Wednesday, August 9, 2017

‪Thus says the Lord Donald Trump! @therealdonald_

‪Thus says the Lord Donald Trump! @therealdonald_ Thus says the Lord: “Let not the wise man boast in his wisdom, let not the mighty man boast in his might, let not the rich man boast in his riches, but let him who boasts boast in this, that he understands and knows me, that I am the Lord who practices steadfast love, justice, and righteousness in the earth. For in these things I delight, declares the Lord.”‬

Tuesday, July 18, 2017

Health Care Reform #HCR, and "The Art of the Deal"

Real Health Care Reform #HCR and "The Art of the Deal".

Real health care reform will deal with costs not access. Donald Trump operating within his strengths as a dealmaker should be able to negotiate these cost reforms through "The Art of The Deal". Each of these reforms require negotiation. I believe the reforms of this BLOG post to be bipartisan, and they can be summarize as... pharmaceutical reciprocity, pharmacist empowerment, and required flexible savings accounts.

Senator Dick Durbin recently suggested that legislators must look at "Big Pharma" if they truly want to reform the cost of health care. The increasing percentage of pharmaceuticals is a key driver in health care costs. Pharmaceuticals were 9.3% of health care costs in 2013 and projected to be 10.4% in 2024. There needs for transparency between the cost of prescription medicines and their actual costs. Pharmaceutical companies are selling the same drugs to third world countries at significant discounts. Past presidents have accomplished greatness by reaching across the aisle to take on traditional opposing party positions. Theodore Roosevelt was willing to take on the monopolies of the industrial revolution by talking softly and carrying a big stick. Could Donald Trump as a republican take on the pharmaceutical companies to enforce transparency of profits and reciprocity of costs that other countries enjoy? Pharmaceutical drugs should be globally priced.

In my first visit to Egypt I ate some bad food on an overnight train from Cairo to Luxor. When I arrived in Luxor that morning, I went straight to the local drug store, and with their broken English they were able to prescribe an antibiotic to cure my intestinal pain within an hour.  In other countries you can get pharmaceutical drugs by going to the local pharmacy and having the local pharmacist prescribe the drug for you. This elimination of the gatekeeper, middle man is a large cost savings. I agree that we need to continue to guard some drugs like opiates, and blind spots with drug interactions, but most people are not asking for that type or quantity of medicine. The Food and Drug Administration in the name of safety is suffocating us with unnecessary costs. Pharmacist should be empowered to dispense most pharmaceutical drugs.

When I had my fifth child my health insurance deductible was $2500 in 1994. I decided to negotiate upfront the cost of the hospitalization. I went to my local hospital and explained my situation. They said they had a program for me and the cost would only be $1500. I realize that the real cost of my child's birth was more that $1500. I was the beneficiary of cost shifting from other people's insurance policies.  However, this does not make the negotiation of a fee for service a mute point. If more people would ask the cost of procedures instead of pulling out their insurance cards, then most doctors would agree that prices would come down. Flexible savings accounts should be required.

The debate about health care reform needs to focused on costs instead of access. Donald Trump has stated that there will be winners and losers in health care reform. While I agree with him, I disagree that the middle class should should shoulder the costs. Instead, they should be empowered to negotiate costs. Taking away people's access to health care cannot be the solution. We must look for win-win cost saving strategies. These strategies can systemically lower costs so that the affluent and the middle class will embrace these strategies.

What can you do? I found a website where you can vote on at least some of these reforms. Currently the con position is winning. Will you vote yes to these reform? 

Thursday, March 11, 2010

Risks, Alternatives, Cost Control and Health Reform Twitter #HCR

Let’s talk about these powerful words in relation to the current health care crisis.

If the doctor patient relationship was established with a greater risk component, then the patient and not the doctor would be assuming the risk of deciding upon a treatment protocol. In my opinion, this is a healthy way to contain costs in health care. Law suits are not driving up the cost of health care but any medical professional will tell you that defensive medicine practices are. If the medical professionals shift the risk to the patient, then patients will be assuming risks for treatment. I recommend this shift for several reasons.

  • The growth of alternative medicine in providing comfort where cures do not exist
  • The growth of defensive medical practices
  • The growth of information sources now available to patients that did not exist 20 years ago.
  • The need to tie cost containment to health care delivery systems
  • The growth of electronic means of reporting and monitoring medical treatment

So let the patient beware. One of the reasons that health care has had explosive costs is because health care does not have reciprocal mechanisms built into it which occurs in our free market. This has been a primary cause why health care costs have gone out of control. It also has had an impact on the growth of bio-medical stocks exploding growth in a recessive economy. If the government is going to write a bottomless check for health care, then why not invest in it? Most investors wisely see that they would be foolish not to. The argument that we have the world’s best health care and it should be protected is breaking down. This week The Cancer Society reported that PSA blood testing in 50 year olds is a cash cow that is not delivering any real benefits for many men. I still believe that we have the best health care delivery system, but unchecked medical research and development can not survive on a bottomless pit of borrowed money.

Alternative medicine can provide relief to people where a cure does not exist. For example, pharmaceuticals are not the always the best way to manage pain. They can lead to addiction where withdrawal is just as significant as the pain they are attempting to control. The alternative medicine field is less expensive than the traditional medical practices. They have less burden of regulatory compliance and few defensive medical practices because the patient assumes the risk. Electronic portable devices have made the monitoring and reporting of medical treatment portable. Patients can now monitor their own vital signs and feed back that information to a medical professional with wireless technology.

Perhaps in the future a consumer protection agency for patients can be established that will protect the interests of patients. This regulatory idea is far more preferable to defensive medical practices that encourage medical professionals to exacerbate costs to protect themselves. It is not medical malpractice law suits that are raising our health care costs. It is the threat of them. Medical professionals tend to be compliant individuals that cross their "t’s" and dot their "i’s". They will do everything in their power to avoid being accused of negligence. These people have good values that are being turned on the ear because of the threats of law suits.

Tuesday, March 9, 2010

Why insurers don't control costs

I read Ezra Klein's article in the Washington Post today. It is titled ...  Why insurers don't control costs
From Wikipedia ... "Health insurance like other forms of insurance is a form of collectivism by means of which people collectively pool their risk, in this case the risk of incurring medical expenses."

The pooling of medical expenses is a good idea. The problem with our insurance is that it is managed badly. Employers paying 70% of the cost is a bad idea. The risk must be shared for cost containment to work. Otherwise it is viewed as an entitlement that we deserve. I would prefer the private sector doing this, but we are saddled with Medicare now so fix it.

We do not deserve anything that we do not pay for. If we are going to use a single pay-or system then raise the tax for Medicare and bail it out. Begin to pre-pay Medicare instead of pay as you go. When we pay forward our medical expenses through a pay roll tax we will treat it differently. The magic of compounding interest will put us in the enviable position of having medicare surpluses.

Contain costs by introducing more reciprocity into the health care delivery system. Open up choices for patients to consult with medical professionals and not just doctors. I even think that alternative medicine can provide more comfort at less money than our current system.

Get rid of defensive medical practices. Patients should be aware that all surgery and medical treatments have some risk. Assume the risk or refuse the treatment. Medical reporting and monitoring should become electronic to reduce mistakes and decrease administrative costs. Wireless devices make every home a hospital

I am for any business that is profiting from health care paying an excise tax on profits. If a company is benefiting then they should share their profits with the recipients of health care to lower costs.

Friday, February 26, 2010

I give in!

I give in!

Let's pass it, but let's also continue to work on making health care something that we can pay for as well as benefit from. Let's continue to work on developing technology with an eye toward cost savings as well as health care.

I think regulation on alternative medicine should be loosened to emphasize comfort over cure.

I think that insuring 30 million Americans is worth the risk of a few bad apples if there are incentives put in place to stop abuse.

The respect the economists in the NY Times article. There is no reason why medicare can be fixed and defensive medicine corrected after this bill is passed.

Our President has done a masterful job of bring the stake holders together. Although I think the summit could have taken place with a caucus process.  (See my previous post) I believe that he make the changes necessary to the health care bill after it is passed.

Monday, February 22, 2010

The Blind Spot of Obama Health Care #HC

Let’s simplify things about the health care debate. Republicans are for states rights. They generally would agree with a health care proposal that has the most limitations on the federal government. Democrats are for federal initiatives. They disagree with the republicans that states should solve national problems and wish to maximize national solutions. The libertarian camp has recently entered the debate in the form of Ron Paul. They go a step beyond Republicans to maximize individual rights over the rights of individual states. I would recommend that there is a forth point on the political compass that is being ignored. That point could be called the “Statist” solution. A statist solution would delegate our democratic freedoms to a panel of experts for a time to solve a problem. This solution would be the way that countries like Germany have traditionally solved problems. Countries like Germany hire a commission of experts to solve these problems, and then take the governing of this solution out of political hands so that the commission can stay the course and solve the problem. Recently, our president set up a bipartisan commission of two former deficit hawks in both parties to remove this blind spot from our eyes. I believe that our president is on the right track here. Why shouldn’t this same strategy work on health care?

I appreciate technological tools like twitter that open up this debate to small voices like mine to enter the fray. Many of the news commentators and journalist have a vested interest in selling advertising. They choose to interview people who are controversial so they can increase their ratings. I do not believe that the German solution has much controversy or democratic input to drive public policy debate. That is why it is currently a blind spot in the health care debate. America is a country made up of salespeople. We love to give our best pitch and hear about ideas we believe in. I think it is time to give the Americans with more or an engineering perspective a turn to govern. The health care system is broke and it needs to be fixed. Should we consider all possible solutions? Problems that do not appear in the blind spot of our rear view mirror may be better solved by us looking directly to the experts for a time until the problems are more easily seen.

Wednesday, February 10, 2010

The Third Rail of Politics meets Twitter Health Care Reform #HCR

There are three problems facing our president as he prepares for his upcoming televised health care summit. I am a progressive Republican who is rooting for his success. I am going to suggest something that a politician should never do. I would suggest Mr. President that you boldly touch the third rail of American Politics.

1.    He should fix the funding of Medicare and social security.
2.    He should tie the future costs of health care to our standard of living.
3.    He should form an alliance with the Republican Party as well as secure populist support with all stakeholders.

My proposal would be to pre-pay Medicare and Social Security with a 13.5% payroll tax for the employee and employer. A 13.5% payroll tax would enable to begin pre-paying social security and then slowly reduce the tax over 10 years. This could also be accomplished by keeping payroll taxes as they are now and taxing employee benefits. Then contain costs by tying future expense to GDP growth. If our country is not growing, then we must make decisions about comfort instead of cures for those of us in need of health care. Another funding proposal to pre-pay Medicare and Social Security is to empower the IRS and the Social Security Administration to debit $3500 from every retirement account in US. These funds would be used to pre-pay medicare for those designated social security numbers in those households. If a household does not have a retirement account then they would have the option of a 13.5% payroll tax to meet the prepayment option. The magic of compounding interest multiplies the usefulness of these pre-paid funds. Within five years payroll taxes can be lowered to more reasonable levels. The investment options for these funds will be determined by an independent commission  of economists elected by the National Association for Business Economics. (NABE) It could be set up similar to the federal reserve board.

Health care must make sense…

•    Pre-existing conditions must be included in the insurance pool
•    Health Insurance should be able to be purchased across state lines.
•    Those with out health insurance should pre-pay medical expenses at a discount for preventative health care.
•    The uninsured should continue to receive acute critical care through the established practice of cost shifting.
•    Universal health coverage can still be explored at the state level.

Health care cost must be contained

•    Pharmaceutical companies should pay a portion of health care based on their profits.
•    Disincentives must be built into the health care delivery system for patients to sue. 
•    Alternative medicine practices should be encouraged to provide comfort when cures are beyond our ability to pay for them.
•    Electronic reporting procedures must become standard in the delivery of health care by medical professionals.

We are currently being slammed by a snow storm in the Mid-Atlantic States. I am history teacher stuck in my house spinning solutions to problems that I have no business attempting to solve. Perhaps this snow storm can generate more ideas right now. A snow storm can slow things down enough to include the average Joe’s opinion on issues that matter to us all. I want you to solve these difficult problems that are facing our nation. I believe that your judgment is probably better than the intellectual community as you enter into negotiations with the stake holders of this dilemma. I am at the bottom of the list of these stakeholders. The beauty of democracy is that when a snow storm happens I have the time to think through these issues as both the least significant and most numerous of your constituents as I twitter my thoughts to you.

I see the stakeholders as …

•    The Democratic Party
•    The Republican Party
•    Organized Labor
•    Small business
•    Pharmaceutical companies
•    Defensive medical practices
•    Medical community
•    And me Pat Citizen