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Slightly skeptical view on programmers
and system administrators health issues

News Skepticism and PseudoScience Recommended books Recommended Links Medical Industrial Complex The Audacity of Greed Overuse of Cardiac Stents Linked to Patient Deaths
Health insurance Obamacare vs. Trumpcare Trump's bustard neoliberalism and his betrayal of his voters Quality of Life Insurance fraud Short Introduction to Lysenkoism Conformism pressures in large organizations
Ambulances overcharges Medical Overbilling Hospital overcharges Medicare Controlling your Weight Notes on Diabetes Type II Flat feet
Coronary Artery Disease Hypertension Paroxysmal supraventricular tachycardia (PSVT) Ultrasonic humidifiers Fighting nasal congestion Basics of Preventing RSI for programmers and sysadmins Vision
Haggling with doctors and health insurers Techno-fundamentalism

First, do no harm

Personal health insurance plans  Overload Dumbing down america Coping with the toxic stress in IT environment
Cargo Cult Science Scientific Fraud Pseudoscience and Scientific Press Toxic managers Quotes Humor Etc

Programmers and system administrators are mass profession. There were approximately 435K programmers in the USA in 2006. I think number of system administrators are roughly the same so we can speak about the labor army of one million people.

Contrary to superficial impression of individual cubicles and nice environment, IT is actually very unhealthy profession. With a high chance to be unemployed after 50.  More often then not, there are periods of considerable stress. Some are caused by catastrophic failures of hardware equipment, some by unrealistic schedules and workloads, some by own errors of particular programmer or sysadmin.

Overtime is common. Job security is deteriorating as outsourcing is rampant.  Employment after 50 is not guaranteed. Environment changes way too fast, and not always for good. Fashion rules (remember The Devil Wears Prada). Toxic managers are common (remember Office Space ;-)

So sooner of later a programmer need to face "medical-industrial complex" of the USA. And this is a dangerous "for profit" beast with tremendous appetite which maims and kills annually considerable amount of people. Living under Neoliberalism with its "greed is good" mentality and "homo homini lupus est" slogan is indeed dangerous  and requires knowledge of elementary "self-defense". Hippocratic oath no longer applies to medical profession in the USA. Most doctors still follow it, but there real sharks among them (with some ending their careers in jail like regular criminals) and you need to hope for the best but  prepare for the worst.  Especially rampant abuse is with cardiac stents (Overuse of Cardiac Stents Linked to Patient Deaths) with around a dozen of cardiologists serving jail terms (see for example Stent doctor Salisbury stent doctor sentenced to federal prison )

As USA Today reported (Doctors perform thousands of unnecessary surgeries):

Since 2005, more than 1,000 doctors have made payments to settle or close malpractice claims in surgical cases that involved allegations of unnecessary or inappropriate procedures, according to a USA TODAY analysis of the U.S. government's National Practitioner Data Bank public use file, which tracks the suits. About half the doctors' payments involved allegations of serious permanent injury or death, and many of the cases involved multiple plaintiffs, suggesting many hundreds, if not thousands, of victims.

Journal of the American Medical Association reviewed records for 112,000 patients who had an implantable cardioverter-defibrillator (ICD), a pacemaker-like device that corrects heartbeat irregularities. In 22.5% of the cases, researchers found no medical evidence to support installing the devices.

"Don't just take a doctor's word," says Patty Skolnik, who founded Citizens for Patient Safety after her son, Michael, died at 22 from complications in what she says was unnecessary brain surgery. "Research your doctor, research the procedure, ask questions, including the most important one: 'What will happen if I don't get this done?'"

A 1982 study in the journal Medical Care found that a mandatory second opinion program for Massachusetts Medicaid patients led to a 20% drop in certain surgeries, such as hysterectomies, that were considered more likely to be done unnecessarily. A 1997 study in the Journal of the American College of Surgeons looked at 5,601 patients recommended for surgery and found that second opinions found no need for the operation in 9% of the cases. Among those who got the countervailing second opinion, 62% opted not to have the operation.

But many patients simply aren't inclined to question their doctors.

"We expect the physician to know what's best for a patient," says William Root, chief compliance officer at Louisiana's Department of Health and Hospitals. "

We put so much faith and confidence in our physicians, (and) most of them deserve it. But when one of them is wrong or goes astray, it can do a lot of damage."

Chronic stress, overload, long hours, unhealthy diet  and other environmental factors  deeply and negatively affects the lifestyle of programmers and system administrators.  So there is nothing surprising that despite pretty comfortable work conditions many programmers/system administrators suffer from assortments on various diseases. Like other workers who spend long periods in front of a computer terminal typing at a keyboard, programmers are susceptible to:

Additional health problems are typical for those who experience constant stress and/or are typical "diseases of civilization". Among them

Also many programmers/sysadmins works as contractors and either do not have health insurance or have very basic health insurance. This is typical for young programmers and those who are over 50 and were let go on their previous jobs die to outsourcing

Low and middle income US citizens  spends far more on health care than any other country but gets only mediocre care in return for its investment. The U.S. national average score on 37 separate measures of health care falls far short when compared either to a few centers of excellence within the country, or to other countries, the report from the Commonwealth Fund found. And that's true not only in terms of mortality statistics but also in terms of quality of life.

The main problems with US healthcare are:

Programmers and system administrators can do much better is maintaining their health. And they are naturally equipped for dealing with complex system and thus able to navigate the maze of the USA "medical industrial complex"

A lot of outcomes depends on the level of individual knowledge. Knowledge is power both for avoiding unnecessary procedures (with some causing irreversible damage) , unnecessary overprescribed drugs, and when negotiating with health care providers.

Some facts:


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[Apr 15, 2017] US Pursues Selective Protectionism Not Free Trade

Notable quotes:
"... As a result of this protectionism, average pay for doctors is over $250,000 a year and more than $200,000 a year for dentists, putting the vast majority of both groups in the top 2.0 percent of wage earners. Their pay is roughly twice the average received by their counterparts in other wealthy countries, adding close to $100 billion a year ($700 per family per year) to our medical bill. ..."
"... We also have actively been pushing for longer and stronger patent and copyright protections. While these protections, like all forms of protectionism, serve a purpose, they are 180 degrees at odds with free trade. And, they are very costly. Patent protection in prescription drugs will lead to us pay more than $440 billion this year for drugs that would likely sell for less than $80 billion in a free market. The difference of $360 billion comes to almost $3,000 a year for every family in the country. ..."
"... It is also worth noting patent protection results in exactly the sort of corruption that would be expected from a huge government imposed tariff. (When patents raise the price of a drug by a factor of 100 or more, as is often the case , it is equivalent to a tariff of 10,000 percent.) The result is that pharmaceutical companies often make payoffs to doctors to promote their drugs or conceal evidence that their drugs are less effective than claimed or even harmful. ..."
"... Stop using the term "free trade" at all...when wall street bankers and hedge fund managers and the corporate media use the term "free trade", what they are really talking about is labor arbitrage. Shifting factories to nations with the lowest worker living standards, health, safety and environmental standards. It usually means a nation without a democracy, run by either oligarchs or despots. ..."
"... Bbbbut patents are essential to allow top executives to extract half the annual expenditures of unprofitable corporations in compensation while still leaving a few pennies for "research". ..."
"... Fake news...about a reliable as a Democrat's promise that he's for the working folks. ..."
"... The "law" of supply and demand just does not apply in this field. That "law" also does not work in certain other areas where important conclusions are drawn from it - applying it is not a substitute for empirical evidence. ..."
Apr 12, 2017 | cepr.net

The Washington Post and other major news outlets are strong supporters of the trade policy pursued by administrations of both political parties. They routinely allow their position on this issue to spill over into their news reporting, touting the policy as "free trade." We got yet another example of this in the Washington Post today.

Of course the policy is very far from free trade. We have largely left in place the protectionist barriers that keep doctors and dentists from other countries from competing with our own doctors. (Doctors have to complete a U.S. residency program before they can practice in the United States and dentists must graduate from a U.S. dental school. The lone exception is for Canadian doctors and dentists, although even here we have left unnecessary barriers in place.)

As a result of this protectionism, average pay for doctors is over $250,000 a year and more than $200,000 a year for dentists, putting the vast majority of both groups in the top 2.0 percent of wage earners. Their pay is roughly twice the average received by their counterparts in other wealthy countries, adding close to $100 billion a year ($700 per family per year) to our medical bill.

While trade negotiators may feel this protectionism is justified, since these professionals lack the skills to compete in the global economy, it is nonetheless protectionism, not free trade.

We also have actively been pushing for longer and stronger patent and copyright protections. While these protections, like all forms of protectionism, serve a purpose, they are 180 degrees at odds with free trade. And, they are very costly. Patent protection in prescription drugs will lead to us pay more than $440 billion this year for drugs that would likely sell for less than $80 billion in a free market. The difference of $360 billion comes to almost $3,000 a year for every family in the country.

It is also worth noting patent protection results in exactly the sort of corruption that would be expected from a huge government imposed tariff. (When patents raise the price of a drug by a factor of 100 or more, as is often the case , it is equivalent to a tariff of 10,000 percent.) The result is that pharmaceutical companies often make payoffs to doctors to promote their drugs or conceal evidence that their drugs are less effective than claimed or even harmful.

Raye 2 days ago

I was pleased to see that PBS looked into the matter of physician supply a few years ago.. They noted: "There are fewer physicians per person than in most other OECD countries. In 2010, for instance, the US had 2.4 practicing physicians per 1000 people--well below the OECD average of 3.1." They also noted that "US physicians get higher incomes than in other countries." They didn't go so far as to note a cause-and-effect relationship here, a deliberate restriction of supply going on, for purposes of raising MD incomes. But at least they were presenting the facts.

They even mentioned the $750 billion wasted each year by our health care system.. I expect it's up to at least $3000 per person by now. And they suggested some good uses that so much money could be put to (VA health care, state college education for all the 17- and 18-year-olds in the country). I would like to add another use. If we were wasting less on overpriced health, more people might be able to afford a little more leisure and recreation time. And this (especially the recreation time) might lead to a lowering of our very high rates of obesity, diabetes and prediabetes.

Harlan Raye , 2 days ago

Physician density (as reported by CIA dot gov with dates) shows Canada with smaller ratio than the U.S. but they still retain lower costs, and U.K. though higher by 10 or 15% has considerably lower costs, and the U.S. has more specialists but they get higher incomes, and states with more doctors have higher incomes.

We may need more doctors, especially general practitioners, and more medical schools since 8% of U.S. citizens are forced to train abroad already, but increased supply won't lower costs. It is the medical system and not the supply of doctors that determines fees being charged, which only amount to 10% of total costs. Cut their fees 30% and you still have a $1 trillion 1/3 cost higher than other developed nations. Doctors are not the main cause of the dysfunctional system. Look at what other countries do.

Harlan , 3 days ago

This bolsters my case, there is a high skills job shortage. Take 100,000 proposed increase in doctors and give the jobs exclusively to foreign graduates, and you've robbed Americans of needed jobs. College graduates only have a 2.5 percent unemployment rate because they take jobs away from those without college. So lack of enough high skills jobs really hurts the working class lower income groups with less formal education.

New argument, pay attention. No one would deny that a gap of 1 million jobs, or nearly 1% of increased unemployment (really only .8% since there are 120 jobs), is enough to suppress wages, induce slack in the economy, suppress growth, and possibly even create contraction or self sustaining stagnation. Well a 100,000 new doctor jobs is only 1/10 of that amount. How important is that? I would argue it's very important. 10 percent cause of any such serious effect as a 1 percent rise in unemployment is nutty to dismiss. That's why we cheer when the unemployment drops even .1 percent. You don't get the benefits of full employment until reach full employment, whether 1 percent away or .1 percent away. Really.

EPI

Even the Most Educated Workers Have Declining Wages
Feb 2015

Harlan ->Harlan , 3 days ago

Was trying to highlight this report, but buried the lead:

EPI
Even the Most Educated Workers Have Declining Wages
Feb 2015

Also in my comment where I wrote "since there are 120 jobs," obviously meant "120 million jobs".

And finally, left out a "you" in closing:

You don't get the benefits of full employment until you reach full employment, whether 1 percent away or .1 percent away.

David Havelka , 3 days ago

Isn't 10 years and 1 million dollars too much for the average family practice physican to pay to become a doctor. Reducing the cost of educating a doctor would be a better solution. Increasing the use of midwives and nurse practicioners is another unexplored solution.

Stop using the term "free trade" at all...when wall street bankers and hedge fund managers and the corporate media use the term "free trade", what they are really talking about is labor arbitrage. Shifting factories to nations with the lowest worker living standards, health, safety and environmental standards. It usually means a nation without a democracy, run by either oligarchs or despots.

As best I can see, neither NAFTA or any other "free trade" agreement mentions anything about wages, or for that matter worker health and safety, or environmental standards. The only purpose of NAFTA and TPP was to force trade partners to accept US patent and copyright protections as the price of access to the lucrative US market.

Dean's argumen that just because we import cheap foreign labor to displace American workers in the contruction and lawn-mowing and housekeeping labor markets, it's fair and justified to import highly educated professionals seems wrong-headed to me. Are you talking about extending H1B Visa categories to include doctors.

In my opinion the people behind the high cost of highly educated professions is the AMA, and the universities and education trade associations---who set the standards for doctors and lawyers, and are the ones demanding foreigners complete American educational standards to be permitted to work in the USA

Harlan-> David Havelka , 3 days ago

The truth is the exact opposite of what you report. The medical educational establishment favors increased admissions. The AMA is another story, perhaps. In any event you need more medical schools for more doctors, not lower standards or importing more than the already high 12% foreign medical school graduates we recruit each year.

Our high standards are fine. But already 8% of US citizens train abroad for lack of medical schools. Even if you don't favor more doctors, that in itself screams for more U.S. medical schools.

From the Association of American Medical Colleges
Tuesday, March 14, 2017
New Research Reaffirms Physician Shortage
Shortages Likely to Have Significant Impact on Patient Care

More corrections: H1B can already include doctors, though 60 percent are in tech. Trade agreements were not about patents and copyright, they were about making it easier to do what they were already doing. No surprise is you lower barriers to trade, your domestic industry suffers in competition with cheaper goods. Unions opposed them to protect their jobs. Do you think the union officials were geniuses and the economists were stupid? Or was it common sense exactly what would happen and that it was just too convenient for economists not to favor trade, deregulation of banks, lower taxes, derivative markets, hedge funds.

David Havelka -> Harlan , 2 days ago

Sound like "fake news"---the educational establishment supports increasing admissions but if the price of admission is 10 years and 1 million dollars, well....so the cost of entry they charge is usually a barrier to entry.. Aside from that, there is the standards for admission are set by the educational establishment...so between the two, what have you got? A contrived limit on doctors. Oh, but apologists for the educational establishment like you keep repeating the PR/BS line that universities and trade unions want to increase admissions to medical schools.

Next another one of your "facts" that sounds seriously contradictory...that trade agreements make things "easier" to do what they were doing. HUH? What does that mean? Look none of the trade agreements have anything to do with anything except patent and copyright protection. If a trading partner accepts patent and copyright protection for their economy, they get access to the Us market without trade barriers. Except for productts that receive public subsidies, like franken-food and growth hormone treated meat. So a trading partner is forced to remove the barriers to entry on things like the growth hormone raised beef to Japan, and genetically modified and subsidized crazycorn to Mexico. Is that what you mean by "making things easier"....Sure it makes things "easier"---but is that the point? Or do citizens from Japan have the right to prohibit meat raised with growth hormones? Or do Mexican citizens have the right to prohibit genetically raised corn?

Look, "free trade" is a utopian fantasy, invented by a bunch of liars to sell something to the US consumer that isn't good for him.

Harlan -> David Havelka , 2 days ago

Why don't you try reading what people wrote before posting under their comment? I'm against trade agreements and increased trade that undercuts American workers.

Maybe you should read even the most elementary news report on the effect of NAFTA and China's entry into the WTO. Patent and copyright protections were neither the main motivation nor an important effect. China pays little heed to any IP law anyway and their state efforts to coerce and steal American technology are barely concealed.

Japan doesn't buy American due to cultural norms, American incompetence, and laziness, and Japanese protectionist laws and regulations.

Most free traders have been Republicans, and most objections to free trade have come from the Democrats and the left. Except for Trump Clinton reversal, Liberals (and unions) can claim the high ground over conservatives when it comes to trade issues. This blog and Dean Baker consistently decries the effects of international trade and trade agreements effects on the working class.

There is a shortage of medical schools, there is no shortage of qualified students, admissions standards do not prevent medical student enrollment from increasing. Your comment is virtually fact free.
You obviously hate education and unions and real news.

AlanInAZ , 3 days ago

Expanding doctor supply without major changes to the insurance system is as likely to increase overall healthcare costs as reduce them. In the world of healthcare, demand increases to meet supply.

The country with the insurance and healthcare system closest to the US is probably Switzerland with the exception that costs are controlled with a national fee for service scale (TARMED).

The Swiss estimate that each new private medical practice adds $536,000 per doctor to the nation's overall healthcare spending. This is one of the main reasons the Swiss limit the number of new medical practices and control doctor immigration to balance demand. The Swiss are concerned about rising costs and the government is now proposing to reduce the allowable charges by specialists.

Those that are attracted to Baker's immigration proposal should ask what is the long term consequence of relying on immigration to fill the doctor shortfall and/or control cost. In the short run there may be some average income reduction for physicians with little or no change in total healthcare costs (remember total cost equals average income times the larger number of doctors). Longer term, it restricts domestic investment in expansion of healthcare training and that is a restriction of opportunity for all Americans.

Mitch Beales , 3 days ago

Bbbbut patents are essential to allow top executives to extract half the annual expenditures of unprofitable corporations in compensation while still leaving a few pennies for "research".

pieceofcake , 3 days ago

'U.S. Pursues Selective Protectionism: Not Free Trade'

Oh absolutely - and I'm also really worried about these doctors... and the meat - the meat - as if we can't export all of our meat to China - we for sure will need more doctors to operate on all these oversized boobs which will grow if we have to eat all of our hormone meat by ourselves - and you know how painful it is to carry these big boobs around?

And I happen to know this Plastic Surgeon who told me we need lots and lot more Plastic Surgeons -(as Americans get older and older) - and perhaps - if your plan finally comes through - also facelifts will get cheaper - as who wants to have her or his face done in a undeveloped country -(even if it comes with a nice and long vacation)

So more power to y'a and you finally have completely convinced me and let's do it together!

Get them doctors!!

Harlan , 3 days ago

There is no protectionism when it comes to doctors as they are well represented by immigrants who make up 12% of doctors, including new doctors, comparing favorably to the near record 13.5% U.S. immigrant population.

U.S. doctors don't make twice the salary of other developed countries, with their incomes running about 40% to 60% for GPs and specialists respectively.

More doctors should be supplied by relieving the shortage of medical schools, even an extra 100,000 would help the working class stop getting bumped into unemployment by an overskilled work force. Too many college graduates and not enough jobs, so they bump off those without. They get 2.5% unemployment, those without north of 5 or 7%.

This paper cited below clearly shows we do not pay our doctors twice the salary of other developed countries. The figure is actually around 40% for those in general practice, 60% for specialists, and largely because U.S. salaries overall are higher (in every occupation). When you look at the comparative advantage a doctors salary in any country enjoys over the average salary in that country, even that advantage largely disappears. See figure 2 on page 16 for general practitioners and and figure 6 on page 21 for specialists.
"THE REMUNERATION OF GENERAL PRACTITIONERS AND SPECIALISTS IN 14 OECD COUNTRIES: WHAT ARE THE FACTORS INFLUENCING VARIATIONS ACROSS COUNTRIES?"

Unlike Dean Baker's anti-labor, anti-working class stance that we should end any protection against importing cheaper foreign labor to undercut wages, we should of course afford the same protections to all occupations.

David Havelka ->Harlan , 3 days ago

It is the Democrat Party politics that is behind the high cost of doctors and lawyers. Why because the Educational establishment---the trade associattions and the universities themselves are the ones limiting the admissions, and the ones demanding that all medical professioanls get their education and qualifications through themselves...And we all know that is the universities, the education trade unions and their lobbiest that are one of the most powerful constituencies for the Democrat Party.

Mitch Beales ->David Havelka , 2 days ago

It is the republic party that is behind the high cost of everything as well as the pollution of the internet with ridiculous comments like yours.

Harlan ->David Havelka , 3 days ago

The truth is the exact opposite of what you report. The medical educational establishment favors increased admissions.

From the Association of American Medical Colleges
Tuesday, March 14, 2017
New Research Reaffirms Physician Shortage
Shortages Likely to Have Significant Impact on Patient Care

David Havelka ->Harlan , 2 days ago

Sound like a "fake newa"...so the educational establishment's official public relations read BULL-TOSS position is to support increased admissions to medical school. Yet the same establishment imposed the "barrier to entry" cost of obtaining a doctor ticket, 10 years and 1 million dollars. And who the heck sets the admission standards for their precious schools that results in the high rejection rate of applicants.

Fake news...about a reliable as a Democrat's promise that he's for the working folks.

skeptonomist ->Harlan , 3 days ago

The OECD article should be read by anyone interested in this. Figure 11 shows that the number of physicians in the US is close to the OECD average - in fact the number of specialists is actually less, but the US level of pay is higher. Of course there is also no correlation of pay with the fraction of foreign doctors.

And despite the supposed shortage of GP's in the US their pay is still much less. The "law" of supply and demand just does not apply in this field. That "law" also does not work in certain other areas where important conclusions are drawn from it - applying it is not a substitute for empirical evidence.

The comparison of physician pay would be better if done with the overall median rather than average. Greater inequality in the US means that the average pay is greater than in the other countries.

[Apr 15, 2017] U.S. Pursues Selective Protectionism Not Free Trade

Notable quotes:
"... As a result of this protectionism, average pay for doctors is over $250,000 a year and more than $200,000 a year for dentists, putting the vast majority of both groups in the top 2.0 percent of wage earners. Their pay is roughly twice the average received by their counterparts in other wealthy countries, adding close to $100 billion a year ($700 per family per year) to our medical bill. ..."
"... We also have actively been pushing for longer and stronger patent and copyright protections. While these protections, like all forms of protectionism, serve a purpose, they are 180 degrees at odds with free trade. And, they are very costly. Patent protection in prescription drugs will lead to us pay more than $440 billion this year for drugs that would likely sell for less than $80 billion in a free market. The difference of $360 billion comes to almost $3,000 a year for every family in the country. ..."
"... It is also worth noting patent protection results in exactly the sort of corruption that would be expected from a huge government imposed tariff. (When patents raise the price of a drug by a factor of 100 or more, as is often the case , it is equivalent to a tariff of 10,000 percent.) The result is that pharmaceutical companies often make payoffs to doctors to promote their drugs or conceal evidence that their drugs are less effective than claimed or even harmful. ..."
"... Stop using the term "free trade" at all...when wall street bankers and hedge fund managers and the corporate media use the term "free trade", what they are really talking about is labor arbitrage. Shifting factories to nations with the lowest worker living standards, health, safety and environmental standards. It usually means a nation without a democracy, run by either oligarchs or despots. ..."
"... Bbbbut patents are essential to allow top executives to extract half the annual expenditures of unprofitable corporations in compensation while still leaving a few pennies for "research". ..."
"... Fake news...about a reliable as a Democrat's promise that he's for the working folks. ..."
"... The "law" of supply and demand just does not apply in this field. That "law" also does not work in certain other areas where important conclusions are drawn from it - applying it is not a substitute for empirical evidence. ..."
Apr 12, 2017 | cepr.net

The Washington Post and other major news outlets are strong supporters of the trade policy pursued by administrations of both political parties. They routinely allow their position on this issue to spill over into their news reporting, touting the policy as "free trade." We got yet another example of this in the Washington Post today.

Of course the policy is very far from free trade. We have largely left in place the protectionist barriers that keep doctors and dentists from other countries from competing with our own doctors. (Doctors have to complete a U.S. residency program before they can practice in the United States and dentists must graduate from a U.S. dental school. The lone exception is for Canadian doctors and dentists, although even here we have left unnecessary barriers in place.)

As a result of this protectionism, average pay for doctors is over $250,000 a year and more than $200,000 a year for dentists, putting the vast majority of both groups in the top 2.0 percent of wage earners. Their pay is roughly twice the average received by their counterparts in other wealthy countries, adding close to $100 billion a year ($700 per family per year) to our medical bill.

While trade negotiators may feel this protectionism is justified, since these professionals lack the skills to compete in the global economy, it is nonetheless protectionism, not free trade.

We also have actively been pushing for longer and stronger patent and copyright protections. While these protections, like all forms of protectionism, serve a purpose, they are 180 degrees at odds with free trade. And, they are very costly. Patent protection in prescription drugs will lead to us pay more than $440 billion this year for drugs that would likely sell for less than $80 billion in a free market. The difference of $360 billion comes to almost $3,000 a year for every family in the country.

It is also worth noting patent protection results in exactly the sort of corruption that would be expected from a huge government imposed tariff. (When patents raise the price of a drug by a factor of 100 or more, as is often the case , it is equivalent to a tariff of 10,000 percent.) The result is that pharmaceutical companies often make payoffs to doctors to promote their drugs or conceal evidence that their drugs are less effective than claimed or even harmful.

Raye 2 days ago

I was pleased to see that PBS looked into the matter of physician supply a few years ago.. They noted: "There are fewer physicians per person than in most other OECD countries. In 2010, for instance, the US had 2.4 practicing physicians per 1000 people--well below the OECD average of 3.1." They also noted that "US physicians get higher incomes than in other countries." They didn't go so far as to note a cause-and-effect relationship here, a deliberate restriction of supply going on, for purposes of raising MD incomes. But at least they were presenting the facts.

They even mentioned the $750 billion wasted each year by our health care system.. I expect it's up to at least $3000 per person by now. And they suggested some good uses that so much money could be put to (VA health care, state college education for all the 17- and 18-year-olds in the country). I would like to add another use. If we were wasting less on overpriced health, more people might be able to afford a little more leisure and recreation time. And this (especially the recreation time) might lead to a lowering of our very high rates of obesity, diabetes and prediabetes.

Harlan Raye , 2 days ago

Physician density (as reported by CIA dot gov with dates) shows Canada with smaller ratio than the U.S. but they still retain lower costs, and U.K. though higher by 10 or 15% has considerably lower costs, and the U.S. has more specialists but they get higher incomes, and states with more doctors have higher incomes.

We may need more doctors, especially general practitioners, and more medical schools since 8% of U.S. citizens are forced to train abroad already, but increased supply won't lower costs. It is the medical system and not the supply of doctors that determines fees being charged, which only amount to 10% of total costs. Cut their fees 30% and you still have a $1 trillion 1/3 cost higher than other developed nations. Doctors are not the main cause of the dysfunctional system. Look at what other countries do.

Harlan , 3 days ago

This bolsters my case, there is a high skills job shortage. Take 100,000 proposed increase in doctors and give the jobs exclusively to foreign graduates, and you've robbed Americans of needed jobs. College graduates only have a 2.5 percent unemployment rate because they take jobs away from those without college. So lack of enough high skills jobs really hurts the working class lower income groups with less formal education.

New argument, pay attention. No one would deny that a gap of 1 million jobs, or nearly 1% of increased unemployment (really only .8% since there are 120 jobs), is enough to suppress wages, induce slack in the economy, suppress growth, and possibly even create contraction or self sustaining stagnation. Well a 100,000 new doctor jobs is only 1/10 of that amount. How important is that? I would argue it's very important. 10 percent cause of any such serious effect as a 1 percent rise in unemployment is nutty to dismiss. That's why we cheer when the unemployment drops even .1 percent. You don't get the benefits of full employment until reach full employment, whether 1 percent away or .1 percent away. Really.

EPI

Even the Most Educated Workers Have Declining Wages
Feb 2015

Harlan ->Harlan , 3 days ago

Was trying to highlight this report, but buried the lead:

EPI
Even the Most Educated Workers Have Declining Wages
Feb 2015

Also in my comment where I wrote "since there are 120 jobs," obviously meant "120 million jobs".

And finally, left out a "you" in closing:

You don't get the benefits of full employment until you reach full employment, whether 1 percent away or .1 percent away.

David Havelka , 3 days ago

Isn't 10 years and 1 million dollars too much for the average family practice physican to pay to become a doctor. Reducing the cost of educating a doctor would be a better solution. Increasing the use of midwives and nurse practicioners is another unexplored solution.

Stop using the term "free trade" at all...when wall street bankers and hedge fund managers and the corporate media use the term "free trade", what they are really talking about is labor arbitrage. Shifting factories to nations with the lowest worker living standards, health, safety and environmental standards. It usually means a nation without a democracy, run by either oligarchs or despots.

As best I can see, neither NAFTA or any other "free trade" agreement mentions anything about wages, or for that matter worker health and safety, or environmental standards. The only purpose of NAFTA and TPP was to force trade partners to accept US patent and copyright protections as the price of access to the lucrative US market.

Dean's argumen that just because we import cheap foreign labor to displace American workers in the contruction and lawn-mowing and housekeeping labor markets, it's fair and justified to import highly educated professionals seems wrong-headed to me. Are you talking about extending H1B Visa categories to include doctors.

In my opinion the people behind the high cost of highly educated professions is the AMA, and the universities and education trade associations---who set the standards for doctors and lawyers, and are the ones demanding foreigners complete American educational standards to be permitted to work in the USA

Harlan-> David Havelka , 3 days ago

The truth is the exact opposite of what you report. The medical educational establishment favors increased admissions. The AMA is another story, perhaps. In any event you need more medical schools for more doctors, not lower standards or importing more than the already high 12% foreign medical school graduates we recruit each year.

Our high standards are fine. But already 8% of US citizens train abroad for lack of medical schools. Even if you don't favor more doctors, that in itself screams for more U.S. medical schools.

From the Association of American Medical Colleges
Tuesday, March 14, 2017
New Research Reaffirms Physician Shortage
Shortages Likely to Have Significant Impact on Patient Care

More corrections: H1B can already include doctors, though 60 percent are in tech. Trade agreements were not about patents and copyright, they were about making it easier to do what they were already doing. No surprise is you lower barriers to trade, your domestic industry suffers in competition with cheaper goods. Unions opposed them to protect their jobs. Do you think the union officials were geniuses and the economists were stupid? Or was it common sense exactly what would happen and that it was just too convenient for economists not to favor trade, deregulation of banks, lower taxes, derivative markets, hedge funds.

David Havelka -> Harlan , 2 days ago

Sound like "fake news"---the educational establishment supports increasing admissions but if the price of admission is 10 years and 1 million dollars, well....so the cost of entry they charge is usually a barrier to entry.. Aside from that, there is the standards for admission are set by the educational establishment...so between the two, what have you got? A contrived limit on doctors. Oh, but apologists for the educational establishment like you keep repeating the PR/BS line that universities and trade unions want to increase admissions to medical schools.

Next another one of your "facts" that sounds seriously contradictory...that trade agreements make things "easier" to do what they were doing. HUH? What does that mean? Look none of the trade agreements have anything to do with anything except patent and copyright protection. If a trading partner accepts patent and copyright protection for their economy, they get access to the Us market without trade barriers. Except for productts that receive public subsidies, like franken-food and growth hormone treated meat. So a trading partner is forced to remove the barriers to entry on things like the growth hormone raised beef to Japan, and genetically modified and subsidized crazycorn to Mexico. Is that what you mean by "making things easier"....Sure it makes things "easier"---but is that the point? Or do citizens from Japan have the right to prohibit meat raised with growth hormones? Or do Mexican citizens have the right to prohibit genetically raised corn?

Look, "free trade" is a utopian fantasy, invented by a bunch of liars to sell something to the US consumer that isn't good for him.

Harlan -> David Havelka , 2 days ago

Why don't you try reading what people wrote before posting under their comment? I'm against trade agreements and increased trade that undercuts American workers.

Maybe you should read even the most elementary news report on the effect of NAFTA and China's entry into the WTO. Patent and copyright protections were neither the main motivation nor an important effect. China pays little heed to any IP law anyway and their state efforts to coerce and steal American technology are barely concealed.

Japan doesn't buy American due to cultural norms, American incompetence, and laziness, and Japanese protectionist laws and regulations.

Most free traders have been Republicans, and most objections to free trade have come from the Democrats and the left. Except for Trump Clinton reversal, Liberals (and unions) can claim the high ground over conservatives when it comes to trade issues. This blog and Dean Baker consistently decries the effects of international trade and trade agreements effects on the working class.

There is a shortage of medical schools, there is no shortage of qualified students, admissions standards do not prevent medical student enrollment from increasing. Your comment is virtually fact free.
You obviously hate education and unions and real news.

AlanInAZ , 3 days ago

Expanding doctor supply without major changes to the insurance system is as likely to increase overall healthcare costs as reduce them. In the world of healthcare, demand increases to meet supply.

The country with the insurance and healthcare system closest to the US is probably Switzerland with the exception that costs are controlled with a national fee for service scale (TARMED).

The Swiss estimate that each new private medical practice adds $536,000 per doctor to the nation's overall healthcare spending. This is one of the main reasons the Swiss limit the number of new medical practices and control doctor immigration to balance demand. The Swiss are concerned about rising costs and the government is now proposing to reduce the allowable charges by specialists.

Those that are attracted to Baker's immigration proposal should ask what is the long term consequence of relying on immigration to fill the doctor shortfall and/or control cost. In the short run there may be some average income reduction for physicians with little or no change in total healthcare costs (remember total cost equals average income times the larger number of doctors). Longer term, it restricts domestic investment in expansion of healthcare training and that is a restriction of opportunity for all Americans.

Mitch Beales , 3 days ago

Bbbbut patents are essential to allow top executives to extract half the annual expenditures of unprofitable corporations in compensation while still leaving a few pennies for "research".

pieceofcake , 3 days ago

'U.S. Pursues Selective Protectionism: Not Free Trade'

Oh absolutely - and I'm also really worried about these doctors... and the meat - the meat - as if we can't export all of our meat to China - we for sure will need more doctors to operate on all these oversized boobs which will grow if we have to eat all of our hormone meat by ourselves - and you know how painful it is to carry these big boobs around?

And I happen to know this Plastic Surgeon who told me we need lots and lot more Plastic Surgeons -(as Americans get older and older) - and perhaps - if your plan finally comes through - also facelifts will get cheaper - as who wants to have her or his face done in a undeveloped country -(even if it comes with a nice and long vacation)

So more power to y'a and you finally have completely convinced me and let's do it together!

Get them doctors!!

Harlan , 3 days ago

There is no protectionism when it comes to doctors as they are well represented by immigrants who make up 12% of doctors, including new doctors, comparing favorably to the near record 13.5% U.S. immigrant population.

U.S. doctors don't make twice the salary of other developed countries, with their incomes running about 40% to 60% for GPs and specialists respectively.

More doctors should be supplied by relieving the shortage of medical schools, even an extra 100,000 would help the working class stop getting bumped into unemployment by an overskilled work force. Too many college graduates and not enough jobs, so they bump off those without. They get 2.5% unemployment, those without north of 5 or 7%.

This paper cited below clearly shows we do not pay our doctors twice the salary of other developed countries. The figure is actually around 40% for those in general practice, 60% for specialists, and largely because U.S. salaries overall are higher (in every occupation). When you look at the comparative advantage a doctors salary in any country enjoys over the average salary in that country, even that advantage largely disappears. See figure 2 on page 16 for general practitioners and and figure 6 on page 21 for specialists.
"THE REMUNERATION OF GENERAL PRACTITIONERS AND SPECIALISTS IN 14 OECD COUNTRIES: WHAT ARE THE FACTORS INFLUENCING VARIATIONS ACROSS COUNTRIES?"

Unlike Dean Baker's anti-labor, anti-working class stance that we should end any protection against importing cheaper foreign labor to undercut wages, we should of course afford the same protections to all occupations.

David Havelka ->Harlan , 3 days ago

It is the Democrat Party politics that is behind the high cost of doctors and lawyers. Why because the Educational establishment---the trade associattions and the universities themselves are the ones limiting the admissions, and the ones demanding that all medical professioanls get their education and qualifications through themselves...And we all know that is the universities, the education trade unions and their lobbiest that are one of the most powerful constituencies for the Democrat Party.

Mitch Beales ->David Havelka , 2 days ago

It is the republic party that is behind the high cost of everything as well as the pollution of the internet with ridiculous comments like yours.

Harlan ->David Havelka , 3 days ago

The truth is the exact opposite of what you report. The medical educational establishment favors increased admissions.

From the Association of American Medical Colleges
Tuesday, March 14, 2017
New Research Reaffirms Physician Shortage
Shortages Likely to Have Significant Impact on Patient Care

David Havelka ->Harlan , 2 days ago

Sound like a "fake newa"...so the educational establishment's official public relations read BULL-TOSS position is to support increased admissions to medical school. Yet the same establishment imposed the "barrier to entry" cost of obtaining a doctor ticket, 10 years and 1 million dollars. And who the heck sets the admission standards for their precious schools that results in the high rejection rate of applicants.

Fake news...about a reliable as a Democrat's promise that he's for the working folks.

skeptonomist ->Harlan , 3 days ago

The OECD article should be read by anyone interested in this. Figure 11 shows that the number of physicians in the US is close to the OECD average - in fact the number of specialists is actually less, but the US level of pay is higher. Of course there is also no correlation of pay with the fraction of foreign doctors.

And despite the supposed shortage of GP's in the US their pay is still much less. The "law" of supply and demand just does not apply in this field. That "law" also does not work in certain other areas where important conclusions are drawn from it - applying it is not a substitute for empirical evidence.

The comparison of physician pay would be better if done with the overall median rather than average. Greater inequality in the US means that the average pay is greater than in the other countries.

[Apr 09, 2017] When consulting a second opinion, the physician only confirmed the original diagnosis 12 percent of the time

Notable quotes:
"... The study, conducted using records of patients referred to the Mayo Clinic's General Internal Medicine Division over a two-year period, ultimately found that when consulting a second opinion, the physician only confirmed the original diagnosis 12 percent of the time. ..."
"... Among those with updated diagnoses, 66% received a refined or redefined diagnosis, while 21% were diagnosed with something completely different than what their first physician concluded. ..."
"... The researchers acknowledged that receiving a completely different diagnosis could result in a patient facing otherwise unexpected expenditures, "but the alternative could be deadly." ..."
Apr 09, 2017 | economistsview.typepad.com
im1dc April 09, 2017 at 10:31 AM
"when consulting a second opinion, the physician only confirmed the original diagnosis 12 percent of the time"

Are you sure you have what your provider said you have?

https://www.studyfinds.org/second-opinion-doctor-diagnosis-study/

"Second Opinion From Doctor Nets Different Diagnosis 88% Of Time, Study Finds"

by Daniel Steingold...4.8.2017

"ROCHESTER, Minn. - When it comes to treating a serious illness, two brains are better than one. A new study finds that nearly 9 in 10 people who go for a second opinion after seeing a doctor are likely to leave with a refined or new diagnosis from what they were first told.

Researchers at the Mayo Clinic examined 286 patient records of individuals who had decided to consult a second opinion, hoping to determine whether being referred to a second specialist impacted one's likelihood of receiving an accurate diagnosis.

The study, conducted using records of patients referred to the Mayo Clinic's General Internal Medicine Division over a two-year period, ultimately found that when consulting a second opinion, the physician only confirmed the original diagnosis 12 percent of the time.

Among those with updated diagnoses, 66% received a refined or redefined diagnosis, while 21% were diagnosed with something completely different than what their first physician concluded.

"Effective and efficient treatment depends on the right diagnosis," says lead researcher Dr. James Naessens in a Mayo news release. "Knowing that more than 1 out of every 5 referral patients may be completely [and] incorrectly diagnosed is troubling ─ not only because of the safety risks for these patients prior to correct diagnosis, but also because of the patients we assume are not being referred at all."

Considering how health insurance companies often limit the ability of patients to visit multiple specialists, this figure could be seen as troubling.

Combine this with the fact that primary care physicians are often overly-confident in their diagnoses, not to mention how a high number of patients feel amiss about questioning their diagnoses, a massive issue is revealed.

"Referrals to advanced specialty care for undifferentiated problems are an essential component of patient care," says Naessens. "Without adequate resources to handle undifferentiated diagnoses, a potential unintended consequence is misdiagnosis, resulting in treatment delays and complications, and leading to more costly treatments."

The researchers acknowledged that receiving a completely different diagnosis could result in a patient facing otherwise unexpected expenditures, "but the alternative could be deadly."

According to the release, The National Academy of Medicine cites diagnostic error as an important component in determining the quality of health care in its new publication, Improving Diagnosis in Health Care:

....."Despite the pervasiveness of diagnostic errors and the risk for serious patient harm, diagnostic errors have been largely unappreciated within the quality and patient safety movements in health care. Without a dedicated focus on improving diagnosis, these errors will likely worsen as the delivery of health care and the diagnostic process continue to increase in complexity."

* The study was published in the Journal of Evaluation in Clinical Practice.

[Apr 06, 2017] The country will spend over $440 billion this year for drugs that would likely sell for less than $80 billion in a free market.

Apr 06, 2017 | economistsview.typepad.com
anne , April 06, 2017 at 05:31 AM
http://cepr.net/blogs/beat-the-press/robert-atkinson-pushes-pro-rich-protectionist-agenda-in-the-washington-post

April 6, 2017

Robert Atkinson Pushes Pro-Rich Protectionist Agenda in the Washington Post

The Washington Post is always open to plans for taking money from ordinary workers and giving it to the rich. For this reason it was not surprising to see a piece * by Robert Atkinson, the head of the industry funded Information Technology and Innovation Foundation, advocating for more protectionism in the form of stronger and longer patent and copyright monopolies.

These monopolies, legacies from the medieval guild system, can raise the price of the protected items by one or two orders of magnitudes making them equivalent to tariffs of several hundred or several thousand percent. They are especially important in the case of prescription drugs.

Life-saving drugs that would sell for $200 or $300 in a free market can sell for tens or even hundreds of thousands of dollars due to patent protection. The country will spend over $440 billion this year for drugs that would likely sell for less than $80 billion in a free market. The strengthening of these protections is an important cause of the upward redistribution of the last four decades. The difference comes to more than $2,700 a year for an average family. (This is discussed in "Rigged: How Globalization and the Rules of the Modern Economy Were Structured to Make the Rich Richer," ** where I also lay out alternative mechanisms for financing innovation and creative work.)

Atkinson makes this argument in the context of the U.S. relationship with China. He also is explicitly prepared to have ordinary workers pay the price for this protectionism. He warns that not following his recommendation for a new approach to dealing with China, including forcing them to impose more protection for U.S. patents and copyrights, would lead to a lower valued dollar.

Of course a lower valued dollar will make U.S. goods and services more competitive internationally. That would mean a smaller trade deficit as we sell more manufactured goods elsewhere in the world and buy fewer imported goods in the United States. This could increase manufacturing employment by 1-2 million, putting upward pressure on the wages of non-college educated workers.

In short, not following Atkinson's path is likely to mean more money for less-educated workers, less money for the rich, and more overall growth, as the economy benefits from the lessening of protectionist barriers.

* https://www.washingtonpost.com/opinions/global-opinions/how-trump-can-stop-china-from-eating-our-lunch/2017/04/05/b83e4460-1953-11e7-bcc2-7d1a0973e7b2_story.html

** http://deanbaker.net/images/stories/documents/Rigged.pdf

-- Dean Baker

[Apr 06, 2017] Health Care Renewal Not Going to Take it Anymore - Doctors in the Pacific Northwest Unionize, Begin Collective Bargaining with Hospital Systems

Apr 06, 2017 | hcrenewal.blogspot.com
Managerialist Tactics: Outsourcing

The NYT article opened with

in the spring of 2014, when the administration announced it would seek bids to outsource its 36 hospitalists , the hospital doctors who supervise patients' care, to a management company that would become their employer.

The outsourcing of hospitalists became relatively common in the last decade, driven by a combination of factors. There is the obvious hunger for efficiency gains. But there is also growing pressure on hospitals to measure quality and keep people healthy after they are discharged. This can be a complicated data collection and management challenge that many hospitals, especially smaller ones, are not set up for and that some outsourcing companies excel in.

Outsourcing is a now familiar entry in the managerialists' playbook. It is seen more in manufacturing than in health care. Although touted as improving economic "efficiency," it also may reduce the accountability of the managers of the organization that does the outsourcing.

Pursuit of Economic Efficiency

In this case,

Outsourced hospitalists tend to make as much or more money than those that hospitals employ directly, typically in excess of $200,000 a year. But the catch is that their compensation is often tied more directly to the number of patients they see in a day - which the hospitalists at Sacred Heart worried could be as many as 18 or 20, versus the 15 that they and many other hospitalists contend should be the maximum.

It was the idea that they could end up seeing more patients that prompted outrage among the hospitalists at Sacred Heart, which has two facilities in the area, with a total of nearly 450 beds. 'We're doctors, we're professionals,' Dr. [Rajeev] Alexander said. 'Giving me a bonus for seeing two more patients - I'm not sure I should be doing that. It's not safe .' (A hospital representative said patient safety was 'inviolate.')


A constant theme of managerialism, and the neoliberalism that underlies it, is economic efficiency. The usual narrative is that efficiency means providing better goods and services at lower costs. Instead, managerialism and neliberalism may mean decontenting goods and services so as to lower costs to the organizations providing them, but not necessarily providing more value to consumers. In health care terms, managerialism and neliberalism may lead to less accessible, more mediocre health care that increase revenue to the organizations providing it, as implied by the physicians' comments above. Making the US the most commercialized, managerialist run, and arguably neoliberal health care system among the developed countries has not led to lower costs, better access, or better health care quality.


The backstory for the outsourcing emphasizes that managerialism, and the resulting economic efficiency was indeed the goal of PeaceHealth...

In 2012, Sacred Heart's parent, PeaceHealth, a nonprofit health care system, installed an executive named John Hill to adapt its Oregon hospitals to the latest trends in health care . Mr. Hill, in an effort to rein in the budget and improve the efficiency of a hospital that administrators said was lagging in key respects, including how long the typical patient stayed, eventually concluded that the hospitalists at Sacred Heart should be outsourced.

Centralization of Control

Furthermore,

The hospitalists also chafe at the way the administration has tried to centralize decisions they used to make for themselves. This might include hiring fellow doctors or the order in which they see patients on any day. They also complain of being loaded down with administrative tasks.

'We're trained to be leaders, but they treat us like assembly line workers ,' said Dr. Brittany Ellison, a hospitalist in the group. 'You need that time with the patient,...'


A major feature of managerialism is the concentration of power within (generic) management. To quote Komesaroff(1),

In the workplace, the authority of management is intensified, and behaviour that previously might have been regarded as bullying becomes accepted good practice. The autonomous discretion of the professional is undermined, and cuts in staff and increases in caseload occur without democratic consultation of staff. Loyal long-term staff are dismissed and often humiliated, and rigorous monitoring of the performance of the remaining employees focuses on narrowly defined criteria relating to attainment of financial targets, efficiency and effectiveness.

We're Only In It for the Money

Also, the negotiations that started once the PeaceHealth physicians formed their union demonstrated a central tenet of managerialism

Even starker than the divide over these questions are the differences in worldview represented on opposite sides of the table. During a bargaining session last fall, the administration proposed increasing the number of shifts a year. Hospitalists now earn about $223,000 a year for 173 shifts and are paid extra for working more. The hospital offered $260,000 for a mandatory 182 shifts, and up to $20,000 in bonus pay for hitting certain medical performance targets. The hospitalists work seven days on and seven days off, so this would have effectively eliminated any time off for sick days or vacation.

When the doctors pointed this out, the administration responded that if they missed a few days, it would make sure they got extra days to hit the required number of shifts for full pay.

The hospitalists assured the administration negotiators that their concern had nothing to do with money - that none of this had ever been about money. They preferred to work less and make less to avoid burnout, which was bad for them and worse for patients. At which point the administration responded that money was always the issue , according to several people in the room. (The hospital declined to comment.)

Suddenly it dawned on the doctors why they had failed to break through, Dr. Alexander said. 'Imagine Mr. Burns,' the cartoonishly evil capitalist from 'The Simpsons,' 'sitting across the table,' he said. 'There's no way we can say, 'This isn't what we're talking about. We're not trying to get the bonus.''


Again, managerialism is based on neoliberalism, and neoliberal view is that the market rules. The market is the arbiter of success, and money is the only outcome that matters. As Komesaroff put it(1),

The particular system of beliefs and practices defining the roles and powers of managers in our present context is what is referred to as managerialism. This is defined by two basic tenets: (i) that all social organisations must conform to a single structure; and (ii) that the sole regulatory principle is the market .

Mission-Hostile Management

Never mind that the centrality of money seems entirely inconsistent with the stated mission of PeaceHealth ,

We carry on the healing mission of Jesus Christ by promoting personal and community health, relieving pain and suffering, and treating each person in a loving and caring way.

Ostensibly, this is accompanied by core values, such as,

Stewardship We choose to serve the community and hold ourselves accountable to exercise ethical and responsible stewardship in the allocation and utilization of human, financial, and environmental resources. and,

Social Justice
We build and evaluate the structures of our organization and those of society to promote the just distribution of health care resources.


We have frequently discussed how leadership of contemporary health care organizations often seem to act contrary to the organizations' stated mission, that is, mission-hostile management .

Value Extraction

Finally, while managerialism is ostensibly concerned with economic efficiency, whose efficiency matters. When managers address physicians' efficiency, they seem to look at amount of work done divided by the cost to the hospital of paying physicians. However, they never seem to look at their own costs, the costs of management, as being a negative.

The PeaceHealth 2014 form 990 , the latest available, states that the then CEO, Mr Alan Yordy (whose highest academic degree was an MBA, according to his LinkedIn page ) had total compensation in 2013 of $1,366,742, and 11 other managers had total compensation greater than $250,000, with 9 having total compensation greater than $500,000. Those figures should be compared to the highest compensation offered the hospitalists, a maximum of $280,000 for 182 shifts a year, eliminating all vacation and sick leave. So if it is all about the money, the managers are making the most of it.

We have discussed ad nauseum the ridiculous compensation of the leaders of health care organization, even non-profit organizations. Value extraction by top management has become a central feature of the US and global economy (look here ).

The NYT article did not discuss whether the upset hospitalists knew about their bosses' compensation. I suspect they did.

Forming a Functioning Union at the University of Washington

The media coverage of the UW housestaff unionization was less detailed. It does appear, though, that a stimulus was the pursuit of economic efficiency by UW management through squeezing the pay of housestaff, as described in the December article in the Seattle Times . In it the house staff said,

they account for about one-fifth of King County's doctors and they want higher pay, new child-care benefits and free parking. Some UW residents and fellows earn so little that they qualify for welfare programs like Temporary Assistance for Needy Families and the Seattle City Light Utility Discount Program, according to the UWHA [University of Washington Housestaff Association.]

Another article in early January, 2016 in the Seattle Times added,

The association has proposed that residents and fellows earn at least the same salary as the UW's lowest-paid physician assistants . Because the doctors in training work very long hours, they sometimes earn less than Seattle's minimum hourly wage , the UWHA has said.

The council members, in their letter to Cauce, called the situation shocking. And based on information from the UWHA, they wrote that some residents and fellows qualify for welfare programs like Temporary Assistance for Needy Families (TANF).


The Seattle articles noted that the UW housestaff may earn from just over $53,000 to just under $70,000 a year. Keep in mind, however, that under current rules, house staff may work up to 80 hours a week. So $53,000 for someone working those hours translates into $13.25/ hour, under what many people now claim is the living wage. That could be considered exploitation of workers with doctoral degrees working in often highly stressful situations where lives may be on the line. Whether there were issues other than money (and the respect it implies) involved at UW was not apparent based on the minimal press coverage.

[Apr 05, 2017] Health Care Renewal managerialism

Apr 05, 2017 | hcrenewal.blogspot.com
John Stossel Discovers Health Care Dysfunction, Blames it on "Socialists" - Like Maurice Greenberg (AIG), John Thain (Merrill Lynch), Sanford Weill (Citigroup), and David H Koch? We have been ranting for a while about the dysfunctionality of the US health care system. Unfortunately, many people only realize how bad things are when they become patients, when they have bigger things to worry about than complaining. Furthermore, even if they complain, many patients may not feel they understand enough about what has gone wrong to suggest solutions.

Bad Customer Service at New York Presbyterian

This may not apply when media pundits, especially those with strong ideological views, become patients. So this week Fox News commentator and well known libertarian John Stossel disclosed his new illness, and vented his opinions about his hospital stay . Mr Stossel unfortunately developed lung cancer, although he was optimistic about his prognosis: "My doctors tell me my growth was caught early and I'll be fine. Soon I will barely notice that a fifth of my lung is gone."

However, he was not happy about his hospital's customer service:

But as a consumer reporter, I have to say, the hospital's customer service stinks . Doctors keep me waiting for hours, and no one bothers to call or email to say, 'I'm running late.' Few doctors give out their email address. Patients can't communicate using modern technology.

I get X-rays, EKG tests, echocardiograms, blood tests. Are all needed? I doubt it. But no one discusses that with me or mentions the cost .

Also,
I fill out long medical history forms by hand and, in the next office, do it again . Same wording: name, address, insurance, etc.
And,
In the intensive care unit, night after night, machines beep, but often no one responds . Nurses say things like 'old machines,' 'bad batteries,' 'we know it's not an emergency.'
Finally,
Some of my nurses were great -- concerned about my comfort and stress -- but other hospital workers were indifferent .
Unfortunately, long wait times, poor communications, excess paperwork, and misapplied technology are all too familiar problems to those in the health care system.

Moreover, this all was happening at one of the most highly rated US hospitals,

After all, I'm at New York-Presbyterian Hospital. U.S. News & World Report ranked it No. 1 in New York .
Were "Socialist Bureaucracies" Responsible?

Mr Stossel had his own ideas about the causes of these problems.

Customer service is sclerotic because hospitals are largely socialist bureaucracies. Instead of answering to consumers, which forces businesses to be nimble, hospitals report to government, lawyers and insurance companies.

Whenever there's a mistake, politicians impose new rules: the Health Insurance Portability and Accountability Act paperwork, patient rights regulations, new layers of bureaucracy...

Also,

Leftists say the solution to such problems is government health care. But did they not notice what happened at Veterans Affairs? Bureaucrats let veterans die, waiting for care. When the scandal was exposed, they didn't stop. USA Today reports that the abuse continues. Sometimes the VA's suicide hotline goes to voicemail.

Patients will have a better experience only when more of us spend our own money for care. That's what makes markets work.

A "Socialist Bureaucracy" with a VIP Penthouse?

I am sorry to hear Mr Stossel has lung cancer, and hope that his prognosis is indeed good. I am a bit surprised that a media celebrity who became a patient found big issues with "customer service" at such a prestigious hospital. After all, many big hospitals have programs to give special treatment to VIPs (for example, see these posts from 2007 and 2011 ).

In particular, back in 2012 we posted about the contrast between the VIP services specifically at New York - Presbyterian Hospital and how poor patients are treated there. Then we quoted from a 21 January, 2012 article from the New York Times focused on the ritzy comforts now provided for wealthy (but perhaps not very sick) patients at the renowned New York Presbyterian/ Weill Cornell Hospital. It opened,

The feverish patient had spent hours in a crowded emergency room. When she opened her eyes in her Manhattan hospital room last winter, she recalled later, she wondered if she could be hallucinating: 'This is like the Four Seasons - where am I?'

The bed linens were by Frette, Italian purveyors of high-thread-count sheets to popes and princes. The bathroom gleamed with polished marble . Huge windows displayed panoramic East River views. And in the hush of her $2,400 suite, a man in a black vest and tie proffered an elaborate menu and told her, 'I'll be your butler.'

It was Greenberg 14 South, the elite wing on the new penthouse floor of NewYork-Presbyterian/Weill Cornell hospital . Pampering and décor to rival a grand hotel, if not a Downton Abbey, have long been the hallmark of such 'amenities units,' often hidden behind closed doors at New York's premier hospitals. But the phenomenon is escalating here and around the country, health care design specialists say, part of an international competition for wealthy patients willing to pay extra, even as the federal government cuts back hospital reimbursement in pursuit of a more universal and affordable American medical system.

Additional amenities include:

A waterfall, a grand piano and the image of a giant orchid grace the soaring ninth floor atrium....
Also,
the visitors' lounge seems to hang over the East River in a glass prow and Ciao Bella gelato is available on demand....
An architect who specializes in designing such luxury facilities for hospitals noted:
'These kinds of patients, they're paying cash - they're the best kind of patient to have,' she added. 'Theoretically, it trickles down.'
It appears that someone failed to book Mr Stossel into the penthouse. Instead, he found out what service was like for the masses.

Perhaps this was why Mr Stossel railed at the "socialist bureaucracies" he perceived as running New York - Presbyterian Hospital. However, calling the hospital management "socialist" seems - not to put too fine a point on it - wrong.

A "Socialist Bureaucracy" Paying Millions to its CEOs?

First of all, New York Presbyterian is hardly a government agency. It is a private, non-profit corporation. Every year as such it files a form 990 with the dread US Internal Revenue Service. (The latest publicly available version is from 2013, here.) Obviously, US government agencies do not file with the IRS.

In fact, the New York Presbyterian system seems about as far from a federal government agency as one can imagine.

First, its top managers are paid like for-profit corporate executives. In 2014, we posted about the humongous compensation given to its previous, long-serving CEO, Dr Herbert Pardes, who received multi-million dollar compensation every year through his 2011 retirement, and then continued to receive several million a year from the system in his retirement. His successor, current CEO Dr Steven Corwin, received $3.6 million in 2012. (More recent compensation figures are not yet available.)

A "Socialist Bureaucracy" Dominated by Managers, with Stewardship by Top Financial Executives, and one of the Koch Brothers?

The current leadership of New York Presbyterian is dominated by businesspeople, not physicians, nurses, or other health care professionals. Only 10 of 33 listed senior leaders are health care professionals. The rest have administrative/ management or legal backgrounds and training. Many appear to be generic managers , that is, people with background and experience primarily in administration or management, but not in medicine, health care, public health, etc.

The hospital system's board of trustees was and is filled with some of the top business executives in the US, including some finance executives who have been cited as responsible for the global financial collapse/ great recession.

For example, we wrote about Mr Dick Fuld, a trustee until recently. Mr Fuld was the CEO who presided over the bankruptcy of Lehman Brothers, which heralded the beginning of the great financial crisis/ great recession of 2008 onward. Mr Fuld seemed to lack the sort of compassionate approach one might expect from someone charged with the stewardship of a big hospital system. He had once publicly said about those who sold Lehman Brother stock short: "what I really want to do is I want to reach in, rip out their heart, and eat it before they die ."

[Apr 02, 2017] I took multivitamins every day for a decade. Then I found out they're useless.

Notable quotes:
"... Annals of Internal Medicine ..."
"... Annals of Internal Medicine ..."
"... The New York Times ..."
Apr 02, 2017 | theweek.com
ave for a few lapses in my irresponsible college days, I've popped a multivitamin every single day since middle school.

First it was the chalky multivitamins that left a lump in my throat for minutes after I'd gulped one down. Then it was the slightly grainy, massive pills that my mom bought in bulk at Costco. (They were technically for post-menopausal women, but my mother assured me they would be just fine for my 17-year-old self.) Then last year, tired of big, bad-tasting pills, I bought gummy vitamins. Who doesn't like noshing on some candy that holds the promise of great health?

Well, last week I threw my vitamins away. I'll miss that sugary, fruity taste - but, according to my doctor, that's about all I'll be missing.

At my appointment last Wednesday, my doctor bluntly informed me that my multivitamins weren't doing a darn thing for me. Though the idea of getting just a little bit more of all the most important vitamins may seem like a foolproof idea, she informed me that more isn't necessarily better. Few people have vitamin deficiencies. Moreover, for those who do have a deficiency in, say, Vitamin D or Vitamin B12, those little grape-shaped gummies - or any multivitamin, for that matter - don't pack anywhere near enough of any one vitamin to correct that deficiency, she explained.

That could be passed off as just one doctor's opinion ... except there are a plethora of studies out there that back up her argument. A much buzzed-about study published in Annals of Internal Medicine in 2013, for instance, came to this clear-cut conclusion after reviewing three trials of multivitamin supplements and 24 trials of "single or paired vitamins that randomly assigned more than 40,000 participants":

Evidence is sufficient to advise against routine supplementation, and we should translate null and negative findings into action. The message is simple: Most supplements do not prevent chronic disease or death, their use is not justified, and they should be avoided. This message is especially true for the general population with no clear evidence of micronutrient deficiencies, who represent most supplement users in the United States and in other countries. [ Annals of Internal Medicine ]

Specifically, the study found vitamins to be ineffective when it comes to reducing the risk of heart disease, cancer, declines in cognitive ability, and premature death. And, Quartz noted , some vitamins can even be "harmful in high enough quantities":

Our bodies can easily get rid of excess vitamins that dissolve in water, like vitamin C, all the B vitamins, and folate, but they hold onto the ones that are fat soluble. Buildup of vitamin A, K, E, or D - all of which are necessary in low levels - can cause problems with your heart and kidneys, and can even be fatal in some cases. [ Quartz ]

Though the FDA says on its vitamins information page that there "are many good reasons to consider taking supplements," it indicates vitamins only "may be useful when they fill a specific identified nutrient gap that cannot or is not otherwise being met by the individuals' intake of food." The CDC estimated in 2014 that "nine out of 10 people in the U.S. are indeed getting enough of some important vitamins and nutrients."

So why are so many Americans still taking multivitamins? Steven Salzberg, a medicine professor at Johns Hopkins, told NPR multivitamins are "a great example of how our intuition leads us astray." "It seems reasonable that if a little bit of something is good for you, then more should be better for you. It's not true," Salzberg said. "Supplementation with extra vitamins or micronutrients doesn't really benefit you if you don't have a deficiency."

Americans' abysmally bad diets also give vitamin companies some marketing ammunition. When the average American is eating just one or two servings of fruits and veggies a day (experts recommend as many as 10 servings of fruits and veggies a day for maximum benefits), a little boost of vitamins might seem like a good idea. But popping a pill isn't going to make up for all those lost servings. "Food contains thousands of phyto-chemicals, fiber, and more that work together to promote good health that cannot be duplicated with a pill," said nutritionist Karen Ansel.

And if it's those tasty gummy vitamins we're falling back on , there's an even better chance we're not offsetting our sugar- and fat-laden diets. The women's gummy multivitamins I was taking pack three grams of sugar per gummy. A serving size is two gummies. Even before breakfast, I was consuming six grams of sugar - almost a quarter of the American Heart Association's recommended maximum sugar intake for women.

So why, if there are so many signs pointing to no on multivitamins, had I never really heard any of them until that fateful visit to the doctor? Pediatrician Paul Offit explained in a 2013 New York Times opinion article that it might have something to do with a bill introduced in the 1970s:

In December 1972, concerned that people were consuming larger and larger quantities of vitamins, the FDA announced a plan to regulate vitamin supplements containing more than 150 percent of the recommended daily allowance. Vitamin makers would now have to prove that these "megavitamins" were safe before selling them. Not surprisingly, the vitamin industry saw this as a threat, and set out to destroy the bill. In the end, it did far more than that.

Industry executives recruited William Proxmire, a Democratic senator from Wisconsin, to introduce a bill preventing the FDA from regulating megavitamins. [ Paul Offit, via The New York Times ]

That bill became law in 1976 . Some 30 years later, almost a third of Americans were still taking a daily multivitamin. But count this gal out.

[Mar 23, 2017] A "good start" at the expence of sick people for Collectly a new medical debt collection startuo -- they now collect twise larger share of debt then before. The founder is a former CEO of a debt collection agency and collected over $100 million before

Notable quotes:
"... our intelligent algorithm using state of the art innovative techniques of automation innovation disruption innovation disruption automatically sends orders to police and judges to prepare and serve pay or stay warrants, making sure your debtor goes to jail for their crime! ..."
Mar 23, 2017 | www.nakedcapitalism.com

"All 51 startups that debuted at Y Combinator W17 Demo Day 2" [ TechCrunch ] ( day one ). This is a good one:

Collectly helps doctors collect 2x's more debt than they have before. It's a business with $280 billion sent to debt but the debt collectors only collect on average up to 20%. The founder is a former CEO of a debt collection agency and collected over $100 million before

The acerbic Pinboard comments:
D Pinboard * Follow

@Pinboard

YC so far: surreptitious recording of phone calls, bus tickets for
the starving, debt collection, go live in a box, cow collars,
chatbots

11:41 PM-21 Mar 2017

He's not wrong. (And any time you encounter an online company with a cute name that's also an adverb, like collectly , run a mile, because it's a startup that wants to harm you. Kidding! I think .)

cocomaan , March 22, 2017 at 4:03 pm

Collectly is some really depressing stuff. Wow. More from their website.

3. Transparent collection
Our intelligent software automatically reaches out to customers that didn't pay in time, so you will never need to manually chase them again. And you can see every action on every case.

Totaly fair.

Totaly fair? I had to read it twice. Is that a typo? Or does it mean something?

Next up: our intelligent algorithm using state of the art innovative techniques of automation innovation disruption innovation disruption automatically sends orders to police and judges to prepare and serve pay or stay warrants, making sure your debtor goes to jail for their crime!

Edit: Weird, this went in the wrong place. Oh well.

[Mar 23, 2017] Paradoxically, we appear to be seeing a coalescence and consolidation of insurers, we will end up being delightfully exceptional, again- effectively being single-payer, private sector, paying a monopoly an add-on cost of 35-40% to a parasitic industry whose executives and employees do not contribute to the CARE equation.

Notable quotes:
"... Why Steve Bannon Wants You to Believe in the Deep State" [Politico]. "Like the Death Star, the American Deep State does not, of course, exist. " ..."
Mar 23, 2017 | www.nakedcapitalism.com
djrichard , March 22, 2017 at 5:35 pm

Just a bit of a thought experiment, building on some thinking from a comment yesterday by jefemt

Paradoxically, we appear to be seeing a coalescence and consolidation of insurers, we will end up being delightfully exceptional, again- effectively being single-payer, private sector, paying a monopoly an add-on cost of 35-40% to a parasitic industry whose executives and employees do not contribute to the CARE equation.

Taking jefemt's thinking further, imagine the health insurance provider was not only monopolistic (owned the entire market), but was also a GSE (government sponsored enterprise). Now take it one more step and imagine it was an actual part of the government and not merely a GSE.

Conceivably, it wouldn't even have to live off appropriations from congress, assuming it was equally as extractive from the private sector as it is now (i.e. revenue model is the same). Talk about good living. Who knows, maybe they pocket their proceeds into some kind of surplus in Treasury dept.

But let's assume they had to give up on revenue models. [Afterall, it's easier to find partners in congress when you have an appropriations process that binds you to them.] Then they would be exposed. Somebody would get the bright idea that this agency doesn't need as much staffing since they are no longer revenue oriented. That indeed, they could have the same staffing profile as the agency responsible for medicare. Indeed they could be folded into medicare.

I was thinking of this too as a reponse to Why Steve Bannon Wants You to Believe in the Deep State" [Politico]. "Like the Death Star, the American Deep State does not, of course, exist. "

Indeed, I think of the insurance industry as being part of the deep state already. It seems that congress's preference is that this part of the deep state is outsourced. So that's it not a GSE, and not even a monopoly, but maintained as an oligopoly. And then, well hey whatever surplus it can hoover up is fair game. After all free-hand of the market and all that. [And heaven knows, we don't want to crowd that out.]

In contrast to other parts of the deep state that don't really have a revenue model. In which case, those parts need to be insourced by the Fed Gov.

human , March 22, 2017 at 7:46 pm

The CIA has a long history of drug trafficking. The FBI traffics in blackmail. The NSA in network surveillance. DIA, special ops. NRO, satelite throughput. 11 more in the US of A and countless more globally. They all have opaque resources outside of regular channels.

Ernesto Lyon , March 23, 2017 at 12:09 am

Great documentary about the 80's cocaine business in Miami called "Cocaine Cowboys." It's real life Scarface.

Guess who the Feds sent to get a handle on the cocaine smuggling?

See-eye-aye man George H.W. Bush. Coincidence?

[Mar 22, 2017] The Men Who Stole the World

Notable quotes:
"... History will look back at us with the same wonder that we look back on the mad excesses of certain nations founded in devotion to extreme, almost other-worldly, ideologies of the last century. ..."
"... Apparently the slashing of health benefits for the unfortunate is not severe enough in the proposed Trump/Ryan plan. Our GOP house neo-liberals are enthusiastic to unleash the wonders of the cure-all deregulated market on the American public, again. Like a dog returns to its vomit. ..."
Mar 22, 2017 | jessescrossroadscafe.blogspot.com
"The problem of the last three decades is not the 'vicissitudes of the marketplace,' but rather deliberate actions by the government to redistribute income from the rest of us to the one percent. This pattern of government action shows up in all areas of government policy."

Dean Baker

"When the modern corporation acquires power over markets, power in the community, power over the state and power over belief, it is a political instrument, different in degree but not in kind from the state itself. To hold otherwise - to deny the political character of the modern corporation - is not merely to avoid the reality.

It is to disguise the reality. The victims of that disguise are those we instruct in error."

John Kenneth Galbraith

And unfortunately the working class victims of that disguise are going to be receiving the consequences of their folly, and then some.

Secure in their monopolies and key positions with regard to reform and the law, the corporations are further acquiring access to the protections of the rights of individuals as well, it appears, at least according to Citizens United .

Maybe our leaders and their self-proclaimed technocrats will finally do the right thing. I personally doubt it, except that if they do it will probably be by accident.

More likely, the right thing will eventually come about the old-fashioned way- under the duress of a crisis, and the growing protests of the much neglected and long suffering.

History will look back at us with the same wonder that we look back on the mad excesses of certain nations founded in devotion to extreme, almost other-worldly, ideologies of the last century.

... ... ...

Apparently the slashing of health benefits for the unfortunate is not severe enough in the proposed Trump/Ryan plan. Our GOP house neo-liberals are enthusiastic to unleash the wonders of the cure-all deregulated market on the American public, again. Like a dog returns to its vomit.

Better if they start breaking up corporate health monopolies and embrace real reform at the sources of the soaring costs. The US pays far, far too much for drugs and healthcare, and deregulating the markets is not the solution. We do have the example of the rest of the developed world for what to do about this. It is called 'single payer.'

But players keep on playing. And politicians and their enablers in the professions will not see what their big money donors do not wish them to see. And that is one of their few bipartisan efforts.

Might one suggest that our political animals stop trying to do all the reforming and cost controls bottom up, while applying the stimulus top down? That approach they have been flogging to no avail for about thirty years is a recipe for a dying middle class.

Here is a short video from the Bernie Sanders WV town hall that shows The Face of American Desperation. By the way, the governor of West Virginia is a Democrat. He wasn't there.

...

[Mar 17, 2017] The Affordable Care Act came nowhere close to universal healthcare insurance coverage:

Mar 17, 2017 | economistsview.typepad.com
anne -> Fred C. Dobbs... March 16, 2017 at 06:41 AM , 2017 at 06:41 AM
The Affordable Care Act came nowhere close to universal healthcare insurance coverage:

https://www.census.gov/content/dam/Census/library/publications/2016/demo/p60-257.pdf

September 13, 2016

People Without Health Insurance Coverage, 2007-2015

(Thousands without insurance for entire year)

2007 ( 44,088)
2008 ( 44,780)
2009 ( 48,985) Obama

2010 ( 49,951) (Affordable Care Act)
2011 ( 48,613)
2012 ( 47,951)
2013 ( 41,795)
2014 ( 32,968)

2015 ( 28,966)

anne -> Fred C. Dobbs... , March 16, 2017 at 07:26 AM
https://www.census.gov/content/dam/Census/library/publications/2016/demo/p60-257.pdf

September 13, 2016

People Without Health Insurance Coverage, 2007-2015

(Percent without insurance for entire year)

2007 ( 14.7)
2008 ( 14.9)
2009 ( 16.1) Obama

2010 ( 16.3) (Affordable Care Act)
2011 ( 15.7)
2012 ( 15.4)
2013 ( 13.3)
2014 ( 10.4)

2015 ( 9.1)

[Mar 17, 2017] The difficulties that many families have paying for cancer treatments. The piece points out that even middle income families with good insurance may still face co-payments of tens of thousands of dollars a year

Mar 17, 2017 | economistsview.typepad.com
anne : March 16, 2017 at 06:19 AM

, 2017 at 06:19 AM
http://cepr.net/blogs/beat-the-press/government-granted-patent-monopolies-cause-people-to-skip-cancer-treatments

March 16, 2017

Government Granted Patent Monopolies Cause People to Skip Cancer Treatments

National Public Radio had an interesting segment * on the difficulties that many families have paying for cancer treatments. The piece points out that even middle income families with good insurance may still face co-payments of tens of thousands of dollars a year.

One item not mentioned in this piece is that the reason the prices of new cancer drugs is high is that the government grants companies patent monopolies. This is done as a way to finance research. In almost all cases these drugs would be available for less than a thousand dollars ** for a year's treatment if the drugs were sold in a free market.

While it is necessary to pay for research, there are more modern and efficient mechanisms than patent monopolies (see "Rigged: How Globalization and the Rules of the Modern Economy Were Structured to Make the Rich Richer" *** ).

* http://www.npr.org/sections/health-shots/2017/03/15/520110742/as-drug-costs-soar-people-delay-or-skip-cancer-treatments

** http://www.thebodypro.com/content/78658/1000-fold-mark-up-for-drug-prices-in-high-income-c.html

*** http://deanbaker.net/images/stories/documents/Rigged.pdf

-- Dean Baker

anne -> anne... , March 16, 2017 at 06:20 AM
http://deanbaker.net/images/stories/documents/Rigged.pdf

October, 2016

Rigged: How Globalization and the Rules of the Modern Economy Were Structured to Make the Rich Richer
By Dean Baker

The Old Technology and Inequality Scam: The Story of Patents and Copyrights

One of the amazing lines often repeated by people in policy debates is that, as a result of technology, we are seeing income redistributed from people who work for a living to the people who own the technology. While the redistribution part of the story may be mostly true, the problem is that the technology does not determine who "owns" the technology. The people who write the laws determine who owns the technology.

Specifically, patents and copyrights give their holders monopolies on technology or creative work for their duration. If we are concerned that money is going from ordinary workers to people who hold patents and copyrights, then one policy we may want to consider is shortening and weakening these monopolies. But policy has gone sharply in the opposite direction over the last four decades, as a wide variety of measures have been put into law that make these protections longer and stronger. Thus, the redistribution from people who work to people who own the technology should not be surprising - that was the purpose of the policy.

If stronger rules on patents and copyrights produced economic dividends in the form of more innovation and more creative output, then this upward redistribution might be justified. But the evidence doesn't indicate there has been any noticeable growth dividend associated with this upward redistribution. In fact, stronger patent protection seems to be associated with slower growth.

Before directly considering the case, it is worth thinking for a minute about what the world might look like if we had alternative mechanisms to patents and copyrights, so that the items now subject to these monopolies could be sold in a free market just like paper cups and shovels.

The biggest impact would be in prescription drugs. The breakthrough drugs for cancer, hepatitis C, and other diseases, which now sell for tens or hundreds of thousands of dollars annually, would instead sell for a few hundred dollars. No one would have to struggle to get their insurer to pay for drugs or scrape together the money from friends and family. Almost every drug would be well within an affordable price range for a middle-class family, and covering the cost for poorer families could be easily managed by governments and aid agencies.

The same would be the case with various medical tests and treatments. Doctors would not have to struggle with a decision about whether to prescribe an expensive scan, which might be the best way to detect a cancerous growth or other health issue, or to rely on cheaper but less reliable technology. In the absence of patent protection even the most cutting edge scans would be reasonably priced.

Health care is not the only area that would be transformed by a free market in technology and creative work. Imagine that all the textbooks needed by college students could be downloaded at no cost over the web and printed out for the price of the paper. Suppose that a vast amount of new books, recorded music, and movies was freely available on the web.

People or companies who create and innovate deserve to be compensated, but there is little reason to believe that the current system of patent and copyright monopolies is the best way to support their work. It's not surprising that the people who benefit from the current system are reluctant to have the efficiency of patents and copyrights become a topic for public debate, but those who are serious about inequality have no choice. These forms of property claims have been important drivers of inequality in the last four decades.

The explicit assumption behind the steps over the last four decades to increase the strength and duration of patent and copyright protection is that the higher prices resulting from increased protection will be more than offset by an increased incentive for innovation and creative work. Patent and copyright protection should be understood as being like very large tariffs. These protections can often the raise the price of protected items by several multiples of the free market price, making them comparable to tariffs of several hundred or even several thousand percent. The resulting economic distortions are comparable to what they would be if we imposed tariffs of this magnitude.

The justification for granting these monopoly protections is that the increased innovation and creative work that is produced as a result of these incentives exceeds the economic costs from patent and copyright monopolies. However, there is remarkably little evidence to support this assumption. While the cost of patent and copyright protection in higher prices is apparent, even if not well-measured, there is little evidence of a substantial payoff in the form of a more rapid pace of innovation or more and better creative work....

Tom aka Rusty said in reply to anne... , -1
I'm trying to imagine why anyone would write a 900 page textbook, plus add-ons (test bank, solutions manual) and then give it away.

I have refused to co-author several times because the work is agonizing, the revisions never ending, and only a few texts make anyone rich.

[Mar 14, 2017] No wonder the unemployed increasingly kill themselves, or others. The whole economy tells them, indirectly but unmistakably, that their human value does not exist.

Mar 14, 2017 | economistsview.typepad.com
Noni Mausa : March 13, 2017 at 04:13 PM

What the wealthy right wing has decided in the past 40 years is that they don't need citizens. At least, not as many citizens as are actually citizens. What they are comfortable with is a large population of free range people, like the longhorn cattle of the old west, who care for themselves as best they can, and are convenient to be used when the "ranchers" want them.

Of course, this is their approach to foreign workers, also, but for the purpose of maintaining a domestic society within which the domestic rich can comfortably live, only native born Americans really suit.

With the development of high productivity production, farming, and hands-off war technology the need for a large number of citizens is reduced. The wealthy can sit in their towers and arrange the world as suits them, and use the rest of the world as a "farm team" to supply skills and labour as needed.

Proof of this is the fact that they talk about the economy's need for certain skills, training, services and so on, but never about the inherent value of citizens independent of their utility to someone else.

No wonder the unemployed increasingly kill themselves, or others. The whole economy tells them, indirectly but unmistakably, that their human value does not exist. ken melvin : , March 13, 2017 at 04:48 PM

Can someone get me from $300 billion tax cut for the rich to getting the markets work for health care?
ken melvin : , March 13, 2017 at 04:54 PM
It isn't about 'markets', never is. It is about extraction of as much profit as possible using whatever means necessary. This is what the CEOs of insurance companies get payed to do. Insurance policies they don't pay out, the ones Ryan is referring to, are as good as any for scoring.
libezkova : , March 13, 2017 at 07:09 PM
"It isn't about 'markets', never is. It is about extraction of as much profit as possible using whatever means necessary. This is what the CEOs of insurance companies get payed to do."

What surprises me most in this discussion is how Obamacare suddenly changed from a dismal and expensive failure enriching private insurers to a "good deal".

Lesseevilism in action ;-)

ilsm : , March 13, 2017 at 01:41 PM
When the PPACA band-aid is pulled off the US health care mess the gusher will be blamed on "the Russians running the White House".

Cuba does better than the US despite being economically sanctioned for 55 years. Distribution of artificially scarce health care resources is utterly broken. This failed market is financed by a mix of 'for profit' insurance and medicare (which sublets a big part to 'for profit' insurance).

Coverage!!! PPACA added taxpayers' money to finance a bigger failed market. It did nothing to address the market fail!

Single payer would not address the market failure. Single payer would put the government financing most of the failed market.

Democrats have put band-aids on severe bleeds since Truman made the cold war more important than Americans.

At least we know what Trump stands for!

jeff fisher said in reply to ilsm... , March 13, 2017 at 01:58 PM
Cuba is the shining example of how doing the first 20% of healthcare well for everyone gets you 80% of the benefit cheap.

The US is the shining example of how refusing to do the first 20% of healthcare well for everyone only gets you 80% of the benefit no matter how much you spend.

jonny bakho : , March 13, 2017 at 12:09 PM
Mark's very nice argument does nothing to address The Official Trump Counter Argument:

[Shorter version: Obamacare is doomed, going to blow up. Any replacement is therefore better than Obamacare; Facts seldom win arguments against beliefs]

"During a listening session on healthcare at the White House on Monday, President Donald Trump said Republicans "are putting themselves in a very bad position by repealing Obamacare."

Trump said that his administration is "committed to repealing and replacing" Obamacare and that the House Obamacare replacement will lead to more choice at a lower cost. He further stated, "[T]he press is making Obamacare look so good all, of a sudden. I'm watching the news. It looks so good. They're showing these reports about this one gets so much, and this one gets so much. First of all, it covers very few people, and it's imploding. And '17 will be the worst year. And I said it once; I'll say it again: because Obama's gone."

He continued, "And the Republicans, frankly, are putting themselves in a very bad position - I tell this to Tom Price all the time - by repealing Obamacare. Because people aren't gonna see the truly devastating effects of Obamacare. They're not gonna see the devastation. In '17 and '18 and '19, it'll be gone by then. It'll - whether we do it or not, it'll be imploded off the map."

He added, "So, the press is making it look so wonderful, so that if we end it, everyone's going to say, 'Oh, remember how great Obamacare used to be? Remember how wonderful it used to be? It was so great.' It's a little bit like President Obama. When he left, people liked him. When he was here, people didn't like him so much. That's the way life goes. That's human nature."

Trump further stated that while letting Obamacare collapse on its own was the best thing to do politically, it wasn't the right thing to do for the country.

http://www.breitbart.com/video/2017/03/13/trump-republicans-putting-bad-position-repealing-obamacare/

[Mar 07, 2017] Americans' Challenges with Health Care Costs

Notable quotes:
"... Three in ten (29 percent) Americans report problems paying medical bills, and these problems come with real consequences for some. For example, among those reporting problems paying medical bills, seven in ten (73 percent) report cutting back spending on food, clothing, or basic household items. ..."
"... Challenges affording care also result in some Americans saying they have delayed or skipped care due to costs in the past year, including 27 percent who say they have put off or postponed getting health care they needed, 23 percent who say they have skipped a recommended medical test or treatment, and 21 percent who say they have not filled a prescription for a medicine. ..."
Mar 07, 2017 | economistsview.typepad.com
anne : March 06, 2017 at 11:40 AM , 2017 at 11:40 AM
http://kff.org/health-costs/poll-finding/data-note-americans-challenges-with-health-care-costs/

March 2, 2017

Americans' Challenges with Health Care Costs
By Bianca DiJulio, Ashley Kirzinger, Bryan Wu, and Mollyann Brodie

As lawmakers debate the future of the country's health care system and outline plans to repeal and replace the Affordable Care Act, much of the current debate surrounds how to change or eliminate the health insurance marketplaces developed under the ACA where individuals eligible for financial assistance could compare plans and purchase insurance. While this is an important source of coverage for some, the vast majority of Americans with insurance have coverage from other sources, such as an employer, Medicaid or Medicare, and the public's top priority for lawmakers is reducing what Americans pay for health care. Two recent Kaiser Health Tracking Polls take stock of the public's current experience with and worries about health care costs, including their ability to afford premiums and deductibles. For the most part, the majority of the public does not have difficulty paying for care, but significant minorities do, and even more worry about their ability to afford care in the future. Some of the key findings include:

Four in ten (43 percent) adults with health insurance say they have difficulty affording their deductible, and roughly a third say they have trouble affording their premiums and other cost sharing; all shares have increased since 2015.

Three in ten (29 percent) Americans report problems paying medical bills, and these problems come with real consequences for some. For example, among those reporting problems paying medical bills, seven in ten (73 percent) report cutting back spending on food, clothing, or basic household items.

Challenges affording care also result in some Americans saying they have delayed or skipped care due to costs in the past year, including 27 percent who say they have put off or postponed getting health care they needed, 23 percent who say they have skipped a recommended medical test or treatment, and 21 percent who say they have not filled a prescription for a medicine.

Even for those who may not have had difficulty affording care or paying medical bills, there is still a widespread worry about being able to afford needed health care services, with half of the public expressing worry about this.

Health care-related worries and problems paying for care are particularly prevalent among the uninsured, individuals with lower incomes, and those in poorer health; but women and members of racial minority groups are also more likely than their peers to report these issues....

Peter K. -> anne... , March 06, 2017 at 11:48 AM
"For example, among those reporting problems paying medical bills, seven in ten (73 percent) report cutting back spending on food, clothing, or basic household items."

That's what the neoliberals like our dear trolls kthomas and PGL want.

They're in the pocket of the lobbyists.

[Mar 07, 2017] Uncertainty and the Welfare Economics of Medical Care

Mar 07, 2017 | economistsview.typepad.com
anne -> anne... March 06, 2017 at 05:11 PM , 2017 at 05:11 PM
https://web.stanford.edu/~jay/health_class/Readings/Lecture01/arrow.pdf

December, 1963

Uncertainty and the Welfare Economics of Medical Care
By KENNETH J. ARROW

I. Introduction: Scope and Method

This paper is an exploratory and tentative study of the specific differentia of medical care as the object of normative economics. It is contended here, on the basis of comparison of obvious characteristics of the medical-care industry with the norms of welfare economics, that the special economic problems of medical care can be explained as adaptations to the existence of uncertainty in the incidence of disease and in the efficacy of treatment.

It should be noted that the subject is the medical-care industry, not health. The causal factors in health are many, and the provision of medical care is only one. Particularly at low levels of income, other commodities such as nutrition, shelter, clothing, and sanitation may be much more significant. It is the complex of services that center about the physician, private and group practice, hospitals, and public health, which I propose to discuss.

The focus of discussion will be on the way the operation of the medical-care industry and the efficacy with which it satisfies the needs of society differ from a norm, if at all. The "norm" that the economist usually uses for the purposes of such comparisons is the operation of a competitive model, that is, the flows of services that would be offered and purchased and the prices that would be paid for them if each individual in the market offered or purchased services at the going prices as if his decisions had no influence over them, and the going prices were such that the amounts of services which were available equalled the total amounts which other individuals were willing to purchase, with no imposed restrictions on supply or demand.

The interest in the competitive model stems partly from its presumed descriptive power and partly from its implications for economic efficiency. In particular, we can state the following well-known proposition (First Optimality Theorem)....

a

[Mar 07, 2017] Notes on US healthdoesntcare

Mar 07, 2017 | economistsview.typepad.com
libezkova : March 06, 2017 at 08:41 PM

The problems with US Healthdoesn'tcare started around 1980.

What we observe now (completely broken and corrupt to the core system) is the result of long term term slow deterioration.

Now the US Healthdoesn'tcare in many cases represent the completely opposite practice to healthcare -- health racket.

And they even created their specialized firms that help to extract maximum dollars for private providers.

An interesting example of how pervert the USA healthcare system became in the USA under neoliberalism is proliferation of private ambulance services which are technically are always "out of network" and after providing services (often non-essential and equal to the ride to ER, but mostly unavoidable as soon as 911 service or traffic police is involved, especially for those who are in this situation for the first time ) they bill an outrageous amount to lemmings who do not know how to fight the system.

Average private ambulance bill is probably around $5K in the USA. And that if this was just a ride to ER.

If you have insurance it will pay around the same as Medicare and your bill will be around ~$3.5K

This so called differential billing in now outlawed in a couple of states (CA, partially NY), but still is legal in most other states.

This industry also creates specialized collector agencies that deal almost exclusively with collecting ambulance bills like Revenue Guard - Ambulance Billing & Financial Management ( https://www.revenue-guard.com/). And look who is at the helm of this wonder of neoliberal health industry (pretty profitable -- currently bills over 120 million in revenue annually taking in probably lion share of that) -- James J. Loures, President & CEO

James began his career as a broker on Wall Street. In 1984 he left the financial world and founded MultiCare, which grew to be a largest private EMS operation in the Northeast operating 140 ambulances in the New Jersey, New York, and Philadelphia region.

Is not neoliberalism wonderful social system ?

So when somebody is taking about destruction of the US health care system by Trump one needs to understand that there is not much left to destruct. Most of the heavy lifting was done by previous administrations.

Including Obama with his coward method of betrayal of his voters and serving medical industrial complex.

Trump is bad, but to claim that because of that Obama was good is silly. He was just a perfect example of neoliberal "bait and switch" politician.

B.T. :
, March 06, 2017 at 07:51 PM
So it's like the ACA?

Or it's terrible?

Make up your minds neoliberals. Since you didn't want single payer.

libezkova -> B.T.... , March 06, 2017 at 09:12 PM
It's estimated that at least 3 percent of all health care spending – roughly $68 billion – is lost to fraud and billing errors annually. ( http://khn.org/morning-breakout/health-care-billing-errors/ )

"thousands of providers turned to more expensive Medicare billing codes, while spurning use of cheaper ones."

Private medical industry and insurance are symbiotic in their desire to milk patients out of their money in the most efficient way possible.

And while those "death panel" decisions are very difficult indeed, fraud is rampant and they are very successful in over-billing patients.

This symbiosis is very similar in nature to what we observe with body shops and car insurance.

[Mar 06, 2017] Something about the meaning of life under neoliberalism

Notable quotes:
"... Probably the most telling example on neoliberal transformation is transformation of healthcare. ..."
"... Mulligan's research shows how "market values come to displace competing notions of what is "good" or "right" in health care" (Mulligan 2010:308–309). She argues that quality in health care is not only a technical matter for evaluating the performance of systems, but, more importantly, it is a particular epistemology, a specific way of knowing. ..."
"... Managing for-profit health care systems successfully requires innovative mechanisms of population control (Abadía-Barrero et al. 2011), including people's acceptance of market principles. ..."
"... In this historical context, what is crucial is the understanding of the relationship between techniques of governance and the production of social inequality (i.e., an ideological domination reflected in people's support for political practices that are antithetical to their interests). ..."
"... James began his career as a broker on Wall Street. In 1984 he left the financial world and founded MultiCare, which grew to be a largest private EMS operation in the Northeast operating 140 ambulances in the New Jersey, New York, and Philadelphia region. ..."
Mar 03, 2017 | economistsview.typepad.com
libezkova : March 03, 2017 at 03:51 PM
Something about the "meaning of life" under neoliberalism

Probably the most telling example on neoliberal transformation is transformation of healthcare.

http://onlinelibrary.wiley.com/doi/10.1111/maq.12161/full

== quote ==

Several anthropologists have written about how "market ideology and corporate structures are shaping medicine and health care delivery" (Horton et al. 2014; Lamphere 2005; Rylko-Bauer and Farmer 2002:476).

Mulligan's research shows how "market values come to displace competing notions of what is "good" or "right" in health care" (Mulligan 2010:308–309). She argues that quality in health care is not only a technical matter for evaluating the performance of systems, but, more importantly, it is a particular epistemology, a specific way of knowing.

The information that is produced in technical public health policy terms, and, I would add, in technical legal terms, is "a knowledge-making practice that creates information about the health care system and for managing the system in new ways" (Mulligan 2010:309).

Managing for-profit health care systems successfully requires innovative mechanisms of population control (Abadía-Barrero et al. 2011), including people's acceptance of market principles.

In this historical context, what is crucial is the understanding of the relationship between techniques of governance and the production of social inequality (i.e., an ideological domination reflected in people's support for political practices that are antithetical to their interests).

According to Fassin (2009), Foucault's undeveloped concept of a Politics of Life can illuminate how in regulating populations and normalizing societies, moral ideas about the meaning of life and about how life is valued are enforced.

An understanding of moral definitions of human life must take into account how history becomes embodied, which then illuminates the political tensions that support differential values by which life is organized, represented, and responded to, for example through public policy (Fassin 2007).

== end of quote ==

See also

https://www.youtube.com/watch?v=TsoZeg6CDRY

An interesting example of how pervert the healthcare system became in the USA under neoliberalism is proliferation of private ambulance services which are technically always "out of network" and after providing services (often non-essential) bill outrageous amount to lemmings who do not know how to fight the system. Average private ambulance bill is probably around $5K in the USA. If you have insurance your bill will be around ~$3.5K

This so called differential billing in now outlawed in a couple of states, but still is legal in most states.

This industry also creates specialized collector agencies that deal almost exclusively with collecting ambulance bills like Revenue Guard - Ambulance Billing & Financial Management ( https://www.revenue-guard.com/)

== quote ==

Revenue Guard Executive Team

James J. Loures, President & CEO
James began his career as a broker on Wall Street. In 1984 he left the financial world and founded MultiCare, which grew to be a largest private EMS operation in the Northeast operating 140 ambulances in the New Jersey, New York, and Philadelphia region. After merging MultiCare with the publicly traded Rural-Metro in 2001, James then founded Revenue-Guard in 2004. The company has grown to be a premier provider of EMS revenue cycle and management services in the hospital marketplace, and currently bills over 120 million in revenue annually for their clients. James studied economics at Rutgers University .

Steven J. Loures, Co-Founder and Chief Operations Officer
Steven Loures has 30 years of experience in the Emergency Medical Services / Mobile Health Services field and is considered an expert in revenue cycle, compliance and improving ambulance service operating margins. His real-world revenue cycle knowledge combined with 20 years of managing ambulance operations uniquely differentiates himself with a comprehensive industry perspective. His leadership has provided client confidence to initiate targeted change knowing his proven track record. He is the point of contact for all new and existing clients.

Prior to his current role Steven was the New Jersey Division General Manager of Rural Metro Ambulance. Rural Metro is a large nationwide provider of Emergency Medical Services. He was responsible for oversight of 350 employees, 6 operating locations in three states including New Jersey, Pennsylvania and New York City. Additionally, Steven's responsibilities included all budgets, revenue cycle management, billing compliance, and Sarbanes Oxley financial controls.

Prior to Rural Metro Steven was a Commercial Lear Jet Pilot. The operation provided nationwide long distance critical care air ambulance services. Steven graduated from Embry-Riddle Aeronautical University, Daytona Beach Florida with his Federal Aviation Administration Commercial, Multi-Engine, and Instrument ratings. Early in his career path Steven was a certified NJ paramedic at age 21 and one of the youngest certified paramedics in New Jersey.

Stephanie Dall, Vice President of Finance
Stephanie joined Revenue-Guard in 2005 and is responsible for Finance, Administration, Compliance and client reporting. She has 20 years experience in finance and administration with Rural-Metro Inc. the leading EMS provider in the nation. Stephanie develops budgets and establish performance metrics for Revenue-Guard. Stephanie has a bachelors degree in accounting from Rutgers University.

Jennifer Aldana, Vice President of Revenue Cycle
Jennifer joined Revenue-Guard in 2007 to manage and run the billing services division. She manages a staff of 60 billing specialist processing over $120M in ambulance claims annually. Jennifer is a former revenue cycle manager at Rural-Metro The country's largest EMS service based in Scottsdale, Arizona. She handles all system customizations, ePCR integration and client support services. Jen studied at Pace University in New York City.

[Mar 03, 2017] U.S. Medical Coding System

Notable quotes:
"... Successful medical coders learn and follow coding guidelines and use them to their benefit. Often if a claim is denied incorrectly, medical coders and billers use coding guidelines as a way to appeal the denial and get the claim paid. ..."
"... Each diagnosis code has to be coded to the highest level of specificity , so the insurance company knows exactly what the patient's diagnosis was. ..."
"... I've helpfully underlined places where an "unusual opportunity for profit" might be spotted and amplified; after all, it's not the coder's job to set policy in borderline cases; that's for management. ..."
"... A pair of transposed digits in a medical identification number was the difference between insurance coverage for Mike Dziedzic and the seemingly never-ending hounding for payment by the hospitals that cared for his dying wife. The astute eye of a medical billing advocate who Dziedzic hired for help caught the innocuous mistake - the sole reason his insurance company had refused to pay more than $100,000 in claims that had piled up and why collectors were now at his doorstep. ..."
"... Had it remained unnoticed - as often happens to patients faced with daunting medical debt - Dziedzic said, he most surely would have lost his Rifle home, his way of life and had little choice but to live in bankruptcy. ..."
"... thousands of providers turned to more expensive Medicare billing codes, while spurning use of cheaper ones. They did so despite little evidence that Medicare patients as a whole are older or sicker than in past years, or that the amount of time doctors spent treating them on average was rising. ..."
"... More than 7,500 physicians billed the two top paying codes for three out of four office visits in 2008, a sharp rise from the numbers of doctors who did so at the start of the decade. Officials said such changes in billing can signal overcharges occurring on a broad scale. Medical groups deny that. ..."
"... The most lucrative codes are billed two to three times more often in some cities than in others, costly variations government officials said they could not explain or justify. In some instances, higher billing rates appear to be associated with the burgeoning use of electronic medical records and billing software. ..."
"... eight of 10 bills its members have audited from hospitals and health care providers contain errors. ..."
"... It's estimated that at least 3 percent of all health care spending – roughly $68 billion – is lost to fraud and billing errors annually. ..."
"... Accounts of medical billing errors vary widely. While the American Medical Association estimated that 7.1 percent of paid claims in 2013 contained an error, a 2014 NerdWallet study found mistakes in 49 percent of Medicare claims. Groups that review bills on patients' behalf, including Medical Billing Advocates of America and CoPatient, put the error rate closer to 75 or 80 percent. ..."
"... Most services don't get paid based on ICD, they get paid based on HCPCs/CPTs (healthcare procedure codes) which is what is shown in the nerdwallet image. Also revenue codes will be used for facility services (such as the room charge in image). ..."
"... ICD-Diaganosis codes just tell you what conditions the provider diagnosed you with. ICD-Procedure codes are sometimes used for payments but usually only on inpatient claims. ..."
Mar 03, 2017 | www.nakedcapitalism.com
From my review of Akerlof and Shiller's Phishing for Phools , November 25, 2015 :

As businesspeople choose what line of business to undertake - as well as where they expand, or contract, their existing business - they (like customers approaching checkout) pick off the best opportunities. This too creates an equilibrium. Any opportunities for unusual profits are quickly taken off the table, leading to a situation where such opportunities are hard to find. This principle, with the concept of equilibrium it entails, lies at the heart of economics.

The principle also applies to phishing for phools. That means that if we have some weakness or other - some way in which we can be phished for fools for more than the usual profit - in the phishing equilibrium someone will take advantage of it . Among all those business persons figuratively arriving at the checkout counter, looking around, and deciding where to spend their investment dollars, some will look to see if there are unusual profits from phishing us for phools. And if they see such an opportunity for profit, that will (again figuratively) be the "checkout lane" they choose.

And economies will have a "phishing equilibrium," in which every chance for profit more than the ordinary will be taken up.

We might summarize Akerlof and Shiller as "If a system enables fraud, fraud will happen," or, in stronger form, "If a system enables fraud, fraud will already have happened."[1] And as we shall see, plenty of "opportunities for unusual profits" exist in medical coding.

... ... ...

Here is the medical coding process, from the coders perspective, as described by MB-Guide, a site for aspiring medical coders :

Successful medical coders learn and follow coding guidelines and use them to their benefit. Often if a claim is denied incorrectly, medical coders and billers use coding guidelines as a way to appeal the denial and get the claim paid.

Hmm. "Their" benefit. Here are the guidelines:

I've helpfully underlined places where an "unusual opportunity for profit" might be spotted and amplified; after all, it's not the coder's job to set policy in borderline cases; that's for management. The Denver Post gives a horrific example:

Miscoding Fictions, frauds found to abound in medical bills

A pair of transposed digits in a medical identification number was the difference between insurance coverage for Mike Dziedzic and the seemingly never-ending hounding for payment by the hospitals that cared for his dying wife. The astute eye of a medical billing advocate who Dziedzic hired for help caught the innocuous mistake - the sole reason his insurance company had refused to pay more than $100,000 in claims that had piled up and why collectors were now at his doorstep.

Had it remained unnoticed - as often happens to patients faced with daunting medical debt - Dziedzic said, he most surely would have lost his Rifle home, his way of life and had little choice but to live in bankruptcy.

Finally, there's "upcoding," and if you are reminded of "upselling" you are exactly right. The Center for Public Integrity :

But the Center's analysis of Medicare claims from 2001 through 2010 shows that over time, thousands of providers turned to more expensive Medicare billing codes, while spurning use of cheaper ones. They did so despite little evidence that Medicare patients as a whole are older or sicker than in past years, or that the amount of time doctors spent treating them on average was rising.

More than 7,500 physicians billed the two top paying codes for three out of four office visits in 2008, a sharp rise from the numbers of doctors who did so at the start of the decade. Officials said such changes in billing can signal overcharges occurring on a broad scale. Medical groups deny that.

The most lucrative codes are billed two to three times more often in some cities than in others, costly variations government officials said they could not explain or justify. In some instances, higher billing rates appear to be associated with the burgeoning use of electronic medical records and billing software.

Now, I'll be the first to admit that I can't quantify the impedance mismatches, the miscoding, and the upcoding. Regardless, medical coding is the key dataflow in the healthcare system :

"Roughly $250 billion is moving through those codes," [says Steve Parente, professor of finance at the Carlson School of Management at the University of Minnesota]. On top of that, about 80% of medical bills contain errors, according to Christie Hudson, vice president of Medical Billing Advocates of America, making already-expensive bills higher. Today's complex medical-billing system, guided by hundreds of pages of procedure codes, allows fraud, abuse and human error to go undetected, Hudson says. "Until the fraud is detected in these bills the cost of health care is just going to increase. It's not accidental. We've been fighting these overcharges they continue to happen and we continue to get them removed from bills." These errors, which are hard to detect because medical bills are written in a mysterious code, can result in overcharges that run from a few dollars to tens of thousands.

That "mysterious code" is (now) ICD-10, and it's the mystery plus the profit motive that creates the phishing equilibrium. Kaiser Health News quotes the Denver Post :

Experts say there are tens of thousands more like Dziedzic across the country with strangling medical debts.

Medical Billing Advocates of America, a trade group in Salem, Va., says that eight of 10 bills its members have audited from hospitals and health care providers contain errors.

It's estimated that at least 3 percent of all health care spending – roughly $68 billion – is lost to fraud and billing errors annually. Some say new reform laws will only make things worse." Others say that errors occur largely because of "the complexity of deciphering bills and claims weighted down by complex codes."

Even if the "trade group" is talking it's book, it's still quite a book . NBC :

Accounts of medical billing errors vary widely. While the American Medical Association estimated that 7.1 percent of paid claims in 2013 contained an error, a 2014 NerdWallet study found mistakes in 49 percent of Medicare claims. Groups that review bills on patients' behalf, including Medical Billing Advocates of America and CoPatient, put the error rate closer to 75 or 80 percent.

Gee, I wonder if the errors are randomly distributed?

Neoliberal "Consumer"-Driven Solutions

My guts have started to gripe, so I won't go into detail about how you too, the citizen , can learn medical billing codes if you want to dispute your bill. See this cheery post from NerdWallet on "How to Read Your Medical Bill :

Once you have the itemized medical bill for your care, you're ready to analyze it for mistakes and overcharges.

Your medical bill is going to be chock-full of codes and words you may not understand, so the first step is gathering resources that will translate them into plain English.

Ivy , March 2, 2017 at 2:29 pm

One useful adjunct to the coding discussion concerns other billing details such as meds. There is wide variability in prices charged, and when you see $160 for a single pill (e.g., Hexabrix) or $26 for a single Tylenol, then something is not right. Of course, that does not include any allocation for nurses, pharmacy or other potential costs, since those are rolled into other line items to decipher. When hospital billing reps are asked about the reasonability and basis of their charges, they spout the canned line about being in line with their local competitors.

Why not have some program with mutual insurance companies, removing in theory some of the profit that is driving the typical health care insurers?

TheBellTolling , March 2, 2017 at 2:31 pm

Most services don't get paid based on ICD, they get paid based on HCPCs/CPTs (healthcare procedure codes) which is what is shown in the nerdwallet image. Also revenue codes will be used for facility services (such as the room charge in image).

ICD-Diaganosis codes just tell you what conditions the provider diagnosed you with. ICD-Procedure codes are sometimes used for payments but usually only on inpatient claims.

_________________________________

Additionaly, coding also affects "risk adjustment" in Medicare Advantage and ACA payments and this form of payment does use ICD codes. They use the codes on the claims to determine how "sick"(has conditions that will cost more) each member is and give insurers more or less money based on the average risk scores of their members. Since it relies on coding this system is also subject to gaming.

In Medicare Advantage this is done relative to non-Medicare Advantage population, so if the MA plans are upcoding they get more money from Federal government. In 2010 CMS was given the ability to use some adjustment factors to MA payments to address the issue but I don't really know how effective it is.

In ACA this is done relative to all the other insurers in the individual/small group market(so all the money is changing hands between the insurers). More established plans generally do better since they have more data on members from before ACA to make sure they get coded in addition to resources they probably built from Medicare Advantage. This ends up disadvantaging smaller and newer plans like co-ops.
_____________

[Mar 03, 2017] How to Read Your Medical Bill

Notable quotes:
"... That is not the bill you want. To know what you're actually being charged for, you'll want to call the clinic or hospital and ask for the complete, itemized bill for all services you received, with codes. It is your right to know what you're being charged for, but you will probably have to call and request the detailed charges. The body of that bill should look more like this: ..."
NerdWallet
Clerical errors are more likely than you might think, says Gross, who has seen small mistakes in names and addresses result in huge billing complications. Before you move on, make sure your name, address, insurance information and dates of care are correct on the top of the bill.

header

When you receive inpatient or outpatient care, the first statement you'll receive is most likely a summary bill. Often, but not always, health care providers will send only a summary of charges with a final charge at the end. The body of the bill has a few generic categories and no codes, looking something like this:

summarybill

That is not the bill you want. To know what you're actually being charged for, you'll want to call the clinic or hospital and ask for the complete, itemized bill for all services you received, with codes. It is your right to know what you're being charged for, but you will probably have to call and request the detailed charges. The body of that bill should look more like this:

detailed

Once you have the itemized medical bill for your care, you're ready to analyze it for mistakes and overcharges.

Next, know what the codes are for

Before we get into the nuts and bolts of reading your medical bill, it's worth noting that there's more than one type of code that may be listed on your bill.

svccode

HCPCS Level I, or CPT Codes, are universal, used by all providers in the U.S. and consist of five digits that identify procedures or tests. Often, they are listed as service codes.

svccode2

HCPCS Level II Codes identify supplies or products used during your visit. These codes often start with a letter, rather than a number, but are also referred to as service codes.

[Feb 27, 2017] Stents for stable patients prevent zero heart attacks and extend the lives of patients a grand total of not at all

Notable quotes:
"... Stents for stable patients prevent zero heart attacks and extend the lives of patients a grand total of not at all. ..."
"... It found that atenolol didn't prevent heart attacks or extend life at all; it just lowered blood pressure. ..."
"... Of course, myriad medical innovations improve and save lives, but even as scientists push the cutting edge (and expense) of medicine, the National Center for Health Statistics reported last month that American life expectancy dropped, slightly. There is, though, something that does powerfully and assuredly bolster life expectancy: sustained public-health initiatives... ..."
Feb 27, 2017 | economistsview.typepad.com
im1dc : February 26, 2017 at 11:18 AM , 2017 at 11:18 AM
If you are looking for a World Class Global Scam - you found it documented below

"Stents for stable patients prevent zero heart attacks and extend the lives of patients a grand total of not at all"

My takeaway: There are HERO Physicians doing WORLD CLASS MEDICINE (read article) but they are greatly outnumbered by those who put the health of their wallet ahead of patient health...so beware and be aware

https://www.propublica.org/article/when-evidence-says-no-but-doctors-say-yes

"When Evidence Says No, But Doctors Say Yes"

'Years after research contradicts common practices, patients continue to demand them and doctors continue to deliver. The result is an epidemic of unnecessary and unhelpful treatment'

by David Epstein, ProPublica...February 22, 2017

*This story was co-published with The Atlantic

"The 21st Century Cures Act - a rare bipartisan bill, pushed by more than 1,400 lobbyists and signed into law in December - lowers evidentiary standards for new uses of drugs and for marketing and approval of some medical devices. Furthermore, last month President Donald Trump scolded the FDA for what he characterized as withholding drugs from dying patients. He promised to slash regulations "big league. It could even be up to 80 percent" of current FDA regulations, he said. To that end, one of the president's top candidates to head the FDA, tech investor Jim O'Neill, has openly advocated for drugs to be approved before they're shown to work. "Let people start using them at their own risk," O'Neill has argued.

Stents for stable patients prevent zero heart attacks and extend the lives of patients a grand total of not at all.

So, while Americans can expect to see more drugs and devices sped to those who need them, they should also expect the problem of therapies based on flimsy evidence to accelerate...

...it's not hard to understand why Sir James Black won a Nobel Prize largely for his 1960s discovery of beta-blockers, which slow the heart rate and reduce blood pressure. The Nobel committee lauded the discovery as the "greatest breakthrough when it comes to pharmaceuticals against heart illness since the discovery of digitalis 200 years ago." In 1981, the FDA approved one of the first beta-blockers, atenolol, after it was shown to dramatically lower blood pressure. Atenolol became such a standard treatment that it was used as a reference drug for comparison with other blood-pressure drugs.

In 1997, a Swedish hospital began a trial of more than 9,000 patients with high blood pressure who were randomly assigned to take either atenolol or a competitor drug that was designed to lower blood pressure for at least four years. The competitor-drug group had fewer deaths (204) than the atenolol group (234) and fewer strokes (232 compared with 309). But the study also found that both drugs lowered blood pressure by the exact same amount, so why wasn't the vaunted atenolol saving more people? That odd result prompted a subsequent study, which compared atenolol with sugar pills. It found that atenolol didn't prevent heart attacks or extend life at all; it just lowered blood pressure. A 2004 analysis of clinical trials - including eight randomized controlled trials comprising more than 24,000 patients - concluded that atenolol did not reduce heart attacks or deaths compared with using no treatment whatsoever; patients on atenolol just had better blood-pressure numbers when they died...

...Replication of results in science was a cause-célèbre last year, due to the growing realization that researchers have been unable to duplicate a lot of high-profile results. A decade ago, Stanford's Ioannidis published a paper warning the scientific community that "Most Published Research Findings Are False." (In 2012, he coauthored a paper showing that pretty much everything in your fridge has been found to both cause and prevent cancer - except bacon, which apparently only causes cancer.) Ioannidis's prescience led his paper to be cited in other scientific articles more than 800 times in 2016 alone. Point being, sensitivity in the scientific community to replication problems is at an all-time high...

Of course, myriad medical innovations improve and save lives, but even as scientists push the cutting edge (and expense) of medicine, the National Center for Health Statistics reported last month that American life expectancy dropped, slightly. There is, though, something that does powerfully and assuredly bolster life expectancy: sustained public-health initiatives...

"Relative risk is just another way of lying."

At the same time, patients and even doctors themselves are sometimes unsure of just how effective common treatments are, or how to appropriately measure and express such things. Graham Walker, an emergency physician in San Francisco, co-runs a website staffed by doctor volunteers called the NNT that helps doctors and patients understand how impactful drugs are - and often are not. "NNT" is an abbreviation for "number needed to treat," as in: How many patients need to be treated with a drug or procedure for one patient to get the hoped-for benefit? In almost all popular media, the effects of a drug are reported by relative risk reduction. To use a fictional illness, for example, say you hear on the radio that a drug reduces your risk of dying from Hogwart's disease by 20 percent, which sounds pretty good. Except, that means if 10 in 1,000 people who get Hogwart's disease normally die from it, and every single patient goes on the drug, eight in 1,000 will die from Hogwart's disease. So, for every 500 patients who get the drug, one will be spared death by Hogwart's disease. Hence, the NNT is 500. That might sound fine, but if the drug's "NNH" - "number needed to harm" - is, say, 20 and the unwanted side effect is severe, then 25 patients suffer serious harm for each one who is saved. Suddenly, the trade-off looks grim.

Now, consider a real and familiar drug: aspirin. For elderly women who take it daily for a year to prevent a first heart attack, aspirin has an estimated NNT of 872 and an NNH of 436. That means if 1,000 elderly women take aspirin daily for a decade, 11 of them will avoid a heart attack; meanwhile, twice that many will suffer a major gastrointestinal bleeding event that would not have occurred if they hadn't been taking aspirin. As with most drugs, though, aspirin will not cause anything particularly good or bad for the vast majority of people who take it. That is the theme of the medicine in your cabinet: It likely isn't significantly harming or helping you. "Most people struggle with the idea that medicine is all about probability," says Aron Sousa, an internist and senior associate dean at Michigan State University's medical school. As to the more common metric, relative risk, "it's horrible," Sousa says. "It's not just drug companies that use it; physicians use it, too. They want their work to look more useful, and they genuinely think patients need to take this [drug], and relative risk is more compelling than NNT. Relative risk is just another way of lying."

A Different Way to Think About Medicine

For every 100 older adults who take a sleep aid, 7 will experience improved sleep, while 17 will suffer side effects that range widely in severity, from simple morning "hangover" to memory loss and serious accidents. As with many medications, most who take a sleep aid will experience neither benefit nor harm...

"There's this cognitive dissonance, or almost professional depression," Walker says. "You think, 'Oh my gosh, I'm a doctor, I'm going to give all these drugs because they help people.' But I've almost become more fatalistic, especially in emergency medicine." If we really wanted to make a big impact on a large number of people, Walker says, "we'd be doing a lot more diet and exercise and lifestyle stuff. That was by far the hardest thing for me to conceptually appreciate before I really started looking at studies critically."...

In the 1990s, the American Cancer Society's board of directors put out a national challenge to cut cancer rates from a peak in 1990. Encouragingly, deaths in the United States from all types of cancer since then have been falling. Still, American men have a ways to go to return to 1930s levels. Medical innovation has certainly helped; it's just that public health has more often been the society-wide game changer. Most people just don't believe it.

In 2014, two researchers at Brigham Young University surveyed Americans and found that typical adults attributed about 80 percent of the increase in life expectancy since the mid-1800s to modern medicine. "The public grossly overestimates how much of our increased life expectancy should be attributed to medical care," they wrote, "and is largely unaware of the critical role played by public health and improved social conditions determinants." This perception, they continued, might hinder funding for public health, and it "may also contribute to overfunding the medical sector of the economy and impede efforts to contain health care costs."

It is a loaded claim. But consider the $6.3 billion 21st Century Cures Act, which recently passed Congress to widespread acclaim. Who can argue with a law created in part to bolster cancer research? Among others, the heads of the American Academy of Family Physicians and the American Public Health Association. They argue against the new law because it will take $3.5 billion away from public-health efforts in order to fund research on new medical technology and drugs, including former Vice President Joe Biden's "cancer moonshot." The new law takes money from programs - like vaccination and smoking-cessation efforts - that are known to prevent disease and moves it to work that might, eventually, treat disease. The bill will also allow the FDA to approve new uses for drugs based on observational studies or even "summary-level reviews" of data submitted by pharmaceutical companies. Prasad has been a particularly trenchant and public critic, tweeting that "the only people who don't like the bill are people who study drug approval, safety, and who aren't paid by Pharma."..."

[Feb 27, 2017] Why Markets Can't Cure Healthcare

Feb 27, 2017 | economistsview.typepad.com
anne -> anne... February 26, 2017 at 02:07 PM , 2017 at 02:07 PM
http://krugman.blogs.nytimes.com/2009/07/25/why-markets-cant-cure-healthcare/

July 25, 2009

Why Markets Can't Cure Healthcare
By Paul Krugman

Judging both from comments on this blog and from some of my mail, a significant number of Americans believe that the answer to our health care problems - indeed, the only answer - is to rely on the free market. Quite a few seem to believe that this view reflects the lessons of economic theory.

Not so. One of the most influential economic papers of the postwar era was Kenneth Arrow's "Uncertainty and the Welfare Economics of Health Care," * which demonstrated - decisively, I and many others believe - that health care can't be marketed like bread or TVs. Let me offer my own version of Arrow's argument.

There are two strongly distinctive aspects of health care. One is that you don't know when or whether you'll need care - but if you do, the care can be extremely expensive. The big bucks are in triple coronary bypass surgery, not routine visits to the doctor's office; and very, very few people can afford to pay major medical costs out of pocket.

This tells you right away that health care can't be sold like bread. It must be largely paid for by some kind of insurance. And this in turn means that someone other than the patient ends up making decisions about what to buy. Consumer choice is nonsense when it comes to health care. And you can't just trust insurance companies either - they're not in business for their health, or yours.

This problem is made worse by the fact that actually paying for your health care is a loss from an insurers' point of view - they actually refer to it as "medical costs." This means both that insurers try to deny as many claims as possible, and that they try to avoid covering people who are actually likely to need care. Both of these strategies use a lot of resources, which is why private insurance has much higher administrative costs than single-payer systems. And since there's a widespread sense that our fellow citizens should get the care we need - not everyone agrees, but most do - this means that private insurance basically spends a lot of money on socially destructive activities.

The second thing about health care is that it's complicated, and you can't rely on experience or comparison shopping. ("I hear they've got a real deal on stents over at St. Mary's!") That's why doctors are supposed to follow an ethical code, why we expect more from them than from bakers or grocery store owners.

You could rely on a health maintenance organization to make the hard choices and do the cost management, and to some extent we do. But HMOs have been highly limited in their ability to achieve cost-effectiveness because people don't trust them - they're profit-making institutions, and your treatment is their cost.

Between those two factors, health care just doesn't work as a standard market story.

All of this doesn't necessarily mean that socialized medicine, or even single-payer, is the only way to go. There are a number of successful healthcare systems, at least as measured by pretty good care much cheaper than here, and they are quite different from each other. There are, however, no examples of successful health care based on the principles of the free market, for one simple reason: in health care, the free market just doesn't work. And people who say that the market is the answer are flying in the face of both theory and overwhelming evidence.

* https://web.stanford.edu/~jay/health_class/Readings/Lecture01/arrow.pdf

anne -> anne... , February 26, 2017 at 02:44 PM
Correcting again and continuing:

Though Krugman always praises the work of Arrow on healthcare markets, Krugman never seems much been influenced by the work.

Though praising Arrow on healthcare markets, Krugman seemingly has spent no time on or possibly has dismissed research affirming Arrow and has not supported the sorts of healthcare insurance systems that would follow from accepting the work of Arrow:

https://promarket.org/there-is-regulatory-capture-but-it-is-by-no-means-complete/
/
March 15, 2016

"There Is Regulatory Capture, But It Is By No Means Complete"
By Asher Schechter

Kenneth J. Arrow, one of the most influential economists of the 20th century, reflects on the benefits of a single payer health care system, the role of government and regulatory capture.

Mr. Bill : , February 26, 2017 at 03:32 PM
So Anne, what your saying is that "health care" is a monopolistic industry that makes more money by restricting care and charging more ? Allowing people that can't afford to live, too die?

Well. yes, I agree with your presumed hypothesis, and I admire your boldness for stepping out in front of this moving freight train, risking your beloved tenure.

To me ? Thanks for asking.

I think that the 3 % administrative costs of the existing single payer system are more pareto optimal than the 25 % that the monopolists' extract. What do I know. This is America. Dumb is not an option.

anne : , February 26, 2017 at 06:33 PM
Turning again to Kenneth Arrow and healthcare markets, assuming that Arrow was correct for all these years, and subsequent research repeatedly has confirmed Arrow, then a typical American market-based healthcare insurance system is going to prove unworkable. Why then has the work of Arrow which is at least superficially so broadly praised by economists not been more influential in forming policy?
libezkova -> anne... , February 26, 2017 at 07:12 PM
"It is difficult to get a man to understand something, when his salary depends on his not understanding it."

― Upton Sinclair, I, Candidate for Governor: And How I Got Licked

[Feb 26, 2017] Clowbacks to benefits manager is "It's like crack cocaine," said Susan Hayes, a consultant with Pharmacy Outcomes Specialists in Lake Zurich, Illinois. "They just can't get

Feb 26, 2017 | economistsview.typepad.com
im1dc : February 24, 2017 at 05:26 PM , 2017 at 05:26 PM
Real World Economics

"You're Overpaying for Drugs and Your Pharmacist Can't Tell You"

https://www.bloomberg.com/news/articles/2017-02-24/sworn-to-secrecy-drugstores-stay-silent-as-customers-overpay

"You're Overpaying for Drugs and Your Pharmacist Can't Tell You"

by Jared S Hopkins...February 24, 2017...9:52 AM EST

> Gag clauses stop pharmacists from pointing out a cheaper way

> Cigna, UnitedHealth and Humana face at least 16 lawsuits

"Eric Pusey has to bite his tongue when customers at his pharmacy cough up co-payments far higher than the cost of their low-cost generic drugs, thinking their insurance is getting them a good deal.

Pusey's contracts with drug-benefit managers at his Medicap Pharmacy in Olyphant, Pennsylvania, bar him from volunteering the fact that for many cheap, generic medicines, co-pays sometimes are more expensive than if patients simply pay out of pocket and bypass insurance. The extra money -- what the industry calls a clawback -- ends up with the benefit companies. Pusey tells customers only if they ask.

"Some of them get fired up," he said. "Some of them get angry at the whole system. Some of them don't even believe that what we're telling them is accurate."

Graphic

Clawbacks, which can be as little as $2 a prescription or as much as $30, may boost profits by hundreds of millions for benefit managers and have prompted at least 16 lawsuits since October. The legal cases as well dozens of receipts obtained by Bloomberg and interviews with more than a dozen pharmacists and industry consultants show the growing importance of the clawbacks.

"It's like crack cocaine," said Susan Hayes, a consultant with Pharmacy Outcomes Specialists in Lake Zurich, Illinois. "They just can't get enough."

The cases arrive at a critical juncture in the quarter-century debate over how to make health care more affordable in America. President Donald Trump is promising to lower drug costs, saying the government should get better prices and the pharmaceutical industry is "getting away with murder." The Pharmaceutical Care Management Association, a benefits-manager trade group, says it expects greater scrutiny over its role in the price of medicine and wants to make its case "vocally and effectively."
Racketeering Accusations

Suits have been filed against insurers UnitedHealth Group Inc., which owns manager OptumRx; Cigna Corp., which contracts with that manager; and Humana Inc., which runs its own. Among the accusations are defrauding patients through racketeering, breach of contract and violating insurance laws.

"Pharmacies should always charge our members the lowest amount outlined under their plan when filling prescriptions," UnitedHealthcare spokesman Matthew Wiggin said in a statement. "We believe these lawsuits are without merit and will vigorously defend ourselves."

Mark Mathis, a Humana spokesman, declined to comment. Matt Asensio, a Cigna spokesman, said the company doesn't comment on litigation.

"Patients should not have to pay more than a network drugstore's submitted charges to the health plan," Charles Cote, a spokesman for the Pharmaceutical Care Management Association, said in a statement.

Read more: Escalating U.S. drug prices -- a QuickTake explainer

Benefit managers are obscure but influential middlemen. They process prescriptions for insurers and large employers that back their own plans, determine which drugs are covered and negotiate with manufacturers on one end and pharmacies on the other. They have said their work keeps prices low, in part by pitting rival drugmakers against one other to get better deals.

The clawbacks work like this: A patient goes to a pharmacy and pays a co-pay amount -- perhaps $10 -- agreed to by the pharmacy benefits manager, or PBM, and the insurers who hire it. The pharmacist gets reimbursed for the price of the drug, say $2, and possibly a small profit. Then the benefits manager "claws back" the remainder. Most patients never realize there's a cheaper cash price.

"There's this whole industry that most people don't know about," said Connecticut lawyer Craig Raabe, who represents people accusing the companies of defrauding them. "The customers see that they go in, they are paying a $10 co-pay for amoxicillin, having no idea that the PBM and the pharmacy have agreed that the actual cost is less than a dollar, and they're still paying the $10 co-pay."

On Feb. 10, a customer at an Ohio pharmacy paid a $15 co-pay for 15 milligrams of generic stomach medicine pantoprazole that the pharmacist bought for $2.05, according to receipts obtained by Bloomberg. The pharmacist was repaid $7.22, giving him a profit of $5.17. The remaining $7.78 went back to the benefits manager.
Opaque Market

Clawbacks are possible because benefit managers take advantage of an opaque market, said Hayes, the Illinois consultant. Only they know who pays what.

In interviews, some pharmacists estimate clawbacks happen in 10 percent of their transactions. A survey by the more than 22,000-member National Community Pharmacists Association found 83 percent of 640 independent pharmacists had at least 10 a month.

"I've got three drugstores, so I see a lot of it," David Spence, a Houston pharmacist, said in an interview. "We look at it as theft -- another way for the PBMs to steal."

Lawsuits began in October in multiple states, and some have since been consolidated. Most cite an investigation by New Orleans television station Fox 8, which featured interviews with Louisiana pharmacists whose faces and voices were obscured.
Tight Restrictions

Many plans require pharmacies to collect payment when prescriptions are filled and prohibit them from waiving or reducing the amount. They can't even tell their customers about the clawbacks, according to the suits. Contracts obtained by Bloomberg prohibit pharmacists from publicly criticizing benefit managers or suggesting customers obtain the medication cheaper by paying out of pocket.

Pharmacists who contract with OptumRx in 2017 could be terminated for "actions detrimental to the provider network," doing anything that "disparages" it or trying to "steer" customers to other coverage or discounted plans, according to an agreement obtained by Bloomberg.

"They're usually take-it-or-leave-it contracts," said Mel Brodsky, who just retired as chief executive officer of Pennsylvania's Keystone Pharmacy Purchasing Alliance, which buys drugs on behalf of independent pharmacies.

OptumRx is among the three largest benefit managers that combine to process 80 percent of the prescriptions in the U.S. The other two, Express Scripts Holding Co. and CVS Caremark, haven't been accused of clawbacks. CVS doesn't use them, it said in a statement. Express Scripts is so opposed that it explains the practice on its website and promises customers will pay the lowest price available.
Potential Death Blow

Pharmacies fear getting removed from reimbursement networks, a potential death blow in smaller communities. But some pharmacists jump at opportunities to inform customers who question their co-pay amounts.

"Most don't understand," said Spence, who owns two pharmacies in Houston. "If their co-pay is high, then they care."

States are responding. Last year, Louisiana began allowing pharmacists to tell customers how to get the cheapest price for drugs, trumping contract gag clauses. In 2015, Arkansas prohibited benefit managers and pharmacies from charging customers more than the pharmacy will be paid.

"The consumers don't know what's going on," said Steve Nelson, a pharmacist in Okeechobee, Florida. "We try to educate them with regards to what goes into a prescription, OK? You've got to kind of tip-toe around things."

ilsm -> im1dc... , February 24, 2017 at 07:08 PM
pharma to USG

like drug cartel in Mexico

except no briefcases

im1dc -> ilsm... , February 24, 2017 at 07:47 PM
That's a valid observation.

[Feb 19, 2017] As Democrats stare down eight years of policies being wiped out within months, but those policies did virtually nothing for their electoral success at any level.

Notable quotes:
"... This point has been made before on Obamacare, but the tendency behind it, the tendency to muddle and mask benefits, has become endemic to center-left politics. Either Democrats complicate their initiatives enough to be inscrutable to anyone who doesn't love reading hours of explainers on public policy, or else they don't take credit for the few simple policies they do enact. Let's run through a few examples. ..."
"... missed the point the big winner is FIRE. ACA should have been everyone in medicare, and have medicare run Part B not FIRE. Obamcare is welfare for FIRE, who sabotage it with huge deductibles and raging rises in premium.. ..."
Feb 19, 2017 | economistsview.typepad.com
Peter K. -> Chris G ... , February 18, 2017 at 07:35 AM
via J.W. Mason (lots of F-bombs!):

http://democracyjournal.org/arguments/keep-it-simple-and-take-credit/

Keep It Simple and Take Credit

BY JACK MESERVE
FROM FEBRUARY 3, 2017, 5:42 PM

As Democrats stare down eight years of policies being wiped out within months, it's worth looking at why those policies did virtually nothing for their electoral success at any level. And, in the interest of supporting a united front between liberals and socialists, let me start this off with a rather long quote from Matt Christman of Chapo Trap House, on why Obamacare failed to gain more popularity:

There are parts to it that are unambiguously good - like, Medicaid expansion is good, and why? Because there's no f!@#ing strings attached. You don't have to go to a goddamned website and become a f@!#ing hacker to try to figure out how to pick the right plan, they just tell you "you're covered now." And that's it! That's all it ever should have been and that is why - [Jonathan Chait] is bemoaning why it's a political failure? Because modern neoliberal, left-neoliberal policy is all about making this shit invisible to people so that they don't know what they're getting out of it.

And as Rick Perlstein has talked about a lot, that's one of the reasons that Democrats end up f!@#$ing themselves over. The reason they held Congress for 40 years after enacting Social Security is because Social Security was right in your f!@ing face. They could say to you, "you didn't used to have money when you were old, now you do. Thank Democrats." And they f!@#ing did. Now it's, "you didn't used to be able to log on to a website and negotiate between 15 different providers to pick a platinum or gold or zinc plan and apply a f!@#$ing formula for a subsidy that's gonna change depending on your income so you might end up having to retroactively owe money or have a higher premium." Holy shit, thank you so much.

This point has been made before on Obamacare, but the tendency behind it, the tendency to muddle and mask benefits, has become endemic to center-left politics. Either Democrats complicate their initiatives enough to be inscrutable to anyone who doesn't love reading hours of explainers on public policy, or else they don't take credit for the few simple policies they do enact. Let's run through a few examples.

...

ilsm -> Peter K.... , February 18, 2017 at 12:47 PM
missed the point the big winner is FIRE. ACA should have been everyone in medicare, and have medicare run Part B not FIRE. Obamcare is welfare for FIRE, who sabotage it with huge deductibles and raging rises in premium..

[Jan 23, 2017] Consumer Guide to Health Care - Coping with Medical Bills and Debt Wisconsin Department of Health Services

Notable quotes:
"... Record the names and phone numbers of the people you are dealing with. ..."
"... Document the date, time, and results of your phone calls. ..."
"... Pay something - even a small amount - on each bill each month as a gesture of good faith. ..."
"... Be aware, though, that some services charge high fees and do nothing to really help reduce your debt. ..."
"... Don't ignore bills. Though tempting, this is not a good strategy. Hospitals and providers are more likely to negotiate with you if you contact them immediately. ..."
"... Don't transfer debt to a credit card. Most experts warn that this is a poor choice for paying off medical debt ..."
Jan 23, 2017 | dhs.wisconsin.gov
Unless you have successfully challenged your bill, you are responsible for paying all of your medical bills. If you cannot pay, here are some things to consider.
  1. Try to negotiate a payment plan. Your hospital or provider may be willing to accept smaller monthly payments. Keep in mind that your payments generally need to be reasonable and you must keep up with your payments. In its advice to parents of chronically ill children (link is external) , the American Academy of Family Physicians recommends the following:
    • Notify the appropriate offices quickly.
    • Keep in touch with your creditors.
    • Record the names and phone numbers of the people you are dealing with.
    • Document the date, time, and results of your phone calls.
    • Pay something - even a small amount - on each bill each month as a gesture of good faith.
  2. Get information on charity care in Wisconsin hospitals.
  3. Apply for Wisconsin Medicaid or BadgerCare Plus . If you are eligible, Medicaid may pay for some of your existing medical bills. Wisconsin Medicaid coverage can begin as early as the first day of the month, three months before the month you apply, if you would have been eligible in those months, so apply as soon as possible.
  4. Go for credit counseling. Be aware, though, that some services charge high fees and do nothing to really help reduce your debt. Make sure you are working with a credit counseling service (also known as an adjustment service agency) that is licensed by the Wisconsin Department of Financial Institutions.
  5. Be creative about finding help from outside sources. Charitable foundations, civic organizations and churches and community groups might be able to help. The Patient Pal (link is external) (PDF, 197 KB) from the Patient Advocate Foundation (link is external) includes some fundraising ideas for those with high medical bills.
  6. Don't ignore bills. Though tempting, this is not a good strategy. Hospitals and providers are more likely to negotiate with you if you contact them immediately.
  7. Don't transfer debt to a credit card. Most experts warn that this is a poor choice for paying off medical debt for two reasons:
    • The interest rates on your credit card will add significantly to your total payment.
    • Transferring medical debt to a credit card may affect your eligibility for Medicaid. Some medical costs can be deducted from gross income to determine your Medicaid eligibility. Medical debt on a credit card may no longer qualify as medical debt.
Dealing with collection agencies

If your hospital or other health care provider has turned your bill over to a collection agency, you are protected against harassment by the Fair Debt Collection Practices Act (FDCPA).

If you have questions about your rights or the conduct of a collection agency, contact the Department of Financial Institutions at (608) 264-7969, or 1-800-452-3328 (in Wisconsin only).

Bankruptcy The decision to file for bankruptcy should be last resort. More (PDF, 129 KB) information on how bankruptcy works and the different types (link is external) is available from the Wisconsin Department of Agriculture, Trade and Consumer Protection.

Legal help

If you find that you need legal help to deal with your medical debt, the Wisconsin State Bar Association's website provides general information on finding a lawyer (link is external) and information on finding a lawyer if you have a low income (link is external) .

The Legal Services Corporation (link is external) , a private, non-profit corporation established by Congress, provides a list of Wisconsin local legal aid programs (link is external) from its website.

[Jan 23, 2017] Medical Debt Collections –Unexpected Health Problems Costs

Jan 23, 2017 | www.debt.org

Medical debt collectors must abide by specific regulations, as set forth by the Fair Debt Collection Practices Act . Collectors cannot harass or lie to debtors, or perform any other practices deemed unfair.

[Jan 23, 2017] Medical Debt Collection

You can get a free Kindle version of "Debt Collection Answers" ebook on Amazon here .
Notable quotes:
"... We have heard from consumers who first hear about a medical bill from a collection agency. There is no federal law that protects you from this type of situation. ..."
Jan 23, 2017 | www.debtcollectionanswers.com
Having even a small medical debt reported as past due or in collections can seriously damage your credit history, you may be tempted to pay just to protect your credit.

Some medical providers may even try to pressure you into paying your debt owe by refusing to provide you (or one of your family members) with additional medical care until you do. Some of them may even refuse you future care while you are paying off your debt through an installment plan! Others may have a policy that as long as you owe them money, you must pay up-front for all future medical services they provide to you.

Warning: Aggressive medical providers can be a special problem for seniors living on fixed incomes when their spouses have been hospitalized or have accumulated a large outstanding bill with one or more of their doctors.


When Can I Be Sent to Collections On a Medical Bill?

If at all possible, you want to keep a medical bill out of collections. Once it is turned over to a collection agency, it will likely appear on your credit reports as a collection account and damage your credit rating.

Your medical debt may be turned over to collections:

How can you protect yourself from medical debt collection? Don't ignore medical bills. Talk to the medical provider. Get everything in writing, or follow up in writing yourself

... ... ...

If You Have Insurance and Your Insurer Refuses to Pay All or a Portion of Your Medical Bills

It's not unusual for health insurers to deny coverage for medical care. If that happens to you and you believe that the care should be covered, or if your insurer pays some but not all of your medical bill and you believe it should cover the entire bill, here's what we recommend:

[Jan 23, 2017] In debt and afraid: dealing with debt collectors

Notable quotes:
"... The CFPB says debt collection is a multi-billion dollar industry affecting 70 million consumers. People are most often contacted about medical and credit card debt. And more consumers complain to the CFPB about debt collection than any other financial product or service. ..."
"... Debt collectors can contact you by phone, letter, email or text message, as long as they follow the rules and disclose that they are debt collectors. It's against the law for a debt collector to pretend to be someone else to harass, threaten or deceive you. ..."
"... Collectors cannot lie to collect a debt, by falsely representing themselves or the amount you owe. And other than trying to obtain information about you, such as a telephone number or whereabouts, a debt collector generally is not permitted to discuss your debt with anyone other than you, your spouse, or your attorney. ..."
"... Also when you pay them off keep the document marked paid in full or zero balance or whatever else the send you on file including your financial proof (canceled check, money order, credit card receipt) keep it until you die! ..."
"... Debt industry buys billions of dollars of dead debt. 90% does end up as default judgement because scared debtors do not have the money to hire a attorney or do not know what to do. The other 10% of debtors who hire attorneys are off the hook. ..."
"... Consumer debts are self inflicted foolishness, medical debts aren't, but just goes to show the Empire is ran by business interests who refuse to allow any type of universal medical and have installed a system that allows them profits for illness and death ..."
Jan 23, 2017 | finance.yahoo.com
Sarah Skidmore Sell, AP Personal Finance Writer

It's a scary place to be - in debt and afraid.

A new Consumer Financial Protection Bureau report found that more than one in four consumers felt threatened when contacted by debt collectors. The first-ever national survey of consumer experiences with debt collectors found consumers often faced calls that came too often, at odd hours and contained warnings of jail time and other threats. Some were contacted for debts they didn't owe. And many said when they asked the collector to stop contacting them, the request was ignored.

CFPB Director Rich Cordray said the report casts a "troubling light" on the industry, and that the bureau is working to stop abuses. But what are your rights when facing off with a debt collector?

A few things to know:

YOU ARE NOT ALONE

The CFPB says debt collection is a multi-billion dollar industry affecting 70 million consumers. People are most often contacted about medical and credit card debt. And more consumers complain to the CFPB about debt collection than any other financial product or service.

The Federal Trade Commission, which enforces the Fair Debt Collection Practices Act, also said debt collectors generate more complaints to its offices than any other industry. While many debt collectors are careful to comply with consumer protection laws, some engage in illegal practices.

YOU ARE PROTECTED

The Fair Debt Collection Practices Act provides protection for those being pursued for personal debts, such as money owed on a credit card account, an auto loan or a mortgage. It doesn't cover debts incurred to run a business.

YOU HAVE RIGHTS

Debt collectors can contact you by phone, letter, email or text message, as long as they follow the rules and disclose that they are debt collectors. It's against the law for a debt collector to pretend to be someone else to harass, threaten or deceive you.

They may not contact you at inconvenient times or places, such as early in the morning or late at night. And they may not contact you at work if they're told not to.

Debt collectors may not harass, oppress, or abuse you, according to the FTC. That includes threats of violence or using obscene language. Federal law also limits the number of calls a debt collector can place.

Collectors cannot lie to collect a debt, by falsely representing themselves or the amount you owe. And other than trying to obtain information about you, such as a telephone number or whereabouts, a debt collector generally is not permitted to discuss your debt with anyone other than you, your spouse, or your attorney.

YOU CAN TAKE ACTION

Report any problems you have with a debt collector to your state Attorney General's office, the Federal Trade Commission and the Consumer Financial Protection Bureau. Many states have their own debt collection laws that vary from federal law, so contact your attorney general's office for help.

Gary G

They are debt collectors the lowest form of bottom feeding #$%$ on the planet.step one, NEVER tell them any personal information whatsoever.step two, get a phone number and case number so you can call them back.step three call them from a phone that can record the conversation (theres an app for that)step three, call them when you are really ready to talk to them Inform them the call is being recorded. let them know clearly what forms of contact are and are not acceptable.step four, get the pertinent information about the debt including the debtor any account numbers and any settlement offers they have. Still NEVER give away any personal information. once you have all the information you need end the call, if at any time during the call you feel you are being harassed or intimidated inform them it is not acceptable (remember you are recording the conversation) and terminate the call. call back later.Now you are in control and can make informed decisions.If at some point you want/need to work out a settlement NEVER finalize anything on the phone, GET IT IN WRITING. NEVER, agree to give them your credit card or banking information under any circumstances!!!once you make an arrangement keep the printed document with the arrangement on file for the rest of your life.

Also when you pay them off keep the document marked paid in full or zero balance or whatever else the send you on file including your financial proof (canceled check, money order, credit card receipt) keep it until you die!

steven

Based on personal experience, the worst debt collectors are of the medical variety. Two years of a fatal ovarian cancer case overwhelmed not only my finances, but jeopardized my mental health as well. The only thing that kept me going was the necessity of showing up for work, and the support of coworkers and (may I say this?) my managers as well.

Mark

Consumer Financial Protection Bureau will be gutted under the GOP agenda. So the next time some cable company, Wall Street bank, or some other huge corporation screws you over, you'll have no recourse and you'll be on your own.

pfk

I find tgheses stories and the ads on TV (If you owe $1000 to IRS..., If you have more than $5,00 credit card debt, Reduce $50,00 debt to $5000..., etc) to e morally contemptible. If you cannot afford something do not buy it; if you have a job, pay your IRS taxes, etc. I'm tired paying extra for everything I buy or do for these people who spend and expect someone else (me) to pay.

a

hogwash! To scare off a junk debt buyer attorney all you need to do is make one call to your attorney. Many of you collectors "start fake lawsuits" to coerce debtors to pay. With no filing numbers, court stamps, etc... Once the debtor's attorney files a 'notice of appearance' and asks for a real lawsuit/trial, what happens? The creditor never files the lawsuit. Why? Because the junk debt buyer has to PROVE IT. The JDB creditor has no original contract signed to prove the debt exists, no chain of assignment/invoice to show they have standing to sue (own the debt) nor the account statements to verify what is owed. They are hoping at best for default judgements.

Debt industry buys billions of dollars of dead debt. 90% does end up as default judgement because scared debtors do not have the money to hire a attorney or do not know what to do. The other 10% of debtors who hire attorneys are off the hook. You see Junk Debt Buyers buy debt with no contract signed by debtors, have no invoice they even own this particular debt in detail and no account statements to verify correct amount owed.

So debtors, beware, pay the few hundred dollars to your attorney to ask for a lawsuit and notice of appearance and see how fast that debt collector disappears. 99% of junk debt buyers/creditors buy unwarranted debt and CAN NOT PROVE IT IN COURT. There is a disclaimer on the debt stating there is no contract, invoice that it is sold nor account statements offered.

Just sue these junk debt buyers and they go away. If they sell the debt to another JDB again sue again and they drop the debt again. Resold debt has even less chance of winning in court because even less proof is available every time it is sold.

But DO NOT AVOID the fake lawsuit. If you do the creditor gets the default judgement and will garnish wages, lien your house, and will win. Now if the original creditor files the lawsuit you will most likely lose and owe (they have all the proof in their records). So in this case make a settlement offer of lump sum repay or payments you can afford.

Call me scum or whatever but I have used this strategy and it works. After a few decades of paying usurious interest rates I have some cash finally coming back; and no need to file bankruptcy. After 7 years it drops off your credit report and credit score goes way up. Make it anywhere to 4-7 years (depending on your state law timeframe) and the statute of limitations kicks in and money not legally owed any longer. Just do not make any payments on it to renew statute of limitations. No problems! Hell I gambled the money away anyway, how was I suppose to get it back -Ha, Ha. Joke was on the JDB in my case!

Gregory

Very poor article. Take it from some one who was being threatened for some one else's debt. A certified letter to the debt collector explaining you do not owe the debt means that once they receive the letter they can no longer contact you.

Violation of that law carries a 10,000 dollar fine. If the amount is in dispute the same tactic works, except they can contact you with the proof of what you owe. A lot times this involves too much work and they do not pursue it. So if they do not pursue it once the Statute of Limitations is over the debt can no longer be collected.

The limit varies by State Law and amount. Finally be aware that uncollected debts are often sold and the new "owner" of the debt may try to collect on it. Again a certified letter stops them as you have proof of notification that the debt is not owed. I hope this helps the victims out there.

Chub

Buying debt has become a large industry that attracts a lot of crooks. Companies buy debt for as little as a dime on the dollar! The original lender benefits because they are getting a little something out of a debt that they have no hope of collecting. The buyer of the debt benefits because the potential profit is very

Many of the people buying debt aren't your traditional debt collection agency. They are many times just an individual with a cell phone who could bend the rules because they can change their name and location as easy as you can report their activity. Many times you are just dealing with thugs with cellphones. If you owe them, don't be afraid to offer a lesser amount because they had bought the debt so cheap that they may still make a pretty good profit.

Chief_blamestormer

Realize that some debtors never borrowed a dime. It could be the result of a civil judgement. If you think all civil judgements are fair, then have a look at the cases in your local courthouse, or serve a couple rounds of jury duty.

W, 19 hours ago

Industry? There's nothing industrious about. Bill collectors are mostly thugs who can't get real jobs so they have to leverage their values off other people's misery. Consumer debts are self inflicted foolishness, medical debts aren't, but just goes to show the Empire is ran by business interests who refuse to allow any type of universal medical and have installed a system that allows them profits for illness and death , which is similar to a developing country, not a developed superpower.

[Jan 16, 2017] Trump said he will target pharmaceutical companies over drug prices and demand that they negotiate directly with Medicaid and Medicare.

Jan 16, 2017 | economistsview.typepad.com

pgl -> Fred C. Dobbs... , January 16, 2017 at 05:57 AM

If Trump is serious about what he said - expect a real battle with Speaker Ryan.
DeDude -> pgl... , January 16, 2017 at 06:57 AM
That may be exactly what Trump is counting on. Trump is a classic bully, he gets back at people (to make an example and reduce future "resistance"). It would be very difficult for the GOP to fight with Trump publicly in the first year. Question is what his specifics are. He may even be able to get bipartisan support and split the GOP, the way Bush did with his prescription drug plan for seniors.
reason -> DeDude... , January 16, 2017 at 07:35 AM
Trump doesn't do details. Details are for little people.
libezkova -> DeDude... , January 16, 2017 at 07:44 AM
Crushing Speaker Ryan is not bulling per se. This is a great service for the country.

He is definitely out of touch with reality.

Peter K. -> Fred C. Dobbs... , January 16, 2017 at 05:55 AM
"We're going to have insurance for everybody," Mr. Trump said. "There was a philosophy in some circles that if you can't pay for it, you don't get it. That's not going to happen with us."

In the interview, Mr. Trump provided no details about how his plan would work or what it would cost. He spoke in the same generalities that he used to describe his health care goals during the campaign - that it would be "great health care" that left people "beautifully covered."

Single payer!

ilsm -> Peter K.... , January 16, 2017 at 06:10 AM
Trump would have to sell it, but in the past he has praised European style single payer, but said it would be a hard sell in the US.

If Nixon could go to China.

MLK would observe "if US can pay to gut the world, it can afford a little for the home front".

Peter K. -> ilsm... , January 16, 2017 at 06:52 AM
"Beautifully covered."

Can't wait!

Fred C. Dobbs -> Fred C. Dobbs... , January 16, 2017 at 06:00 AM
The GOP's strategy for Obamacare? Repeal and run.
http://www.bostonglobe.com/opinion/2017/01/15/gop-strategy-for-aca-repeal-and-run/aCcjrJWQDjx4r4aRxkMCaL/story.html?event=event25 via @BostonGlobe
Elizabeth Warren - January 15, 2017

For eight years, Republicans in Congress have complained about health care in America, heaping most of the blame on President Obama. Meanwhile, they've hung out on the sidelines making doomsday predictions and cheering every stumble, but refusing to lift a finger to actually improve our health care system.

The GOP is about to control the White House, Senate, and House. So what's the first thing on their agenda? Are they working to bring down premiums and deductibles? Are they making fixes to expand the network of doctors and the number of plans people can choose from? Nope. The number one priority for congressional Republicans is repealing the Affordable Care Act and breaking up our health care system while offering zero solutions.

Their strategy? Repeal and run.

Many Massachusetts families are watching this play out, worried about what will happen - including thousands from across the Commonwealth that I joined at Faneuil Hall on Sunday to rally in support of the ACA. Hospitals and insurers are watching too, concerned that repealing the ACA will create chaos in the health insurance market and send costs spiraling out of control.

They are right to worry. Massachusetts has worked for years to provide high-quality, affordable health care for everyone. But there's no magic wand we can wave to simply snap back to our old system if congressional Republicans decide to rip up the Affordable Care Act and run away.

Health care reform in Massachusetts wasn't partisan. Democrats, Republicans, business leaders, hospitals, insurers, doctors, and consumers all came together behind a commitment that every single person in our Commonwealth deserves access to affordable, high-quality care. When Republican Governor Mitt Romney signed Massachusetts health reform into law in 2006, our state took huge strides toward offering universal health care coverage and financial security to millions of Bay State residents.

That law was a major step forward. Today, more than 97 percent of Bay Staters are covered - the highest rate of any state in the country.

But Massachusetts still has a lot to lose if the ACA is repealed. One big reason for our state's health care success is that we took advantage of the new opportunities offered under the ACA. In addition to making care more accessible and efficient, our state expanded Medicaid, using federal funds to help even more people. And we combined federal and state dollars to help reduce the cost of insurance on the Health Connector.

When the ACA passed, Massachusetts already had in place some of the best consumer protections in the nation. But the ACA still made a big difference. It strengthened protections for people in Massachusetts with pre-existing conditions, allowed for free preventive care visits, and - for the first time in our state - banned setting lifetime caps on benefits.

If the ACA is repealed, our health care system would hang in the balance. Half a million people in the Commonwealth would risk losing their coverage. People who now have an iron-clad guarantee that they can't be turned away due to their pre-existing conditions or discriminated against because of their gender could lose that security. Preventive health care, community health centers, and rural hospitals could lose crucial support. In short, the Massachusetts health care law is a big achievement and a national model, but it also depends on the ACA and a strong partnership with the federal government.

If the cost-sharing subsidies provided by the ACA are slashed to zero, Massachusetts will have a tough time keeping down the cost of plans on the Health Connector. The state can't make funds appear out of thin air to help families on the Medicaid expansion if Republicans yank away support. And our ability to address the opioid crisis will be severely hampered if people lose access to health insurance or if the federal funding provided through the Medicaid waiver disappears. Even in states with strong health care systems - states like Massachusetts - the ACA is critical.

The current system isn't perfect - not by a long shot. There are important steps Congress could take to lower deductibles and premiums, to expand the network of doctors people can see on their plans, and to increase the stability and predictability of the market. We should be working together to make health care better all across the country, just like we've tried to do here in Massachusetts.

This doesn't need to be a partisan fight. But if congressional Republicans continue to pursue repeal of the ACA with nothing more than vague assurances that they might - someday - think up a replacement plan, the millions of Americans who believe in guaranteeing people's access to affordable health care will fight back every step of the way.

Repeal and run is for cowards.

pgl -> Fred C. Dobbs... , January 16, 2017 at 06:00 AM
"Providing health insurance to everyone in the country is likely to be very costly, a fact that could diminish support from fiscal conservatives."

Herein lies the real issue. Of course we could reduce these costs by ending the doctor cartel, ending the oligopoly power of the health insurance giants, and pushing back on Big Pharma. Alas, Speaker Ryan is not interested in any of these things.

Fred C. Dobbs -> Fred C. Dobbs... , January 16, 2017 at 06:01 AM
Rand Paul says he's drafting
a measure to replace Obamacare http://www.bostonglobe.com/news/politics/2017/01/15/rand-paul-says-drafting-measure-replace-obamacare/y6wMEPKjbi1oEkj9TkekSO/story.html?event=event25 via @BostonGlobe
Miles Weiss - Bloomberg - January 15, 2017

Republican Senator Rand Paul said he's drafting legislation for a health-care insurance plan that could replace Obamacare, including a provision to ''legalize'' the sale of inexpensive insurance policies that provide abbreviated coverage.

''That means getting rid of the Obamacare mandates on what you can buy,'' Paul said in an interview on CNN's ''State of the Union'' on Sunday. Obamacare, which Republicans are moving to repeal, requires insurers to cover a number of procedures -- such as preventive care and pregnancy -- that Paul said drives up the cost.

The Kentucky Republican said he'll propose helping people pay for medical bills through tax credits and health savings accounts, which allow users to set aside money tax-free to pay for medical expenses. His bill would allow individuals and small businesses to form associations when buying insurance, giving them more leverage, he said.

''There's no reason why someone with four employees shouldn't be able to join with hundreds and hundreds of other businesses'' to negotiate better prices, Paul said. Becoming part of larger pools would help small companies secure coverage ''that guarantees the issue of the insurance even if you get sick.'' ...

Paul said his legislation is meant to address concern among Democrats and some Republicans that ending Obamacare would also end health-care coverage for many of the 20 million people who acquired insurance under the law. While Republicans move ahead with their plans to eradicate Obamacare, they have yet to outline an alternative.

''It's incredibly important that we do replacement on the same day as we do repeal,'' Paul said on CNN. ''Our goal,'' he added, is to ''give access to the most amount of people at the least amount of cost.''

Fred C. Dobbs -> Fred C. Dobbs... , January 16, 2017 at 07:28 AM
(I urge that Dr Paul's plan include
guv'mint-supplied snake bite kits
for all. That could save a bundle.)

[Jan 16, 2017] The Biggest Changes Obamacare Made, and Those That May Disappear

Jan 16, 2017 | economistsview.typepad.com
Fred C. Dobbs : January 15, 2017 at 08:37 AM , 2017 at 08:37 AM
The Biggest Changes Obamacare Made, and Those That
May Disappear https://nyti.ms/2itydsr via @UpshotNYT
NYT - Margot Sanger-Katz - January 13, 2017

It looks like the beginning of the end for Obamacare as we know it.

After years of vowing to repeal the Affordable Care Act, as it is formally known, Republican lawmakers in both chambers of Congress have now passed a bill that will make it easier to gut the law.

Because they are using a special budget process, Republicans won't be able to repeal all provisions of the health law. But it seems like a good time to look at the major changes Obamacare brought to health care, which of those changes may now disappear, and what might replace them.

An important note: We still don't know the details of a repeal bill, and passage is not guaranteed. But Republicans passed a similar package in 2015, vetoed by President Obama, that provides a rough template. Republicans have also said they hope to make further changes through additional legislation. We'll provide updates when new legislative language arrives, expected in several weeks.

1) Obamacare insured millions through new insurance markets.

The health law reduced the number of uninsured Americans by an estimated 20 million people from 2010 to 2016. One of the primary ways it did so was by creating online markets where people who didn't get insurance through work or the government could shop for a health plan from a private insurer. The law offered subsidies for Americans with lower incomes to help pay their premiums and deductibles.

What would happen? The Republican bill is expected to eliminate the subsidies. This would make insurance unaffordable for millions of Americans and sharply reduce the number who buy their own health coverage.

With many fewer people buying coverage, the insurance markets are likely to become increasingly unstable. Many insurers will stop offering policies, and the remaining customers are likely to be sicker than current Obamacare buyers, a reality that will drive up the cost of insurance for everyone who buys it, and force more people out of the markets. The Urban Institute estimates that the change would cause a total of 22.5 million people to lose their health insurance.

What might replace it? Separate legislation may include some new form of subsidy to help people afford insurance. Plans from House Speaker Paul Ryan and the budget committee chairman Tom Price, President-elect Donald J. Trump's pick to lead the Department of Health and Human Services, would both offer a flat tax credit to help buy insurance that varies by age. A proposal from the House Republican Study Committee would give all Americans a standard tax deduction to buy insurance.

2) Obamacare insured millions more by expanding Medicaid.

The health law provided federal funds for states to offer Medicaid coverage to anyone earning less than about $16,000 for a single person or $33,000 for a family of four. Not every state chose to expand, but most did.

What would happen? The Republican plan is expected to eliminate federal funding for the expansion. An estimated 12.9 million people would lose Medicaid coverage, according to the Urban Institute's projections.

What might replace it? Republican leaders have discussed reforming the remaining Medicaid program to give states more autonomy and to reduce future federal investment.

3) Obamacare established consumer protections for health insurance.

One of the law's signature features prevents insurance companies from denying coverage or charging a higher price to someone with a pre-existing health problem. The law included a host of other protections for all health plans: a ban on setting a lifetime limit on how much an insurer has to pay to cover someone; a requirement that insurers offer a minimum package of benefits; a guarantee that preventive health services be covered without a co-payment; a cap on insurance company profits; and limits on how much more insurers can charge older people than younger people. The law also required insurance plans to allow adult children to stay on their parents' policies until age 26.

What would happen? These rules can't be changed using the special budget process, so they would stay in place for now. But eliminating some of the other provisions, like the subsidies, and leaving the insurance rules could create turmoil in the insurance markets, since sick customers would have a much stronger incentive to stay covered when premiums rise. .

What might replace it? Mr. Trump has said that he'd like to keep the law's policies on pre-existing conditions and family coverage for young adults, but Senate Republicans recently voted against nonbinding resolutions to preserve those measures, suggesting they may be less committed. Some of the other provisions would probably be on the table if there were new legislation. Republicans in Congress would probably eliminate rules that require a minimum package of benefits for all insurance plans and allow states to determine what insurers would have to include. Mr. Trump has said he'd like to encourage the sale of insurance across state lines, a policy likely to make coverage more skimpy but less expensive for many customers. Republicans would also like to expand tax incentives for people to save money for health expenses.

Many of the Republican proposals would also establish so-called high-risk pools, which would provide subsidized insurance options for people with chronic health problems who wouldn't be able to buy insurance without rules forcing insurers to sell them coverage.

4) Obamacare required individuals to have health insurance and companies to offer it to their workers.

To ensure that enough healthy people entered insurance markets, the law included mandates to encourage broader coverage. Large employers that failed to offer affordable coverage, or individuals who failed to obtain insurance, could be charged a tax penalty.

What would happen? The bill is expected to eliminate the mandates. Some experts think that eliminating the individual mandate, in particular, could destabilize insurance markets by reducing incentives for healthy people to buy coverage. The mandate had less of an impact on the employers, which had already been offering coverage.

What might replace it? Some Republican plans would allow insurers to charge much higher rates to customers who allow their coverage to lapse than to those who renew their policies every year. Such a system might provide a different financial incentive for healthy people to stay insured.

5) Obamacare raised taxes related to high incomes, prescription drugs, medical devices and health insurance.

To help pay for the law's coverage expansion, it raised taxes on several players in the health industry and on high-income earners.

What would happen? The G.O.P. package may roll back those tax increases, though there is some disagreement among Republican lawmakers about the deficit impact of such changes.

What might replace it? Republicans have not discussed raising new taxes to replace those in the Affordable Care Act. But some of their plans would limit the tax benefits offered to people who get their health insurance through work. That change would increase tax revenues, but would increase the cost of health insurance for many people who get it through work.

6) Obamacare made major reforms to Medicare payments.

The law cut the annual pay raises Medicare gives hospitals and reduced the fees Medicare pays private insurance companies. It created new incentives for hospitals and doctors to improve quality. It also set up a special office to run experiments in how Medicare pays doctors and hospitals for health care services. Those experiments are now widespread and have begun changing the way medicine is practiced in some places.

What would happen? The new legislation is expected to leave these changes alone, even though many have come under criticism by Republicans in Congress over the years, including from Mr. Price, an orthopedic surgeon. Many of the experiments could be reshaped or eliminated through regulation or through a future budget process.

What might replace it? Republicans in Congress have long talked about even more ambitious changes to Medicare, intended to move more beneficiaries into private insurance coverage. Mr. Trump has said that he does not want to make major changes to Medicare, so it is unclear if such a proposal would move forward.

7) Obamacare made many smaller changes that will probably last.

Obamacare had a range of policies meant to improve health and health care, including requirements that drug companies report payments made to physicians, a provision written by the Iowa senator Chuck Grassley, a Republican; a requirement that chain restaurants publish calorie counts on their menus; and a rule that large employers must provide a space for women to express breast milk.

What would happen? When Republicans talk about repealing Obamacare, they tend to focus on the parts of the law that expanded insurance coverage and regulated health insurance products, not these ancillary parts. That means that portions of the Affordable Care Act that people don't associate with the word "Obamacare" are likely to endure.

Fred C. Dobbs -> Fred C. Dobbs... , January 15, 2017 at 08:42 AM
Perhaps the most horrendous loss
(to Big Healthcare) will be if ~20M
people lose coverage, even if it is
high-deductible 'catastrophic' coverage,
hospitals will lose billions in insurance
reimbursements for 'free care', which had
*much* to do with why/how Massachusetts
got the ball rolling in the first place.
im1dc -> Fred C. Dobbs... , January 15, 2017 at 11:32 AM
Every time I read an article about the Republicans 'Repeal of Obamacare' I remind myself that Trump has not said he would sign Repeal only.

Rather, he repeatedly has said and recently reiterated that he wants Repeal to coincide with Replace, hours, days, not weeks, months, or years.

That sets up an Executive Branch vs Legislative Branch conflict.

One of the party's pledges will have to give to the others, either Trump or the Speaker Ryan House Republican majority and or the Majority Leader McConnell's Republican majority Senate.

Today I'm guessing Trump gets his wish.

But that leads me to ask what are the Republicans going to substitute for PACA/Obamacare that is 'cheaper and provides more and better health care' that Donald Trump promised, repeatedly.

If it is exciting to watch a train wreck then it is exciting to watch this budding and self-inflicted catastrophe develop in Republican controlled D.C., although I would rather not.

DeDude -> im1dc... , January 15, 2017 at 12:49 PM
"what are the Republicans going to substitute for PACA/Obamacare that is 'cheaper and provides more and better health care' that Donald Trump promised"

Yes my guess is that TrumpCare will not be bigger and better. More likely it will be small - like his hands

DeDude -> Fred C. Dobbs... , January 15, 2017 at 01:02 PM
She missed the biggest and most important part. ACA reduced the size of the doughnut hole in Medicare part D. Indeed ObamaCare was going to make the doughnut hole go completely away by 2020. So if we go back to the old Bush part D there will suddenly be a $4000 gap of no coverage for prescription drugs for our seniors. What are the GOPsters going to do about that?
Fred C. Dobbs -> DeDude... , January 15, 2017 at 01:19 PM
Get rich(er), I'd guess.

[Jan 15, 2017] Michael Moores movie Sicko. In it he talks to people in Canada, Britain, France about their experiences with their health care systems

Notable quotes:
"... "According to Sicko, almost fifty million Americans are uninsured while the remainder, who are covered, are often victims of insurance company fraud and red tape. Furthermore, Sicko points out that the U.S. health care system is ranked 37 out of 191 by the World Health Organization with certain health measures, such as infant mortality and life expectancy, equal to countries with much less economic wealth. Interviews are conducted with people who thought they had adequate coverage but were denied care. Former employees of insurance companies describe cost-cutting initiatives that give bonuses to insurance company physicians and others to find reasons for the company to avoid meeting the cost of medically necessary treatments for policy holders, and thus increase company profitability." ..."
Jan 15, 2017 | economistsview.typepad.com

RGC said...

I just watched Michael Moore's movie "Sicko. In it he talks to people in Canada, Britain, France about their experiences with their health care systems.

It is a bunch of little anecdotes, but if you watch it, be prepared to be ticked-off at the US system.

The most compelling point for me was when one of the Americans living in France mentioned that the big difference she noticed was that the French government is afraid of the people, while in the US the people are afraid of the government.

https://freedocumentaries.org/documentary/sicko Reply Saturday, January 14, 2017 at 11:14 AM

pgl -> RGC...

"According to Sicko, almost fifty million Americans are uninsured while the remainder, who are covered, are often victims of insurance company fraud and red tape. Furthermore, Sicko points out that the U.S. health care system is ranked 37 out of 191 by the World Health Organization with certain health measures, such as infant mortality and life expectancy, equal to countries with much less economic wealth. Interviews are conducted with people who thought they had adequate coverage but were denied care. Former employees of insurance companies describe cost-cutting initiatives that give bonuses to insurance company physicians and others to find reasons for the company to avoid meeting the cost of medically necessary treatments for policy holders, and thus increase company profitability."

Great movie.

[Jan 15, 2017] Doctors in the United States get paid on average more than $250,000 a year

Jan 15, 2017 | economistsview.typepad.com
libezkova -> anne... , January 14, 2017 at 10:45 PM
"Doctors in the United States get paid on average more than $250,000 a year,"

I am sure that this is a right estimate. Certain specialties probably yes (dentists, cardiologist, gastroenterologists, neurosurgeons, etc), but family doctors, probably no.

[Jan 15, 2017] The Congressional defeat, insured by Democrats, of the proposal by Bernie Sanders to allow the import of drugs from Canada to lower drug prices in the United States

Jan 15, 2017 | economistsview.typepad.com
JohnH -> anne... , January 14, 2017 at 08:00 AM
The Congressional defeat, insured by Democrats, of the proposal by Bernie Sanders to allow the import of drugs from Canada to lower drug prices in the United States.
'
This is only the beginning of Democrats' appeasement of Trump and Republicans...it will be stunning to watch how much damage Republicans can do during Trump's first 90 days with only a slim majority in the Senate. During the first 90 days under Obama, who had a true electoral mandate and big majorities in both houses, Democrats basically sat on their hands, blaming Republicans for their unwillingness to do much for the American people.
Observer -> anne... , January 14, 2017 at 08:50 AM
So if we matched Canada, we'd see a 30% decrease, of a segment which comprises 10% of health care spending, or 3% overall decrease.

"PwC's Health Research Institute projects the 2017 medical cost trend to be the same as the current year – a 6.5% growth rate."

So reaching Canadian spending levels would counter ~ 6 months of health care cost increases. Reaching OECD levels buys you another couple of months.

Put another way, reaching OECD levels for drug spending closes 10% of the US-OECD spending gap.

Not nothing, but "fixing" drug prices seems more like an emotional (i.e. political) talking point than a real silver bullet for health care costs.

http://www.pwc.com/us/en/health-industries/health-research-institute/behind-the-numbers.html

pgl -> Observer... , January 14, 2017 at 11:17 AM
Ever noticed that marketing costs are 30% of revenue? This is a by product of the monopoly power in this sector. Dean Baker has often noted we could have the government do the R&D and then have real competition in manufacturing.
libezkova -> Observer... , January 14, 2017 at 10:40 PM
Don't be a lobbyist for Big Farma.

You forgot that those researchers often produce useless or even dangerous drags, which are inferior to existing. Looks as scams practiced with hypertension drugs.

This rat race for blockbuster drugs is the same as corruption in financial industry.

http://www.alternet.org/story/148907/15_dangerous_drugs_big_pharma_shoves_down_our_throats

pgl -> anne... , January 14, 2017 at 11:16 AM
Actually the industry profile is very relevant but goes in a different direction - if US firms were compelled to charge market (not monopoly) prices, we would better compete with foreign firms.
pgl -> Observer... , January 14, 2017 at 11:14 AM
Any excuse to charge sky high prices for drugs that don't cost that much to manufacture? If these monopoly profits were not so high, we would buy more drugs and employ more people.
Observer -> pgl... , January 14, 2017 at 12:57 PM
Do you think we would really buy materially more drugs if prices were lower? Particularly enough more, at those (30-50%?) lower prices, to generate the funds to employ more people?

(If that actually generated at much or more funds, it would seem like the pharma companies, seeking to make as much money as possible, would have already set prices at that lower per unit level.)

In any case, that seems like a LOT more drugs.

Perhaps Anne has data on the number of scripts per person in the US vs OECD.

pgl -> Observer... , January 14, 2017 at 01:06 PM
There are lots of poor people who don't take drugs because they can't afford them. This will become especially true if the Republican repeal Obamacare.
anne -> Observer... , January 14, 2017 at 09:05 AM
The point of course is wildly exploiting ordinary people in need of healthcare in every possible way, or a reflection of what we have come to. Returning now to the market...

[Jan 15, 2017] Lasik is a good demonstration of what is wrong with the US medical-industrial complex.

Jan 15, 2017 | economistsview.typepad.com
Observer -> anne... , January 14, 2017 at 09:16 AM
Well, for some services, clearly yes. Here's a Yelp review for Lasik, 4.5 star rated by users provider, with prices "Starting as Low as $250 an Eye".

https://www.yelp.com/biz/lasikplus-vision-center-chicago-2

It can also work when the consumer is only indirectly in the loop. I was reading a presentation on Skilled Nursing Care yesterday, where they were pointing out hospitasl that were getting more selective in discharging to only highly rated SNFs. (The people making this point were the highly rated SNFs.)

Would I do price shopping for cardiac surgery? No. MRI for a troublesome shoulder? Yes, I've actually done that, and seen 5X or more cost deltas from facilities on the insurance "approved" list.

ilsm -> Observer... , January 14, 2017 at 07:05 PM
Lasik is like liposuction .........

cosmetic.

libezkova -> ilsm... , January 14, 2017 at 10:30 PM
Lasik is a good demonstration of what is wrong with the US medical-industrial complex.

Vision is one of the most important functions for a person and some effects of Lasik are highly negative, especially on your night vision.

You get a halo.

One of the most common Lasik complications is dry eye.

https://www.symptomfind.com/procedures-tests/lasik-complications/

libezkova -> libezkova... , January 14, 2017 at 10:33 PM
See also
http://www.mayoclinic.org/tests-procedures/lasik-eye-surgery/basics/risks/prc-20019041

[Jan 14, 2017] Insurance overhead runs are probably the best argument for single payer

Jan 14, 2017 | economistsview.typepad.com
pgl -> Fred C. Dobbs... , January 13, 2017 at 06:14 AM
There are 3 ways we could reduce what we pay for health care:

(1) Ending the oligopoly power of the health insurance companies;

(2) Ending the doctor cartel;

(3) Reducing the monopoly power of Big Pharma.

Alas, the Republicans have no intention in doing any of this. So when they tell people they want to lower their costs, they are talking to rich people. The cost to the rest of us will go up if they have their way.

Observer -> pgl... , -1
From what I read, and recall from data Anne has posted a number of times, pharma costs are about 10% of total health care costs, and run about 2X EU average, or Canada, if we adopt that as a reference baseline. If we cut it in half, that would reduce our costs about 5%.

Doctors fees (physicians and clinical services in this reference) are about 20%. I think you have mentioned before we pay about 2X typical EU wages. So if we cut that in half, it reduces our costs about 10%.

Taken together, that's ~ 15% reduction. Not nothing, but in a few years of cost growth we are back to current cost levels.

Do you see that differently?

I don't have offhand figures for what insurance overhead runs. I think reducing that is probably the best argument for single payer, although comparisons to medicare overhead seem suspect (I'd expect much lower overhead percentages when much of your costs you are processing are $40K end of life hospital events vs. routine GP visits.) So one might zero out the profit, and reduce costs by having one IT/billing system. What's the scale of the opportunity here - another 15%?

https://www.cdc.gov/nchs/fastats/health-expenditures.htm

[Jan 13, 2017] Reducing the cost of healthcare

Jan 13, 2017 | economistsview.typepad.com
pgl -> Fred C. Dobbs... , January 13, 2017 at 06:14 AM
There are 3 ways we could reduce what we pay for health care:

(1) Ending the oligopoly power of the health insurance companies;

(2) Ending the doctor cartel;

(3) Reducing the monopoly power of Big Pharma.

Alas, the Republicans have no intention in doing any of this. So when they tell people they want to lower their costs, they are talking to rich people. The cost to the rest of us will go up if they have their way.

Observer -> pgl... , January 13, 2017 at 07:12 AM
From what I read, and recall from data Anne has posted a number of times, pharma costs are about 10% of total health care costs, and run about 2X EU average, or Canada, if we adopt that as a reference baseline. If we cut it in half, that would reduce our costs about 5%.

Doctors fees (physicians and clinical services in this reference) are about 20%. I think you have mentioned before we pay about 2X typical EU wages. So if we cut that in half, it reduces our costs about 10%.

Taken together, that's ~ 15% reduction. Not nothing, but in a few years of cost growth we are back to current cost levels.

Do you see that differently?

I don't have offhand figures for what insurance overhead runs. I think reducing that is probably the best argument for single payer, although comparisons to medicare overhead seem suspect (I'd expect much lower overhead percentages when much of your costs you are processing are $40K end of life hospital events vs. routine GP visits.) So one might zero out the profit, and reduce costs by having one IT/billing system. What's the scale of the opportunity here - another 15%?

https://www.cdc.gov/nchs/fastats/health-expenditures.htm

anne -> Observer... , January 13, 2017 at 07:37 AM
https://www.nytimes.com/2017/01/12/us/politics/health-care-congress-vote-a-rama.html

January 12, 2017

Senate Takes Major Step Toward Repealing Health Care Law
By THOMAS KAPLAN and ROBERT PEAR

In its lengthy series of votes, the Senate rejected amendments proposed by Democrats that were intended to allow imports of prescription drugs from Canada, protect rural hospitals and ensure continued access to coverage for people with pre-existing conditions, among other causes....

[Jan 13, 2017] What was at stake why Cory Booker joined Senate Republicans to kill a measure to import cheaper medicine

Jan 13, 2017 | economistsview.typepad.com
anne -> Observer... , January 13, 2017 at 07:39 AM
https://twitter.com/lhfang/status/819677587408568320

Lee Fang ‏@lhfang

What was at stake & why Cory Booker joined Senate Republicans to kill a measure to import cheaper medicine:

https://theintercept.com/2017/01/12/cory-booker-joins-senate-republicans-to-kill-measure-to-import-cheaper-medicine-from-canada/

BERNIE SANDERS INTRODUCED a very simple symbolic amendment Wednesday night, urging the federal government to allow Americans to purchase pharmaceutical drugs from Canada, where they are considerably cheaper.

2:49 PM - 12 Jan 2017

Peter K. -> anne... , January 13, 2017 at 09:33 AM
Cory Booker, another progressive neoliberal....
pgl -> Observer... , January 13, 2017 at 09:37 AM
Very good. On health insurance, they get 20% gross margins. I have argued many times we can cut this to 10%.

[Jan 12, 2017] Almost six in 10 Americans don't have enough savings to pay for a $500 car repair or a $1,000 emergency room bill

Jan 12, 2017 | www.nakedcapitalism.com
Class Warfare

"In a report from Bankrate.com, the firm found that almost six in 10 Americans don't have enough savings to pay for a $500 car repair or a $1,000 emergency room bill" [ 247 Wall Street ]. "While Millennials may be looked down on by older demographics, they are the most equipped generation to pay for an unexpected expense using their savings. It was found that 47% of those within the ages of 18 to 29 responded that they would use their savings to cover such a burden, up from 33% in 2014." I'd argue that's not virtue, but a rational response to the neoliberal destruction of universal benefits and government services generally.

Knifecatcher , January 12, 2017 at 2:12 pm

Re: Bankrate story – is there such thing as a $1k ER bill anymore? We paid nearly $3k for our unexpected trip, which involved 15 minutes with the doc, no tests or scans, and only a single dose of Childrens' Tylenol for consumables. (5 year old tried to poke his eye out with a stick and failed – but only just).

And of course our crapified insurance hadn't hit the deductible so we had to pay the whole bill out of pocket.

Vatch , January 12, 2017 at 2:31 pm

I'm lucky - I only have a $150 deductible, which is what I paid when I needed five stitches in my hand last year. The total bill was "only" about $1250, probably because I never saw an actual doctor. A nurse practitioner sewed me up. The explanation of benefits from the insurance company later showed that they only paid the hospital about one third of the billed price. I'm sorry that you had to pay the whole thing; I guess the insurance companies only enforce their standard payable fees when it's their money on the line.

optimader , January 12, 2017 at 2:58 pm

The kids I grew up with, that would have been crazy-glue/packaging-tape unless a finger articulation was compromised

http://morethanjustsurviving.com/stitches-bandages-or-super-glue/

btw..Animal bites should be left open and bandaged and treated w/ antibiotic so they heal from the inside out..

I remember in my misspent college youth an idiot scuba diver in Honduras (feeding a moray eel cheese wiz out of a can, guess what happened when she ran out?) who came to my friend's dad (a surgeon) insisting he sew her up.
He only bandaged her with butterfly bandages and gave her some kick-ass antibiotics. She was sure she was being undeserved (w/ gratis treatment) because he refused to sew her up, potentially trapping an infection.

ian , January 12, 2017 at 2:43 pm

I had a similar experience: 3 stitches on my sons finger. Treated by nurse (no doc), sutures and lidocaine was $1800. It got me wondering about how anyone could hope to reform health care when the accounting is so completely out of whack with reality.

[Jan 12, 2017] Cory Booker understands that a candidate cannot expect the Democratic nomination if he/she goes against the interests of BigPharma.

Jan 12, 2017 | www.nakedcapitalism.com
Benedict@Large , January 12, 2017 at 2:53 pm

Cory Booker understands that a candidate cannot expect the Democratic nomination if he/she goes against the interests of BigPharma.

RUKidding , January 12, 2017 at 3:26 pm

After spending day time hours publically going after Jeff Sessions (good), Booker uses the cover of darkness to reveal who he really works for.

Here's a clue: it isn't any of the 99%, whether in NJ or elsewhere.

Talk's cheap, but money walks – eh, Booker?

EndOfTheWorld , January 12, 2017 at 3:40 pm

Somewhere I saw that Bernie praised Trump taking on Big Pharma.

curlydan , January 12, 2017 at 3:33 pm

'specially if you're from Jersey. Kind of like Biden, Delaware, and credit cards. The strings on the puppets are awfully tight.

[Jan 12, 2017] 200PM Water Cooler 1-12-2017 naked capitalism

Jan 12, 2017 | www.nakedcapitalism.com
Class Warfare

"Hierarchies aren't natural phenomena within the human race. Outside of parenting, human beings aren't born with the inclination to be ruled, controlled, 'managed,' and 'supervised' by other human beings" [ The Hampton Institute ]. Hierarchies are artificial constructs designed to serve a purpose. They are a necessity within any society that boasts high degrees of wealth and power inequities. They are a necessity for maintaining these inequities and ensuring they are not challenged from below."

"In a report from Bankrate.com, the firm found that almost six in 10 Americans don't have enough savings to pay for a $500 car repair or a $1,000 emergency room bill" [ 247 Wall Street ]. "While Millennials may be looked down on by older demographics, they are the most equipped generation to pay for an unexpected expense using their savings. It was found that 47% of those within the ages of 18 to 29 responded that they would use their savings to cover such a burden, up from 33% in 2014." I'd argue that's not virtue, but a rational response to the neoliberal destruction of universal benefits and government services generally.

"[A] good deal of [Wallace] Stevens's poetic output conveyed a feeling of sehnsucht ("inconsolable longing"). For example, in 'Sad Strains of a Gay Waltz,' Stevens writes of American southerners (although the words just as easily apply to their author) as 'voices crying without knowing for what, / Except to be happy, without knowing how.' The object of Stevens's inconsolable longing changed over time. In his early professional days, when he first moved to New York City, it was his hometown of Reading, Pa. Writing to his future wife, Elsie, Stevens lamented that he 'lost a world' when he left there" [ The American Conservative ].

Knifecatcher , January 12, 2017 at 2:12 pm

Re: Bankrate story – is there such thing as a $1k ER bill anymore? We paid nearly $3k for our unexpected trip, which involved 15 minutes with the doc, no tests or scans, and only a single dose of Childrens' Tylenol for consumables. (5 year old tried to poke his eye out with a stick and failed – but only just).

And of course our crapified insurance hadn't hit the deductible so we had to pay the whole bill out of pocket.

Vatch , January 12, 2017 at 2:31 pm

I'm lucky - I only have a $150 deductible, which is what I paid when I needed five stitches in my hand last year. The total bill was "only" about $1250, probably because I never saw an actual doctor. A nurse practitioner sewed me up. The explanation of benefits from the insurance company later showed that they only paid the hospital about one third of the billed price. I'm sorry that you had to pay the whole thing; I guess the insurance companies only enforce their standard payable fees when it's their money on the line.

optimader , January 12, 2017 at 2:58 pm

The kids I grew up with, that would have been crazy-glue/packaging-tape unless a finger articulation was compromised

http://morethanjustsurviving.com/stitches-bandages-or-super-glue/

btw..Animal bites should be left open and bandaged and treated w/ antibiotic so they heal from the inside out..

I remember in my misspent college youth an idiot scuba diver in Honduras (feeding a moray eel cheese wiz out of a can, guess what happened when she ran out?) who came to my friend's dad (a surgeon) insisting he sew her up.
He only bandaged her with butterfly bandages and gave her some kick-ass antibiotics. She was sure she was being undeserved (w/ gratis treatment) because he refused to sew her up, potentially trapping an infection.

ian , January 12, 2017 at 2:43 pm

I had a similar experience: 3 stitches on my sons finger. Treated by nurse (no doc), sutures and lidocaine was $1800. It got me wondering about how anyone could hope to reform health care when the accounting is so completely out of whack with reality.

[Jan 11, 2017] the DEPRAVED nature of the American "Health Kare" system

Jan 11, 2017 | www.nakedcapitalism.com
clarky90 , January 10, 2017 at 6:12 pm

For me, often it is the "small crimes" that exemplify the DEPRAVED nature of the American "Health Kare" system. (See the right hand panel of The Last Judgment Bosch triptych) https://en.wikipedia.org/wiki/The_Last_Judgment_(Bosch_triptych)

US drugmaker charges 200 times UK price for common worm pill

A US drugmaker has put a price tag of more than $800 on a pinworm treatment - 200 times more expensive than the equivalent medicine on British pharmacy shelves, in the latest example of "price gouging" in the world's largest healthcare market.
Impax Laboratories (Bastards!) started selling mebendazole this year at an average wholesale price of $442 per pill, according to figures seen by the Financial Times, which were checked with several US pharmacy chains including Walgreens and CVS.

Most cases of pinworm, a parasitic infection also known as threadworm, require two pills, meaning a course of treatment costs about $884. The drug is available prescription-only in the US but can be bought over the counter in the UK, where Boots, a British chemist chain, charges £6.99 for a pack of four pills, or £1.75 each.

The pinworm parasite, which is common in children, affects 200m people a year worldwide and up to 40m in the US. It is recommended that family members are treated for the highly contagious infection at the same time, meaning a household of five's treatment costs more than $4,400.

https://www.ft.com/content/f0080fe4-c3ad-11e6-9bca-2b93a6856354

"Mebendazole came into use in 1971, after it was developed in Belgium.[4] It is included in the WHO Model List of Essential Medicines, the most important medications needed in a basic health system .[5] Mebendazole is available as a generic medication.[6] The wholesale cost in the developing world is between 0.004 and 0.04 USD per dose .[7] In the United States a single dose is about 884.00 USD as of 2016.[8]

https://en.wikipedia.org/wiki/Mebendazole

[Jan 05, 2017] Chris Lowery

Notable quotes:
"... They were not, by and large, angry about their health care; they were simply afraid they will be unable to afford coverage for themselves and their families. ..."
"... They spoke anxiously about rising premiums, deductibles, copays and drug costs. ..."
Jan 05, 2017 | plus.google.com
said... And an interesting take on Trump voters' views on healthcare --


http://www.nytimes.com/2017/01/05/opinion/the-health-care-plan-trump-voters-really-want.html?ref=opinion

The Health Care Plan Trump Voters Really Want
By DREW ALTMAN•JAN. 5, 2017
This week Republicans in Congress began their effort to repeal and potentially replace the Affordable Care Act. But after listening to working-class supporters of Donald J. Trump - people who are enrolled in the very health care marketplaces created by the law - one comes away feeling that the Washington debate is sadly disconnected from the concerns of working people.

Those voters have been disappointed by Obamacare, but they could be even more disappointed by Republican alternatives to replace it. They have no strong ideological views about repealing and replacing the Affordable Care Act, or future directions for health policy. What they want are pragmatic solutions to their insurance problems. The very last thing they want is higher out-of-pocket costs.

The Kaiser Foundation organized six focus groups in the Rust Belt areas - three with Trump voters who are enrolled in the Affordable Care Act marketplaces, and three with Trump voters receiving Medicaid. The sessions, with eight to 10 men and women each, were held in late December in Columbus, Ohio, Grand Rapids, Mich., and New Cumberland, Pa. Though the participants did not agree on everything, they expressed remarkably similar opinions on many health care questions. They were not, by and large, angry about their health care; they were simply afraid they will be unable to afford coverage for themselves and their families. They trusted Mr. Trump to do the right thing but were quick to say that they didn't really know what he would do, and were worried about what would come next.

They spoke anxiously about rising premiums, deductibles, copays and drug costs. They were especially upset by surprise bills for services they believed were covered. They said their coverage was hopelessly complex. Those with marketplace insurance - for which they were eligible for subsidies - saw Medicaid as a much better deal than their insurance and were resentful that people with incomes lower than theirs could get it. They expressed animosity for drug and insurance companies, and sounded as much like Bernie Sanders supporters as Trump voters. One man in Pennsylvania with Type 1 diabetes reported making frequent trips to Eastern Europe to purchase insulin at one-tenth the cost he paid here.

Surveys show that most enrollees in the Affordable Care Act marketplaces are happy with their plans. The Trump voters in our focus groups were representative of people who had not fared as well. Several described their frustration with being forced to change plans annually to keep premiums down, losing their doctors in the process. But asked about policies found in several Republican plans to replace the Affordable Care Act - including a tax credit to help defray the cost of premiums, a tax-preferred savings account and a large deductible typical of catastrophic coverage - several of these Trump voters recoiled, calling such proposals "not insurance at all." One of those plans has been proposed by Representative Tom Price, Mr. Trump's nominee to be secretary of Health and Human Services. These voters said they did not understand health savings accounts and displayed skepticism about the concept.

When told Mr. Trump might embrace a plan that included these elements, and particularly very high deductibles, they expressed disbelief. They were also worried about what they called "chaos" if there was a gap between repealing and replacing Obamacare. But most did not think that, as one participant put it, "a smart businessman like Trump would let that happen." Some were uninsured before the Affordable Care Act and said they did not want to be uninsured again. Generally, the Trump voters on Medicaid were much more satisfied with their coverage.

There was one thing many said they liked about the pre-Affordable Care Act insurance market: their ability to buy lower-cost plans that fit their needs, even if it meant that less healthy people had to pay more. They were unmoved by the principle of risk-sharing, and trusted that Mr. Trump would find a way to protect people with pre-existing medical conditions without a mandate, which most viewed as "un-American."

If these Trump voters could write a health plan, it would, many said, focus on keeping their out-of-pocket costs low, control drug prices and improve access to cheaper drugs. It would also address consumer issues many had complained about loudly, including eliminating surprise medical bills for out-of-network care, assuring the adequacy of provider networks and making their insurance much more understandable.

Several states are addressing the problem of surprise medical bills. But other steps urged by these Trump voters will be harder to achieve, including controlling drug costs. Republican health reform plans would probably increase deductibles, not lower them. And providing the more generous subsidies for premiums and deductibles that these voters want would require higher taxes, something the Republican Congress seems disinclined to accept.

In general, the focus among congressional Republicans has been on repealing the Affordable Care Act. There has been little discussion of the priorities favored by the Trump voters who spoke to us. But once a Republican replacement plan becomes real, these working-class voters, frustrated with their current coverage, will want to know one thing: how that plan fixes their health insurance problems. And they will not be happy if they are asked to pay even more for their health care.

Drew Altman is president and chief executive of the Henry J. Kaiser Family Foundation.
Reply Thursday, January 05, 2017 at 06:42 AM pgl said in reply to Chris Lowery ... Excellent story. Yesterday Pence and Paul Ryan lied to us. They are basically assuming Trump supporters are really stupid. This says these supporters are smarter than the GOP frauds assume:

But asked about policies found in several Republican plans to replace the Affordable Care Act - including a tax credit to help defray the cost of premiums, a tax-preferred savings account and a large deductible typical of catastrophic coverage - several of these Trump voters recoiled, calling such proposals "not insurance at all." One of those plans has been proposed by Representative Tom Price, Mr. Trump's nominee to be secretary of Health and Human Services. These voters said they did not understand health savings accounts and displayed skepticism about the concept. Reply Thursday, January 05, 2017 at 06:53 AM EMichael said in reply to pgl... These Trump voters will quickly become convinced that whatever happens to the ACA due to Trump and the GOP's actions, it will be the fault of Obama.

That is why they are stupid. Reply Thursday, January 05, 2017 at 07:24 AM JohnH said in reply to pgl... The partisan hack opines...oblivious to the fact that people might have good reason to be angry at skyrocketing prices for what used to be known as catastrophic coverage.

Sad that there seems to be no one but Bernie and his supporters to stand for real health care reform. Instead the debate gets left to partisan hacks, who have nobody's interest in mind except the party's. Reply Thursday, January 05, 2017 at 07:42 AM Peter K. said in reply to JohnH... Obamacare is basically Romneycare, a Republican plan set up to be an alternative to universal care.

Know-nothing Republicans hate it because Obama signed it into law.
Reply Thursday, January 05, 2017 at 07:45 AM anne said in reply to JohnH... The partisan hack opines...
The partisan hack opines...
The partisan hack opines...

[ Enough personal attacks. Enough. ] Reply Thursday, January 05, 2017 at 07:48 AM pgl said in reply to JohnH... I think even your dog just went "snore". Reply Thursday, January 05, 2017 at 08:18 AM pgl said in reply to Chris Lowery ... "If these Trump voters could write a health plan, it would, many said, focus on keeping their out-of-pocket costs low, control drug prices and improve access to cheaper drugs."

As in reigning in the monopoly power of Big Pharma. We should also reign the doctor cartel. And of course end the oligopoly power of the health insurance sector. Of course Paul Ryan is in the pockets of the latter - so it ain't gonna happen under his "leadership". Reply Thursday, January 05, 2017 at 06:55 AM EMichael said in reply to Chris Lowery ... Now is not the time to ignore what was actually the "real" problem.


" Republicans Hate Obamacare Because _______


I'm not one to defend the worst parts of Obamacare and those who find themselves on the receiving end of the mandate with no subsidies have some genuine complaints, but generally the bit that goes in the blank there is "it was the blah president's signature legislative achievement."

http://www.eschatonblog.com/

And yes those whose incomes are too high for subsidies do have a complaint.

But for the most part, the single most important "problem" with the ACA is that healthcare in the US is incredibly expensive.

One day people will stop attacking the ACA because of something the ACA had absolutely nothing to do with.

I am thinking that will be when it is gone, and people will then be shocked to see that healthcare in the US is very expensive. Reply Thursday, January 05, 2017 at 07:31 AM JF said in reply to EMichael... Yes, it is expense. This results from pricing that is free from any real market balances or alignments. The incentives are all misaligned.

Need to stop using the word, 'cost' so much. It is all about a non-market space where pricing is unfettered.

Normally, the public brings in uniform rules of Commerce to apply here, or the public does the services directly. Alas. Reply Thursday, January 05, 2017 at 09:07 AM Peter K. said in reply to Chris Lowery ... "If these Trump voters could write a health plan, it would, many said, focus on keeping their out-of-pocket costs low, control drug prices and improve access to cheaper drugs."

Why don't the Democrats do this?

Progressive neoliberalism.... Reply Thursday, January 05, 2017 at 08:44 AM pgl said... "Michigan's expansion of Medicaid health insurance coverage has boosted the state's economy and budget, and will continue to do so for at least the next five years, according to a new University of Michigan study."

When Mike Pence and Paul Ryan appeared together to declare Obama's medical reforms a complete failure, it is odd that they never mentioned Michigan - which seems to be a success story. Reply Thursday, January 05, 2017 at 06:50 AM Fred C. Dobbs said... A Threat to US Democracy:
Political Dysfunction
http://nyti.ms/2hOJ9AB
NYT - Eduardo Porter - Jan 3

Is American democracy broken?

There are precedents around the world for the kind of political jolt the United States experienced in November. They usually include a political firebrand who promises to sweep away a system rigged to serve the powerful rather than the interests of ordinary people. They usually end badly, when the popular champion decides to read electoral victory as an invitation to bend the institutions of democracy to the force of his will.

Most Americans, I'm sure, never expected to worry about that sort of thing in the United States. And yet concern is decidedly in the air (*). Did a combination of globalization, demographic change, cultural revolutions and whatever else just upend America's consensus in support of liberal market democracy? Did American democracy just succumb to the strongman's promise?

(* Is Donald Trump a Threat to
Democracy? http://nyti.ms/2hNr32N )

I'm skeptical that the United States is about to careen down the path taken by, say, Venezuela, governed by the whim of President Nicolás Maduro - the handpicked successor of the populist champion Hugo Chávez, who was elected in the late 1990s on a promise to sweep away an entrenched ruling class and proceeded to battle any democratic institution that stood in his way.

Still, the embrace by millions of American voters of a billionaire authoritarian who argues that the "system" has been rigged to serve a cosmopolitan ruling class against the interests of ordinary people does suggest that American democracy has a unique credibility problem.

The United States resisted the temptations of Nazism, fascism and communism that beguiled Europe in the first half of the 20th century. Extreme parties like France's National Front or the United Kingdom Independence Party never established an American toehold. Populist candidates running as outsiders - Pat Buchanan, Ross Perot, Ralph Nader - could only tip the balance between the two parties of the establishment.

And yet, when the 21st century brought about a populist insurrection, the United States government was quick to cave.

"What makes the United States so distinctive?" wrote Ronald Inglehart, a political scientist at the University of Michigan, in a somewhat prescient article a few months before the election. "One reason may be that in recent years U.S. democracy has become appallingly dysfunctional."

Working Americans have suffered disproportionately from the economic shocks of our time. Income inequality in the United States far exceeds anything seen in other advanced nations. Families from the middle on down have suffered stagnant or declining incomes for years. And the nation's threadbare social safety net remains the weakest in the industrialized world, providing only the most meager insurance to working families undercut by globalization and technological change.

But for all the reasons Americans may have to rebel against the status quo, what made the political system so vulnerable to a populist insurrection in November was that - for all its institutional strengths - the political system itself has come to be seen by too many voters as illegitimate.

"There is persistent lack of confidence in U.S. political institutions which allows populists to make hay," said Pippa Norris, a political scientist at the Kennedy School of Government at Harvard and the University of Sydney in Australia. "And the institutions need a major overhaul because some, like elections, are badly broken."

This is not just about the Electoral College system, which awarded the presidency to the candidate who lost the popular vote. It is not just about money's growing influence in politics, though that plays a part, too.

The problems are embedded in the design of America's political institutions - with all their checks and balances ostensibly designed to slow down policy-making and prevent political extremists from swiftly taking over the gears of government. These institutions have produced a polarized government, paralyzed by partisan gridlock, unable to govern effectively. They have built a system easy to demonize as rigged.

The Electoral Integrity Project, run by Professor Norris and colleagues from Harvard and the University of Sydney in Australia, surveys thousands of election experts to assess the quality of hundreds of elections around the world. They are asked to rate how well district boundaries are drawn, whether voter registration procedures are adequate, and the effectiveness of campaign finance regulation, among other things.

Based on the average evaluations of the elections in 2012 and 2014, the United States' electoral integrity was ranked 52nd among the 153 countries in the survey - behind all the rich Western democracies and also countries like Costa Rica and Uruguay, the Baltic states, and Cape Verde and Benin in Africa.

A paper by Professor Norris on these results, titled "Why American Elections Are Flawed," describes the major problems with American electoral institutions, perhaps the most critical of which is partisan control over electoral institutions, which has subjected the integrity of elections to the distortions of a partisan lens.

( https://papers.ssrn.com/sol3/papers.cfm?abstract_id=2844793 )

The fact that each state has its own set of electoral regulations - covering things like the type of technology used and opening hours of the polls - means that Americans' voting rights can change substantially from state to state. And the party polarization that has gripped statehouses across the country has stymied attempts to build sensible, effective electoral regulations and bred mistrust.

The patchwork of electoral systems - run by politically appointed local officials managing part-time workers - is hardly a recipe for competence. "Among mature democracies, the nuts and bolts of American contests seem notoriously vulnerable to incompetence and simple human errors," Ms. Norris notes. ...
Reply Thursday, January 05, 2017 at 06:53 AM kthomas said in reply to Fred C. Dobbs... Gerry Mander.

Oh, and let's not forget the Corporations have Constitutional rights. Reply Thursday, January 05, 2017 at 07:29 AM Peter K. said... All of the political, partisan progressive neoliberals are pretty pessimistic about Trump: DeLong, Krugman, Vox, etc.

(the same people that assured us Clinton was a great candidate who would win easily...)

And it's funny how the stock market is booming (despite the looming trade wars) and all of the establishment type neoliberals are pretty optimistic! (DeLong here questions Olivier Blanchard)

http://www.bradford-delong.com/2017/01/should-read-disagreeing-with-olivier-my-chances-of-success-are-surely-less-than-50-50-nevertheless-as-i-read-the-e.html

DeLong: January 04, 2017 at 06:44 AM

Should-Read: Disagreeing with Olivier, my chances of success are surely less than 50-50. Nevertheless...

As I read the evidence, the short-run fiscal multipliers (1) from government purchases are rather high, (2) from transfer payments to the liquidity-constrained are moderate, and (3) from high-income tax cuts are next to zero. At the moment it looks like effectively all of the Trump fiscal initiative to be will take the form of (3). Some of it will be direct tax cuts. The rest will be tax credits to businesses that are not currently cash-constrained but rather, at the margin, in the share buyback business.

But they will produce a stronger dollar.

Thus I expect next to no effective fiscal stimulus. I expect a larger capital inflow (trade deficit). And I am told we now expect the trade war to start soon.

Thus I do not see why Olivier Blanchard is so optimistic.
Where is he coming from? What does he see that I do not?

... Reply Thursday, January 05, 2017 at 07:12 AM Peter K. said in reply to Peter K.... The "stronger dollar" seems to be the go-to criticism.

I agree that tax cuts and deregulation alone won't do much (see the Bush years) except blow more asset bubbles.

I just don't get the theory of a larger capital inflow and strong dollar. Aren't those good things?

All of the comfortable progressive neoliberals' vacations in foreign countries will be cheaper. Their multinational corporate sponsors now can purchase more for the dollar in foreign lands, whether it be labor, assets, whatever.

Yes the export sector will be hurt, but they've never really cared about the export sector or unionized manufacturing jobs. The Fed will create more jobs as necessary. Plus it's mostly automation which can't be stopped. What, are you a Luddite?
Reply Thursday, January 05, 2017 at 07:17 AM Peter K. said in reply to Peter K.... Olivier Blanchard:

https://piie.com/blogs/realtime-economic-issues-watch/light-elections-recession-expansion-and-inequality

"To the extent that both growth and interest rates are higher, the dollar is likely to appreciate, leading, ironically, to larger US trade deficits, which Donald Trump the candidate indicated he wanted to fight. This leads me to trade issues and trade measures."

Isn't that what Clinton wanted? Higher growth and interest rates? That would also lead to a stronger dollar.

But absent tax cuts for the rich and deficits, interest rates wouldn't be so high.

Seems like progressive neoliberals and mainstream macro economists are slaves to the bond vigilantes. See Bill Clinton dropping his middle class spending bill campaign promise.

"ncrease the demand for domestic goods, and increase output (although, even then, as pointed out by Robert Mundell more than fifty years ago, the exchange rate may appreciate enough to lead to lower output in the end). But the "by themselves" assumption is just not right: Tariffs imposed by the United States would most likely lead to a tariff war and thus decrease exports. And the decrease in imports and exports would not be a wash. On the demand side, higher import prices would lead the Fed to increase interest rates further. "

So tariffs are bad because they cause retaliation. That's politics, not economics. And again the Fed is brought in to tell us that something good is actually bad.

High growth causes the Fed to kill the economy. Same would happen under Democrats.

Neoliberal BS.
Reply Thursday, January 05, 2017 at 07:24 AM kthomas said in reply to Peter K.... Da, comrade! Reply Thursday, January 05, 2017 at 07:30 AM Peter K. said in reply to kthomas... Where is our Miss Manners, Chris Lowrey? Reply Thursday, January 05, 2017 at 07:34 AM anne said in reply to kthomas... Da, comrade!
Da, comrade!
Da, comrade!

[ Ceaseless crazed destructiveness. ] Reply Thursday, January 05, 2017 at 07:42 AM Fred C. Dobbs said... (Harding redux?)

The Trump Administration
http://tws.io/2iFd3rC
via @WeeklyStandard
Nov 28, 2016 - William Kristol

Who now gives much thought to the presidency of Warren G. Harding? Who ever did? Not us.

But let us briefly turn our thoughts to our 29th president (while stipulating that we're certainly no experts on his life or times). Here's our summary notion: Warren G. Harding may have been a problematic president. But the Harding administration was in some ways an impressive one, which served the country reasonably well.

It was possible to say, before Warren G. Harding was elected, that he wasn't particularly well-qualified to be president. And he did turn out as president to have, as we say nowadays, some issues. But his administration was stocked with (mostly) well-qualified men who served with considerable distinction.

Andrew Mellon was a successful Treasury secretary whose tax reforms and deregulatory efforts spurred years of economic growth. Charles Dawes, the first director of the Bureau of the Budget, reduced government expenditures and, helped by Mellon's economic policies, brought the budget into balance. Charles Evans Hughes as secretary of state dealt responsibly with a very difficult world situation his administration had inherited-though in light of what followed in the next decade, one wishes in retrospect for bolder assertions of American leadership, though in those years just after World War I, they would have been contrary to the national mood.

In addition, President Harding's first two Supreme Court appointments-William Howard Taft and George Sutherland-were distinguished ones. And Harding personally did some admirable things: He made pronouncements, impressive in the context of that era, in favor of racial equality; he commuted the wartime prison sentence of the Socialist leader, Eugene V. Debs. In these ways, he contributed to an atmosphere of national healing and civility.

The brief Harding administration-and for that matter the eight years constituting his administration and that of his vice president and successor, Calvin Coolidge-may not have been times of surpassing national greatness. But there were real achievements, especially in the economic sphere; those years were not disastrous; they were not dark times.

President-elect Donald J. Trump probably doesn't intend to model his administration on that of President Warren G. Harding. But he could do worse than reflect on that administration's successes-and also on its failures, particularly the scandals that exploded into public view after Harding's sudden death. These were produced by cronies appointed by Harding to important positions, where they betrayed his trust and tarnished his historical reputation.

Donald Trump manifestly cares about his reputation. He surely knows that reputation ultimately depends on performance. If a Trump hotel and casino is successful, it's not because of the Trump brand-that may get people through the door the first time-but because it provides a worthwhile experience thanks to a good management team, fine restaurants, deft croupiers, and fun shows. If a Trump golf course succeeds, it's because it has been built and is run by people who know something about golf. The failed Trump efforts-from the university to the steaks-seem to have in common the assumption that the Trump name by itself would be enough to carry mediocre or worse enterprises across the finish line.

To succeed in business, the brand only gets you so far. Quality matters. To succeed in the presidency, getting elected only gets you so far. Governing matters.

It would be ironic if Trump's very personal electoral achievement were followed by a mode of governance that restored greater responsibility to the cabinet agencies formally entrusted with the duties of governance. It would be ironic if a Trump presidency also featured a return of authority to Congress, the states, and to other civic institutions. It would be ironic if Trump's victory led not to a kind of American Caesarism but to a strengthening of republican institutions and forms. It would be ironic if the election of Donald J. Trump heralded a return to a kind of constitutional normalcy.

If we are not mistaken, it was Georg Wilhelm Friedrich Hegel (though sadly unaware of the phenomena of either Warren G. Harding or Donald J. Trump) who made much of the Irony of History. But how Hegelian it would be if the thesis of the Bush and Clinton dynasties, followed by the antithesis of a Trump victory over first a Bush and then a Clinton in 2016, were to produce an unanticipated synthesis: a Trump administration marked by the reconstruction of republican normalcy in America. In its own way, that would be a genuine contribution to making America great again.

(Harding-Coolidge-Hoover were a disastrous triumvirate
that ascended to power after the Taft & Wilson administrations, as the GOP - then the embodiment
of progressivism - split apart due to the
efforts of Teddy Roosevelt.)
Reply Thursday, January 05, 2017 at 07:40 AM Peter K. said in reply to Fred C. Dobbs... Kristol is mad Trump lambasted the Iraq war.

Was Putin against the Iraq war? I think the whole world was except for the "Coalition of the Willing."

You'll never see the UK back another war like that. Reply Thursday, January 05, 2017 at 07:56 AM EMichael said... Sad, sad day for NBC News.

" Megyn Kelly had a good 2016. Between her news-making stint as a Fox News debate moderator, a flattering profile in Vanity Fair, and a lucrative book deal, she cemented her reputation as a talented and no-nonsense journalist-one of the most highly paid in the industry. And now she's making the jump to NBC News, where she will anchor a Sunday evening news show, host a daytime show, and cover major political events. "Megyn is an exceptional journalist and news anchor, who has had an extraordinary career," said NBC News Chairman Andrew Lack in a statement. "She's demonstrated tremendous skill and poise, and we're lucky to have her."


Another thing Kelly has demonstrated is racist demagoguery, which defined much of her tenure at Fox News....

The NBPP "controversy" represents a particular fixation of Kelly's, but it was not her only racist display. In 2013, in reaction to my colleague Aisha Harris' Slate piece, "Santa Claus Should Not Be a White Man Anymore," the Fox anchor infamously claimed that both Santa Claus and Jesus of Nazareth were white men. "Jesus was a white man, too ... he's a historical figure and that's a verifiable fact, as is Santa." (The truth is that "white" as a political or racial category didn't exist in either 1st century Palestine or 3rd and 4th century Turkey-and that Santa's not real.) In 2015, Kelly insisted that the racist emails exchanged by officials in Ferguson, Missouri-which included a joke about a man seeking "welfare" for his dogs because they are "mixed in color, unemployed, lazy, can't speak English and have no frigging clue who their Daddies are"-were normal."

http://www.slate.com/articles/news_and_politics/politics/2017/01/megyn_kelly_is_a_racial_demagogue.html
Reply Thursday, January 05, 2017 at 07:40 AM Peter K. said... It's now democratic socialists versus progressive neoliberals.

The progressive neoliberals have failed the world over.

Hillary Clinton, a competent, knowledgeable establishment politician, lost to a laughable reality TV star clown.

Think about it. Mull it over in your mind. It's hilarious how cocky and confident the neoliberals were throughout the election. It's amazing how wrong they were. Trump's victory is almost worth it. Not quite.

http://www.commondreams.org/views/2016/02/26/we-are-not-denmark-hillary-clinton-and-liberal-american-exceptionalism

Published on
Friday, February 26, 2016
by Common Dreams

"We Are Not Denmark": Hillary Clinton and Liberal American Exceptionalism

by Matthew Stanley

Several months removed, it now seems clear that the Democratic debate on October 13 contained an illuminating moment that has come to embody the 2016 Democratic Primary and the key differences between its two candidates. Confronting Bernie Sanders's insistence that the United States has much to learn from more socialized nations, particularly the Nordic Model, Hillary Clinton was direct: "I love Denmark. But we are not Denmark. We are the United States of America."

The implication behind this statement-the reasoning that ideas and institutions (in this case social and economic programs) that are successful in other nations are somehow practically or ideologically inconsistent with Americans and American principles-speaks to a longstanding sociopolitical framework that has justified everything from continental expansion to the Iraq War: American exceptionalism. Rooted in writings of Alexis de Tocqueville and the mythology of John Winthrop's "City Upon a Hill," the notion that the history and mission of the United States and the superiority of its political and economic traditions makes it impervious to same the forces that influence other peoples has coursed through Abraham Lincoln's "Gettysburg Address," the Cold War rhetoric of John F. Kennedy and Lyndon Johnson, and the foreign policy declarations of Barack Obama.

espite particular historical trends-early and relatively stable political democracy, birthright citizenship, the absence of a feudal tradition, the relative weakness of class consciousness-historians have critiqued this "American exceptionalism" as far more fictive than physical, frequently citing the concept as a form of state mythology. Although different histories lead naturally to historical and perhaps even structural dissimilarities, America's twenty-first century "exceptions" appear as dubious distinctions: gun violence, carbon emissions, mass incarceration, wealth inequality, racial disparities, capital punishment, child poverty, and military spending.

et even at a time when American exceptionalism has never been more challenged both by empirically-validated social and economic data and in public conversation, the concept continues to play an elemental role in our two-party political discourse. The Republican Party is, of course, awash with spurious, almost comically stupid dialogue about a mythic American past-"making America great again"-the racial and ethnic undertones of which are unmistakable. Those same Republicans have lambasted Obama and other high profile Democrats for not believing sufficiently in their brand of innate, transhistoric American supremacy.

But this Americentrism is not the sole province of the GOP. We need look no further than bipartisan support for the military-industrial complex and the surveillance state to see that national exceptionalism, and its explicit double-standard toward other nations, resides comfortably within the Democratic Party as well. Russian President Vladimir Putin and Ecuadorean President Rafael Correa censured Obama's use of the term in the fall of 2013, with the latter likening it to the "chosen race" theories of Nazi Germany. Hyperbole notwithstanding, academics often do associate American exceptionalism with military conquest. It does, after all, have deep roots in the Manifest Destiny ethos that spurred the Mexican War, drove continental and trans-Pacific expansion, and emerged as a paternalistic justification for voluminous military interventions in Latin America, Africa, and the Middle East. As Dick Cheney suggests, "the world needs a powerful America." In this unilateral missionizing zeal Clinton proves most typical. As historian Michael Kazin argues in a recent piece for The Nation: "Hillary Clinton is best described as a liberal. Like every liberal president (and most failed Democratic nominees) since Wilson, she wants the United States to be the dominant power in the world, so she doesn't question the massive sums spent on the military and on the other branches of the national-security state."

But Clinton's brand of American exceptionalism goes beyond the issue of American military dominion and into the policy potentials of mid-century social liberalism and, more specifically, the neoliberalism that has since replaced it. Indeed, since George McGovern's failed presidential bid of 1972, neoliberals, moving decidedly rightward on economic issues, have consistently employed exceptionalist code to fight off movements, ideas, and challengers from the left. The victims include leftist efforts toward both American demilitarization and the expansion of a "socialistic" welfare state. Socialist feminist Liza Featherstone and others have denounced Clinton's uncritical praise of the "opportunity" and "freedom" of American capitalism vis-à-vis other developed nations. "With this bit of frankness," Featherstone explains, referring to the former Secretary of State's "Denmark" comments, "Clinton helpfully explained why no socialist-indeed, no non-millionaire-should support her. She is smart enough to know that women in the United States endure far more poverty, unemployment, and food insecurity than women in Denmark-yet she shamelessly made clear that she was happy to keep it that way." Indeed, Clinton's denunciation of the idea that the United States should look more like Denmark betrayed one of the glaring the fault lines within the Democratic Party, and between Clintonian liberalism and Sandersite leftism. It also revealed a more clandestine strain of American exceptionalism common among liberals and the Democratic Party elite in which "opportunity" serves as a stand-in for wider egalitarian reform. As Elizabeth Bruenig highlighted in The New Republic: "Since getting ahead on one's own grit is such a key part of the American narrative, it's easy to see how voters might be attracted to Clinton's opportunity-based answer to our social and economic woes, though it leaves the problem of inequality vastly under-addressed. Indeed, a kind of American exceptionalism does seem to underpin much opportunity-focused political rhetoric."

This preference for insider politics (rather than mass movements involving direct action) and limited, means-tested social programs speaks to a broader truth about modern liberalism: it functions in a way that not only doesn't challenge the basic tenets of American exceptionalism, it often reinforces them. Whether vindicating war and torture and civil liberties violations, talking past the War on Drugs and the carceral state, or exhibiting coolness toward the type of popular protest seen during of Occupy Wall Street, with its direct attacks on a sort of American Sonderweg, establishment Democrats are adept at using a more "realistic" brand of Americentrism to consolidate power and anchor the party in the status quo. Now the 2016 Democratic Primary has seen progressive ideas including universal health care, tuition-free college, and a living minimum wage, all hallmarks of large swaths of the rest of the developed world, delegitimized through some mutation of liberal exceptionalist thinking. These broadminded reforms are apparently off limits, not because they are not good ideas (though opponents make that appraisal too), but because somehow their unachievability is exceptional to the United States.

All this is not to exclude (despite his "democratic socialist" professions) Sanders's own milder brand of "America first," most evident in his economic nationalism, but to emphasize that American exceptionalism and the logical and practical dangers it poses exist in degrees across a spectrum of American politics. Whatever his nationalistic inclinations, Sanders's constant reiteration of America's need to learn from and adapt to the social, economic, and political models of other nations demonstrates an ethno-flexibility rarely seen in American major party politics. "Every other major country " might as well be his official campaign slogan. This bilateral outlook does not fit nearly as neatly within Clinton's traditional liberal paradigm that, from defenses of American war and empire to the, uses American exceptionalism tactically, dismissing its conservative adherents as nationalist overkill yet quietly exploiting the theory when politically or personally expeditious.

In looking beyond our national shores and domestic origin-sources for fresh and functional policy, Sanders seems to grasp that, from the so-called "foreign influences" of the Republican free soil program or Robert La Follette's Wisconsin Idea or even Lyndon Johnson's Great Society, American high politics have been at their most morally creative and sweepingly influential not only when swayed by direct action and mass movements, but also when they are less impeded by the constraints of ethnocentrism and exceptionalism. The "We are not Denmark" sentiment might appear benign, lacking as it does the bluster of Republican claims to national supremacy and imaginary "golden age" pasts and what economist Thomas Picketty has termed a "mythical capitalism." But it is the "seriousness" and very gentility of liberal Americentrism that underscores the power, omnipresence, and intellectual poverty of cultural dismissal. "I still believe in American exceptionalism," Clinton has proclaimed in pushing for U.S. military escalation in Syria. Indeed she does, and it is by no means relegated to the sphere of foreign policy.
Reply Thursday, January 05, 2017 at 07:42 AM Peter K. said in reply to Peter K.... "Socialist feminist Liza Featherstone and others have denounced Clinton's uncritical praise of the "opportunity" and "freedom" of American capitalism vis-à-vis other developed nations. "With this bit of frankness," Featherstone explains, referring to the former Secretary of State's "Denmark" comments, "Clinton helpfully explained why no socialist-indeed, no non-millionaire-should support her. She is smart enough to know that women in the United States endure far more poverty, unemployment, and food insecurity than women in Denmark-yet she shamelessly made clear that she was happy to keep it that way." Indeed, Clinton's denunciation of the idea that the United States should look more like Denmark betrayed one of the glaring the fault lines within the Democratic Party, and between Clintonian liberalism and Sandersite leftism."

Is it better to ignore this fault line and try to paper it over or is it better to debate the issues in a polite and congenial manner?

Of course the progressive neoliberals in this forum regularly resort to ad hominem to any ideas or facts that don't line up with the agreed-upon party line.

And then our Miss Manners Chris Lowrey complains about all sides.
Reply Thursday, January 05, 2017 at 07:52 AM EMichael said... Survival guide for those opposed to Trump and just plain tired of the Sarandonistas of the world.


Indivisible
A practical guide For resisting the Trump agenda

Former congressional staffers reveal best practices for making Congress listen.

https://www.indivisibleguide.com/ Reply Thursday, January 05, 2017 at 07:53 AM Peter K. said... http://stumblingandmumbling.typepad.com/stumbling_and_mumbling/2017/01/economists-in-an-alienated-society.html

January 05, 2017

ECONOMISTS IN AN ALIENATED SOCIETY
by Chris Dillow

"The social power, ie the multiplied productive force", wrote Marx, appears to people "not as their own united power but as an alien force existing outside them, of the origin and end of which they are ignorant, which they thus cannot control."

I was reminded of this by a fine passage in The Econocracy in which the authors show that "the economy" in the sense we now know it is a relatively recent invention and that economists claim to be experts capable of understanding this alien force:

As increasing areas of political and social life are colonized by economic language and logic, the vast majority of citizens face the struggle of making informed democratic choices in a language they have never been taught. (p19)

This leads to the sort of alienation which Marx described. This is summed up by respondents to a You Gov survey (pdf) cited by Earle, Moran and Ward-Perkins, who said; "Economics is out of my hands so there is no point discussing it."

In one important sense such an attitude is absurd. Every time you decide what to buy, or how much to save, or what job to do or how long to work, economics is in your hands and you are making an economic decision.

This suggests to me two different conceptions of what economics is. In one conception – that of Earle, Moran and Ward-Perkins – economists claim to be a priestly elite who understand "the economy". As Alasdair MacIntyre said, such a claim functions as a demand for power and wealth:

Civil servants and managers alike [he might have added economists-CD] justify themselves and their claims to authority, power and money by invoking their own competence as scientific managers (After Virtue, p 86).

There is, though, a second conception of what economists should do. Rather than exploit alienation for their own advantage, we should help people mitigate it. This consists of three different tasks:

- We should help people make better decisions for themselves. This needn't consist of "nudging". We might do it by increasing their information. Or we might do it by warning people to avoid the most common errors of judgment. This is what I do in the day job. By this standard, Martin Lewis is one of country's leading economists.

- We shouldn't engage in futurology. That's the job of soothsayers, necromancers and charlatans*. Instead we should help build resilience to shocks. At the individual level, this consists in helping people to make choices, such as in building well-balanced portfolios. And at the social level it means helping to build institutions which allow people to bear risk: this can be private insurance markets as well as a welfare state.

- We can undermine the justifications for inequalities of wealth and power by pointing out that bosses and bankers' claims to them are often plain wrong.

The difference between these two conceptions has been highlighted, inadvertently, by Jeremy Warner. He says economists have had a "terrible year" because their warnings of a Brexit shock were wrong. Maybe, maybe not. But this allegation only applies to economists as priests. In our second conception, economists have had a good year. For example, most actively managed UK equity unit trusts have under-performed trackers, which supports our longstanding advice in favour of passive management.

I should stress here that the distinction between economists as priests and economists as dentists is separate from the heterodox-orthodox distinction. Orthodox economics, when properly used, can both serve a radical function and help inform everyday decisions.

You might object here that my distinction is an idiosyncratic one. Certainly, economists as dentists earn less than economists as priests: I know as I've done both. But there are reasons for that, which have little to do with economists' social utility.

* OK, I do it sometimes – but only to keep my editor happy.
Reply Thursday, January 05, 2017 at 08:05 AM RGC said... The US nomenclatura is embarked on a massive media campaign to divert and reframe the election issues away from the economic and inequality concerns expressed by the Sanders campaign. No "break up the banks", no "free public college", no "medicare for all", no campaign funding reform.

For a while we had the Russian hacking accusations, which have suddenly gone dormant (will we ever get proof?). Now we have divide and conquer identity issues. But no proposed alternatives to Trump for curing our economic malaise along the lines suggested by Sanders.

We are headed back to business as usual, with the right fighting the so-called center left (our two neoliberal factions) for dominance. Apparently conditions have not deteriorated enough yet for a populist uprising. How much more does it take before we reach a critical mass? Reply Thursday, January 05, 2017 at 08:16 AM Peter K. said... From Thomas Edsall's NYTimes column:

"At the moment, the Democratic Party is structurally fragile and its members have shied away from the kind of radical upheaval Republicans have been forced to embrace. Nonetheless, Democrats will soon face enormously risky decisions.

Does the party move left, as a choice of Keith Ellison for D.N.C. chairman would suggest? Does it wait for internecine conflict to emerge among Republicans as Trump and his allies fulfill campaign promises - repealing Obamacare, enacting tax reform and deporting millions of undocumented aliens?"

It's funny how there has been no discussion of the DNC chair contest, and yet the progressive neoliberals here still whine that the forum isn't an echo chamber which reflects their views. And then they fantasize about banning people with whom they disagree. Reply Thursday, January 05, 2017 at 08:20 AM Denis Drew said... State governments famously (or infamously) give away billions in tax breaks to lure in firms that make jobs. 19 Republican governors -- by rejecting Medicaid expansion -- have rejected TAKING IN federal tax money to generate good medical jobs, not to mention the multiplier effect of new spending ...

.. and it's the states' own money that they sent to the federal government that they don't want to TAKE BACK ...

... oh, almost forgot; it's good for uninsured poor people too (almost forgot about that). Reply Thursday, January 05, 2017 at 08:27 AM pgl said in reply to Denis Drew ... Nice point. My DINO governor (Cuomo) was smart enough to take the Medicaid funding but he gives all sorts of stupid supply-side breaks to businesses. Reply Thursday, January 05, 2017 at 09:05 AM Peter K. said... http://www.nytimes.com/2017/01/04/business/economy/federal-reserve-minutes-interest-rates.html

Fed Officials See Faster Economic Growth Under Trump, but No Boom

By BINYAMIN APPELBAUM
JAN. 4, 2017

"Ms. Yellen has warned that fiscal stimulus, like a tax cut or a spending increase, could increase economic growth to an unsustainable pace in the near term, resulting in increased inflation. The Fed quite likely would seek to offset such policies by raising interest rates more quickly."

Progressive neoliberalism...

And Alan Blinder said Hillary's fiscal plans wouldn't be large enough to cause the Fed to alter its path of rate hikes.

And Trump promised more better infrastructure like clean airports.

And Trump won.
Reply Thursday, January 05, 2017 at 08:39 AM Peter K. said in reply to Peter K.... I'm now thinking that Trump will have conflict with the Fed.

He lives for conflict and drama. Reply Thursday, January 05, 2017 at 08:41 AM pgl said... An update on the Chevy Cruze controversy. US consumption was 194,500 vehicles with 190,000 made here in the US. That's 97.7% of them being produced locally. Tweet that.

[Jan 04, 2017] Study suggests route to improve artery repair

Notable quotes:
"... People with any form of diabetes are at greater risk of developing cardiovascular conditions than people without the disease. Moreover, if they undergo an operation to open up a clogged artery by inserting a "stent" surgical tube, the artery is much more likely to clog up again. ..."
"... Surgical stents for artery repair are typically coated with slow-releasing drugs that aim to suppress excessive regrowth of the surrounding smooth muscle cells. This approach to release drugs locally might work for drugs that boost SHP-1 expression, King speculates. ..."
Jan 04, 2017 | www.eurekalert.org
BOSTON - (January 4, 2017) - People with any form of diabetes are at greater risk of developing cardiovascular conditions than people without the disease. Moreover, if they undergo an operation to open up a clogged artery by inserting a "stent" surgical tube, the artery is much more likely to clog up again.

However, researchers at Joslin Diabetes Centers now have uncovered an explanation for why these procedures often fail, which may lead toward better alternatives.

An enzyme known as SHP-1, which can suppress the growth of smooth muscle cells lining the inside of blood vessels, plays a crucial role in stent failure, says George King, M.D., Joslin's Chief Scientific Officer and senior author on a paper in the journal Diabetologia describing the work.

Stents coated with a drug that activates SHP-1, and thus slows the accelerated growth of these vascular cells, might help in treating arterial disease in diabetes, says King, who is also Professor of Medicine at Harvard Medical School.

His team's research began with experiments among mice fed a high-fat diet and rats that were genetically modified to display insulin resistance and related metabolic conditions related to diabetes. "We found that SHP-1 expression was decreased in the arteries from all of these animal models," says Weier (Glorian) Qi, co-lead author on the paper. "We also found that SHP-1 expression dropped in the arteries of patients with type 2 diabetes."

Next, the scientists created mice that were genetically engineered to over-express the protein in their vascular smooth muscle cells. When the scientists fed these mice a high-fat diet that clogged their arteries and performed a procedure similar to stent insertion, they found that the arteries in these animals were less clogged than in normal mice given the same procedure.

The researchers went on to demonstrate that SHP-1 is reduced in mouse vascular smooth muscle cells primarily by the high levels of lipids in the blood associated with diabetes and related conditions, rather than the high levels of glucose also present in those conditions.

Following up on these findings may help to address a major research puzzle in diabetic complications, says King: Each type of tissue seems to react differently to the disease.

For example, he explains, smooth muscle cells grow thicker in large blood vessels like arteries, but similar type of contractile cells begin to die off in tiny blood vessels in the eye.

"These opposite cell growth patterns are an enigma," King comments. "They also make it difficult to develop therapeutics, because we would want to deactivate SHP-1 in the eye and activate it in large arteries."

Surgical stents for artery repair are typically coated with slow-releasing drugs that aim to suppress excessive regrowth of the surrounding smooth muscle cells. This approach to release drugs locally might work for drugs that boost SHP-1 expression, King speculates.

"We hope our research encourages ideas about how to address this problem for people with diabetes," he adds. ""The more ideas that come up, the greater the chances that we can achieve such a needed treatment."

Joslin's Qian Li1 was the other co-lead author on the paper. Joslin contributors also included Christian Rask-Madsen, Samuel Lockhart, Yu Xia, Xuanchun Wang and Mogher Khamaisi. Chong Wee Liew of the University of Illinois at Chicago; Lars Melholt Rasmussen of Odense University Hospital in Odense, Denmark; and Kevin Croce of Brigham and Women's Hospital also were co-authors. Lead research support came from the JDRF, the American Diabetes Association and the National Institute of Diabetes and Digestive and Kidney Diseases.

[Jan 04, 2017] Mediterranean diet may have lasting effects on brain health

Jan 04, 2017 | www.eurekalert.org
MINNEAPOLIS - A new study shows that older people who followed a Mediterranean diet retained more brain volume over a three-year period than those who did not follow the diet as closely. The study is published in the January 4, 2017, online issue of Neurology ®, the medical journal of the American Academy of Neurology. But contrary to earlier studies, eating more fish and less meat was not related to changes in the brain.

The Mediterranean diet includes large amounts of fruits, vegetables, olive oil, beans and cereal grains such as wheat and rice, moderate amounts of fish, dairy and wine, and limited red meat and poultry.

"As we age, the brain shrinks and we lose brain cells which can affect learning and memory," said study author Michelle Luciano, PhD, of the University of Edinburgh in Scotland. "This study adds to the body of evidence that suggests the Mediterranean diet has a positive impact on brain health."

Researchers gathered information on the eating habits of 967 Scottish people around age 70 who did not have dementia. Of those people, 562 had an MRI brain scan around age 73 to measure overall brain volume, gray matter volume and thickness of the cortex, which is the outer layer of the brain. From that group, 401 people then returned for a second MRI at age 76. These measurements were compared to how closely participants followed the Mediterranean diet.

The participants varied in how closely their dietary habits followed the Mediterranean diet principles. People who didn't follow as closely to the Mediterranean diet were more likely to have a higher loss of total brain volume over the three years than people who followed the diet more closely. The difference in diet explained 0.5 percent of the variation in total brain volume, an effect that was half the size of that due to normal aging.

The results were the same when researchers adjusted for other factors that could affect brain volume, such as age, education and having diabetes or high blood pressure.

There was no relationship between grey matter volume or cortical thickness and the Mediterranean diet.

The researchers also found that fish and meat consumption were not related to brain changes, which is contrary to earlier studies.

"It's possible that other components of the Mediterranean diet are responsible for this relationship, or that it's due to all of the components in combination," Luciano said.

Luciano noted that earlier studies looked at brain measurements at one point in time, whereas the current study followed people over time.

"In our study, eating habits were measured before brain volume was, which suggests that the diet may be able to provide long-term protection to the brain," said Luciano. "Still, larger studies are needed to confirm these results."

[Jan 02, 2017] U.S. Healthcare Is A Global Outlier (And Not In A Good Way)

Jan 02, 2017 | www.zerohedge.com

Historically, the United States has spent more money than any other country on healthcare.

In the late 1990s, for example, the U.S. spent roughly 13% of GDP on healthcare, compared to about a 9.5% average for all high income countries.

However, as Visual Capitalist's Jeff Desjardins notes, in recent years, the difference has become more stark . Last year, as Obamacare continued to roll out, costs in the U.S. reached an all-time high of 17.5% of GDP . That's over $3 trillion spent on healthcare annually, and the rate of spending is expected accelerate over the next decade .

HIGH COSTS, HIGH BENEFIT?

With all that money being poured into healthcare, surely the U.S. must be getting better care in contrast to other high income countries.

At least, that's what one would think.

Today's chart comes to us from economist Max Roser (h/t @NinjaEconomics ) and it shows the extreme divergence of the U.S. healthcare system using two simple stats: life expectancy vs. health expenditures per capita.

Courtesy of: Visual Capitalist

THE DIVERGENCE OF U.S. HEALTHCARE

As you can see, Americans are spending more money – but they are not receiving results using the most basic metric of life expectancy. The divergence starts just before 1980, and it widens all the way to 2014.

It's worth noting that the 2015 statistics are not plotted on this chart. However, given that healthcare spend was 17.5% of GDP in 2015, the divergence is likely to continue to widen. U.S. spending is now closing in on $10,000 per person.

Perhaps the most concerning revelation from this data?

Not only is U.S. healthcare spending wildly inefficient, but it's also relatively ineffective. It would be one thing to spend more money and get the same results, but according to the above data that is not true. In fact, Americans on average will have shorter lives people in other high income countries.

Life expectancy in the U.S. has nearly flatlined, and it hasn't yet crossed the 80 year threshold. Meanwhile, Chileans, Greeks, and Israelis are all outliving their American counterparts for a fraction of the associated costs. buckstopshere , Jan 1, 2017 10:02 PM

A shorter life expectancy makes Social Security look more solvent.

Cooking the books.

junction buckstopshere , Jan 1, 2017 10:08 PM
The chart shows that Monsanto and the New World Order are succeeding, that more glyphosate herbicide in the food, more toxic chemtrails and more unneccessary operations are having the desired effect, to cull the American population. Helped immeasurably by the cocaine and heroin flown into the USA by the Bush Crime Cartel on Air Force cargo planes.
cheka junction , Jan 1, 2017 10:10 PM
nyc runs US health care. that tells one all he needs to know.
Pinch Dog Will Hunt , Jan 2, 2017 12:58 AM
Republitards and Freedumb-lovers need to watch Michael Moore's movie about this called "Sicko"

https://www.youtube.com/watch?v=thkBLpRwdSM

You need MORE socialism, not less.

Tards.

Chief Wonder Bread balolalo , Jan 1, 2017 10:42 PM
Australia, Norway, Switzerland, Germany, South Korea, Japan, Italy, U.S.

Which of these countries is not like any of the others? Haha. Multiculturalism is such a fantastic deal. Some "cultures" just don't make good lifestyle decisions such as thinking that grape drank and swisher sweets are healthful choices.

philipat cheka , Jan 1, 2017 10:35 PM
It is, of course, in part a "Lifestyle" issue but the US system is grossly inefficient because there are adverse incentives built in (Adverse selection etc.). The US still uses a "Fee for service" model which has never been able to control costs anywhere in the world. On top of that, high pharmaceutical prices in the US account for up to 90% of total Big Pharma profits ane Medical Malpractise insurance not only directly adds large costs but indirectly forces the use of an unnecessary number of tests and the use of the newest drugs etc. Without any sensible controls at any point in the system it will only continue to get further out of control, as ACA has illustrated.
Ballin D philipat , Jan 1, 2017 10:41 PM
What's the alternative to "fee for service?" Seems pretty standard to charge for services rendered.
philipat Ballin D , Jan 1, 2017 11:47 PM
Except that more services = more fees = higher costs. Hence multiple tests, multiple procedures and multiple drugs = higher costs and higher fees = inefficiency bias and higher still costs. Physicians are human and the Healthcare providers have become experts at maximising costs to breaking point. There are many alternative models within which to control costs through negotiated standard procedures and fixed costs for each procedure and drug formularies (including the use of generic drugs) etc. Single payer is used by much of the developed world where the supplier agrees to supply at a negotiated price or doesn't get to participate, which focuses their attention nicely. The benefits of scale, in whatever system is used, should result in lower prices but don't in the US where USG is already the largest single provider of healthcare (Medicare/Medicaid etc).
Canoe Driver philipat , Jan 2, 2017 12:36 AM
A lot of people, certainly not just doctors, are making a lot of money from this dysfunctional medical system. That is the difference no one is talking about. The money is not disappearing down a rabbit hole. It is being pocketed by thousands of multi-millionaires. It is a profit-based system. Medicine is the one field where Capitalism has no hope of efficiency. Why? Because the demand is infinite and inelastic. A recipe for the financial rape of millions.
dogsandhoney2 junction , Jan 2, 2017 12:43 AM
yeah,
and it also shows the effect of a
30% increase in psychological stress since 1980.
stress = ^stress hormones = stressed immune system =
anxiety/depression/cardiovascular disease/hyper inflammatory response/etc..

all to be treated by those in the stressed-out health care system,
usually with hyper-cost pharmaceuticals.

it's well past due date for the u.s. to become civilized by starting
single payer medical plans.

health insurance corporations = the terror.

sinbad2 heresy101 , Jan 1, 2017 10:48 PM
I wouldn't count on it.

Private healthcare and insurance is very profitable 2 of the 3 trillion the US spends on healthcare would go to shareholders and management of healthcare companies.

Mr Trump is a businessman and a realist. The media would be calling him a commie if he tried to fix it.

sinbad2 , Jan 1, 2017 10:38 PM
Americans would not have it any other way.

The countries that have the most cost effective healthcare, are countries that provide government run health insurance.

Americans would never tolerate claiming helthcare costs back from a Government run health providor, like in Australia, or waisting taxpayers money building hospitals.

Americans have to pay for their belief that private for profit health insurance is cheaper and better than government provided insurance.

Xena fobe sinbad2 , Jan 1, 2017 11:41 PM
Americans would accept single payer. But insurance companies would not.
TheEndIsNear I Write Code , Jan 2, 2017 12:05 AM
250,000 deaths in 2015 were due to medical error, the third leading cause of death in the U.S.
http://www.hopkinsmedicine.org/news/media/releases/study_suggests_medica...

38,300 people were killed on U.S. roads in 2015.
http://www.newsweek.com/2015-brought-biggest-us-traffic-death-increase-5...

33,636 deaths due to "Injury by firearms" of which only 11,208 were homicides, 21,175 were self inflicted suicides, and the remainder were due to accidental/negligent discharge of a firearm or "undetermined intent".
https://en.wikipedia.org/wiki/Gun_violence_in_the_United_States

brooklinite8 , Jan 1, 2017 11:07 PM
When I was visiting India I saw few women administer a baby birth basically in few minutes with bare hands, water, oil and some sarees. Here in the US I believe the bill comes around 5-10k at the least. Did we ever ask the question as to why do we need insurance to afford health care? Did we ever ask how has it become so out of control? Why has healthcare become such a big business? Where are the morals of humanity?

In USA the welfare of the state takes precedence to the welfare of the people. Human beings are valued at no different rate in USA than India. Welcome to the Land of the Free, Home of the Brave. Good Old USA. We are outliers and Everything we do should be an outlier. If not we will revisit and make sure it becomes an outlier. Lol

Canoe Driver brooklinite8 , Jan 2, 2017 12:57 AM
The total cost per childbirth in the US is said to be $50-65k. This figure is so outrageous that it is impossible to correlate it with the cost of providing the services. It is simply a bunch of profiteers taking their cut. And the profit can be several hundred percent of the underlying cost, precisely because the "customer" has no choice at all. Capitalism, which works well in many contexts, fails miserably in medicine. Demand is infinite and inelastic in the medical field.
hairball48 , Jan 1, 2017 11:15 PM
A shitty diet of sugar laden, high carbohydrate fast food products is what contributes to most Americans' shorter life spans, not "poor health care".

Health care is expensive because it's run by a de facto "health care mafia". I worked in the technical field of health care for 28 years. Excessive regulation is but just one reason health care is so expensive in the USA. Barriers to entry are another. Try to establish a medical school. See how long it takes. Fewer docs, the higher the price of docs. ECO 101. Don't look for a change anytime soon.

hairball

Miffed Microbio... hairball48 , Jan 2, 2017 12:14 AM
When I was an intern for clinical microbiology they gave us $300/month as a stipend. Today an internship costs $24k. This is on top of the 4 years degree. Plus the mechanization of the lab is continuing every year to the point there will be fewer jobs in the future. Hate to say it but my field is fucked. Much of my time is spent meeting regulatory compliance and it gets worse every year.

Miffed

tyberious , Jan 1, 2017 11:52 PM
Me, 20 years in Healthcare BS, MSPH, , started in reference labs, then trauma center, biotech and now in healthcare insurance quality improvement (Medicare). 1st of all the money is in the government, we all know that!

But my main response to the article is that the America sheep are being sheared! The assault starts at birth with 21 vaccines by adulthood( infant mortality), hormones in the food (preteen secondary sex characteristics)(breast cancer)(prostate cancer) , HFC (diabetes, heart diseases, and other complications) GMO's, glycophosphates, glutens, and the multitude of useless pharmaceuticals.

My point is Americans are being poisoned, not so much intentionally, but through fascist business models.

So recap: Chronic preventable illnesses, extensive bureaucracy, poor food choices (# 1 in my book), and a government that cares zero fucks about you!

chosen , Jan 2, 2017 12:18 AM
Doctors are way overpaid. Hospitals charge ridiculous prices that have no relation to reality. Insurance companies screw us even more.

The US medical system is worse than the university system. Both are scams whose main goal is to make the providers more and more money, and the users poorer and poorer. It is sick.

Canoe Driver chosen , Jan 2, 2017 1:12 AM
Basically, you are right. The idea is that the price is all the funds the "customer" has in the world, every time there is significant illness. This is because the demand for healthcare is essentially infinite and inelastic. If you want to live, pay us everything you have, then declare bankruptcy. That is what happens naturally in a for-profit medical system.

[Dec 30, 2016] Payment for Emergency Ambulance Services.

Dec 30, 2016 | dfs.ny.gov
The Office of General Counsel issued the following opinion on June 7, 2006, representing the position of the New York State Insurance Department.

Payment for Emergency Ambulance Services.

Re: Payment for Emergency Ambulance Services.

Questions Presented:

1. Pursuant to the New York Insurance Law, may a medical provider, such as an ambulance company issued a certificate to operate under N.Y. Pub. Health Law § 3005, bill a patient directly for prehospital emergency ambulance services where a New York authorized insurer or health maintenance organization ("HMO") has made partial payment of a bill?

2. Pursuant to the New York Insurance Law, may a medical provider, such as an ambulance company issued a certificate to operate under N.Y. Pub. Health Law § 3005, bill a patient directly for prehospital emergency ambulance services where a New York authorized insurer or health maintenance organization has denied payment entirely?

Conclusions:

1. Pursuant to N.Y. Ins. Law §§ 3216(h)(24), 3221(l)(15) and 4303(aa) (McKinney Supp. 2006), the ambulance company may not bill a patient directly for prehospital emergency ambulance services where a New York authorized insurer or HMO has made partial payment of a bill under an insurance contract that provides major medical or similar comprehensive-type coverage. However, if such a contract is not involved, these provisions do not apply and there is no prohibition in the Insurance Law against the ambulance company billing the patient directly for the balance of the bill.

2. Yes. The ambulance company may bill a patient directly for prehospital emergency ambulance services where a New York authorized insurer or HMO has denied payment entirely, subject to the remedies available to the patient.

Facts:

This inquiry is general in nature.

Analysis:

N. Y. Ins. Law § 4303 (McKinney Supp. 2006) applies to non-profit health plans and HMO's. Although HMO's are primarily regulated by the New York Health Department, their subscriber contracts are regulated by the Insurance Department as if they were subscriber contracts of non-profit health insurers. See N.Y. Public Health Law § 4406(1) (McKinney 2002).

N.Y. Ins. Law § 4303(aa) (McKinney Supp. 2006) provides, in relevant part, as follows:

(aa)(1) Every contract issued by a hospital service company or health service corporation which provides major medical or similar comprehensive-type coverage shall include coverage for prehospital emergency medical services for the treatment of an emergency condition when such services are provided by an ambulance service issued a certificate to operate pursuant to section three thousand five of the public health law.

(2) Payment by an insurer pursuant to this section shall be payment in full for the services provided. An ambulance service reimbursed pursuant to this section shall not charge or seek any reimbursement from, or have any recourse against an insured for the services provided pursuant to this subsection, except for the collection of copayments, coinsurance or deductibles for which the insured is responsible for under the terms of the policy.

(3) An insurer shall provide reimbursement for those services prescribed by this section at rates negotiated between the insurer and the provider of such services. In the absence of agreed upon rates, an insurer shall pay for such services at the usual and customary charge, which shall not be excessive or unreasonable.

(4) The provisions of this subsection shall have no application to transfers of patients between hospitals or health care facilities by an ambulance service as described in paragraph one of this subsection. . . .

N.Y. Ins. Law § 3221(l)(15) (McKinney Supp. 2006), which applies to group or blanket accident and health insurance policies issued by commercial insurers and N.Y. Ins. Law § 3216(h)(24) (McKinney Supp. 2006), which applies to individual accident and health insurance policies issued by commercial insurers contain identical provisions.

In accordance with the above, if the insurance contract provides major medical or similar comprehensive-type coverage, it must include coverage for prehospital emergency medical services for the treatment of an emergency condition when such services are provided by an ambulance service issued a certificate to operate pursuant to section three thousand five of the public health law. The insurer must provide coverage for emergency ambulance services based upon the rates negotiated between the insurer and the provider of such services. If no participating provider contract exists, the insurer must pay for the services at the usual and customary charge, which shall not be excessive or unreasonable.

Once the insurer makes payment at the usual and customary charge, the provider must accept such payment as payment in full. The provider may not bill the patient directly for emergency ambulance services for the balance of a bill, except for the collection of copayments, coinsurance or deductibles that the insured is responsible for under the terms of the insurance contract.

Please note that N.Y. Ins. Law §§ 3216(h)(24), 3221(l)(15) and 4303(aa) (McKinney Supp. 2006) are applicable only to insurance contracts that provide major medical or similar comprehensive-type coverage. Thus, if such a contract is not involved, these provisions do not apply and there is no prohibition in the Insurance Law against the ambulance company billing the insured directly. In addition, these provisions do not address a situation in which a New York authorized insurer or HMO has denied payment entirely for emergency ambulance services (i.e. where the insurer or HMO states that coverage was not in effect or that treatment was not medically necessary). In such cases, the ambulance company may bill the patient directly, subject to the remedies available to the patient.

If the ambulance company or patient disputes a payment made by the insurer or HMO as not constituting the usual and customary charge or disputes the fact that no payment was made, the ambulance company or patient may raise the issue with the insurer or HMO and/or file a complaint with the Department's Consumer Services Bureau.

Lastly, the New York Attorney General's Office has conducted an investigation on balance billing by ambulance companies. For further information, the inquirer was directed to contact the Attorney General's Office at (518)474-7330 or access their web site which is located at http://www.oag.state.ny.us.

This opinion does not provide an analysis of the No-Fault Insurance Law, which would result in a different analysis and conclusion, since the inquirer already had OGC Opinions on this subject. 1 Please note also that this opinion is limited to an interpretation of the New York Insurance Law. No opinion is rendered on any other laws.

For further information you may contact Associate Attorney Pascale Jean-Baptiste at the New York City Office.


1 See OGC Opinion No. 03-02-18, dated Feb. 18, 2003 and OGC Opinion No. 03-04-36, dated April 30, 2003; see also OGC Opinion No. 05-05-29, dated May 28, 2005.

[Dec 30, 2016] 20 things to know about balance billing

Notable quotes:
"... Balance billing is on the rise nationally. In 2011, around 8 percent of privately insured individuals used out-of-network care, 40 percent of which resulted in unanticipated medical costs due to balance billing, reports Health Services Research . ..."
"... Balance billing complaints are up 1,000 percent in Texas . ..."
"... The rise in balance billing is partially attributable to a lack of network transparency with patients. ..."
"... The New York Times ..."
"... Kaiser Health News ..."
"... In 2014 Aetna sued a physician at Monmouth Medical Center in Long Branch, N.J., a hospital within Aetna's network, who did not notify a patient he would not accept Aetna's discounted reimbursement rate, according to the lawsuit. The physician charged Aetna $31,939 to treat abdominal pain in the patient. After Aetna paid the amount it deemed reasonable - $2,811, based on Medicare rates - the physician balance billed the patient for an additional $10,635. ..."
"... Montana Public Radio ..."
"... Sunshine State News ..."
"... The New York Times ..."
"... The New York Times ..."
Dec 30, 2016 | www.beckershospitalreview.com

Patients, caught in the financial crosshairs, often feel powerless to negotiate costs. Consumer advocacy groups and federal and state legislators are turning their attention to balance billing practices this year with renewed vigor, forcing payers and providers to find other ways to settle financial disagreements.

Here are 20 things to know about balance billing.

1. Balance billing is on the rise nationally. In 2011, around 8 percent of privately insured individuals used out-of-network care, 40 percent of which resulted in unanticipated medical costs due to balance billing, reports Health Services Research . In 2015, a nationwide study from Consumers Union found nearly one third of privately insured Americans received an unanticipated bill when their health plan paid less than expected for medical services within the past two years.

2. Balance billing complaints are up 1,000 percent in Texas . According to the Texas Department of Insurance , balance billing complaints rose from 112 in 2012 to 1,334 in 2015, an increase of 1,000 percent.

3. Lack of provider, network transparency. The rise in balance billing is partially attributable to a lack of network transparency with patients. In many cases patients are unaware they have received out-of-network care until they receive a balance bill in the mail. Nearly 70 percent of individuals with unaffordable out-of-network medical bills did not know the healthcare provider was not in their plan's network at the time of care, according to a survey conducted by Kaiser Family Foundation and The New York Times .

4. Emergency room services to blame, in part. A Health Services Research survey found in 2011, 68 percent of inpatient involuntary contact with out-of-network physicians was related to emergency care. These kinds of unanticipated medical bills may arise when a hospital participates in an insurer's network but its employed emergency physicians do not. For example, more than half of the hospitals in some Texas insurers' networks did not have a single physician on staff covered by the insurer, according to a 2015 study from the Centers for Public Policy Priorities in Austin.

5. Balance billing and contracted physicians. Many hospitals use physician outsourcing firms for anesthesiologists, emergency physicians, pathologists and radiologists, or will bring in an outside assistant surgeon to help with procedures. In many cases, these physicians do not participate in the same network as the hospital, unbeknownst to the patient. When physician groups and insurers are unable to resolve reimbursement disputes, patients can be served with much higher out-of-network charges. In Texas, for example, the specialty services most likely to submit balance bills are anesthesiologists, lab services, surgery and radiology, reports the Texas Department of Insurance .

6. Payers will fight out-of-network physicians with lower reimbursement rates. Last year, health insurance giant UnitedHealthcare said it would scale back how much it pays out-of-network physicians who practice at in-network hospitals, accusing physicians of demanding excessively high reimbursement levels, according to Kaiser Health News . During a billing dispute with out-of-network Bayonne (N.J.) Medical Center, the insurer accused the hospital of charging out-of-network rates 10 to 12 times higher for a medical service than area hospitals participating in United'snetwork. If a payer refuses to match physician reimbursement rates, the financial burden is passed on to the patient. In the aforementioned dispute between Bayonne and UnitedHealthcare, the patient was balance billed $1,170 for a total of five stitches.

7. Insurers are narrowing networks in an effort to reduce costs. As insurance companies have narrowed provider networks to keep premiums down, the number of patients who inadvertently received out-of-network care has jumped at hospitals, particularly with regard to contracted physicians.

8. Payers have sued providers for 'excessive' out-of-network fees. Aetna has sued a half dozen out-of-network physicians in recent years, alleging gross over charging for medical services. In 2014 Aetna sued a physician at Monmouth Medical Center in Long Branch, N.J., a hospital within Aetna's network, who did not notify a patient he would not accept Aetna's discounted reimbursement rate, according to the lawsuit. The physician charged Aetna $31,939 to treat abdominal pain in the patient. After Aetna paid the amount it deemed reasonable - $2,811, based on Medicare rates - the physician balance billed the patient for an additional $10,635.

9. Balance billing can occur even when a payer adjusts out-of-network emergency bills to in-network rates for patients. A patient recently accused Duke University Medical Center in Durham, N.C., of balance billing his account for an out-of-network rate after the patient submitted in-network payment rates to Blue Cross Blue Shield. Owing to the medical emergency of his situation, Matthew Aitken said he received an in-network rate from Blue Cross Blue Shield of North Carolina. However, Mr. Aitken alleged Duke proceeded to charge him for the remainder of the bill at the higher out-of-network rate, resulting in a bill nearly double that of Mr. Aitken's out-of-pocket limit.

10. Air ambulance billing disputes, complaints on the rise. In rural areas of the U.S. the high price for life-saving air ambulance flights has grabbed media attention as rural residents, faced with excessive balance billing, have turned to state and federal auditors for intervention. Those in rural areas often must rely on air ambulance flights in life-or-death situations in lieu of feasible ground transportation. Reimbursement rate disputes between payers and medical air transport companies have strapped patients with devastating medical bills. When Amy Thomson's newborn daughter was in heart failure, Ms. Thomson had to use an air ambulance service in rural Montana for transport to a more capable facility. At the time her insurance company, PacificSource, did not have an in-network air ambulance company near her family, reports Montana Public Radio . Ms. Thomson received a $43,000 balance bill from Airlift Northwest after PacificSource contributed a policy cap of $13,000.

11. Provider-based billing practices. Consumers have been increasingly vocal about surprise medical bills derived from provider-based billing practices. Provider-based billing allows a healthcare organization to bill patients for physician care in addition to a service charge for the patient's use of hospital facilities and equipment. In some cases, a patient may be responsible for the service bill if their insurance declines to pay or if the patient has a high deductible health plan. Large hospitals like Cleveland Clinic have faced increased scrutiny for provider-based billing practices. After paying a $30 copayment for in-network care with a Cleveland Clinic chiropractor, Julie Beinhardt reported receiving a balance bill of $3,000 for provider-based service fees her insurance plan refused to cover.

12. President Barack Obama signed legislation against provider-based billing. Last year, President Obama signed legislation outlawing provider-based billing at off-campus outpatient facilities. The legislation does not apply to existing outpatient centers that already engage in the practice, however.

13. The president's 2017 budget proposal includes a provision to eliminate surprise medical bills. Although details are minimal, the president's 2017 budget proposal includes a provision to eliminate balance billing privately insured patients. The administration would address the issue by requiring physicians who regularly provide services in hospitals to accept in-network rates for service reimbursement, even if they aren't in the insurer's network.

14. About a quarter of U.S. states have laws that protect consumers from out-of-network medical bills incurred by emergency care. According to a study from Kaiser Family Foundation , 24 states have implemented laws that restrict providers from balance billing in emergency care situations, including California, Delaware, New Jersey, New York and Pennsylvania, among others.

15. More states are proposing independent dispute resolution between payers and providers in balance billing cases. Independent dispute resolution establishes a legal space in which providers and health insurers can settle disagreements regarding balance billing without involving the patient. The states of Illinois and New Yorkhave arbitration methods in place, and Florida , Washington and Pennsylvania are currently considering a similar resolution methods.

16. New York has some of the strongest consumer protection laws. Under New York law , consumers are generally protected from owing more than their in-network copayment, coinsurance or deductible on bills they receive for out-of-network emergency services. Patients can complete an assignment of benefits form that absolves them of financial responsibility and allows the provider to pursue payment from the health plan in balance billing disputes.

17. Florida state legislature is currently embroiled in a fight to pass balance billing laws. Legislation to outlaw balance billing in Florida has continued to creep through the state legislature since last fall. Introduced in both the house and senate, the bills have sparked conflicting and outspoken opinions from patients, payers, hospitals and physicians. Hospitals have largely denounced the bill, blaming balance billing disputes on payers that demand allegedly unsustainable reimbursement rates, reports Sunshine State News .

18. The "End Surprise Billing Act". Federal lawmakers are making moves to outlaw balance billing nationally. Co-sponsored by 25 lawmakers, the End Surprise Billing Act would protect patients from balance billing who went to in-network facilities for emergency services, reports Consumerist . In non-emergency cases, it would require providers to notify patients within 24 hours if an out-of-network specialist will be involved in an episode of care.

19. Consumers don't know how to navigate the legal waters. According to a Consumer Union report, 57 percent of patients who encountered balance billing from contracted physicians within the last two years paid in full because they didn't know their rights to fight the bills. An overwhelming majority (87 percent) did not know which agency or department in their state government is tasked with handling complaints about health insurance. "So many times, people just give up [in surprise billing disputes]," Elisabeth Benjamin, vice president of health initiatives with Community Service Society of New York, told NPR .

20. The New York Times dedicated a series to consumer encounters with surprise healthcare bills. Elisabeth Rosenthal's series in The New York Times entitled Paying Til it Hurts examined the personal and financial implications of excessive, unexpected medical costs on Americans, their families and their healthcare consumption. Ms. Rosenthal's installments often feature individuals with unaffordable balance bills like Peter Drier , who was served a $117,000 balance bill for an out-of-network physician's assistant he never knew was present during surgery.

[Dec 26, 2016] IBMs Watson Used In Life-Saving Medical Diagnosis

Dec 26, 2016 | science.slashdot.org
(businessinsider.co.id) 83
Posted by EditorDavid on Sunday December 11, 2016 @09:34PM from the damn-it-Jim-I'm-a-doctor-not-a-supercomputer dept.
"Supercomputing has another use," writes Slashdot reader rmdingler , sharing a story that quotes David Kenny, the General Manager of IBM Watson:
"There's a 60-year-old woman in Tokyo. She was at the University of Tokyo. She had been diagnosed with leukemia six years ago. She was living, but not healthy. So the University of Tokyo ran her genomic sequence through Watson and it was able to ascertain that they were off by one thing . Actually, she had two strains of leukemia. They did treat her and she is healthy."

"That's one example. Statistically, we're seeing that about one third of the time, Watson is proposing an additional diagnosis."

[Dec 26, 2016] New Google Trusted Contacts Service Shares User Location In Real Time

Dec 26, 2016 | tech.slashdot.org
(onthewire.io) 89 Posted by msmash on Monday December 05, 2016 @11:00AM from the interesting-features dept. Reader Trailrunner7 writes: Google has spent a lot of time and money on security over the last few years, developing new technologies and systems to protect users' devices. One of the newer technologies the company has come up with is designed to provide security for users themselves rather than their laptops or phones .

On Monday Google launched a new app for Android called Trusted Contacts that allows users to share their locations and some limited other information with a set of close friends and family members. The system is a two-way road, so a user can actively share her location with her Trusted Contacts, and stop sharing it at her discretion. But, when a problem or potential emergency comes up, one of those contacts can request to get that user's location to see where she is at any moment. The app is designed to give users a way to reassure contacts that they're safe, or request help if there's something wrong.

[Dec 26, 2016] Are Psychiatric Medications Hurting More Patients Than They Help?

Notable quotes:
"... Scientific American ..."
Dec 26, 2016 | science.slashdot.org
(scientificamerican.com) 431

Posted by EditorDavid on Sunday December 18, 2016 @01:34PM from the depressing-anti-depressant-news dept.

An anonymous reader quotes Scientific American 's Cross-Check blog :

Two new posts on this website have me contemplating, once again, the terrible possibility that psychiatry is hurting more people than it helps. Reporter Sarah G. Miller notes in "1 in 6 Americans Takes a Psychiatric Drug" that prescriptions for mental illness keep surging. As of 2013, almost 17 percent of Americans were taking at least one psychiatric drug , up from 10 percent in 2011, according to a new study. "Antidepressants were the most common type of psychiatric drug in the survey, with 12 percent of adults reporting that they filled prescriptions for these drugs..."

This increase in medications must be boosting our mental health, right? Wrong. In "Is Mental Health Declining in the U.S.?," Edmund S. Higgins, professor of psychiatry at the Medical University of South Carolina, acknowledges the "inconvenient truth" that Americans' mental health has, according to some measures, deteriorated ...

It's all more evidence of something their blogger wrote in 2012. "American psychiatry, in collusion with the pharmaceutical industry, may be perpetrating the biggest case of iatrogenesis -- harmful medical treatment -- in history ."

[Dec 26, 2016] Google Successfully Uses Machine Learning To Detect Diabetic Retinopathy

Dec 26, 2016 | news.slashdot.org
(betanews.com) 30 Posted by BeauHD on Tuesday November 29, 2016 @05:40PM from the medical-breakthrough dept. BrianFagioli writes from a report via BetaNews: Diabetic eye disease is caused by retinopathy. Affected diabetics can have small tears inside the eye, causing bleeding. Over time, they can lose vision, and ultimately, they can go blind. Luckily, Google has been trying to use machine learning to detect diabetic retinopathy. Guess what? The search giant has seen much success. Not only are the computers able to detect the disease at the same level as ophthalmologists , but Google is actually slightly better! "A few years ago, a Google research team began studying whether machine learning could be used to screen for diabetic retinopathy (DR). Today, in the Journal of the American Medical Association , we've published our results: a deep learning algorithm capable of interpreting signs of DR in retinal photographs, potentially helping doctors screen more patients, especially in underserved communities with limited resources," says Lily Peng , MD Ph.D., Product Manger at Google. She goes on to say "our algorithm performs on par with the ophthalmologists, achieving both high sensitivity and specificity . [...] For example, on the validation set described in Figure 2, the algorithm has a F-score of 0.95, which is slightly better than the median. F-score of the 8 ophthalmologists we consulted (measured at 0.91)."

[Dec 26, 2016] Japanese City Tags Elderly Dementia Sufferers With Barcodes

Dec 26, 2016 | science.slashdot.org
(japantimes.co.jp) 115 Posted by EditorDavid on Sunday December 11, 2016 @03:34PM from the scans-of-the-setting-sun dept. "The Japanese city of Iruma has introduced scannable adhesive barcodes to tag fingernails of senior citizens with dementia who are prone to getting lost as a way to help concerned families find missing loved ones," writes HughPickens.com , citing this article from Japan Times : The adhesive QR-coded seals for nails -- part of a free service launched last month and a first in the country -- measure just 1 cm (0.4 inches) in size. "Being able to attach the seals on nails is a great advantage," says a city worker. "There are already ID stickers for clothes or shoes but dementia patients are not always wearing those items." If an elderly person becomes disorientated, police will find the local city hall, its telephone number and the wearer's ID all embedded in the QR code. Japan is grappling with a rapidly aging population , with senior citizens expected to make up a whopping 40 percent of the population around 2060 .
The article describes Japan as "a country where 4.8 million people aged 75 or older hold a license... Last month, police started offering discounts for noodles at local restaurants to elderly citizens who agreed to hand in their driving licenses."

[Dec 26, 2016] 'Fatal' Flaws Found in Medical Implant Software

Dec 26, 2016 | tech.slashdot.org
(bbc.com) 38 Posted by msmash on Thursday December 01, 2016 @07:35PM from the security-woes dept. Security researchers have warned of flaws in medical implants in what they say could have fatal consequences . The flaws were found in the radio-based communications used to update implants, including pacemakers, and read data from them. From a BBC report: By exploiting the flaws, the researchers were able to adjust settings and even switch off gadgets. The attacks were also able to steal confidential data about patients and their health history. A software patch has been created to help thwart any real-world attacks. The flaws were found by an international team of security researchers based at the University of Leuven in Belgium and the University of Birmingham.

[Dec 26, 2016] New Study Shows Marijuana Users Have Low Blood Flow To the Brain

Dec 26, 2016 | science.slashdot.org
(eurekalert.org) 560 Posted by BeauHD on Wednesday November 30, 2016 @08:00AM from the time-for-a-check-up dept. cold fjord writes: State level marijuana legalization efforts across the U.S. have been gaining traction driven by the folk wisdom that marijuana is both a harmless recreational drug and a useful medical treatment for many aliments. However, some cracks have appeared in that story with indications that marijuana use is associated with the development of mental disorders and the long-term blunting of the brain's reward system of dopamine levels . A new study has found that marijuana appears to have a widespread effect on blood flow in the brain. EurekAlert reports: "Published in the Journal of Alzheimer's Disease , researchers using single photon emission computed tomography (SPECT), a sophisticated imaging study that evaluates blood flow and activity patterns, demonstrated abnormally low blood flow in virtually every area of the brain studies in nearly 1,000 marijuana users compared to healthy controls, including areas known to be affected by Alzheimer's pathology such as the hippocampus. According to Daniel Amen, M.D., 'Our research demonstrates that marijuana can have significant negative effects on brain function. The media has given the general impression that marijuana is a safe recreational drug, this research directly challenges that notion. In another new study just released, researchers showed that marijuana use tripled the risk of psychosis. Caution is clearly in order.'"

[Dec 26, 2016] 5 Ways to Lower Your Medical Bills Personal Finance

Notable quotes:
"... "One should know what the cost of the procedure is, and that is something that is just impossible to figure out before or after the procedure," Luthra says. "I had no way of knowing beforehand there were going to be these six different types of providers . . . sending me bills." ..."
Nov 29, 2007 | US News

Insurance companies aren't the only ones who can negotiate a lower price -- you can, too. Here's how.

By U.S. News & World Report

Sanjiv Luthra of Los Altos, Calif., suffered from the pain and fatigue of rapid-onset arthritis so severe that he couldn't walk 10 feet until he underwent double knee-replacement surgery in 2006. Now, two years later, he can walk and run, but he still suffers the fallout from another ailment: medical bills.

Six hours in an operating room, two knee replacements, medications and a five-day hospital stay added up to a bill of $80,000, Luthra estimates. That's not counting bills for an anesthesiologist, physical therapy, additional medicines and special exercise equipment to help him recover.

"One should know what the cost of the procedure is, and that is something that is just impossible to figure out before or after the procedure," Luthra says. "I had no way of knowing beforehand there were going to be these six different types of providers . . . sending me bills."

Luthra's insurance company was able to negotiate with the hospital so that it paid about $20,000, and he parted with about $5,000, including expenses outside the hospital.

But individual patients can haggle for lower medical bills, too. Here are tips on how to go about it.

Work up the courage to ask. It's not just insurance companies that can negotiate.

"The typical insurer gets about a 60% discount," says Gerard Anderson, the director of the Johns Hopkins Center for Hospital Finance and Management. "If you go into the hospital and ask the chief financial officer , you may get a 30% discount, but you have to ask for it. It's totally up to the discretion of the CFO how much they or the person in the billing office are willing to give you."

Although it's common to negotiate with a real-estate agent or car salesperson you probably never will see again, it's much more difficult to negotiate with a doctor you trust to make you well and to provide continuing care for your family. Only 31% of Americans have tried to negotiate the price of medical bills, a survey by Consumer Reports National Research Center indicated. But of those who tried, 93% have been successful at least once, and more than a third saved more than $100.

Explore low-cost treatments. Many doctors incurred large loans to finance medical school and probably understand the need to get a fair price as well as you do.

But even though almost 80% of physicians will prescribe a generic medication over a brand-name drug to save patients money, far fewer consider patient costs when recommending diagnostic tests (51%) or choosing between hospitalization and outpatient treatment (40%), according to a survey of physicians by the Center for Health System Change and the University of Chicago

If money is an issue, you need to ask your doctor if cheaper, medically sound options are available. The trick is to keep it friendly and ask nicely. For minor health ailments such as ear infections and pinkeye, drugstore clinics list reasonable prices upfront, with no negotiating required.

Find the correct person. Although they are heavily involved in treatment decisions, doctors may not be directly involved in other billing issues, so you need to find a person with the ability to adjust your bill.

"I would suggest the consumer go to the office manager," says Timothy Cahill, a health-care consultant in Louisville, Ky., who has negotiated hospital bills on behalf of patients. The office manager should be able to direct you to the person in charge of billing.

Offer cash payments. This could be a mutually beneficial solution for you and the medical establishment.

"Paying cash is worth a lot to a doctor in terms of time and trouble, and it is a lot less complex for the hospital to deal with," says Shankar Srinivasan. He is a co-founder and the chief technology officer of Vimo.com, a company that uses public records to figure out what prices insurers negotiate with hospitals. Cash, he says, saves hospitals the trouble of negotiating financing terms, paying credit card transaction fees and sending collection agencies after patients who fail to pay.

Scrutinize the bill and your insurance. If you don't have the cash to pay a large medical bill, you need to educate yourself about what your insurance should cover and try to negotiate a discount off the sticker price.

"As a consumer, just like a detective, you have to really understand the specifics of your insurance benefit plan, take the initiative of setting up conference calls (including yourself, the hospital and your insurance company) proactively, and you have to document everything," says Luthra, who is chief operating officer of the health-care-consulting company Benu. "You don't just pay the bill as is."

This article was reported and written by Emily Brandon for U.S. News & World Report.

[Dec 26, 2016] How to avoid and handle surprise medical bills

Notable quotes:
"... The average balance billed to patients was $622.55 , though the study reported bills as high as $19,603.30. But, ERs are not the only source of surprise bills. ..."
"... Even when a patient goes to a hospital for routine surgery, and takes care to choose an in-network hospital and in-network surgeon, the anesthesiologist, radiologist or pathologist assigned to the case may be out of network, and follow up with a surprise bill. ..."
"... If you have a serious medical emergency, your nearest hospital may not be in-network and all your treatment may result in out-of-pocket expense for high surprise bills. But, even if you visit an in-network ER, you have little control over the choice of doctor: By definition, you are facing an emergency, and must take whoever is available. ..."
"... Check with your state insurance regulator to see if your state has any consumer protections against surprise bills. ..."
"... At present, California, Colorado, Connecticut, Florida and New York do have such protections against unexpected balance bills - either for out-of-network ER situations alone or for additional types of surprise bills. ..."
"... If your state does not offer protection against surprise bills, check first to make sure the provider is really not in your network. Back offices and billing companies deal with many plans and sometimes make mistakes. Providers who are in your network have to accept the insurer's contracted rate. ..."
"... If the provider is out of network, do some research on an independent website, such as fairhealthconsumer.org , to estimate what the procedure typically costs in your locality. ..."
"... If neither the insurer nor the provider is willing to budge, do not be afraid to seek help. If you get your insurance through your employer, your human resources department may be able to intervene. Call your state representative or your local consumer protection office. With the right assistance, you might be able to reduce the bill, if not make it go away entirely. ..."
thehill.com
Surprise bills are never a welcome surprise. Typically, they arrive after you arranged care from a doctor and a hospital that were both in your health plan's network, but then you were unexpectedly treated by one or more other providers who, unbeknownst to you, were outside that network.

When these out-of-network providers send you a bill for their services, you may have to pay the full amount out of pocket or, if your health plan covers out-of-network care, to pay the balance of the bill that your insurance fails to cover. And the balance bill generally requires you to pay more than the out-of-pocket amount you would have owed if you had been treated by an in-network provider.

Emergency rooms are one of the most common locations where healthcare results in surprise bills.

As detailed recently in an article by two Yale scholars in the New England Journal of Medicine, in more than one in five cases nationwide, ER visits to an in-network facility involved out-of-network physicians. The average balance billed to patients was $622.55, though the study reported bills as high as $19,603.30. But, ERs are not the only source of surprise bills.

Even when a patient goes to a hospital for routine surgery, and takes care to choose an in-network hospital and in-network surgeon, the anesthesiologist, radiologist or pathologist assigned to the case may be out of network, and follow up with a surprise bill.

Several states have already enacted laws to protect consumers against surprise bills, although some of the statutes protect patients only in the case of balance bills for out-of-network ER services for a serious medical emergency. Currently, the issue is being discussed in a number of statehouses. In the meantime, here are steps you can take to protect yourself from such surprises.

Prevent surprise bills

The best defense against a surprise bill is prevention. If you have a serious medical emergency, your nearest hospital may not be in-network and all your treatment may result in out-of-pocket expense for high surprise bills. But, even if you visit an in-network ER, you have little control over the choice of doctor: By definition, you are facing an emergency, and must take whoever is available.

However, for a planned surgery or other procedure, you probably have time to speak up. Make sure that your doctor and hospital are in your plan's network. Check with them and with your plan. Ask your physician and your hospital in advance if they can arrange to have only in-network providers treat you.

Some hospitals may have no in-network specialist for care you might require. Find out if another hospital in your area can provide all your necessary services on an in-network basis. In some areas, there may be no in-network specialists available of the type you need. In that case, inform your plan that its network lacks necessary services and find out if the terms of the plan or state law provide you protection from large balance bills in such circumstances.

Always refer to your plan by its exact official name. Often insurers have multiple plans with similar names but different networks. If you use the wrong plan name when inquiring about a plan's network, you may get a wrong and costly answer. Make your inquiries and requests in writing so you have documentation. Ask for the names of the providers who will be involved in your care, and check with your insurer and with the providers themselves to see if they are all in your plan's network.

Check if your state protects consumers

If you do get a surprise bill, take action. Check with your state insurance regulator to see if your state has any consumer protections against surprise bills. Many states have laws that require HMOs to protect consumers from surprise bills, especially with respect to necessary ER services. Fewer states have similar protections for other types of health plans, such as PPOs and EPOs.

At present, California, Colorado, Connecticut, Florida and New York do have such protections against unexpected balance bills - either for out-of-network ER situations alone or for additional types of surprise bills. Generally, these laws provide that the consumer is required to pay only the amount he or she would owe for the services if provided in-network. States have different mechanisms for settling the balance, but they generally involve the insurer and the provider, not the patient.

If your state does not provide protection

If your state does not offer protection against surprise bills, check first to make sure the provider is really not in your network. Back offices and billing companies deal with many plans and sometimes make mistakes. Providers who are in your network have to accept the insurer's contracted rate.

If the provider is out of network, do some research on an independent website, such as fairhealthconsumer.org, to estimate what the procedure typically costs in your locality. If your plan's reimbursement is based on an amount that is less than the typical charge, you can use this information to ask the plan to pay the provider on the basis of at least the typical rate. If the out-of-network provider's charge is higher than the typical rate, you might be able to negotiate with the provider to reduce your costs. You can try to persuade the provider to reduce the charge, or to discount an excessive balance bill, by showing the provider that his or her charge is above the typical market rate.

If neither the insurer nor the provider is willing to budge, do not be afraid to seek help. If you get your insurance through your employer, your human resources department may be able to intervene. Call your state representative or your local consumer protection office. With the right assistance, you might be able to reduce the bill, if not make it go away entirely.

Robin Gelburd, JD, is the president of FAIR Health, a national, independent nonprofit with the mission of bringing transparency to healthcare costs and insurance reimbursement. FAIR Health oversees the nation's largest repository of private healthcare claims data, comprising over 21 billion billed medical and dental charges that reflect the claims experience of over 150 million privately insured Americans. Follow on twitter @FAIRHealth

[Dec 25, 2016] How to Fight Back Against Outrageous E.R. Bills

Two excellent resources-Healthcare Blue Book and FAIR Health-can give you estimates of how much health care services should cost in your area. Plus, your insurer's website may also provide a tool that will allow you to compare costs.
Notable quotes:
"... But the bill did come-all $9,000 of it. The ambulance company charged $6,500, including a $300 fee for the linens and a $30 charge for aspirin. The E.R. billed the remaining $2,500. "My mouth literally dropped open when I saw the cost," she says. ..."
"... "I've always heard emergency room visits were costly, but $9,000 for nothing more than a conversation that lasted one minute? That's robbery," she says. ..."
"... "Employers often try to stay away from filing a claim under worker's compensation, so it does not impact their experience rating or trigger an [occupational safety and health administration] review, but it would save her money." ..."
"... This piece is by Drew Anne Scarantino ..."
www.thefiscaltimes.com

It's no secret that hospital bills in the U.S.-especially ones from the E.R.-can often hit astronomical proportions.

According to a recent cost study conducted by researchers at Stanford University, the University of Minnesota, the University of California, San Francisco and the Ecologic Institute, the median charge for an emergency room trip in the U.S. comes in at $1,233. But where it really gets interesting is when you look at the specific reasons for those E.R. visits: The researchers found that the treatment price for a headache could range from $15 to a whopping $17,797. As for a sprained ankle, it could set someone back a paltry $4 or up to $24,110!

So what gives with these wildly fluctuating price points?

For starters, most emergency room prices are inflated based on the rates at which insurance companies will reimburse the hospital on a patient's behalf. That's why a single aspirin can cost $30 per pill in the E.R., which is more than six times the price for a bottle of them at the drug store.

On the flip side, patients will often contact the hospital or surgeon's billing office to ask for a cost reduction, further adding to the inconsistency in pricing. It's a practice that often works in a patient's favor, says billing advocacy specialist Sharon Salters of Medical Cost Advocatea professional medical bill negotiation service.

And then there's also the fact that most hospitals offer discounts to self-paying individuals-especially if there's a risk that they might not pay at all.

So to help shed some light on the complexities of hospital medical billing for the average consumer, we asked three people to share their craziest emergency room stories, the even crazier bills that followed-and the steps they took to remedy them.

... ... ...

The Emergency: Head Injury
The Bill: $9,000

A few months ago, Amanda Harris, 27, of Morristown, N.J., fainted at work, hitting her head in the process. Due to liability concerns, her production company required Harris to take an ambulance to the emergency room, despite her refusal. "I didn't even have a cut on my head, just a slight bump. No headache, no nausea, no confusion, nothing," she says.

Harris waited for over an hour in the E.R. before her husband told the nurse that they were leaving. Minutes later, a doctor spoke to Harris for under a minute, confirming that she was fine to go. "He didn't do any tests-no light in my eyes, no blood pressure," says Harris. "I left thinking I wouldn't even get a bill."

But the bill did come-all $9,000 of it. The ambulance company charged $6,500, including a $300 fee for the linens and a $30 charge for aspirin. The E.R. billed the remaining $2,500. "My mouth literally dropped open when I saw the cost," she says.

RELATED: Hospital Costs Explode: Between $127 and $151 Billion

What This Patient Did: Harris called her insurer and fought the bill. Luckily, her insurance covered all but a $3,000 deductible-but she was too exhausted to push for more. "I've always heard emergency room visits were costly, but $9,000 for nothing more than a conversation that lasted one minute? That's robbery," she says.

What the Expert Says: Even though Harris didn't want to take an ambulance, Salters says that her company's suggestion was well-advised. "However, she should consider working with her employer to file the claim with her company's worker's compensation carrier," says Salters. "Employers often try to stay away from filing a claim under worker's compensation, so it does not impact their experience rating or trigger an [occupational safety and health administration] review, but it would save her money."

How You Can Avoid Outrageous E.R. Bills (Really!)

When it comes to a trip to the E.R., the reality is that there's usually no time to shop around and compare prices in advance. But if you do some research before an emergency happens, you could potentially keep costs significantly down.

The negotiation can seem like a lot of extra work, but the payoff can be tens of thousands of dollars in savings shaved off a potentially outrageous E.R. bill.

This piece is by Drew Anne Scarantino.

[Dec 04, 2016] The goal of the majority of providers is to increase total sales by ordering many procedures and or drugs that are not needed. Much of this is done from ignorance and is not necessarily indicative of a purely capitalistic motive.

Notable quotes:
"... The goal of the majority of providers is to increase total "sales" by ordering many procedures and or drugs that are not needed. Much of this is done from ignorance and is not necessarily indicative of a purely capitalistic motive. ..."
www.amazon.com
Dwight Clark on May 1, 2013
An author that really knows and understands the complexities of the healthcare (sickcare) industry

I was a practicing cardiologist in the US for over 30 years. I, as most other practicing cardiologist, was trained and fully believed the prevailing methods of diagnosis and treatment were not only correct but absolutely necessary. Several decades of experience taught me this is not close to being accurate. The majority of medical tests, and much of the treatment, is not only unnecessary, but harmful and/or dangerous. The goal of the majority of providers is to increase total "sales" by ordering many procedures and or drugs that are not needed. Much of this is done from ignorance and is not necessarily indicative of a purely capitalistic motive.

David Goldhill is one of the few authors that have experienced this travesty and is educated and intelligent enough to understand the consequences of this nationwide epidemic and the needless, wasteful, and dangerous care. His ability to sort through all of the "noise" prevalent in the governmental and media diatribe and isolate the real problem as full insurance for everyone is unique. This system is doomed for failure. There will never be enough resources to fund medical care as long as the consumer is not the payer. They will always demand more and the providers are happy to accommodate them.

I have left the US and am presently living in Beijing, China, attempting to establish purely preventive heartcare clinics. This is more general education regarding diet, smoking, sedentary lifestyle, and alcohol abuse. than traditional western medicine. Less income, but certainly more satisfying.

[Dec 04, 2016] Overuse of Cardiac Stents Linked to Patient Deaths

About a third of all cardiac stents implanted in patients are unnecessary, says cardiologist David Brown of Stony Brook University School of Medicine
Notable quotes:
"... About a third of all cardiac stents implanted in patients are unnecessary, says cardiologist David Brown of Stony Brook University School of Medicine. That amounts to more than 200,000 stents a year, and controversy surrounding this practice has spurred nationwide litigation and a federal investigation into several cases involving illegal kickbacks and allegations of cardiac stent malpractice. ..."
"... Blood clots can occasionally form in an inserted stent, which can then lead to the artery narrowing once again. In some cases, the blood vessel can become completely blocked – a condition called in-stent thrombosis. ..."
"... Most patients that undergo stenting are prescribed blood thinners in the wake of the procedure to ensure such events don't occur. ..."
"... Cardiac stents are big business for hospitals and their staff, with the average private insurance reimbursement for a procedure totaling $25,000. By placing a stent inside an artery, surgeons can restore blood flow that has been compromised in heart attack patients, or give help to patients at risk for future heart attack. But when misused or overused in patients, cardiac stents can prove fatal, as they did for former postal service worker Bruce Peterson. ..."
"... Peterson developed several blood clots and blockages due to his weakened heart, which ultimately caused his untimely demise, argues his widow Shirlee Peterson. ..."
"... Nortin Hadler, a UNC Chapel Hill professor of medicine told Bloomberg News, "Stenting belongs to one of the bleakest chapters in the history of Western medicine. Cardiologists "are marching on" because "the interventional cardiology industry has a cash flow comparable to the GDP of many countries" and doesn't want to sacrifice the revenue, he said. ..."
medstak.com

About a third of all cardiac stents implanted in patients are unnecessary, says cardiologist David Brown of Stony Brook University School of Medicine. That amounts to more than 200,000 stents a year, and controversy surrounding this practice has spurred nationwide litigation and a federal investigation into several cases involving illegal kickbacks and allegations of cardiac stent malpractice.

For the most part, stenting procedures are relatively low in risk and moderately safe. However, as with any surgical procedure – even a minimally invasive one – there is a risk of developing complications. Blood clots can occasionally form in an inserted stent, which can then lead to the artery narrowing once again. In some cases, the blood vessel can become completely blocked – a condition called in-stent thrombosis.

Most patients that undergo stenting are prescribed blood thinners in the wake of the procedure to ensure such events don't occur.

Additionally, manipulating arteries with a stent or any other sort of medical procedure can lead to the walls of the blood vessel becoming injured or damaged. The innermost layer of coronary arteries, known as the endothelium, is particularly susceptible to this sort of damage; the result can be the formation of scar tissue in the area of the stent, and this too can lead to the artery re-narrowing in a process known as restenosis. Treating Restenosis can involve an additional stenting procedure, though in severe cases where a stented artery recloses it may be necessary to have a patient undergo a coronary artery bypass to remedy the condition.

Overuse of cardiac stents leads to patient deaths

Cardiac stents are big business for hospitals and their staff, with the average private insurance reimbursement for a procedure totaling $25,000. By placing a stent inside an artery, surgeons can restore blood flow that has been compromised in heart attack patients, or give help to patients at risk for future heart attack. But when misused or overused in patients, cardiac stents can prove fatal, as they did for former postal service worker Bruce Peterson.

After suffering chest pain, Peterson paid a visit to cardiologist Dr. Samuel DeMaio, who inserted 21 stents in his patient's chest over a period of eight months, including five mesh tubes in a single artery. Peterson developed several blood clots and blockages due to his weakened heart, which ultimately caused his untimely demise, argues his widow Shirlee Peterson.

She later sued DeMaio for cardiac stent malpractice – an increasingly common charge in a Dr. Darshan P. Godkar, MD - Cedar Knolls, NJ - Cardiology & Interventional Cardiology & Internal Medicine Healthgrades.comqaDr. Darshan P. Godkar, MD - Cedar Knolls, NJ - Cardiology & Interventional Cardiology & Internal Medicine Healthgrades.com

Nortin Hadler, a UNC Chapel Hill professor of medicine told Bloomberg News, "Stenting belongs to one of the bleakest chapters in the history of Western medicine. Cardiologists "are marching on" because "the interventional cardiology industry has a cash flow comparable to the GDP of many countries" and doesn't want to sacrifice the revenue, he said.

Cardiac stent problems cost $2.4 billion a year

The U.S. health care system spends an estimated $2.4 billion a year caring for patients that received unnecessary cardiac stents, says Dr. Sanjay Kaul, of Cedars-Sinai Medical Center. Patients face a much greater risk for complications like coronary scar tissue, blood clots and uncontrolled bleeding from anticoagulant medications – all of which can be life-threatening. Jim Simecek told Bloomberg that he is on blood-thinning medicine for the rest of his life to prevent clots in the cardiac stents he received from a Cleveland doctor who is currently the subject of a federal probe.

Sixty-four year old Monica Crabtree's cardiac stent problems caused a torn artery, which resulted in an infection and her death, according to her husband. He also pursued legal action after it was determined by another cardiologist that Monica's stent was completely needless. The surviving spouse recovered $240,000 in a malpractice settlement brought against the surgeon.

FDA reports hundreds of deaths attributed to cardiac stents

Some 773 patient deaths linked with cardiac stents were logged with the FDA last year, according to Bloomberg. Though this figure has jumped more than 70 percent since 2008, with recent media coverage on cardiac stent overuse and ongoing federal investigations, cardiologists may be using fewer stents and only on suitable patients.

John Harold, president of the American College of Cardiology said the doctors who have been charged with cardiac stent malpractice or fraud are essentially "outliers" in their community, and that these surgeons fail to represent the "overwhelming majority."

[Nov 27, 2016] The likely death toll from Voixx had actually been several times greater than the FDA estimate

Nov 27, 2016 | www.unz.com
Author James Bovard has described our society as an "attention deficit democracy," and the speed with which important events are forgotten once the media loses interest might surprise George Orwell.

Consider the story of Vioxx, a highly lucrative anti-pain medication marketed by Merck to the elderly as a substitute for simple aspirin. After years of very profitable Vioxx sales, an FDA researcher published a study demonstrating that the drug greatly increased the risk of fatal strokes and heart attacks and had probably already caused tens of thousands of premature American deaths. Vioxx was immediately pulled from the market, but Merck eventually settled the resulting lawsuits for relatively small penalties, despite direct evidence the company had long been aware of the drug's deadly nature.

Our national media, which had earned hundreds of millions of dollars in advertising revenue from Vioxx marketing, provided no sustained coverage and the scandal was soon forgotten.

Furthermore, the press never investigated the dramatic upward and downward shifts in the mortality rates of elderly Americans that so closely tracked the introduction and recall of Vioxx; as I pointed out in a 2012 article , these indicated that the likely death toll had actually been several times greater than the FDA estimate. Vast numbers Americans died, no one was punished, and almost everyone has now forgotten.

[Nov 26, 2016] Fat is the Cause of Type 2 Diabetes

Notable quotes:
"... We can decrease insulin resistance, however, by decreasing fat intake. ..."
Nov 26, 2016 | nutritionfacts.org

We can also do the opposite experiment. Lower the level of fat in people's blood and the insulin resistance comes right down . If we clear the fat out of the blood, we also clear the sugar out. That explains the finding that on the high fat, ketogenic diet, insulin doesn't work very well. Our bodies become insulin resistant. But as the amount of fat in our diet gets lower and lower, insulin works better and better-a clear demonstration that the sugar tolerance of even healthy individuals can be impaired by administering a low-carb, high-fat diet. We can decrease insulin resistance, however, by decreasing fat intake.

[Nov 24, 2016] Cost of an Angiogram - Consumer Information

Nov 24, 2016 | health.costhelper.com
What People Are Paying - Recent Comments
Angiogram of heart
Amount: $55,150.00
Posted by: Pamela Garrett in Palm Springs, FL. Posted: September 1st, 2015 07:09PM
Physician: Medical Center: Jfk medical center
Had this procedure done to check heart due to abnormal stress test. Did not need any stents or any other procedure as everything was negative. I about had a heart attack when I opened the bill!!!
Was this post helpful to you? yes no Report prohibited or spam
Angiogram
Amount: $30,000.00
Posted by: StubbsMagoo in Richland, WA. Posted: January 20th, 2015 08:01PM
Physician: Doctor Korimerla Medical Center: Kadlec Medical Center Richland, WA.
My angiogram was done through the wrist area, with no stents, and was over in 20 minutes. 30 k ...really? I wish I was one of the millions in the U.S. that had no insurance to rape, then I could have gotten it for free. So now I am looking at 2k I owe immediately!!!!! This price is ridiculous and Kadlec Medical Center in Richland Washington should be ashamed and the community should be appalled. Shame on you Kadlec!!!!
Was this post helpful to you? yes no

[Nov 24, 2016] More young people contracting old-age conditions including varicose veins due to sedentary lifestyles The Independent

Nov 24, 2016 | independent.co.uk
People in their 20s and 30s are being treated for varicose veins, knee joint problems and other conditions usually associated with old age.

Bad postures and sedentary lifestyles have led to a rise in the number of younger people experiencing complaints such as back pain and haemorrhoids, according to analysis by Bupa.

Data from more than 60,000 medical procedures in 2015 was compiled by the private healthcare group .

[Nov 24, 2016] How to Fight Back Against Outrageous E.R. Bills

Two excellent resources-Healthcare Blue Book and FAIR Health-can give you estimates of how much health care services should cost in your area. Plus, your insurer's website may also provide a tool that will allow you to compare costs.
Notable quotes:
"... The ambulance company charged $6,500, including a $300 fee for the linens and a $30 charge for aspirin ..."
www.thefiscaltimes.com

It's no secret that hospital bills in the U.S.-especially ones from the E.R.-can often hit astronomical proportions.

According to a recent cost study conducted by researchers at Stanford University, the University of Minnesota, the University of California, San Francisco and the Ecologic Institute, the median charge for an emergency room trip in the U.S. comes in at $1,233. But where it really gets interesting is when you look at the specific reasons for those E.R. visits: The researchers found that the treatment price for a headache could range from $15 to a whopping $17,797. As for a sprained ankle, it could set someone back a paltry $4 or up to $24,110!

So what gives with these wildly fluctuating price points?

For starters, most emergency room prices are inflated based on the rates at which insurance companies will reimburse the hospital on a patient's behalf. That's why a single aspirin can cost $30 per pill in the E.R., which is more than six times the price for a bottle of them at the drug store.

On the flip side, patients will often contact the hospital or surgeon's billing office to ask for a cost reduction, further adding to the inconsistency in pricing. It's a practice that often works in a patient's favor, says billing advocacy specialist Sharon Salters of Medical Cost Advocatea professional medical bill negotiation service.

And then there's also the fact that most hospitals offer discounts to self-paying individuals-especially if there's a risk that they might not pay at all.

So to help shed some light on the complexities of hospital medical billing for the average consumer, we asked three people to share their craziest emergency room stories, the even crazier bills that followed-and the steps they took to remedy them.

... ... ...

The Emergency: Head Injury
The Bill: $9,000

A few months ago, Amanda Harris, 27, of Morristown, N.J., fainted at work, hitting her head in the process. Due to liability concerns, her production company required Harris to take an ambulance to the emergency room, despite her refusal. "I didn't even have a cut on my head, just a slight bump. No headache, no nausea, no confusion, nothing," she says.

Harris waited for over an hour in the E.R. before her husband told the nurse that they were leaving. Minutes later, a doctor spoke to Harris for under a minute, confirming that she was fine to go. "He didn't do any tests-no light in my eyes, no blood pressure," says Harris. "I left thinking I wouldn't even get a bill."

But the bill did come-all $9,000 of it. The ambulance company charged $6,500, including a $300 fee for the linens and a $30 charge for aspirin. The E.R. billed the remaining $2,500. "My mouth literally dropped open when I saw the cost," she says.

RELATED: Hospital Costs Explode: Between $127 and $151 Billion

What This Patient Did: Harris called her insurer and fought the bill. Luckily, her insurance covered all but a $3,000 deductible-but she was too exhausted to push for more. "I've always heard emergency room visits were costly, but $9,000 for nothing more than a conversation that lasted one minute? That's robbery," she says.

What the Expert Says: Even though Harris didn't want to take an ambulance, Salters says that her company's suggestion was well-advised. "However, she should consider working with her employer to file the claim with her company's worker's compensation carrier," says Salters. "Employers often try to stay away from filing a claim under worker's compensation, so it does not impact their experience rating or trigger an [occupational safety and health administration] review, but it would save her money."

[Nov 24, 2016] Legislature's ambulance bill is too costly

Notable quotes:
"... Price-gouging by ambulance services, including those run by municipalities, was always a disreputable exercise, preying on people who suffer emergency illnesses or injuries. ..."
"... The federal Medicare rate isn't usually high enough to cover all the ambulance costs, so the Legislature is right to go above it. But 300 percent is too high. ..."
The Boston Globe

When the Legislature finally produced a measure to prevent ambulance companies from gouging out-of-network patients and their insurers, it set a limit of 300 percent of the federal Medicare reimbursement rate or the ambulance's regular fee, whichever is lower. This is a ceiling that might function more like a floor, pushing ambulance firms to raise their rates to 300 percent of Medicare. It's a bad idea.

Price-gouging by ambulance services, including those run by municipalities, was always a disreputable exercise, preying on people who suffer emergency illnesses or injuries. And when insurers decided to fight back by reimbursing patients a set amount, rather than pay whatever the ambulance demanded, they, too, threw patients under the wheels: Ambulances expected the patients to make up the difference between the insurers' rate and the ambulance's. Few situations better illustrate patients' frustrations with the health care system.

So the unwanted task of deciding on an appropriate level of reimbursement fell to the state. And it should surprise no one that both insurers and ambulance services are lobbying for the best possible deal, while grumbling about government interference. Fire departments and other municipal offices that operate ambulances are hoping their friends in the Legislature can deliver a generous fee.

The federal Medicare rate isn't usually high enough to cover all the ambulance costs, so the Legislature is right to go above it. But 300 percent is too high. Patrick should veto the bill and ask the House and Senate to send it back to him with a lower price ceiling.

[Nov 23, 2016] 7 Tips For Fighting And Paying A Big Hospital Bill

Notable quotes:
"... Also consider using Medicare rates as a guide; the federal health system for people 65 and older typically has the lowest reimbursement rate for hospitals and medical providers. Your hospital may not agree to charge you its Medicare fee, but this figure is a good starting point for any negotiation. ..."
"... don't hesitate to appeal its decisions. You'd be surprised how often carriers overturn their earlier rejections. ..."
Sep 17, 2013 | www.forbes.com

Conversely, you may be able to wrangle a cash discount for agreeing to pay your entire cost at once.

You may also be able to successfully bargain down the particular dollar amounts you've been charged.

Tell the billing department that if your insurance requires, say, a 20% co-payment to the hospital, you'll pay only 20% of the insurer's negotiated rate with that hospital. That's usually far less than the initial rate quoted - the figure charged to uninsured patients.

Go online to check the rates other local hospitals charge for the procedure you had. Then, if you find your bill was way out of line, use this data as ammunition to try to get your fees lowered. You can get this type of information at such sites as Clear Health Costs, Healthcare Blue Book and FAIR Health.

Also consider using Medicare rates as a guide; the federal health system for people 65 and older typically has the lowest reimbursement rate for hospitals and medical providers. Your hospital may not agree to charge you its Medicare fee, but this figure is a good starting point for any negotiation.

2. Vigilantly review the bills. "It's very common for hospital bills to contain errors and overcharges, so make sure you've actually received the services they said you did," Detweiler says.

Candice Butcher, vice president of Medical Billing Advocates of America, says if you're discharged in the morning (as most patients are), protest if you're socked with a full daily-room rate for the date you left the hospital.

And if you brought your medications with you, make sure you weren't charged for them by the hospital. "This frequently happens," Butcher says.

Also, dispute any additional fees on the bill for routine supplies, like gowns, gloves or sheets. These items should be factored into the hospital daily-room charge, because, Butcher says, they are "considered the cost of doing business."

3. Challenge your health insurer's decisions, when warranted. Keep track of any hospital bills the company rejects on grounds that the procedure or drug isn't covered by your policy. If you believe the insurer should be paying more, don't hesitate to appeal its decisions. You'd be surprised how often carriers overturn their earlier rejections.

4. Negotiate bills once you know how much you'll have to pay out of pocket. If you just want extra time to send the money, Dale says, "it is relatively easy to speak with hospital or clinic business office staff to arrange a payment plan."

Conversely, you may be able to wrangle a cash discount for agreeing to pay your entire cost at once.

You may also be able to successfully bargain down the particular dollar amounts you've been charged.

Tell the billing department that if your insurance requires, say, a 20% co-payment to the hospital, you'll pay only 20% of the insurer's negotiated rate with that hospital. That's usually far less than the initial rate quoted - the figure charged to uninsured patients.

Go online to check the rates other local hospitals charge for the procedure you had. Then, if you find your bill was way out of line, use this data as ammunition to try to get your fees lowered. You can get this type of information at such sites as Clear Health Costs, Healthcare Blue Book and FAIR Health.

Also consider using Medicare rates as a guide; the federal health system for people 65 and older typically has the lowest reimbursement rate for hospitals and medical providers. Your hospital may not agree to charge you its Medicare fee, but this figure is a good starting point for any negotiation.

5. Consider hiring a pro. Since hospital bills are hairy, messy beasts, it may be worth your while to bring in a patient- or medical-billing advocate (Detweiler recommends the advocacy firm Copatient.com, which charges 30% of what it saves you) or an attorney. "It's like hiring a CPA to do your taxes," Dale says.

Be sure you won't be required to pay this expert any fees upfront. Patient advocates typically charge 20 to 30% of your savings; some put a cap on their fees. Karis' firm, for example, charges no more than $3,000. Attorneys often charge 30% of the savings they achieve.

... ... ...

Caroline Mayer is a consumer reporter who spent 25 years working for The Washington Post. Follow her on Twitter TWTR -0.69% @consumermayer.

[Nov 23, 2016] How Can I Negotiate A Sky-High Ambulance Charge On My Medical Bill

Notable quotes:
"... My husband suffered a heart attack when we were on vacation, and I called an ambulance. He's OK now, but we've been billed more than $6,000 for his 15-minute ride to the hospital. As it turns out, the ambulance service wasn't in our health insurer's network, so they paid only a small portion of the bill. We're making small payments on the balance, but the initial bill seems so high. The collector calls all the time to demand we pay the balance in full. Is there anything we can do to get the bill looked at and possibly lowered? ..."
"... Fortunately, medical bills are not always set in stone, and there may be ways for you to negotiate a lower balance. ..."
"... I recommend you first review an itemized copy of the bill for any errors. Look for duplicate charges, inaccurate service dates or incorrect mileage. If you spot any errors, take it up with the billing department immediately. ..."
"... Standard practice for insurers is to negotiate with providers to pay merely a fraction of the cost. ..."
"... Medicare negotiates, on average, a 73% discount. ..."
"... Negotiating with an ambulance service or any medical provider is not easy, but it is possible. Be persistent. If your efforts prove fruitless, you can always consider hiring a professional ..."
| www.forbes.com

... ... ...

Question:

My husband suffered a heart attack when we were on vacation, and I called an ambulance. He's OK now, but we've been billed more than $6,000 for his 15-minute ride to the hospital. As it turns out, the ambulance service wasn't in our health insurer's network, so they paid only a small portion of the bill. We're making small payments on the balance, but the initial bill seems so high. The collector calls all the time to demand we pay the balance in full. Is there anything we can do to get the bill looked at and possibly lowered?

Answer:

I'm glad to hear your husband is recovering, but I am sure the stress of an unexpected medical bill isn't helping him heal. Ambulance bills are notoriously costly, but yours seems to be inflated. Fortunately, medical bills are not always set in stone, and there may be ways for you to negotiate a lower balance.

I recommend you first review an itemized copy of the bill for any errors. Look for duplicate charges, inaccurate service dates or incorrect mileage. If you spot any errors, take it up with the billing department immediately.

Even if the bill is correct, you should still set up a time to speak with someone in the billing office-someone with the authority to negotiate on your balance. Go into the conversation equipped with the knowledge that Medicare and insurance companies rarely pay the hefty price tags that consumers see.

Standard practice for insurers is to negotiate with providers to pay merely a fraction of the cost. In the case of inpatient hospital bills, for example, a NerdWallet study found Medicare negotiates, on average, a 73% discount. While the ambulance service may not agree to such a large discount for you, coming to any negotiation equipped with such knowledge will put the company on notice that you aren't going to lay down and take its bullying or an inflated bill.

... ... ...

Negotiating with an ambulance service or any medical provider is not easy, but it is possible. Be persistent. If your efforts prove fruitless, you can always consider hiring a professional . A medical billing advocate is able to represent clients' interests much in the way an attorney would advocate for you in a courtroom. Their experience and expertise in the field can sometimes prove more effective (and less stressful) than taking on a stubborn provider alone.

See also

[Nov 23, 2016] 7 Steps in Appealing a Health Insurance Denial

Notable quotes:
"... As a practicing physician who is fed up with the way insurance carriers have managed to take over the delivery of health care in this country, my comments, I warn you, will be brutally frank. The way the game is played, the providers of health care bill as much as they believe they can get away with. ..."
"... That's because they are in business to make money - that's why it's called "for profit" health care. The insurance carriers try their damn best to find excuses to not pay as many of these charges as they can. Same reason. These two conspirators become co-conspirators when they play the game of "crap runs down hill". ..."
"... So here's my advice. Don't pay any "balance billing" no matter what they choose to call it. Activate the pump that sends the crap back uphill. Write letters to the provider asking for specifics as to the balance billing. ..."
Nov 23, 2016 | blogs.nytimes.com
MJ Columbus OH July 12, 2011

Unfortunately sometimes the only way to get around denial of precertification is to ask your doctor to lie. I had an MRI after a fainting episode that showed possible MS, which runs in my family. All other diseases were excluded. The medical recommendation is to get a follow-up MRI in 6-months. Because I wasn't having active symptoms, the follow-up MRI was not precertified when ordered by my neurologist. I went to my family physician for help, she requested the MRI, saying I was having headaches (everybody gets one occasionally, right?). I immediately got the necessary MRI and am now being treated. I think the insurance company didn't really want to deny the MRI, they wanted to delay expensive treatment, which was the likely outcome.

o'keefe illinois July 12, 2011

I am currently appealing a claim with HealthLink. Too long to go into but it involves an Intensive Outpatient Treatement program for my 20 year old son. There own guidelines state that this may well be the best initial choice for treatment. However, they advised us when they would not precertify that he needs to fail at out patient treatment and community support. Really? So I get to the External appeal process. Healthlink contracts with MCMC to provide the physician to do the reveiw. Can we say conflict of interest? She spits out the same verbage used to deny the precertification but mentions criteria that is no longer being used to asses such cases. Or and then there is the mention of my son's "wearable cardioverter defibrillor" has nothing to do with our case. So I appeal to the State of Illinois (eye roll) and am told I cannot appeal a denial of a precertification. I must have a denied claim. OK, but I can't get to the denied claim as HealthLInk won't even percert the care. Who are these people?

Clint N. NYC July 12, 2011

I recently had to deal with the insurance company VS primary care provider VS patient VS lab test provider. Its a cluster-expletive. Even trying to keep track of who said what when is difficult. Not too mention the hours upon hours of your precious time it *will* consume.

Short summary:

I had a severe flu (possibly swine flu) and made a doctor's appointment. They were very busy and couldn't see me for 2 weeks. When I came in for my appointment, I had recovered from the flu. My appointment was reclassified as well-care. My job's health insurance plan was revised two months prior to exclude well-care. I was now on the hook for 100% of the cost of the visit. The doctor ordered a full blood work since I was a new patient.

I realize it was my fault that I didn't know well-care wasn't covered. Lesson learned - I've read my EOB a couple times now, cover to cover. Unfortunately, I still only kind of know what is covered.

Anne Marie Bryn Mawr, Pa. July 12, 2011

As a practicing physician who is fed up with the way insurance carriers have managed to take over the delivery of health care in this country, my comments, I warn you, will be brutally frank. The way the game is played, the providers of health care bill as much as they believe they can get away with.

That's because they are in business to make money - that's why it's called "for profit" health care. The insurance carriers try their damn best to find excuses to not pay as many of these charges as they can. Same reason. These two conspirators become co-conspirators when they play the game of "crap runs down hill".

That's when they come up with things like "co-pays", "deductibles", "co-insurance", and a whole host of creative ways of attempting to coerce the patient to pick up the tab.

So here's my advice. Don't pay any "balance billing" no matter what they choose to call it. Activate the pump that sends the crap back uphill. Write letters to the provider asking for specifics as to the balance billing.

Don't accept their response. Write again. Write to the insurance carrier and appeal.

Then write the provider with the appeal number from the insurance company. Keep it going round and round. If contacted by a collection agency, write back explaining your appeals and that your financial condition won't allow you to pay without getting a disposition from your claim, and a better explanation from the provider as to why the procedure wasn't covered. Tell them to not contact you again. Tell them that you refuse to pay until you get a decent explanation. Dare them to sue you. CC a law firm on all correspondence. Make the providers get hurt enough to fight against the carrier. Bust up their friendship. Neither will hire a lawyer to get you. The publicity is the only thing they are afraid of.

KR NYC July 11, 2011

I am in the process of filing a claim for the first time ever. Cigna denied coverage for an operation after the fact. This was not even a marginal case, it was an obvious medical need. I suspect that insurance companies simply play the odds, deny and spread the costs to hospitals, surgeons, patients and maybe themselves. A lot less than paying the whole thing. This has nothing to do with medicine, as I have discovered. It is about how to boost revenues and damn fairness and the patient. Plan to fight and publicize my fight. This is as clean cut a case that can be found.

Walter San Diego, CA July 11, 2011

Having handled over 4000 health care appeals over the past 15 years, this article is a pretty good basic overview (so long as most of the Comments are ignored). The Affordable Care Act may ultimately be helpful in making this hodgepodge of rules more uniform, but that remains to be seen. The ultimate message for patients must remain clear: It is imperative to FIGHT for the care you need using all available resources and expertise at your disposal!

Frederick Willman Madison, WI July 11, 2011

One more reason why we must furiously resume pushing for medicare for all to replace the GOP health solution of just die folks.

FW
Madison, WI.

Lisa NYC July 11, 2011

#7 is correct: it is a game to the health insurance companies. They routinely deny perhaps 40% of all claims thinking that most people will just shrug off the denial and go away. The key is to keep calling, resubmitting and fighting the portion that they have denied. I have received initial denials for the most ludicrous reasons: the doctor retired; there is no such doctor at that address, etc... It is a game designed for the health insurance companies to win UNLESS you fight back.

Mollace Toledo, Ohio July 11, 2011

"If you feel too frail or overwhelmed to pursue an appeal yourself, nonprofit groups like the Patient Advocate Foundation can provide guidance for free."

A single person battling a life-threatening illness or condition is, of course, going to be overwhelmed and frail. Insurance companies bank on it. My suggestion is to start with advocacy first. Insurance companies make things difficult because they are in the business of making money, not helping patients. They want you to give up. When you have another person or two in your corner everything moves along better. Especially when the advocate knows how to fight hard and isn't afraid to speak frankly. There are witnesses to what is happening and you are taken more seriously.

It is ironic that there is now Health Proponent, a company that will fleece you in order to "advocate" for you. Only in America, folks.

Susan is a trusted commenter Eastern WA July 11, 2011

I had to have all my teeth extracted before I could begin treatment for throat cancer. I did not have enough dental insurance, and the oral surgeon's office told me that medical had informed them it would not pay the remainder.

I contacted mymedical insurance company, which recommended that I wait for a denial and then appeal. I pointed out that by that time I would be quite sick from the radiation, and would like to deal with it while I was still capable. Turns out there is a board that considers these things, so I had both of the oral surgeons, my oncologist, and my ENT all write letters to this board. The medical insurance company paid for the whole thing, since it was proven to be a medical necessity.

Now, if we could just get the oral surgery place to refund all that we paid, plus the dental insurance, so that the dental insurance can in turn use my benefit to help repay us for the dentures . . .

Michael in Vermont North Clarendon, VT July 11, 2011

This happens all the time. There are gajillions of codes used by the insurance companies. If your healthcare provider uses an incorrect code, then the insurance company won't pay the bill. Call the insurance company and find out what the codes should be. Then call or visit your health care provider and bring them up to date on the codes. Blue Cross and Blue Shield have all of their codes listed on their Internet site.

tough old bird Virginia July 11, 2011

sounds like Chinese water torture.

Harry St. Louis, MO July 11, 2011

You start off with the most important thing in any claim or grievance, and in almost any business deal - get it (and put it) in writing!

All the phone calls in the world will not help you but just trip you up. (And if you have to hire an attorney, this will save time and money.)

Robert Leff Cambridge, MA July 11, 2011

I have a friend who broke his back in a car accident and as a result has had ongoing medical issues. He told me that he treats the denials as a game. You submit the entire claim, they reject part of it, you resubmit the rejected part, they pay part and reject part, and you keep on going until you get your money. It seems cruel, but an insurance company's profit is the amount of money each year that they do not pay out in claims, so the incentive to deny is very strong.

Caught in the Middle Tenafly, NJ July 11, 2011

After some back and forth, Medicare paid its share of a claim that I, rather than my doctor, submitted,
I then submitted the claim to my secondary insurer who, after further back and forth, said that it could not pay the claim because it had been agent for my former employer and no longer had access to the employer's funds. The employer in turn, after more back and forth, says it plans tosubmit this and other claims to the current secondary employer for payment rather than pay them directl y. The process seems to go on forever.

mary browning is a trusted commenter miami beach, FL July 11, 2011

Good heavens, why should it take instructions that would require a graduate degree? In other countries none of this mess would be required. Disgraceful.

If you are sick and don't feel up to doing things, how, indeed could you do what you are said to do to simply get what is required or due to you?

George Eliot Annapolis, MD July 11, 2011

Stop. Just sue them and put them on the defensive. Denial of claims is the way the criminal health insurance companies provide record salaries to the gangsters who run the companies, and big dividends to their share holders.

All hail the American Plutocracy!

Barry New Jersey July 11, 2011

Appealing a health insurance denial which involves a substantial financial liability can be viewed like any other do-it-yourself endeavor. If you are comfortable handling a matter upon which, say, $75,000 or more is at stake (which is not uncommon), good luck. On the other hand, if the stakes are high, you may want consider having it handled by an attorney who specializes in this area of practice

TB is a trusted commenter Philadelphia July 11, 2011

As someone who went through this process recently, I would make the following suggestions:
1) Be very legalistic in your approach to the appeal, and quote appropriately from the policy and from law (this of course assumes you have a solid legal basis for your appeal).
2) Inform the insurance company in writing that if they require a full appeal, you will hire legal counsel to research and document your appeal.
3) Remind the insurance company that under ERISA, if you ultimately win, you are entitled to reimbursement of your legal fees and expenses.

This won't win obviously if you are on shaky legal ground. But if the insurance company is on shaky ground and just trying to avoid paying a claim (which was the case with us), this sort of saber rattling can help resolve the question quickly before you end up in a formal appeal. The insurance company doesn't want you to hire a lawyer if you have a good chance of winning.

stevesw1 Baltimore, MD July 11, 2011

Assistance with appeals and grievances from denials of health insurance claims is a service that many state Attorneys General provide for free, so check with your Attorney General's office before paying someone to assist you with the process.

[Nov 22, 2016] Hiring a Guide to the Medical Bill Maze

Notable quotes:
"... As part of her husband's benefits package, Isaac had access to a medical billing assistance company called Health Advocate . It negotiated with the physician's health-care group to reduce her bill to $7,000. ..."
Apr 29, 2013 | Bloomberg

When Annrose Isaac's twins were born prematurely, she thought her insurer would cover their stay in the neonatal intensive care unit. "The hospital was in our network, but it turned out the physician in the NICU who saw our daughters didn't participate with our insurer," says the Westwood (New Jersey)-based financial planner. "All of a sudden we were getting bills for over $30,000."

As part of her husband's benefits package, Isaac had access to a medical billing assistance company called Health Advocate. It negotiated with the physician's health-care group to reduce her bill to $7,000.

More than 60 percent of all U.S. personal bankruptcies are linked to illness and unpaid medical bills, according to a 2009 Harvard University study, even though 78 percent of those filing for bankruptcy because of illness have some form of health insurance. So hiring a medical billing advocate can be an essential part of the cure to financial ills.

Yet finding the right advocate can be tough, and those in the direst situations can ill afford the typical $75- to $130-an-hour rate. "This business is painfully slow-growing," says Becky Stephenson, co-president of the Alliance of Claims Assistance Professionals (ACAP), an advocate trade group. "There are a lot of people with problems but not a lot of people willing to pay you to help them." Despite long experience, Stephenson herself has trouble making a good living purely from advocacy, so she supplements her income by serving as an expert witness in medical lawsuits.

Employees working at sizable companies may already have access to a health advocate. Just over half of U.S. companies with more than 500 employees offer it as a benefit, according to Steven Noeldner, a senior consultant for Mercer's Total Health Management practice. Many employees don't know the benefit exists, he says, and the services generally aren't as customized as those of an independent billing advocate.

Credential Check

Unlike with more established professions such as accounting or law, there is no standard credential to look for when seeking a qualified advocate. At the most basic level you should ask if an advocate has certifications in medical bill coding from either the American Academy of Professional Coders or the American Health Information Management Association.

Many people with those designations aren't advocates, however, working instead for hospitals or insurers. And understanding the codes is only half the battle. Because of the complexity of our health-care system, you'll need someone who specializes in your specific kind of billing problem.

A good place to start is Claims.org, ACAP's website. It lets you search for experienced advocates by state. In a case like Isaac's, you'd need someone who specializes in hospital bills. Other advocates specialize in Medicare appeals, long-term care insurance, workers' compensation and insurance for special needs children.

Privacy Issues

The best way to find the right specialist is to ask the advocate for a resume and references. This can be tricky, because laws about disclosing private medical information are so strict that some advocates have difficulty providing references. In order to do so, their clients must agree to discuss their medical history.

Stephenson specializes in hospital bill audits. She studies itemized bills line by line, identifies padding and mistakes and negotiates lower rates. Prior to starting her Austin (Texas)-based advocacy firm VersaClaim in 2002, she ran an organization that helped doctors affiliated with hospitals set up their practices. That included all aspects of hospital billing.

A registered nurse for 12 years, Stephenson has an intimate knowledge of medical terminology and hospital procedures. "I ask questions like, Are there dosages of medications that are not compatible with my medical experience in real life?" she says. "Do the charges look realistic, or is there an $85 Tylenol?"

Location Matters

Another important factor to consider is an advocate's location. State laws vary in how they regulate insurers and hospitals. For Katalin Goencz, an advocate in Stamford, Connecticut, location is often irrelevant because she specializes in Medicare appeals: "The rules for Medicare are federal and pretty much universal, so the client's location doesn't really matter."

For a patient negotiating a lower bill directly with a local hospital or private insurer, having an advocate who knows the specific state regulations helps. State rules for advocates can also vary dramatically. Florida has some of the strictest. "Due to the large senior population in our state, we have a strong urge to make sure our people adjusting medical claims are licensed, competent and held to a high standard," says Matthew Guy, a spokesman for Florida's Division of Agent and Agency Services, which licenses and regulates advocates.

The state's Public Adjuster license for advocates requires licensees to be fingerprinted, have a criminal background check and hold a $50,000 surety bond. "If there's any wrongdoing by the adjuster, we can take the bond amount and use that towards restitution for the consumer," Guy says. Adjusters must pass an exam and take 24 hours of continuing education classes every two years.

Contingency Basis

A handful of advocates will work on contingency if they think you have a negotiable claim. Most will impose strict conditions to ensure they get paid if they win. "When I started my practice, I did everything on contingency but learned very quickly that a lot of consumers who want you to take their case on contingency in the end don't want to pay you," says Sheri Samotin, a billing advocate at Life Bridge Solutions in Naples, Florida.

Now Samotin requires a credit-card authorization up front for an amount sufficient to cover what her estimated contingency fee will be if her work succeeds. If the client doesn't pay within 10 days of a settlement being reached, she charges the card. Her fee is 35 percent of the client's medical bill savings.

Samotin is unusual in the advocacy world as she is more of a generalist, taking on all kinds of medical billing problems, including those of the uninsured. She has 25 years of experience in the health-care industry, so she has the knowledge to handle different kinds of problems, Samotin says. For a monthly $285 fee she will manage her clients' entire billing life -- a common need for seniors who have lost their capacity or desire to manage daily finances.

Instead of being a member of ACAP, Samotin is a member of the American Association of Daily Money Managers, a trade group for generalists. Only a handful of the AADMM's 700-plus members have the skills to also handle medical billing advocacy, Samotin says. Nor does she expect rapid growth in the field.

"Because this is a disorganized profession, people entering the field have to be entrepreneurs," she says. "They have to hang out their shingle and go out and get clients. In my experience, the majority of people who are good medical analysts and advocates are not necessarily good business getters."

So until the profession matures, finding a good advocate will remain difficult, no matter how vital the service is.

(Lewis Braham is a freelance writer based in Pittsburgh.)

To contact the editor responsible for this story: Suzanne Woolley at swoolley2@bloomberg.net

[Nov 22, 2016] Negotiating can cut hundreds off your medical bills

Notable quotes:
"... There are also companies who claim they have a network of physicians throughout the state who offer medical services for 50 percent off or more. ..."
13 WTHR Indianapolis
But you can fight back against skyrocketing medical costs.

"I've heard discounts up in the area of 30 percent sometimes, which can be pretty significant," said Cathryn Perron, director of program development with Consumer Credit Counseling.

She says it's possible to negotiate down your medical bills - everything from ambulance rides to surgery. She says you can also bargain with your dentist, the lab that does your blood tests, the eye doctor - even the company that makes you prescription medication.

"Each company has a specific number you can call to fill out an application and many times, you'll get a discount, or you'll get the product free through the drug companies, if you qualify financially," Perron said.

All you have to do, with or without insurance, is make a call. Each case is handled differently. In most cases, everyone wants to pay the bill, but they're afraid to contact their doctor or hospital. They'll work with you to make sure the cost is paid.

So how do you pay less?

There are a number of options:

Charity care - Bills are forgiven, based on your income and expenses, but you'll have to fill out hardship paperwork.

"You'll most likely have to provide proof of income, they'll ask about your monthly living expenses and your other bills that you have to pay every month," said Perron.

Sholar called Indianapolis EMS.

"He says, 'Sir, you got to pay for the ambulance, all the stuff in the ambulance, the two people who drive the ambulance. That's just the way it is'," he said.

But he didn't give up.

"This bill says $1,300. She said, 'Yeah, that sounds about right.' I said, 'Let me talk to a supervisor'," Sholar said. "The supervisor's name is John. John wasn't too happy."

Mike put on the pressure and the bill was reduced by $532. The wounds to his buttocks are healed, but the other injury he got that night, on his thumb, is a constant reminder of the cost of healthcare.

"I don't need no X-rays, I don't need no other stuff. Just give me the stitches and I still haven't received a bill for that," he said.

But he's ready to negotiate and he says, in the future, he'll also weigh the costs before calling 911.

"I would have put a rag over it and got a ride here," he said.

Tips to Negotiate Your Medical Costs

Consumer Credit Counseling and Apprisen offer tips to get your medical bills reduced:

First and foremost be informed. Understand what type of medical insurance coverage you have and what your co-pays or financial responsibilities are. Some insurance companies have contracts with certain medical providers to offer a discount if you receive treatment from a "preferred provider." We encourage individuals to meet with their Human Resource department or contact their insurance company to speak with a representative about their coverage and benefits prior to receiving medical treatment. This could reduce your financial responsibility significantly.

Apprisen recommends for you to review your itemized statement from your medical provider. If you feel there are discrepancies or charges in question, contact your medical provider to meet with their Patient Account Specialist to discuss your questions or discrepancies. Communication is a vital part of resolving your issues. Simply ignoring communication from your medical provider will not resolve the issue and could potentially lead to a negative impact on your credit rating if resolution is not reached.

Whether you have insurance or not, you are encouraged to contact your medical provider prior to treatment (if possible) to discuss costs associated with your treatment and to work out the possibility of negotiating those costs down. Many medical providers will consider giving discounts to individuals who are willing to pay the balance in full upon services rendered or within a short period of time after receiving treatment. If you find yourself in a position where you are not able to pay the balance in full, consider negotiating with your medical provider for a monthly repayment plan interest free. You are encourage to analyze your personal budget to insure you are able to make the financial commitment to your medical provider. Negotiating your medical bill then failing to follow through with the financial payment arrangement could negate your hard effort to reduce your medical bill.

If you are uninsured, you are encouraged to meet with a Patient Account Specialist or a "decision maker" to see if you qualify for any financial hardship programs. Most hardship programs require you to provide evidence of your financial situation and the award is based on financial need. Be prepared to give a full budget disclosure in order to be considered for the hardship program.

Apprisen's mission is "To help people improve their financial well-being through counseling, community outreach and financial education."

You can call Apprisen at 1-800-355-2227 or visit apprisen.com.

There are also companies who claim they have a network of physicians throughout the state who offer medical services for 50 percent off or more. You can find out more about those companies at objectivedx.com.

[Nov 21, 2016] Pharmaceutical Executives Indicted: Protectionism Leads to Corruption

Notable quotes:
"... Every economist in the world can quickly explain how a 10 percent tariff on imported steel will lead to corruption. The same logic applies to drug patents, although since they are the equivalent of tariffs many thousand percent (they typically raise the price of protected drugs by factors of ten or even 100 or more), the incentives for corruption are much greater. ..."
"... kickback scheme between a major drug manufacturer and a mail order pharmacy. ..."
"... Gary Tanner, the former Valeant executive, entered into a secret relationship with Philidor's chief executive, Andrew Davenport, federal authorities said. ..."
Nov 19, 2016 | economistsview.typepad.com

anne : November 18, 2016 at 05:00 AM , 2016 at 05:00 AM

http://cepr.net/blogs/beat-the-press/pharmaceutical-executives-indicted-protectionism-leads-to-corruption-43-641

November 18, 2016

Pharmaceutical Executives Indicted: Protectionism Leads to Corruption #43,641

Every economist in the world can quickly explain how a 10 percent tariff on imported steel will lead to corruption. The same logic applies to drug patents, although since they are the equivalent of tariffs many thousand percent (they typically raise the price of protected drugs by factors of ten or even 100 or more), the incentives for corruption are much greater.

This is why every economist in the world should have been nodding their heads saying "I told you so" when they read this New York Times article * about a kickback scheme between a major drug manufacturer and a mail order pharmacy. Unfortunately, there were no economists mentioned in this piece. And, it is quite possible that most economists support this form of protectionism, in spite of the enormous inefficiency and corruption that results. (Yes this is a major point in my free book, "Rigged: How Globalization and the Rules of the Modern Economy Were Structured to Make the Rich Richer." ** )

* http://www.nytimes.com/2016/11/18/business/valeant-philidor-fraud-kickback-scheme.html

** http://deanbaker.net/books/rigged.htm

-- Dean Baker

anne -> anne... , November 18, 2016 at 05:06 AM
http://www.nytimes.com/2016/11/18/business/valeant-philidor-fraud-kickback-scheme.html

November 17, 2016

Former Valeant and Philidor Executives Charged in Kickback Scheme
By KATIE THOMAS and MATTHEW GOLDSTEIN

Gary Tanner, the former Valeant executive, entered into a secret relationship with Philidor's chief executive, Andrew Davenport, federal authorities said.

[Nov 07, 2016] The Cigna CEO took home $49 million in total comp last year – and wasn't the highest paid Cigna executive

www.nakedcapitalism.com

Knifecatcher November 7, 2016 at 2:59 pm

Today our HR department revealed the "new and improved" 2017 benefits package… and it's massively crapified. But good news! The "High Deductible Health Plan" is now a "Consumer Driven Health Plan" thanks to our good friends at Cigna, who kindly reminded us that we just haven't been doing our part as active health care consumers to help reduce health care costs. Because the real problem with health care today is obviously branding.

Knifecatcher November 7, 2016 at 3:27 pm

The consultant they brought in to dump this on us actually said "most people spend more time shopping for the best price on shoes than they spend shopping for the most cost-effective health care."

I had the temerity to point out what I've learned from firsthand experience – that there is NO WAY TO KNOW what a provider will charge for a particular procedure beforehand. The response was that they'd follow up with me later. :)

Apropos of nothing, the Cigna CEO took home $49 million in total comp last year – and wasn't the highest paid Cigna executive.

Waldenpond November 7, 2016 at 5:26 pm

Have you seen the commercial where a female basketball player is goofing off for her child in the house… falls and injures herself. Later she's in a sling and grabbing a small trampoline and in response the 'husband' is on the phone. I guess the inference is he's calling the insurance company but I think it makes more sense to be calling for a price check.

The next time you have a compound fracture, remember to stay calm, and get the best price.

Tvc15 November 7, 2016 at 3:28 pm

And my company is offering a new 2017 "benefit"; Critical Illness Insurance to provide financial protection for an illness such as cancer, stroke or heart attack.

Uh, okay, I thought that is why I pay $6,000 / yr for my high deductible medical plan, not including company subsidy, dental or vision.

Maybe they should have asked marketing to help with the branding.

jrs November 7, 2016 at 3:38 pm

I think it's not actually for medical costs in most cases. It's for the cost of say not being able to work due to cancer and so on. Or that's what I've seen out there, obviously I don't know about your particular plan.

Waldenpond November 7, 2016 at 5:33 pm

Check the policy. Some policies are very specific in that they will include specific cancers and exclude others. The additional can cover illnesses not covered by the initial contract, lost wages, support, and unemployment in case your employer fires you. It may apply to Cobra costs in case of job loss so a person can maintain continuity of care.

Knifecatcher November 7, 2016 at 4:03 pm

We got that too, along with a number of other optional programs. My assumption is that once you get past medical, dental, and vision all those other post-tax "benefits" (pre-paid legal, long term care insurance, etc) are just profit centers, and that the provider gives the employer a kickback for allowing them access to a captive customer base – with payments automatically deducted from each paycheck! I don't know that for sure, but it's the only explanation I can see as to why HR pushes those so hard.

[Nov 01, 2016] Guillotine Watch, Health Care Edition

Nov 01, 2016 | www.nakedcapitalism.com
allan November 1, 2016 at 8:36 pm

Guillotine Watch, Health Care Edition

Divorce trial 'lifestyle analysis': Ex-wife needs $5 million a year [Chi Trib]

With multiple homes, a full-time private chef, vacations, entertainment and $746 for pet care, Alicia Stephenson needs more than $400,000 a month to meet her living expenses, according to testimony from a financial expert who specializes in divorces.

Cathleen Belmonte Newman, a certified divorce financial analyst, said she completed a "lifestyle analysis" to determine that Stephenson would need $433,991 "net" in monthly maintenance to keep up a standard of living similar to what she had during her marriage to Richard Stephenson, the multimillionaire founder of the Cancer Treatment Centers of America hospital network. …

Much of the trial, now in its third week, has featured testimony from Alicia Stephenson's friends and business associates who have outlined her lavish lifestyle during the marriage: trips on private jets, several homes complete with staff and high-end furnishings and artwork, millions of dollars in jewelry, couture clothing, fancy parties, expensive vehicles, motorcycles and yachts. …

All paid for by cancer patients and, truth be told, by their insurance companies.

Edit: from a comment on the article, a story about CTCA:

http://scienceblogs.com/insolence/2013/03/07/the-cancer-treatment-centers-of-america-cherry-picked/

[Oct 25, 2016] Cholesterol Down Ten Simple Steps to Lower Your Cholesterol in Four Weeks--Without Prescription Drugs

Oct 25, 2016 | www.amazon.com
by Janet Brill

5.0 out of 5 stars /span> By Kelly Jadon on September 28, 2008 Format: Paperback

10 Simple Steps To Naturally Lower Your Cholesterol From: [...]

Book Review: Cholesterol Down by Dr. Janet Brill

Cholesterol Down is for the 105 million Americans who have high cholesterol. The author, Dr. Janet Brill, a registered and licensed dietitian/nutritionist, exercise physiologist, and certified wellness coach has spent years counseling patients on cardiovascular disease prevention, researching, and writing on the subject of cholesterol. Her work has been published in the International Journal of Obesity and the International Journal of Sport Nutrition.

Cholesterol Down provides readers with the information they need regarding cholesterol -- what it is and how it works both for and against the body. It is significantly endorsed by Dr. Jennifer H. Mieres, the National Spokesperson for the American Heart Association. She states, "The simple, consistent, and inexpensive lifestyle therapy outlined in her {Dr. Janet Brill's} Cholesterol Down Plan could be the most important investment you make in your future health." Dr. Brill explains LDL, the bad portion of cholesterol, and offers an effective combination therapy of foods, scientifically based, that are as effective as statins. Besides lowering LDL, the following ten-step program also offers further health benefits.

First, eat 1 cup of oatmeal every day. The U.S. Department of Agriculture recommends three whole-grain servings daily. This is linked to reduced risk of heart disease, stroke, type 2 diabetes, obesity, some cancers, lower blood pressure, and improved bowel movement. Oatmeal lowers LDL, may raise HDL--the good portion of cholesterol, and studies show that the more consumed, the greater the benefit.

Second, eat a handful of almonds daily, approximately 30. Read more › 2 Comments 238 people found this helpful. Was this review helpful to you? Yes No Sending feedback... Thank you for your feedback. Sorry, we failed to record your vote. Please try again Report abuse

5.0 out of 5 stars /span> By Dr. Jonathan Dolhenty on February 17, 2007 Format: Paperback
Must Reading for Those Interested in Their Health I have a personal interest in this particular subject so I was pleased to be asked to read and review "Cholesterol Down," a book which definitely should be read by anyone with a current cholesterol problem and, for that matter, by anyone in the younger set who wants to prevent such a problem from occurring in his or her future. If I had had this information many decades ago, I probably could have prevented or at least delayed the coronary problems I am now fighting. After my first heart attack five years ago, I had to face the fact that some extraordinary changes were necessary and at the top of that list was diet. I was placed on a "Mediterranean" diet which is very similar to the diet which Dr. Brill recommends in her book.

Dr. Brill suggests ten simple steps to lower one's cholesterol without resorting to prescription drugs. I am all in favor of that because nothing disturbs me more within the medical area of my life than the taking of prescription drugs. I try to avoid that sort of thing like the plague. I much prefer to utilize "natural" remedies whenever and wherever possible. So far I've been fairly successful, having to take only one prescription medication (an anti-clotting drug) and only because I have found no comparable natural remedy.

This book is divided into two parts plus an appendix. The first part of the book provides the reader with information about cholesterol and heart disease, basically the scientific foundations upon which Dr. Brill's ten-step plan is based. This can be read first but it is not necessary. I read the second part first, which actually describes the ten-step cholesterol down plan, because I was specifically interested in reviewing what the author suggests; one can always go back to the scientific rationale later. Read more › 27 Comments 502 people found this helpful. Was this review helpful to you? Yes No Sending feedback... Thank you for your feedback. Sorry, we failed to record your vote. Please try again Report abuse

5.0 out of 5 stars /span> By Tom Bruce on November 25, 2007 Format: Paperback Verified Purchase
Good for what ails you The book promises "10 Simple Steps to Lower Your Cholesterol" and it delivers. The first section of this book deals with what cholesterol is and what it does, and as this reader-friendly author suggests, "If science is not your cup of tea, simply cut to Part II." Part II is the meat of the book, listing the ten simple - and they are - steps to lowering your cholesterol. Not only simple, but affordable, too - much more so than prescribed medicine. With each step, the good Doctor explains how each process helps us reach our medical goal, gives the medical proof that exists for each, presents case histories, and lists further options and tips on how to additionally simplify each step. Yet, if you're not into the medical jargon, this section of the book is formated so you can skip over much of the material presented and get the basic information you need in a few short paragraphs. She does make it easy. The third and final section of the book offers charts to help you follow this course, if you're into such regimentation. There are also a few dozen healthful recipes, few of which appealed to me. Now here's the bonus part: as Brill explains, each of these steps will also help in lowering blood pressure, aiding diabetics, fighting obesity, forestalling aging, even stopping hair loss. So, if you suffer from any of these ills and more, you can't go wrong with this basic recipe for good health. After five weeks on this regimen, my cholesterol numbers were back to normal. The one problem I found with this diet, it was almost too much to eat. Well, not too much, but very filling. I have followed a modified version of the plan, mainly keeping in the oatmeal and heart-friendly orange juice, and my numbers continue to be where they should be months later. Comment 61 people found this helpful. Was this review helpful to you? Yes No Sending feedback... Thank you for your feedback. Sorry, we failed to record your vote. Please try again Report abuse

[Oct 16, 2016] How to Make Healthier Food Choices

Oct 16, 2016 | familydoctor.org
handout for more tips. Try a Mediterranean Diet for one of the healthiest approaches to eating we know about.

[Oct 15, 2016] Nuclear Stress Test Side Effects Side Effects Guide

Oct 15, 2016 | www.sideeffectsguide.org

Before saying anything about nuclear stress test side effects, let's explain nuclear stress test first. This test is designed to show your heart details. This way your doctor can determine irregularities regarding your heart or arteries.

How does this test actually look like? First, metal electrodes are attached to the chest and back of the patient; then the patient will have to run on a treadmill. While he is running, the electrocardiogram is recording the entire activity. After that, the patient will get an injection and then the pictures of his/her heart will be taken. This injections contain small amounts of radioactive substances which is a reason why people believe this test is harmful for the body. However, experts agree that these amounts are too small to harm any patient.

Although this test is useful for many reasons, it also has its side effects. Some of the following effects may occur:

Headache – it can be mild or quite severe and last for a couple of hours. This side effect is common among patients. It can be accompanied by nausea.

Pain in chest – another common side effect which appears shortly after the test, but soon disappears.

Breathing difficulties and heart rate changes – both of which come to normal after a while.

Some of the patients may experience bitter taste in their mouth.

All of these side effects are just temporary and they vanish in relatively short time. But before going for this test, make sure to follow your doctor's instructions. He will probably tell you not to drink or eat anything 4 hours before your test begins. Also you will be told not to take any medicines and to wear sports clothes appropriate for running. If you are pregnant , consult your doctor before deciding to take this test. Also, if you are very ill, talk to your doctor about some other option.

[Oct 15, 2016] NIH What To Expect During a Nuclear Heart Scan

Oct 15, 2016 | nhlbi.nih.gov
Many nuclear medicine centers are located in hospitals. A doctor who has special training in nuclear heart scans-a cardiologist or radiologist-will oversee the test.

Cardiologists are doctors who specialize in diagnosing and treating heart problems. Radiologists are doctors who have special training in medical imaging techniques.

Before the test begins, the doctor or a technician will use a needle to insert an intravenous (IV) line into a vein in your arm. Through this IV line, he or she will put radioactive tracer into your bloodstream at the right time.

You also will have EKG (electrocardiogram) patches attached to your body to check your heart rate during the test. (An EKG is a simple test that detects and records the heart's electrical activity.)

During the Stress Test

If you're having an exercise stress test as part of your nuclear scan, you'll walk on a treadmill or pedal a stationary bike. During this time, you'll be attached to EKG and blood pressure monitors.

Your doctor will ask you to exercise until you're too tired to continue, short of breath, or having chest or leg pain. You can expect that your heart will beat faster, you'll breathe faster, your blood pressure will increase, and you'll sweat.

Tell your doctor if you have any chest, arm, or jaw pain or discomfort. Also, report any dizziness, light-headedness, or other unusual symptoms.

If you're unable to exercise, your doctor may give you medicine to increase your heart rate. This is called a pharmacological stress test. The medicine might make you feel anxious, sick, dizzy, or shaky for a short time. If the side effects are severe, your doctor may give you other medicine to relieve the symptoms.

Before the exercise or pharmacological stress test ends, the tracer is injected through the IV line.

During the Nuclear Heart Scan

The nuclear heart scan will start shortly after the stress test. You'll lie very still on a padded table.

The nuclear heart scan camera, called a gamma camera, is enclosed in metal housing. The camera can be put in several positions around your body as you lie on the padded table.

For some nuclear heart scans, the metal housing is shaped like a doughnut (with a hole in the middle). You lie on a table that slowly moves through the hole. A computer nearby or in another room collects pictures of your heart.

Usually, two sets of pictures are taken. One will be taken right after the stress test and the other will be taken after a period of rest. The pictures might be taken all in 1 day or over 2 days. Each set of pictures takes about 15–30 minutes.

Some people find it hard to stay in one position during the test. Others may feel anxious while lying in the doughnut-shaped scanner. The table may feel hard, and the room may feel chilly because of the air conditioning needed to maintain the machines.

Let your doctor or technician know how you're feeling during the test so he or she can respond as needed.

[Oct 15, 2016] The Breakaway insurance plan amounted to a reverse Ponzi scheme where unsuspecting employers expecting to buy affordable policies instead bought costly reinsurance requiring them to cover each others losses

Notable quotes:
"... Breakaway, with about 300 employees, accused Berkshire and Applied of "siphoning" premiums through a web of illegal shell companies, with diverted premiums going to unlicensed out-of-state insurers, the wire agency said. ..."
"... The plan amounted to a "reverse Ponzi scheme" where unsuspecting employers expecting to buy affordable policies instead bought costly "reinsurance" requiring them to cover each other's losses, leaving taxpayers on the hook for shortfalls when too many workers are injured on the job, Breakaway said. ..."
Oct 15, 2016 | www.nakedcapitalism.com

Cry Shop September 13, 2016 at 1:11 am

Class Warfare:
http://www.ejinsight.com/20160913-buffett-flagship-sued-over-workers-compensation-siphoning/

Breakaway, with about 300 employees, accused Berkshire and Applied of "siphoning" premiums through a web of illegal shell companies, with diverted premiums going to unlicensed out-of-state insurers, the wire agency said.

The plan amounted to a "reverse Ponzi scheme" where unsuspecting employers expecting to buy affordable policies instead bought costly "reinsurance" requiring them to cover each other's losses, leaving taxpayers on the hook for shortfalls when too many workers are injured on the job, Breakaway said.

[Oct 15, 2016] How Accurate Are Omron Blood Pressure Monitors And Cuffs

Oct 15, 2016 | diabeteswell.com
It is essential to know the instructions on how to use an omron blood pressure monitor. It is vital to get accuate readings. Omron makes sure that you have the equipment correctly fitted before use because there is a light or sign telling you that it is attached correctly. It is also important that your posture is correct when taking such readings. For example, position your hand of the bp device on the other elbow when using a wrist monitor. Once again full details and diagram instructions are provided with their equipment. They make blood pressure readings simple and you will quickly incorporate these into your weekly routine. Important – Take a morning and evening reading

You should choose a certain day of the week in terms of regularly checking your blood pressure and stick with it. The procedure is very simple and straightforward. You should take your first reading around one hour after waking up. Note the rating and then take a second reading around one hour before going to bed. This will help get an accurate reading of what your levels are.

We have asked the question; how accurate are Omron blood pressure machines? Now let's ask a much more general question that all of you should understand the answer to;

Why do I need to bother with blood pressure readings?

Hypertension may well be the medical term given for high blood pressure, but the name you should associate it with is one which is widely used. That is "The Silent Killer". Many people are unaware that they actually have high levels of blood pressure. They feel the odd twinge or headache, but simply put this down to feeling a little under the weather.

The fact is that although possible symptoms such as severe headaches, fatigue, chest pains, or a feeling of confusion could affect you, many feel that such symptoms are not associated with high blood pressure, or they simply do not get very many of these symptoms.

Consider this; Hypertension is the biggest cause of strokes known, it also has a massive say in the amount of heart related problems we suffer from.

If that is not enough reason for you to take blood pressure readings seriously then I feel nothing will persuade you.

How can you keep those blood pressure levels in the 'healthy zone'?

Those who are overweight are increasing their risk of high blood pressure and the more overweight you are the bigger your problems. This makes blood pressure monitors particularly important for this group of people. You really need to address your weight issues, lifestyle and exercise regimen if you are to get yourself back on track. It cannot be overstated just how important looking after yourself is if you are to avoid high blood pressure problems.

Those of us who smoke, drink alcohol to excess and generally eat a poor diet are also leaving ourselves wide-open to high blood pressure.

One diet in particular should help you!

There is a really effective diet for those with high blood pressure which is known as the DASH diet. If you have home blood pressure equipment such as the wrist monitor versions that Omron provide and you find that your blood pressure is creeping up the wrong way please ask your doctor about this excellent diet.

It has been devised specifically to bring your blood pressure levels down, and if you follow it to the letter it should have you back to normal in around 2 weeks of use.

Those 2 weeks could be the difference between a new you and a very poorly you!

One of the wisest investments you will make in terms of health

There may be lots of gimmicks or unnecessary bits of equipment for your health available today, but please rest assured that home monitors for blood pressure are not gimmicks and they are highly useful. So useful they could actually save your life. Try putting a price on that!

This is the other thing, the price of such equipment really is trifling in terms of how low it is, and the peace of mind it will give you and your loved ones will pay for such a purchase many times over.

Hopefully the above has shown you the answer to our question; how accurate are Omron blood pressure machines, and you will use this advice to purchase one of their extensive range to suit your needs. Remember; it could be a life saver!

[Oct 15, 2016] How Big Pharma's Industrial Waste Is Fueling the Rise in Superbugs Worldwide

Oct 15, 2016 | www.truth-out.org
Sep 22, 2016 | www.truth-out.org
Written by The Bureau of Investigative Journalism | Report Pharmaceutical companies are fuelling the rise of superbugs by manufacturing drugs in factories that leak industrial waste, says a new report which calls on them to radically improve their supply chains.

Factories in China and India -- where the majority of the world's antibiotics are produced -- are releasing untreated waste fluid containing active ingredients into surrounding areas, highlights the report by a coalition of environmental and public health organisations.

Ingredients used in antibiotics get into the local soil and water systems, leading to bacteria in the environment becoming resistant to the drugs. They are able to exchange genetic material with other nearby germs, spreading antibiotic resistance around the world, the report claims.

Ahead of a United Nations summit on antimicrobial resistance in New York this week, the report -- by the European Public Health Alliance (EPHA) and pressure group Changing Markets -- calls on major drug companies to tackle the pollution which is one of its root causes.

They say the industry is ignoring the pollution in its supply chain while it drives the proliferation of drug resistant bacteria -- a phenomenon which kills an estimated 25,000 people across Europe and globally poses "as big a threat as terrorism," according to NHS England's Chief Medical Officer Dame Sally Davies.

If no action is taken antimicrobial resistance (AMR) will kill 10 million people worldwide every year -- more than cancer -- according to an independent review into AMR last year led by economist Professor Jim O'Neill.

Changing Markets compiled previous detailed reports and conducted its own on-the-ground research looking at a range of Chinese and Indian drug manufacturing plants making products for some of the world's biggest pharmaceutical companies. One of the world's biggest antibiotic production plants, in Inner Mongolia, was found in 2014 to be "pumping tonnes of toxic and antibiotic-rich effluent waste into the fields and waterways surrounding the factory," according to Chinese state television.

In India, where much of the raw material produced by Chinese factories is turned into finished drugs, various studies have found "high levels of hazardous waste" and "large volumes of effluent waste" being dumped into the environment. About a quarter of UK medicines are made in India.

[Oct 14, 2016] Deaths Linked to Cardiac Stents Rise as Overuse Seen

Notable quotes:
"... Jashu Patel, an interventionalist in Jackson, Michigan, billed $2.7 million for procedures in 2007, according to a U.S. Justice Department case against him settled in July. (He is no relation to Mehmood Patel). ..."
"... The suit alleged Patel implanted needless stents in at least two patients, including one that led to a blood clot that killed an unnamed woman who had reported no symptoms of reduced cardiac blood supply. A stress test showed normal blood flow, and notes in her file said she didn't want interventions, said Julie Kovach, a cardiologist who worked with Patel and brought the case to the government's attention. ..."
"... "It was appalling," Kovach said in an interview. "Patel coerced her into getting a stent she didn't need, which killed her." ..."
"... "I do believe that Bruce was a guinea pig," she said. "That was the way it was done." ..."
Bloomberg

When Bruce Peterson left the U.S. Postal Service after 24 years delivering mail, he started a travel agency. It was his dream career, his wife Shirlee said.

Then he went to see cardiologist Samuel DeMaio for chest pain. DeMaio put 21 coronary stents in Peterson's chest over eight months, and in one procedure tore a blood vessel and placed five of the metal-mesh tubes in a single artery, the Texas Medical Board staff said in a complaint. Unneeded stents weakened Peterson's heart and exposed him to complications including clots, blockages "and ultimately his death," the complaint said.

DeMaio paid $10,000 and agreed to two years' oversight to settle the complaint over Peterson and other patients in 2011. He said his treatment didn't contribute to Peterson's death.

"We've learned a lot since Bruce died," Shirlee Peterson said. "Too many stents can kill you."

Peterson's case is part of the expanding impact of U.S. medicine's binge on cardiac stents -- implants used to prop open the arteries of 7 million Americans in the last decade at a cost of more than $110 billion.

When stents are used to restore blood flow in heart attack patients, few dispute they are beneficial. These and other acute cases account for about half of the 700,000 stent procedures in the U.S. annually.

Among the other half -- elective-surgery patients in stable condition -- overuse, death, injury and fraud have accompanied the devices' use as a go-to treatment, according to thousands of pages of court documents and regulatory filings, interviews with 37 cardiologists and 33 heart patients or their survivors, and more than a dozen medical studies.

'Marching On'

These sources point to stent practices that underscore the waste and patient vulnerability in a U.S. health care system that rewards doctors based on volume of procedures rather than quality of care. Cardiologists get paid less than $250 to talk to patients about stents' risks and alternative measures, and an average of four times that fee for putting in a stent.

"Stenting belongs to one of the bleakest chapters in the history of Western medicine," said Nortin Hadler, a professor of medicine at the University of North Carolina at Chapel Hill. Cardiologists "are marching on" because "the interventional cardiology industry has a cash flow comparable to the GDP of many countries" and doesn't want to lose it, he said.

Stenting abuse is by no means the norm, but neither is it a rarity. Federal cases have extended from regional medical centers in Louisiana, Kentucky and Georgia to a top-ranked metropolitan hospital system in Ohio.

Asset Seizure

A doctor practicing at a hospital owned by the Cleveland Clinic, rated the premier heart center in the country by U.S. News and World Report, had his assets seized by federal agents in a stent investigation, according to federal court filings in April. The Clinic has not been accused of wrongdoing, and says it's cooperating with the investigation.

Two out of three elective stents, or more than 200,000 procedures a year, are unnecessary, according to David Brown, a cardiologist at Stony Brook University School of Medicine in New York. That works out to about a third of all stents.

Brown said his estimate is based on eight clinical trials of 7,000 patients in the last decade, which he analyzed in the Archives of Internal Medicine last year. Two cardiology researchers who have studied the use of stents say the number could be as low as about half Brown's estimate, and one said it is probably larger.

Costs, Risks

Even the low end of these estimates translates into more than a million Americans in the past decade with implants in their coronary arteries they didn't need, said William Boden, chief of medicine at a Veterans Administration hospital in Albany, New York. Boden was the principal investigator of a 2007 study known as Courage that found stents added no benefit over medicines, exercise and dietary changes in stable patients.

Unnecessary stents cost the U.S. health care system $2.4 billion a year, according to Sanjay Kaul, a cardiologist and researcher at Cedars-Sinai Medical Center in Los Angeles. Patients who received them are living with risks including blood clots, bleeding from anti-clotting medicine and blockages from coronary scar tissue, any of which can be fatal, Kaul said.

Monica Crabtree died at age 64 after one of her arteries was torn in a stent procedure that led to infection, according to her widower, Gary Crabtree. He received at least $240,000 from a 2011 settlement of his lawsuit against her doctor, after a second cardiologist reviewed the case and told him the stent wasn't needed. Crabtree choked up speaking about his late wife and showed pictures of their 47 years together.

Worried Shaving

"It wasn't just a simple mistake," said the retired auto worker in Largo, Florida. "If the stent was something she really needed, I could have handled it. But it was a total loss of life that didn't need to happen."

Jim Simecek, of Medina, Ohio, said he worries every morning that a nick from shaving could bleed out of control. Simecek, who works at a Ford dealership, said he has to take blood-thinning medicine for life to ward off clots in the six stents he received from a Cleveland-area cardiologist who's under federal investigation for his stent work.

"It's as if your heart was open and somebody was sticking a knife in," said Rhonda McClure, 54, referring to eight stents she received from a Kentucky cardiologist who agreed in June to plead guilty to a federal Medicaid-fraud charge for falsifying records used to justify a stent he placed.

Patient Letters

Cardiac stents were linked to at least 773 deaths in incident reports to the U.S. Food and Drug Administration last year, according to a review by Bloomberg News. That was 71 percent higher than the number found in the FDA's public files for 2008. The 4,135 non-fatal stent injuries reported to the FDA last year -- including perforated arteries, blood clots and other incidents -- were 33 percent higher than 2008 levels.

The FDA declined to comment on whether the reports were a cause for concern. It said adverse-event reports tied to medical devices have increased overall due to agency efforts. It also said the data can contain incomplete and unverified accounts from reporting parties.

More than 1,500 patients have gotten letters from hospitals since 2010 alerting them that their stents may have been unnecessary. In Philadelphia, the University of Pennsylvania Health System sent 700 such notices in April.

Stenting Decline

At least 11 hospitals have settled federal allegations of charging for needless stenting and other misdeeds in the catheterization labs where the procedures are performed. Federal probes of stenting practices continue in at least five states. In Louisiana and Maryland, cardiologists went to federal prison last year for implanting the devices and charging for them without medical justification. A third doctor has agreed to do time in a plea bargain.

"There is a huge financial incentive to increase the number of these procedures," said Jamie Bennett, a former assistant U.S. Attorney in Baltimore who handled stent investigations. "The cases we have seen to date are just the tip of the iceberg."

Since Boden's Courage study, stenting procedures have declined by about 20 percent. Still, this July, a panel of experts convened by the American Medical Association and the Joint Commission, a hospital accreditor, named elective stenting as one of five overused treatments that too often "provide zero or negligible benefit to patients, potentially exposing them to the risk of harm."

Better Choices

Doctors are using fewer stents and choosing more-appropriate patients than they were a few years ago, according to John Harold, president of the American College of Cardiology, the specialty's main professional group. Harold said that "real-world clinical practice" and research indicates Brown probably overestimated how many people with coronary artery disease could be handled initially only with drug-based treatment.

He said there are examples of inappropriate use and the ACC is taking steps to "address and correct the imbalance" with treatment guidelines and by urging more hospital oversight. Cardiologists who've been accused of fraud or are serving prison time are "outliers" who don't represent the "overwhelming majority."

Lawyers for John McLean, a Salisbury, Maryland, cardiologist convicted of billing for unwarranted stenting, argued in a federal appeal last year that inappropriate usage is widespread and their client was prosecuted for behavior that's the industry norm.

Lost Appeal

They cited a 2011 study in the Journal of the American Medical Association that found only half of elective stent procedures nationally were appropriate under usage guidelines written by societies of heart specialists. The study found 12 percent were inappropriate, and 38 percent fell into the uncertain category of the guidelines.

"The study demonstrated clearly that a large number of stable patients receive coronary artery stents that are later found to be inappropriate or questionable," the appeal argued. "The same was true of the patients in Dr. McLean's practice." McLean's appeal was denied in April. He is serving an eight-year sentence.

Elective-stent patients typically see rapid quality-of-life improvements, including in their ability to work and be active, according to Ted Bass, president of the Society for Cardiovascular Angiography and Interventions, whose members specialize in cardiac implants. The Courage trial found stents, compared to medication and lifestyle changes, were better at relieving chest pain for as long as two years after placement -- a benefit that ended by 36 months.

Profit Centers

First used in Europe in 1986, cardiac stents took off in the 2000s as cardiologists found them to be more effective in heart attacks than angioplasty. In that earlier technology, a small balloon is inflated to widen blood passages and then withdrawn. Stenting facilities, known as "cath labs," spread at hospitals and became profit centers.

Hospitals receive an average payment of about $25,000 per stent case from private insurers, according to Healthcare Blue Book, a website that tracks reimbursements. The federal Medicare program pays less. Doctors who implant stents earn a separate fee that averages about $1,000 and ranges from $500 to $2,850, according to Medicare and Blue Book data.

The procedure typically involves inserting the stent with a catheter through a small incision in the groin area or wrist and snaking it through to heart vessels. It usually takes less than 45 minutes.

Kickbacks Alleged

Stony Brook's Brown, and Boden, who led the Courage study, argue that many elective patients should be getting medical therapy before they risk stents. Only 44 percent try medication and lifestyle changes before stenting, a 2011 study in the Journal of the American Medical Association found.

At least five hospitals have reached settlements with the Justice Department over allegations that they paid illegal kickbacks to doctors for patient referrals to their cath labs. St. Joseph Medical Center in Towson, Maryland, paid the government $22 million without admitting liability.

Prosecutors alleged the hospital paid kickbacks to a practice co-founded by Baltimore cardiologist Mark Midei for stent referrals. His doctor's license was revoked in 2011 when the Maryland Board of Physicians found he falsified records to justify unwarranted stents.

St. Joseph told 585 of its patients they may have received unnecessary stents. In May, 252 patients reached a settlement with the hospital under confidential terms, according to Jay D. Miller, an attorney for the plaintiffs.

Plea Agreement

The hospital settled the government's case "to avoid the expense and uncertainty of litigation," it said in a statement. Spokeswoman Julia Sutherland said the hospital declined to comment on any patient lawsuits.

In an interview, Midei denied he stented without medical need. He took issue with experts who deemed many of his stents needless, and said disagreement among cardiologists on cases is common. Midei was not a party to the federal settlement. The government has said its investigation of the case continues.

In June, Sandesh Patil, a cardiologist practicing at another St. Joseph hospital -- this one in London, Kentucky -- agreed to plead guilty to charging Medicaid for a stent that wasn't medically warranted under the program's rules. (Although both hospitals were once owned by the same parent, the one in Maryland has been sold.)

Catheterization procedures multiplied at St. Joseph in London after Patil began practicing there in 2000, when the hospital had a different name. In that year, the type of procedure used for stents was done 210 times. They climbed to 929 by 2009, state data show.

Multiple Stents

Stenting income from Medicare alone was more than a sixth of the hospital's 2009 operating income, based on data from American Hospital Directory, a research firm. When Patil left London in 2010, catheterization procedures fell 34 percent from their 2009 high. Using the midpoint of the directory's price range for such procedures, the decline would have cost the hospital about $15 million. David McArthur, the hospital's spokesman, declined to comment on its revenues.

Rhonda McClure, one of Patil's patients, had her arteries catheterized 18 times by him and his partners over four years, according to her deposition and other filings in a lawsuit she and 361 other patients have brought against Patil, St. Joseph and other doctors who practiced there. She said she received eight cardiac stents. The defendants deny the negligence and fraud allegations against them.

McClure's deposition says a cardiologist who reviewed her case after the stents told her that scarring caused by "too many procedures" was her main problem.

Short Breath

McClure said she suffers from chest pain and shortness of breath, and has been told by her new doctor that she may need more stents and surgery to keep her coronary arteries from closing. She said she gets so tired she needs to sit and rest after walking down the stairs.

St. Joseph-London repaid Medicare $256,800 for unnecessary procedures and is cooperating with federal prosecutors, McArthur said. He said Patil was never employed by St. Joseph and lost his privileges to practice there in December 2010. Patil's attorney said his client had no comment.

Under his plea bargain, Patil agreed to serve 30 to 37 months in federal prison. He forfeited his Kentucky medical license for five years. In 2012, he told a family court judge his monthly income was $53,300.

"Thirty-seven months is nothing for all the injuries he done for money," McClure said.

Message Balancing

After the Courage trial shed doubt on stents' effectiveness for stable patients, stent-implanting cardiologists felt unfairly attacked and organized a campaign to "better balance the messaging," said Bonnie Weiner, who was president of the Society for Cardiovascular Angiography and Interventions at the time.

The society hired a public relations firm and paid it more than $300,000 a year to help publicize the benefits of stents, according to the group's filings with the Internal Revenue Service. The firm helped launch a consumer website for SCAI, SecondsCount.org, which has published several articles, including one under the headline, "For many patients, open arteries are better than closed arteries."

SCAI collected $2.7 million in donations for "public education" between 2008 and 2011 from stent makers Abbott Laboratories Inc., Boston Scientific Corp., Cordis Corp. and Medtronic Inc., its Web site says. Manufacturers' sales of cardiac stents were about $5.5 billion globally last year, down 5 percent from 2011, according to the Health Research International consulting firm.

High Median

Medtronic spokesman Joseph McGrath said grants to SCAI for patient education are "unrestricted," and SCAI is solely responsible for how the funds are used. Spokesmen for Abbott, Boston Scientific and Cordis declined to comment.

Interventional cardiologists, the specialty SCAI represents, earn a median income of $562,855 a year, as compared to $207,117 for family doctors, according to Medical Group Management Association, which surveys physician practices. The interventionalists ranked 13th among 118 specialties tracked by MGMA.

Michigan Death

Mehmood Patel, a Lafayette, Louisiana, cardiologist who went to prison last year on 51 counts of charging for needless stents, made over $16 million in one three-year span, evidence in the case showed. Prosecutors said he was driven by the desire to be the busiest cardiologist in town.

He unsuccessfully argued that he used his best medical judgment in every case and lost an appeal. Patel is serving a 10-year sentence in a federal penitentiary.

Jashu Patel, an interventionalist in Jackson, Michigan, billed $2.7 million for procedures in 2007, according to a U.S. Justice Department case against him settled in July. (He is no relation to Mehmood Patel).

The suit alleged Patel implanted needless stents in at least two patients, including one that led to a blood clot that killed an unnamed woman who had reported no symptoms of reduced cardiac blood supply. A stress test showed normal blood flow, and notes in her file said she didn't want interventions, said Julie Kovach, a cardiologist who worked with Patel and brought the case to the government's attention.

"It was appalling," Kovach said in an interview. "Patel coerced her into getting a stent she didn't need, which killed her."

False Claims

Kovach said that when she told the chief operating officer of the hospital where Patel worked about the death, the executive, Karen Chaprnka, diverted the conversation. Reached recently by e-mail through a hospital spokesman, Chaprnka said she "disagreed with the allegations made by Dr. Kovach."

"He's their cash cow," said Kovach, now co-director of a clinic that treats congenital heart disease at the Detroit Medical Center. "They're not about to turn him in."

Patel and the hospital, Allegiance Health, agreed to pay the U.S. a total of $4 million to settle the federal charges. Kovach was awarded $760,000 as a whistle-blower under the U.S. False Claims Act. Allegiance disagreed with the allegations and settled the claims to avoid "lengthy litigation," it said in a statement.

Patel continues to practice at the hospital and must improve record-keeping to substantiate cardiology procedures, Allegiance said. In the settlement, Patel agreed to hire a consultant to oversee treatment of his patients and an auditing firm to monitor billings. He didn't return phone messages.

Cleveland Raid

In Ohio, Simecek, the worker at the Ford dealership, grew suspicious after his sixth stent from cardiologist Harry Persaud at the Cleveland Clinic's Fairview Hospital in 2011. Simecek said he went for a second opinion and was told he didn't need any of the stents. Now he said he has to take blood thinners the rest of his life.

"With the littlest cut, the blood starts running," said Simecek. "What if I am in an auto accident?"

Persaud is under criminal investigation for health care fraud, mail fraud and money laundering, according to federal court filings. Last October, Federal Bureau of Investigation agents raided his office and removed financial records and patient files for procedures at three Cleveland-area hospitals. The government has seized $343,634 from his and his wife's bank accounts, alleging the funds represent the proceeds of fraud related to a "significant number" of unnecessary stent procedures.

Multiple, Elongated

The Cleveland Clinic found "problems related to the use of stents in some patients" at Fairview and reported them to the government, according to spokeswoman Eileen Sheil. She would not say how many patients were affected. Persaud resigned from the hospital staff last year.

At least 64 of Persaud's patients at St. John Medical Center in suburban Westlake received letters from the hospital saying they may have received an unnecessary stent between 2010 and 2012, according to spokesman Patrick Garmone, who said Persaud no longer practices there.

Persaud denied wrongdoing in court filings and said his stent procedures were proper. Neil Freund, his attorney in lawsuits filed by patients alleging unwarranted stents, said "it is our intent to defend these cases." He had no comment on the federal investigation.

Final Order

In Texas, the state medical board's final order in DeMaio's case found that the cardiologist placed "multiple, elongated, overlapping" stents in patients in areas of "insignificant or only moderate disease." Peterson, the retired mailman, was identified only as Patient C in the staff complaint. No patient was mentioned in the final order.

Peterson was thriving in his new career in the travel business, his wife Shirlee said. He had a heart attack in 1997, which didn't crimp his love of travel and dance, she said. "He was an awesome man who never met a stranger," she said.

After his death, Shirlee Peterson said a friend told her she had a cardiologist who refused to do multiple stents.

"I do believe that Bruce was a guinea pig," she said. "That was the way it was done."

DeMaio said Peterson was extremely sick when he came to him. He said it was significant that the board's final order didn't use the word "excessive" in describing his stent work. That included 31 stents stretching for 14 inches inside the arteries of Patient B in the staff complaint.

"Any patient of mine who received a full metal jacket" -- interventional cardiology's term for such extensive work -- "would have been turned down by at least one, if not multiple surgeons," DeMaio said. He said he doesn't use stents as much these days because standards have changed and he doesn't see as many seriously ill patients.

[Oct 12, 2016] Managing hyperlipidemia means controlling cholesterol and triglycerides.

Aug 01, 2021 | www.heart.org

Hyperlipidemia is a mouthful, but it's really just a fancy word for too many lipids – or fats – in the blood.

That can cover many conditions, but for most people, it comes down to two well-known terms: high cholesterol and high triglycerides . Our bodies make and use a certain amount of cholesterol every day, but sometimes that system gets out of whack, either through genetics or diet. Higher levels of the "good" HDL cholesterol are associated with decreased risk of heart disease and stroke. HDL helps by removing cholesterol from your arteries, which slows the development of plaque. The "bad" LDL cholesterol, on the other hand, can lead to blockages if there's too much in the body.

What's the treatment?

If you are diagnosed with hyperlipidemia, your overall health status and risks will help guide treatment . Making healthy diet choices and increasing exercise are important first steps in lowering your high cholesterol . Depending on your overall risk, your doctor may also prescribe medication in conjunction with healthy eating and regular exercise.

"The combination of diet and regular physical activity is important even if you're on medication for high cholesterol ," said Dr. Vincent Bufalino, an American Heart Association volunteer. "It's the most critical piece."

Consulting a doctor is important, since each condition has it quirks. For people with high triglycerides, for example, alcohol can be particularly dangerous. But for those with high cholesterol, a daily glass of wine or other alcohol, along with healthy eating and exercise, may actually help, Dr. Bufalino said.

Once I have it, can I reverse it?

Hyperlipidemia can be improved in many cases through healthy eating and regular exercise.

Here are some tips on how to manage your risk of high cholesterol. Learn more about cholesterol:

[Oct 12, 2016] What You Need to Know about the New Cholesterol Guidelines CHI Health Blogs

Feb 25, 2015 | blogs.chihealth.com

In late 2013, after an extensive review of evidence, the National Heart, Lung and Blood Institute updated cholesterol guidelines. Why did they do this? These new guidelines better identify those at risk of atherosclerotic cardiovascular disease (ASCVD), and also better diagnose people who already have ASCVD. Patients who have ASCVD are more likely to suffer a heart attack or stroke.

To determine if someone is at risk of developing ASCVD a risk estimator is available through Cardio Source. Information including Systolic Blood Pressure, a patient's race, HDL Cholesterol and more are entered.

Depending on the level of risk, patients should take different courses of action. For all patients who are determined to be at risk for ASCVD there are behavioral modifications they should implement. These include: eating a heart-healthy diet, regularly exercising, avoiding tobacco products and maintaining a healthy weight.

For lower risk individuals, there are other items to take into account on whether they are likely to develop ASCVD. These include a family history of premature ASCVD, LDL greater than 160, high sensitivity C-reactive protein, Coronary calcium score and Ankle/brachial index.

For those with a high likelihood of developing ASCVD and for those individuals who already have ASCVD, statins should be taken. The guidelines have also been updated. There are non-statin medications also available for those patients unable to take statins (due to side effects or drug interactions). Talk with your doctor to determine which medicine is best for you.

[Oct 12, 2016] Doctors Behaving Badly

Notable quotes:
"... Doctors Behaving Badly ..."
Oct 12, 2016 | blogs.chihealth.com

CHI Health Blogs CHI Health Heart

Cardiology
Eric Van De Graaff, M.D.
May 14, 2012 As odd as this might sound, my mother was upset when I declared my intention to go to medical school.

It wasn't the mountain of debt I was sure to incur since I'd already figured out how to get Uncle Sam to pick up the bill (a small deal that put me in a military uniform for a decade). It wasn't the fact that medical school would delay the litter of bouncing grandbabies she wanted to fawn over. And it certainly wasn't because she'd miss me-she'd already seen too much of me and my dirty laundry on weekends during college.

No, my mother was legitimately disappointed in me for choosing to enter the medical profession simply because she had a deep-seated disdain for doctors. I could almost envision her sad disgrace as she chatted with the neighbors during my final year as a resident in brain surgery:

Mom: "What's little Festus up to these days?"

Neighbor 1: "Oh he's doin' real good. He's got hisself a carwash business up in Magna that pulls in a couple hundred a week. Lookin' to buy a bass boat for him and the misses."

Mom: "And Cletus?"

Neighbor 2: "Almost done with his ten years up at the state pen in Bluffdale. Won an award for license plate stampin'. Trixie and the boys are real proud of him."

Neighbor 1: "And what's Eric doing?"

Mom: "He's still not married."

My mother never told me why she disliked doctors so much. I'm left to assume that she'd had a number of bad interactions with them over the years, but she never bothered to back up her expressions of disapproval with any sort of details. It took several years for my mother to warm up to the idea that I had not turned to the dark side by becoming a doctor. I think a lot of it had to do with inertia-by the time she finally decided to express any acknowledgement of my career decision, two more of us boys were in medical school and I supposed she realized she couldn't be disappointed in all of us.

Now that I've been in practice a number of years I've finally learned what it was that so intensely turned my mother off about doctors: they can be arrogant, condescending and impolite. Of course, many of my readers are at this moment wondering if I'm also going to reveal other mysteries such as "birds fly" and "dogs bark."

I had a roommate in medical school who was a great guy. He studied hard, didn't party too much, and always managed to put the toilet paper on the right way (rolling out from the top down, in case you were wondering). Years after we graduated and had gone our separate ways I had a phone conversation with a physician assistant who'd gone to work for my old roommate. "It must be great working for Dr. X," I added. A pause on the phone. "No," he said slowly, "he's a total jerk. Everybody hates him."

I have two theories. One is that all medical students believe they will go on to become an Albert Schweizer in their field-kind, self-sacrificing, benevolent-but somewhere along the way a certain fraction of them let the glory of their career go to their heads and begin to treat patients and underlings like chewing gum on a movie theater floor. What constitutes that percentage is in the eye of the beholder. For my mother it was some where around the 98% mark. I'm a little more generous-I'll say 20%.

My second theory is that all doctors believe themselves to be noble, kind, and beloved by all. Rarely do I come across an arrogant doctor who recognizes him- or herself as such. Rather, almost all of us think we're appropriately mannered. And we are . . . most of the time.

The rubber hits the road, though, when job-related stress enters the picture. A physician who ends up an hour behind in a busy clinic can become snappy at his nurses and receptionists. A surgeon who is elbow-deep in a case gone awry will turn her anger toward the anesthesiologist and scrub techs. In both cases, the doctors in question feel they were simply reacting appropriately to the situation: "Of course I yelled at my nurse. Doesn't she realize she is making me later than I already am?" or "Of course I hurled the Metzenbaums across the room. Am I the only one in the OR who cares what happens to this patient?!"

As any nurse will tell you, the true measure of a doctor's demeanor is not how he or she acts during times of ease. Instead, the nature of a physician's soul is uncovered precisely during those times when he or she has the most right to explode in a volcano of vulgarities and instrument-throwing. A doctor who can keep cool while juggling 3 phone calls, a clinic filled with patients, and a patient exsanguinating on the operating table is both rare and worthy of high esteem.

In fellowship I had the misfortune to work under a cardiologist described by all other fellows thus: "She's fun socially but awful to work with." This proved to be true: at a staff party she was great to have around, but when faced with the challenge of rounding on 15 patients in a two-hour period she transformed into Medusa. Yet, I'm sure, if asked, she would maintain that she is polite, kind, and patient-as long as the situation doesn't demand otherwise. The problem is that her definition of "situation" was pretty much every day at work.

We doctors have chosen professions that are inherently filled with stress, deadlines, and treading in deep emotional waters. None of that grants us a free pass to behave like spoiled toddlers. As I see it, doctors should always follow 2 simple rules:

Rule #1: It is simply not allowable to be impolite, mean, nasty or snippy with staff or patients even when you are in a stressful situation.

Rule #2: Whatever is stressing you is probably stressing those around you as much or more. Under those circumstances you have to go out of your way to be kinder and more understanding. As a doctor, you control the mood in the clinic and operating room even if you can't control the situation.

I freely admit I am unable to always adhere to these rules but I at least recognize them and intend to spend the rest of my career trying to do better. My mother passed away many years ago but I'm hoping that somewhere up there she can look down and see that I didn't turn out to be so terrible after all.

This entry was posted in Cardiology . Bookmark the permalink .

8 Responses to Doctors Behaving Badly

  1. Loan Eby says: May 15, 2012 at 4:26 pm Bedside manner
    I was with my mom when her doctor told her she had Stage IV pancreatic cancer. After learning my mom had 6-months to live, I remember walking out of Good Sam in Kearney and running into my high school friend who was a nurse there. My friend greeted me with a smile because she had not seen me in years. I told her the devastating news and how awful the doctor was to my mom. She told me he was one of the best oncologists around. If he was the best round, I would have hated to see their worst. Thank you for your post.
  2. Nikki says: May 15, 2012 at 4:44 pm It's refreshing to read Dr. Van De Graaff post. I have worked with many Dr. and nurses in my time in the medical field. Sometime you get the nice fun loving Dr. / nurse or sometimes they are possessed, as a clinic worker it's my job ( and I take pride in it) to not let it get so bad in the clinic and if it does everyone better start doing their best to make the situation the best they can. I don't think that there is a day that goes by we aren't laughing even when we are all a little crazy. It's nice to know that when you behave badly you know you shouldn't….
  3. Lance Taylor says: May 15, 2012 at 10:53 pm Treat other how you would expect to be treated, and all will be well.
  4. Sandra says: May 18, 2012 at 8:42 am My mother also had the same attitude towards physicians. However, my mother took everything in stride and always voiced her opinion. A few times she would bluntly express to the physician/nurse when they were not very nice and did not answer her questions. It was interesting to see the look on the physician/nurse's faces; it is evident that they were not aware how they come across to their patients at any given time. Sometimes it is up to the patient to express to their care provider how they are treating the patient. I saw first handed how their attitudes changed each time my mother came into the clinic for the chemo/radiation treatments. I would advise others to ask the provider/nurse how is your day going, it is amazing how their attitude can fall into a positive manner when someone shows interest in them as a person not just a physician/nurse. Thanks for sharing your story Dr. V.
  5. RS says: June 26, 2012 at 11:00 am I have to say, your mother raised you right! Its not everyone that knows the correct way to put the toliet paper on! Your attitude is refreshing and you make your profession proud! Your well written article should be a reminder to everyone that we should all treat those around us with dignity and respect.
  6. Leslie says: August 13, 2012 at 10:22 am I am a retired respiratory therapist, my father was a pharmacist who owned his own pharmacy and I have 3 cousins and an uncle who are physicians. I say that because I want you to know that I have been around physicians all of my life. All that being said I would come alot closer to your mother's 98%(probably around95%) than your generous 20%. That would include my uncle. To find a physician who is both a good dr and a good person is rare indeed. For decades I had to endure tamtrum throwing doctors. Now we have added millions of doctors from middle eastern countries who have NO respect for women, zero manners and have such thick accents the poor little old people have no clue what the physician just said, let alone who he actually was(no name, no specialty, no time for questions, no business card).
    My opinion has been for years that if you can't keep your cool under stressful conditions then you need to be a plumber. Anyone who doesn't think that every level of healthcare is extremely stressful-think again. Yelling at people who have done no wrong only makes them more nervous and more likely to really make a mistake. Yep, a plumber. You can make as much money(perhaps more). You can make your own hours. No insurance companies to deal with.
    Think about it. Some people make everyone happy by entering a room…and others by leaving.
  7. Jonathan hersch says: August 14, 2012 at 2:05 pm I find that my patients say the same thing about other doctors as your mother. Certainly many have let this career go to their head. I have many techniques to control my anger and frustration when things are going bad in the operating room. It's hard but a must.

    I find myself hanging out with doctors who are like myself. Laid back and don't take life too serious. The rest are hard to get along with. Patients feel the same.

  8. KEITH BARKLEY says: April 10, 2013 at 9:34 am I had the privelege of meeting DR. van de Graaf after a trip to the hospital via rescue squad. These people really saved my life.I was near death and Dr van de Graff helped preform a miracle for me.I haved been exposed to many medical people over the past 80+ years and I will critisize few of them – – but Dr van de Graff is truly a special person – as well as Dr.

[Oct 12, 2016] The American Heart Association -- Protecting Industry Not Patients

Dec 16, 2013 | www.huffingtonpost.com
The American Heart Association (AHA) and the American College of Cardiology (ACC) recently released new cardiovascular disease prevention guidelines . They are an egregious example of much that is wrong with medicine today.

The guidelines propose a vast expansion of the use of statins in healthy people, recommending them for about 44 percent of men and 22 percent of healthy women between the ages of 40 and 75. According to calculations by John Abramson, lecturer at Harvard Medical School, 13,598,000 healthy people for whom statins were not recommended based on the 2001 guidelines now fall into the category of being advised to take moderate or high intensity statin therapy.

The American Heart Association (AHA) is a nonprofit organization with a mission to "build healthier lives free of cardiovascular disease and stroke." Yet in its 2011-2012 financial statement , the AHA noted $521 million in donations from non-government and non-membership sources and many well-known large drug companies, including those who make and market statins, contribute amounts in the $1 million range.

Even as many in the medical community suspected the guidelines were a ploy to help the AHA's drug partners sell statins, it was revealed that the guideline's online calculator to determine cardiac disease risk over predicts risk by an astonishing 75 to 150 percent. But the guideline writers are standing firmly behind their faulty calculator.

Seven of the 15 authors disclosed ties to industry. Originally, the panel chair, Neil J. Stone, MD of Northwestern University, declared that he has had no ties to industry since 2008. Jeanne Lenzer, writing in the British Medical Journal (BMJ) last month, interviewed Dr. Stone who said: "When I was asked by NHLBI [National Heart, Lung and Blood Institute] to chair the [cholesterol] panel, I immediately severed ties with all industry connections prior to assuming my role as chair." However, prior to 2008, he accepted funding and consultancy fees from multiple pharmaceutical companies, including Abbott, AstraZeneca, Pfizer, Merck, and Schering-Plough among others. Dr. Stone also told the BMJthat he will "definitely" not take any industry funding for two years. Are we to believe that by severing his ties in 2008 his mind became an instant tabula rasa, completely devoid of any conscious or unconscious bias towards the drug companies which had been paying him? To do so strains the bonds of credulity past the breaking point.

The financial ties between large pharmaceutical companies and the AHA are numerous and very remunerative for the AHA, including huge donations from Abbott, Bayer, Boehringer Ingelheim, Bristol-Myers Squibb (BMS), Eli Lilly, Merck and Pfizer. BMS, along with Merck and Pfizer are national sponsors of AHA's Go Red For Women> heart disease awareness campaign whose web site tells patients "If your doctor has placed you on statin therapy to reduce your cholesterol, you can rest easy-the benefits outweigh the risks" The site also proclaims that "Zocor and Pravachol - have the fewest side effects," and "statins may only slightly increase diabetes risks." The Women's Health Initiative , a federal study of over 160,000 healthy women to investigate the most common causes of death, disability and poor quality of life in postmenopausal women, showed that a healthy woman's risk of developing diabetes was increased 48 percent compared to women who were not on a statin. And contrary to what statin apologists say about statins only increasing diabetes risk in people who are at high risk of developing it anyway, for example the obese, women on statins in the Women's Health Initiative who were of normal weight increased their risk of diabetes 89 percent compared to same weight women not taking a statin.

In 2010, AHA received $21,570 from statin maker AstraZeneca to run an AHA course about "emerging strategies with statins" at the Discovery Institute of Medical Education and almost $100,000 for learning projects including "debating controversial topics in cardiovascular disease." The AHA defended the deceptively marketed and controversial cholesterol drug Vytorin. Did that have anything to do with the $2 million a year the AHA was taking from marketer Merck/Schering-Plough Pharmaceuticals?

The AHA also rakes in millions from food companies which are also million dollar donors and which pay from $5,490 to $7,500 per product to gain the "heart-check mark" imprimatur from the AHA, renewable, at a price, every year. The foods so anointed have to be low in fat, saturated fat, and cholesterol yet Boar's Head All Natural Ham somehow made the cut as did Boar's Head EverRoast Oven Roasted Chicken Breast . Such processed, high-sodium meats raise blood pressure, the risk of cardiovascular disease and the risk of diabetes. A review of almost 1,600 studies involving one million people in ten countries on four continents showed that a 1.8-ounce daily serving of processed meat raised the risk of diabetes by 19 percent and of heart disease by 42 percent.

The new guidelines might make sense if statins were truly as effective as their proponents claim, and if they had no adverse effects. But they have an increasing list of side effects, which affect at least 18 percent of people who take them. These range from muscle pain, weakness and damage to cataracts, cognitive dysfunction, nerve damage, liver injury and kidney failure.

As Jerome Hoffman, M.D., Professor Emeritus of Medicine at UCLA wrote recently with regard to these guidelines: "How did we arrive at a place where conflicted parties get to make distorted semi-official pronouncements that have so much impact on public policy?" How indeed? By Barbara Roberts, M.D. is an Associate Clinical Professor of Medicine at the Alpert Medical School of Brown University. She is the author of The Truth about Statins and How to Keep from Breaking Your Heart: What Every Woman Needs to Know about Cardiovascular Disease . Martha Rosenberg is a health reporter and author of Born with a Junk Food Deficiency.

[Oct 11, 2016] Doctors perform thousands of unnecessary surgeries

Notable quotes:
"... A 1982 study in the journal Medical Care found that a mandatory second opinion program for Massachusetts Medicaid patients led to a 20% drop in certain surgeries, such as hysterectomies, that were considered more likely to be done unnecessarily. ..."
"... "We expect the physician to know what's best for a patient," says William Root, chief compliance officer at Louisiana's Department of Health and Hospitals. "We put so much faith and confidence in our physicians, (and) most of them deserve it. But when one of them is wrong or goes astray, it can do a lot of damage." ..."
Oct 11, 2016 | www.usatoday.com
June 20, 2013 |

Jonathan Stelly was 22, a semi-pro baseball player aiming for the big leagues, when a fainting spell sent him to his cardiologist for tests. The doctor's office called afterward with shocking news: If Stelly wanted to live to age 30, he was told, he'd need a pacemaker.

Stelly knew it would be the end of his baseball dream, but he made a quick decision. "I did what the doctor said," he recalls. "I trusted him."

Months after the surgery, local news outlets reported that the Louisiana cardiologist, Mehmood Patel, was being investigated for performing unnecessary surgeries. Stelly had another doctor review his case. Then another. And another. They all agreed: He needed blood pressure medication, but he never needed the pacemaker.

Today, Patel is in prison, convicted of billing Medicare for dozens of unnecessary heart procedures. Stelly, now 34, still has the pacemaker – but the doctors shut it off years ago.

"Baseball was my life, and he took that away," Stelly says. "For nothing."

... ... ...

Tens of thousands of times each year, patients are wheeled into the nation's operating rooms for surgery that isn't necessary, a USA TODAY review of government records and medical databases finds. Some, such as Stelly, fall victim to predators who enrich themselves by bilking insurers for operations that are not medically justified. Even more turn to doctors who simply lack the competence or training to recognize when a surgical procedure can be avoided, either because the medical facts don't warrant it or because there are non-surgical treatments that would better serve the patient.

... ... ...

Since 2005, more than 1,000 doctors have made payments to settle or close malpractice claims in surgical cases that involved allegations of unnecessary or inappropriate procedures, according to a USA TODAY analysis of the U.S. government 's National Practitioner Data Bank public use file, which tracks the suits. About half the doctors' payments involved allegations of serious permanent injury or death, and many of the cases involved multiple plaintiffs, suggesting many hundreds, if not thousands, of victims. <

... ... ...

A 2011 study in the Journal of the American Medical Association reviewed records for 112,000 patients who had an implantable cardioverter-defibrillator (ICD), a pacemaker-like device that corrects heartbeat irregularities. In 22.5% of the cases, researchers found no medical evidence to support installing the devices.

... ... ...

"Don't just take a doctor's word," says Patty Skolnik, who founded Citizens for Patient Safety after her son, Michael, died at 22 from complications in what she says was unnecessary brain surgery. "Research your doctor, research the procedure, ask questions, including the most important one: 'What will happen if I don't get this done?'"

... ... ...

A 1982 study in the journal Medical Care found that a mandatory second opinion program for Massachusetts Medicaid patients led to a 20% drop in certain surgeries, such as hysterectomies, that were considered more likely to be done unnecessarily. A 1997 study in the Journal of the American College of Surgeons looked at 5,601 patients recommended for surgery and found that second opinions found no need for the operation in 9% of the cases. Among those who got the countervailing second opinion, 62% opted not to have the operation.

But many patients simply aren't inclined to question their doctors.

"We expect the physician to know what's best for a patient," says William Root, chief compliance officer at Louisiana's Department of Health and Hospitals. "We put so much faith and confidence in our physicians, (and) most of them deserve it. But when one of them is wrong or goes astray, it can do a lot of damage."

[Oct 10, 2016] Report Highlights Prevalence of Diagnostic Errors

medstak.com
"Everyone will experience one meaningful diagnostic error in their lifetime," Dr. John Ball recently told NBC News. Ball, who chairs the Committee on Diagnostic Error in Medicine, helped draft a report on the alarming rates of late or misdiagnosis in U.S. healthcare settings – the consequences of which are often catastrophic if not fatal for some patients.

Prevalence of medical misdiagnoses

According to the study:

In sum, the majority of American adults will suffer the effects of misdiagnosis or diagnostic error at some point in their lives.

Doctors afraid to admit their mistakes

The report suggests that better training and guidelines can help reduce incidence of diagnostic errors in clinical settings. However, we live in a culture where doctors and hospitals are not always willing to speak freely about mistakes, making it that much more challenging to learn from near misses.

"If people are afraid to speak up, then bad things can continue to happen," Ball said.

This sentiment was echoed back in 1998 by The Institute of Medicine, which found that medical errors and surgical mistakes claimed the lives of tens of thousands of American patients each year. The organization also called for a "culture of confession" in the hopes that healthcare professionals wouldn't be afraid to fess up their blunders. With a more open dialogue among medical providers regarding botched surgeries and missed diagnoses, new approaches could be developed to help prevent the same errors from repeating themselves.

Ball also says that pathologists and radiologists should get more involved in clinical care and patient diagnosis for more accurate testing.

Real life examples of diagnostic errors

The life-altering consequences of diagnostic mistakes are all too familiar to Susan Sheridan of Boise, Idaho. Sheridan's husband died after his doctors failed to diagnose an aggressive cancer in his spine, and her child – who is now an adult – was rendered permanently disabled after physicians failed to treat his infant jaundice.

In 1995, her newborn son Cal developed a dangerous condition known as kernicterus which is caused by high levels of bilirubin. At just a few days old his skin had turned a bright orange, but Sheridan's concerns were continually dismissed by pediatricians. By the time the correct diagnosis was finally made, Cal had suffered extensive brain damage leading to cerebral palsy. He is both hearing and speech impaired, uses a walker and will need medical care for the remainder of his life.

Sheridan hopes that other families will never have to endure similar heartache and loss and has since become the director of patient engagement for the Patient-Centered Outcomes Research Institute (PCORI). Still, Sheridan laments that there is no organization or system where medical errors can be logged and tracked.

"The first thing I wanted to do was tell somebody, so they could make sure that will never happen again."

[Oct 10, 2016] The FDA is compromised and they can't be trusted

Oct 10, 2016 | www.nakedcapitalism.com

patrick October 10, 2016 at 7:27 pm

The FDA is compromised and they can't be trusted. http://ssrn.com/abstract=2282014

[Oct 10, 2016] The moment you see the phrase 'surrogate outcome' you know they aren't looking at the disease anymore

Oct 10, 2016 | www.nakedcapitalism.com

paul October 10, 2016 at 10:26 am

The moment you see the phrase 'surrogate outcome' you know they aren't looking at the disease anymore.

Gee October 10, 2016 at 10:50 am

Absolutely.

See page 6 for a good summary of the ways surrogates can be problematic.

http://depts.washington.edu/ssbiost/PRESENTATIONS/DeMets.pdf

SpringTexan October 10, 2016 at 7:16 pm

Great reference with good list of trials that make the point; thanks!

[Oct 10, 2016] Is it any coincidence that the US is one of the few developed countries that allows drug advertising on television

Notable quotes:
"... Is it any coincidence that the US is one of the few developed countries that allows drug advertising on television ? I've lost count of the number of times I've wanted to throw something at the TV when I hear the phrase " … ask your doctor whether Drug X is right for you !". ..."
"... Better yet, just avoid the TV at all costs. You are simply being manipulated. ..."
"... If you did not choose to put something in front of your eyeballs, you can be highly confident that somewhere, there's a serious conflict between the message being delivered and your best interests. ..."
Oct 10, 2016 | www.nakedcapitalism.com

JustAnObserver October 10, 2016 at 1:04 pm

Is it any coincidence that the US is one of the few developed countries that allows drug advertising on television ? I've lost count of the number of times I've wanted to throw something at the TV when I hear the phrase " … ask your doctor whether Drug X is right for you !".

OTOH maybe that's a plus. If its being promoted on TV then avoid it at all costs until you've read the independent trial evidence.

Anonymouse October 10, 2016 at 3:09 pm

Better yet, just avoid the TV at all costs. You are simply being manipulated.

If you did not choose to put something in front of your eyeballs, you can be highly confident that somewhere, there's a serious conflict between the message being delivered and your best interests.

And even if you did choose it, be careful what the producer's motives were…

[Oct 10, 2016] When profit motive replaces Hippocratic oath terrible things happen

Notable quotes:
"... We are talking about "medical industrial complex" here. So this is a systemic problem: Dangerous drugs, "blockbuster drugs" are just the tip of an iceberg. ..."
"... Hospitals became more of a money making machines and the duration of your stay in hospital often is determined by the insurance you have and doctors financial motives, not by your disease. ..."
"... First step of the government take over all pharmaceutical research could be government paying for all clinical trials. What could the industry object? It would mean much less financial risk for the firms - an incentive. ..."
"... Read more about this for profit fantastic here - I think I've got it right: http://ontodayspage.blogspot.com/2016/06/will-500000-americans-year-die-for-lack.html ..."
Oct 10, 2016 | www.nakedcapitalism.com

likbez October 10, 2016 at 1:30 pm

We are talking about "medical industrial complex" here. So this is a systemic problem: Dangerous drugs, "blockbuster drugs" are just the tip of an iceberg.

When profit motive replaces Hippocratic oath terrible things happen. And this is what happened under neoliberalism. "Greed is good" is the new morality.

That include useless surgeries, such as cardiac stenting (which is a mass practice in the USA).

See

Actually any area where control is difficult and the same doctor recommends the procedure and later does the surgery is suspect. When you're a hammer everything looks like a nail.

Hospitals became more of a money making machines and the duration of your stay in hospital often is determined by the insurance you have and doctors financial motives, not by your disease.

Denis Drew October 10, 2016 at 1:43 pm

First step of the government take over all pharmaceutical research could be government paying for all clinical trials. What could the industry object? It would mean much less financial risk for the firms - an incentive.

No matter who pays for the research it is the same university researchers doing the work - as far as I know. Government could fund the whole thing without any need for greed.
* * * * * *
Right now, 10,000 Americans die weekly (!) of heart failure. Formerly there was no improvement and certainly no cure. In 2012 a small clinical trial or a balloon inserted around the heart to assist pumping ended with 5 actual cures, most improved and a few held steady. A much larger trial of 200 is being attempted to get FDA approval …

… but is in Limbo (from my reading) by inability to get investors to pony up for more than 100 of the 200 - $30 million short being the reason. The flip side of profit based research ripoff.

I'm sure today's 5 million heart failure sufferers in the US would gladly pony up $6 apiece. Maybe one of them should start a go-fund-me for $30 million. Maybe investors would not want them to.

Read more about this for profit fantastic here - I think I've got it right: http://ontodayspage.blogspot.com/2016/06/will-500000-americans-year-die-for-lack.html

* * * * * *
Gilead - the same company that brought us Sovaldi - now has developed a drug that claims to be 95% effective against all versions of hepatitis: Epclusa. At $75,000 a treatment (that may only cost them $150 to manufacture) X 300 million worldwide sufferers, that comes to $22.5 trillion (with a "t") to treat all. I'm sure they need most of that for future research (or divert it to pay for the living and business expenses for every man, woman and child in the US, Canada and Mexico for one year).

http://www.marinij.com/article/NO/20160710/FEATURES/160719994

[Oct 10, 2016] Never to take any drug that hasn't been on the market for at least 5 years. The FDA is toothless and is corrupt

Notable quotes:
"... A pharmacist friend of mine told me never to take any drug that hasn't been on the market for at least 5 years. The FDA is toothless and is corrupt just like every other regulatory agency in this country. Big pharma is primarily concerned with huge profits like "blockbuster" (expensive) and drugs that you have to take over a long period of time and this is probably one reason why a lot of research on superbugs isn't being done. There's no money in it. ..."
Oct 10, 2016 | www.nakedcapitalism.com

Elizabeth October 10, 2016 at 3:14 pm

A pharmacist friend of mine told me never to take any drug that hasn't been on the market for at least 5 years. The FDA is toothless and is corrupt just like every other regulatory agency in this country. Big pharma is primarily concerned with huge profits like "blockbuster" (expensive) and drugs that you have to take over a long period of time and this is probably one reason why a lot of research on superbugs isn't being done. There's no money in it.

[Oct 10, 2016] Why Useless Surgery Is Still Popular

Notable quotes:
"... An accompanying editorial came to a scathing conclusion: The surgery is "a highly questionable practice without supporting evidence of even moderate quality," adding, "Good evidence has been widely ignored." ..."
"... "We have randomized clinical trials that produce the highest quality of evidence. They strongly suggest that the procedure is next to useless. If there is any benefit, it is very small and there are downsides, expense and potential complications." ..."
"... What decisions in medicine today give priority to what is best for the patient? Unnecessary surgery is only one component of patient care taking a back seat to money. Pharmaceutical companies remove lower-priced drugs from market and set sky-rocketing prices for drugs that remain. Devices, such as morcellators that spread cancer during surgery and vaginal mesh that can irreversibly ruin a woman's health, are still being used despite their terrible impacts because of the money in it for the device makers and doctors who use them. ..."
"... Capitalism works when consumer protection laws are enforced to protect consumers from predatory suppliers. American consumers have been left to fend for ourselves. We must not trust our doctors to provide sound health care. Instead, we are forced to do our own research and draw our own conclusions from credible, independent sources, to the extent they still exist. ..."
"... DO NOT look to news articles for medical advice! And lastly, know that medical doctors are often biased too much against surgery, while surgeons are often biased too much in favor of surgery. ..."
"... As a physician, and this is me speaking for myself, I feel that unnecessary surgeries, procedures, and diagnostic tests are a byproduct of a culture where people would prefer a pill or surgery to behavioral change and where doctors are compensated well to provide