Category Archives: healthcare

Going Backwards

The Senate’s “Better Care” reconciliation bill appears to be the shit-show we all knew it would be. You can read the non-partisan CBO report here. But I’m sure we’ve all heard the “22 million more uninsured” talking point which has come out of the report.

I feel like “22 million” doesn’t sufficiently illustrate the situation. So just to explain what this means: according to the CBO, there will be 49 million uninsured Americans if this reconciliation bill passes, compared to 28 million under the current law.

From the report:

49 million.jpeg

Just to remind people: in 2008, when “the crisis of the uninsured” became a major issue in the 2008 presidential campaign, there were 47 million uninsured in America.

This bill doesn’t just take us back to the pre-Obamacare days, it makes it worse.

Carry on.

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Filed under health insurance, healthcare, Obamacare

Repeal Proceeds, Replace Not So Much

Just to build on this post, I woke up to a flurry of headlines about the repeal of Obamacare (here, here, and here), but very little has been said about what will replace it.

Meanwhile, the New York Times reports that Trump supporters are not exactly fired up about repealing the healthcare law:

Those voters have been disappointed by Obamacare, but they could be even more disappointed by Republican alternatives to replace it. They have no strong ideological views about repealing and replacing the Affordable Care Act, or future directions for health policy. What they want are pragmatic solutions to their insurance problems. The very last thing they want is higher out-of-pocket costs.

Yes, well, duh. I’ve been saying this for years, haven’t I? And thank you, Kaiser Foundation, for actually asking people what they want. Because this conversation seems to have ignored the healthcare consumer, hasn’t it? We hear precious little from actual people about healthcare, but we sure hear a lot about what the insurance companies want, what the AMA wants, and what BigPharma wants. I’m tired of hearing what they want. If repeal is inevitable, shouldn’t we find out what consumers want (and don’t want) to replace it?

Things I don’t want:

• I don’t want to “shop” for healthcare or my health insurance. I hate shopping anyway, but who wants to “shop” for something like health insurance? People, I do not have the time for that! This infatuation with “shopping” and “marketplaces” in America is something I do not understand. People want to shop for fun stuff. They do not want to shop for un-fun stuff.

I don’t want to compare healthcare plans and read the fine print and find out who’s selling me a shit sandwich and who’s selling me a Tiffany watch. I don’t want to think I have the Tiffany plan only to find out, too late, that I bought a shit sandwich and oh well, sucks to be me. This is not how healthcare is supposed to work.

• I don’t want a “health savings account,” a tax deduction for making a contribution to said “savings account,” or a voucher, coupon or other gimmick. This is something else I don’t get. Conservatives are always saying you can’t throw money at a problem but isn’t that what these special accounts and vouchers do, at their heart? So I have a pile of money I can use as I see fit, so what. That’s great when I’m healthy, but what if something awful happens and my costs exceed what’s in the account? What if my kid gets leukemia and my husband gets in a car accident? Who has the time to keep up with all of the red tape and paperwork associated with these accounts? Everyone is already complaining about how complicated taxes are, but an HSA just adds to that. You have to keep every single receipt and keep up with your statements and there are fees associated with these accounts and it’s just a ginormous headache.

• I don’t care if I can buy health insurance across state lines. What is the point of this? Republicans always mention this as a key part of their plans, but how is this supposed to make my life better? I know the idea is that it will create “competition” and thus lower costs, but does it really? Where is the evidence of this? There is none. In fact, Medicare Advantage plans are uniform across the country, but there are still very limited choices, which means removing the hodge-podge of state regulations really doesn’t increase “choice.”

Furthermore, the insurance companies themselves have not embraced this idea.

Healthcare is not laundry detergent. There are huge regional differences in people’s health. It’s well known that Southern states have some of the worst health statistics in the country: higher rates of obesity, diabetes, heart disease, etc. This is where insurance is more expensive. In states where people tend to be healthier — California, Colorado, Minnesota — insurance tends to be cheaper. So wouldn’t allowing someone in Alabama to buy insurance from Colorado actually increase costs because you’re adding all those unhealthy Southerners into the pool?

• I don’t want medical malpractice “reform.” This is another favorite Republican talking point: medical malpractice insurance is killing healthcare, frivolous lawsuits are killing healthcare, etc. It’s not true. And if some Doctor Fuckup injures a patient, that patient should have the right to sue.

Speaking of frivolous lawsuits, you know where they don’t have to worry about that stuff? Countries with a functioning healthcare system. Let my tell you about my American friend who opened a hotel in Norway. When he asked about liability insurance for the property, his Norwegian business partners looked at him like he was crazy. They don’t have that here, they said. What would be the point? My friend said, you know, if someone slips and falls in the lobby, they could sue to get their medical costs taken care of. They laughed at him. Why would someone do that? The social safety net already takes care of people’s medical costs in Norway! And a big ol’ lightbulb went off.

• I don’t want to have to fly to Poland to buy insulin. Seriously, you know your healthcare system is broken when this happens:

One man in Pennsylvania with Type 1 diabetes reported making frequent trips to Eastern Europe to purchase insulin at one-tenth the cost he paid here.

This is not unusual. I have a friend who lives part-time in India, part-time in the U.S. She broke her foot a few years ago and had it fixed in India for $15. She said this was a good deal, even when one includes the airfare, because back then she didn’t have insurance. This strikes me as ridiculous, but this is what right-wingers gleefully call “medical tourism,” as if flying to Thailand for your heart surgery makes sense. Yeah, if I’m going to Thailand it’s as a tourist, not a patient.

Okay, in summary: I don’t want red tape and paperwork, high prices, a lot of extra work and time spent figuring coverage out or getting the healthcare I need, or unreasonable restrictions on who I can see or what is covered.

What do I want? What does anyone want? This:

1) I JUST WANT TO SEE THE DOCTOR OF MY CHOICE WHEN I NEED TO WITHOUT DRAINING MY BANK ACCOUNT. 2) I WANT TO GET THE PRESCRIPTIONS I NEED FROM MY LOCAL PHARMACY WITHOUT TAKING OUT A SECOND MORTGAGE.

It’s really that simple. Just those two things. Any plan, be it from the Democrats or the Republicans, needs to address those two simple things. If it doesn’t, then I’m not interested.

I say “simple things” but I realize it’s far more complicated than that. But seriously, it shouldn’t be that hard to figure this out.

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Filed under health insurance, healthcare, Obamacare

No Good Healthcare Answers

There’s been a lot of chatter lately about the repeal of Obamacare and the complicated reality this oft-repeated campaign promise presents. It appears Republican mouths may have written a check their elected politicians can’t cash. It seems obvious that despite all their talk of “repeal and replace,” Republicans really don’t have any idea how to “replace” Obamacare, perhaps because the ACA was the GOP’s “replacement” for Democrats’ push for universal healthcare in the first place. Once Democrats adopted the Heritage Foundation’s 1989 healthcare plan, Republicans reflexively opposed it and used it as the lynchpin of their “Operation Obstruct Obama” strategy.

Well, chickens have come home to roost and surprise, surprise, some Republicans are now saying the actual “repeal” might not happen until after the 2020 election. Does this make sense to anyone? Eight more years of people getting used to Obamacare, getting more dependent on the things they like about it, while Republicans back down on a promise in the hopes of continuing to use it as an election tool? Or something? What about that old boogeyman, “uncertainty.” Doesn’t promising to repeal something in eight years create uncertainty? Doesn’t it make it harder for people to accept one of the several sucky “replacement” ideas Republicans are currently arguing over?

So I don’t get it. And hey, it may not happen.

One thing that Republicans seem to really like are these Health Savings Accounts, Flexible Spending Accounts, etc. Apparently, they are “the future of healthcare,” and I hear them as parts of not only whatever will replace the Affordable Care Act but also Medicare reform and the like. We’ve had HSAs, HRAs, etc. over the years and I have to say, I don’t like them. There’s a lot of paperwork you need to keep up with, they all charge fees which eat away at your balance if you don’t use them, and I don’t understand the basic principle behind them.

There seems to be this idea that people are getting unnecessary healthcare and that’s why everything is so damn expensive, so an HSA/FSA will encourage people to be more responsible. I’m sure there are some people who run to the doctor for every little thing but from everything I’ve read, the problem is not that people are getting too much healthcare, it’s that they aren’t getting enough. They put things off until a problem reaches a crisis stage and they end up in the ER.

I don’t get this idea of being given a pile of money to spend, as if that’s going to solve everything. It’s great if you just have ordinary healthcare needs, but what if your family gets hit with a couple of catastrophes? What if you run out? Are you supposed to decide whether to give your kid leukemia treatment or dad gets to go to the hospital after his car accident?

We’ve had an old HSA plan that still has about a thousand dollars in it, going back to some ancient iteration of our health insurance plan. We only use it to buy eyeglasses, but every quarter they take out more money for “fees,” eating away at what’s available for us to actually use.

I know as a good liberal I’m supposed to embrace Single Payer. In principle it’s a good idea but I don’t think it will ever happen and I’m starting to think it’s a waste of time to keep pursuing it, seeing as how we’ve been trying — and failing — to get universal healthcare for over 100 years now. We’ve now reached a point where our current private insurance system, flawed though it is, is too interwoven into our economy to dismantle it. I absolutely hate insurance companies, with a passion, they no longer serve the function they were created to do, and yet they have become such a big part of the economy I don’t see them going away, do you?

And don’t even get me started on Bernie Sanders and his plan for Medicare For All. I never understood how that was supposed to work for the majority of us who get insurance through our employers. Insurance is a benefit. It’s in lieu of a higher salary. Do the Bernie people really think that if employers don’t have to provide that benefit we’re all going to magically get comparable raises?

I’ll admit that I’m no expert on this stuff. I really don’t understand what’s happened to our healthcare system. I don’t understand why everything is so damn expensive now. It didn’t used to be this way. What happened? Can someone explain this to me? One thing I know for sure is that back when I was a kid, the family doctor didn’t drive the most expensive car and live in the biggest mansion in town. Nowadays, our local “headline homes” report of multi-million dollar home sales is routinely populated with healthcare executives, doctors and the like. Some people are getting really rich off our healthcare system, while too many other people are going broke because of it. Does this make sense to anyone?

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Filed under health insurance, healthcare, Obamacare

Told Ya So, Part 2

I always knew the over-hyped Elizabeth Holmes and her equally over-valued company Theranos were too good to be true:

United States regulators have banned Elizabeth Holmes, the chief executive of Theranos, from owning or operating a medical laboratory for at least two years, in a major setback for the embattled blood-testing start-up and its once widely lauded founder.

In a statement late Thursday, Theranos said the regulators revoked the certification of its Newark, Calif., laboratory and prohibited the laboratory from taking Medicare and Medicaid payments for its services. Regulators also levied a monetary penalty that Theranos did not specify. The sanctions take effect in 60 days, Theranos said.

I mean geez, when Henry Kissinger and Bill Frist are on the board of directors, you know there’s a rat somewhere. And I never bought Homes’ founding story, which read like something Aaron Sorkin would have dreamed up:

Theranos and its young founder in particular offered a compelling narrative in the crowded start-up universe: a brilliant college dropout with an audacious idea that would upend the medical testing business. Ms. Holmes invited comparisons to the Apple co-founder Steve Jobs because of her youth, her tight control of the company she founded and even her customary black turtleneck sweaters.

Ms. Holmes began the company in 2003 after dropping out of Stanford University at the age of 19. Her goal was to create a new way to perform blood tests that relied on a few drops of blood rather than the larger amounts medical testing often requires. Tests would be cheaper, the argument went, and more people would be inclined to get them. In interviews focused on Theranos’s success, she said the idea came from her fear of needles.

Yeah, turns out it was all bullshit.

(For background, see here and here.)

Comments Off on Told Ya So, Part 2

Filed under healthcare

Taxes & Presidential Candidates

It’s that time of year again when we all must render unto Caesar, so this seems like a good time to compare the candidates’ tax plans.

Not too long ago Vox and the Tax Policy Center teamed up to provide this handy tool where you can calculate how much tax you’d pay under each candidate’s plan.

Keeping in mind that these are estimates, I used the calculator and found that the Beale household would pay $270 more a year under a President Hillary Clinton and … wait for it … a whopping $16,000 a year more under a President Bernie Sanders.

(In the interest of fairness, let me point out that we’d evidently pay $14,340 less under a President Cruz, but in no way would I ever vote for Ted Cruz. The entire nation would pay in so many other ways, for a generation or more. It hardly seems worth it to give up the Supreme Court for that.)

The upshot is, we simply could not afford Bernie Sanders’ tax plan. When I mentioned this a while back, a Bernie supporter told me that we’d actually come out even or maybe even a little ahead because universal healthcare would magically happen somehow, and we’d save money in the long run because we wouldn’t have to pay monthly health insurance premiums.

Ignoring all of the very real questions about how universal healthcare could happen with a gerrymandered Republican House and recalcitrant Republicans in the Senate, I have another question nobody has asked. Let’s pretend for a second that Bernie gets his “revolution” and universal healthcare happens. Could someone explain to me how people such as myself realize this insurance premium savings in the real world? Our family, like most American households, gets its health insurance through an employer. We don’t pay out of pocket for it: it’s an earned benefit.

So for people like us, who represent more than half of insured Americans, how do we realize this supposed health insurance premium savings? Is the Sanders camp assuming that employers will just raise everyone’s salaries, dollar-for-dollar, the same amount they’re paying on employee healthcare? Does anyone seriously think this would happen? Are they expecting this to happen voluntarily, or is there some legislative hammer they would enforce implement, forcing private employers to pay their employees the cash amount of this earned benefit? And does anyone think this would pass a Supreme Court challenge?

It just seems to me that the more you unpack Bernie’s pretty little packages, the more you find they’re filled with sawdust.

I don’t mind paying $270 more a year in tax so that low-income families have Head Start classes and all the rest. But paying $16,000 a year on some unrealistic promise of universal healthcare which doesn’t seem possible, let alone reasonable, strikes me as a stretch.

What am I missing here?

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Filed under 2016 Election, 2016 Presidential Election, healthcare, taxes

Told Ya So

My bullshit meter smelled a rat when Theranos was first hailed as the greatest thing since sliced bread, and CEO Elizabeth Holmes was being elevated to Tech Hero status.

Seems I was right:

Theranos, the Silicon Valley blood-analysis upstart founded by Elizabeth Holmes, is under fire.

The Wall Street Journal and others have questioned the company’s technology, which is supposed to require only a tiny sample of blood to deliver accurate, quick and cheap test results. Ms. Holmes and Theranos have fired back with counterclaims and additional information, but the company’s purported $9 billion valuation now looks overestimated.

[…]

On Friday, though, The Journal reported that a Theranos partner, the pharmacy chain Walgreens Boots Alliance, was postponing its introduction of the company’s testing centers. That suggests that even after 12 years of development, Ms. Holmes’s approach is far from proven. In any case, the promised tiny finger-stick blood samples and proprietary equipment aren’t yet being used for most tests. That makes Theranos look more like a small, cut-price version of testing incumbents like Quest Diagnostics and LabCorp than a disruptive force.

I just felt all along that the hype surrounding Theranos was more about promoting Holmes and elevating the price of her upstart’s stock than anything else. It just had the whiff of scam to me.

Will be interesting to see how this all shakes out.

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I Have A Steaming Cup of STFU For HCA/Centennial

[UPDATE]:

Oh, God. It’s worse than we thought. I just heard two stories from people in my same insurance group that are as bad if not worse — both involving emergency care. One at Vanderbilt hospital.

Let me repeat: we all have excellent insurance. We have an HRA which pays 100% of the deductible. I’m not out one penny and the hospitals aren’t footing the bill for anyone. You will get your money from us. Leave us the fuck alone.

It appears the entire hospital system is trying to harass and bully fully insured patients into paying more/sooner. Hey fellas, if you have a beef about payment, take it up with AHIP. Patients shouldn’t be put in the middle of this.

More suckitude from the “best healthcare system in the world.” Baaah. I don’t know why we have to put up with this bullshit.

—————————————————————————–

Dear HCA/Centennial: I am beyond tired of you dicking me around on payment for a goddamn mammogram. You do this every year. The creative lengths you go to wrest payment from me, the patient, instead of waiting for BlueCross-BlueShield to pay you, as they do every year, has grown old.

You will get your money. You always get your money. You have never not gotten your money. I have top-notch insurance for a reason, one of them being so I don’t have to deal with some hospital billing office calling and sending me invoices when they haven’t even given my insurance company sufficient time to process payment. I’m just sick of it.

So this year I go in for services at the end of May, they billed insurance on June 3, and they sent me a bill on June 8. That’s barely time for BlueCross-BlueShield to receive the bill, let alone process it. I called the billing office and they apologized saying it was “a mistake” and I “shouldn’t have been sent a bill this soon.” Gee, ya think?

Thing is, a similar thing happened last year. I blogged about it here. That time it wasn’t “a mistake” but an “option.” I could pay now “if I wanted to” and have HCA pay me back when they got their payment from the insurance company.

Why the fuck would I want to do that?

Let me add, a neighbor of mine was in a horrific bicycle accident last year and got a whole bunch of diagnostic imaging services at HCA-Centennial. He told me they got the same “pay us now, if you want to” harassing phone calls. Followed by bills they knew they didn’t have to pay because it was covered by insurance. They wanted to know what that was about, too. They thought it was weird, too. It’s not just me.

You guys have to cut this out. It’s obnoxious and unnecessary. I”m sick of it.

I’m going to call my doctor and ask if someone else does mammograms in Nashville so I don’t have to deal with it anymore. I’m done with you people.

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Filed under health insurance, healthcare

I Don’t Understand This

[UPDATE]:

10/27/15

I said all along this was hinky.

——————————————————–

Can one of my readers in the healthcare field please explain to me what “consumer-based lab testing” is? AHIP (America’s Health Insurance Plans) is holding its annual convention in Nashville right now and one of our local biz rags gave a brief rundown of what they’re discussing. “Consumer-based lab testing” came up and it sounds all shiny-sparkly-free-markety-“let’s all shop for our healthcare”-y. And I’m just trying to understand who this is for:

“Without consumer engagement, there is no pressure for prices to go down,” said Elizabeth Holmes, founder and CEO of Theranos.

Theranos, which Holmes founded in 2003 and has former Sen. Bill Frist as a board member, offers accessible and affordable lab testing, with transparent prices available on the company’s website. Holmes likened consumer-based lab testing to at-home pregnancy tests, and said by making lab testing more accessible, early detection becomes possible for patients who are not a part of the existing health care system.

“When prices are transparent and consumers are informed, competition flourishes,” Holmes said.

What the fuck does this mean? If you’re not part of the existing health care system, it’s because you’re either too poor (but not so poor as to qualify for Medicaid), or else you’re one of those young fools who thinks they’re invincible. So you’re gonna, what, get a blood test or a PAP smear or funny lump biopsied by “shopping around” for your labwork? Without a doctor’s referral? I don’t get it. Who’s taking the sample? If it’s a PAP or a biopsy, you need to see a doctor. So I’m just confused who would be “shopping around” for their labwork.

And is cost really the only issue when it comes to who is analyzing your lab work? Or even the most important issue? Isn’t accuracy kind of important, too? Even more important than cost? I mean, I can divine your labwork by gazing into a crystal ball and I’ll do it for $5. Don’t think I’d get many takers.

Or is she saying this is for people who are in the healthcare system? So that when I get my annual PAP smear or have a funny lump biopsied, I’m going to have to shop around and tell my doctor which lab I want processing my test sample? Like I have time for this? Like “consumer choice” is something I have time to deal with in my life? (And yes, I’ve already been down this road with Bill Frist and his infatuation with “shopping” for healthcare). Because again, cost is the only thing I’m supposed to care about?

Please tell me what I’m missing here. I swear to Goddess, Republican infatuation with “shopping” is so far removed from the way most of us navigate our daily lives. I do not want to shop for this shit. Who would? What consumers want, and deserve, is the absolute best healthcare, when they need it, without having to go bankrupt. Always and forever. That’s not shopping, that’s fixing our fucked up system.

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Filed under health insurance, healthcare

My Annual Healthcare Rant

It’s time for me to get my annual mammogram at the for-profit HCA/Centennial, which means it’s time for my annual rant about our for-profit healthcare system. I blogged about my experience last year, in which I was offered an opportunity to pay for the service out of pocket upfront, at no discernible benefit to me because it’s all going to be paid by my insurance anyway.

So this year I got the same “give me my money” phone call, which they laughably call “pre-registration.” I give them my name and address and other contact info (which they already have because it’s in their system) and then I get the rigamarole about how much the service will cost — this time she’s clear to say it’s “because my insurance hasn’t been verified.” Last year, they just told me the service would be $150. So I’m glad they’re at least clarifying the insurance angle. But still, I’m supposed to do what, exactly, with this information? Start selling off the family heirlooms? I have insurance, mammograms are covered, now go away, please.

And then 24 hours later I get yet another phone call from the same person who “pre-registered” me yesterday, to say my insurance has been verified. Which you’d think would be good news, but in HCA Land, it’s actually another opportunity for them to try to get my money. For a 20% discount, I can pay now! Yes, that’s actually the deal I was offered. I can pay for the service at 20% off now, or I can do nothing and my insurance company will pay the full price (repriced, but whatevs). I mean, my insurance pays 100%.

I mean, seriously, people? WTF? Why not just lower your prices 20% and then we can all reap the reward of lower insurance premiums?

I cannot believe this is going on.

Mr. Beale is furious. He wants to know, if I do pay now at the 20% discount, and then BlueCross/BlueShield remimburses at 100%, who gets that extra 20%? HCA?

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Filed under HCA, health insurance, healthcare, Nashville

Republicans, Make Up Your Damn Minds, Already

[UPDATE]:

HA HA HA HA HA:

Sen. Rand Paul’s letter to Harry Reid about blocking Surgeon General nominee Dr. Murthy over gun control:

RandPaul

Full text at the link. My trolls who keep trying to blame Democrats for the stuff Republicans are doing can go fuck themselves.

—————————————————————————-

Proving yet again that there is literally nothing President Obama can do to please Republicans, Sen. Lamar Alexander is not happy with President Obama’s pick for “Ebola Czar.” (Keep in mind, the hissy fits/impeachment threats conservatives had over Obama’s so-called “Czars” in the first place make their current call for an Ebola Czar especially hypocritical):

“I had in mind a cabinet-level official with the skills of a four-star general or admiral who had a broad public health background and would be accountable to Congress. That kind of action would give Americans confidence about our government’s response to Ebola.”

Hmm … someone like, maybe, the Surgeon General we don’t have because the Republicans are too scared of the gun lobby to approve Dr. Vivek H. Murthy?

Honestly, I truly believe that President Obama could personally develop a cure for Ebola, cancer, and stupidity all in one tasty, affordable treat — but the GOP would complain that it’s gluten-free.

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Filed under healthcare, Republican Party, Sen. Lamar Alexander