How Some Hospitals Are Balking At These New Rules And One That Is Not
This week respected Houston based neurologist Dr. Steven Goldstein will discuss the price’s patients are charged by doctors and hospitals. Specifically, on the new rules about healthcare price transparency. Specifically, on the new rules about healthcare and price transparency. What needed to change on disclosing prices and is anything different as a result? Of course, there are ways that the hospitals are playing around with the information. But there is one shining example of what looks like full compliance.
How Haven Failed at Repairing America’s Healthcare System. The reason that healthcare and associated costs for medical treatment are so high is the way pricing is established, managed care. Making healthcare more affordable and accessible was what Haven was supposed to do. Its failure to address how prices are kept artificially high via managed care was among its biggest failures.
Haven was a joint venture between Amazon, Berkshire Hathaway and JPMorgan-Chase. Its purpose was to use the leverage of its tens of thousands of employees and its expertise in technology to improve the healthcare system.
Managed Care Keeps Prices High
How Haven Failed at Repairing America’s Healthcare System. Haven was a $100 million bellyflop of a failure, as represented here.
Haven worked at the edges of what really made medicine expensive and avoided the fundamental challenge of the managed care model. “We need a system that enables hospital systems to profit from the improved health of the population rather than the amount of ‘sick care’ delivered,” Dr. Goldstein told his podcast audience. “Innovative ideas need to focus first on improving health. The only way for this to happen is for hospital systems to profit from this outcome.”
How?
One example of how to accomplish this, is for hospitals to offer Medicare pricing to patients without insurance at Medicare rates. In return for the discounted prices, patients would pay the hospital a monthly fee. They would also pay a monthly fee into a savings account in order to pay the hospital bill. In this scenario, the hospital would collect the monthly fee even if no patients were admitted to hospital. If patients were kept well, the need for hospitalizations would decrease. “In this environment, the innovative ideas of Haven would have found a much warmer reception,” Dr. Goldstein said.
No Reason for Change or New Ideas
Haven also failed to understand why the medical business was not interested in new, innovative ways to provide and charge for medicine. The reasons were simple. Insurance companies and providers make lots of money from the current way of doing things,” Dr. Goldstein said. “There are few enticements for them to change and why should they when money is pouring in and there is no pressure to do things differently.”
Thanks, But No
Would the ‘industry’ be open to creative ideas and problem solving when it comes to pricing, service delivery or an emphasis on making the public healthy and not just treating illness? “Probably not,” Dr. Goldstein reported. “The current system of managed care frowns on innovation. It controls innovation by only paying for services that have codes. It likes to use words like usual and customary. Medicine lags behind the tech world by approximately 25 years. So no, in a change averse industry I would not look for any creative approaches to take place except over long periods of time.”
About Dr. Steven Goldstein and the Houston Healthcare Initiative
The Houston Healthcare Initiative (HHI) was founded by respected, Houston neurologist Dr. Steven Goldstein. Like many Americans, Dr. Goldstein is concerned about the state of the U.S healthcare system and the sorry state of the public’s health. The Houston Healthcare Initiative web site is an aggregator of news, healthcare pricing information, and resources for those who want to help drive reform for the healthcare industry. HHI’s emphasis for reform is on free market innovation and personal responsibility.
The goal of the Houston Healthcare Initiative is to be a catalyst for change in the way Americans receive and pay for medical treatment. To cause change the site aggregates information, tools, and targets for the reform of the healthcare industry with an emphasis on free market innovation and personal responsibility.
Haven is closed forever. Why it went so wrong is the subject of Dr. Goldstein’s podcast.
A healthcare company blessed with lots of money, high tech abilities and really smart people will close up the end of January. Of course, this was Haven, the joint venture between Amazon, Berkshire Hathaway and JPMorgan-Chase. Its purpose was to use the leverage of its tens of thousands of employees and its expertise in technology to improve the healthcare system. What lessons can we learn from its failure to accomplish its mission. Here to help reset the focus of reforming healthcare is respected Houston neurologist, Dr. Steven Goldstein.
In spite of the high tech ability and deep pockets of the joint venture partners, Haven went out of business on January 31, 2021.
Big fail. Haven, a joint venture between Amazon, JPMorgan-Chase, and Berkshire Hathaway, booted the chance to reform their collective employee health insurance, in part, by not working on the correct challenge, according to respected neurologist Dr. Steven Goldstein. Dr. Goldstein hosts the Houston Healthcare Initiative podcast with a focus on reforming the highest priced healthcare system in the world. Haven is the most recent, but likely not the last, story of corporate good intentions not delivering what was hoped. So, what’s the right challenge?
The System Is the Problem
“Our current healthcare system is focused on treating sick people, not preventing illness,” Dr. Goldstein told his audience, and he gave an example. “The more people there are in hospital beds, the more money is made by the hospitals, doctors and everyone else involved in patient care.” The U.S. healthcare industry is a volume-based scheme of reimbursement for getting paid. Better patient health is not part of the current equation.
More of the Same
The business system Haven tried to disrupt offers no tie to healthier outcomes for patients or incentives for those same people to take better care of themselves. “It’s just more of the same,” Dr. Goldstein said. “Haven failed at reforming their collective employee health insurance in part by not working on the correct challenge but instead ‘worked on the fringes’ of a non-competitive business.”
Worthy Goal but Poor Execution
At Haven, the published goal was improving healthcare services and lower costs for the three companies’ employees. With a heavy reliance on ‘big data’ and the ability to analyze patient information in big amounts, Haven promised to make primary care easier to access, prescription drugs more affordable and render insurance benefits easier to understand. While essentially getting nowhere but costing a lot of money to get there, Haven shut down without affecting the healthcare industry at all.
Healthcare as a Commodity?
The best way to ensure an adequate supply of anything at the lowest possible price is to permit the laws of supply and demand to work. “But as we also know, that is not what we have and not the way costs are assigned or managed by insurance companies, hospitals and pharmaceutical companies that assign prices,” Dr. Goldstein said.
Employee & Patient Voices Heard for a Change?
The public has little to say about how pricing is determined but could have a great deal to say with the right type of organization. The correct method available to everyone is via the non-profit, employee-owned healthcare cooperative.
The cooperative or ‘co-op’, can replace traditional health insurance for qualified individuals and families. Co-ops can also provide incentives for members to adopt healthier lifestyle habits. Financial incentives based on lifestyle would result in lower healthcare costs by decreasing utilization. Ownership of the cooperative would pass the savings from the cooperative to the employees. Co-ops can allow employees to remain members even if they leave the company. By transferring ownership of the cooperative to the employees, companies are no longer responsible for healthcare and can concentrate on their core business.
How Co-ops Work
Co-ops provide affordable medical coverage through a combination of negotiated rates, low monthly payments, personal accountability and lifestyle incentives. “By organizing their workers and families, businesses of any size can overcome this less than efficient way of doing things,” Dr. Goldstein said. “For example, financial incentives based on choices about diet and exercise will result in lower healthcare costs by decreasing utilization. The ownership of the cooperative will pass the savings from the cooperative to the employees. But there are other benefits that will make those employees healthier.”
About the Houston Healthcare Initiative
The Houston Healthcare Initiative podcast with Dr. Steven Goldstein is an information vehicle for people who want to know all medical options for themselves and are interested in reforming the healthcare industry. To learn more about the Houston Healthcare Initiative please visit www.houstonhealthcareinitiative.org.
With the resources of three large and very successful companies, Haven will cease operations in late January, 2021.
Why Did Haven Healthcare Fail? Because they focused and worked on the wrong thing. That is the topic and lesson from Dr. Steven Goldstein on the latest edition of the Houston Healthcare Initiative Podcast.
Haven was a joint venture of Amazon, Berkshire Hathaway, and JPMorgan. It was formed three years ago to better manage healthcare for the one million employees of these three large, successful and high tech companies. After three years and approximately $100 million Haven will cease operations. Dr. Goldstein tells his podcast audience the reason for the shortfall had nothing to do with resources, talent or intention and everything to do with trying to fix the wrong thing. The people at Haven were approaching the challenge with trying to fix the existing system.
But according to Dr. Goldstein, the existing system is the problem. “Our current healthcare system is focused on treating sick people not preventing illness,” Dr. Goldstein told his audience and he gave an example. “The more people there are in hospital beds, the more money is made by the hospitals, doctors and everyone else involved in patient care. Ours is a volume-based system of reimbursement for getting paid. There is no tie to healthier outcomes for patients or incentives for those same patients to take better care of themselves. It’s just more of the same.”
The strategies Haven pursued was to leverage the scale of all those employees for better rates and prices. With over a million employees it seems like that might have worked. But it did not because the healthcare industry is not governed by the free market. Instead, it is governed by lobbyists from the hospital, pharmaceutical and insurance industries all who work together to help make sure that little meaningful change is ever introduced never mind adopted. “The focus is not on improving the population’s health, Dr. Goldstein said. “And ultimately that was the biggest mistake the people at Haven made. They were focused on the wrong problem. They might have been able to make a bad system work somewhat better, but it is still a bad system.”
It was a shame that so much money and time went into this laudable goal but yielded no good outcome. A common sense approach to managing the public’s health and is exactly what the insurance, hospital, and drug companies do not want. Given the collective influence (deep pockets) of these businesses and their lobbyists, the American public will continue to get the bill for a medical industry that puts maintaining the status quo as its priority.
Guest Link from Dr. CRISTIN A. DICKERSON, MD. Dr. Cristin A. Dickerson is the founding partner of Green Imaging. Her article about how the public will be sent the bill for the Covid-19 pandemic is very revealing. To read it please follow this link:
January 5, 2021 – In the midst of an ongoing and worsening global pandemic, there are those who are more likely to be sicker and die than others. This according to respected neurologist Dr. Steven Goldstein, founder of the Houston Healthcare Initiative. He told his regular podcast audience that the mortality rate from the Covid-19 infection was greater for patients with obesity, chronic lung disease, diabetes and hypertension and that the older a patient was, the greater the mortality. “The Covid-19 pandemic teaches us that improving public health should be a priority in reforming healthcare,” Dr. Goldstein said. The Houston Healthcare Initiative podcast can be heard on Backtracks,SoundCloud, Libsyn, Listen Notes, iHeart Radio, Spotify, Stitcher, Apple Podcasts and the Houston Healthcare Initiative web site.
Americans remain in the midst of the Covid-19 pandemic. What can we learn from it and how can this influence our thinking when it comes to personal lifestyle choices and healthcare reform?
Mayo Clinic Data
According to the Mayo Clinic web site, risk of severe Covid-19 is highest based on age; older people are at higher risk than those who are younger. Other conditions include type 2 diabetes, severe obesity and serious heart diseases. The site states, “obesity and diabetes both reduce the efficiency of a person’s immune system. Diabetes increases the risk of infections in general. The risk of infections, including COVID-19, can be reduced by keeping blood sugar levels controlled and continuing your diabetes medications and insulin.”
What Individuals Can Control
Dr. Goldstein said that people can take control of their own health by leading a healthier lifestyle. “By this I mean maintaining a modicum of physical fitness and being compliant with medical treatment if you have a chronic illness like diabetes and hypertension,” Dr. Goldstein told his audience. These and other voluntary measures like quitting smoking, moderating alcohol consumption and eating sensibly will help prevent an infection of Covid-19 or keep one from being more serious.
Freedom & Responsibility
Dr. Goldstein believes that in the New Year, the congress should find a balance of individual freedom, responsibility and monetary incentives for a better, national outcome. “People should have the freedom to adopt any lifestyle they wish as long as they do not interfere with anyone else. But, along with that freedom comes the responsibility to pay for it,” Dr. Goldstein said. He mentioned how the government frequently uses its power to promote lifestyle choices. “For example, they impose high taxes on cigarettes to discourage tobacco use. But it does not outlaw the use of cigarettes. If anyone wants to lower their healthcare costs, they can adopt a healthier lifestyle.”
About the Houston Healthcare Initiative
The Houston Healthcare Initiative podcast with Dr. Steven Goldstein is an information vehicle for people who want to know all medical options for themselves and are interested in reforming the healthcare industry. To learn more about the Houston Healthcare Initiative please visit www.houstonhealthcareinitiative.org.
Photo Caption: Americans remain in the midst of the Covid-19 pandemic. What can we learn from it and how can this influence our thinking when it comes to personal lifestyle choices and healthcare reform?
2021 starts with healthcare no less unsettled than it ended in 2020.
Healthcare reform in unsettled times. That times are troubled was never truer than in 2020 and 2021 will start out that way. But in an unsettled time with so much of the nation’s attention turned to medical care, could it be the time to really push healthcare reform and what might that reform look like? Americans remain in the midst of the Covid-19 pandemic. What can we learn from it and how can this influence our thinking when it comes to healthcare reform? Or is it all too big for any of us to do anything meaningful? Here to share his insight with us is respected neurologist and founder of the Houston Healthcare Initiative, Dr. Steven Goldstein.
The incoming Biden administration will face a shrinking workforce and growing number of Medicare enrollees through 2028.
In the New Year What a New Administration May Mean for Healthcare Reform
December 2, 2020 – The incoming Biden administration could force mandates for private firms and their employees to provide for and buy health insurance. This according to Dr. Steven Goldstein on his regular podcast. The respected neurosurgeon and founder of the Houston Healthcare Initiative discussed the possibilities for healthcare reform in the coming year on his regular podcast. The Houston Healthcare Initiative podcast can be heard on: on SoundCloud, Google Play, Libsyn Feed, Stitcher, iHeartRadio, Spotify, and the Houston Healthcare Initiative web site.
Mandates Could Eliminate Opting Out
The Affordable Care Act, also known as Obama Care, made more choices for insurance available and penalized people who did not purchase health insurance. While not ideal, it was a way to get more people covered by private insurance than before. And it offered subsidies for people who could not afford insurance. But there was a downside.
The financial penalties were unpopular and made Obama Care an easy target for those who were against it. Without the specter of financial penalties, many employees chose to go without health insurance and keep the part of their pay that would normally go to help fund it. “One economic rationale for employer mandates is that the cost of care for these uninsured workers is often passed along to the insured through higher insurance premiums, taxes and other mechanisms,” Dr. Goldstein said. “Employer mandates are, in part, an attempt to eliminate those who opt out of available coverage. By adding more payers, health insurance is more affordable at the individual level. At least in theory.”
Do Less for More Or just Pay More
According to the Centers for Medicare and Medicaid, national health spending will grow at an average annual rate of 5.4 percent for the years 2019-28 and reach $6.2 trillion by 2028. Among major payers, Medicare is expected to experience the fastest spending growth of 7.6 percent per year from 2019-to 2028, largely as a result of the highest projected enrollment growth. “National health expenditures will grow 1.1 percentage points faster than the gross domestic product every year on average from now through 2028, said Dr. Goldstein. “The health share of the economy is projected to rise over a full percentage point by 2028. In other words, the costs are growing faster than the income. So, we have to do less of something or boost the gross national product.”
Make A Bad System Less Bad
If the current healthcare system remains unchanged, there will be less in the way of medical resources for the public. But according to Dr. Goldstein, that is unlikely. The overall insurance industry and its approach to paying for healthcare are very flawed in fundamental ways but unlikely to realize any dramatic reform. Working around the edges to make a bad system work somewhat better is what he believes will happen. As Dr. Goldstein told his audience, “we can spend time and money to make a bad system work better and that is probably what will happen in the near term.”
Another Possibility, Pay Cash
According to Dr. Goldstein, cash payments are accepted for most if not all medical charges and prescription drugs. But that comes with a caveat for those who do have insurance, especially catastrophic health insurance. “Do not try to get the ‘insured’ rate to put against your deductible,” he counselled. “Paying cash is much less desirable when put against the insured rate, it will cost you more but not buy any more benefit.”
Most people with catastrophic coverage will never reach their deductible amount. Better to put that money directly into care, at a much-discounted price. This arrangement is the best value for people under the current system. So, while at the doctors’ office show them your insurance card but tell them you are paying cash.
About Houston Healthcare Initiative
The Houston Healthcare Initiative podcast with Dr. Steven Goldstein is an information vehicle for people who want to know all medical options for themselves and are interested in reforming the healthcare industry. To learn more about the Houston Healthcare Initiative please visit www.houstonhealthcareinitiative.org.
Three in ten uninsured adults in 2019 went without needed medical care due to cost.
In wake of the 2020 election outcome…
For These Uncertain Times What Type of Health Insurance Is Best?
November 24, 2020 – According to Dr. Steven Goldstein, founder of the Houston Healthcare Initiative, “with the current system we have, I would buy a policy that has a high deductible,” he told his podcast audience. “This is sometimes known as ‘catastrophic’ health coverage. Then I would pay cash for my health expenses.”
That times are unsettled was never truer than in 2020. With the U.S. House and the presidential election settled, the majority of the senate remains undecided and will stay that way until the two runoff elections for both Georgia senate seats on January 5, 2021. The implications for the U.S. healthcare system are many. What can or should Americans do in the near term? Listen to “The Houston Healthcare Initiative Podcast to find out. The Houston Healthcare Initiative podcast can be heard on SoundCloud, Google Play, Libsyn Feed, Stitcher, iHeartRadio, Spotify, and the Houston Healthcare Initiative web site.
Cash & Catastrophic Coverage
According to Dr. Goldstein, cash payments are accepted for most if not all medical charges and prescription drugs. Do not try to get the ‘insured’ rate to put against your deductible. Paying cash is much less desirable with the insured rate. “Most people will never reach their deductible amount anyway,” he said. “This arrangement is the best value for people under the current system. So, while at the doctors’ office show them your insurance card but tell them you are paying cash.”
Return of the Mandate?
Most Americans get their health insurance through their employer. The Affordable Care Act, also known as Obama Care, made more choices for insurance available and penalized people who did not purchase health insurance. While not ideal, it was a way to get more people covered by private insurance than before. Plus, it offered subsidies for those who could not afford insurance. But at the same time, it was the mandate and accompanying monetary penalty that seemed to make the policy so unpopular with many. “The overall insurance industry and its approach to paying for healthcare are very flawed in fundamental ways,” Dr. Goldstein told his listeners. “We can spend time and money to make a bad system work better and that is probably what will happen in the near term.”
Likely Short-Term Changes
Some near-term changes are likely to be mandates for private firms and their employees to provide for and buy health insurance. The cost of care for uninsured workers is often passed along to the insured through taxes and other mechanisms. There are employed people now who go without health insurance and keep the part of their pay that would go to health insurance. One economic rationale for employer mandates is that the cost of care for uninsured workers is often passed along to the insured through taxes and other mechanisms. Mandates are, in part, an attempt to eliminate those who opt out of available coverage.
American Attitudes About Caring for Each Other
Generally, Americans have decided that we will treat sick and injured people who do not have insurance, but that treatment is not free. “So, we have all these schemes for the uninsured, or others to make people buy insurance,” Dr. Goldstein said. “While caring for the sick and injured is laudable, paying for it is another matter, like with the Obama Care mandate.”
Three in ten uninsured adults in 2019 went without needed medical care due to cost. Studies repeatedly demonstrate that uninsured people are less likely than those with insurance to receive preventive care and services for major health conditions and chronic diseases. Not having insurance is generally a financial issue and one that leads to unhealthier people. “With the catastrophic coverage, patients are able to be seen as many practices will not see anyone without insurance,” Dr. Goldstein said. “Paying cash for services and not applying them to the deductible will both save money and result in a healthier population.”
About Houston Healthcare Initiative
The Houston Healthcare Initiative podcast with Dr. Steven Goldstein is an information vehicle for people who want to know all medical options for themselves and are interested in reforming the healthcare industry. To learn more about the Houston Healthcare Initiative please visit www.houstonhealthcareinitiative.org.
Hospital Price Transparency Podcast
