What are the reasons prices for prescribed medicine here are far higher than they are in Canada? Is there a good reason or any reason? Add to this the recent federal government action to bring U.S. drug prices close to or on par with their costs in Canada. To make sense of this, please listen to the Houston Healthcare Initiative podcast. Listen here to find out Why Canadian Drug Prices Are Lower Than US Drug Prices.
Listen for more here at https://soundcloud.com/you/tracks.
Even for those who have private insurance…
Patients Can Save Money When They Pay Their Doctor In Cash
Even patients who have their own health insurance can often save themselves money by paying cash. The Houston Healthcare Initiative website (www.houstonhealthcareinitiative.org) now has a page that lists seventy-eight separate medical services that will accept cash payments. The number expands almost daily as independent providers look for ways to compete with the large conglomerates that provide most of the care here in the U.S. and provide more and better service to their patients. To go directly to the “Healthcare Pricing” page click here: https://houstonhealthcareinitiative.org/pricing.
There is no charge to visit the site, nor is there any fee to those who want to list their practice or
facility.
Direct Payments Are Counter Intuitive
How could a patients’ direct payments be more affordable than those from their health insurance? “People who have health insurance assume that the insured price is always better than the cash price, but that is not always the case,” said neurologist and founder of the Houston Healthcare Initiative, Dr. Steven Goldstein. This has to do with meeting deductibles that are now higher than in years past. “Businesses who provide their employees with health insurance often require them to bare more of the cost in the form of higher deductibles, paying thousands of dollars on their healthcare before they can make a claim.” It is for these people and families that direct payments for service, on the day provided, makes sense.
But Do Not Go Without
Of course, this is not always the case nor is it a good reason to completely forgo health insurance. “Health insurance can protect people from high fees associated with serious long-term illnesses and accidents that could potentially bankrupt them,” Dr. Goldstein said. “But if someone has a high deductible and wants to save, this is a reasonable alternative that is at least worth investigation.”
Good For Doctors Too?
It is costly and labor intensive to administer health insurance. Healthcare providers benefit from accepting cash because of lower administrative and collection costs. “The labor required to file claims, negotiate with the insurance company and wait for payment, chase down their compensation from the insurance company or the patient saves the office manager a lot of time and hassle,” Dr. Goldstein said. “So much so that providers can pass that savings on to those who can pay cash.”
Potential Downside
The biggest potential negative for those who want to pay in cash is that often those payments will not count toward a deductible. All insurance companies have different rules for out of pocket payments and where the cap is for them. It is a good idea for those with such policies to investigate what the requirements and restrictions are in advance. Cash payment makes more sense for someone with a deductible not met or high enough that it likely will not be reached anytime in the same calendar year (deductibles reset annually). The insurance company web site or employer administrator will be able to answer these questions. “There is no substitute for knowing what a policy will or will not allow,” Dr. Goldstein said. “Before making a decision make sure it is informed.”
About Houston Healthcare Initiative
The Houston Healthcare Initiative web site is an aggregator of health 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.
Court Rules Against the Hospital Industry Mandates Price Disclosure. Hospital prices that were historically rigged by the medical business along with the insurance industry, and kept secret from the public, will see the light of day January 1, 2021. This because on June 23, 2020 a federal judge in Washington D.C. dismissed a suit brought by the American Hospital Association (AHA) that challenged the Department of Health and Human Services rule mandating hospitals to disclose their privately negotiated prices with health insurance companies. This ruling, and what it means for doctors, patients and the industry, is the subject of the latest edition of the Houston Healthcare Initiative podcast. The Houston Healthcare Initiative podcast can be heard on SoundCloud, iTunes, iHeart, Spotify and on the Houston Healthcare Initiative website.
Court Ruling Allows Transparency
The court ruled that an executive order from the Trump administration requiring hospitals to disclose pricing was legal. A federal judge upheld a policy that requires hospitals and health insurers to publish their negotiated prices for health services, numbers that are typically kept secret. The policy is part of a major push by the Trump administration to improve transparency in health care. Insurers and health providers usually negotiate deals behind closed doors, and patients rarely know the cost of services until after the fact.
Healthcare Industry Public Relations Offensive
The meaning of the ruling and what will happen are different. As Dr. Goldstein told his audience, “there will be an appeal accompanied by a full court public relations press by the hospital industry to derail this effort.” Dr. Goldstein went on to say, “if the battle can be dragged out until after the presidential election, hospitals and insurance companies can hope a new administration will rescind the executive order.”
Four organizations are now urging the Department of Health and Human Services to delay implementation of the price transparency rule until after the appeals court makes a decision in the case. The American Hospital Association, the Federation of American Hospitals, the Association of American Medical Colleges and the Children’s Hospital Association made their request in a letter to HHS Secretary Alex Azar on June 29, five days after these associations and others filed an appeal against the ruling which would implement a rule on price transparency on January first. The groups said the rule would ‘pose a burden to hospitals and health systems responding to the COVID-19 public health emergency.’ Thirty-four hospital groups have already urged HHS to delay the start of the price disclosure.
In an article published in “Becker Hospital Review” AHA General Counsel Melinda Hatton said, “the proposal does nothing to help patients understand their out-of-pocket costs.” She added, “it also imposes significant burdens on hospitals at a time when resources are stretched thin and need to be devoted to patient care. Hospitals and health systems have consistently supported efforts to provide patients with information about the costs of their medical care. This is not the right way to achieve this important goal.”
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. Court Rules Against the Hospital Industry Mandates Price Disclosure.
This week on the Houston Healthcare Initiative podcast, Dr. Steven Goldstein takes a deeper dive into a court decision where hospitals must reveal private negotiated rates with insurers starting this coming January 1, 2021. Plus, he will provide more insight into how hospitals decide what and how much to charge us, and man is that a story. It’s all more than a little complex. The podcast is available on all the popular podcast networks including SoundCloud, iHeart, and Spotify among others.
How Are Prices Now Assessed
Hospital prices are not based on the free market. Instead, prices are agreed on via secret agreements between hospitals and insurance companies. The truth is that pricing for medical services as paid by insurance companies are artificially set and not competitive at all. Prices are agreed to in advance by the hospital and the insurance company, not disclosed to the public. “We are led to believe that our insurance providers negotiate on behalf of their policyholders,” Dr. Goldstein told his audience. This is not the case. The court has ruled that this will no longer be permitted, that hospitals will have to reveal these negotiated rates and thus hospitals must reveal private negotiated rates .
Why Hospitals Object
One reason many hospitals do not list their actual prices is that, according to them, some cases are more complicated than others. “An appendectomy may go smoothly or may be complicated by other factors such as adhesions from a previous surgery that caused scarring,” Dr. Goldstein said. “This may require additional operating room time resulting in a higher cost. Thus hospitals claim they can only give estimates.”
Alternatively, this could be handled in one of two ways. 1). Publish the price for each procedure at what the hospital perceives as the average price. Then find ways to cut costs so that average cost is lowered resulting in increased profit for the hospital. 2). Alternatively, publish a price for operating room time by the hour that would include all the ancillary charges + publish the range of operating room times for each procedure.
How Prices Are Set Now
With the use of computer technology, hospitals are able to establish a charge for each product or service, no matter how small. “Every aspirin, every blood test, every x-ray, every bandage, every suture has a charge; Dr. Goldstein said. “Some of these charges beg credulity e.g. the $20 aspirin. All these charges are added up to give the total hospital charge. Of course, this doesn’t include multiple physician charges that are separate.” This all resulted in the Trump administration’s order that hospitals must reveal private negotiated rates to the public.
But the final charge is the “sticker price”. The insurance companies never pay this price. They have a secret, negotiated price based on the Medicare price for those services.
The actual price of what a medical test, procedure, exam and often prescription cost and how charges are assigned is not based on the free market. Instead, prices are agreed on via secret agreements between hospitals and insurance companies. This is the subject of the Houston Healthcare Initiative podcast with Dr. Steven Goldstein. To hear the Houston Healthcare Initiative podcast, please visit: SoundCloud, Apple Podcasts, iHeart, PlayerFM, or the Houston Healthcare Initiative web site. Secret Revealed on Pricing Practices of Health Insurance Companies & Hospitals.
Pay More Attention
Most people get health insurance from their employer which is the reason, so few pay much attention to the price of the medical services and pharmaceuticals that Americans purchase. Employer funded insurance pays for most of what is charged with individuals picking up a smaller deductible. But according to neurologist Dr. Steven Goldstein, it is past time to start devoting attention to not just what is charged but how the health insurance companies, and the medical community decides what to charge and why. Spoiler Alert: it is not based on the free market.
The idea that pricing for medical services as paid by insurance companies are artificially set and not competitive at all. They are agreed to in advance by the hospital and the insurance company, not disclosed to the public, and we are all led to believe that our insurance providers were negotiating on behalf of the people that pay the premiums.
It Is Expensive But…
The fact that the charges for visits to the doctor, hospital and pharmacist are mostly paid for by employer funded insurance does not make us any less likely to get both overcharged and underserved. It is a lack of transparency that makes medical costs so high. It was not wrong to believe that research, new equipment, and pharmaceutical discovery were what was behind the increase in healthcare prices; they account for some. “The issue is that patients do not know the actual price of services,” Dr. Goldstein told his listeners. “The list price is the price charged to patients without insurance. Each insurance company negotiates a discounted price.”
Thus, there are multiple discounted prices depending on the insurance company plus a different price for Medicare and Medicaid. These prices have traditionally been secret. There is no competition between hospitals based on price. “Medicare sets the price standard based on costs,” he said. “Thus, hospitals are cost plus operations with little incentive to reduce costs.”
Why Not Just Pay Cash?
Cash prices are often much less than what is charged even to the insurance companies. People often can secure better deals if they don’t use their insurance. A 2016 Wall Street Journal investigation found that hospitals frequently offer far better deals for people who pay in cash rather than use their insurance. “Price transparency allows individuals to shop for the best nonemergency deal. It would also force hospitals to compete, thus saving consumers money. It gives them a choice,” Dr. Goldstein said. The way any of us chooses to spend our money is the most democratic thing anyone can do.
Price transparency allows individuals to find the best non-emergency deal. It would also force hospitals to compete, thus saving consumers money. “If prices were known, posted in public, people could shop for the non-emergency services,” Dr. Goldstein said.
About 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.Secret Revealed on Pricing Practices of Health Insurance Companies & Hospitals
Transparency and the need for it in different industries is a word and requirement we hear a lot about. It should not surprise anyone that some insurers and hospital groups are working to block the implementation of federal rules that make hospital pricing transparent. They argue these will confuse consumers and potentially lead to higher costs. But there is good news. According to the New York Times, a federal judge has upheld a Trump administration policy that requires hospitals and health insurers to publish their negotiated prices for health services, numbers that are typically kept secret.
Most of us have our health insurance provided by our employers and we do not pay as much attention to the price of medical care as we do the cost of other consumer items. But maybe we should pay more attention? The fact that the charges for our visits to the doctor, hospital and pharmacist are mostly paid for by our insurance does not make us any less likely to get both overcharged and underserved. In fact, it is a lack of transparency that makes medical costs so high.
The issue is that patients do not know the actual price of services. The list price is the price charged to patients without insurance. Each Insurance company negotiates a discounted price. Thus there are multiple discounted prices depending on the insurance company plus a different price for Medicare and Medicaid. These prices have traditionally been secret. There is no competition between hospitals based on price. Medicare sets the price standard based on costs. Thus, hospitals are cost plus operations with little incentive to reduce costs.
Learn more by listening to the podcast.
Provided at no charge by the Houston Healthcare Initiative.
For Those Who Lost Their Employer Funded Health Insurance Resources Are Available
Because of the Coronavirus/Covid-19 pandemic, 25–43 million people could lose their jobs and their health insurance. People who had a serious illness before the outbreak and job loss could be dealt a literally fatal blow. Others who had symptoms and even serious accidents while unemployed and without insurance could suffer more than they would have if their insurance were in place. But there are resources available as described this week on the Houston Healthcare Initiative podcast. To learn more, go to www.houstonhealthcareinitiative.org. To hear about this on Dr. Goldstein’s podcast, please visit: Job Losses Equal Employer Funded Health Insurance Loss.
This is not an exhaustive list for those who lost their employer funded health insurance but is some go the most popular ones that are available.
About Houston Healthcare Initiative And Dr. Steven Goldstein
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.
From Heart Attacks to Cancer Screenings and Chemotherapy
During the Coronavirus/Covid-19 pandemic, people who did not have symptoms of the disease put themselves at risk as those with chronic conditions missed treatments, skipped appointments and chose not to report serious symptoms; this is the healthcare not received during the coronavirus/covid-19 pandemic. Many who lost their employer funded health insurance also missed schedules and treatments. Add to this the fear of visiting a doctor’s office or clinic with reported cases of Coronavirus/Covid-19 on the uptick, another health crisis may be on the horizon.
This was one of the issues affecting the American public discussed by Houston based neurologist Dr. Steven Goldstein on his regular podcast. The Houston Healthcare Initiative podcast can be heard on: Soundcloud, iHeart, Spotify, or iTunes. To learn more about the Houston Healthcare Initiative, go to www.houstonhealthcareinitiative.org.
Cancer Screenings Plummet
In March and April, patients were asked to postpone appointments that were not urgent. According to a white paper published by ‘Epic Health Research Network’ cancer screenings for cervix, colon, and breast cancer decreased between 86% – 94% in March, 2020. Care for heart attacks, organ transplants, high blood pressure and diabetes fell in March and remain significantly lower compared to the same time in 2019. “There is a 20% decrease in the number of interactions between patients and their oncologists during the COVID-19 pandemic,” Dr. Goldstein told his listeners. “Anytime a screening is delayed, it means that detection and early treatment are too, plus important therapy on advanced cancer are not administered.
Some Need To Be Seen
Many physicians, like Dr. Goldstein, ramped up their telemedicine capabilities in March and see patients that way. But there are still times when a patient needs to be seen. Instances where patients have symptoms that include shortness of breath is one. This symptom could signal heart failure, asthma, pneumonia or even the Covid-19 virus. A diagnosis like that cannot be done over the phone. “Patients and their families should err on the side of caution, contact their doctor and allow their physician the opportunity to make the right decision for the best treatment,” Dr. Goldstein said.
What Concerned Patients Can Ask
For those who believe or are told they must get in to see a doctor, and there is time available in a non-emergency, Dr. Goldstein has some potential questions to pose.
According to Dr. Goldstein, “we have a responsibility to our patients to provide the most appropriate and effective care possible while at the same time keeping potential exposure to the Coronavirus/Covid-19 virus to a minimum.”
About Houston Healthcare Initiative And Dr. Steven Goldstein
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.
Even with fewer jobs lost in May than anticipated Americans now experience an unemployment rate of 13.3% or 21 million people out of work due to the coronavirus/covid-19 pandemic. On top of lost income, loss of employer provided health insurance makes the cost even higher for those who through no fault of their own find themselves in a very challenging situation. On his podcast this week, Dr. Steven Goldstein describes how job losses equal employer funded health insurance loss and some available and often free resources for those who need health insurance. To listen to the podcast go to: Soundcloud, iHeart, Spotify, or iTunes. Or click here to listen:
Double Loss; Job and Health Insurance
Most Americans rely on their employers to provide health insurance for them and their families and when those jobs disappear so does the coverage. “It is extremely important that people get some type of coverage when they have lost their health insurance,” Dr. Goldstein told his listeners. “The available things to look into are COBRA, spouse insurance, faith-based cooperatives, enrollment on the insurance exchange (Obama Care), Medicaid and CHIP.”
COBRA Coverage
COBRA allows employees (and their families) who would otherwise lose their group health coverage due to certain life events to continue their same group health coverage. The former employee generally pays the full monthly rate and not the discounted one for their health insurance. Under COBRA, group health plans must also provide covered employees and their families with certain notices explaining their COBRA rights. The revised model notices provide additional information to address COBRA’s interaction with Medicare. The model notices explain that there may be advantages to enrolling in Medicare before, or instead of, electing COBRA.
State Insurance Exchange
While typically only available during certain months of the year, the state insurance exchange can open for those who experience a ‘life changing’ event. One such event is the loss of a job and employer sponsored health insurance. “You can shop for health plans through your state’s insurance marketplace,” Dr. Goldstein said. “But don’t wait around, there are 30 to 60 days to sign up after a qualifying life event before the end of that special enrollment period.”
Spouse Insurance
In households where a spouse’ employer offers health insurance; those benefits may be available. “It is easy enough to find out if a spouse’s job offers health insurance and sign on for that,” Dr. Goldstein said.
Faith Based Health Cooperatives
Faith based plans most often share expenses among members. Each member pays a monthly premium. When one of the members becomes ill or needs treatment for an injury, his or her contributions cover the expenses, in conjunction with the collective input of fellow members. “As such, the premiums are lower in comparison to those of traditional health care,” Dr. Goldstein said. “These operate with exemptions to the mandates of the Affordable Care Act, also known as Obama Care.”
Medicare
Eligibility for Medicare is based on income and the size of family. Medicaid provides health coverage for some low-income people, families and children, pregnant women, the elderly, and people with disabilities in all fifty states. In some states the program covers all low-income adults below a certain income level. “But do not assume that you do or do not qualify,” said Dr. Goldstein. “There are online resources available from the U.S. Department of Health and Human Services along with state references to help guide you.”
CHIP
CHIP stands for ‘Children’s Health Insurance Program.’ CHIP offers low-cost health coverage for children from birth through age 18. CHIP is designed for families who earn too much money to qualify for Medicaid but cannot afford to buy private health coverage. This coverage comes through the Medicaid program, which is why they are frequently seen together.
Income Qualification for Medicare
A family of four with an income of $25,750.00 at the poverty level and eligible for Medicaid or CHIP coverage. For an individual the amount was $12,490.00. The amount goes up by $4,420.00 for each additional family member. “The guidelines change every year,” Goldstein said.
The Good News
There are plenty of alternatives available to individuals and families that can be used short or for the longer term that are not all based on a job with insurance. People under age 26, may even be able to join their parents’ employer-based plan. “There are places to go and affordable resources available,” Dr. Goldstein concluded. “Any type of healthcare insurance or coverage will help protect your finances later.”
About Houston Healthcare Initiative And Dr. Steven Goldstein
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.
Doctors, hospitals, state and federal government agencies along with drug and insurance companies have all made concessions to the public during the time of the Coronavirus Covid-19 pandemic. This emergency affects every American so it stands to reason that what follows will too. But will common sense, red tape cutting, sensible changes that benefit patients remain, or be disposed of like so much medical waste? And what about preparations for future outbreaks? Houston based neurologist Dr. Steven Goldstein of the Houston Healthcare Initiative shares his views on this topic with his podcast audience. The podcast is available on iTunes, Soundcloud, Libsyn, and on www.houstonhealthcareinitiative.org.
Telemedicine
While remote access to doctors via Internet based communications is nothing new, it was never widely used until the outbreak of the Coronavirus/Covid-19 pandemic. But will patients continue to use this convenience? “It depends on what insurance companies will cover as well as what the regulations are from the state board of medical examiners,” Dr. Goldstein told his listeners. “There are plenty of good reasons to maintain this capability. Remote locations, lack of transportation resources and the reality that sick people are not keen to go to a clinic or doctor’s office whether they have the flu, a stomachache or even the Coronavirus should all help persuade the insurance industry to maintain payments for remote appointments.”
Lessons from the Pandemic – Rapid Strike Force
The speed that a viral outbreak is met with can prevent wider infection. Borrowing from an analogy coined by Bill Gates, Dr. Goldstein compared treatment to fighting a war. “We need a standing army to spring into action when a virus is first found and ready to travel anywhere in the world to go to work,” he said.
Dr. Goldstein envisions teams of doctors, nurses, epidemiologists, virologists, and other medical professionals who can very quickly construct field hospitals on the site of the outbreak, isolate and treat the sick people and find treatments for them. “This would be like a ‘Mobile Army Surgical Hospital’ or MASH unit; fully equipped, staffed and right at the front line. The enemy is disease and must be fought aggressively.”
No Excuses
Goldstein thinks that the federal government must put a greater emphasis on public health and do more to keep people from getting sick. “This is not the first epidemic we’ve faced in recent years just the most recent,” Dr. Goldstein said. He described the many recent health crises the world has faced and faces including HIV/AIDS, Ebola, Zika, MERS and lately the Coronavirus/Covid-19 outbreak. “There will be no excuse for any lack of preparedness when this happens again, and we know it will happen again.”
About Dr. Steven Goldstein
The goal of Dr. Steven Goldstein and the Houston Healthcare Initiative is to be a catalyst for change in the way Americans receive and pay for medical treatment. To cause change his web site is an aggregator of information, tools, and targets for the reform of the healthcare industry with an emphasis on free market innovation and personal responsibility.