Pharma: Greed Lies and the Poisoning of America

Gerald Posner on the podcast this week.

On this special edition of the Houston Healthcare Initiative podcast, author Gerald Posner discusses the history of the pharmaceutical industry and his new book “Pharma: Greed, Lies, and the Poisoning of America.” This book describes the history of the pharmaceutical manufacturing industry and how we and they got to the place we are now.

Among many shocking facts included are that many of the practices that were incorporated into marketing and selling heroin and cocaine in the early 20th century are still used today. And like before, those same companies are deliberately downplaying of the risk of modern-day medicines like opioids. Refer to www.houstonhealthcareinitiative.org and www.posner.com. Be sure to read “Pharma: Greed, Lies, and the Poisoning of America.”

Why Are Prescription Drugs Cheaper in Canada?

Why Are Prescription Drugs Cheaper in Canada?

Even those with private, employer funded health insurance gasp at the price of some prescription medications. Learning that the same medicine is available north of the border at a substantially reduced price often produces other emotional reactions from surprise to anger. There are plenty of reasons those drugs are priced differently.

drug prices in Canada are lower because the Canadian government regulates the price.
Why Are Prescription Drugs Cheaper in Canada? Prices in Canada are lower because the Canadian government regulates the price.

Listeners to the Houston Healthcare Initiative podcast will learn why as respected neurologist Dr. Steven Goldstein explains how the combination of foreign government requirements and U.S. government non-regulation combined to give the American public sticker shock at the drug store.

The Houston Healthcare Initiative podcast can be heard on SoundCloud, iHeartRadio, iTunes, Stitcher, and the website at www.houstonhealthcareinitiative.org.

Canadian Government Declares Prices

In short, drug prices in Canada are lower because the Canadian government regulates the price. In Canada, a review board decides on pricing and what they believe are reasonable or excessive prices. If they decide a drug is priced too high, they will not allow it on the drug formulary. This board, the Patented Medicine Prices Review Board, is described in Canada as a quasi-judicial agency.

Before a prescription drug can be sold in Canada it is scientifically reviewed to make certain that it can do what it is supposed to do. A committee of experts known as the Human Drug Advisory Panel will make recommendations about other valid drugs on which to make comparison, in addition to recommendations for the categorization of new drugs. The level of therapeutic improvement of an existing patented drug is used to determine a ceiling price, known as the Maximum Average Potential Price, at its introduction.

U.S. Prices Set by Industry

The U.S. government is prohibited by law from negotiating prices for Medicare and other government programs. “Obviously, the drug company needs to recoup the cost of research, manufacture, advertising and the cost of getting the drug approved by the FDA,” Dr. Goldstein told his listeners. “The people in this country essentially pay for all of this work as countries like Canada do not allow their citizens to share the cost.” New drugs are issued a patent giving the drug company a monopoly on sale of the drug for 20 years. The drug company is free to set whatever price it likes for prescription drugs. Prices are then negotiated between insurance companies and the manufacturers.

Needed Drug Price Reforms

The U.S. and Canadian systems each present two very different models for drug pricing, neither of which is reasonable. The Canadian system does not allow enough incentive for new drugs to be created. The American system results in unaffordable prices. “There are several needed reforms,” Dr. Goldstein said. “We are not able to flip a switch and adopt the prices charged in Canada, though that would be nice.”

The reforms Dr. Goldstein recommends are:

  • Reform drug patent law. The patent system for drugs needs to be reformed so that drug development costs can be recouped along with a profit. Once this occurs, the patent should expire.
  • Streamline approval. The FDA needs reform so that drug authorizations are more efficient. Possibly, an international FDA funded by a consortium of countries could approve drugs.
  • Eliminate monetary incentives for writing prescriptions.
  • Drug discounts to insurance companies and Medicare should be illegal.
  • Enforce the laws already passed. Antitrust laws for price collusion need to be enforced.

“If these reforms were enacted, prices for drugs would be determined more by supply and demand,” Dr. Goldstein said. “This would ensure an adequate supply at the lowest price. For high priced drugs of marginal benefit, demand would be low and would tend to cause the price to drop. For new orphan drugs, the government could provide subsidies.”

About Houston Healthcare Initiative

Houston Healthcare Initiative (HHI) was founded by Dr. Steven Goldstein. Like many Americans, Dr. Goldstein is concerned about the state of the U.S healthcare system as well as 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.

 

Why Canadian Drug Prices Are Lower Than US Drug Prices

US & Canadian Drug Prices

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.

 

Patients Can Save Money When They Pay Their Doctor In Cash

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

Medical Price Transparency
Save money when paying cash, even when patients have their own health insurance. 

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.

 

Secret Revealed on Pricing Practices of Health Insurance Companies & Hospitals

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

Price Transparency
Price transparency from insurance companies and medical companies is a rare thing.

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

 

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

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

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.

For Those Who Lost Their Employer Funded Health Insurance; Resources Are Available

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.

  • Testing for the Coronavirus/Covid-19 illness: testing for the Coronavirus/Covid-19 virus is free. But if the test is positive and you have the virus, the treatment for it can get expensive. Fortunately, most people recover at home. However, an estimated 15% of infected people may end up hospitalized, according to the Kaiser Family Foundation. Recent data suggests that patients who go to intensive care stay there for an average of 20 days. The Castlight Covid-19 test site finder will provide information on Coronavirus testing near you: https://my.castlighthealth.com/corona-virus-testing-sites/.
  • The Health Insurance Exchange: Open enrollment typically runs from November to January, depending on the state in which you live. But people are allowed a change in coverage when experiencing a life altering 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. 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. Go to this link and find out if you qualify for coverage: https://www.healthcare.gov.
  • Medicaid: 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. There are online resources available from the U.S. Department of Health and Human Services along with state references to guide you. Visit the official U.S. government Medicaid site to see of you are eligible: https://www.medicaid.gov.
  • CHIP: CHIP stands for Children’s Health Insurance Program. If your children need health coverage, they may be eligible for the Children’s Health Insurance Program (CHIP). CHIP provides low-cost health coverage to children in families that earn too much money to qualify for Medicaid. In some states, CHIP covers pregnant women. Each state offers CHIP coverage and works closely with its state Medicaid program. Get all the details, go to: https://www.healthcare.gov/medicaid-chip/childrens-health-insurance-program/.
  • Faith Based Cooperatives: Faith-based plans are designed to provide essential coverage for the good health and physical well-being of their members. In return they expect members to live faith-based lives in adherence to the principles behind such plans. As such, faith-based plans will not cover hospital costs that stem from activities they deem immoral or unessential. 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. These operate with exemptions to the mandates of the Affordable Care Act, also known as Obama Care. There are several options. Here are a few:Medi-Share, Liberty HealthShare, Samaritan MinistriesOneShare, Christian Healthcare Ministries.

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.

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.

To Help Prevent the Spread of Coronavirus/Covid19 Houston Neurologist Makes Telemedicine Appointments Available

Houston, TX. (March 19, 2020) – As a result of the Coronavirus/Covid19 outbreak and efforts to contain exposure, long time Houston neurologist Dr. Steven Goldstein will offer his diagnostic and medical skills via virtual or ‘telemedicine’ appointments for both new and existing patients.  As long as Houstonians are suffering from the effects of the pandemic, Dr. Goldstein will waive copayments for those who have health insurance and significantly lower fees for those without insurance. “With so many of us all working hard to prevent the increase of this virus, I wanted to leverage existing technology and keep access to myself and my staff available without putting any of us or our patients at unnecessary risk,” Dr. Goldstein said. “It seemed like a pretty good way to be of service here in the greater Houston area during such a challenging time.” Those who do not have insurance pay $75.00 for a first time visit and $35.00 for any needed follow-up visit.  Virtual office visits are conducted via the free Zoom Cloud Meeting app. Payments via debit or credit card are available through the office.

To Help Prevent the Spread of Coronavirus/Covid19 Houston Neurologist Makes Telemedicine Appointments Available

Telemedicine

The use of technology along with the reduced price makes Dr. Goldstein’s expertise available to people who cannot come to his office or afford to see a specialist like him or both. “Virtual medicine is nothing new, but it has not caught on like other remote services have,” Dr. Goldstein said. “This way of seeing patients now may be a turning point for the use of remote communications technology during this health crisis, with positive implications into the future.”

Treat Patients & Prevent the Spread of Coronavirus/Covid 19

The focus of the medical world now is on the prevention of Coronavirus/Covid 19. But there are plenty of people with symptoms a neurologist needs to diagnose and treat. Some symptoms include:

  • severe headaches,
  • seizures,
  • numbness,
  • weakness,
  • double vision,
  • dizziness,
  • passing out,
  • tingling,
  • trouble with movement,
  • memory challenges or confusion,
  • and trouble sleeping.

How To Be Seen

To be seen by Dr. Goldstein via ‘telemedicine’ call his office and make an appointment, just like always;  give the patients’ email address and then go to the App Store and download Zoom Cloud Meeting. Zoom is free. Dr. Goldstein will email a link to the patient to use during the time of the appointment. Dr. Goldstein can diagnose, order tests, and prescribe medication via the Zoom link. To make an appointment call (713) 451-5421, or (281) 481-4236.

Zoom App Information

Zoom is available for Apple, Google Play and Windows. For all the ways to download and use Zoom go to their download page here: https://zoom.us/download.

Follow Dr. Goldstein from his Facebook page at: https://www.facebook.com/Houston-Healthcare-Initiative-192537484753616/?modal=admin_todo_tour. Or his website address: https://houstonhealthcareinitiative.org.

 

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Unexpected Emergency Room Bills Add To Patient Ills

Patients may go to the hospital designated as in network by their insurance, but the doctors who treat them may not be part of that network. This is one of the main reasons for big bills even among those who have health insurance. Patients rarely have any say about who treats them, especially in the case of accidents where they are incapacitated. This is the message that Dr. Steven Goldstein has for podcast listeners this week. The Houston Healthcare Initiative CO-OP podcast can be heard on Soundcloud, Google Play, and iTunes. The podcast and much more information is available from the Houston Healthcare Initiative CO-OP website: www.houstonhealthcareinitiative.org. Or click here to listen:


Unexpected Emergency Room Bills Add To Patient Ills

Wide Awake Nightmare

Imagine leaving the hospital after recovering from an accident, illness or some other unexpected and unwelcome ailment thinking that the worst is over, but then getting a walloping big bill to pay even with really good health insurance. It’s a scenario that plays out ever day and one that respected Houston based neurologist and founder of the Houston Healthcare Initiative CO-OP thinks the public has a right to know.

The out-of-network billing problem exists in part because insurers have sought to rein in costs by shrinking their provider networks and steering patients to less expensive doctors and hospitals. But some specialists and provider groups have deliberately stayed out-of-networks because they can make more money.“This is especially true in emergency rooms, where the patients’ inability to choose their doctors provides a strong incentive for physicians not to cut deals with insurers,” Dr. Goldstein said.  “For example, a 2017 study on surprise bills by Yale University researchers reported that one group of emergency room physicians that exited networks to bill as out-of-network providers charged twice as much for care as their ERs used to charge. It’s ridiculously unfair.”

Facts About Bad Surprises

Unwelcome E.R. and hospital bill surprises are not unusual and that is the disappointing part. On average, 16% of inpatient stays and 18% of emergency visits left a patient with at least one out-of-network charge. “Most of those came from doctors offering treatment at the hospital, even when the patients chose an in-network hospital, according to researchers from the Kaiser Family Foundation,” Dr. Goldstein told his audience. “But the news gets worse because the same study found that when a patient is admitted to the hospital from the emergency room, there’s a higher likelihood of an out-of-network charge. As many as 26% of admissions from the emergency room resulted in a surprise medical bill.”

Why We All Tolerate This

When asked about the reasons the public chooses to tolerate this, Dr. Goldstein replied, “the medical and insurance industries have trained us all to think that there is but one choice for us and that is to work with them, exclusively, and that there are no alternatives available for anyone not old enough to get Medicare.” There are alternatives, like the one we have at the Houston Healthcare Initiative CO-OP, but so few are aware of this and other similar organizations that we all simply take and pay for what is available.”

To learn more about the Houston Healthcare Initiative CO-OP please visit the web site atwww.houstonhealthcareinitiative.org