Vol. 178 October 1, 2017 What is Single-Payer Health Insurance?

October 1, 2017

Now that Bernie Sanders is again firing up the discussion about single-payer health insurance, it might be a good idea to review this complex issue. So, here’s a short self-test for you to gauge your understanding of what Bernie, and a lot of other people, are talking about.  The correct answers are supplied right away, so you won’t stay confused for long. Since this is an internet-based test, YOUR ANSWERS, of course, WILL BE COMPLETELY ANONYMOUS. Nothing will  be recorded by NSA , Equifax, or the Russians.

 

“Single-payer” means:

  1. socialized medicine
  2. 100% of health care costs are paid for with taxes
  3. Pop-Pop picks up the dinner bill for everyone
  4. none of the above

Answer: 4. none of the above – In socialized medicine health care facilities and providers are owned by the government. “Socialized medicine” is a pejorative term which is now irrelevant since at least 70% of U.S. healthcare costs are already met by tax dollars  from Medicare, Medicaid, or the Veterans Administration. “Single-payer” is just an insurance scheme for public or privately owned services. In countries with universal health care insurance 77%-87% of costs are met by taxes. In the U.K. private insurance pays for about 13%. Pop-Pop gladly picks up the dinner bill for his children, but health insurance is still on them.

The number of countries with universal health insurance are:

  1.  1
  2.  2
  3.  3
  4. 58

Answer: 4. 58 – Germany in 1883, France in 1945, UK in 1946, Australia in 1975, Canada in 1984, Israel in 1995.

A basic tenet of single-payer insurance is that everyone will be covered without regard to income level:

  1. true
  2. false
  3. true, but …

Answer: 3. True, but … it will take years to bring everyone in the U.S. under “Medicare For All”.  Each year or so another decade of ages will be added to the coverage. States will need to coordinate their income-based Medicaid programs with “Medicare For All”.  Some states could request and receive waivers from the national program. Etc., etc., as incrementally we always go.

Universal health care insurance in other countries is administered:

  1. nationally
  2. regionally
  3. locally (municipalities)
  4. all of the above

Answer: 4. all of the above – Germany has 1100 public and private “sickness funds” with a national standard level of coverage. In the Netherlands health insurance is administered by municipalities that levy local taxes to pay the costs. This  apparently enhances transparency and both taxpayer and patient satisfaction. Conclusion: If you have seen one system of universal health coverage, you have seen ONE. By the way, isn’t “sickness fund” a much more honest name for insurance which pays for medical care and does not necessarily buy “health”. (Leave it to the Germans to say it like it is).

Universal health insurance is based on which basic insurance principles:

  1. spread the risk over the greatest number of people
  2. use education and regulation (i.e.. fire laws) to reduce the highest risks of loss
  3. if you win (stay healthy), you “lose” (your premiums). If you “lose” (get sick), you win (care is paid for)
  4. use excess premium revenue to build fancy office buildings and pay for expensive lobbyists .

Answer: 1-3 (see subsequent question for further information on #4)

Single payer health insurance will cost less to administer than our present system:

  1. true
  2. false
  3. true, but …

Answer: 3. true, but… maybe not as much reduction as we hope. Administrative costs for the individual provider will probably remain the same because “meaningful criteria” compliance, complex diagnostic coding, need for medical necessity justification, and need for data showing that quality is not being eroded will continue to require significant personnel time and computer capability. Remember also that Medicare is currently administered in large part by “fiscal intermediaries” like Blue Cross. That probably won’t change. Some predict that because of continued pressure on a single-payer to reduce costs, it may, if fact,  get even more complicated for providers to get paid for their services. Of course, the huge consumer advertising, employer marketing, and lobbying expenses of private health insurance companies will be greatly reduced when the market share of private insurance is reduced to 10-15% as has occurred in other countries. If only we could get Visa to run Medicare’s fraud protection system!

Why not “Medicaid For All”;  could individual states institute universal health insurance so that we wouldn’t have to wait for a national consensus?

  1. no
  2. yes
  3. yes, but…

Answer: 3. Yes, but … the hallmark of universal health insurance in other countries is a consistent standard of coverage for all residents. Medicaid programs are state-specific and coverage is extremely variable, as is provider payments. If you see one, you have seen one. Attempts to waive the Obamacare national standards by those wishing to repeal it spotlighted the potential glaring inequities. But, Massachusetts has done it for 90% of its population, and there are bills in its legislature to do it for all. California is attempting to do it. Most California families and businesses, a University of Massachusetts study has said, would pay less for health care than they do now, even with the new taxes, because they would no longer pay premiums, deductibles or co-pays. As Samantha Bee recently noted: “You don’t have to be racist anymore to believe in States’ Rights .”

Why is a single-payer sometimes described as a “double-edged sword”?

  1.  a single-payer could have much greater negotiating leverage with both suppliers (drug companies) and providers (doctors and hospitals)
  2. a single-payer would be perched on the sharpest edge of the cost-quality equation
  3. the standardization of payments by a single-payer could dampen innovation and hamper medical progress
  4. all of the above

Answer: 4. all of the above – More leverage against the drug companies is “good”. More leverage against the providers could be “bad”.  Despite studies that show that good quality care is less costly, many still see a dichotomy between cost and quality. Concern about hampering innovation (“new ways of doing things”) with excessive standardization (“the old ways”) was one reason Obamacare created a Center for Innovation within Medicare as part of the ACA .

Who is in favor of single-payer health insurance?

  1. 60% of those polled
  2. 38% of those polled
  3. depends on the nature of the poll
  4.  all of the above

Answer: 4. all of the above – The 60% in favor of single-payer health insurance dropped to 38% when the question was tied to one about increased taxes. The most recent Harris-Harvard poll (9/17/17) showed that 52% were in favor of single-payer insurance. 69% believe that it would provide more coverage, including 54% of Republicans. . Most of the other questions about a governmental single-payer were 50/50 pro and con. Some physicians, hospitals, and other providers are in favor of single-payer insurance.

What are some of the barriers to implementing single-payer, universal health insurance in the U.S.?:

What does President Trump think?:

 

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Vol. 168 April 1, 2017 Trump Tweets About Medical Tourism

April 1, 2017


“Medical Tourism is where people who live in one country travel to
another country to receive medical, dental and surgical care.”

Medical Tourism Association


We believe the market size is  $45 – 72 Billion based on approximately 14 million cross-border patients worldwide spending an average of $3,800-6,000 per visit.  We estimate some 1,400,000 Americans will travel outside the US for medical care this year (2016).”
 – Patients Beyond Borders


@realDonaldTrump
 
 People will do ANYTHING to escape Obamacare. TRUE fact! #obamacareimploding


“Using US costs across a variety of specialties and procedures as a benchmark, average range of savings for the most-traveled destinations:
Brazil: 20-30%
Costa Rica: 45-65%
India: 65-90%
Malaysia: 65-80%
Mexico: 40-65%”

@realDonaldTrump 
TREMENDOUS deals, and I love a deal. Except maybe for that Mexican country. I want them making big profits to pay for the wall. #BEAUTIFULwallfrombladders/gall

“Igor Lanskoi, Advisor to the Russian Health Minister, says the number of medical travelers coming to Russia is increasing, with four times as many foreign patients entering the country in 2015 than in 2014.  Last year, foreign patients brought in nearly 10 billion rubles, or $154 million, in revenue for Russia. More and more Americans are traveling to Russia to improve their health. “

@realDonaldTrump
                             Just watched the totally biased and fake news reports of my partnership with the Putin Institute of Plastic                                 Surgery and Tanning in Moscow on NBC and ABC. Such dishonesty! #palesbycomparisonwithTRUTH!

@realDonaldTrump
                              How would they know? More FAKE news! I don’t even know where my money is. All my businesses are                                      with my kids now. #note2IRS#4getCaymanIslands  

When someone wants to undergo treatment in his own country but his insurance doesn’t cover it, he gets angry and chooses to come to Russia since here he can receive the same medical services at a much lower price,” said Yakov Margolin, General Director of the Clinical Hospital in Yauza.  – Rise of Medical Tourism in Russia
 
@realDonaldTrump
I usually don’t agree with the Russians, but America hates Obamacare! SAD but TRUE.
  Suck it up liberal                                  
Democrats… and Freedom Caucus.  #PaulRyan/wimp

Cosmetic and dental surgery are the most frequent treatments sought by medical tourists. Plastic surgery is a close third.

@realDonaldTrump
                              I don’t care. NOT interested. Ivanka needs none of that anymore! #URbeautifulbabe#hairtransplant

Medical travel to Israel has shown significant growth over the years and was recently ranked as the world’s third most popular medical travel destination by VISA and Oxford Economics. – Medical Tourism Magazine 

@realDonaldTrump
                              NO new hospital buildings on the West Bank! Jared says we have an agreement. BETTER BE                                                          TRUE! #gojewishsoninlaw

@realDonaldTrump
                             I love Jews. I have made lots of H-Y-UGE deals with Jews. The Palestinians? Not so much.                                                                     
#go4thejewishvote  

“Some insurers and large employers have formed alliances with overseas hospitals to control health care costs, and several major medical schools in the United States have developed joint initiatives with overseas providers, such as the Harvard Medical School Dubai Center, the Johns Hopkins Singapore International Medical Center, and the Duke-National University of Singapore.” – CDC Yellowbook on Medical Tourism

@realDonaldTrump
                             Like Ghandi – a great friend of mine – said last week, “Just follow the money”. #greatquote

The administration’s reduction and delay in issuing H-1B visas will drastically reduce the number of International Medical Graduates allowed to enter the U.S.  Since 25% of U.S. working physicians are IMGs this will exacerbate our physician shortage, particularly in underserved rural areas.  – New England Journal of Medicine

@realDonaldTrump
                             If you can’t find a doc here, just go to THEIR country. SIMPLE! #betterthanOcare

Funds withdrawn from Health Savings Accounts (HSAs) can be used for medical treatments outside the country.

@realDonaldTrump
                              But come to Florida for your tan.#tanningboothtax/gone

HAPPY APRIL FOOLS DAY
(but only the tweets are made up)


Vol. 140 January 15, 2016 A Review of 2015 Hubslist Blogs

January 15, 2016

Hub thumbnail 2015

 

Click on the date to see the full blog

 

January 1 – 5 out of 10 of my resolutions were “kept”. You guess which ones.

January 15 – 6 reasons why patients are non-compliant , excuse me, “non-adherent”- the new PC term, with their medications.

February 1 – incidence of sudden death while watching the Super Bowl (Patriot fans probably don’t have to worry about that THIS year.)

February 15 – some myths revealed about cholesterol in your diet, global warming, measles vaccination rates, herbal supplements, and Dr. Oz, vendor of snake oil(s).

March 1 – 8 new causes of death caused by cigarette smoking added to the previously identified 12; a total of 20.

April 1 – Athena Health purchases MySpace which raises more concerns about privacy of health care data (April Fools edition).

April 15 – what does a “board certified physician” mean, and what does it have to do with Presidential candidates (Rand Paul)?

May 1 – physicians’ prognoses are often too optimistic for the same reasons patients’ are.

May 15 – E-cigarettes open new avenues for adolescent use of marijuana and synthetic cannabinoids (“bath salts”).

June 1 – annual review of sunscreens and bug repellents plus less universities providing student access to tanning booths.

June 15 – new forensic techniques of identifying individuals by bacterial, viral, and DNA “fingerprints”.

July 1 – 6 positive access outcomes and 4 positive health care delivery outcomes of Obamacare at 5 years of age.

July 15 – dangers of synthetic cannabinoids (attn: Chandler Jones?) and the minimal (“pending”) review of sunscreens by FDA.

August 1 – two websites with the best “symptom diagnosis” track record for helpfulness, and the one that is the worst.

August 15 – [ family vacation in a lighthouse without electricity or running water]
DSC01581

September 1 – why new drugs cost so much, no “gay gene” identified yet, and the myths of low testosterone, chronic Lyme, and  8 glasses of water a day.

September 15 – The health benefits of our “microbiome” and the “microbiome” of the New York City subway.

October 1 – the misleading, untruthful attacks on Planned Parenthood.

October 15 – the scope and magnitude of adverse effects of dietary supplements.

November 1 – transgender, transsexual, transvestite, and hermaphrodite, oh my!

November 15 – toddlers shooting people and other “norms” of gun deaths – “By Degrees“.

December 1 – changing advice about what NOT to eat during the holidays.

December 15 – the benefits of research using fetal tissue, short history of political attacks on Planned Parenthood, and why if you are NOT fat and live a long life you should thank your parents.

HAPPY NEW YEAR


Vol. 122 April 1, 2015 Athena Health Buys Myspace!

March 31, 2015

hub“Even as the public decries government spying programs and panics at the news of the latest data-breach the daily traffic to sites like Facebook and Twitter—especially through mobile devices—not only stays high, but continues to grow. Both the collective behavior of social sharing, and the technology for analyzing and interpreting social data, are already widely in place. The trick is to actually merge the two—which does not necessitate a whole new system.”

– Victoria Wangia, Professor of Health Informatics, University of Cincinnati
quoted in “The Facebook Model for Socialized Health Care” by Edgar Wilson, The Health Care Blog, 2/26/2015

Athena Health, a major provider of electronic health records (EHR) NOT to be confused with Anthem, has announced its purchase of MySpace, the pioneer social network.

MySpace (original spelling) was the first social network on the internet, but has steadily lost users to its competitor Facebook. Myspace (current spelling) was bought by Justin Timberlake in 2008. Despite efforts to revamp and redirect, Myspace user registrations continued to decline, and it has become a limited network for musical performers. Mr. Timberlake is confident that this move with Athena Health will broaden the scope of his company positively, “I am looking forward to making a more significant contribution to society than singing “D**k in a Box” on Saturday Night Live’s Christmas show”.

Jonathan Bush, CEO of Athena Health and related to both presidential Bushes, says he is making this move because it is time that health care providers make more innovative use of the social networks. Athena Health, based in Massachusetts, already provides electronic medical record (EMR) capability to health care providers nationwide. AthenaClinicals, its popular cloud-based electronic medical record and billing program, is available on desktop and mobile computers via AthenaNet. Its 2007 initial stock price of $18 is now at $120.

Using well-tested Facebook-like methodology Athena Health will create a wall, “The Health Wall”, in everyone’s Myspace account which will be renamed AthenaFace. This will add new meaning to “updating your status”. “Sick”, “Well”, “Recovering nicely”, “Waiting to find a doctor”, and “A little worried about what is happening to me” will be examples of clickable boxes.

Pop-up ads and informational banners will be health-oriented. Such as:
“Check your immunization score FREE”,
“Need help figuring out your Health Insurance deductible, Obamacare tax credit, or fine?”,
“Find the Nearest Medical Marijuana Dispensary”, and
“Special discounts on fitness club dues”.

AthenaFace representatives neither denied nor confirmed plans to link up with Groupon, another semi-floundering internet company, that provides discount coupons for a whole variety of services and products.

Record entries will be encrypted and saved, of course, though users will have the “Snapshot option” of having certain parts of the record being deleted within 30 seconds of being read. “The Health Wall” will accept postings of pictures and videos which will certainly enhance the robustness of the medical record for skin rashes, wounds, gait disturbances, and seizure disorders.

Efforts to link with relevant mobile apps like “Breathalyzer”, “Fitbit”, “Sleepbot”, “Whazthat!?”, etc. have already begun.  An app to link with Uber for the “Next available doctor to see you” will be in the first upgrade. However, that app, UberDoc, will include a charge. Prices will vary depending on circumstances, so customers will be urged to settle on the price before taking the appointment.

In response to critics who worry about the security of personal information in a combined health care/social network platform Jonathan Bush has stated, “Lots of people are obviously not at all concerned about such privacy issues. They are sexting and sending pictures of their genitalia all over the internet. Why would they care if somebody knew their blood pressure and cholesterol level? ”

But, AthenaFace will have different levels of privacy options that can be set by the user. On the user-sharing side the options will include:
“All”,
“Family and Friends”,
“Just Family”.
“Just (insert name here) ”, and
“Nobody”.

For provider-sharing the options for the customer will include:
“All”,
“Specialists Only”,
“Primary Care Only”,
“Dr.(insert name here)” , and
“Nobody, especially that nosey office nurse who thinks she runs the place.”

Why wait until your physician and hospital catches up with the federal EMR incentives for establishing a patient portal?

Do it yourself with AthenaFace!

Coming soon to your internet browser, but most probably after 2016 … depending on election results.

HAPPY APRIL FOOLS DAY.


Vol. 117 January 1, 2015 New Year’s Resolutions

December 31, 2014

hub“I can resist everything but temptation.”
-Oscar Wilde

Recent “scientific” surveys reveal that 45% of us in the U.S. make New Year’s resolution but only 8% succeed in fulfilling them. Those under 30 years of age apparently do much better; 16% of them succeed. (1) Here is another statistic that is hard to believe: “38% of 2600 respondents polled by their fitness program failed to accomplish their fitness goals in the past year”. (2) Boy, talk about underreporting!

It makes me wonder, “why bother?”.  But, the social pressure of age-old traditions is unremitting, so here are my 2015 resolutions. (Maybe my first one should  “be stronger against social pressure of age-old traditions”. )

In 2015:

1. I will continue to resist committing myself fully to the social media fray while I patiently wait for the ultimate app, “TwitterFace”, “FaceTube”, “InstantaYou”.

2. I will no longer make wise cracks about brussel sprouts, broccoli, and eggplant dishes now that my grand children like them, but I still don’t eat them.

3. I will start the Paleo diet (no grain, no processed foods, no sugar, no milk – basically “what a caveman would eat”) as soon as Market Basket or Stop and Shop puts saber-tooth tiger steaks on sale.

4. I will try to treat anti-gun control and anti-vaccine advocates with respect since they are probably rational people, even through their arguments are irrational.

5. I will read the computer screen from left to right, line by line, and word-for-word before I call my son when I lose my way, since that is the first instruction he will give me. (It unravels my confusion about 95% of the time.)

6. I will not spend hours this year comparing bills while trying to decide whether Verizon or Comcast has the best “bundle”. (It always seems fruitless no matter how or when I do it.)

7. I will continue to collect articles and study results that promote the health benefits of an afternoon nap, but I will also stop my occasional designation of a nap as my ”accomplishment for that day”.

8. I will wear my new, gifted fit-bit bracelet (Jawbone-UP/24 which apparently measures all my activity and my non-activity) for at least a month, even though I probably won’t understand all of its features by that time. (If all else fails, I will download the manual, if I can find it on their website.)

9. If I find myself using my son-in-law’s or daughter’s Netflix password on my home TV more than once a week, I will get my own subscription.

10. I will complete and publish my compilation of “You may be a Geezer if…” aphorisms.

That’s it.
Nothing magic about the number ten except that it avoids any connotations of the number 12, either disciples or members of a jury.

Feel free to add any of your own resolutions here. Maybe announcing them will generate some needed social pressure on you to succeed.

References:
1. Jour of Clinical Psychology, 1/1/14
2. New.Health.Com/2014/BlueGojjPlatform

 

 

 

 


Vol. 115 June 15, 2014 Sometimes a picture IS worth a thousand words.

June 15, 2014

 

hub

THE LAST OF MY “FOOD BLOGS” FOR A WHILE.

After blogs about the evils of excess added sugar, added trans fats, the obfuscation of ingredient lists, and manipulative marketing by food manufacturers  I find it easy and appropriate to finish up this series with pictures that capture more than I can write.

 

Food cartoons1

 

Some churches have come up with the ultimate answer to WWJD?  Gluten-free communion wafers!!

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Food cartoons2

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Wouldn’t it be great if parents were as paranoid about gun deaths – 500 children per year – as we are about peanut allergy deaths – 150 children and adults per year.

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Food cartoons3

As a pediatrician with 45 years of experience and a grandfather, I think that the moment depicted here is much more important in the long run for the child than reading the % of trans fat or sugar content in the ingredients list.

 


Vol. 111 April 15, 2014 Who’s On First?

April 15, 2014

Abbott_and_Costello_9396

Washington – April 10, 2014
“A welcome relief from rising health care cost for U.S. consumers is being less warmly received by the Federal Reserve.”

Mr. Abbott, a Washington economist, is heard explaining it to Dr. Costello, a physician.

A: The cost of health care services rose just 0.8% this year.
C: That’s good news. We all have been working hard to reduce costs,what with meaningful use, and evidence-based medicine, and transparent patient portals. It’s hard work.
A: Its not good news.
C: What?
A: Health care sevice prices are down from its 10 year average of 2.6% increase.
C: That’s really good.
A: No,its not.
C: Why?
A: It’s a sign of persistent deflation.
C: Aren’t we afraid of inflation?
A: Not now.
C: What?
A: Their current goal is 2% inflation.
C: Whose?
A: The Federal Reserve.
C: Who?
A: They measure the economy.
C: How?
A: Using the Personal Consumption Expenditures or PCE.
C: What?
A: LIke the Consumer Price Index, the PCE measures what people spend on things.
C: Why?
A: People spending more money on things means the economy is growing stronger.
C: Who says?
A: Mr. Bush. Remember, he asked us all to go shopping to get out of the recession.
C: Where?
A: In America, of course.
C: What do health care services have to do with the mall?
A: Health care services make up 25% of the prices measured by the PCE.
C: So what.
A: Physician fees went up only 0.2%, down from 1.6% in 2012.
C: THAT’S not good for me!
A: No, its not.
C: What!?
A: Nursing home prices went up only 0.3% rather than the 1.8% rise of two years ago.
C: I know, I know. That sounds good but its not?
A: Right!
C: Why?
A: If health care prices don’t go up, the PCE doesn’t go up, and our economy looks stagnant.
C: Oh, boy! I think I got it. If all the efforts to reduce health care costs succeed, the PCE will not rise, inflation will be less than 2% a year, deflation will persist, and the Federal Reserve will label the economy as stagnant.
A: Now you’ve got it!
C: What about the impact of the Affordable Care Act?
A: Economists agree that the impact of Obamacare is not yet clear.
C: Oh boy!
A: Any questions?
C: Just one.
A: What?
C: Who’s on first? 


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