Stephen Brill Terry Gross Healthcare

[Thailandnotes]

Basically what Obamacare did was a very good thing. It gave tens of millions more people in this country the opportunity to have health care....

The bad news is the way it does it is it provides them with subsidies that taxpayers pay....taxpayers are paying for tens of millions of new customers to pay the same exorbitant prices and fees that everybody else has been paying...

...we have lived with the illusion that health care can be a free market.

http://www.npr.org/blogs/health/2015...-law-wont-work

[jk]

Re: Stephen Brill Terry Gross Healthcare

malcolm gladwell's review of brill's book really slams it. not necessarily for its conclusions, but for the way it is written and documented and the unimpressive means by which it reaches its conclusions.

[DSpencer]

Re: Stephen Brill Terry Gross Healthcare

...we have lived with the illusion that health care can be a free market.

More accurately, some people have lived with the delusion that health care is a free market in the US. It's a shocking delusion, given how obviously false it is.

[sunskyfan]

Re: Stephen Brill Terry Gross Healthcare

This has always been about the bait and switch that health insurance = health care. When Obama came in and a "stimulus" was needed did he set about to train more doctors, nurses, and PAs? Did he build more clinics and hospitals? No. The "I" in the FIRE economy strikes again. Create the illusion of transaction for goods and services, transfer risk and liability, and escape with percetange. Rinse. Repeat.

[Ghent12]

Re: Stephen Brill Terry Gross Healthcare

This has always been about the bait and switch that health insurance = health care. When Obama came in and a "stimulus" was needed did he set about to train more doctors, nurses, and PAs? Did he build more clinics and hospitals? No. The "I" in the FIRE economy strikes again. Create the illusion of transaction for goods and services, transfer risk and liability, and escape with percetange. Rinse. Repeat.

Bingo. That's his reward to the FIRE industry for their help in his ascendency into the White House.

The ACA or Obamacare is a failed policy.

[vt]

Re: Stephen Brill Terry Gross Healthcare

http://www.washingtonpost.com/blogs/...less-generous/

[Thailandnotes]

Re: Stephen Brill Terry Gross Healthcare

malcolm gladwell's review of brill's book really slams it. not necessarily for its conclusions, but for the way it is written and documented and the unimpressive means by which it reaches its conclusions.

It's too bad Gladwell tries to coin "a Woodward." Woodward gets huge fees speaking at corporate gatherings often in direct conflict of stories he is reporting and long ago stopped being a trustworthy journalist.

Thanks for the link, some interesting points, but Gladwell should dig deeper before he tries to justify 1,000 dollars a pill (Sovaldi) I think Brill's main point is well taken. More people have health insurance and some access to healthcare, but it's the same crappy convoluted expensive stuff and taxpayers are on the hook.

[vt]

Re: Stephen Brill Terry Gross Healthcare

http://www.independent.co.uk/life-st...e-9961509.html

[sunskyfan]

Re: Stephen Brill Terry Gross Healthcare

It really is remarkable this is not part of the debate and dialogue. Whether you voted for Obama or not (I did) it is hard to get past this very obvious flaw or deception in his Presidency. The other side of the coin is the obvious corruption of the Republican "opposition" for not making this argument since this IS the critical flaw of the ACA.

[lektrode]

Re: Stephen Brill Terry Gross Healthcare

It really is remarkable this is not part of the debate and dialogue. Whether you voted for Obama or not (I did) it is hard to get past this very obvious flaw or deception in his Presidency. The other side of the coin is the obvious corruption of the Republican "opposition" for not making this argument since this IS the critical flaw of the ACA.

+1 (i didnt)
re: the 'flaw or deception' - but queen nancy deserves AT LEAST as much 'credit' for this, after all, it was her...
hubris (for want of a better term)
'we have to pass it to read it/understand whats in it' ???

and the repubs share 1/4 of the blame FOR NOT COMING UP WITH A BETTER PLAN (or at least some sort of 'compromise') than simply sandbagging, ie: 'becoming the party of no'

epic fail all the way round
and now we're STUCK WITH the unintended consequences...
(as per usual, with pert near everything that comes out of the DNC...)

[DSpencer]

Re: Stephen Brill Terry Gross Healthcare

This has always been about the bait and switch that health insurance = health care. When Obama came in and a "stimulus" was needed did he set about to train more doctors, nurses, and PAs? Did he build more clinics and hospitals? No. The "I" in the FIRE economy strikes again. Create the illusion of transaction for goods and services, transfer risk and liability, and escape with percetange. Rinse. Repeat.

This is why the Stephen Brill interview/article rang so hollow to me. I couldn't believe this part:

The insurance companies are not really the bad actors in this movie. The insurance companies are in many ways like us: They pay health care bills. The culprit here — and the reason that the Affordable Care Act doesn't work is, is not going to work — is that nothing has been done to curb the marketplace of exorbitant bills and exorbitant profiteering on the part of hospitals, medical device makers and obviously the drug companies. The insurance companies are as much the victim of that as we are. Now, they're terribly managed; again, the CEO of the largest company can't even explain what his bill means. They're incompetently managed; they're not very nice people when you get them on the phone. But they're sort of stuck in the same ditch we're in, which is being forced — unlike the payers for health care in any other developed country on the planet — being forced to pay uncontrolled, exorbitant prices and high profits that are generated by nonprofit hospitals and by drug companies and medical device makers. In that sense, I kind of feel sorry for them.

Is he freakin' serious??? Who does he think wrote the bill? They are as much the victim?

I'm not an investigative journalist and it took me 30 seconds to Google the stock price of United Heathcare. Ditto for Anthem/Wellpoint, Cigna, etc. They took off like rockets when the ACA passed and haven't looked back. It doesn't take a genius to realize that the insurance industry is anything but the victim of Obamacare.

He also claims they are terribly managed because the CEO can't explain what the bill means and the phone reps are rude? Give me a break! The bills and "customer service" experience are part of an intentional plan to ensure that what the insurance company is doing is obfuscated from the consumers, providers, journalists and anyone else who tries to understand it. Their goal is to make the claims process a huge black box where they set pricing for everything.

Insurance companies are also right in the middle of patient treatment. Insurance companies routinely decide what is or isn't medically necessary despite the opinion of the patient's actual, real life doctor. Good luck working as a doctor in the real world and getting away with determining treatment without ever examining the patient.

Brill is either woefully naive or he is just a shill. He demonstrates no knowledge of the immense power the insurance industry wields and the amount of legal protection they have bought.

[vt]

Re: Stephen Brill Terry Gross Healthcare

Meanwhile tremendous waste at HHS:

http://www.foxnews.com/politics/2015...cmp=latestnews

[lektrode]

Re: Stephen Brill Terry Gross Healthcare

This is why the Stephen Brill interview/article rang so hollow to me. I couldn't believe this part:


Is he freakin' serious??? Who does he think wrote the bill? They are as much the victim? ....
....
Brill is either woefully naive or he is just a shill. He demonstrates no knowledge of the immense power the insurance industry wields and the amount of legal protection they have bought.

methinks the real problem is the fact that to the insurance co's the 'insured' is NOT 'the customer'.

the customer is the corporation (read: the exec suite) that employs 'the insured'

the corporation's 'job' is to get as much from (out of) the employee as they can possibly wrangle out of them, for as LITTLE OUTGO AS POSSIBLE -

and one of the ways they do this is by 'offering health insurance' in lieu of WAGES

the corporation then hires the 'insurance co' that offers the LOWEST COST coverage - with the corporation being 'the customer' and the relationship between 'the insured' and the insurer being purely adversarial

meaning that the insurer works for the corporation to keep the outgo (from premiums collected) as little as they can wrangle OUT of the employee (and/or the actual med service providers)

and they do it via their lawyers, whos function is to DENY, DELAY AND OBFUSCATE
(perty much the same as the majority of the 535+1 clowns who voted for this scam 'so they could read whats in it' )

[DSpencer]

Re: Stephen Brill Terry Gross Healthcare

methinks the real problem is the fact that to the insurance co's the 'insured' is NOT 'the customer'.

the customer is the corporation (read: the exec suite) that employs 'the insured'

the corporation's 'job' is to get as much from (out of) the employee as they can possibly wrangle out of them, for as LITTLE OUTGO AS POSSIBLE -

and one of the ways they do this is by 'offering health insurance' in lieu of WAGES

the corporation then hires the 'insurance co' that offers the LOWEST COST coverage - with the corporation being 'the customer' and the relationship between 'the insured' and the insurer being purely adversarial

meaning that the insurer works for the corporation to keep the outgo (from premiums collected) as little as they can wrangle OUT of the employee (and/or the actual med service providers)

and they do it via their lawyers, whos function is to DENY, DELAY AND OBFUSCATE
(perty much the same as the majority of the 535+1 clowns who voted for this scam 'so they could read whats in it' )

That's definitely a big problem. And they do it because the tax code incentives them to do it that way. In our supposedly free health care market it's much cheaper to have your company pick one plan for everyone than let people choose for themselves.

[don]

Re: Stephen Brill Terry Gross Healthcare

file under "Let the Market Decide"

New Dosages of Old Drugs Are Used to Raise Their Prices

By BARRY MEIERFEB. 10, 2015

Doctors have long prescribed a muscle relaxant called cyclobenzaprine to treat injuries like back strains, using five- or 10-milligram pills.

But doctors who also dispense the drugs they prescribe directly to patients have recently embraced a new pill that contains 7.5 milligrams of the muscle relaxant. There is no evidence to suggest that the pill works any better except, perhaps, for doctors and the middlemen supplying them. They can charge $3.45, or about five times as much as a five- or 10-milligram pill.

Over the last two years, states nationwide have moved to crack down on so-called physician dispensing of prescription drugs, a practice largely limited to doctors who treat injured workers. But doctors and companies have responded by exploiting loopholes in those rules and adopting new strategies to stay one step ahead, recent studies suggest.

One tactic has been to create novel dosages of old drugs to get around cost controls on traditional ones, according to a report issued in January by the Workers Compensation Research Institute, a group in Cambridge, Mass. Along with the 7.5-milligram version of cyclobenzaprine, the muscle relaxant, new dosages of two older painkillers, tramadol and hydrocodone, that carry far higher prices than the standard versions, have also appeared, the study found.

“The regulations stimulated this innovation,” said Richard A. Victor, the executive director of the research group, which is financed by insurers and state governments.

Along with the new drug strengths, doctors are finding ways to generate added income by dispensing medical foods and compounded drugs, other studies show.

Typically, a doctor writes a prescription that is filled at a pharmacy. But with physician dispensing, the doctor gives the patient the drug and bills an insurer for its cost. Behind that transaction is a network of small companies and distributors that manufacture or repackage drugs for dispensing by doctors and collect payments from insurers, splitting the profits with physicians.

Doctors say the practice benefits patients because it is convenient and allows physicians to better monitor the patient’s use of medication. Insurers and business groups have long tried to control or eliminate physician dispensing because of its higher costs and because doctors in some states were dispensing large volumes of narcotic painkillers like OxyContin.

A number of states, including Florida, Pennsylvania and Indiana, have adopted rules tying the price of a drug dispensed by a physician to a benchmark known as the medication’s “average wholesale price.” The rules vary, but they typically allow the cost of a physician-dispensed drug to reflect a small markup above the medication’s “average wholesale price.” Some states do not allow any markup, but permit a doctor to charge a modest prescribing fee.

Mr. Victor said that staff members at the Workers Compensation Research Institute, while reviewing data for another project, stumbled over information indicating that entrepreneurial doctors and companies had responded with new strategies. By producing a novel dosage, a manufacturer could also create a new “average wholesale price” for that dose that bore little relation to existing forms of the drug and could be many times higher.

Looking at two states, California and Illinois, the group found that doctors who dispense drugs had quickly embraced those dosage forms. By early 2013, dispensing physicians in California were using the 7.5-milligram version of cyclobenzaprine as often as traditional strengths. Just a year earlier, they had rarely, if ever, prescribed the new dosage and doctors who send patients to pharmacies do not use it, the study found.

Similar trends were seen in California and Illinois for two narcotic painkillers, tramadol and generic Vicodin, which have recently appeared in new dosages at far higher prices, the study found. The new form of tramadol contains 150 milligrams, rather than 100 or 200 milligrams. The new form of generic Vicodin contains 2.5 milligrams of hydrocodone rather than five milligrams.

A small Los Angeles-based company called KLE 2 Pharmaceuticals appears to be a major supplier of the new drug doses, which it promotes on its website. The company uses contract manufacturers to make the drugs, which it sells to middlemen known as repackagers that supply the medications to doctors. The president of KLE 2, Kevin Laxer, who also runs a compounding pharmacy, declined to be interviewed for this article.

Prescribing data reviewed by The New York Times indicates that a Los Angeles physician, Dr. Edwin Haronian, and a Chicago-area physician, Dr. Ronald L. Silver, prescribe the new dosage forms of tramadol and generic Vicodin. They did not respond to telephone calls or email messages sent to their offices.

Alex Swedlow, the chief executive of the California Workers’ Compensation Institute, a research group financed by insurers, said he was unaware of any evidence showing that the new versions of cyclobenzaprine, tramadol or generic Vicodin were more effective than existing ones.

He also added that efforts by California lawmakers to rein in the cost of physician dispensing had largely failed, adding that companies and government officials had begun discussing other options to address the practice. “There is interest in moving towards a formulary,” said Mr. Swedlow, referring to a list of drugs that doctors could dispense for specific conditions.

An executive with the Illinois Chamber of Commerce, Jay Shattuck, said that representatives there from insurance companies, businesses and government agencies expected to meet shortly to discuss the issue.

Meanwhile, another recent study by a consulting group, CompPharma, found that doctors treating injured workers were increasingly using compounded medications, such as specially prepared topical creams to treat pain containing various drugs and ingredients. There is little evidence such preparations work, the consulting group reported.