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Health Care In America

Uglytruth

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NW Ohio has all these medical (I call them stations) popping up about every 15-20 miles apart. Take care of a lot of minor stuff leaving big stuff to get life flighted to a big hospital / specialist.
 

DodgebyDave

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I don't mind if it's expensive as long as it's exclusive
 

Alton

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Hospitals are the investment go to in order to recoup losses on the over-investment into nursing homes which the Baby Boomers are soundly rejecting. So many companies were drooling over the prospect of aging baby boomers, retirees, those suffering the typical failing health patterns of aging and they simply over-built and all around jumped the gun on these afflictions of aging overtaking the boomers. This was being drooled over back in 1986 when I returned to college for a couple of semesters.

After the losses on the excess nursing homes, hospitals seemed to be the natural solution because if the boomers weren't heading to the nursing homes in droves then certainly they would be heading to hospitals for medical care! Wrong again.

Now, add in a LARGE popular move to a more natural based form of healthcare (vitamins, supplements, more fitness activities), a rejection of nursing facilities, the failure of Ocare, the fustercluck of MediCare and institutional healthcare facilities are FAILING. There's LOTS of money to be lost here. The HUGE wave of "medical need" has not yet developed and all of this investment into medical facilities has been about a decade too soon. So now new ideas and new money will have to be conjured while still waiting for the "medical gold rush". Might be a good time to build a pile of bonds...
 

Uglytruth

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Radio yesterday said govt passed a law requiring prices to be listed in all the advertisements.........
Then callers called in and mentioned "www.goodrx.com" and it saved some people HUNDREDS of fiat doolars for perscriptions.
One was Krogers at $450 or something & Cosco at $75. When Krogers was called the guy said yea we make a lot on that one.

Why don't some of you check it out & post your results?
 
Last edited:

searcher

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'They're going to give me another heart attack': Texas teacher and father-of-two is billed $109K for cardiac surgery even though hospital assured him they took his insurance

  • Drew Calver, 44, a high school history teacher and swim coach, suffered a heart attack in April 2017
  • He was taken to a hospital closest to his Austin home, St David's Medical Center, which was out of his insurance network
  • Calver said he was told by staff his insurance would cover his treatment, including four stents in his heart and a four-day hospital stay
  • He later got a bill saying he was responsible for paying an outstanding balance of $108,951
  • Calver says his annual income as a teacher is about half of the total amount
  • St David's has now offered Calver to apply for its financial assistance program, that could reduce his bill down to $800
http://www.dailymail.co.uk/news/article-6107749/Texas-teacher-billed-109K-hospital-heart-attack.html
 

Area51

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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.
Surely you're not that dense.

Most people have auto insurance - - yet there's no price gouging from repair shops like there is from hospitals.

Why do you suppose auto insurers scrutinize the repair costs unlike medical insurers?
 

Joe King

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th_smiley-raising-waving-hand.gif


Most people have auto insurance - - yet there's no price gouging from repair shops like there is from hospitals.
A good reason for that is because auto repair is subject to free market competition. They also publish prices for normal automotive repair procedures so one has a good idea of the final cost prior to choosing a mechanic.

Healthcare providers on the other hand are not subject to free market competition and do everything they can to hide the actual costs of service from their customers so that they never have any idea of what anything costs.
 

Buck

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Medical Advice?

Have a Pop Tart you pussies

why waste a perfectly good day to check out the nurses boobs when your really sick

chicken soup and having a hobby cure that, no, stop and think
enjoy everything you have, while you have it, not after you die

Have a Pop Tart


goes with my beer i'm having right now



pussies

lol

your wives are speaking for you
 

Buck

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mines asleep

LOL
:secret:
 

searcher

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A Texas Lawsuit Being Heard This Week Could Mean Life Or Death For The ACA

Posted on September 5, 2018 by Yves Smith

By Julie Rovner, the Robin Toner Distinguished Fellow, who is Chief Washington Correspondent for Kaiser Health News. Prior to that, she spent 16 years as health policy correspondent for NPR, where she helped lead the network’s coverage of the passage and implementation of the Affordable Care Act. A noted expert on health policy issues, Julie is the author of the critically praised reference book Health Care Politics and Policy A-Z, now in its third edition. Originally published at Kaiser Health News

Listen on NPR here:
https://www.npr.org/2018/09/04/6444...n-texas-to-hear-states-case-against-obamacare



Wednesday is looking like yet another pivotal day in the life-or-death saga that has marked the history of the Affordable Care Act.

In a Texas courtroom, a group of Republican attorneys general, led by Texas’ Ken Paxton, are set to face off against a group of Democratic attorneys general, led by California’s Xavier Becerra, in a lawsuit aimed at striking down the federal health law. The Republicans say that when Congress eliminated the penalty for not having health insurance as part of last year’s tax bill, lawmakers rendered the entire health law unconstitutional. The Democrats argue that’s not the case.

But first, the sides will argue before U.S. District Judge Reed O’Connor in Fort Worth, Texas, whether the health law should be put on hold while the case is litigated. The GOP plaintiffs are seeking a “preliminary injunction” on the law.

Ending the health law, even temporarily, “would wreak havoc in our health care system,” said Becerra in a call with reporters last week. “And we don’t believe Americans are ready to see that their children are no longer able to see a doctor or that they cannot get treated for a preexisting health condition.”

Here are five questions and answers to help understand the case, Texas v. U.S.

1. What is this suit about?
In February, 18 GOP attorneys general and two GOP governors filed the suit in federal district court in the Northern District of Texas. They argue that because the Supreme Court upheld the ACA in 2012 by saying its requirement to carry insurance was a legitimate use of Congress’ taxing power, eliminating the tax penalty for failure to have health insurance makes the entire law unconstitutional.

“Texans have known all along that Obamacare is unlawful and a divided Supreme Court’s approval rested solely on the flimsy support of Congress’ authority to tax,” Paxton said in a statement when the suit was filed. “Congress has now kicked that flimsy support from beneath the law.”

The lawsuit asks the judge to prohibit the federal government “from implementing, regulating, enforcing, or otherwise acting under the authority of the ACA.”

2. Why are Democratic attorneys general defending the law?
The defendant in the case is technically the Trump administration. But in June, the administration announced it would not fully defend the law in court.

The Justice Department, in its filing in the case, did not agree with the plaintiffs that eliminating the tax penalty should require that the entire law be struck down. But it did say that without the tax, the provisions of the law requiring insurance companies to sell to people with preexisting conditions and not charge them more should fall, beginning Jan. 1, 2019. That is when the tax penalty goes away.

The Republican attorneys general say they still believe the entire law should be invalidated, but if that does not happen, they would accept the elimination of the preexisting condition protections.

The Democratic attorneys general applied to “intervene” in the case to defend the law in its entirety. They say they needed to step forward to protect the health and well-being of their residents. The judge granted them that status on May 16.

3. What would happen if the judge grants a preliminary injunction?
The GOP plaintiffs say the law needs to be stopped immediately, “both because individuals will make insurance decisions during fall open-enrollment periods and because the States cannot turn their employee insurance plans and Medicaid operations on a dime,” according to their brief.

But setting aside the ACA while the case proceeds “would throw the entire [health] system into chaos,” Becerra said. That’s because the ACA made major changes not just to the insurance market for individuals, but also to Medicare, Medicaid and the employer insurance market.

Even in 2012, when the Supreme Court was considering the constitutionality of the law before much of it had taken effect, some analysts from both parties predicted that finding the law unconstitutional could have serious repercussions for the Medicare program and the rest of the health care system.

In practice, however, even if Judge O’Connor were to rule in favor of the Republicans’ request to stop the law’s enforcement immediately, the decision could be quickly appealed up the line, including, if necessary, before the Supreme Court.

4. Is this case purely Republicans versus Democrats?
The case is largely partisan — with Republicans who oppose the health law arguing for its cancellation and Democrats who support it fighting to keep it in place.

But a friend-of-the-court brief filed by five law professors who disagree on the merits of the ACA said that, regardless, both the GOP states and the Justice Department are wrong to conclude that eliminating the tax penalty should result in the entire law being thrown out.

In this case, “Congress itself has essentially eliminated the provision in question and left the rest of a statute standing,” so courts do not need to guess whether lawmakers intended for the rest of the law to remain, they wrote.

5. What is Congress doing about this?
Technically, Congress is watching the case just as everyone else is. But Republicans in particular, while they mostly oppose the health law, are aware that the provisions protecting people with preexisting conditions are by far the most popular part of the ACA. And Democrats are already using the issue to hammer opponents in the upcoming midterm elections.

Last month, 10 GOP senators introduced legislation they said would maintain the ACA’s preexisting condition protections in the event the lawsuit succeeds.

“This legislation is a common-sense solution that guarantees Americans with preexisting conditions will have health care coverage, regardless of how our judicial system rules on the future of Obamacare,” said Sen. Thom Tillis (R-N.C.), the bill’s lead sponsor, in a statement.

Critics, however, were quick to point out that the bill doesn’t actually offer the same protections that are embodied in the ACA. While the health law requires coverage for all conditions without extra premiums, the GOP bill would require that insurers sell to people with preexisting conditions, but not that those policies actually cover those conditions.

This entry was posted in Banana republic, Guest Post, Health care on September 5, 2018 by Yves Smith.

https://www.nakedcapitalism.com/2018/09/texas-lawsuit-heard-week-mean-life-death-aca.html
 

searcher

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Killer Health Care & James Lieber
RT America


Published on Sep 7, 2018
Jesse Ventura and Brigida Santos look under the hood of the American health care system. How does it compare to health care systems in other wealthy nations? Attorney James B. Lieber discusses his book, “Killer Care: How Medical Error Became America’s Third Largest Cause of Death And What Can Be Done About It.”
 

searcher

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Drug company defends 400% rise in price of a bottle of antibiotic, says it is a 'moral requirement'
CEO of pharmaceutical giant Nostrum Laboratories defends raising the price of a bottle of antibiotics by 400%, saying it is a 'moral requirement to make money where you can'

  • Nirmal Mulye is the CEO of Missouri-based Nostrum Laboratories
  • Company manufactures liquid form of the antibiotic nitrofurantoin
  • Instead of costing $474.75 per bottle, the drug will now cost $2,392 per bottle
  • Mulye defended price hike saying it was key to remaining competitive
  • He also defended 'Pharma Bro' Martin Shkreli over a similar constrovery
  • Shkreli raised price of vital AIDS drug by 5,000 per cent, outraging the nation
https://www.dailymail.co.uk/news/ar...bottle-antibiotic-says-moral-requirement.html
 

searcher

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Pharmaceutical Giant Involved in Massive Fraud Case
RT America


Published on Sep 21, 2018
A massive lawsuit is targeting a pharmaceutical company, claiming the case is one of California’s biggest instances of insurance fraud. RT America’s Natasha Sweatte reports.
 

searcher

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Trump trashes Democrats' Medicare for All plan in op-ed


AP
24 mins ago


WASHINGTON — President Donald Trump is stepping up his attack on Democrats over a health care proposal called Medicare for All, claiming it "would end Medicare as we know it and take away benefits that seniors have paid for their entire lives."

Trump, omitting any mention of improved benefits for seniors that Democrats promise, writes in an op-ed published Wednesday in USA Today, "The Democrats' plan means that after a life of hard work and sacrifice, seniors would no longer be able to depend on the benefits they were promised."

But Medicare for All means different things to different Democrats. The plan pushed by Sen. Bernie Sanders, the Vermont independent who challenged Hillary Clinton for the 2016 Democratic presidential nomination, would expand Medicare to cover almost everyone in the country, and current Medicare recipients would get improved benefits. Other Democratic plans would allow people to buy into a new government system modeled on Medicare, moving toward the goal of coverage for all while leaving private insurance in place.

Trump's column comes as he is looking to paint Democratic candidates as extreme ahead of next month's midterm elections. A White House official speaking to The Associated Press on the condition of anonymity to describe internal plans said that Trump's health care attack will be echoed by the Republican National Committee and other GOP groups and that the president will continue to raise the attack during his campaign rallies.

As Trump escalates his efforts on behalf of fellow Republicans, he is casting health care as one of an expanding list of choices for the electorate this year while seeking to raise the alarm about the consequences of Democratic control of the House or the Senate.

Medicare for All, also called single-payer over the years, was until fairly recently outside the mainstream of Democratic politics, but this year it has become a key litmus test in many party primaries and a rallying cry for progressive candidates. Under the plan by Sanders, all Americans would gain access to government insurance with no copays or deductibles for medical services.

Republicans contend that the proposal would be cost-prohibitive and argue it marks government overreach.

Trump has already sought to paint Democrats as extremists after the bitter confirmation battle over Supreme Court Justice Brett Kavanaugh, and internal GOP polling obtained last month by the AP shows that the party believes the message will help galvanize Republican voters to the polls.

At a rally in Iowa on Tuesday, Trump argued that the only reason to vote for Democrats "is if you are tired of winning." He will be holding a rally in Pennsylvania on Wednesday evening.

http://www.msn.com/en-us/news/polit...e-for-all-plan-in-op-ed/ar-BBObDVX?ocid=ientp
 

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Medicare Advantage Plans Shift Their Financial Risk To Doctors; Do Patients Win or Lose?

Posted on October 10, 2018 by Yves Smith

By Phil Galewitz, a Kaiser Health News Senior Correspondent and a former board member of the Association of Health Care Journalists. He previously wrote for The Palm Beach Post, Associated Press and The Patriot-News in Harrisburg, Pa. Originally published at Kaiser Health News

STUART, Fla. — Dr. Christopher Rao jumped out of his office chair. He’d just learned an elderly patient at high risk of falling was resisting his advice to go to an inpatient rehabilitation facility following a hip fracture.

He strode into the exam room where Priscilla Finamore was crying about having to leave her home and husband, Freddy.

“Look, I would feel the same way if I was you and did not want to go to a nursing home, to a strange place,” Rao told her in September, holding her hand. “But the reality is, if you slip at home even a little, it could end up in a bad, bad way.”

After a few minutes of coaxing, Finamore, 89, relented and agreed to go into rehab.

Keeping patients healthy and out of the hospital is a goal for any physician. For Rao, a family doctor in this retiree-rich city 100 miles north of Miami, it’s also a wise financial strategy.

Rao works for WellMed, a physician-management company whose doctors treat more than 350,000 Medicare patients at primary care clinics in Florida and Texas. Instead of being reimbursed for each patient visit, WellMed gets a fixed monthly payment from private Medicare Advantage plans to cover virtually all of their members’ health needs, including drugs and physician, hospital, mental health and rehabilitation services.

If they can stay under budget, the physician companies profit. If not, they lose money.


Dr. Christopher Rao, a family doctor at WellMed in Stuart, Fla., comforts Priscilla Finamore about seeking inpatient rehabilitation care. (Phil Galewitz/KHN)


This model — known as “full-risk” or “global risk” — is increasingly used by Medicare plans such as Humana and UnitedHealthcare to shift their financial exposure from costly patients to WellMed and other physician-management companies. It gives the doctors’ groups more money upfront and control over patient care.

As a result, they go to extraordinary lengths to keep their members healthy and avoid expensive hospital stays.

WellMed, along with similar fast-growing companies such as Miami-based ChenMed, Boston-based Iora Health and Chicago-based Oak Street Health, say they provide patients significantly more time with their doctors, same-day or next-day appointments and health coaches. These doctors generally work on salary.

ChenMed doctors encourage their Medicare patients to visit their clinic every month — for no charge and with free door-to-door transportation — to stay on top of preventive care and better manage chronic conditions. If patients are not feeling well after-hours, ChenMed even will send a paramedic to their home.

“We can be much more creative in how we meet patient needs,” said Iora CEO Rushika Fernandopulle. “By taking risk, we never have to ask … ‘Do we get paid for this or not?’”

A Way To ‘Provide Less Care’
Some patient advocates, pointing to similar experiments that failed in the 1990s, fear “global risk” could lead doctors to skimp on care — particularly for expensive services such as CT tests and surgical procedures.

“At the end of the day, this is a way to keep costs down and provide less care,” said Judith Stein, executive director of the Center for Medicare Advocacy.

Dr. Brant Mittler, a Texas cardiologist and trial attorney who has followed the issue, said Medicare Advantage members should be suspicious.

“Patients don’t know that decisions made on their behalf are often financially based. There may be pressure on doctors to cut corners to save money and that may not be in the best interests of a patient’s health,” he said.

The insurers and physician groups disagree. They said limiting necessary care would only exacerbate a patient’s health problems and cost the doctors’ group more money.

Noting that Medicare members stay with Humana an average of eight years, Roy Beveridge, the insurer’s chief medical officer, said the plan would be unwise to skimp on care because that would eventually leave the company with sicker patients and longer hospitalizations.

“It makes even less sense for physicians at financial risk to skimp on care because patients are typically with their physicians much longer than they are with a health plan,” he said.

A study that examined care at ChenMed, published last month in the American Journal of Managed Care, found health costs were 28 percent lower among patients who had more than double the number of typical visits with their primary physician. The study was conductedby researchers at ChenMed and the University of Miami.

To offer more personal care, ChenMed doctors typically see only about a dozen patients per day — about half as many as is usual for a doctor who gets paid for each individual service.

Medicare beneficiaries, who can choose a private health plan during the open-enrollment periodthat runs from Oct. 15 to Dec. 7, generally have no idea if their health plan has ceded control of their care to these large doctors’ groups.

After choosing a Medicare Advantage plan, they generally sign up for a medical group that is part of their health plan’s network, often because doctors are close to where they live or because the doctors offer extra benefits such as free transportation to appointments.

Eloy Gonzalez, 71, of Miami, said that before switching to ChenMed a couple of years ago his doctors always seemed to be in a hurry when he saw them. He’s happy with his ChenMed physicians.

On a recent visit, he spent nearly 20 minutes with Dr. Juana Sofia Recabarren-Velarde talking about keeping his blood pressure and lung condition under control. She also showed him exercises to manage back and shoulder pain.

“If she thinks she needs to see me once a month to monitor my blood pressure and see if anything else is happening, it’s OK with me,” said Gonzalez, who pays nothing for the office visits or generic drugs under his Humana Medicare Advantage plan with ChenMed.

A Growth Spurt
Nearly one-third of the 57 million Medicare beneficiaries are covered by private Medicare Advantage plans — an alternative to government-run Medicare — and federal officials have estimated that the proportion will rise to 41 percentover the next decade. The government pays these plans to provide medical services to their members.

The “global risk” system has been used in South Florida and Southern California since the late 1990s and nearly half of Medicare Advantage members in those regions get care in the model. The use has spread further in the past two years as large physician companies have become more common, and about 10 percent of Medicare Advantage plan members across the nation are in them now, health consultants say.

In addition, new information technology allows these groups to better track their patients. With mixed results, Medicare Advantage insurers for years offered doctors bonuses to meet certain quality care standards, such as getting members vaccinated against the flu or controlling diabetes and other chronic diseases.

Under the “global risk” arrangements, the health plans give the physician companies the bulk of their Medicare funding when they take on the mantle of being financially responsible for all patient care.

For the doctors’ groups, the arrangement means they get paid a large amount of money upfront for patient care and don’t have to worry about billing or having to get insurers to always preapprove treatments.

Because the “global risk” arrangements are designed to reduce plans’ costs, they potentially allow the companies to lower premiums and attract more customers, said Mark Fendrick, director of the University of Michigan’s Center for Value-Based Insurance Design.

“I see this trend continuing to grow as clinicians will be accountable for the first time for the care they provide,” he said.

Historical Lessons
But Ana Gupte, a securities analyst with Leerink Partners in New York, noted providers can also lose money if not successful.

That’s what happened in the late 1990swhen some physician-management companies such as FPA Medical Management and PhyMatrix took on financial risk from insurers only to later go bankrupt, interrupting care to thousands of patients.

Health insurers say they now trust only doctors’ groups that have shown they can handle the financial risk. They also retain varying levels of control. Insurers set benefits, handle member complaints and review which doctors are allowed in its network.

Martin Graf, a partner with consulting firm Oliver Wyman, said the old financial arrangements failed because provider groups did not manage the risks facing their patients.

“Now they know physician groups must be vigilant about their patients — whether they are in the office or not,” he said. “Everyone is aware of the failure of the past.”


This entry was posted in Free markets and their discontents, Guest Post, Health care on October 10, 2018 by Yves Smith.

https://www.nakedcapitalism.com/2018/10/medicare-advantage-plans-shift-financial-risk-doctors.html
 

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Trump Signs New Laws Aimed at Drug Costs and Battles Democrats on Medicare


NYT
By ROBERT PEAR
43 mins ago

WASHINGTON — President Trump signed bipartisan legislation on Wednesday that would free pharmacists to tell consumers when they could actually save money by paying the full cash price for prescription drugs rather than using health insurance with large co-payments, deductibles and other out-of-pocket costs.

The legislation on gag clauses has been praised by lawmakers in both parties, but the signing was nearly eclipsed on Wednesday by a separate health care furor: Mr. Trump asserted in an essay in USA Today that Democrats supporting “Medicare for All” would wreck the program for older Americans, infuriating Democrats who said he was lying to millions of Americans.

“Democrats would gut Medicare with their planned government takeover of American health care,” Mr. Trump said, and he assailed Democrats as “radical socialists.”

The back-and-forth over health care showed how prominent the issue has become in the midterm election campaigns. As the parties were coming together on prescription drug costs and fighting over Medicare, the Senate deadlocked on Wednesday over a Democratic proposal to block the expansion of cheap “short term” health insurance policies that do not have to cover maternity care or pre-existing conditions, a top priority of Mr. Trump’s.

Democrats, hoping to regain control of the Senate, had pushed for the vote to put Republicans on the record as opposing protections for people with pre-existing conditions.

“The Trump administration has expanded junk insurance plans,” said Senator Tammy Baldwin, Democrat of Wisconsin, who led the effort. “These plans are cheap for a reason. They do not have to provide essential health benefits like hospitalization, prescription drugs and maternity care.”

The agreement over ending the gag clauses showed how Congress, despite all the partisan rancor, can still get things done. Pharmacists around the country say they have often been forbidden to share information on drug pricing with customers. The restrictions, they say, have been imposed by companies that manage drug benefits for insurers and employers.

The legislation will “completely end these unjust gag clauses once and for all,” Mr. Trump said.

He signed two bills. One, introduced by Senator Susan Collins, Republican of Maine, bans gag clauses in commercial health insurance, including coverage offered by employers and plans bought by individuals and families on their own.

The other bill, introduced by Senator Debbie Stabenow, Democrat of Michigan, applies to outpatient drug coverage in Medicare, whether provided by the traditional fee-for-service program or by private Medicare Advantage plans.

“Insurance is intended to save consumers money,” Ms. Collins said. “Gag clauses do the opposite. They prevent pharmacists from telling patients how to pay the lowest possible price for their prescription drugs.”

Lawmakers were not so sanguine about the president’s attack on Democrats over Medicare. Senator Bernie Sanders of Vermont, the author of the Medicare for All plan supported by at least 15 Democratic senators and more than 100 House Democrats, said Mr. Trump’s broadside was full of falsehoods.

“Our proposal wouldn’t cut benefits for seniors,” Mr. Sanders said. “In fact, we expand benefits. Millions of seniors today cannot afford the dental care, vision care or hearing aids they desperately need. Our proposal covers them. In addition, Medicare for All would eliminate deductibles and co-pays for seniors and significantly lower the cost of prescription drugs.”

Mr. Trump and members of Congress from both parties have bewailed the high cost of many drugs. But aside from the bills signed Wednesday, Congress has not done much to address the issue this year.

Steven F. Moore, whose family owns Condo Pharmacy in Plattsburgh, N.Y., said the new federal laws would be “a big help.” The restrictions on pharmacists’ ability to discuss prices with patients are “incredibly frustrating,” he said.

The clauses force pharmacists to remain silent as, for example, consumers pay $125 under an insurance plan for an influenza drug that would have cost $100 if purchased with cash.

Representative Earl L. Carter, Republican of Georgia, also hailed approval of the legislation.

“As a pharmacist for more than 30 years, there were many times when I was prevented from telling my patients that there was a cheaper option because of a gag clause,” said Mr. Carter, known as Buddy.

Lobbyists for pharmacy benefit managers did not fight the legislation and suggested that gag clauses were dying out.

Mark Merritt, the president and chief executive of the Pharmaceutical Care Management Association, which represents drug benefit managers, said: “We don’t condone the use of gag clauses. It has occurred on rare occasions, but it’s an outlier practice that we oppose.”

Pharmacists tell a different story. They say gag clauses have been common for years. Hugh Chancy, a pharmacist who owns five community drugstores in southern Georgia, said his company had been reprimanded by a pharmacy benefit manager for telling customers when it would be cheaper to pay for medicines without using insurance.

The legislation signed Wednesday also includes a provision to combat agreements between drug makers that stifle competition by delaying the marketing of lower-cost copycat versions of expensive biotechnology medicines. Such biologic medicines account for a rapidly growing share of drug spending.

Under the new law, manufacturers of the original product and the copy, known as a biosimilar, will have to report such agreements to the Federal Trade Commission, which can challenge them as violations of antitrust laws. The agreements are known as pay-for-delay deals because the branded drug company pays a potential competitor to delay entering the market.

“These agreements are great deals for the drug companies, but bad deals for consumers,” said Representative John Sarbanes, Democrat of Maryland. Until now, he said, officials had “no way of knowing how many of these back-room deals occur between manufacturers of biologic and biosimilar drugs — new, cutting-edge drugs that are often extremely expensive.”

On a separate issue, the Senate allowed the Trump administration on Wednesday to move ahead with its plan to promote the sale of “short term” health insurance policies that do not have to provide all the benefits required by the Affordable Care Act.

Under a rule that took effect this month, it will be much easier for insurers to issue and renew such plans. The maximum duration, including any extensions, would be 36 months.

An attempt by Democrats to overturn the rule failed in the Senate on a tie vote of 50 to 50. Ms. Collins was the only Republican who voted for the resolution of disapproval.

Mr. Trump said such short-term policies would be available for “just a fraction of the cost of Obamacare — much less money.”

http://www.msn.com/en-us/news/polit...s-democrats-on-medicare/ar-BBOd7hQ?ocid=ientp
 

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McConnell says Senate Republicans might revisit Obamacare repeal


Reuters
By David Morgan
3 hrs ago


Republicans could try again to repeal Obamacare if they win enough seats in U.S. elections next month, Senate Republican Leader Mitch McConnell said on Wednesday, calling a failed 2017 push to repeal the healthcare law a "disappointment."

In a forecast of 2019 policy goals tempered by uncertainty about who will win the congressional elections, McConnell also blamed costly social programs, such as Social Security and Medicare, for the fast-rising national debt.

On Nov. 6, Americans will vote for candidates for the Senate and the House of Representatives.

McConnell's Republicans now hold majority control of both chambers. Democrats will try to wrest control in races for all 435 House seats and one-third of the 100 Senate seats.

Despite their dominance of Congress and the White House, Republicans dramatically failed last year to overturn former President Barack Obama's signature healthcare law, known as Obamacare. McConnell called it "the one disappointment of this Congress from a Republican point of view."

He said, "If we had the votes to completely start over, we'd do it. But that depends on what happens in a couple weeks... We're not satisfied with the way Obamacare is working."

President Donald Trump also favors ending Obamacare, which Republicans criticized as a costly and unneeded intrusion on Americans' healthcare. About 20 million Americans have received health insurance coverage through the program, a landmark legislative achievement for Obama and Democrats.

On social programs, McConnell said in an interview with Reuters: "Entitlements are the long-term drivers of the debt."

Social programs that help the poor, the aged, the unemployed, veterans and the disabled are often referred to as "entitlements" in Washington. These also include Medicaid.

"We all know that there will be no solution to that, short of some kind of bipartisan grand bargain that makes the very, very popular entitlement programs be in a position to be sustained. That hasn't happened since the '80s," he added.

"But at some point we will have to sit down on a bipartisan basis and address the long-term drivers of the debt."

The Treasury Department this week reported a 2018 budget deficit of $779 billion, the highest since 2012.

The report cited higher military spending as a reason for the increase and showed government revenues were flat after deep tax cuts pushed through late last year by Republicans, despite a growing economy and rising spending levels.

McConnell said Republicans would take a hard look at funding for discretionary domestic programs next year, saying he reluctantly agreed to increased discretionary spending this year to get Democrats to accept more military spending.

"We had to negotiate with the Democrats and spend more on the domestic side than I would have preferred," McConnell said.

"We'll have to sit down again and decide what we're going to do with our annual discretionary spending after the first of the year and see what kind of agreements we can reach."

Trump on Wednesday asked his cabinet for proposals to cut their budgets by five percent.

(Reporting by David Morgan. Additional reporting by David Shepardson, Richard Cowan, Amanda Becker, Patricia Zengerle; Editing by Kevin Drawbaugh and Alistair Bell)

http://www.msn.com/en-us/news/polit...evisit-obamacare-repeal/ar-BBOwlCJ?ocid=ientp
 

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Pharmacist refuses medicine to complete a miscarriage for married Michigan woman, 35, whose twins had died inside of her because 'he's a good Catholic'

  • Rachel Peterson, 35, had miscarried twins in July and was prescribed medication to completely empty her uterus of fetal tissue and complete the miscarriage
  • A Meijer pharmacist denied her the prescription because of his religious beliefs
  • The medication can also be used for abortions but he said 'he's a good Catholic'
  • If she did not complete the miscarriage she could have developed an infection
  • Meijer said it is policy that a pharmacist transfer medication to another location
  • The man refused to transfer the prescription but she was finally able to get it
https://www.dailymail.co.uk/news/ar...arriage-Michigan-woman-religious-beliefs.html
 

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Watch President Trump And Cruz Get Demolished In Obamacare Lie | The Beat With Ari Melber | MSNBC
MSNBC


Published on Oct 23, 2018
Ari Melber fact-checks Republican messaging on healthcare ahead of the midterm elections, breaking down how 91% of Americans now have health insurance and support for Obamacare is surging, prompting Republicans to change their messaging political messaging. Prominent Republicans who voted to repeal it, now say they support protecting pre-existing conditions. Health and Human Services Secretary under Obama, Kathleen Sebelius tells Ari Melber that Republicans trying to “pretend they also have been a part of” the Obamacare “bandwagon” is “just a flat out lie”.
» Subscribe to MSNBC: http://on.msnbc.com/SubscribeTomsnbc
 

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Former Health Insurance Executive Debunks Trump Attacks on Single Payer
Posted on November 7, 2018 by Yves Smith


Yves here. This Real News Network interview with former Cigna executive Wendell Potter, who among other things now heads Tarbell.org, a site that investigates money in politics, provided a point-by-point takedown of the factually-challenged criticisms Trump has made of single payer. The fact that this rebuttal comes from a former health industry insider may make it more persuasive to skeptics in your circle.

And let us not forget that polls shortly before the election showed that health care was the most important issue to voters, but as we know, the Vichy Dems are much more willing to give lip service to the idea of addressing this inefficient and too often predatory industry than doing something about it.


GREG WILPERT: It’s The Real News Network, and I’m Greg Wilpert coming to you from Baltimore.

For the midterm elections this year, Republicans have been blasting Democrats on two main issues: immigration and health care. While Trump’s remarks on immigration have been receiving a lot of attention, what he has been saying about healthcare has not received so much attention. In general, Trump is accusing Democrats of wanting to impose socialism, and he uses single-payer healthcare, also known as Medicare for All, as one of his main examples. Here’s what he said recently in one of his rallies.

DONALD TRUMP: A majority of House Democrats have already signed up for socialist healthcare. By the way, it doesn’t work anywhere in the world. Just so you understand. It doesn’t work. It’s good if you don’t mind waiting, like, five weeks to see your doctor. They come from socialist countries. Frankly, they come from Canada because they want to use our doctors. They come from all over the world. And we’re making it now better. And they want to destroy everything that’s been built. All of that great foundation.

GREG WILPERT: Meanwhile, the White House, under the direction of the Council of Economic Advisers, released a pamphlet last month titled The Opportunity Costs of Socialism. This pamphlet develops a detailed critique of state socialism as it was practiced in the Soviet Union, as well as a social democratic government of Scandinavia. One of the main areas of focus of the document is the healthcare system in single-payer countries, system-payer countries, as well as Medicare for All, a bill that Senator Bernie Sanders introduced earlier this year.

Joining me now to take a look at some of the criticisms of single-payer healthcare is Wendell Potter. He’s a former health insurance executive and author of several books, including Deadly Spin, Obamacare: What’s In It for Me? and his latest is Nation on the Take. He’s also the founder of Tarbell.org, an investigative site that examines the role of money in politics. Thanks for joining us today, Wendell.

WENDELL POTTER: My pleasure, Greg.

GREG WILPERT: So there are many criticisms that Republicans have leveled against single-payer healthcare systems; both the proposals for the U.S. healthcare and also the ones that have been implemented in countries such as Canada and various countries of Europe. We can’t go over all of these criticisms, but some of the main ones include increased costs, worse health outcomes, loss of medical innovation, and longer wait times. Let’s take these one by one.

So first, regarding costs, proponents of single-payer healthcare say that increases in taxes will be offset by not having to pay insurance premiums of private insurance companies. Critics, though, say that higher taxes distort the economy, which reduces economic activity, and thus makes the overall cost of healthcare greater. What’s your response to this argument? I mean, what is the balance in terms of the costs? Which would be cheaper, according to your analysis?

WENDELL POTTER: According to my analysis and that of many others, the proponents of Medicare for All have it right. We would be paying ultimately far less than we will be, that we are paying now or will be paying in the future, if we maintain the status quo. The problem is in a multipayer system like we have in the United States, the payers being the insurance companies, the multiple insurance companies that we have supposedly competing with each other, they just don’t have the clout to negotiate good deals with their customers, with big hospital systems and big physician groups, and certainly with the pharmaceutical industry.

So what we have in this country in the US is a classic example of market failure, because the system does not work to control costs, nor does it work to bring everyone into coverage. We still have almost 30 million Americans who do not have insurance. But under a Medicare for All-type plan you can bring everyone into coverage, and you can cover everyone and have better outcomes than you have under our current system.
And when you look at- what people need to do is kind of have a paradigm shift in their thinking. You would no longer have to pay the ever-increasing premiums to your health insurance company, or the ever-increasing deductibles, which means that your insurance doesn’t even kick in until you’ve spent several thousand dollars out of your own pocket, even though you’re making payments for your insurance.

So that would go away. You instead would be making the equivalent of your premium payments in taxes, and the system will be structured so that everyone could be brought into coverage. And studies have shown even in this country that- not only that, but a single-payer system in this country would do much more to control healthcare costs than our multipayer system does now.

GREG WILPERT: Now, a related argument in this regard is that single-payer healthcare costs save money in terms of administrative costs, but those savings are lost then again through fraud. In other words, that there are people who would try to cheat the system. And they claim that there’s a lot of fraud in the Medicare system in the United States, and that doesn’t happen so much in the private system. What’s your response to that?

WENDELL POTTER: I would say that’s absolute nonsense. And having worked in the private system for more than 20 years, I can tell you that fraud is just as prevalent, and probably more so, in the system that we have, the private system of insurance. The company that I worked for most recently, Cigna, instituted a system several years ago to try to detect fraudulent billing. So I can tell you it’s just as rampant, probably more so, in the private system. For one reason, because private companies just don’t have the resources to combat fraud and abuse as much as a single system with combined resources would have.

So it’s a completely bogus argument. In fact, we see, when you look at statistics for other countries that have a single payer or a similar system, there’s far, far less fraud and abuse in those countries and their healthcare system than in the U.S. system.

GREG WILPERT: So now the other main argument that the White House critique of single-payer brings up is that health outcomes would be worse. They cite a fairly specific study of life expectancy in the U.S. and in Europe which claims to show that once cancer is diagnosed, U.S. patients tend to live longer. And the argument is basically that under single-payer healthcare, cancer treatment would be rationed, especially for seniors. And they give examples in Europe, basically, while in the U.S. cancer patients tend to receive better care. What’s the response to this claim in terms of outcomes, health outcomes?

WENDELL POTTER: Well, what you’re seeing here, and as in many of their arguments, they being the opponents of moving to a single-payer system, is the selective use of data and the confusing and misleading use of data.

The reality is that most of the developed countries around the world- and many of them have a single-payer system- all do a better job, broadly, in healthcare outcomes than we do. The Commonwealth Fund in the United States has annually done an analysis of the performance of healthcare systems around the world. They look at 11 countries, developed countries, including the U.S. And the United States consistently, even after the Affordable Care Act was passed, brings up the rear. It’s always number 11 in the composite score. So outcomes are typically better across the board, or in many, by many measurements in other systems.

And as far as cancer treatment is concerned, or life expectancy in particular, the United States is alone in the developed world over the last two years in which life expectancy has been declining. And those are statistics from the government. And we’re seeing that in the other countries, in both the developing and developed world, life expectancy is going up. And we’re pretty much alone in the world going in the opposite, in the wrong direction.

Now, with regards to cancer, you have a lot of people in this country who do not have insurance and who cannot afford to get the care that they need. Period. So we have a lot of people in this country who just simply- and also, even if they have insurance, as I mentioned earlier, people have very high deductibles in most of their plans, if they have a private insurance company. And a lot of those people just don’t have the money to pay out of pocket for the care that they need to spend money for before their their coverage kicks in. So again, it’s the selective use of data and trying to scare people, when in reality the outcomes across the board in other countries are generally far better than they are in the U.S.

GREG WILPERT: Actually, related to this issue of health care outcomes is also the question of innovation. The White House paper argues that single-payer healthcare would reduce innovation; that is, more expensive treatments in the U.S. result in more innovation because there’s more money available for such innovation, whereas price controls, which are usual in single-payer systems, would reduce innovation because there’s less money available for them. What’s your response to this argument?

WENDELL POTTER: The question we often used in the industry- and they still do, obviously- is that any kind of reforms that would move us away from the status quo would have a “chilling effect” on innovation. But that’s not, it’s not true at all. In fact, most of the innovation, actually, in the health insurance industry has been innovation that has been detrimental to the needs of patients in this country. The most prevalent innovation in this country has been shifting more and more of the cost of care from insurance companies and employers to regular folks. So that is a kind of example that I think we could move away from and everyone would benefit from it.

But there’s no, there’s no evidence that suggests that moving to a single-payer system would mean that there would be less innovation on the provider side. In fact, we’re seeing quite a bit of innovation in the UK and Canada that this country should adopt. In the UK, for example, hospitals have a way of treating people. They can admit them, but there’s kind of a blend of inpatient and outpatient that saves the system a lot of money and allows the patient to get much of their care outside of an inpatient setting. So there’s a lot of innovation that you’re saying in single-payer systems that we have not adopted yet in this country. So there’s no reason why if we move to a system like that we would have less innovation than we have now, and probably would have innovation that benefits patients more than we have now.

GREG WILPERT: So finally, the White House paper that I cited earlier argues that wait times in the U.S. are shorter mainly because in single payer systems there are no market signals about what type of care is needed, and that the lack of deductibles and all that would cause an overuse of certain treatments. And so as a result, single-payer systems have much longer wait times. And they specifically cite the example of Canada actually having one of the longest wait times, whereas the U.S. in an international comparison supposedly has the shortest. What’s your response to that argument?

WENDELL POTTER: Well, once again, when you’re looking at the U.S. compared to other countries, keep in mind that many millions of us wait forever for the care that we need because we don’t have the money, and we have don’t have insurance. And 30 million of us don’t have insurance. The wait is indefinite. And so that’s something that needs to be factored in, as well, too. There are people in this country who just simply cannot access care at any point. So the wait lines, or the waiting period, is endless for a lot of people.

But even in Canada, the waits have been dramatized in the U.S. by opponents. There is a very short wait for essential care in Canada. Now, it is true that for elective procedures like joint replacement, a knee replacement, for example, the wait time can be fairly long; possibly longer than it would be for some patients to get the same procedure done in the U.S. But the majority, the vast majority of people in Canada, get knee and hip replacements and cataract surgery within the recommended period of time. So again, for essential care, for life-threatening events and for other kinds of care and to see a physician it’s not a significant problem in Canada or other single-payer systems. But in the U.S. for many people it’s an indefinite wait.

GREG WILPERT: OK. Well, we’re going to leave it there for now, but I’m sure we’re going to get back to this topic again very soon. I was speaking to Wendell Potter, former health insurance executive and founder of the website Tarbell.org. Thanks again, Wendell, for having joined us today.

WENDELL POTTER: My pleasure. Thank you, Greg.

GREG WILPERT: And thank you for joining The Real News Network.

This entry was posted in Banana republic, Dubious statistics, Health care, Politics on November 7, 2018 by Yves Smith.

https://www.nakedcapitalism.com/201...utive-debunks-trump-attacks-single-payer.html
 

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Former Health Insurance Executive Debunks Trump Attacks on Single Payer
Posted on November 7, 2018 by Yves Smith


Yves here. This Real News Network interview with former Cigna executive Wendell Potter, who among other things now heads Tarbell.org, a site that investigates money in politics, provided a point-by-point takedown of the factually-challenged criticisms Trump has made of single payer. The fact that this rebuttal comes from a former health industry insider may make it more persuasive to skeptics in your circle.

And let us not forget that polls shortly before the election showed that health care was the most important issue to voters, but as we know, the Vichy Dems are much more willing to give lip service to the idea of addressing this inefficient and too often predatory industry than doing something about it.

Wendell Potter is full cow feces. At 3 minutes he talks of insurance companies being unable to get a good deal from healthcare providers for their services. That's bs because the insurance companies are the ones telling the healthcare providers how much they will be paid for services.



Here's the real answer. Get rid of the insurance.

 

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Jury orders Aetna to pay $25million to the family of a woman who died of cancer after the insurance company REFUSED to cover her treatment recommended by doctors

  • Orrana Cunningham, 54, of Meeker, Oklahoma, was diagnosed with stage IV nasopharyngeal cancer in November 2014
  • The disease occurs when malignant cells form in the tissues of the upper part of the throat behind the nose
  • Doctors recommended proton beam therapy, which delivers a high energy beam of protons rather than high energy X-rays to the cancerous areas
  • Aetna denied coverage in 2014, saying the therapy was experimental
  • The Cunninghams mortgaged their house for $92,000 to pay for the treatment themselves, but Orrana died in May 2015
  • Last week, a jury awarded her husband Ron $592,000 and $10 million in punitive damages, and Orrana’s estate was awarded $15 million
  • The jury ruled that Aetna 'recklessly' disregarded its duty to deal fairly and in good faith with Orrana's case

https://www.dailymail.co.uk/news/ar...mily-woman-died-cancer-refusing-coverage.html
 

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Find a Great Doc Outside the System & Reclaim Your Life | Elaina George MD
Reluctant Preppers


Published on Nov 19, 2018
Have you noticed that you're paying more and more for less and less real health care? Been wondering where all the money goes? Medical doctor, Ear, Nose & Throat specialist (ENT), author of the book "Big Medicine," radio host, and champion for health care liberty, Elaina George MD, returns to HealingYourself.Life for this second interview.

Dr. George follows the money and exposes the dirty trail of graft that lines the pockets of Big Pharma, Hospital Administrators, and Medical Insurers, while leaving ordinary people feeling trapped, helpless, and afraid to opt out of the corrupt system.

What's more, the rigged system is driving many great doctors out and beating down many of those who stay, making them "donkeys" of the system, rather than inspired healers.

Finally, Dr. George gives us a hearty message of encouragement and a list of great options to free us from the clutches of the modern medical extortion system, so we can take better care of our families!

Websites mentioned in this interview:
-----------------------------------
DrElainaGeorge.com
JoinTheWedge.com
AAPSOnline.org
surgerycenterok.com
LibertyHealthshare.org
AFLAC.com
MedRetreat.com

==================================
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LEGAL DISCLAIMER:
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HealingYourself.Life provides information for awareness, educational, and support purposes only, and does not diagnose or prescribe treatment for any medical condition. HealingYourself.Life does not assume any responsibility for the accuracy of opinions of the guests or the testimony of hosts, nor any liability for consequences of viewer decisions in response to these expressed opinions or testimonies.

Viewers are solely responsible to do their own due diligence & consult with their own medical caregivers before making personal treatment decisions.
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Without Obamacare Penalty, Think It’ll Be Nice To Drop Your Health Insurance? Better Think Twice

Posted on December 7, 2018 by Yves Smith

Yves here. This post is a reminder that for most people in the US, health insurance is an exercise in exploitation thanks to the catastrophically costs of hospitalizations and certain medications. For instance, a leukemia survivor I know takes a drug that cost $14,000 a month to keep the cancer from recurring.

By Emily Bazar, Senior Editor and Columnist for California Healthline, who writes the “Ask Emily” column, which addresses readers’ concerns about the Affordable Care Act and other health care topics. She regularly appears on KPCC, KQED, Capital Public Radio and other California radio stations. Emily previously worked at the CHCF Center for Health Reporting, USA Today and the Sacramento Bee. She graduated from Stanford University. Originally published at Kaiser Health News

Dana Farrell’s car insurance is due. So is her homeowner’s insurance — plus her property taxes.

It’s also time to re-up her health coverage. But that’s where Farrell, a 54-year-old former social worker, is drawing the line.

“I’ve been retired two years and my savings is gone. I’m at my wit’s end,” says the Murrieta, Calif., resident.

So Farrell plans — reluctantly — to drop her health coverage next year because the Affordable Care Act tax penalty for not having insurance is going away.

That penalty — which can reach thousands of dollars annually — was a key reason that Farrell, who considers herself healthy, kept her coverage.
Now, “why do it?” she wonders. “I don’t have any major health issues and I’ve got a lot of bills that just popped up. I can’t afford to pay it anymore.

Farrell is among millions of people likely to dump their health insurance because of a provision in last year’s Republican tax bill that repeals the Obamacare tax penalty, starting in 2019, by zeroing out the fines.

The Congressional Budget Office estimated that the repeal of the penalty would move 4 million people to drop their health insurance next year — or not buy it in the first place — and 13 million in 2027.

Some people who hated Obamacare from the start will drop their coverage as a political statement. For people like Farrell, it’s simply an issue of affordability.

Since Farrell started buying her own insurance through the open market in 2016, her monthly premium has swelled by about $200, she says, and she bears the entire cost of her premium because she doesn’t qualify for federal ACA tax credits. Next year, she says, her premium would have jumped to about $600 a month.

Instead, she plans to pay cash for her doctor visits at about $80 a pop, and for any medications she might use — all the while praying that she doesn’t get into a car accident or have a medical emergency.

“It’s a situation that a lot of people find themselves in,” says Miranda Dietz, lead author of a new study that projects how ending the penalty will affect California.

People like Farrell whose incomes are too high to qualify for tax credits are especially vulnerable, says Dietz, a research and policy associate at the University of California-Berkeley Center for Labor Research and Education. They must pay the entire premium themselves.

Premiums, even for a bronze plan with a deductible of more than $6,000, are enormous in some cases, she says. “The state’s done a great job of implementing the ACA,” she says, “but there are still Californians who just find insurance out of reach.”

Up to 450,000 more Californians may be uninsured in 2020 as a result of the penalty ending, and up to 790,000 more by 2023, boosting the state’s uninsurance rate for residents under 65 to 12.9 percent, according to the study. The individual market would suffer the biggest losses.

Covered California, the state health insurance exchange, predicts that enrollment in the individual market — both on and off the exchange — could drop by 12 percent next year, says agency spokesman James Scullary.

Exchange officials also blame the end of the penalty for a 3.5 percent average increase in premiums, because the departure of some healthy people from the market will lead to a sicker and costlier insurance pool.

Health insurance can be difficult to afford, but going without it is a “bad gamble,” Scullary says. Keep in mind: More than 22,000 Covered California enrollees broke, dislocated or sprained arms or shoulders in 2017, and 50,000 enrollees were either diagnosed with — or treated for — cancer, he explains.

“We know that none of those people began the year thinking, ‘This is when I’m going to break my arm,’ or ‘This is the year I get cancer,’” he says.

If you’re considering dropping your plan and risking the devastating financial consequences of an unexpected medical expense, check first to see if you can lower your premium.

“A big mistake for people is to look at the notice they get for their current health insurance and see it’s going up a lot and then throw up their hands and decide they’re going to go without,” says Donna Rosato, a New York-based editor at Consumer Reports who covers health care cost issues.

“Before you do that, look at other options.”

The most important thing to do is seek free help from a certified insurance agent or enrollment “navigator.” You can find local options by clicking on the “Find Help” tab on Covered California’s website, http://www.CoveredCA.com.

Next, see if you can qualify for more financial aid. For instance, if your incomeis close to the threshold to qualify for tax credits through Covered California or another Obamacare insurance exchange — about $48,500 for an individual or $100,000 for a family of four this year — check with a financial professional about adjusting it, Rosato suggests. You might be able to contribute to an IRA, 401(k) or health savings account to lower the total, she says.

Beyond that, be flexible and willing to switch plans, she advises. Consider different coverage levels, both on and off health insurance exchanges. If you’re in a silver-level plan (the second-lowest tier), you might save money by purchasing a less expensive bronze-level plan that has higher out-of-pocket costs but would protect you in case of a medical emergency.

This year, Farrell got a clean bill of health from her doctor after a round of tests. She’s nervous about being without coverage next year, but feels she doesn’t have a choice.

“It’s going to be the first time in my life I’m not going to have insurance,” she says.


This entry was posted in Free markets and their discontents, Guest Post, Health care on December 7, 2018 by Yves Smith.
 

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So Farrell plans — reluctantly — to drop her health coverage next year because the Affordable Care Act tax penalty for not having insurance is going away.
If one knew how it all worked, one would realize that there's never really been a tax penalty for not having health ins.
....and Farrell complains about her savings being gone due to ObozoCare, but doesn't seem to realize that even if she had paid the penalty, she would still have some of her savings left? Because the so-called penalty doesn't come anywhere close to even the most affordable of ObozoCare plans.
 

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Federal judge rules Obamacare is unconstitutional - and President Trump calls it 'great news for America'

  • Judge Reed O'Connor in Fort Worth ruled Affordable Care Act is unconstitutional
  • Ruled that a change in tax law last year eliminating a penalty for not having health insurance invalidated the entire law
  • Last year Trump signed a $1.5 trillion tax bill that included a provision eliminating the individual mandate
  • Trump celebrated the 55-page ruling in two Tweets sent shortly after 9 pm
  • Obamacare will remain in place pending its expected appeal to Supreme Court
https://www.dailymail.co.uk/news/ar...l-judge-rules-Obamacare-unconstitutional.html
 

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Just a little food for thought, nothing more. Take it fwiw and dyodd.

What the US Could Learn from Thailand About Health Care Coverage

Posted on December 15, 2018 by Yves Smith

By Joseph Harris, Assistant Professor of Sociology, Boston University. Originally published at The Conversation

The open enrollment period for the Affordable Care Act (ACA) draws to a close on Dec. 15. Yet, recent assaults on the ACA by the Trump administration stand in marked contrast to efforts to expand access to health care and medicine in the rest of the world. In fact, on Dec. 12, the world observed Universal Coverage Day, a day celebrated by the United Nations to commemorate passage of a momentous, unanimous U.N. General Assembly resolution in support of universal health coverage in 2012.

While the U.N. measure was nonbinding and did not commit U.N. member states to adopt universal health care, many global health experts viewed it as an achievement of extraordinary symbolic importance, as it drew attention to the importance of providing access to quality health care services, medicines and financial protection for all.

Co-sponsored by 90 member states, the declaration shined a light on the profound effect that expansion of health care coverage has had on the lives of ordinary people in parts of the world with far fewer resources than the U.S., including Thailand, Mexico and Ghana. Can the U.S. learn anything from these countries’ efforts?

US and Thailand: A Study in Contrasts
I came to understand these changes as I researched and wrote my book, “Achieving Access: Professional Movements and the Politics of Health Universalism.” The book offers a comparative and historical take on the politics of universal health care and AIDS treatment, featuring Thailand as the primary case. For me, Thailand’s remarkable achievements also put into perspective some of the work we still have to do here in the United States with respect to health reform.

Before the reform, Thailand had four different state health insurance schemes, which collectively covered about 70 percent of the population. The reform in 2002 consolidated two of those programs and extended coverage to everyone who did not already receive coverage through the country’s health insurance programs for civil servants and formal sector workers.

Thailand’s universal coverage policy contributed to rising life expectancy, decreased mortality among infants and children, and a leveling of the historical health disparities between rich and poor regions of the country. The number of people being impoverished by health care payments also declined dramatically, particularly among the poor.

However, Thailand’s reform had other important consequences that aimed to make the reform sustainable as well. Sensible financing and gatekeeping arrangements – that tied patients to a medical home near where they lived and provided fixed annual payments for physicians to cover outpatient care – were instituted to curb the kind of cost escalationthat has historically been a hallmark of the United States (though it has slowed lately). The reform also improved the quality of care for patients in remote areas by mandating that qualified providers in community hospitals collaborate more extensively with rural health centers.

The United States, by contrast, seems to be moving in the opposite direction, both in terms of insurance coverage and health outcomes. Although recent Republican efforts to repeal the Affordable Care Act were narrowly defeated, lawsuits that aim to terminate popular pre-existing conditions protections continue. In addition, the Trump administration has sought to weaken the reform in other ways: including by cutting the open enrollment periods, which ends Dec. 15 and lasts 45 days; cutting outreach and advertising for open enrollment; and threatening to suspend risk adjustment payments to private insurers, which help to stabilize the market.

Moreover, effective repeal of the Affordable Care Act’s individual mandate through a provision in the 2017 Tax Reconciliation Act that reduces the penalty for not having insurance to zero in 2019 will have the effect of reducing the number of insured. This will have an effect on health insurance markets, likely reducing the number of younger and healthier people that help give balance to health insurance risk pools and that help keep overall costs down. And without the financial protection afforded by health insurance, those who are uninsured may face rising rates of medical bankruptcy, to say nothing for the loss of access to sorely needed medical care.

Learning from Thailand
To be sure, the Thai and American contexts are very, very different. While health spending stands at around 4 percent of GDP in Thailand, in America nearly 20 percent, or one-fifth, of the country’s total economic output is spent on health. Yet, in some ways, that makes Thailand’s achievement all the more remarkable. And while no program is perfect, Thailand’s reform is one of the reasons that health costs in Thailand have remained so low, despite such a dramatic increase in coverage.

Reformers also drew on other innovative policy instruments to keep costs down, including the Government Pharmaceutical Organization that produces generic medication for the universal coverage program and the use of compulsory licenses, which allow governments to produce or import generic versions of patented medication under WTO law.

The Affordable Care Act similarly sought to improve access, while curbing costs. Some of the most important mechanisms to curb costs fell victim to the legislative process however. Most notably, lobbyists succeeded in killing the “public option,” a government (as opposed to private) health insurer with much lower administrative costs that aimed to bring costs down among private health insurers through competition with them….

What the contrast makes clear, however, is that reforms done properly can expand access while at the same time instituting measures that help to contain costs. The U.S., in my view, should pursue similarly creative and constructive reforms that seek to do both.

What does that look like in the United States? To me, that means preserving the ACA’s individual mandate and protections related to pre-existing conditions; creating (or expanding) a public insurer like Medicare to compete alongside private insurers and keep costs down; addressing the lack of price transparency in our nation’s hospitals; and actively negotiating with pharmaceutical companies and hospitals to bring costs of drugs and health care down for millions.

Done sensibly, developing nations like Thailand are proving that they do not have to join the ranks of the world’s wealthiest nations for their citizens to enjoy access to health care and medicine. Using evidence-based decision-making, even expensive benefits, like dialysis, heart surgery and chemotherapy, need not remain out of reach. Policymakers in all countries can institute reforms using tools that promote cost savings at the same time they improve access and equity.

While efforts to implement universal coverage are not without challenges, these results suggest that leaders in Congress would do well to learn from countries like Thailand as they chart a fiscally responsible path forward on health care.


This entry was posted in Free markets and their discontents, Guest Post, Health care, Income disparity, Social policy on December 15, 2018 by Yves Smith.

https://www.nakedcapitalism.com/2018/12/us-learn-thailand-health-care-coverage.html
 

Garyw

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Garyw

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Any system that creates competion across state lines is better than single payer or Obozo care.
 

Garyw

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Another thing that will drop medical cost is limit awards on malpractice.
 

Joe King

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Any system that creates competion across state lines is better than single payer or Obozo care.
Competition is exactly what's needed. All doctors and hospitals should be required to publish basic prices for all normal and routine procedures.


For example, delivering babies is one of the most common things done at hospitals. However, none of them can tell you ahead of time the standard cost of a normal no-complications delivery.

If you did something day in day out that you billed for, wouldn't you eventually come to realize what the standard costs would be?

IMHO, the only reason they don't want to do this, is because the providers have been conditioned by the insurance companies to pad the bill as much as possible. If they give you a standard price ahead of time, they have to show good reason for exceeding that price.

As it stands now, they just whip up a bill afterwards and the patient has no way of knowing whether or not it's a fair charge for the services rendered.

Imagine taking your car to the shop and them not being able to tell you anything about the charges until after the car was completely fixed, and you were asked to sign off on a blank work order. No one would stand for it, but with healthcare no one questions it.
 

michael59

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There has to be a price sheet or there would be no insurance companies.
no, just dammno. I tried it the what are you going to charge thingy..... and the sit bluewed me off....charged me for a fucking level four 'TRAMA' shit excousionariy )YES I KNOW IT IS NOT A WORD( ....now where was EYE? oh yeah I got fucked because I had let...yes silly people....I had let a cat roller get away and smash my fucking finger on its tip from two inches away...so what the fuck is going on here?..AND YES IT FUCKING HURT! FUCK IT DID HURT! and that brought it up to 2K or UCK
 

Joe King

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There has to be a price sheet or there would be no insurance companies.
The insurance companies do have one that says what they pay for each procedure.
...but you the policy holder gets to see it?

If the providers have one, the patients definately never get to see it. Only thing they see is the severely padded bill* after-the-fact.


* at least 10-50 times the actual cost of the treatment rendered to the patient if it's anything involving a hospital.
 

GOLDBRIX

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no, just dammno. I tried it the what are you going to charge thingy..... and the sit bluewed me off....charged me for a fucking level four 'TRAMA' shit excousionariy )YES I KNOW IT IS NOT A WORD( ....now where was EYE? oh yeah I got fucked because I had let...yes silly people....I had let a cat roller get away and smash my fucking finger on its tip from two inches away...so what the fuck is going on here?..AND YES IT FUCKING HURT! FUCK IT DID HURT! and that brought it up to 2K or UCK
SPELL CHECK is your friend Mike. Jus' Sayin'
 

GOLDZILLA

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I actually got an itemized price list when I asked for one and they had a thousand incidentals listed with every procedure and even had overtime bills for each doctor/anesthesiologist.