With Haven in the rearview mirror… Failures to Reform U.S. Healthcare System Are Because the System Is the Problem

Haven Failure
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.

Why Did Haven Healthcare Fail?

Haven
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. 

 

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Why did Haven fail?

In regard to your recent article in the Wall Street Journal, “Why the Amazon, JPMorgan, Berkshire Venture Collapsed: Healthcare Was Too Big a Problem” and the reasons for failure.  Haven failed because it did not use first principles thinking. The people that ran Haven thought that by using technology, innovative ideas and big data they could lower the cost of healthcare.

Why did Haven fail?

Haven failed because it did not use first principles thinking. The people that ran Haven thought that by using technology, innovative ideas and big data they could lower the cost of healthcare.

But they neglected to ask and answer the question why do we need healthcare in the first place? Many would answer we need it to preserve health. If you think about it, health is preserved by clean air and water and a proper sewer system. Health is also preserved by an appropriate diet, adequate exercise, proper sleep and avoidance of toxins such as cigarettes, drugs and alcohol. Early detection of disease is also important as well as compliance with treatment of chronic disease. Thus any healthcare reform should focus on improving public health.

Nevertheless most of us would still like care when we get sick. Ok then, what should healthcare look like? If we treat healthcare as the commodity that it is, we know that the best way to insure an adequate supply at the lowest possible price is to permit the laws of supply and demand to work. Our current system is a highly government regulated system largely influenced by lobbyists who represent doctors, insurance companies, hospitals and drug companies. The consumers I.e. the public has little to say about it. But they could have a great deal to say.

For example, large groups of consumers or large companies, by organizing their workers and their families, can overcome this system. Companies that self insure can use the healthcare cooperative model with the “co-op” owned by the employees. 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. It allows 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.

An innovative cooperative can educate its members to utilize independent providers of healthcare and avoid hospital systems as much as possible. They can publicize providers that offer transparent cash prices for services. Other savings can be achieved by the cooperative owning the electronic medical record (EMR) and granting access to providers as well as to patients. By owning the EMR, the cooperative would own the data.

The cooperative model encourages the use of technology, innovative ideas and big data to improve access, decrease bureaucratic inefficiency, improve diagnostic accuracy, improve treatment outcomes. The failure of Haven illustrates how the current insurance system is resistant to change in spite of the rhetoric to the contrary.

Steve Goldstein

Healthcare Premiums? WHO WILL BEAR THE BRUNT OF THE COSTS?

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:

WHO WILL BEAR THE BRUNT OF THE COSTS?

Written by Dr. Cristin Dickerson, MD

In The Global Covid-19 Pandemic Who Suffers Most?

In The Global Covid-19 Pandemic Who Suffers Most?

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.

When things are uncertain
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?

What a New Administration May Mean for Healthcare Reform

Biden Healthcare Reform 2021
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 SoundCloudGoogle PlayLibsyn FeedStitcheriHeartRadioSpotify, 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.

For These Uncertain Times What Type of Health Insurance Is Best?

In wake of the election which insurance is best?
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 SoundCloudGoogle PlayLibsyn FeedStitcheriHeartRadioSpotify, 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.

Are There Alternatives To Traditional Health Insurance?

Alternatives to Health Insurance

November is health care selection month…

Are There Alternatives To Traditional Health Insurance?

November 16, 2020 — With November the time many Americans are asked to choose their health insurance coverage, the cost, expense, and value are on people’s minds. Are There Alternatives To Traditional Health Insurance? Healthcare is expensive. The healthcare and medical insurance industries are massive with billions of dollars of income. They are able to buy advertising and lobbyists to gain every advantage that money can buy. As Americans try to find ways to pay for it, do any really have any chance of meaningful change for an industry that all but regulates itself? Or should we just resign ourselves to healthcare and insurance companies doing and charging what they want with little if any restriction on them?

Alternatives To Big Insurance

According to Dr. Steven Goldstein, founder of the Houston Healthcare Initiative, there are ways to be insured and save money. As he told his podcast audience, the best alternative to insurance at this time is the healthcare cooperative. The Houston Healthcare Initiative podcast can be heard on SoundCloud, Google Play, Libsyn Feed, Stitcher, iHeartRadio, Spotify, and the Houston Healthcare Initiative web site. When combined with a health savings account and a high deductible, sharing of healthcare costs will go down.

Take Care of Yourself

Of course, the best way to lower costs is to lead a healthy lifestyle. Exercise, diet, limited alcohol consumption, adequate sleep and not smoking are the best ways anyone can be healthier. But for those who refuse these, there should be consequences. “There needs to be consequences for individuals that do not take care of themselves,” Dr. Goldstein told his audience.   “For those that do nothing, laws need to be changed so that care would only be provided at charity hospitals. I know this is a radical change of thinking, but I believe it would go a long way to improving public health. Subsidizing unhealthy behavior only leads to more unhealthy behavior.”

About the Houston Healthcare Initiative Podcast

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.

Compare Democratic and Republican Healthcare Plans and What the Public Can Do About Them

Compare Healthcare By Party

Compare Democratic and Republican Healthcare Plans and What the Public Can Do About Them. The healthcare and medical insurance industries are massive with billions of dollars of income. They are able to buy advertising and lobbyists to gain every advantage that money can buy. To listen to the podcast, click below. 

Do we really have any chance of meaningful change for an industry that all but regulates itself? Or should we just resign ourselves to healthcare and insurance companies doing and charging what they want with little if any restriction on them? On this podcast, with what is a more optimistic point of view is respected Houston based neurologist and founder of the Houston Healthcare Initiative, Dr. Steven Goldstein.

Healthcare reform according to the Democrats is some form of single payer system. According to the Republicans it means more price transparency and more competition between insurance companies. The Democratic reforms will indeed lower healthcare costs by fiat and not cause any appreciable decline of public health. However it also will not improve public health. It will however make individual patients unhappy because of rationing of care. The Republican reforms will have little effect on lowering costs but will avoid the rationing of care. It also will not improve public health. No matter which reforms are adopted patients will be unhappy with the results. Also no legislation will be passed without the blessing of the insurance companies, pharmaceutical companies and hospitals.

What Can The Public Do?

Individuals and companies need to walk away from the insurance system. If enough companies  and individuals leave, the current system will collapse. The best alternative to insurance at this time is the healthcare cooperative. When combined with a health savings account and a high deductible sharing of healthcare costs we can begin to see a gradual reduction in cost. Of course, the best way to lower costs is to lead a healthy lifestyle. This will indeed improve public health. For the medicare age groups, the managed medicare plans lower costs by partial rationing of care combined with encouraging a healthy lifestyle. I do not have the statistics as to whether or not managed medicare plans improve public health.

What About Obamacare?

Didn’t the Affordable Care Act, also known as Obama Care, make more choices for insurance available and penalize people who did not purchase health insurance?Yes, but look what happened to health insurance premiums. They kept rising even faster than before. The subsidies, while allowing more people to be covered by insurance, were a boon to the insurance companies allowing for the increase of premiums and increasing the number of policies sold. This is why the insurance companies and hospitals were in favor of the bill in the first place. We can see the result- higher premiums. Things are worse than they were before. The overall insurance system is flawed in fundamental ways. We are spending time and money to make a bad system work better and that is probably what will happen in the near term.

There needs to be consequences for individuals that do not take care of themselves.             They can subsidize the government insurance by paying the government a higher premium; pay for care themselves or do nothing. For those that do nothing, laws need to be changed so that care would only be provided at charity hospitals. I know this is a radical change of thinking but i believe it would go a long way to improving public health. Subsidizing unhealthy behavior only leads to more unhealthy behavior.

November Is Health Coverage Selection Month; Which One Is Best?

Time To Choose Health Insurance

November 3, 2020 – Is it possible to get good health insurance coverage in 2021 and save money on treatments, prescription drugs and the policy too? The answer according to Dr. Steven Goldstein, founder of the Houston Healthcare Initiative and respected neurologist, is yes. On his regular podcast Dr. Goldstein, describes how this could work. The Houston Healthcare Initiative podcast is heard on SoundCloud, Libsyn, iHeart Radio, Apple Podcasts, Spotify, Stitcher, Pod Cast Addict, Back Tracks and the Houston Healthcare Initiative web site.

The Virtues of Catastrophic Policies

So called ‘catastrophic’ health insurance policies come with high deductibles and limited coverage for office visits, tests or prescription drugs. These may be the perfect way to remain insured and provide an outlet for savings and that is to pay cash and ignore the deductible. “When people pay cash, they will be charged less than what the insurance company has to pay on the same claim,” Dr. Goldstein told his listeners. “Many doctors and specialists actually prefer cash which is why they usually charge less.”

Does This Apply To The Deductible?

When paying cash and the lower price offered for it, does this apply to the annual deductible amount? “No, the cash price will not apply, but for most who will never meet the deductible amount, it really does not make any difference,” Dr. Goldstein said. “Remember the reason for buying catastrophic insurance, it is in case of a catastrophe. Even if in one year you would’ve met the deductible otherwise, the money you save in other years will more than make up for it.”

About the Houston Healthcare Initiative

Dr. Steven Goldstein is a Houston based neurologist. He founded the Houston Healthcare Initiative and is an advocate for common sense solutions to the healthcare crisis that confronts the citizens and residents of the United States of America.