The Healthcare Blog

This is a great article that explains why just doing things isn't necessarily safe: http://thehealthcareblog.com/blog/2015/04/05/radiologists-vs-mark-cuba…

This is a neat little free app we made, after placing second on the Berlin Health 2.0 hackathon last year (http://thehealthcareblog.com/blog/2012/11/28/health-2-0-berlin-code-a-… In a nutshell, it's like an Instagram/Lift mashup, and is really fun to use (take my word for it, ha :). It's goal is for people to be motivated to do something about their health, when they see their friends also doing fun challenges to get healthier. We'd love to hear your opinions!

> ^ When the grossly overweight 60yo smoker pays the same amount as a health-conscious 30yo, we have a problem. It depends on what your goals are. The reasoning behind why the ACA ("Obamacare") is the way it is: > Suppose you want to make health coverage available to everyone, including people with pre-existing conditions. Most of the health economists I know would love to see single-payer — Medicare for all. Realistically, however, that’s too heavy a lift for the time being. > For one thing, the insurance industry would not take kindly to being eliminated, and has a lot of clout. Also, a switch to single-payer would require a large tax increase. Most people would gain more from the elimination of insurance premiums than they would lose from the tax hike, but that would be a hard case to make in an election campaign. > Beyond that, most Americans under 65 are covered by their employers, and are reasonably happy with that coverage. They would understandably be nervous about any proposal to replace that coverage with something else, no matter how truthfully you assured them that the replacement would be better. > So the Affordable Care Act went for incrementalism — the so-called three-legged stool. > It starts by requiring that insurers offer the same plans, at the same prices, to everyone, regardless of medical history. This deals with the problem of pre-existing conditions. On its own, however, this would lead to a “death spiral”: healthy people would wait until they…

> Even with all the regulation, when you get in an ambulance you can tell them to take you to a specific hospital. A) you may be unconscious B) you may not know anything that would allow you to differentiate ER facilities C) you almost certainly have no information on the current wait times at an ER facility, let alone specific physicians on call D) you may be unaware of the intersection between your insurance and hospital choice (for example, I had insurance once that only covered care at a (very fine, major urban) hospital that was unable to treat my amputation accident). So really ... just no. If you're going to start dismissing the fact that smart people have written smart stuff on a topic by saying that we revise what is considered smart, then I'd just do the same in reverse, and say that none of the worldview/policy view that you're arguing for is supported by anyone worth paying attention to, since it's all just out of date and/or will be consigned to the trash heap of history very soon. The books I am talking about are not "musty old volumes". Here's Forbes from 2017: https://www.forbes.com/sites/chrisladd/2017/03/07/there-is-never-a-fre… Somewhat older, here's Krugman from 2009: https://krugman.blogs.nytimes.com/2009/07/25/why-markets-cant-cure-hea… Here's (supposedly) a libertarian on the problems in 2018: https://thehealthcareblog.com/blog/2018/08/02/a-libertarians-case-agai… And…

It isn't that simple. >...Seven of the top 10 most profitable hospitals in the United States are nonprofit facilities that each netted more than $150 million from caring for patients in 2013, >...The study’s main purpose was to determine the characteristics of the nation’s most profitable hospitals. They found that facilities that were part of a system were more profitable because they were able to dominate their local market, which gives them greater clout in negotiating higher prices from private insurers. It also means consumers end up paying more if their health-care provider is out of network, Anderson said. https://www.washingtonpost.com/news/to-your-health/wp/2016/05/02/these… Also: >...Nonprofit hospitals have higher profit margins than most for-profit hospitals after accounting for their tax obligations. http://thehealthcareblog.com/blog/2017/04/25/the-fairy-tale-of-a-non-p…

> Currently I take NSAIDs, especially newer medicines like Vimovo https://www.vimovo.com/ helps a lot, but is not something you should take every day. If you want to save some money then skip the Vimovo and take generics of the two active ingredients: Aleve (Naproxen) and Nexium (Omeprazole) http://thehealthcareblog.com/blog/2015/11/04/dont-fall-for-this-otc-pa… Only reason I can see to take Vimovo is if your doctor gives you a few samples at the office.

True, but there was at least an attempt before at cost containment, as they could directly capture that revenue and increase their profitability. Now there's both no incentive for cost containment measures beyond what's needed to hit their maximum allowed profitability percentage and a direct disincentive to spend more than is needed in this area, since it'd eat into the limited amount administrative overheard allowed by the MLR[1]. [1] http://thehealthcareblog.com/blog/2012/02/04/does-obamacare-limit-prof…

It's not illegal to take them, but yes I doubt insurance will cover unapproved treatments. Also, while it's not directly illegal for a doctor to prescribe an unapproved drug, I think it would open them up to malpractice lawsuits, and it just seems like a bad idea in general. Here's a doctor's blog post about this issue: http://thehealthcareblog.com/blog/2013/08/26/should-a-doctor-prescribe…

> The difference is governments don't have competition. There are many governments in the world. If one government plays hardball with a drug company, drug company can go find a different government, or negotiate with private insurers in that same country. Yes, private insurers exist even in countries that provide basic healthcare to all their citizens. [0] > And insurance companies can't throw drug company officers in jail. Show me where this has happened. This scaremongering and black-ops has nothing to do with the practice of negotiating price. There are many people that wish Martin Shkreli went to jail for gouging AIDS patients, but that's not happening. 0. http://thehealthcareblog.com/blog/2012/01/16/the-awkward-world-of-priv…

Just a heads up that this may not be the case for everyone. I have an ACA plan and while the PCP visit was free, the blood test he ordered was not. There's still some confusion about exactly what's covered and what's not, and it sounds like it could change over time. http://thehealthcareblog.com/blog/2015/03/08/does-the-aca-actually-man…

Anyone who googles him (or does a background check) will see a ton of red flags, including being involved in several lawsuits over the last few years. I'm not shocked no one will let him rent a place - I sure wouldn't. http://nypost.com/2014/11/11/embattled-manhattan-doc-faces-accusation-… http://nypost.com/2014/03/28/comedian-outs-pr-execs-affair-as-payback-… http://thehealthcareblog.com/blog/2012/03/23/the-strange-tale-of-nextg… http://www.nydailynews.com/new-york/airbnb-orgy-victim-sues-nyc-condo-…

The poor guy seems to have a remarkable knack for accidentally stumbling into all kinds of drama. http://thehealthcareblog.com/blog/2012/03/23/the-strange-tale-of-nextg…

Interesting. This doctor reports that some UK private insurance options, which have coexisted with the NHS since its inception, are banned in Canada: http://thehealthcareblog.com/blog/2012/01/16/the-awkward-world-of-priv… My point is that "single-payer" doesn't mean one specific thing, and the implementation details in different political systems matter.

This reminds me of an interesting article I read about Doctors being more likely to refuse cancer treatment - on the knowledge of trading quality of life for a shorter period rather than hanging on for longer. http://thehealthcareblog.com/blog/2012/08/06/how-doctors-die/

You'd be right, if CDC's Covid-19 response isn't a repeat of their initial incompetence during Ebola, SARS, etc. https://thehealthcareblog.com/blog/2020/04/11/the-covid-pandemic-who-d… "To be fair, what’s on display here is a broader institutional malady. The US version of the WHO, the CDC, took a similar stance with another controversial topic—quarantines for health care workers returning from treating patients with Ebola. Four states—New York, New Jersey, Florida, and Illinois—instituted policies to quarantine anyone who had contact with someone infected with the Ebola virus while in west Africa, including medical personnel who cared for patients. No less than the Obama administration, backed by the CDC, attempted to squash these policies, arguing that this would serve as a disincentive for US health workers to travel to Africa to combat the disease at a time this help was sorely needed."

A few comments: First, US insurance companies are often pseudo non-profits, with profit caps. [1] Second, another model is Medicare Advantage where beneficiaries can choose a private entity to administer their Medicare plan. Third, most commercial insurance in the US is not actually underwritten by insurance co's, but by "self-funded" employers. In this case, the insurance company is merely a third-party administrator (TPA) for the employee plans, using XYZ's bank account (and trying to save them money, offer health incentive programs, etc., to secure repeat business). Most companies with more than, say, 500 employees operate this way, though usually you won't even know this is the case. --- Finally, if by > do we want to provide universal access to healthcare? you mean "do we want everyone to have healthcare?", the answer is an easy "yes". We want universal access to housing, healthcare, employment, etc. But if the question is "do we want the government to use taxes to ensure that everyone has healthcare?", the answer is far more divided. There's a lot of interesting examples elsewhere. But as you've mentioned, the US government has already dipped its toe into those waters with the VA, and I don't think it's been perceived as a success. [1] http://thehealthcareblog.com/blog/2012/02/04/does-obamacare-limit-prof…

Contrary to your comment, yes, they generally are; they're just using Hollywood accounting and referring to their profits as "excess earnings". "A study published in the May issue of Health Affairs revealed that in 2013, seven of the top ten most profitable hospitals in the United States were nonprofit hospitals, with each earning over $163 million in profits from patient care." https://www.forbes.com/sites/brucelee/2016/05/08/very-profitable-nonpr… (Forbes, yuck, I know. This Washington Post link covers the same story: https://www.washingtonpost.com/news/to-your-health/wp/2016/05/02/these… That article links to a CBS "investigation" into the University of Pittsburgh Medical Center, which claims to be a nonprofit but made $948 million from 2011 to 2012, pays its CEO $6 million a year, gets a private chef, chauffeur, and a jet for additional compensation, and has a dozen other administrators each making over a million dollars a year. https://www.youtube.com/watch?v=zikgppxCFnA Claiming themselves to be a nonprofit saves them about $200 million in state and federal taxes. So, they're just an "accidentally profitable" nonprofit. But yeah, sure, let's just keep taking the health care industry at its word when it says it's not profitable. edit: more, because why use a scalpel when a hammer will work just as well? "Many nonprofit hospitals calculate their…

There is - Obamacare capped the profit margins of insurance companies. So if you're United Health, you can't really improve your profit margins. And if you cut costs, you can't pass the extra value to shareholders. If you want to give more money to your shareholders, you need more revenue and then more costs and you need to maintain your margin - the extra costs defray the extra money you return to your shareholders. If you spend an extra $65 million on 'rehab' - you get to give more money to your shareholders. Here's what's really bad about it, there's no real expectation that the health care improves. The insurance company doesn't care whether the expensive care is better, it cares that expensive care = more money for shareholders. That's such a perverse incentive it's incredible. Healthcare has become a noose around the neck of America - it's 16% of our GDP and it accounts for about half of all the inflation since 1990. Here's a blog post explaining the mechanism in the ACA: http://thehealthcareblog.com/blog/2012/02/04/does-obamacare-limit-prof… Here's Martin Shkreli saying that insurance companies make more money off expensive epipens than cheap epipens: http://www.businessinsider.com/martin-shkreli-on-epipen-and-mylan-pric…