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Why Health Insurance Companies Hate High Deductible Plans

Joe Biden unveiled a White House study on the rise of health insurance premiums.  He pressed for consumer protections the President wants to see in any reform legislation.  Among these are a pledge to pass a law that “ends exorbitant out-of-pocket expenses, deductibles or co-pays.”  Presumably this is meant to address worries many feel over the growth of high-deductible health plans.

The St. Petersburg Times looked into it to find out what this pledge means, in practical terms.  David Axelrod at the White House pointed them to the proposed House legislation, which would create limits on out-of-pocket expenses, deductibles and co-pays of $5,000 a year for an individual, and $10,000 a year for a family.
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*This blog post was originally published at See First Blog*

The Implantable Defibrillator: Pricing Itself Right Out Of The Market

When DrRich left his medical practice nearly a decade ago, he spent much of the next few years as a consultant to certain companies that make implantable defibrillators.

Most of his work was in research and development, and had next to nothing to do with defibrillators themselves, or any aspect of treating cardiac arrhythmias. Rather, DrRich was interested in developing physiologic sensors that could be deployed in implantable devices, and the algorithms that could use these sensors to predict and detect various developing medical conditions (so as to enable early intervention, and potentially prevent said medical conditions from becoming manifest). DrRich considered this work a) interesting, and b) representative of a business model that could potentially flourish within a healthcare system whose chief concern is reducing costs.

And whenever the captains of industry who signed his checks would ask him something about implantable defibrillators, usually seeking his opinion on a proposed subtle variation in some unbelievably complicated programming feature, DrRich’s reply was likely to be something like this: “Sir (or Madam) – I will be happy to study the question you pose to me, as I am working on your dime. But it greatly saddens me to see all this time, energy and talent wasted on adding yet more irrelevant features to a mature technology, in pursuit of a business model that is fundamentally broken.”

To which they would smile indulgently, hand DrRich the document describing the proposed changes, and schedule a meeting to discuss them.

The indulgent smile was in recognition of the fact that DrRich never made a secret of his disdain for the business model embraced by implantable defibrillator companies. The fact that these captains of industry put up with DrRich’s disapproval was a clear indicator that they considered it to be “quaint,” and apparently not worth taking seriously, and that the value DrRich provided in other arenas at least counterbalanced the annoyance of having him criticize their core business every chance he got.

DrRich’s disdain for the implantable defibrillator business model was based on two factors.

First, their business model relies on the artificially high prices the system will pay for their devices. DrRich has discussed this before. While these high prices are not directly the fault of the companies themselves (rather, they are fundamentally the fault of Medicare processes that distort and destroy natural market forces), these companies have now come to rely entirely on this artificial price structure, and have established all their business practices around this high-margin enterprise. The problem is that this high-price model absolutely precludes any reasonable penetration of this life-saving technology into the vast population of patients who might benefit from it. Also, because the price structure is not only artificial but arbitrary, a few simple changes in Medicare processes could abruptly destroy their business overnight.

Second, nobody is really interested in preventing sudden death. It’s difficult to sell any product when there’s no demand for that product, and there is no demand for sudden death prevention.  In contrast, most other medical problems have a built-in constituency Read more »

*This blog post was originally published at The Covert Rationing Blog*

Some of My Best Friends Are Doctors

Steven Pearlstein actually wrote that in the Washington Post on Wednesday, right after (another) long rant against physicians.  At the end, he offers doctors an olive branch.  Or maybe its an offer he thinks doctors can’t refuse:

The choice for doctors now is quite clear: They can agree to give up a modest amount of autonomy and income, embrace more collaboration in the way they practice medicine and take their rightful place at the center of a reform effort that will allow them to focus more on patient care.  Or they can continue to blame everyone else and remain — stubbornly — a part of the problem.

After reading Pearlstein’s columns, I’m still sure not why he has such a problem with doctors.  I am beginning to think it’s because he just misunderstands them.

Pearlstein is convinced that doctors go into medicine for the same reasons investment bankers go to Wall Street: to make money.

Docs seem to take it as a given that physicians in the United States should earn twice as much as doctors in the rest of the world — and five times more than their patients, on average.  Mention these facts and you are guaranteed to get a lecture about the crushing debt burden that young docs face upon completion of their medical training.  Offer to trade free medical education for a 20 percent reduction in physician fees, and you won’t find many takers.

Pearlstein has no source for these claims, but let’s assume they’re true, and do the math.  The government says that there are 633,000 doctors in the United States, and they earned median salaries between $135,000 and $320,000 a year.  If we take a number in the middle — say $200,000 — that means that American doctors earn about $125 billion a year.  A big number, but total health care expenses in the United States are over $2 trillion, which means doctors represent about 5% of the total.  Can physician salaries really be driving our health care problems?

It seems unlikely.  But Pearlstein is desperate for it to be true, so he keeps trying to discount all of the other possible causes of our problems as examples of conspiracies or arrogance or sloppiness:

For example, medical malpractice litigation is a problem…

But one of the reasons malpractice suits are still necessary is because doctors have transformed local professional review boards, which are supposed to protect patients, into nothing more than mutual protection societies

The “infelixible bureaucratic processes” that insurers impose are a problem….

But given that there is overwhelming evidence that doctors tend to order up tests, perform surgeries and prescribe treatments whose costs far outweigh the benefits, you can hardly blame the insurers.

We think it is good to have  “clever and creative” doctors…..

but . . . we could all have better health at a lower cost if docs were less inclined toward the medical equivalent of the diving catch and simply were more disciplined about kneeling down for routine ground balls.

Doctors should be applauded for embracing evidence-based medicine…

however, practicing  physicians still think that nothing should interfere with the sacred right of doctors and patients to make all medical decisions, even when they are wrong.

Pearlstein’s views on how doctors think are fundamentally flawed.  He thinks of them like stock brokers, pushing questionable stock to make commissions for themselves.  He’s thought of all the different ways doctors are abusing the system to their own advantage, but he doesn’t seem to have thought that maybe, possibly, he’s wrong.

So, yes, some doctors abuse the privilege of being asked to help their patients.  But the overwhelming majority don’t.  They want to spend as much time as they can with their patients, collecting information, thinking about their problem, and offering good, sound advice.  They are bothered by the involvement of the insurance company or the government or the plaintiff’s lawyer not because they believe they have a “sacred right” to total independence.  Or because they think the way to fix health care is to give them “free rein to treat their patients . . . run the hospitals and set their own fees.”

No, it is because these things actually interfere with the doctor’s ability to think, process and decide with their patient on the right things to do.

Pearlstein and other would-be reformers of our health care system need to reconsider their assumptions on what motivates doctors.  Maybe it’s something Pearlstein should ask some of his friends about.

*This blog post was originally published at See First Blog*

Why Giving Free Care To The Uninsured Is Good Business

Walgreens made some headlines with their program to give free acute care services to those who are unemployed.

Before you think that they’re doing this out of the goodness of their hearts,

Doctors rarely would drop patients who have recently gone on Medicaid, or worse, lost their health insurance altogether. Why? As Dr. Sidorov writes, “Today’s patients with no or non-remunerative insurance were not only yesterday’s richly insured but tomorrow’s also. These providers know that when the economy eventually turns around, these patients are going to join the ranks of the employed/insured.”

Walgreens is applying the same principle. Today’s uninsured patients will, more likely that not, have insurance in the future, and will repay Walgreens back for helping them out during these tough times.

So, rather than patting Walgreens on the back for their kindness, you should be noting their business shrewdness instead.

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