What seems to be missing from the conversation is the fact that health care here in the US is a for profit system. Health care should be focused more on patient care, and less on making money. Every administrative decision in the healthcare industry is based on financial motives. Until the healthcare industry mindset is altered to prioritize patient care instead of their bottom lines, healthcare will remain broken. There are too many mitts trying to get their hands on money instead of taking care of people.
And concerns about higher taxes is ludicrous too. There is no way a revolutionary change to how we provide and pay for healthcare will cost more than the ridiculous high premiums and high prices we pay now. Obviously the healthcare industry (an oxymoron if ever there was one) is broken here. We don’t even know how to think straight about it.
I have narcolepsy with cataplexy and take a prescription that allows me to live a completely normal life but also costs roughly $20k per month. Once a year I come close to running out of medication or actually run out because my insurance company denies the prior authorization for my medication and my treatment team has to go through the appeals process then peer-to-peer in order to get the prior authorization approved. Every single year this happens, despite the fact that I’ve been taking this medication for over a decade. I for one would welcome with open arms reforms that put a stop to this kind of predatory practice. I’m sorry my medicine is so expensive. There are very few humans with my condition and I’m sure this drives the cost up. I think we also need additional reforms on prescription drug costs so insurance companies don’t have financial incentives to deny necessary care.
I love when an article comes up regarding possible upgrading of medical care. I work in primary care for many years and the prior authorization process is so messed up. It's at least, a delay in medical care and sometimes because of that authorization denial the patient is sent to the emergency room to get evaluated there and bypass the outpatient authorization denial just to hopefully get the necessary care needed and more expediently. And by sending someone for care to the emergency room, it is so much more expensive just to get the tests needed there because the outpatient authorization was denied. It is such a waste of resources. I tell people all the time, pick any country outside of the u.s and throw ours out the window and replace it with whatever country and I bet it is better than what we have here, hands down!
More centrist drivel that the people don't want. This is going to backfire bigger than just going all in on single payer. Time for the dems to be bold!
Honestly I think it would do more good in the long term to simply stand back and let the entire healthcare industry implode. Tinkering with a fundamentally defective system will win no hearts, minds, or votes.
Kinda appealing, Mr. McDonough, but infeasible. That sort of chaos would end in tears and recriminations. What would come next, and how would it do that?
Mr. McDonough, again I don't disagree with you. See my post above. As you can discern, I'm arguing for a new concept. But I'm old and old people have problems. I can't afford to have the system burn down before I die. Nor can you.
Well, very interesting. Economics in healthcare are important. Hospitals (at least in theory) spend their capital on improving care and must replenish it to keep in business. Physicians and other caregivers have invested more years and more dollars than most (but certainly not all) in their education and training, so they're rightful in expecting to get payment in recompense, recognition for their efforts, and (I, as a physician, hope) respect. So long as we have fully private insurers, their job is to deliver value to their shareholders. Nothing bad in any of that, I'd say.
But...but: What about the patient? All of this revolves around them. There would be no healthcare industries without the need to deliver for them. No question that there are only so many dollars available in any given time period to shift among all those competitors. I'm no sociologist and no economist, and, yeah, I'm a lazy, retired old man. I don't know how to look for it. But who...anybody...has taken a clean sheet of paper (or, in the current era, an unpopulated computer screen) with the sole aim of answering an heuristic query: Given that every single person in the U.S. is, at least in theory, a patient, either actively or potentially, WHAT'S BEST FOR THEM?
They well might arrive at some redone version of what we have now...though I beg to doubt that if they hew to the job of answering my question. The thrust of most of primary care (pediatrics, internal medicine, family practice, and often gynecology) is "patient centered care." While there are screwups, and some simple box-checking occurs, the idea is right and the intent is earnest and honest. In my experience, nearly every doc, physician assistant, nurse practitioner, RN, EMT, paramedic, and ib across healthcare support wants people to be well cared for, to feel seen and respected, and to be listened to and heard.
So...call me Pollyanna if you want, or demented far left liberal, which I ain't, but what if...and why in hell not? If EVERYONE has access to good care, it's pretty clear that total costs actually will go down. And they have to, if we're to keep on keepin' on. But that notwithstanding, doesn't that seem like the goal? Shouldn't be?
This is really exciting! I worked in health insurance plan development for years and watched it become so corrupt, both on the payor and the hospital side. I finally left because I couldn't change it from the inside. The last gold rush in was around the SNP (special needs plans) space, using elderly and disabled people for higher margins; the executive salaries are eye-watering; the fact that non-profit hospital systems are exempt when they don't fulfill their community support mandates is terrible.
The Dems need to present a plan to jointly (1) lowers costs, and (2) expands coverage. They are DOOMED if they present a complicated plan with caveats. The plan has to be a SIMPLE message that our SIMPLE minded population can understand. If it's written for policy wonks and political junkies the MAGAs will eviscerate it.
Some of these technical fixes may help with the cost of medical care, but they will not sound satisfying to users of our system. I think Elissa Slotkin's idea of an ACA public option for individuals as well as institutions would be a good start. Making Medicare available to younger people, starting at age 60 for example, should also help. If re-imbursement rates to doctors and hospitals decrease as a result, doesn't that help the cost of medical care?
As long as members of Congress keep taking campaign contributions from Big Insurance and Big Pharma, getting health care reform passed through Congress will be difficult. This also needs to be addressed. Congress needs to work for the people, not just the billionaires and their industries.
Private Equity - until private equity is removed from healthcare nothing will change. And I am doubtful anything will change until a politicians family member is injured or dies.
Great article. The scale of our challenge is daunting, with so many interlocking aspects:
1. would be great for patients (that's every one of us) for our education & licensing systems to produce significant increases in the number of medical providers. Meanwhile, govt policy is to reduce immigration, dismantle and defund higher ed, regulate the ed pipelines from pre-k-to-12 around anti-DEI and 10 commandments on the wall rather than promoting learning outcomes... But without way more providers, how can care be provided "for all"? ...let alone at manageable expense?
2. instead of focus on health care delivery systems, we focus on the financial industry, i.e. insurance. Insurers don't provide medical care. They perform accounting and investment functions, doling out and making money. Their business is not the actual treating of patients, yet they have enormous decision making control over the doctor-patient relationship
3. professional associations/certifications & state licensing complicate numbers 1 & 2 above. Regulatory capture is a thing. Lobbying by prof assns, I hate to tell ya: not always purely for patient benefit.
4. 300+ years ago the great health care analyst, Isaac Newton, laid it out simply: Inertia is a bit*#
Jeffrey - hey, that's the free market at work! ... 'course all those marketing costs gotta get paid for somehow, wonder where that cash might come from...? 🤔
I should have continued my comment with ..."more than we are bombarded currently!"
Several things that should never have been allowed to be advertised on TV: legal care and medical care/ medicine. I truly miss the days when those ads were banned from the public airwaves. But as you say, it's the free market at work.
It reminds me of the great promise made by the cable companies who told us that 200 TV channels would open up a vast new world of entertainment. While all we got was the realization of Newton Minnow's 1961 prediction of TV becoming a 'vast waist land'. There's a definite problem when one can channel surf 200 channels and find not one thing of interest. ]
Seems like for years they've been reading the fine print on prescription bottles to us in half the ads on TV... or maybe that speaks to the marketing dept's demographic analysis of my viewing habits? Lordee me.
It's okay expand coverage to everyone. Universal. But that increase in patients requires an increase in the population in all layers of the medical profession. Drs, nurses, PTs, cleaning staff, home health aids, administrators. To ramp up to meet that demand will require a lot of immigrants. How has that gone lately?
Competition might work if it existed anywhere. None of the Acts passed to prohibit monopoly are enforced. The result is that former competitors merge and acquire interests in one another without restraint. It is corporate incest. The result is that there are fewer competitors and price fixing is the outcome. It is one reason why the gulf between the "haves" and "have nots" grows wider. It enables the "haves" to purchase ever more political power and influence. The consequence is that the "haves" pay less tax, federal deficits grow larger and there is less money for programs that help the "have nots". Corporations are not people and they should not be treated as such. If stare decisis is not binding in Roe v. Wade neither is it binding in Citizens United v. FEC.
Gina - you pinpoint a key issue - that the magic of 'free market' applies to all health care. The model of the farmer negotiating a trade: bushels of spuds for a bypass. Uhh, nope. Need to start from a more reality based understanding of what the many different kinds of health care, in widely different places, really are
What seems to be missing from the conversation is the fact that health care here in the US is a for profit system. Health care should be focused more on patient care, and less on making money. Every administrative decision in the healthcare industry is based on financial motives. Until the healthcare industry mindset is altered to prioritize patient care instead of their bottom lines, healthcare will remain broken. There are too many mitts trying to get their hands on money instead of taking care of people.
And concerns about higher taxes is ludicrous too. There is no way a revolutionary change to how we provide and pay for healthcare will cost more than the ridiculous high premiums and high prices we pay now. Obviously the healthcare industry (an oxymoron if ever there was one) is broken here. We don’t even know how to think straight about it.
I have narcolepsy with cataplexy and take a prescription that allows me to live a completely normal life but also costs roughly $20k per month. Once a year I come close to running out of medication or actually run out because my insurance company denies the prior authorization for my medication and my treatment team has to go through the appeals process then peer-to-peer in order to get the prior authorization approved. Every single year this happens, despite the fact that I’ve been taking this medication for over a decade. I for one would welcome with open arms reforms that put a stop to this kind of predatory practice. I’m sorry my medicine is so expensive. There are very few humans with my condition and I’m sure this drives the cost up. I think we also need additional reforms on prescription drug costs so insurance companies don’t have financial incentives to deny necessary care.
I love when an article comes up regarding possible upgrading of medical care. I work in primary care for many years and the prior authorization process is so messed up. It's at least, a delay in medical care and sometimes because of that authorization denial the patient is sent to the emergency room to get evaluated there and bypass the outpatient authorization denial just to hopefully get the necessary care needed and more expediently. And by sending someone for care to the emergency room, it is so much more expensive just to get the tests needed there because the outpatient authorization was denied. It is such a waste of resources. I tell people all the time, pick any country outside of the u.s and throw ours out the window and replace it with whatever country and I bet it is better than what we have here, hands down!
More centrist drivel that the people don't want. This is going to backfire bigger than just going all in on single payer. Time for the dems to be bold!
Honestly I think it would do more good in the long term to simply stand back and let the entire healthcare industry implode. Tinkering with a fundamentally defective system will win no hearts, minds, or votes.
Kinda appealing, Mr. McDonough, but infeasible. That sort of chaos would end in tears and recriminations. What would come next, and how would it do that?
The situation calls for bold plans which will inspire people. Anything less is pointless.
Mr. McDonough, again I don't disagree with you. See my post above. As you can discern, I'm arguing for a new concept. But I'm old and old people have problems. I can't afford to have the system burn down before I die. Nor can you.
Mayhap selfish...it is...but honest.
Well, very interesting. Economics in healthcare are important. Hospitals (at least in theory) spend their capital on improving care and must replenish it to keep in business. Physicians and other caregivers have invested more years and more dollars than most (but certainly not all) in their education and training, so they're rightful in expecting to get payment in recompense, recognition for their efforts, and (I, as a physician, hope) respect. So long as we have fully private insurers, their job is to deliver value to their shareholders. Nothing bad in any of that, I'd say.
But...but: What about the patient? All of this revolves around them. There would be no healthcare industries without the need to deliver for them. No question that there are only so many dollars available in any given time period to shift among all those competitors. I'm no sociologist and no economist, and, yeah, I'm a lazy, retired old man. I don't know how to look for it. But who...anybody...has taken a clean sheet of paper (or, in the current era, an unpopulated computer screen) with the sole aim of answering an heuristic query: Given that every single person in the U.S. is, at least in theory, a patient, either actively or potentially, WHAT'S BEST FOR THEM?
They well might arrive at some redone version of what we have now...though I beg to doubt that if they hew to the job of answering my question. The thrust of most of primary care (pediatrics, internal medicine, family practice, and often gynecology) is "patient centered care." While there are screwups, and some simple box-checking occurs, the idea is right and the intent is earnest and honest. In my experience, nearly every doc, physician assistant, nurse practitioner, RN, EMT, paramedic, and ib across healthcare support wants people to be well cared for, to feel seen and respected, and to be listened to and heard.
So...call me Pollyanna if you want, or demented far left liberal, which I ain't, but what if...and why in hell not? If EVERYONE has access to good care, it's pretty clear that total costs actually will go down. And they have to, if we're to keep on keepin' on. But that notwithstanding, doesn't that seem like the goal? Shouldn't be?
Two acronyms to fix it all.Stop PE and PBM's from buying it all up and integrating the industry vertically.
ProPublica has some great reporting on what happens to a community when PE or VC gets to buy up hospitals.
This is really exciting! I worked in health insurance plan development for years and watched it become so corrupt, both on the payor and the hospital side. I finally left because I couldn't change it from the inside. The last gold rush in was around the SNP (special needs plans) space, using elderly and disabled people for higher margins; the executive salaries are eye-watering; the fact that non-profit hospital systems are exempt when they don't fulfill their community support mandates is terrible.
The Dems need to present a plan to jointly (1) lowers costs, and (2) expands coverage. They are DOOMED if they present a complicated plan with caveats. The plan has to be a SIMPLE message that our SIMPLE minded population can understand. If it's written for policy wonks and political junkies the MAGAs will eviscerate it.
Yessir! See my comment...well, short dissertation...above.
Some of these technical fixes may help with the cost of medical care, but they will not sound satisfying to users of our system. I think Elissa Slotkin's idea of an ACA public option for individuals as well as institutions would be a good start. Making Medicare available to younger people, starting at age 60 for example, should also help. If re-imbursement rates to doctors and hospitals decrease as a result, doesn't that help the cost of medical care?
As long as members of Congress keep taking campaign contributions from Big Insurance and Big Pharma, getting health care reform passed through Congress will be difficult. This also needs to be addressed. Congress needs to work for the people, not just the billionaires and their industries.
Private Equity - until private equity is removed from healthcare nothing will change. And I am doubtful anything will change until a politicians family member is injured or dies.
Great article. The scale of our challenge is daunting, with so many interlocking aspects:
1. would be great for patients (that's every one of us) for our education & licensing systems to produce significant increases in the number of medical providers. Meanwhile, govt policy is to reduce immigration, dismantle and defund higher ed, regulate the ed pipelines from pre-k-to-12 around anti-DEI and 10 commandments on the wall rather than promoting learning outcomes... But without way more providers, how can care be provided "for all"? ...let alone at manageable expense?
2. instead of focus on health care delivery systems, we focus on the financial industry, i.e. insurance. Insurers don't provide medical care. They perform accounting and investment functions, doling out and making money. Their business is not the actual treating of patients, yet they have enormous decision making control over the doctor-patient relationship
3. professional associations/certifications & state licensing complicate numbers 1 & 2 above. Regulatory capture is a thing. Lobbying by prof assns, I hate to tell ya: not always purely for patient benefit.
4. 300+ years ago the great health care analyst, Isaac Newton, laid it out simply: Inertia is a bit*#
Does this mean we will be bombarded 24 / 7 with Medicare Advantage ads?
Jeffrey - hey, that's the free market at work! ... 'course all those marketing costs gotta get paid for somehow, wonder where that cash might come from...? 🤔
J AZ
I should have continued my comment with ..."more than we are bombarded currently!"
Several things that should never have been allowed to be advertised on TV: legal care and medical care/ medicine. I truly miss the days when those ads were banned from the public airwaves. But as you say, it's the free market at work.
It reminds me of the great promise made by the cable companies who told us that 200 TV channels would open up a vast new world of entertainment. While all we got was the realization of Newton Minnow's 1961 prediction of TV becoming a 'vast waist land'. There's a definite problem when one can channel surf 200 channels and find not one thing of interest. ]
That's my rant of the day.
Seems like for years they've been reading the fine print on prescription bottles to us in half the ads on TV... or maybe that speaks to the marketing dept's demographic analysis of my viewing habits? Lordee me.
re: 200 channels - 32 years ago The Boss underestimated: https://www.youtube.com/watch?v=YAlDbP4tdqc
It's okay expand coverage to everyone. Universal. But that increase in patients requires an increase in the population in all layers of the medical profession. Drs, nurses, PTs, cleaning staff, home health aids, administrators. To ramp up to meet that demand will require a lot of immigrants. How has that gone lately?
Competition might work if it existed anywhere. None of the Acts passed to prohibit monopoly are enforced. The result is that former competitors merge and acquire interests in one another without restraint. It is corporate incest. The result is that there are fewer competitors and price fixing is the outcome. It is one reason why the gulf between the "haves" and "have nots" grows wider. It enables the "haves" to purchase ever more political power and influence. The consequence is that the "haves" pay less tax, federal deficits grow larger and there is less money for programs that help the "have nots". Corporations are not people and they should not be treated as such. If stare decisis is not binding in Roe v. Wade neither is it binding in Citizens United v. FEC.
Gina - you pinpoint a key issue - that the magic of 'free market' applies to all health care. The model of the farmer negotiating a trade: bushels of spuds for a bypass. Uhh, nope. Need to start from a more reality based understanding of what the many different kinds of health care, in widely different places, really are