cost – R&R – Reachout and Rebuild

Our Healthcare System will Change (Like it or Not)

David Posnett — Mon, 05 Nov 2018 01:44:40 +0000

Submitted by John Hooker

In reply to a recent laudable post “Drug Prices: How Pharma Games the System,” I have this to add.

To gather momentum to change our system we should be relentless in emphasizing the cost that affects patients directly.

There is one major fallacy of our healthcare system. We chose to link healthcare insurance to employment in the years following World War II. In contrast, at that same time, Europeans chose to provide health care as a right for all (Universal Healthcare). Their countries chose different systems (some public and some private), but the underlying intent was always to insure everyone in the country, because that is how a successful insurance system works.

Healthcare obtained through your employer was our original sin. It never insured more than 70% of the population, and it actually took over our rights to choose and in stead put our employers in charge.

As per “Drug Prices: How Pharma Games the System,” Medicare is not allowed to negotiate prices. Pharmaceutical prices are still unregulated. Worse, Medicare is hamstrung by administrative rules that tend to increase fraud or waste. As we all know, that led to claims that anything government puts “its hands on” cannot work.

But the reality is that Medicare was engineered to be inefficient and to maximize profits for our private health care industry.

However, recent talk about healthcare is raising factual awareness and creating a platform for campaigns. Excessive patenting to extend branded product life, as described in “Drug Prices: How Pharma Games the System,” is only one aspect of the problem.

Most important is to remind ourselves that American pharmaceutical companies are free to charge whatever they want, whether the product is on or off-patent! Even if the drug is 30+ years old! That is outrageous.

Another point related to messaging: We should stop reminding the younger generations that health care costs are rising and implying they are being made to pay the bill for the costly care of older Americans via higher healthcare premiums. What no one seems to get, is that this is how insurance works! If you are a very careful car driver and never have an accident you are still paying insurance and this “covers” the expenses of the insurance company when others submit claims. In contrast to auto-insurance where higher premiums due to accident prone driving make some sense, health issues are often unrelated to negligent behavior. Even if you think that those who smoke, drink, or have unprotected sex with multiple partners, should be made to pay higher healthcare premiums, consider this. In our immediate future, say in 10-20 years, everyone will get a full sequence of their genetic profile. This means that you, your doctors and perhaps even your health insurance, will know the details of which diseases you are prone to get in the future.

Will you get a heart attack with 10% chance or with a 90% chance? Will you get hypertension? Will you have a stroke? Will you have diabetes? Will you get any number of different cancers? Thanks to Angelina Jolie and other celebrities, everyone already knows about BRCA gene mutations and the high risk for breast cancer and ovarian cancer that they impart. Within a few decades there will be thousands of such cancer genes. You can bet that private for-profit health insurance companies would love to get your genetic profile and charge you insurance rates accordingly.

The ONLY way to “overcome the inequity of nature” is to adopt the widest healthcare insurance pool possible, distribute the risk, and lower premiums for everyone.

It is time to debunk healthcare insurance through employment. It increases the lack of transparency. It decreases control for the individual. It is unmanageable in its current form and it is getting worse.

Experts predict that the expanded use of genomics will eventually afford predictability of disease for the entire population. This is the “holy grail” for healthcare providers. It is also the right time to dramatically change our healthcare insurance system.

If not politics, science may compel us to accept Medicare for all.

Let’s simplify and make good.

John Hooker is an International Medical Communications Consultant with 36 years of experience working with Big Pharma.

US Healthcare: no Bang for the Buck

David Posnett — Sat, 19 May 2018 22:36:07 +0000

Health care in the US is more expensive, by far, than anywhere else on this planet. It represents greater than 17.9% of the US GDP. Health spending is projected to grow 1.0 percentage point faster than Gross Domestic Product (GDP) per year over the 2017-26 period; as a result, the health share of GDP is expected to rise from 17.9 percent in 2016 to 19.7 percent by 2026. Other comparable developed countries pay much less:

The question is why are we so wasteful and what do we get for all this money. If you look at longevity as the overall measure of success for healthcare, we are not doing very well, as described in a recent article in the NY Times:

The above graph shows life expectancy over time compared to similar developed nations.

This shows life expectancy as a function of health spending per person.

So what are the proposed causes for this dramatic inefficiency? The authors propose many factors to explain the sudden up tick in health care spending around 1980. For example:

“suppliers marketed very costly technological innovations with gusto,”and they “found ready customers in hospitals, medical practices and other entities eager to keep up with rivals in the medical arms race.” The last third of the 20th century or so, was a fertile time for expensive health care innovation: Coronary artery bypass grafting, innovative drug treatments for H.I.V. for cancer and expensive NICU care for premature babies.

But innovation does not necessarily translate in to better outcomes. Almost no matter how it’s measured, longevity in the United States has not kept pace with that of other nations.

Another study, published in JAMA, found that even accounting for motor vehicle traffic crashes, firearm-related injuries and drug poisonings, the United States has higher mortality rates than comparably wealthy countries.

So here is the presumed bottom line.

“The lack of universal health coverage and less safety net support for low-income populations could have something to do with it. The most efficient way to improve population health is to focus on those at the bottom,” says Ms Glied from Columbia Univ. “But we don’t do as much for them as other countries.”

The effectiveness of focusing on low-income populations is evident from large expansions of public health insurance for pregnant women and children in the 1980s. There were large reductions in child mortality associated with these expansions. “Those reductions were much larger for poor children than for richer children,” Ms. Currie said.

In 1980 the United States spent 11 percent of its G.D.P. on social programs, excluding health care, while members of the European Union spent an average of about 15 percent. In 2011 the gap had widened to 16 percent versus 22 percent.

Slow income growth could play a role because poorer health is associated with lower incomes. “It’s notable that, apart from the richest Americans, income growth stagnated starting in the late 1970s,” Cutler said. “Social underfunding probably has more long-term implications than underinvestment in medical care.”

Read more here about how social programs can lead to increased longevity: Are better health outcomes related to social expenditure?

It has been known for some time that low income/wealth is associated with much decreased longevity:

as the income gap increases in the US, so does the disparity in life spans between rich and poor as reported in the NY Times
in the U.S., the richest 1 percent of men lives 14.6 years longer on average than the poorest 1 percent of men, while among women in those wealth percentiles, the difference is 10.1 years on average.
This eye-opening gap is also growing rapidly: Over roughly the last 15 years, life expectancy increased by 2.34 years for men and 2.91 years for women who are among the top 5 percent of income earners in America, but by just 0.32 and 0.04 years for men and women in the bottom 5 percent of the income tables.
U.S. tax and spending policy does relatively little, compared with its peers in the developed world, to reduce inequality and with the new tax policies enacted by our current government this will worsen.

In the NY Times (2014) Leonhardt and Quealy note that “The American Middle Class Is No Longer the World’s Richest”. The following interactive graph shows who many developped countries like Norway, Canada, Germany, Sweden, Netherlands are making gains for the lower 20th percentile of wage earners surpassing American incomes for this bracket. American incomes are losing their edge, except at the top:

It is this same bracket (the lower 20th percentile) that have such poor life expectancy dragging down the overall life expectancy for the entire country.

Finally, this study shows an interesting shift: since about 2004 the lowest quintile income group in the US is spending much less on healthcare on a per capita basis, than the highest income quintile. One of the authors remarks that “co-payments and deductibles have bent the cost curve. But it’s come at the expense of poor people and middle-income people.”

My conclusions:

efforts by the GOP to slash medicare will make things worse
the new tax law will make things worse by aggravating income disparity
advances in medicine benefit the health care industry and affluent Americans who have access to the newest treatments, but on average the population does not benefit as measured by life expectancy, for example.
How you vote may be a matter of life or death.

Out-of-pocket healthcare spending could rise thanks to Lee Zeldin

David Posnett — Wed, 24 Jan 2018 18:02:17 +0000

Implementation of the Affordable Care Act (ACA, Obamacare) was associated with reduced out-of-pocket spending for US medical care, particularly among those with lower incomes, but not with reduced premiums.

That is the conclusion of a new study published in the medical journal JAMA Internal Medicine.

As summed up by Les Masterson on the HealthCare Dive

the ACA led to reduced out-of-pocket spending, especially for low-income Americans. That said, many people still feel the burden of high out-of-pocket costs and premium spending.
medical expenses continue to “consume a large share of many families’ incomes and compound income inequities.”
repealing or reversing gains made by the ACA will “especially harm poor and low-income Americans.” Premiums will likely increase for people in the exchanges if healthier people leave the exchanges.

This affects residents in our Congressional district: NY-01. Rep. Lee Zeldin has consistently voted to undermine the ACA and has supported very unpopular Trumpcare. Republicans also putting Medicare and Medicaid in jeopardy via the recently passed tax bill. Thanks for stealing our money!

Read more about the LZ track record on healthcare:

https://resistancesuffolk.blog/2017/03/18/zeldins-deception-on-health-care/

https://resistancesuffolk.blog/2017/06/30/zeldins-approval-of-senate-healthcare-bill-reveals-his-lack-of-concern-for-veterans/

http://www.1clickdaily.com/1429473

https://resistancesuffolk.blog/2017/09/25/zeldin-must-stand-up-and-protect-long-islands-health-care/

https://resistancesuffolk.blog/2017/05/21/is-zeldin-untruthful-about-healthcare/

and Zeldin complicit in CHIP used as bargaining chip:

Cost of Green Energy

David Posnett — Fri, 12 May 2017 02:25:31 +0000

By Don Matheson, East Hampton

Mark Harrington reported in Newsday, on May 7, 2017, about the demands from “ratepayers, lawmakers, and industry groups,” to know the exact cost of the green energy program announced by Governor Cuomo and LIPA. This is analogous to demanding to know the final score of an upcoming Yankee game before deciding to buy a ticket. Obviously, like any procurement program on this scale and spread over numerous years, the exact cost will not be known until the Requests for Proposals are issued and answered.

But there are strong indications that claims that the sky is falling are misguided. LIPA did evaluate, in the case of the 90-megawatt offshore wind program off Montauk, the proposed cost, in competition with proposals for fossil fuel options, and the wind proposal was the winning bidder. LIPA/PSEG’s Integrated Resource Plan, on page 14, has shown a cost comparison based on previous price quotes of between 12 and 16 cents per kw for both large scale renewable power and large-scale fossil power plants. They are now at virtual parity.

Further, technological innovation in fossil plants is mature, so costs are not expected to drop on that side, in contrast to renewables. Within the last month, bids of 6 to 7 cents/KW have been seen for renewables in places where the industry is advanced.

Further, nobody could possibly answer these long-range cost questions for fossil fuels, as the cost of fuels varies on a daily basis, so LIPA would need to guarantee purchasing power from a fossil plant for many years without knowing the cost. Wind and sun are free, so costs for renewable technology can be known on the front end, when RFP’s are issued.

Finally, the whole reason this transition to renewables is happening is that we now know that continuing to burn fossil fuels will exact devastating costs on society in the form of rising seas, storms, droughts, acidification of the ocean, and catastrophes too numerous to list here. What has changed is that the price for renewable energy has dropped precipitously as economies of scale and technological innovation have kicked in,

Long Islanders, who are already making choices about land that must be surrendered to eroding shores, should buckle their seat belts. The most heavily subsidized and most profitable business in the world, the fossil fuel industry, will fund numerous PR campaigns, armies of lawyers, and wholly-owned politicians to defend their profits from clean energy in the years ahead.