should have taken an Uber to the hospital.

How much of that $113k do you suppose could have been "saved" by avoiding the ambulance ride?

Instead of distracting yourself with asinine minutiae, let's focus on the real issue of for-profit health care.
From the article: "But because the ambulance medics called for a trauma team, the total for the visit came to $26,998 — and the vast majority of that was the $22,550 trauma response fee. "
The costs for these people are so high because someone gets a nick and then calls for an ambulance. The ambulance charges $10K and then calls ahead to the hospital saying "we might have a trauma" (probably gets a kickback for making that decision). The person arrives and doesn't need a trauma team yet the patient still has to pay for one which i where these $100K bills are coming from (the trauma on call staff team of 10 doctors). So for those that are slow to understand my point: Had they skipped the ambulance hospital ride which takes longer than a simple friend driving to a hospital in most cases (2 ways vs 1 way) and skips the unnecesary trauma team fee as the ambulance is the one saying the patient might need one when the hospital would be able to decide right away and would avoid the false positives.
 

Area51

Silver Miner
Seeker
Joined
Oct 23, 2012
Messages
1,353
Likes
991
From the article: "But because the ambulance medics called for a trauma team, the total for the visit came to $26,998 — and the vast majority of that was the $22,550 trauma response fee. "
The costs for these people are so high because someone gets a nick and then calls for an ambulance. The ambulance charges $10K and then calls ahead to the hospital saying "we might have a trauma" (probably gets a kickback for making that decision). The person arrives and doesn't need a trauma team yet the patient still has to pay for one which i where these $100K bills are coming from (the trauma on call staff team of 10 doctors). So for those that are slow to understand my point: Had they skipped the ambulance hospital ride which takes longer than a simple friend driving to a hospital in most cases (2 ways vs 1 way) and skips the unnecesary trauma team fee as the ambulance is the one saying the patient might need one when the hospital would be able to decide right away and would avoid the false positives.

The woman had a broken ankle that needed to be surgically repaired, my friend.

Wouldn't have mattered if she took an ambulance, an Uber or hopped on one foot to the hospital - - it was going to be classified as a "trauma" and billed as such.

You're cherry picking a bunch of different incidents and trying to piece them all together to formulate your ridiculous assertions.

A broken ankle is not a "nick". Especially not when it requires surgery to be reset.

Nowhere does the article state that ambulances bill $10k to transport s patient to hospital. That's pure fabrication on your part.
 

goldielox1

Silver Miner
Seeker
Joined
Jun 20, 2013
Messages
1,215
Likes
837
The woman had a broken ankle that needed to be surgically repaired, my friend.

Wouldn't have mattered if she took an ambulance, an Uber or hopped on one foot to the hospital - - it was going to be classified as a "trauma" and billed as such.

You're cherry picking a bunch of different incidents and trying to piece them all together to formulate your ridiculous assertions.

A broken ankle is not a "nick". Especially not when it requires surgery to be reset.

Nowhere does the article state that ambulances bill $10k to transport s patient to hospital. That's pure fabrication on your part.
I'm not cherry picking at all. Someone posted an article with three examples to which I responded to all three examples cited using the facts cited in the article itself. It's the very definition of not cherry picking.

Did they operate on the ankle in the ambulance? I must have missed that part how they operated in the ambulance so the ambulance was necessary. A broken ankle isn't necessarily a trauma; in fact in most cases I would think it would just be a simple surgery. I'm not a doctor (but regardless even if the ankle is considered a trauma requiring 10 doctors? LOL) the other 2 examples clearly prove my point that people are wasteful and don't care about costs since they think their insurance company is going to foot the bill. Billy got a scratch...call 911, we need an ambulance stat, and don't worry Blue Cross will cover it so why not.

And I was just guessing ambulance cost. It looks like it costs more like $2000 average. But $2000 ain't no big deal when you ain't payin right?

Geographical Location Price Reported Chicago, IL$1,200 Cleveland, OH$500 La Jolla, CA$1,772 Longview, TX$1,065 New York, NY$2,480 Oklahoma City, OK$1,300 Phoenix, AZ$860 Pinellas County, Florida$1,007 per person plus $13 per loaded mileSan Diego, CA$1,700Seattle, WA $950Tucson, AZ$1,105
 

searcher

Mother Lode Found
Mother Lode
Sr Site Supporter
Joined
Mar 31, 2010
Messages
179,264
Likes
43,408
'My daughter begged for her life': Mother of woman, 30, who died just days after giving birth claims she had to take her to the hospital because paramedics assumed she couldn't afford an ambulance

  • Crystal Galloway, 30, suffered a stroke on July 4 and died on July 9, less, than two weeks after giving birth to her third child via C-section
  • Her mother says paramedics insisted she could not afford an ambulance ride, and she ended up driving Galloway to the hospital herself
  • Investigation found paramedics failed to check Galloway's vitals and later falsely logged the call as 'patient not found'
  • All four paramedics from Hillsborough County, Florida, have been suspended
  • They have disputed Benhamou’s version of events, claiming the mother told them she would rather take her daughter to the hospital herself
  • Galloway, a recent college graduate, is survived by her two daughters, ages 13 and seven, and her newborn son, Jacob
http://www.dailymail.co.uk/news/art...-assumed-dying-daughter-afford-ambulance.html
 

goldielox1

Silver Miner
Seeker
Joined
Jun 20, 2013
Messages
1,215
Likes
837
So in the time it took to call and wait for the ambulance to show up and then discuss payment options, mother could have already had her daughter in the hospital emergency room being treated.
 

searcher

Mother Lode Found
Mother Lode
Sr Site Supporter
Joined
Mar 31, 2010
Messages
179,264
Likes
43,408
Health Insurance Mafia & The Heroin Of 'Signing Up' For Obamacare


by Tyler Durden
Sun, 07/29/2018 - 14:05


Authored by Eric Peters via EricPetersAutos.com,

A good friend urges me to “sign up” for Obamacare.



He knows about the extortion letters I have been receiving from the federal thugs who are now the enforcers for the health insurance mafia – which succeeded in getting a law passed which forces us to buy their services.

Or else.

The “or else” being punishing fines – plus interest. These are called “shared responsibility” payments but – in the first place – nothing is being “shared” (I am being forcibly mulcted) and in the second place for whom am I “responsible”?


Note the increase SRP for future years. NTTC Training 2014.

Myself, certainly.

But that is precisely the point and the fulcrum of my objection to Obamacare – to this business of being forced to be responsible for other people’s “care” at the expense of my own.

I could afford a high-deductible, catastrophic care insurance policy – something which would “cover” just that, a catastrophic and therefore not-likely event, such as a heart attack or cancer. And precisely because such an event is unlikely, the cost of such a “plan” would actually be insurance and so affordable.

I could therefore afford to be responsible for myself.

But Obamacare has turned the concept of insurance on its head. What is going on now is not insurance. It is wealth redistribution – mostly to the insurance mafia. The law forces me – and you – to pay for things we don’t need or use (for example, maternity care “coverage” for a divorced middle-aged man and “substance abuse counseling” for a man who doesn’t abuse any substances) which means no value received for the money extorted. The money lines the pockets of the mafia, which may perhaps dole out a portion to “cover” some portion of other people’s maternity care or substance abuse counseling.



I resent being mule-hitched to the insurance mafia’s profit wagon and also having the bit shoved into my mouth so that I may be forced to pull other people’s wagons rather than my own wagon – the only wagon for which I am morally “responsible.”

Which brings me back to my dilemma – and my friend’s solution.

Obamacare has made it financially impossible for me to afford “coverage” and so am not “covered,” which makes me all of a sudden a criminal for seeking to take care of myself and not filch other people’s pockets.

For this I am the object of punishment – like any criminal – except I fail to see how I am one given I’ve harmed no one. Not even myself – and even if I do harm myself, that is a matter between me and myself – the aggrieved party. Certainly I have aggrieved no one else, assuming I am not the property of someone else.

Which of course I am, apparently. And you, too. We will get to that momentarily.



At any rate, I am the object of punishment. “Shared responsibility” fines – technically, taxes – which is how the federal thugs legitimated the illegitimate, arguing that the Congress (more thugs) having empowered themselves to tax us – that is, to steal our money as and how they wish, by voting to do so – therefore has the power to vote to tax us for failing to send money to the insurance mafia as ordered by their other edict.

So, $695 so far – plus interest, accumulating. My punishment for failing to be “covered” last year. It will be another $695 plus interest for this year, too.

I cannot afford this, either – not without being unable to afford the care I actually do need, such as the old filling I just had replaced and the crown I had to have done last year, which together cost me about what my “shared responsibility” payment would be for last year and this year except I decided to be responsible for myself instead.



My friend urges me to “sign up” for Obamacare” on the “exchanges.” He says it will cost less – and by “signing up” I will avoid the “shared responsibility” fines (taxes) going forward.

This is all true – but entirely beside the point. Or rather, it is exactly the point.

If I “sign up,” I will be as Lee at Appomattox. I will have surrendered. I will have accepted the idea that I am not a sovereign individual who owns himself absolutely – and the corollary of that, which is the absolute right of others to ownership of themselves. That we are each free individuals, responsible for ourselves and our actions only.

Not for the actions of others, nor they for ours.

If we “sign up, we have accepted that we are all somehow each others’ collective property and as such are subject to being used and controlled by our owners, just like a mule or any other form of property.

That we are enslaved – to each other.


This is why I will not “sign up” – in the spirit of Giles Corey, the refusnik of Salem Witch Trials fame, who declined to go along to get along by witnessing falsely against his neighbors. More weight was all he said – with a contemptuous smile – as his tormentors attempted to get him to “share responsibility” by piling stones upon his chest.

If it comes to it, they can do that to me as well.

I won’t go to the “exchanges.” Will not voluntarily send a single penny of my money to the cretinous insurance mafia. I will not pay the “shared responsibility” tax, either.

I will continue to be responsible for myself.

If that makes me a criminal in a system gone criminal, so be it.

More weight...

https://www.zerohedge.com/news/2018-07-29/health-insurance-mafia-heroin-signing-obamacare
 

edsl48

Silver Member
Silver Miner
Site Supporter
Joined
Apr 2, 2010
Messages
1,960
Likes
3,255
Explaining the High Cost of US Health Care: No Skin in the Game


byMike Mish Shedlock
7 hrs-edited

Costs are expensive because there is almost no skin in the game. Graft has taken over.
The Wall Street Journal has an interesting article on healthcare: Why Americans Spend So Much on Health Care—In 12 Charts.
The U.S. spends more per capita on health care than any other developed nation. It will soon spend close to 20% of its GDP on health—significantly more than the percentage spent by major Organization for Economic Cooperation and Development nations.
What is driving costs so high? As this series of charts shows, Americans aren’t buying more health care overall than other countries. But what they are buying is increasingly expensive. Among the reasons is the troubling fact that few people in health care, from consumers to doctors to hospitals to insurers, know the true cost of what they are buying and selling.
Contributions to employer-sponsored health coverage aren’t taxed, which makes it less expensive for companies to pay workers with health benefits than wages. Generous benefits lead to higher spending, according to many economists, because employees can consume as much health care as they want without having to pay significantly more out of their own pockets.
The prices of many medicines are hidden because pharmacy-benefit managers—the companies that administer drug benefits for employers and health insurers—negotiate confidential discounts and rebates with drugmakers.​
Price Growth Since 2000


Hospitals are becoming more consolidated and are using their market clout to negotiate higher prices from insurers.
Tax Benefits


Contributions to employer-sponsored health coverage aren’t taxed, which makes it less expensive for companies to pay workers with health benefits than wages. Generous benefits lead to higher spending, according to many economists, because employees can consume as much health care as they want without having to pay significantly more out of their own pockets.
The tax benefit is the country’s biggest single income-tax break, costing billions to government revenue.​
WSJ Misses the Big Picture
The charts are interesting but the WSJ misses the big picture: There is no incentive anywhere to reduce costs.
No Skin in the Game
Where the hell is "skin in the game"?
  • Those covered by Medicare have no skin in the game. And that is precisely why Medicare for All would be an abomination.
  • Those covered under company plans have little incentive to reduce costs. Once deductibles are met, there is "no skin in the game".
  • Lobbyists wrote Obamacare. The results speak for themselves.
  • Congress had a golden opportunity to allow drug imports but failed to act. Drug companies can charge what they want and insurers will pony up.
  • There is no right to refuse service. Hospitals take anyone and everyone whether or not they have insurance. As such, many don't have insurance. They have no skin in they game. Bankruptcy is a way out.
  • Massive amounts of money are wasted to keep terminal patients alive. Why? Because hospitals get paid by insurers. If hospitals didn't get paid, and had they had right of refusal, such nonsense would stop.
  • Obama himself: Obama dictated what had to be be in healthcare plans. They labeled them Gold, Silver, and Bronze. Lovely. Arguably they should have been called dumb, dumber, and dumbest. Why? Millennials and healthy people had to overpay to support everyone else. The millennials dropped out, just as free market principles would have dictated.
Let the Free Market Work
Please, let the free market work. Let insurers offer whatever plans they want. Let people buy whatever they want. And let those without insurance pay the price. I assure you, prices will plummet.
If you need a liver transplant and your insurance doesn't cover it. Sorry, you lose.
Costs for routine services will plunge because hospitals will not have to pay $200 for one aspirin to make up for the cost of an unpaid liver transplant.
Insurance plans ought to be able to force treatment overseas if someone is healthy enough to travel. A heart bypass operation in India is 10% of the cost here.
At a bare minimum, insurance companies ought to be able to offer such plans.
Personal Experiences - Stop and Smell the Lilacs
I seriously wonder if chemotherapy is more of a torture than a blessing. I watched my mom die in misery. The cost today is surely thousands of times higher. For what? To prolong someone's life for six months? At what cost? And who should pay?
When my mom stopped breathing, they asked my dad if he wanted them to try and revive her. He said no. Had he not been there, what would they have done? Why?
My wife, Joanne, died from ALS (Lou Gerhig's Disease). She was on extremely expensive drugs paid for under Medicare. Note that one does not have to be 65 to be under Medicare. Rather, Medicare picks up all costs on some terminal diseases.
Did those drugs do her any good? I doubt it. We also need to define "good". If they kept her alive for another three months (which I highly doubt), it was another three months of pain and suffering.
I sponsored a raffle for the benefit of the Les Turner ALS Foundation. And we put on a economic conference. John Hussman did a generous match of non-raffle proceeds. All told, we raised $500,000 for the Les Turner foundation.
This was an early post promoting the fund raiser: My Wife Joanne Has Passed Away; Stop and Smell the Lilacs
I am very proud of that, and also the amazing support from the Hussman Foundation.
That's skin in the game. Thanks again John!
Brass Tacks
We really need to get down to brass tacks.
Other countries seemingly have better healthcare because they control the cost of education, doctors fees, etc. They get cheaper drugs from the US than we have here.
Unless the US wants to control the cost of education, the cost of drugs, the cost of hospital care, and literally the cost of everything related, the US will not compare favorably to other countries.
In case you missed it, please consider "Free Stuff": Medicare for All Cost Pegged at $32.6 Trillion for 10 Years.
Medicare for All cannot possibly work here, even if it "seems" to work elsewhere. I suggest we try the free market, not more Obamaism.
 

searcher

Mother Lode Found
Mother Lode
Sr Site Supporter
Joined
Mar 31, 2010
Messages
179,264
Likes
43,408
Grieving widow is hit with $10,000 bill two weeks after sudden death of her husband when their health insurance provider realized it had 'under-charged them for more than two years'

  • Steve Meagher, 54, died suddenly from a heart attack in Orinda, California
  • Wife April described him as 'epitome of health' and said he ran, swam and cycled
  • She said cardiologist told them he was in great health just weeks prior to death
  • April was billed for $9,600 by Blue Shield of California just 19 days after he died
  • Company said it had been under-charging her family for more than two years
  • However, it has now cleared the charge
http://www.dailymail.co.uk/news/art...afterhealthy-husband-died-running-Orinda.html
 

searcher

Mother Lode Found
Mother Lode
Sr Site Supporter
Joined
Mar 31, 2010
Messages
179,264
Likes
43,408
Once Its Greatest Foes, Doctors Are Embracing Single-Payer

Posted on August 8, 2018 by Yves Smith

By Shefali Luthra, who, covers consumer issues in health care. Her work has appeared in news outlets such as The Washington Post, CNN Health and NPR.org. Originally published at Kaiser Health News

When the American Medical Association — one of the nation’s most powerful health care groups — met in Chicago this June, its medical student caucus seized an opportunity for change.

Though they had tried for years to advance a resolution calling on the organization to drop its decades-long opposition to single-payer health care, this was the first time it got a full hearing. The debate grew heated — older physicians warned their pay would decrease, calling younger advocates naïve to single-payer’s consequences. But this time, by the meeting’s end, the AMA’s older members had agreed to at least study the possibility of changing its stance.

“We believe health care is a human right, maybe more so than past generations,” said Dr. Brad Zehr, a 29-year-old pathology resident at Ohio State University, who was part of the debate. “There’s a generational shift happening, where we see universal health care as a requirement.”

The ins and outs of the AMA’s policymaking may sound like inside baseball. But this year’s youth uprising at the nexus of the medical establishment speaks to a cultural shift in the medical profession, and one with big political implications.

Amid Republican attacks on the Affordable Care Act, an increasing number of Democrats — ranging from candidates to established Congress members — are putting forth proposals that would vastly increase the government’s role in running the health system. These include single-payer, Medicare-for-all or an option for anyone to buy in to the Medicare program. At least 70 House Democratshave signed on to the new “Medicare-for-all” caucus.

Organized medicine, and previous generations of doctors, had for the most part staunchly opposed to any such plan. The AMA has thwarted public health insurance proposals since the 1930s and long been considered one of the policy’s most powerful opponents.

But the battle lines are shifting as younger doctors flip their views, a change that will likely assume greater significance as the next generation of physicians takes on leadership roles. The AMA did not make anyone available for comment.

Many younger physicians are “accepting of single-payer,” said Dr. Christian Pean, 30, a third-year orthopedic surgery resident at New York University.

In prior generations, “intelligent, motivated, quantitative” students pursued medicine, both for the income and because of the workplace independence — running practices with minimal government interference, said Dr. Steven Schroeder, 79, a longtime medical professor at the University of California-San Francisco.

In his 50 years of teaching, students’ attitudes have changed: “The ‘Oh, keep government out of my work’ feeling is not as strong as it was with maybe older cohorts,” said Schroeder. “Students come in saying, ‘We want to make a difference through social justice. That’s why we’re here.’”

Though “single-payer” health care was long dismissed as a left-wing pipe dream, polling suggestsa slim majority of Americans now support the idea — though it is not clear people know what the term means.

A full single-payer system means everyone gets coverage from the same insurance plan, usually sponsored by the government. Medicare-for-all, a phrase that gained currency with the presidential campaign of Sen. Bernie Sanders (I-Vt.), means everyone gets Medicare, but, depending on the proposal, it may or may not allow private insurers to offer Medicare as well. (Sanders’ plan, which eliminates deductibles and expands benefits, would get rid of private insurers.)

Meanwhile, lots of countries achieve universal health care — everyone is covered somehow — but the method can vary. For example, France requires all citizens purchase coverage, which is sold through nonprofits. In Germany, most people get insurance from a government-run “public option,” while others purchase private plans. In England, health care is provided through the tax-funded National Health System.

American skeptics often use the phrase “socialized medicine” pejoratively to describe all of these models.

“Few really understand what you mean when you say single-payer,” said Dr. Frank Opelka, the medical director of quality and health policy for the American College of Surgeons, which opposes such a policy. “What they mean is, ‘I don’t think the current system is working.’”

But the willingness to explore previously unthinkable ideas is evident in young doctors’ ranks.

Recent surveys through LinkedIn, recruiting firm Merritt Hawkinsand trade publication NEJM Catalystindicate growing support. In the March NEJM survey, 61 percent of 607 respondents said single-payer would make it easier to deliver cost-effective, quality health care.

Delving further, that survey data shows support is stronger among younger physicians, said Dr. Namita Mohta, a hospitalist at Brigham and Women’s Hospital and clinical editor at NEJM Catalyst.

But it’s unclear whether these findings reflect young doctors’ feelings about the policy or whether they are tapping in to broader frustrations with the American health system.

Much like the general public, doctors often use terms like single-payer, Medicare-for-all and universal health care interchangeably.

“Our younger generation is less afraid to come out and say we want universal health care,” said Dr. Anna Yap, 26, an emergency medicine resident at UCLA, who served as a medical student delegate to the AMA until this past June. “But how? It’s different in what forms we see.”

Younger doctors also pointed to growing concern about how best to keep patients healthy. They cited research that broadly suggests having health insurance tracks with better health outcomes.

“Medical students, I would say, are very interested in public health and improving social determinants of health — one of them being access to health insurance,” said Dr. Jerome Jeevarajan, 26, a neurology resident at the University of Texas-Houston, referring to non-medical factors that improve health, such as food or housing.

Some of the shift in opinion has to do with the changing realities of medical practice. Doctors now are more likely to end up working for large health systems or hospitals, rather than starting individual practices. Combined with the increasing complexity of billing private insurance, many said, that means contracting with the government may feel like less of an intrusion.

The debate is, at this point, still theoretical. Republicans — who control all branches of the federal government — sharply oppose single-payer. Meanwhile, single-state efforts in California, Colorado and New York have fallen flat.

Also, doctors represent only one part of the sprawling health care industrial complex. Other health care interests — including private insurance, the drug industry and hospital trade groups — have been slower to warm to catchphrases like single-payer or universal health care, all of which would likely mean a drop in income.

But increasingly physicians seem to be switching sides in the debate, and young physicians want to be part of the discussion.

“There’s tremendous potential … to be at the table if single-payer becomes a significant part of the political discourse, and create a system that is more equitable,” Pean said.

This entry was posted in Guest Post, Health care, Politics on August 8, 2018 by Yves Smith.

https://www.nakedcapitalism.com/2018/08/greatest-foes-doctors-embracing-single-payer.html
 

searcher

Mother Lode Found
Mother Lode
Sr Site Supporter
Joined
Mar 31, 2010
Messages
179,264
Likes
43,408
Chris Collins, Indicted for Insider Trading, Wrote Bill That Could Help His Company

Daily Beast
By Justin Glawe
2 hrs ago



Rep. Chris Collins (R-NY) remains invested in the company at the center of a scandal that led to his indictment and he recently introduced legislation that could help that company.

Collins was charged last week for allegedly giving nonpublic information on Innate Immunotherapeutics, where he was a board member while also serving in Congress, to his son. Collins learned Innate’s lone drug failed its clinical trial and allegedly told his son before the company announced the devastating news. Collins’s son and other family members then dumped Innate stock before it crashed after the news was public. Collins, his son, and a third defendant have pleaded not guilty. Collins said he would not seek re-election in November.

Collins still holds about 2.6 million shares of Innate, worth some $780,000 as of Monday. As recently as last month, Collins continued to introduce legislation that could help Innate, as he has done for the past several years.

In July, Collins introduced a proposed bill that would remove infusion drugs (administered by needle) from a federal program called 340B that requires the pharmaceutical industry to sell drugs at steep discounts to hospitals serving poor patients. Many infusion drugs are used to treat deadly diseases like cancer and HIV and can costs tens or hundreds of thousands of dollars per year.

Innate said in April it is developing a cancer treatment that could become an infusion drug, according to the company’s U.S. patent application for the treatment.

If the treatment becomes an infusion drug and if Collins’ bill becomes law, it would mean millions in additional profits for Innate and other pharmaceutical companies. In 2016, the pharmaceutical industry lost out on $16 million in profits thanks to 340B. Compared to the $450 billion in total 2016 U.S. drug sales, 340B cost the pharmaceutical industry 0.000035% of its revenue that year.

At an Energy and Commerce Committee hearing on July 11, Collins lamented the pharmaceutical industry’s increasing losses thanks to 340B purchases, a program he says is improperly expanding.

“Everyone would like more money,” Collins said of hospitals using savings from 340B purchases to both their bottom lines. “But to take it off the backs of pharmaceutical companies inappropriately could lead to higher [drug] prices overall.”

Collins’s office did not immediately respond to a request for comment.

Innate’s previous drug was also an infusion drug that would likely have been covered under 340B’s discounts had it not failed its second clinical trial. That failure is what federal prosecutors say led Collins, then an Innate shareholder, to call his son from the White House lawn, telling him the bad news about the results of the clinical trial before Innate announced it publicly.

The drug’s failure meant about $17 million in lost stock value for Collins, as well as speculation in the pharmaceutical industry that the company was largely finished.

But in April, Innate announced it had acquired another Australian pharmaceutical company, Amplia Therapeutics. Employees of both companies are hopeful that the combination of Innate’s previous work on its failed drug and Amplia’s intellectual property will turn into groundbreaking treatments for a variety of cancers. Innate plans to seek investigational new drug status from the Food and Drug Administration, a process Collins has made easier thanks to legislative language he wrote a 2016 law.

While Collins left Innate’s board of directors in May, he appears to still hold some stock in the company. In March, Collins had 2.8 million shares in Innate, according to its 2018 annual report. On June 20, Collins sold as much as $50,000 worth of Innate stock, or about 178,500 shares, according to a report he filed with the House of Representatives.

His vested interest in the company and work as a lawmaker should prompt questions from the House Ethics Committee, said Virginia Canter, chief ethics counsel for Citizens for Responsibility and Ethics in Washington.

“If you’re a member of Congress you shouldn’t be sitting on the board of publicly traded company, and you shouldn’t be trading stock that could in that company that could benefit from what you’re doing as a lawmaker,” Canter said.

Collins also served on the board of directors of another biotech company, ZeptoMetrix, while he dealt with issues that could have affected the company.

The first bill he sponsored in Congress would have removed Obamacare penalties on small businesses like ZeptoMetrix, The Daily Beast previously reported. In 2016 and 2017, according to the New York Times, he “asked detailed questions about development of a test for the Zika virus, not revealing his connection to ZeptoMetrix, which was selling the virus to laboratories that were developing tests for the disease,” He also did not disclose his ties to ZeptoMetrix when he questioned an FDA official in 2015 about regulation of laboratory tests. Collins left the board last week, the Times said.

The Ethics Committee has been weighing an investigation into Collins since October 2017 when a probe was recommended by the Office of Congressional Ethics. The OCE found that Collins had likely violated House ethics rules in his dealings with Innate by telling other lawmakers about the company and asking a scientist at the National Institutes of Health to help the company prepare for a clinical trial. The committee has not commented on what ethics watchdogs say were glaring conflicts of interest, the OCE’s findings did not include three other bills discovered by The Daily Beast that could have helped the company.

While proponents of 340B have been expecting Collins’ infusion bill for more than a year now, it wasn’t until early July that the discussion draft was released on the Energy and Commerce Committee’s website. (Collins and others say 340B has expanded beyond its original scope of the program while its proponents argue hospitals are simply more adept at taking advantage of its discounts.) Less than after the discussion draft was published on Energy and Commerce’s website, the committee held a hearing at which Collins discussed his proposed bill and more than a dozen others that will fundamentally change 340B.

The draft bill was the culmination of years of work by Collins and his staff on what he and others call “reform” of 340B. Collins had long sought to remove infusion drugs from 340B by changing the “patient definition” of the program. In February 2017, Collins drafted an outline of his discussion draft. The document, obtained by The Daily Beast in April 2018, begins by stating that Collins’ marquee 340B reform bill should immediately address the patient definition.

“Language starts with a patient definition for hospitals (pg 1),” the outline states.

In a section outlining “exceptions” to 340B coverage, Collins’ draft bill excludes patients whose treatment “consists only of the administration or infusion of a drug or drugs,” among other provisions. Infusion drugs comprise about 70 to 80 percent of the estimated $8 billion in 340B drug discounts annually, a former Health and Human Services official who worked on the program at the agency told The Daily Beast in April.

Read more at The Daily Beast.

http://www.msn.com/en-us/news/us/ch...-could-help-his-company/ar-BBLRDsB?ocid=ientp
 

searcher

Mother Lode Found
Mother Lode
Sr Site Supporter
Joined
Mar 31, 2010
Messages
179,264
Likes
43,408
How to Calculate the Costs of #MedicareForAll Properly

Posted on August 21, 2018 by Lambert Strether

By J. D. Alt, author of The Architect Who Couldn’t Sing, available at Amazon.com or iBooks. Originally published at New Economic Perspectives

A report from the Mercatus Center at George Mason University calculating the “cost” of Medicare-for-all has received much attention recently—first, because Bernie Sanders claimed the report concluded that Medicare-for-all would save the American people $2 trillion over a 10-year period. That claim was still warm when the report’s author, Charles Blahous, told the Washington Post that Bernie’s interpretation of the report’s conclusions were blatantly false. In fact, Blahous told the Post, he posited that savings scenario based on a set of assumptions which he subsequently proved were so highly unlikely as to be impossible.

The real conclusion of his report, Blahous said, was that Medicare-for-all will “raise government expenditures by $32.6 trillion” in the first decade—or, about $3.3 trillion per year. Blahous went on to say this: “For perspective on these figures, consider that doubling all currently projected federal individual and corporate income tax collections would be insufficient to finance the added federal costs of the plan.”

So, there you have it: blown out of the water again. When will Democrats understand they can’t collect enough tax-dollars to pay for Medicare-for-all, or to pay America’s public college tuitions, or to pay for pre-school day-care for America’s working-class families? When are Democrats going to get REAL? End of conversation.

Except it should not be the end of the conversation at all, but rather the beginning of a learning experience to help Americans get it right when it comes to understanding what U.S. democracy can “afford” to do. It turns out the arguments framed by Mr. Blahous are, themselves, based upon a particular assumption which is illogical from the perspective of macro-economic bookkeeping in a modern money system—which is what the U.S. has been operating now for over three-quarters of a century.

To see why this is so, begin with the simple statement that Medicare-for-all will increase federal expenditures by $3.3 trillion per year. The first thing to notice is that this number—$3.3 trillion—represents the total amount of health-care services someone has calculated that Americans are going to need. To digress for a moment, I realize that a large part of the controversy around health-care stems from the belief that Americans are paying for services they don’t require and are paying too much for the services they get. Arguments about how to pay for health-care, then, get entangled with arguments about how to reduce its cost—and the entanglement renders clear thinking and debate difficult. So, for the moment, let’s not even consider whether the $3.3 trillion figure is an overpayment—let’s just accept the fact that it is a number somebody calculated about how many services and procedures American’s will need, and how much each service and procedure is estimated to cost. That total guestimate represents what we could call America’s “health-dollars”—i.e. the dollars Americans are going to spend on health-care one way or another, assuming they get the services they’ve been projected to need.

Here’s the second thing to notice about this $3.3 trillion in health-dollars: If Uncle Sam didn’t write the checks for those health-services, someone else would have to. In aggregate, then, if Uncle Sam pays $3.3 trillion for America’s health-care services, America’s families and businesses save $3.3 trillion in expenditures they don’t have to pay—which could be viewed as the same as “earning” an extra $3.3 trillion each year.

From a macro-economic bookkeeping perspective, then, if the folks who “earned” $3.3 trillion (by not having to spend it) “transferred” their $3.3 trillion windfall to Uncle Sam, they would have, remaining, the same number of dollars as if they had bought the health services. And, if Uncle Sam then uses the $3.3 trillion gained through the “transfer” to buy the health services, the net result would be exactly the same as if the folks needing the health services had paid for them in the first place—i.e. the net bookkeeping result would show this: Uncle Sam would have zero health-care dollars, the health-care industry would have earned $3.3 trillion health-care dollars, and the American people would have received the services they needed.

So, what is the point of this exercise? Why does Uncle Sam have to be involved at all? Why not just have everyone pay directly for the health-care services they need since, from an aggregate bookkeeping calculation, the net results are the same?

The answer, obviously, is because while the aggregate bookkeeping calculation works, the details assumed in the aggregate accounting don’t. Specifically, the $3.3 trillion health-care dollars that are to be spent on America’s services and procedures are not equally distributed amongst the Americans who would need to do the spending. A small percentage of the citizens have a huge surplus of the health-care dollars, while a very large slice of the citizenry has virtually none.

In America, this situation poses a profound and conflicting problem. Our foundational core belief is that if a person earns a lot of money through hard work, creative ingenuity, clever dealings, or even sheer good luck, he or she should be able to keep it—or at least keep the vast portion of it after having paid reasonable “dues” (taxes) for the benefits of being an American citizen. The idea of being forced to “redistribute” a portion of what has been hard-earned to others who, for whatever reasons of misfortune, bad luck, or laziness, have not earned enough themselves, is anathema to the American psyche.

At the same time, however, when a human being is suffering or injured, American’s will, by instinct, send the ambulance and open the emergency room doors first—and wonder about payment afterwards. There is a recognition, then, that health-care dollars will get spent no matter what, in any event, either through the front door, or via the back door. There is also a recognition that the general health of the entire population is a collective good that cannot be allowed to falter: communicative diseases do not check the bank balances of their victims.

These conflicting values pose what seems an unsolvable dilemma for American politics. This dilemma causes us to undertake all kinds of subterfuges—like, for example, “health-insurance markets”—to make ourselves believe we are doing something which we are not—or not doing something which we are. And the dilemma is instigated by one key, core-value word: “redistribute.” Implicit in that word is the un-assailed assumption that for Uncle Sam to spend the “health-dollars” Medicare-for-all will require, the dollars will first have to be removed from the bank accounts of the wealthy through taxation. Hence, we have Mr. Blahous’ admonition that even if projected individual and corporate taxes were doubled, it would not generate enough tax-dollars to pay for the health services. It’s simple mathematics.

But why should this surprise us? The fact of the matter is, as it has evolved since the days of Alexander Hamilton, America’s money system has never used tax-dollars to pay for the big-ticket items Congress has deemed necessary for our collective good. To do so has never been a mathematical possibility (as Hamilton himself acknowledged in his 1790 Report Relative To A Provision For The Support Of Public Credit)—nor is it a mathematical possibility today—nor will it ever be a possibility in the future (as most recently pointed out by Mr. Blahous).

But this does not mean that America cannot afford to have big-ticket items for the common good—really Big-Ticket items, in fact. The reality is that America, as a collective society, can afford to buy anything for which the real resources—labor, materiel, human ingenuity—are both available and for sale in U.S. dollars. This is because big-ticket items for the collective good are paid for with new dollars created—as needed—by U.S. treasury operations. Specifically, the operations involve the issuing of U.S. treasury bonds (which are, in effect, dollar-denominated, interest-bearing savings accounts) and trading them for existing currency in the private sector.

We habitually imagine these treasury operations to be “borrowing”—and even tally them up as something we call the “national debt.” But modern analysis and explanation shows that in a sovereign money system the definition of “borrowing” does not apply to treasury operations; the securities created by the operations, themselves, are “money” issued—as needed—by the federal government. Thus, the U.S. government can (and does) pay for anything that Congress deems necessary or desirable—so long as it’s for sale in U.S. dollars—without collecting tax-dollars.

Regarding Medicare-for-all, then, the initial pertinent question is NOT whether we can raise enough taxes to cover $3.3 trillion in new expenditures (that question is not pertinent at all!)—the question is whether the medical services to be purchased are actually available in America. Do we have the doctors and nurses, the hospitals and clinics, necessary to provide the care and procedures? If so, and if Congress decides it is in the interest of the American people to have access to that care, the U.S. treasury can, through its securities operations in coordination with the Federal Reserve, create the “health-dollars” necessary to pay the bill.

We should still ask if the “price” charged for those services is fair—or if some of those services and procedures might be unnecessary for the best health outcomes for American citizens. These inquiries would also include Mr. Blahous’ concern that if health-care is “free” for people to access, they’ll naturally access more of it—which might drive the price up even higher than his calculated $3.3 trillion. But those questions should be part of an ongoing process to imagine and implement the most effective system the American health-industry can operate. They have nothing to do with how many tax-dollars can be collected from individuals or businesses.

The actual macro-economic bookkeeping for Medicare-for-all, then, is this:

  1. Uncle Sam spends $3.3 trillion to pay for America’s health services;
  2. S. families and businesses save $3.3 trillion by not having to spend it for their health-care;
  3. The health-care industry earns $3.3 trillion by providing services;
  4. The U.S. financial sector owns $3.3 trillion in treasury bond “savings accounts.”

That is a proper way to calculate what America’s social democracy can do.

This entry was posted in Guest Post, Health care, The dismal science on August 21, 2018 by Lambert Strether.

https://www.nakedcapitalism.com/2018/08/calculate-costs-medicareforall-properly.html
 

searcher

Mother Lode Found
Mother Lode
Sr Site Supporter
Joined
Mar 31, 2010
Messages
179,264
Likes
43,408
"They're Getting Eaten Alive", Morgan Stanley Warns Of Momentum In Hospital Closings


by Tyler Durden
Fri, 08/24/2018 - 20:05

While the stock market could indeed be in the most extended bull market in history, there are new, troubling signs that the real economy is faltering.

A new report has sounded the alarm about the pace of hospital closures across the country. It says there are several factors pressuring margins at hospitals that are contributing to the accelerating rate of closures, particularly in rural communities.



The American Hospital Association (AHA) conducts an annual survey of hospitals in the United States. The data shows hospitals have been closing at a rate of about 30 per annum.

Bloomberg spoke with Morgan Stanley analysts led by Vikram Malhotra, who examined data from roughly 6,000 US private and public hospitals and determined eight percent are at risk of closing; another 10 percent are considered extremely “weak.” Malhotra defined weak hospitals based on criteria for margins for earnings before interest and other items, occupancy and revenue. The “at risk” group was defined by capital expenditures and efficiency, among others.

In a phone interview with Bloomberg, Malhotra warned about the next wave of hospital closings that could be triggered in the next 6 to 18 months.

“The risks are coming following years of mergers and acquisitions. The most recent deal saw Apollo Global Management LLC swallowing rural hospital chain LifePoint Health Inc. for $5.6 billion last month. Apollo declined to comment on the deal; LifePoint has until Aug. 22 to solicit other offers. Consolidation among other health-care players, such as CVS’s planned takeover of insurer Aetna Inc., could also pressure hospitals as payers push patients toward outpatient services.​

There are already a lot of hospitals with high negative margins, consultancy Veda Partners health care policy analyst Spencer Perlman said, and that’s going to become unsustainable. Rural hospitals with a smaller footprint may have less room to negotiate rates with managed care companies and are often hobbled by more older and poorer patients,” said Bloomberg.​
Infographic: Rural Hospital Closures Since 2010

There have been 83 rural hospital closures since 2010 and 125 since 2005, according to a new infographic by Stroudwater. The infographic breaks down the hospitals’ Medicare payment type, location, whether or not the hospitals are located in a Medicaid expansion state and the closure year (Source/ Melanie Matthews)

Bloomberg Intelligence analyst Jason McGorman said margin compression is also occurring as technological improvements allow patients to get more surgeries and imaging done outside of the hospital.

They “are getting eaten alive from these market trends,” Perlman cautioned.
“Future M&A options could be too late - buyers may hesitate as debt-laden operators like Community Health Systems Inc. and Tenet Healthcare Corp. focus on selling underperforming sites to reduce leverage,” Morgan Stanley’s Zachary Sopcak said.

Some facilities are restructuring as outpatient emergency clinics with free-standing emergency departments. “Microhospitals,” or facilities with ten beds or less, seems to be gaining a foothold across the country. They have been springing up as of late in multiple states, including Texas, Colorado, Nevada, and Arizona. Dignity Health, a health system with facilities in Nevada, Arizona, and California, is also considering the possibility of testing the model in California, Kaiser Health News reports.

As for the incoming wave of hospital closures that Morgan Stanley expects to hit in the near term, well, it is more bad news for rural America that seems to have been left out of the “greatest economy ever.”

https://www.zerohedge.com/news/2018...rgan-stanley-warns-momentum-hospital-closings
 

DodgebyDave

Metal Messiah
Midas Member
Joined
Mar 30, 2010
Messages
10,000
Likes
10,310
I tossed the hand grenade