Healthcare by the Numbers

Where Does the Money Go When Paying for Healthcare; Prices, Costs, and Value…

Healthcare by the Numbers

March 23, 2021 – On the latest edition of the Houston Healthcare Initiative podcast, Houston based neurologist and the founder of the Houston Healthcare Initiative Dr. Steven Goldstein, describes the numbers and dollars associated with health insurance and hospitalization costs. This to inform us all where the money that individuals and employers contribute goes and who really profits most.

Dr. Seven Franklin
Where does your money go when paying for health insurance?

The answers are surprising when it comes to cost, price, and the ultimate value those with health insurance derive from the premiums they and their employers all pay. Ultimately, did the public purchase more benefits or receive a better value as a result of what they were charged? “There is nothing wrong with making a profit, but most people will want to know what they bought and was it worth it,” Dr. Goldstein told his listeners.

Additionally, Dr. Goldstein describes the profits hospitals and health insurance companies accrue, what percentage of their payments actually go to help pay for their healthcare and how much the insurance companies keep. All this to help the public decide if this money was well spent or if it could be better managed.

Where To Listen

The Houston Healthcare Initiative podcast can be heard on: Apple Podcasts, LibSyn, Spotify, Radio.Com, Listen Notes, iHeart Radio, Podcast Addict, Podbay, Backtracks, Player FM, Stitcher, and SoundCloud.

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.

Did The Covid-19 Pandemic Cost You Your Job and Health Insurance?

In a time when so many lost their jobs because of the Covid-19 Pandemic….

Job & Health Insurance Loss Come and Go Together; How To Find Affordable Coverage

March 2, 2021 — In December 2020, 66% of Americans who answered a survey said they fear they won’t be able to afford health care this year. Of the 41% of respondents who are very or moderately concerned about health-care costs, 53% are parents with children. The amount of people who were and remain unemployed because of the Covid-19 pandemic remains high. Since most individuals get their health insurance with their jobs, those same folks are also in need of medical coverage.

On his regular podcast, Houston based neurologist and founder of the Houston Healthcare Initiative Dr. Steven Goldstein has immediate and affordable medical insurance solutions for those who need coverage. To hear the podcast visit: Apple Podcasts, Radio.com, iHeartRadio, SoundCloud, and the Houston Healthcare Initiative web site. Job & Health Insurance Loss Come and Go Together.

Use the Obama Care National Marketplace

People who lost their jobs due to the pandemic have the burden of finding work and paying for healthcare. As most people’s healthcare is tied to their jobs. “There are alternatives for people who lost both their jobs and accompanying health insurance,” Dr. Goldstein told his audience. “The key for those people to get covered is to act quickly.”

One reason for this is that job loss qualifies Americans for a special enrollment period in the health insurance marketplace regulated by the U.S. government, but it only lasts 60 days. “Normally the enrollment period for this is in the month of November, but job loss allows an exception. Just remember the 60-day deadline,” Dr. Goldstein said.

Private Health Insurance

Private health insurance will sometimes offer more flexibility than standard coverage. For example, short-term policies lasting up to one year are available in many states. There are differences between health insurance and private health insurance. People buy private health insurance many times because their place of employment does not offer it. In the case of people who lost their employer provided health insurance, purchasing it like this is an option. Private health insurance is often an option for those who work part time, are self-employed, or own a small business.

Health Co-Ops

Health insurance co-ops are private health insurance plans that serve a small group of people and are owned and operated by the members of that group. The health co-operative or co-op is a member owned not for profit corporation. They are run democratically by the members.

The real benefit of health insurance co-ops are they are significantly cheaper than regular health insurance. “The monthly fees are called membership fees, not premiums, Dr. Goldstein said. “The average cost of a co-op membership is about $40 to $90. To put that into perspective, regular COBRA insurance premiums can cost as much as $650 per month.”

Job loss is unnerving enough at any time. Losing health coverage during a pandemic makes that level of anxiety even higher. Because no one wants to be without medical insurance when a previously unseen virus is spreading.  It could make you or a loved one sick at the worst possible time. Fortunately there are reasons to be optimistic about getting health insurance that is affordable and obtainable if action is taken sooner than later.

The amount of information about this and other similar issues grows ever higher at the Houston Healthcare Initiative web site and its social media sites. To learn more about the Houston Healthcare Initiative go to www.houstonhealthcareinitiative.org.

Job & Health Insurance Loss Come and Go Together.

Job & Health Insurance Loss Come and Go Together; How To Find Affordable Coverage

In a time when so many lost their jobs because of the Covid-19 Pandemic….

Job & Health Insurance Loss Come and Go Together; How To Find Affordable Coverage

Affordable Fixes for Health Insurance
Many Americans lost their jobs and health insurance all at once and are looking for affordable, practical alternatives. That is the subject of this podcast.

March 2, 2021 — The Pandemic Cost Me My Job And Health Insurance Now What? In December 2020, 66% of Americans who answered a survey said they fear they won’t be able to afford health care this year. Of the 41% of respondents who are very or moderately concerned about health-care costs, 53% are parents with children.

The Pandemic Cost Me My Job And Health Insurance Now What?

The amount of people who were and remain unemployed because of the Covid-19 pandemic remains high. Since most individuals get their health insurance with their jobs, those same folks are also in need of medical coverage. On his regular podcast, Houston based neurologist and founder of the Houston Healthcare Initiative Dr. Steven Goldstein has immediate and affordable medical insurance solutions for those who need coverage.

Medstar Washington Offers Transparency Example for Hospitals

Dr. Steven Goldstein discussed the spirit of the law that requires hospitals to make their pricing known to the public on his February 5, 2021 podcast, Medstar Washington Offers Transparency Example for Hospitals. You can listen to that podcast by clicking here: Hospital Price Transparency Podcast.

In late 2020, the Department of Health and Human Services issued the final rules on price transparency for healthcare providers. Prior to the release of these new rules, health insurance companies, and healthcare providers like hospitals negotiated prices for all the things they do for patients and did not make any of this information public.

According to Dr. Goldstein what the spirit of these new rules intended and what is happening in practice are not quite the same. As of January 1, 2021, hospitals are required to make prices, those payer-negotiated rates for their services, available online in a readable format.

The big idea here was to make all of those different rates, payer specific rates all more available and more transparent to patients. Sounds easy enough. But, according to the healthcare industry, procedures and services are often not as cut and dried as placing a price tag on a service and charging your insurance.

According to them, some procedures can affect patients differently, causing them to have different levels of care and other needs that all have different prices. Many healthcare providers also cannot say upfront what exactly the price will be, because doctors do not know the extent of the services until they begin offering care.

But there is one shining example of what looks like full compliance. MedStar in Washington posted its prices in an Excel sheet on its website. It is presented in a way that people can see the charges for various procedures from different insurance companies. It looks like what the spirit of these new rules really intended and an example for others to follow.

Some hospital networks haven’t published their price lists yet because they claim they need more clarification from the federal government on how best to translate complex insurance contracts into straightforward prices for consumers.

They also say they are concerned that a lack of standardization in how hospitals approach job of making prices public will make it impossible for people to accurately compare prices between different systems.

Some hospital networks haven’t published their price lists yet because they claim they need more clarification from the federal government on how best to translate complex insurance contracts into straightforward prices for consumers.

They also say they are concerned that a lack of standardization in how hospitals approach job of making prices public will make it impossible for people to accurately compare prices between different systems and honor the law the way that the podcast describes, Medstar Washington Offers Transparency Example for Hospitals.

All that said, Medstar Washington made a credible attempt to comply with the letter and spirit of the law. Hopefully others will follow this example.

Hospital Price Transparency & The Creative Ways Hospitals Find To Avoid Posting Their Prices For The Public

Lacking transparency
Lacking transparency for hospitals and healthcare.

Some of the most creative writing in business lately are the ‘reasons’ why hospitals and other healthcare providers are not able to post their prices, as the law requires. Respected Houston based neurologist and founder of the Houston Healthcare Initiative, Dr. Steven Goldstein, understands the letter and intent of the new rules on price transparency for healthcare providers and hospitals. Specifically, all the new rules that call for these medical suppliers to essentially post their price list. What the spirit of these new rules intended and what is happening in practice are not quite the same. To hear all of his insights tune to the Houston Healthcare Initiative podcast on SoundCloud, Apple Podcasts, Radio.Com,LibSyn, Spotify, Podcast Addict, iHeartRadio, Stitcher, Backtracks, Podbay, Podbean, and other places where podcasts are syndicated.

Claiming They Do Not Know

The big idea here was to make all of the prices, different rates, payer specific costs charged by insurance companies all more available and more transparent to patients. Sounds easy enough. But, according to the healthcare industry, procedures and services are often not as cut and dried as placing a price tag on a service and charging your insurance. According to them, some procedures can affect patients differently, causing them to have different levels of care and other needs that all have different prices.

Many healthcare providers also cannot say upfront what exactly the price will be, because doctors do not know the extent of the services until they begin offering care. “Hospitals do not want to be pinned down on prices other than to say, ‘it depends’ which is not much of an explanation,” Dr. Goldstein told his audience. “Some hospitals only posted price estimates, uploaded files in difficult to use formats, or promised to release information only after someone enters their insurance information. In New York City, a published investigation found only a handful of hospitals in that city complying while the rest were less than upfront.”

More Reasons To Not Comply

There are other reasons cited for non-compliance. Like the American Hospital Association claim that staff who would help with compliance are stretched thin because of the Covid-19 pandemic. “But the bottom line is that price competition only works if those involved are really competing, Dr. Goldstein said. “Without price disclosure, competition remains very elusive.”

Price Transparency Background

As of January 1, 2021, hospitals are required to make prices, those payer-negotiated rates for their services, available online in a readable format. In late 2020, the Department of Health and Human Services issued the final rules on price transparency for healthcare providers. Prior to the release of these new rules, health insurance companies, and healthcare providers like hospitals negotiated prices for all the things they do for patients and did not make any of this information public. What this arrangement meant was that patients did not know what they would pay for treatment, tests, surgery, drugs and everything else until after they were treated and received the bill. “There is a lot of potential benefit for the American public when or if these rules are fully adopted and made more available for the public,” Dr. Goldstein said.

About The Houston Healthcare Initiative

The Houston Healthcare Initiative (HHI) is a member owned, non-profit medical co-op. Led by Houston based neurologist Dr. Steven Goldstein, the HHI will replace traditional health insurance for qualified individuals and families and provide incentives for members to adopt healthier lifestyle habits. HHI will provide affordable medical coverage through a combination of negotiated rates, low monthly payments, personal accountability and lifestyle incentives. The medical co-op promises to save qualifying individuals and families money on health insurance. At the same time, HHI will help uphold quality care by asking members to bear some responsibility and individual accountability for maintaining their personal health.

 

How Haven Failed at Repairing America’s Healthcare System

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.

The lessons available from this epic ‘bellyflop’ are the subject of the latest Houston Healthcare Initiative podcast, hosted by respected Houston based neurologist Dr. Steven Goldstein. The Houston Healthcare Initiative podcast can be heard on: SoundCloud, Radio.com, Spotify, ListenNotes, iHeartRadio, Podcast Addict, Stitcher, BackTracks,PlayerFM, and the Houston Healthcare Initiative web site.

Resource Rich but Still A Bust

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

Haven Failed to Fix Healthcare
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.

Why Haven Failed To Fix Healthcare

Forever Closed
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.

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