Archive for the ‘#medicalcare’ Tag

This Is Why Government Shouldn’t Be Involved in Health Care | Jeffrey A. Tucker   7 comments

Image result for image of ahcaThe Republican-controlled House vote to “repeal Obamacare” – if that is what this was – was a stunning mess.

Did they get it right? The answer is obviously no, and that’s inevitable. Just imagine a bill that sets out to reorganize any industry that is currently mostly market driven, such as shirts, software, groceries, or furniture. Would any bill coming from Congress that pertains to the whole of any of these be wonderful? It’s impossible.

This is because the minds of politicians working together – with all their mixed motives of special-interest acquiescence, electoral fears, and general ignorance – cannot possibly replicate, much less improve upon, the brilliant mind of the market at work.

Sadly, any structural change in the industry is pushed through via legislation.

Fortunately, we don’t have to deal with such bills in most markets. But the health care industry is different. It’s been heavily regulated for more than a century. Obamacare went in the wrong direction, toward more rather than less government control. It actually disabled the mind of the market. The result has been soaring deductibles and premiums, insurers going belly up, and average citizens being forced to pay for insurance they can’t afford to use.Change is necessary. Sadly, any structural change in the industry is pushed through via legislation. That is a tragedy. The challenge is to sort out real vs. fake reform, and do this amidst grandstanding, bombast, posturing, ideological panic, rhetorical bombast, and media mania.

The Miasma of Politics

The House had little more than one day to consider a bill that would affect the lives of every single living American in the most fundamental way. Meanwhile, those of us in the peanut gallery had to try to make sense of whether or not this bill is a promising development, remembering that not backing something necessarily means de facto settling with the legislative status quo.

Even getting the core facts of the legislation was a challenge.

What is the core standard by which any health care bill should be evaluated, given that nothing coming out of Congress that can gain a majority of Republicans will ever be right? The test is this: does this bill take us in the direction of restoring market competition and market signaling, or does it preserve the current managed, artificial, coercive, and unworkable system that relies on government control?

Donald Trump does not understand this at all.

Two main features of Obamacare (explains David Henderson) disable market competition: guaranteed issue and community rating. Guaranteed issue mandates what is covered under all health insurance, thus ruling out flexibility on the part of either buyers or sellers. Community rating forbids insurance pricing from being influenced by risk assessment, which takes the insurance out of insurance. A reform worthy of support must deal directly with these problems.Donald Trump does not understand this at all. He keeps tweeting that he absolutely insists on keeping the mandate that all health insurance must cover pre-existing conditions. The dogmatic demand painted the Republicans in a corner. They couldn’t repeal the very mandates and disabled-pricing schemes that have created such a mess in the industry.

States, You Do It

Yet Obamacare is so bad that some states have toyed with actually nullifying the law. Taking their cue from such movements, the House bill encourages states to take some steps to do just that. Whether they come through or not is another matter.

Still, this amendment brought some skeptics on board. The final bill permited the states to opt out of both the guaranteed issue and the community rating mandates, thus removing Congressional culpability but allowing a decisive number of votes to come out in favor of the bill.

Two bellwethers that I follow in Congress because of their principled stand for market freedom – Justin Amash of Michigan and Thomas Massie of Kentucky – voted differently. Amash was a yes and Massie was a no.

Massie released the following statement:

As recently as a year ago, Republicans argued that mandates were unconstitutional, bailouts were immoral, and subsidies would bankrupt our country. Today, however, the House voted for a healthcare bill that makes these objectionable measures permanent.

The former Democrat Speaker of the House was rightfully derided for imploring Members to vote for a healthcare bill to “find out what was in it.” Yet today, we voted on a healthcare bill for which the text was available only a few hours before the vote. In fact, the Congressional Budget Office had no time to even provide Congress with a preliminary estimate of the full cost of this bill.

By repealing a small number of Obamacare mandates, while leaving others in place, this bill runs the risk of destroying what remains of the individual health insurance market.

The option in this bill that allows States to apply for waivers from some Obamacare mandates is well-intentioned. However, it falls far short of our promise to repeal Obamacare. There also remains the risk that State legislatures, like our federal legislature, are unable to withstand the political pressure from lobbyists who defend Obamacare, and the pressure from those who receive Obamacare’s welfare handouts.

This bill should have included measures that allow Americans to take charge of their own healthcare and get the government out of the way. These measures include allowing the deduction of health insurance costs from income taxes, giving everyone the ability to purchase insurance across state lines, and allowing individuals to band together through any organization to purchase insurance.

In weighing my vote, I heeded the wise advice that “one should not let the perfect be the enemy of the good.” If this bill becomes law, it could result in worse outcomes, fewer options, and higher prices for Kentuckians who seek health care. In summary, I voted against this bill not because it’s imperfect, but because it’s not good.

His argument is strong. If you live in a state that does not opt out of the community rating, you are stuck with the bulk of Obamacare. Massie had an intuition about this: the pressure would be too great to preserve the status quo, thus making the “repeal” wholly illusory. Then the Republicans get stuck with a failure.

Amash has not released a formal statement on his yes vote, but his rationale is easy to anticipate. This bill is nothing like what it should be, but we also know that the right kind of bill could never pass the House. This one does repeal some mandates and taxes. It does permit a path for states to opt out. A no vote effectively means the preservation of the status quo. A yes vote does not make this bill law; it only sends it to the Senate, which will pass something very different (better or worse is yet to be seen).

Democrats Celebrate

Meanwhile, in the aftermath, Democrats imagine that they just won the greatest victory since 2010, even to the point of singing a song on the House floor. The passage of Obamacare was a catastrophe for them. It nearly wrecked a two-term presidency and contributed heavily to the loss of the Senate and the presidency. It has been an albatross around their necks. Now they get to hurl that onto their enemies.

But that alone presents another danger. If this bill is perceived to be authentic “deregulation” and “free market reform,” every failure will come to be blamed not on government but rather insufficient control. “We tried your free markets and they failed!” And there is no question that the partisans of socialized medicine are already positioning themselves in this direction. If you believe the New York Times editorial after the House vote, we’ve already entered into health-care anarchy.

My purpose here is not to settle the question of how one should have voted or what the effects or eventual outcomes will be. There is a bigger and more important lesson here. Any good, service, or industry that is removed from market control and put into the hands of government thereby becomes subjected to the grueling and ghastly machinations of the political process in all its subterfuge, duplicity, and vast waste.

Even if you don’t like every result of market control, it’s hard to imagine that anyone can defend what necessarily replaces it once you surrender any market to control by government.

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Source: This Is Why Government Shouldn’t Be Involved in Health Care | Jeffrey A. Tucker

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Posted May 5, 2017 by aurorawatcherak in Common sense, Uncategorized

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It Stinks Less, but It Still Stinks   Leave a comment

Rick, my cousin who is a world-class research doctor who has been helping me to understand medical insurance reform, finally got around to sending me his analysis of the most recent Republican effort to sort of repeal and sort of replace the Affordable Care Act. If I were a Trump voter who voted for Trump and the GOP believing the promise that they would repeal of the Affordable Care Act before it bankrupted me, I’d be a bit annoyed. I am a bit annoyed and I didn’t vote for them expecting them to actually do anything because I knew Trump likes universal medical insurance and socialized medical care. He said things supportive of it back in the run-up to the ACA passing.

Related imageBut, here we are, waiting with baited breath to see if the Republicans actually have a votable bill this time.

The AHCA relies on three stages. The passage of the AHCA is simply Stage 1. As Senator Ted Cruz pointed out when the original iteration of the AHCA was being debated, the basket of goodies in the second and third baskets are what the GOP has been promising voters for over half a decade. The problem is that the first “basket” changes almost nothing and the subsequent baskets rely on easily changed mandates from the Secretary of Health and Human Services, who could be a raving progressive from England after 2020.

If the AHCA can in any way be heralded as a conservative win, it’s the amendments made since the March failure-to-launch that move us toward a medical care system based on free markets that are note-worthy, but the AHCA still isn’t a “free market solution.” To make the bill palatable to the must-have House Freedom Caucus, two amendments were added that allow states to apply for waivers to opt-out of the pre-existing conditions requirement and the provision regarding “essential health benefits”.

However, with one dumb comment from President Trump and a moving story from Jimmy Kimmel — another amendment was added that provides $8 billion over 5 years for the nearly inconsequential issue of “pre-existing conditions.”

People really should know, about pre-existing conditions coverage in America, because mention of the phrase seems to halt all rational discussion, while precious few Republicans are prepared to defend the point eloquently or adequately. It is something vital to understand.

Rushing the medical care vote in March has made Americans, and particularly Republicans, wary. The president and Republican Congress only have themselves to blame because they should have spent months talking about the bill before voting on it. That talking would have educated people on what is actually in the bill. Falling short on today’s vote will leave most Americans who voted for Republicans because they promised to repeal Obamacare and later to replace it with something better, with the clear understanding that Republicans never meant what they said. Bye-bye, GOP!

So we’re stuck with what it is … at least for now.

In broad terms, the bill would likely reduce government spending and decrease insurance premiums for people who are healthy and young and don’t get insurance through their employers. It also likely will increase costs for older, sicker people and take away government-provided coverage from people in the lower middle-class. Those are, despite what the naysayers want you to believe, are good things.

The new American Health Care Act would have far less impact on people who get insurance from their employers, but let’s be clear — the AHCA is a complicated bill that builds off of the ACA, another even more complicated bill, so its potential impact is complicated and, therefore, difficult to predict. But Rick identified some of the major changes to the medical care landscape that could occur if the AHCA passes in its current form.

People with pre-existing conditions will no longer be treated as if they are healthy.

The House Freedom Caucus fought for an amendment to be introduced that loosens regulations that requires insurance companies to sell plans to people who buy insurance independent of their employers or the federal government.  It potentially will impact rules that protect people with pre-existing medical conditions from being discriminated against by medical insurers.

Right now there’s panic among Obamacare supporters that the amendment could make insurance coverage unaffordable for people with existing medical issues. And Republicans and conservatives have proved ill-equipped at defending their position as equally compassionate but packaged in a different vehicle. This allows appeals to emotion, like that of Jimmy Kimmel’s tear-jerker about how his baby wouldn’t be covered because he was born with a heart condition, to shut down all thinking and conversation when the phrase “pre-existing condition” is uttered.

 In truth, the MacArthur amendment keeps the ACA’s guaranteed access clause, which requires insurers to provide policies to those with pre-existing conditions. However, the bill would allow states to apply for waivers that could change the cost and quality of their coverage.

First: prior to the ACA, the vast majority of Americans with medical insurance were already in plans that were required to offer them coverage regardless of pre-existing conditions. Employer-based plans were required to offer coverage to everyone regardless of pre-existing conditions. So were Medicare, Medicaid, and other government programs like the VA. Employer- and government-based plans, prior to Obamacare, represented 90 percent of Americans with medical insurance.

The other 10 percent were people buying coverage on their own, on the individual market. In most — but not all — states prior to Obamacare, people buying coverage on their own could, in theory, be denied coverage for a pre-existing condition.

In reality, in practice, a tiny percentage of Americans were being denied coverage due to a pre-existing condition prior to the ACA. We know this in general because surveys consistently indicated that this was the case, and in detail because of an Obamacare program called the Pre-Existing Condition Insurance Plan, or PCIP.

PCIP was designed to work from the years 2010 to 2014, as a bridge until Obamacare’s insurance regulations took effect. During those years, Americans could sign up for heavily subsidized coverage under PCIP if they had documented proof that they had been denied coverage by an insurance company and had a pre-existing condition.

What happened? Enrollment in PCIP peaked in February 2013 at 114,959.

Under the AHCA with the MacArthur amendment, states could opt out of the law’s essential medical benefits measure, which requires insurers to cover 10 main benefits, including hospitalization, prescription drugs and other services. Insurers in those states would likely offer trimmed-down policies might not cover for all the treatments and medications that those with medical issues need. Carriers would likely offer more comprehensive policies to consumers with costly conditions at higher premiums.

Let’s remember that the #1 driver of the out-of-control premium increases under Obamacare has been people with costly conditions paying the same premiums as healthy individuals who don’t go to the doctor nearly as often.

The amendment addresses this by allowing states to change the ACA’s community rating provision, which bans insurers from charging enrollees higher premiums based on their medical history. Under the revised bill, insurers could charge higher premiums to those with pre-existing conditions who let their coverage lapse. This is very similar to what existed prior to the passage of the ACA. It gave people with pre-existing conditions an incentive to remain covered while holding a lid on premium increases for the rest of us.

States that apply for this waiver would have to set up high-risk pools or other programs aimed at minimizing insurers’ exposure to costly policyholders. This would offset some of the price hikes carriers would levy on those with pre-existing conditions. They’ve only set aside $130 billion to fund these programs through 2026, which some observers feel is woefully inadequate, but the alternative is the bankrupting of the middle-class with the ACA’s out-of-control premium increases, so it’s worth it to return to a system that worked in the past. High risk pools existed before Obamacare, but many were underfunded, charged policyholders premiums in line with the costs of their ongoing care and had waiting lists.

 

Lower-income people could get caught by this amendment if the bill becomes law. A Congressional Budget Office analysis of an earlier version of the bill found 24 million people could become uninsured under the GOP legislation. That number is likely ginned up because it assumed that everyone who went on Medicaid under the ACA would be ineligible under reform, but we showed in our earlier analysis that this is not true. The few lower-income folks who become uninsured due to the rollback of Medicaid expansion may encounter higher premiums when they try to get insurance because insurers would be allowed to set rates based on their health backgrounds.

In other words, people will once more pay premiums based on what their cost of care is likely to be.

 

Medical care is incredibly expensive in the United States, and if you get sick, it’s going to cost a lot. Which is why it’s important for older and less healthy people to purchase medical insurance, but when Obamacare required everybody to buy insurance and insurers to offer coverage to everybody, regardless of their cost of care, it distorted the insurance market and drove up premiums to unaffordable levels for everyone. Before Obamacare, insurance companies were required to sell insurance to people with medical issues provided the person could pay the premiums dictated by their cost of care. That was actually a provision within HIPPA that Obamacare supporters refuse to acknowledge.

Why the ACA is failing is that it regulated how much insurers could charge people with medical issues. This is called “a community rating”. That meant insurers suddenly had to charge everyone the same price for the same coverage. Prices can’t currently be based on factors such as a person’s sex or how sick they are. Under the GOP plan, states could get a waiver that would allow insurers to set prices based on how healthy a person is.

Republicans have argued that they wouldn’t be totally eliminating protections for people with pre-existing conditions because states don’t have to ask for a waiver. Obamacare supporters believe that claim ignores some difficult realities.

Subsidies that help people buy insurance will be reduced under the AHCA. That will likely lead healthier people to leave the insurance market, further increasing premiums for those who remain. Yeah, freedom sometimes allows people to act in their own best interest. States might have to seek the waivers to keep the insurance marketplaces up and running. Yup, that’s the whole supply-and-demand cycle that economists warn us about. All this could add up to insurers’ offering coverage that is unaffordable to people with pre-existing conditions.

The AHCA tries to combat those increased costs through a fund for high-risk pools, insurance programs for people with extremely high health care costs. I am familiar with Alaska’s high-risk pool and it did a good job in covering people with pre-existing conditions … far better than having only one insurance company in all of the state of Alaska to cover everybody in the individual market at very high premium prices.

Monopolies can pretty much charge what they want and Obamacare created a lot of monopoly in the insurance market.

 

Medicaid would go back to being a program for the poor.

Although amendments to the AHCA have gotten the most coverage in recent weeks, changes to Medicaid from the original version of the GOP bill are what cut government spending while rolling back multiple taxes.

Before the ACA, Medicaid was an insurance program for people below the federal poverty line and those who met certain criteria, such as having a disability, being pregnant or being a woman with children. Obamacare changed that by opening up Medicaid to everyone below 138 percent of the federal poverty line in states that chose to expand the program. Thirty-one states and D.C. opted to expand Medicaid, and more than 11 million people joined the Medicaid rolls. Many were already eligible for Medicaid and had chosen not to apply or they only became aware that they were previously eligible when they were forced to apply.  Medicaid expansion included families of four making up to $55,000 here in Alaska. The GOP bill would freeze that part of the program on Jan. 1, 2020.

Some Obamacare supporters claim the AHCA wouldn’t just cut back Medicaid expansion, it would also trim the prior existing program, by capping how much states would be reimbursed for enrollees. The Congressional Budget Office estimates that the net effect of the changes would be 14 million fewer people on Medicaid, which might delay the impending bankruptcy of that program by a decade.

 

Insurance premiums would go down for some, but others would pay more than they currently do.

 

Then there are the insurance subsidies and monthly premiums for people who buy insurance on the private market instead of through an employer. The AHCA would make several big changes that would likely lower premiums somewhat, according to the CBO’s analysis. In addition to potentially changing the costs for people with pre-existing conditions, the bill would allow older people to be charged a lot more than they currently are  …  up five times what younger enrollees pay. Again, older people who are not in good health are a primary driver of the premium increases we’ve seen under Obamacare. Currently, subsidies available to people who buy on the Obamacare marketplaces are calculated so that lower-income people won’t pay more than a set percentage of their income. Subsidies go up if you earn less, live in an area where insurance is more expensive or are older. Under the GOP bill, the system would become simpler: You’d get a subsidy based on your age, which would begin phasing out for people with an income of $75,000 a year.

The McArthur amendment would also allow states to get a waiver on the essential health benefits required by Obamacare. This provision requires plans to cover a range of services, including hospital, maternity and mental health care. So, if you’re a single male, you pay for maternity coverage whether you need it or not. The requirements push up insurance premiums, because insurers must cover more services.

This aspect of the AHCA brings up a larger question facing the bill overall. Passage in the Senate is far from certain, but even before that, the AHCA would have to pass muster with the Senate parliamentarian, the gatekeeper for Senate rule making. See, this GOP replacement bill is not really a full replacement; it’s kind of like an update to the ACA. That’s because the GOP doesn’t have the votes to fully repeal the ACA, which would require 60 senators, so it’s using a process called reconciliation, which allows the Senate to to pass bills that affect the federal budget with a simple majority. Much of the AHCA, such as the cuts to Medicaid and changes to insurance subsidies, falls within that mandate. But other changes, such as waivers to essential health benefits, don’t have a direct budgetary impact, leading some experts to believe the Senate parliamentarian will flag those changes as outside the realm of reconciliation.

 

What We Couldn’t Find in the Bill?

There’s still no interstate purchase of insurance and there isn’t a mechanism for allowing individuals to form groups that are not employer-based, so the two biggest tools for driving down premiums remain unavailable. They may come in one of the two later stages, but as already explained, these are easily swept aside by every new Secretary of Health and Human Services.

While the Republican bill may be a step toward making medical care more affordable to most Americans, it is a far cry from the “repeal” Republicans ran on when the Tea Party began to make inroads and win seats and they realized promising something they couldn’t really deliver was better than being realistic.

The AHCA still stinks like three-day-old fish left out on the counter, but it may not stink quite so much as the ACA. Premiums will go down for healthy individuals in the middle class, but so long as we’re still mostly required to buy insurance or pay a penalty, we aren’t really free to make our own decisions.

 

How the Market Is Already Repealing Obamacare | Stewart Jones   Leave a comment

There’s a common misconception that if you’re opposed to government services, programs and/or departments, then you’re opposed to building roads, education, people getting affordable health care and even people taking care of the sick and elderly. These misconceptions are becoming more apparent as the free market offers solutions and options using innovation and technology, as the government continues to fall in on itself.

doc-patient teamSix months into the pregnancy, we received a letter explaining that due to the changes in the law, our policy would no longer cover maternity services.

I continue to be amazed at the ingenuity of people and individuals working toward solutions in the marketplace, in spite of government. Over time government has assumed more and more control over medical decisions that individuals make everyday.

My Own Experience

I have paid my dentist out of pocket for many years and had private insurance for major medical only. In 2011, my wife and I were expecting our first child and had private health insurance which was slowly being limited more and more by regulations from the Affordable Care Act and Patient Protection Act. It was dreadful!

Six months into the pregnancy, we received a letter explaining that due to the changes in the law, our policy would no longer cover maternity or OB-GYN services. This meant that our insurance would no longer pay for anything related to the birth of our daughter. We searched and shopped for insurance that would help cover the cost of the hospital and birth, but the more government regulations and controls were placed on the market, the more difficult it became to actually get affordable medical insurance and health care.

We spoke with our doctor about it and found that by avoiding insurance altogether and paying the doctor directly, it reduced all costs associated with pregnancy by 60%. We avoided the government-burdened insurance market and paid the doctor directly.

This model of doctors and patients actually working out agreements and paying a flat fee in exchange for medical services is actually very effective. If we could only bypass the government regulations and laws on health care, more people would get better service at a more affordable rate.

Market-Based Medicine

One awesome example of markets finding ways around the government’s stronghold on medical services is the Surgery Center of Oklahoma. In order to run their own practice with the least amount of government interference as possible, two doctors formed this practice 15 years ago. The goal was to eliminate the inefficiencies that accompany hospital networks and Medicare/Medicaid networks in order to run their own practice. The practice has done so well, that it has grown to over 40 doctors now.

According to them:

It is no secret to anyone that the pricing of surgical services is at the top of the list of problems in our dysfunctional healthcare system. Bureaucracy at the insurance and hospital levels, cost shifting and the absence of free market principles are among the culprits for what has caused surgical care in the United States to be cost prohibitive. As more and more patients find themselves paying more and more out of pocket, it is clear that something must change. We believe that a very different approach is necessary, one involving transparent and direct pricing.”

This has allowed them the ability to perform the best quality surgeries at the lowest and most transparent cost. All of their procedures and costs appear on their website. By bringing this level of transparency to the public, it has forced a price war for surrounding hospitals to post prices for procedures, something that is often hidden. This has brought costs down in surrounding areas.

Exiting the rat race of hospital networks and eliminating acceptance of government payments has allowed them to cut the cost and provide a better service.

In spite of what government does, people around the country are finding ways to lower costs and raise quality in the most competitive and realistic manners.

Flat Fee Memberships

The difficulties with getting health care at affordable rates come not from marketplace inadequacies, but from government regulations.

Another great example, are physician’s offices like Irmo Primary Care, Gold Standard Pediatrics and many others that are starting flat fee pricing for memberships and monthly medical services called Direct Primary Care. These practices are helping to once again bring patients and doctors together without interference from government and bureaucratic middlemen. I love streamlining services!

Dr. Bryan Hill, a South Carolina pediatrician, opened his direct primary care practice in September. “Instead of accepting insurance for routine visits and drugs, these practices charge a monthly membership fee that covers most of what the average patient needs, including visits and drugs at much lower prices.”

It’s sad that most of the difficulties with getting good health care at affordable rates come not from inadequacies in the marketplace, but from the many regulations by central planners in government.

History has shown us that free-market forces have the ability to lower costs and increase quality while fostering new growth and innovation. It puts the power in the hands of consumers, where it should be. If government would just get out of the way, then the free-market can fix the problems with healthcare.

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Source: How the Market Is Already Repealing Obamacare | Stewart Jones

Posted April 25, 2017 by aurorawatcherak in Common sense

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Cultural Attitudes That Harm Us   1 comment

American citizens have several cultural attitudes toward health care and savings that has resulted in an economy that spends one-sixth of the GDP on medical care. Other countries don’t pay so much and many of them have universal medical coverage.

So what’s our problem?

Image result for image of cutting-edge medicalA major issue is that Americans have stopped saving anything. Many of us have retirement accounts, which work because it’s not easy to tap into them, but most of us do not have savings accounts. I recently read an article by a financial guru who spent most of the article ripping into Dave Ramsey for suggesting that paying off debt and having 3-6 months of living expenses in savings made no sense to her. You should be investing those funds, not leaving them in the bank account.

So, naturally, since, they don’t believe in savings, the American middle class does not believe in saving up for medical care expenses. The idea that you should have $10,000 to 15,000 in savings for a potential acute medical episode is ridiculous in most people’s minds. This isn’t pre-World War 2 America, nor are we a 3rd world country. That’s “wasted money” just sitting in a bank.

We object to paying one-sixth of our personal income directly on health-and-medical expenses, but we also resent paying one-sixth of the government’s treasury on health-and-medical expenses. We are less willing to spend public funds to pay for health maintenance than we are to pay for medical services, even though study after study shows that we get better results from getting people to change unhealthy lifestyles than from treating the consequences of those lifestyles. You can’t really blame the American middle class from objecting to paying taxes in order to support people who are very poor or very sick when they themselves work hard to have an income and to take care of their health. Americans are not Scandinavians. We believe in personal responsibility, if only for other people.

 

Americans, especially medical care providers, do not want to think of medical care as a commodity that is bought and sold in an open market subject to supply and demand rules. Providers want to be paid (and paid well), but they don’t want to think of themselves as capitalists selling their services, so they prefer payment that comes from third parties where the price is hidden from consumers.

 

Americans are individualists at heart and object to telling other people how to live their lives or being told by others how to live theirs. This means that the right to live an unhealthy lifestyle is considered sacrosanct in the United States. Under the ACA or universal coverage, that means that healthier individuals pay for the poor choices of less healthy individuals.

Americans also tend to live in a state of denial about some health choices, so that about one-quarter of our population engages in unhealthy lifestyles that have long-term medical care expense consequences, the cost of which are born by people who take care of themselves rather than the poor decision makers who require the expensive long-term care.

Americans enjoy being “early adopters” of new treatments, which are often much more expensive in their early, experimental stages than when they have been available for many years. Forty years ago, when medical care was a smaller share of the economy, we could afford that attitude, but new treatment options now require expensive equipment and highly-trained specialists. Although these treatments promise incredible results, they are expensive to the individuals receiving the treatments … or the group that’s paying the bills.

All of these attitudes conspire to make the “Affordable” Care Act, or any replacement other than the free market, incredibly and increasingly expensive for all of us. Universal coverage will only exacerbate the problems that these cultural attitudes engender, leading inevitably in medical care rationing and resultant lack of availability of care, with the end results being similar to England’s 45% higher mortality rate.

Yes, we could choose universal coverage and then attempt to outlaw everything that makes people unhealthy. Good luck with that! It hasn’t worked in France and England, which is one reason England has a 45% higher mortality rate than the US.

Alternatively, we could work with human nature and return our medical care system to the free market it began in. Lift the government-created restrictions against individuals forming groups to drive down medical insurance costs. Lift the government-created restrictions that prevent us from buying insurance across state lines. Life the government-created monopoly against increasing medical schools and opening clinics.  Yes, that would mean that some people wouldn’t make good health choices and wouldn’t have medical care coverage when those choices require them to seek medical care. That would be the consequence of being a poor-decision maker and it might drive some of this group to make better choices. Additionally, medical care would become less expensive because government-created barriers to care and affordable insurance would no longer be a factor in price.

We have a choice to make in this country. Do we want reduced access to expensive care, but everybody having insurance or do we want improved access to affordable care with some people choosing (for themselves) not to have insurance?

I know which one I prefer and which one I believe would result in improved health results.

Why ACA is Making Us Less Healthy   Leave a comment

I believe sincerely that everyone should have the right to do whatever he wants, provided it doesn’t harm other people or their property. I’m not saying I like it or think it is good for you, but I stand by your right to smoke like a chimney (so long as you don’t do it in my airspace), drink like a fish (but not if I share a household with you), or eat like a hippo (so long as I don’t pay your grocery bill).

Image result for medical careSadly, your lifestyle choices became my problem when the Affordable Care Act was passed. Your poor decisions now cost me money, which is a form of property. Hey, you, with the 50-inch waistline … that’s my kid’s college education in medical expenses that you expect me to pay, so yeah, I have a problem with the Affordable Care Act.

Back in 2009 when the Democratic-dominated government started touting the Affordable Care Act, they assured that the expansion of medical insurance coverage to all Americans would come at no cost to any citizen. A lot of us (about 60% of the electorate) were skeptical and that time and anyone paying even cursory attention to their medical insurance premiums since the go-live date for Obamacare knows our skepticism was well-founded. Medical insurance premiums have dramatically increased for most Americans not in the subsidized classes.

 

It might have seemed like a noble idea – that everyone should be required to have medical insurance just in case, but the Affordable Care Act also required medical insurance providers to cover pre-existing medical conditions.

That means that health-conscious people like me must subsidize medical care costs for people who make poor health choices. These poor health choices lead to diabetes, coronary artery disease, cancer, obesity, COPD, etc., all long-term chronic diseases that require expensive treatment. Coverage of pre-existing medical conditions greatly increased the cost that medical insurance providers were forced to pay out for treatment. This was supposed to be offset by young, healthy adults joining the health insurance pool, but younger, healthier people take one look at the expensive premiums and choose to pay the mandatory fine, because it is less than the premiums. This increases medical insurance premiums even more.

As Rick tried to highlight, individuals are less likely to make wise health choices if it is perceived that they will not have to bear the financial consequences of those choices because insurance paid by others covers the majority of the costs. Medical insurance holders are able to seek out healthcare services without the cost of those services being a major deterrent, which encourages people to go to the hospital and doctor for very minor ailments. After all, you want to get value for what you are paying for. Then doctors are motivated to extract the maximum amount of payment … prescribing expensive and sometimes unnecessary treatments and medications because insurance is covering the cost.

Rick points out that doctors and hospitals are often at the mercy of insurance companies and what gets approved for coverage, so they use a scatter-gun approach toward billing. Patients often demand more expensive treatment because of an impression that it’s better and because cost isn’t an obstacle. This completely undermines doctor-patient relationships where the goal is to choose the best and most sensible treatment options based on a cost-benefit analysis.

All of this has increased the cost of medical insurance. While providing medical coverage to everyone seems very humanitarian, it forces health-conscious people to subsidize the medical care costs of people who make poor choices and is causing employers to drop insurance coverage as it becomes unaffordable. If current trends hold, and there’s no reason to believe they won’t, the Affordable Care Act is going to bankrupt the middle class.

We’re not joking when we call it the UN-Affordable Care Act.

In a perfect world where liberty was still an ideal we upheld, everyone would be able to live their life however they want and be accountable for the personal and financial impact of their choices. The fact that I love bacon even though my family has a history of stomach and bowel cancer would not matter in the least to you because it wouldn’t affect you. Unfortunately, with the ACA, we’re all in this mess together, which means we all affect each other. It becomes absolutely imperative that we all strive to be the healthiest people we can be so as to reduce the economic burden on our neighbors.

Please don’t think I’m down on obese people to the exclusion of smokers or alcoholics or whatever. I’m using obesity as my demonstration condition because of the costs associated with it and it’s lack of social stigmaticism. My Baptist friends who don’t drink or smoke will smugly sit on their ample rears complaining that I’m wrong. “Being overweight is not unhealthy and has no impact on the cost of healthcare,” they will say.

Sorry, folks. You’re wrong. Research demonstrates that obesity and even being moderately overweight are the second leading causes of preventable death, right behind tobacco usage.

Here are some alarming economic implications for obesity:

  • Obese adults spend 42% more on direct medical care costs than adults who are a healthy weight.
  • Per capita medical care costs for severely or morbidly obese adults (BMI >40) are 81% higher than for healthy weight adults. In 2000, around $11 billion was spent on medical expenditures for morbidly obese U.S. adults.
  • Moderately obese (BMI between 30 and 35) individuals are more than twice as likely as healthy weight individuals to be prescribed prescription pharmaceuticals to manage medical conditions.

Did you know that 68.8% of the US citizens are considered overweight and obese? That represents a dramatic impact of overweight and obese individuals upon our medical care system.

Obesity is just one of many other preventable medical conditions that contribute to the cost of medical insurance, but obesity and being overweight are the most widespread.

We would all be personally well-serviced by quitting smoking, drinking less alcohol, exercising more, making better food choices, taking supplements wisely, and getting adequate sleep. There’s the direct positive impact on yourself, but better health habits would have a direct positive impact on the economy, and especially those of us who are forced to bear the cost of our nation’s medical care costs.

Unfortunately, you won’t see a financial benefit to making these changes. Unlike car insurance, where you receive lower premiums if you are a good driver who doesn’t have a lot of accidents, getting healthy doesn’t work the same way. Unlike life insurance, where you receive lower premiums if you’re a healthy individual, the ACA assures you will be paying for others who don’t make the same wise choices.

The result?

A less health population, which is indicated by slipping mortality rates. Although it sounds like such a great idea to provide medical insurance to everyone so they will be “healthier”, the reality is that the United States population has become less healthy as more of us have become covered by medical insurance.

Truth About Obamacare   1 comment

There’s a lot of misinformation floated about Obamacare repeal. For example, the hysteria over how “20 Million people will lose coverage” – absolutely not true.

These figures are from Forbes and the Heritage Foundation, taken from actual government statistics.

Obamacare Meme 1

Posted March 31, 2017 by aurorawatcherak in Common sense, Uncategorized

Tagged with , ,

Primary Care Clinics Another Option   Leave a comment

The United States medical care crisis has been a long time coming.

Image result for image of medical careIn 1910, the physician oligopoly was started during the Republican administration of William Taft. The American Medical Association lobbied the states to strengthen the regulation of medical licensure and allow their state AMA offices to oversee the closure or merger of nearly half of medical schools and also the reduction of class sizes.  Those restrictions remain in place today, severely curtailing the number of doctors who can enter the market because the bar is very high to get into medical school.

In 1925, prescription drug monopolies begun after the federal government (under Republican President Calvin Coolidge) started allowing the patenting of drugs, essentially creating monopolies.

In 1945, buyer monopolization begun after the McCarran-Ferguson Act led by the Roosevelt Administration exempted the business of medical insurance from most federal regulation, including antitrust laws.  (States have also more recently contributed to the monopolization by requiring health care plans to meet standards for coverage.)

In 1946, institutional provider monopolization begun after favored hospitals received federal subsidies in the form of matching grants and loans provided under the Hospital Survey and Construction Act, passed during the Truman Administration.

In 1951, employers started to become the dominant third-party insurance buyer during the Truman Administration after the Internal Revenue Service declared group premiums tax-deductible.

In 1965, nationalization was started with a government buyer monopoly after the Johnson Administration-led passage of Medicare and Medicaid which provided government-provided health insurance for the elderly and poor, respectively.

In 1972, institutional provider monopolization was strengthened after the Nixon Administration restricted the supply of hospitals by requiring federal certificates-of-need for the construction of medical facilities.

In 1974, buyer monopolization was strengthened during the Nixon Administration after the Employee Retirement Income Security Act exempted employee health benefit plans offered by large employers (e.g., HMOs) from state regulations and lawsuits (e.g., brought by people denied coverage).

In 1984, prescription drug monopolies were strengthened during the Reagan Administration after the Drug Price Competition and Patent Term Restoration Act permitted the extension of patents beyond 20 years.  The government has also allowed pharmaceuticals companies to bribe physicians to prescribe more expensive drugs.

In 2003, prescription drug monopolies were strengthened during the Bush Administration after the Medicare Prescription Drug, Improvement, and Modernization Act provided subsidies to the elderly for drugs.

In 2014, nationalization was further strengthened after the Patient Protection and Affordable Care Act of 2010 (“Obamacare”) provided mandates, subsidies and insurance exchanges, and the expansion of Medicaid.

 

With each new law or set of new regulations, restrictions on the medical care market went further, until, at some point in the 1980s, people began to notice the cost of medical care had skyrocketed … soon to be followed by the cost of medical insurance.

As regulators allowed special interests to help design policy, everything from medical education to drugs became dominated by virtual monopolies that wouldn’t have existed if not for government’s notion that intervening in people’s lives is part of their job.

We started meddling in 1910, but costs didn’t go up immediately and that causes a lot of short-sighted people to think the regulation is not related to the increased costs. They’re wrong, but some regulation was more harmful than other regulation.

In 1972 President Nixon restricted the supply of hospitals and clinics by requiring institutions to provide a certificate-of-need, then in 1974, the president strengthened unions for hospital workers by boosting pension protections, which increased the cost for hospitals. This move began to force doctors who once owned and ran their own hospitals to merge into provider monopolies. These, in turn, are often only able to keep their doors open with the help of government subsidies, so increasing costs to taxpayers..

As the number of hospitals and clinics became further restricted and the medical care industry became obsessed with simple compliance, patients were the first to feel abandoned. According to Business Insider, the average doctor has thousands of patients, and each visit lasts less than 30 minutes. As many in my parents’ generation can attest, doctors listened to their patients prior to the government’s slow but absolute control of medical care, doctors listened to the patients and medical care was easily affordable. Now, doctors can hardly recall the conversations they have with the people they are supposed to be looking after.

Insurance is not the same thing as medical care, but President Barack Obama pushed further restrictions on the insurance industry by touting the Affordable Care Act as a piece of legislation that would make insurance more affordable. That didn’t work out. Insurance had already been increasingly slowly over the years, but since the passage of the ACA, there’s been an average increase of 153% in premiums. And as a result, a new group of independent medical care professionals ignited one of the most liberating revolutions in recent U.S. history. As ACA became increasingly suffocating to patients and providers, many doctors ditched the system altogether while others went into the primary care business.

On average, members of these direct primary care clinics pay as little as $60 per month, with couples paying about $150, which is a lot less than the cost of full medical insurance.  Without having to handle heavily regulated middlemen, patients have a clearer picture of how much they spend on their health by being members of such practices. They also enjoy the peace of mind of knowing their doctor.

Studies have already demonstrated that when there is good communication between doctors and patients, treatments are more efficient. This is not simply because doctors are giving patients attention, but also because they are able to tailor a certain treatment to that patient’s lifestyle, health, and activities.

What many people don’t understand about government-run medical care is that government bureaucrats apply a one-size-fits-all mentality to everything, but what bureaucrats fail to understand is that they do not possess all the answers. Only a doctor who is paying attention will be better able to help the individual patient. Those needs cannot be addressed by a few thousand new regulations under either the ACA or the AHCA.

What this growing movement seems to suggest is that, even if doctors and patients are unaware of the interventionist forces driving the cost of doing business and receiving medical attention, they’re still driven into the open arms of the free market at some point or another.

Sherry Parnell

Author of "Let the Willows Weep"

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