Why Healthcare Insurance & Hospitals Do Not Want You To Know About Pricing

Medical Price Transparency

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.

The Healthcare Not Received During the Coronavirus/Covid-19 Pandemic

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

No Visitors
Patients who may need to be seen in the office are choosing not to go to the doctor for lots of reasons.

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.

  • Does everyone on staff and patients wear masks?
  • Are the number of persons allowed in the office limited?
  • Has everyone on staff been tested for COVID-19?
  • Are cleaning protocols sufficient to manage waiting rooms, offices, and labs?
  • Has the patient taken responsibility for social distancing, hand washing and mask wearing themselves?

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.

Job Losses Equal Employer Funded Health Insurance Loss

Closed for Coronavirus

Here Are Some Resources

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.

 

How Will Healthcare Change After Coronavirus Covid-19

Rapid deployment to battle epidemics is key to winning.

How Will Healthcare Change After Coronavirus Covid-19

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.

LTC-Kryder-E-Van-Buskirk-Commander-of-the-8076th-MASH-in-Kunu-Ri-Korea-November-27
A medical rapid strike force to battle disease is one of the lessons the healthcare industry and government should apply after the Coronavirus/Covid-19 pandemic. LTC Kryder E. Van Buskirk, Commander of the 8076th MASH in Kunu- Ri, Korea, November 27, 1950. U.S. Army photograph 8A/FEC-50-22795 by CPL Fred A. Rice reprinted with permission.

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.

 

 

Houston Based Neurologist Explains Reason for ‘Surprise Hospital Bills’

A Houston based neurologist, Dr. Steven Goldstein, explains the reasons patients can get very expensive hospital bills even if they went to a hospital, clinic or emergency room that is part of their insurance network on his latest podcast. The Houston Healthcare Initiative podcast can be heard on Soundcloud, iTunes, Libsyn, or on www.houstonhealthcareinitiative.org

Houston Based Neurologist Explains Reason for ‘Surprise Hospital Bills’

No Insurance Network Required for Doctors

While the insurance industry has trained patients, doctors, and hospitals that we all must have insurance and be part of an insurance network the same is not the case for doctors. While in-network doctors and hospitals have agreed with the insurance company how much procedures and tests will cost, not all doctors who work in hospitals are part of any insurance network and can charge more than what insurance will cover. To make this worse for patients and the ultimate cause of ‘surprise hospital bills’ hospitals, emergency rooms or clinics are not required to disclose this to patients or their loved ones. As Dr. Goldstein told his listeners, “behind the scenes, the in-network doctor and the hospital agreed in advance what the charges were going to be. So, the in-network doctor is paid a flat rate based on that agreement. The doctor who works at the hospital but is not part of the insurance network can charge more and get paid more. He is under no obligation to say anything about this to the patient and will not.”

How Can This Be? Private Equity Companies

Private equity companies that own staffing firms and place doctors to work in hospitals along with the American Hospital Association have stated publicly that restricting the independent pricing capability will make putting doctors in geographic or socially challenging locations much more difficult, as higher pay is the biggest incentive for going to work in rural or economically disadvantaged areas. These doctors have no incentive to join an insurer network, which would require them to cut their fees. These are the source of many surprise medical bills.

Doctor Patient Unity Unmasked

A shadowy lobbying group known as Doctors and Patients United are owned and funded by TeamHealth and Envision Healthcare, private-equity-backed companies that own physician practices and staff emergency rooms around the country. In late July, 2019 Doctor Patient Unity placed more than $28 million  in ads opposing the legislation that would ban surprise medical bill, without disclosing who was behind the ads.

Current Information on Federal Legislation

There are several committees and bills on this being considered. At this writing the following bill was being considered: S 1895: Lower Health Care Costs Act. The bill was introduced by Senator Lamar Alexander (R, Tennessee) on June 19, 2019 and reported June 26, 2019. The committees assigned to this bill sent it to the House or Senate as a whole for consideration on June 26, 2019. For resources and the information to act on this bill please go to: https://www.govtrack.us/congress/bills/116/s1895.

Well-known and respected Houston based Neurologist Dr. Steven Goldstein is dedicated to reforming healthcare in the U.S. through education and information to the people who need it most. To learn more about the Houston Healthcare Initiative please go to www.houstonhealthcareinitiative.org.

Retired But Too Young for Medicare? What Now?

Retired But Too Young for Medicare? What Now?

There are plenty of people who retire before the age of 65, whether this was their choice or had retirement thrust upon them. Regardless of the circumstance, these people need health coverage. And since they are ‘retired’ they likely need low or lower cost coverage without sacrificing their quality of care. There are several options for those people according to Houston based neurologist and founder of the Houston Healthcare Initiative CO-OP, Dr. Steven Goldstein. 

Retired But Too Young for Medicare? What Now?

Fear of Loss

Employees fear losing their company subsidized health insurance and when accepting or choosing retirement, that benefit ceases along with the paycheck. According to Dr. Goldstein, it is a situation worth examining and planning for. “There are several alternatives for people who are not old enough for Medicare,” Dr. Goldstein said. “For one, they can choose an extension of their former employers’ insurance through what is known as COBRA.”

COBRA

COBRA stands for “Consolidated Omnibus Budget Reconciliation Act. “It’s a law that since 1985, provides for continuing group health insurance coverage for employees and family members after what they call ‘job loss’,” Dr. Goldstein said. “But, it only applies at companies with more than 20 employees and to state and local government workers. It does not apply to federal workers, churches, or some church related organizations. What’s more this is a short-term fix because there is an 18-month limit on this option. So for someone who is 60 this will get them to 61.5. But there are those other 3.5 years remaining.” COBRA is also a costly choice. Those choosing it can expect to pay up to 102% of the premiums including the part your employer used to pay. 

Affordable Care Act

Options for the Affordable Care Act or Obama-Care are available on line. While the politics of healthcare mean that future choices may be different or even non-existent, but at the moment the law remains in place. “Here in Texas, everyone is required to have health insurance, but they are not required to purchase it through the government,” Dr. Goldstein said. “There is no longer the threat of a fine from the federal government for not having health insurance but going without is never a good idea.”

Healthcare Co-Ops

People can and probably should consider one of the health sharing cooperatives. There are several from which to choose, not the least of them the Houston Healthcare Initiative CO-OP. But according to Dr. Goldstein, there is more to the Houston Healthcare Initiative CO-OPthan inexpensive health coverage. “Our first priority is to improve our members health first and help pay for ‘sick care’ second,” Dr Goldstein stated. “As people work with us to manage their own health, the cost goes down. When they do get sick, we can provide lists of places to get the best prices on prescription medicine, tests, imaging and hospitalization. But, and I want to really stress this, our approach to managing the cost of healthcare is to find ways to be sick less often. We help people manage their weight, level of fitness and other choices they can consciously make to be healthier. So, if you want to save money on healthcare, find ways to be sick less often.”

To find ways to be sick less often and save on health coverage, then look to the  Houston Healthcare Initiative CO-OP and visit the web site at www.houstonhealthcareinitiative.org.

 

 

 

Special Offer From The Houston Healthcare Initiative

The Houston Healthcare Initiative began for one reason and that was to improve health, lower healthcare costs and provide access to doctors, medicine and treatment. There is a myth promulgated by the insurance companies that you can’t get access to healthcare if you do not have insurance. This is just not true. Starting Monday June 1, 2020, The Houston Healthcare Initiative is offering a FREE Seizure Clinic.

Special Offer From The Houston Healthcare Initiative

For seizure patients out of work because of the pandemic, we will see in office for no fee as well as provide 30 days of seizure medication for free as long as supplies last. Patients may pay office visit fees after they get back on their feet. During the COVID-19 pandemic, new patients can be seen using telemedicine for $75 & followups for $35. Insured patients will have copays waived.

 

How Insurance Companies Medical Providers and Drug Companies Game the System

How Insurance Companies Medical Providers and Drug Companies Game the System

March 5, 2019 – For those feeling beat up, picked on, and maybe even a bit bullied by their doctor, hospital and health insurance company there is probably good reason to believe that way. Doctors and hospitals are charging more for services and insurance companies are denying more claims.  Patients need both their health care providers and insurers, but as respected neurologist and Houston Healthcare Initiative Co-Op (www.houstonhealthcareinitiative.org) founder Dr. Steven Goldstein tells his podcast audience, this is not a normal ‘business-customer’ relationship.  The Houston Healthcare Initiative Co-Op podcast can be heard on Soundcloud, iTunesand the web site at www.houstonhealthcareinitiative.org.

Human Shields

The Houston Chroniclereported that ‘doctors and insurance companies have proven they are willing to use patients as ‘human shields’ but what were they really saying? According to Dr. Goldstein, “the conflict is about money.” Dr. Goldstein told his audience that the insurance companies wanted premiums to be as high as possible. But the blame does not stop with the insurance company. “Doctors and hospitals want to charge whatever the traffic will bear,” he said. “A system has evolved that benefits insurance companies, doctors and hospitals but is to the detriment to the patient.”

How Doctors and Insurance Companies Do It

Here is how patients get screwed: Very high list prices for various services have been set up by hospitals and doctors. Insurance companies negotiate contracted prices for these services that are significantly less than the list price and they claim these negotiated rates have benefited the patients, “Anyone selling something can claim a high price, but then list the item as ‘on sale’ for a price that is much less and make it seem like a big savings but it is a big fake out,” he said. “That is what the insurance companies are doing to you.”

Human Piñatas

When hospitals are forced to compete in the marketplace, the market determined cash price for just about anything they offer is usually much less than the insurance company negotiated price. “Less than a shield, patients are used more like piñatas who take a beating from both the hospital and the insurance company,” Dr. Goldstein said. But according to Dr. Goldstein, there are more sensible things people can do to protect themselves and save money.

The Insurance Alternative

Alternatives to traditional health insurance are available from medical co-operatives, or co-ops. The Houston Healthcare Initiativeis a member owned, non-profit medical co-op. It will replace traditional health insurance for qualified individuals, families and provides incentives for members to adopt healthier lifestyle habits. The medical co-op promises to provide more value for the healthcare dollar. “At the same time, we will help uphold quality care by asking members to bear some responsibility and individual accountability for maintaining their personal health,” Dr. Goldstein said.  “It removes the insurance company from the relationship between doctor and patient, thus getting rid of all that expense from administering insurance,” he said.

In the medical co-op model, people pay directly for their care at the cash rate. Large hospital expenses are reimbursed by the co-op trust. “Thus, in one fell swoop, a big piece of what is wrong with the healthcare industry is removed from the equation,” Dr. Goldstein concluded.

About Houston Healthcare Initiative Co-Op

The Houston Healthcare Initiative Co-Op is a member owned, non-profit cooperative owned by the members. To learn more visit them on line at www.houstonhealthcareinitiative.org.

HHI Podcast Page

The Houston Healthcare Initiative Co-Op Podcast Page!

What Is Prior Authorization & What To Do About It

Prior approval is a way that insurance companies decide on how or whether a prescribed medical service, medication, test or procedure meets their coverage criteria. What can people do? Listen to find out.

 

What If I Do Not Have Health Insurance?

What happens if someone does not have health insurance? The ramifications will affect the tax filings of people this year but be different next year. Beyond the financial implications, there are others for patients and their loved ones. Here to help us learn what to do and why is Houston based neurologist and the founder of the Houston Health Initiative Dr. Steven Goldstein. You can learn more about The Houston Healthcare Initiative Co-Op at their web site, www.houstonhealthcareinitiative.org.

 

An overview of the Houston Healthcare Initiative Co-Op. 

Complexities of Health Coverage

Healthcare and what causes rates for services and insurance to go up at a startling rate are complicated. What is not that complex is the need for an affordable way to pay for most medical and doctor related expenses. That is what the Houston Healthcare Initiative (HHI) is offering in the form of a member owned co-op. The HHI initiative can replace traditional health insurance for qualified individuals and families. 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.

 

 

Changing Insurance Providers & Managing Change

Medical and health coverage is often a complex proposition for people whether they are thinking of changing providers or getting one for the first time. HHI has a free brochure and lots of other free information about the coverage available from the web site at: houstonhealthcareinitiative.org. Or call them at 346-400-2789 and talk with them in real time.

 

Unintended Consequences of Not Purchasing Insurance

Remember President Obama’s promise to lower health care rates? Experts now say health insurance will be crazy expensive again in 2019. The Heritage Foundation’s Doug Badger says Obamacare was supposed to get lots of young subscribers to sign up and help subsidize the older among us, but that didn’t happen. Young people found that in many cases paying the penalty was still less expensive than insurance. Consider too that millennials tend to marry and start families later in life than those who came before them, so the perceived need for insurance is not as obvious to them as it is for people who have more responsibility. Here to help us make sense of it all is Dr. Steven Goldstein, a much-respected neurologist and founder of the Houston Healthcare Initiative.

Fines for not purchasing insurance under ‘Obamacare’ were supposed to cause more people buy insurance and lower the cost, but neither happened. Dr. Steven Goldstein, respected Houston neurologist and founder of the Houston Healthcare Initiative (www.houstonhealthcareinitiative.org) discussed the ramifications of the cancellation of financial penalties associated with ‘Obamacare’ among other things, on his weekly podcast. To hear the podcast go to https://houstonhealthcareinitiative.org/the-houston-healthcare-initiative-podcast/.

As the Trump administration has cancelled the fines assessed for not purchasing health insurance that were mandated by President Obama, the impact of the removal of these government-imposed purchases did nothing to lower the price of insurance or make the American public healthier. The positive effect of Obamacare on the price of insurance was what was promised, though little happened to make charges for insurance more affordable.

 

Time To Renew Your Health Insurance

It is the time of year for all of us to renew our existing health insurance or pick a provider. Open enrollment for the individual health insurance market starts November 1 and lasts through December 15, 2018. The sign-up time and role of the government in our health care begs the question; is access to healthcare a right or is it a privilege or something else? Should we also have the right to not purchase insurance? To help us sort through this we need someone well versed in medicine and health coverage and we find both in the founder of the Houston Healthcare Initiative (HHI) Dr. Steven Goldstein.

 

Managing Prescription Medicine Costs

Prescription medicine is expensive, and in some cases unaffordable. The reasons for the high costs of some medicine are talked about by patients, physicians and politicians. But the reasons for high costs matter less than the reality that there are people who could get their medicine for a lot less money if they knew just a few things about how drugs are sourced and priced.  Here today to help us crack this code and hack drug prices is respected Houston based neurologist and founder of the Houston Healthcare Initiative Co-Op Dr. Steven Goldstein.

Most people have read or heard about how high the price of prescription medicine is here in the U.S. and how relatively inexpensive it is in other countries, especially Canada. What do the Canadians know? According to Dr. Goldstein, prices for drugs in Canada are set by a special review board that compares prices of medicine in Europeto then decide what to charge.  “Here in the U.S. Medicaid does not negotiate prices with the pharmaceutical companies and consequently the prices are higher,” Dr. Goldstein told his listeners.

 

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Press Background 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 Did HHI Come About?

While the promise of the Affordable Care Act was to lower the cost of health insurance, most Americans experience the opposite with much higher rates. The founder of HHI, Dr. Steven Goldstein, wanted to find a way to help patients and others find affordable health insurance and landed on the idea of the medical cooperative. The ‘medical cooperative’ or co-op as it is commonly known is possible because plans like HHI are exempt from the Obamacare tax penalties assessed to those who do not have health insurance.

What Are Health Care Co-Ops?

Consumer based cooperative purchasing arrangements are not new. The basis of the success of co-ops is they use the ability to buy large amounts on good terms. Health care cooperatives are much like other co-ops. For example, consumer cooperatives are owned by the people who buy the goods or use the services of the cooperative. But instead of electricity or milk, the medical co-op employs physicians, has access to negotiated hospital rates and prices and often own health care facilities.

How HHI Members Benefit

For a co-op to work as well as it might means that the cooperative health plan can obtain the lowest price charged to the most favored customer. For HHI, members benefit from Dr. Goldstein’s expertise and knowledge of how the hospital and pharmaceutical industries assess prices. At the same time, HHI members benefit from discounted rates with local health care providers. In the greater Houston area, health care providers, hospitals and others are able to push back their rates because HHI is in effect buying ‘in bulk’. It sounds odd and most people think of ‘Sams’ or ‘Costco’ when they think of bulk purchase, but there are discounts for large purchases of just about anything including healthcare.

The Health Care Commodity

Health care is not often thought of as a commodity, but in essence it is. It is definitely a business, but the normal laws of supply and demand do not always apply as the government regulations and insurance companies intercede and disqualify many free market concepts. It is only recently that health care has been thought of as a ‘right’ to which Americans are entitled. The public discussion and policies the government has implemented have not yielded better or more affordable medicine. Doctors are leaving their practices as large medical companies buy them out or because of the regulations imposed on them.  Dr. Goldstein has found a way to take the existing laws and build an acceptable alternative to traditional health insurance in the form of a non-profit organization owned by the members.

Details about qualifying for membership in HHI along with prices for coverage are available from the HHI web site at https://houstonhealthcareinitiative.org.

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