medical coverage

10 Ways: Save On Health Insurance Guaranteed

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Save On Health Insurance Guaranteed

To save on health insurance for your business (no matter how big or small), self-insure! If you work with the Houston Healthcare Initiative, we will guarantee that healthcare costs will not increase. How?

First eliminate managed care and pay cash for routine healthcare. This will dramatically lower administrative costs.

Second, utilize the recommended health maintenance tools described below to decrease the need for and improve access to healthcare. The advantage is a less expensive program and healthier people at work. If healthcare costs exceed the previous yearsyear’s costs, your company we will be reimbursed you. by the Houston Healthcare Initiative.

What Are The Health Maintenance Tools to Save On Healthcare Insurance Guaranteed?

Not just ‘sick care’, the Houston Healthcare Initiative program is an entire, comprehensive package. It includes:

  1. Free Annual Physical exam including physical and mental fitness,
  2. Free telemedicine service,
  3. Free Blood pressure cuff and thermometer,
  4. Free medical care for uncomplicated hypertension and diabetes,
  5. Free second opinions,
  6. Health Savings Account,
  7. Financial and other incentives to lead a healthy lifestyle and comply with medical treatment,
  8. Educate employees on how to shop for medical care and ask questions in the doctor’s office,
  9. Educate employees on the advantages of the Health Savings Account or (HSA).
  10. Share the healthcare savings with employees so that employees are incentivized not to over test or over treat.
    A guarantee to save on health insurance.
    Save On Health Insurance Guaranteed. A guaranteed saving on company health insurance from The Houston Healthcare Initiative.

    Save On Health Insurance Guaranteed brochure for download here: Save On Healthcare Guaranteed

The Houston Healthcare Initiative does not just pay for sickness, it helps make your employees healthier.  The likely benefit to employers is fewer lost workdays, lower insurance costs, and employees who feel their employer cares for them.

Save On Health Insurance Guaranteed Small Business & Health Insurance

Businesses with under 50 employees are not required to provide health insurance to employees. But there are good reasons to consider insuring a small workforce.

For one, health insurance is a critical factor for small businesses to retain and recruit the best employees, sustain productivity and workplace satisfaction. Health insurance benefits are a big deal to employees. The Houston Healthcare Initiative Co-op makes coverage possible.

Health Insurance Is Not Required But Is It Needed?

The answer is yes. A 2020 survey of 2,000 people found that 84% surveyed put health insurance at the top of their most desired benefit list. The Society of Human Resource Management reported that 92% of employees say benefits are important to their overall job satisfaction. 

For start-up companies that want to hire and keep the most talented people, health coverage is a must. There are other paybacks from this investment in a healthier workforce. Healthy employees, who believe the company cares about them, are more devoted, industrious, and approving of businesses of any size. The outcome of benefits like these are a challenge to measure, but they are consequentialconsequential, nonetheless.

Competitive Advantage For Whom, Save On Health Insurance Guaranteed?

Health protection for workers is a competitive advantage. For you and your employees if you offer it but for your competition if not.  Health insurance is less of a cost and more an investment in the future and stability of your company.

 How can companies with less than 50 employees self insure and provide an HSA? Health Savings Accounts

Join with other small businesses to share the risk. Join the Houston Healthcare Initiative co-op.

Offer your employees a $5000 deductible plan with an HSA. Your company self insuresself-insures and takes for example the risk for the next $5000 of claims. The not for profitnot-for-profit cCo-op takes the risk from $10,000 on up. This risk is shared by all the co-op members. Members pay their share to the co-op monthly.

How can companies with more than 50 employee’s self insure and provide an HSA?

 These companies can use the same program as the smaller ones companies or they can assume a risk of $50,000 to $100,000 and purchase reinsurance from a reinsurance company separate from the co-op. Either way, by engaging the Houston Healthcare Initiative, the guarantee of no cost increase from last year will apply.

How does the Houston Healthcare Initiative benefit ( or Wwhat’s the Ccatch)?

 WhenIf companies adopt this program, the we can Houston Healthcare Initiative guarantees that your company’s healthcare costs will not exceed the previous year’s expense.  In return, we ask for 15% of the first years’ savings.

FAQs

  1. 1.Who pays the cost for the healthcare tools?

      The company. It is our contention that these additional costs will be more than offset by the

     savings from decreased utilization of the hospital and ERs.

  1. Not all employees will “buy in” to a healthy lifestyle and are more likely to get sick. Won’t this increase the cost of healthcare?

       Certainly. However, these patients will be paying more for their healthcare to cover the

       additional costs. In most cases, it would not increase the amount the employee currently

       pays. They would not get the reduction that other employees would receive.

3.What about pre-existing conditions?

      Most insurance plans exclude pre-existing conditions. This only arises when one switchinges from one insurance plan to another. We would recommend language in the insurance contract to

avoid fraud.  e.g. Like joining the company for a few months getting an expensive elective procedure done and then quitting. the company. In general, we recommend covering pre-existing conditions.

However, as the company iswith  self insurself-insuranceing, it can decide for itself what is best.  for the company.

4. Some employees will not want the HSA’s. How is this handled?

      If the company has less than 50 employees, they do not have to offer insurance.need to be accommodated. If it the company has more than 50 employees, it can offer to subsidize an individual policy and pay the same amount it contributes for each employee in the self insuredself-insured plan.

What Are The Next Steps to Save On Health Insurance Guaranteed?

 For additional information send email to houhealthcareinitiative@gmail.com.

Save On Health Insurance Guaranteed! Listen Here

Listen to Dr. Goldstein describe several ways to save on healthcare: Healthcare Payment Reform is Critical to Improving Primary Care.

Save On Health Insurance Guaranteed brochure for download here: Save On Healthcare Guaranteed

Save On Health Insurance Guaranteed

Good? Joe Biden wants Medicare to start at 60

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Joe Biden wants Medicare to start at 60

Medicare Availability May Not Be Affordable

Former Vice President Joe Biden, the presumed Democratic candidate for president, has eschewed some of the more grandiose schemes of some of his rivals, such as Medicare for All, which would replace the patchwork of private insurance and various government-provided plans with a single-payer system. Instead, Biden prefers to expand on existing healthcare programs to attempt to extend insurance to people who currently lack it.

One such Biden proposal is the idea of lowering the age of eligibility for Medicare to 60. According to a recent article in Forbes, the scheme may be attractive to seniors, especially in the age of the coronavirus when many people have lost their jobs and hence employer-provided health insurance.

When Paying for Medicare?
Medicare for people at age 60 may not be affordable in the long term.

The proposal is an improvement over plans offered under the Affordable Care Act, also known as Obamacare, which has proven to be unaffordable for many middle-income families because they do not qualify for subsidies. Biden would also keep the privately offered Medicare advantage plans that many seniors use to supplement their regular Medicare

The proposal would work by allowing seniors between 60 and 65 who are unemployed or whose job does not offer health insurance to “buy into” the existing Medicare system. The cost of this buy-in is uncertain; however, one analysis suggests that access to Medicare would be more attractive financially than other options, such as plans under the ACA.  Seniors who do not have access to private insurance or who are still too young to be part of the existing Medicare system would have more options.

Of course, some questions remain about the Biden proposal. An analysis by Avalere suggests that 23 million more Americans would be eligible for Medicare under the scheme. Would the Medicare system be able to bear the extra cost? Will the proposal start to undercut private plans for seniors between 60 and 64, causing employers to dump the cost of health insurance onto the government? Would the temptation arise to lower the age of eligibility further, in effect creating a Medicare for All system, with all of its problems, by the back door? These and other questions will doubtlessly be argued about as the campaign cycle goes forward and beyond, should Biden win the presidency.

Rescue The American Healthcare System In Six Steps

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Rescue The American Healthcare System In Six Steps

According to respected neurologist Dr. Steven Goldstein

Dr. Steven Goldstein of the Houston Healthcare Initiative believes that the U.S. healthcare system can be rescued, and that American business can play an instrumental role. He describes the steps to salvage the industry on the Houston Healthcare Initiative podcast.

The Houston Healthcare Initiative podcast can be heard on: Apple Podcasts, Audible, Audacy, iHeart, Listen Notes, Podcast Addict, Podbay, Podnews,  Stitcher, Soundcloud, and Player FM.

What Needs Rescuing

Rescue Healthcare
Dr. Steven Goldstein describes six steps business can take to reduce costs and maintain employee health.

The current American healthcare system is a mis-mash of government regulations, insurance company and medical industry policies designed to separate the public from its money and provide a minimum of care. The current system does not embrace new treatments or scientific breakthroughs. Insurance companies question the judgement of doctors with double approvals of prescriptions and treatments called ‘pre-authorization.’

Government at the state and federal level demonize off label treatments along with those who advocate them and instead peddle more expensive vaccines and treatments.  It’s a mess.

How to Fix Healthcare

There are practical steps a company of any size can take to transition from the current healthcare system to this new cost-effective solution.

  1. Self-Insurance

In addition to an estimated 20-30% savings compared to regular insurance self-insurance allows a company to adopt new technologies, financial and other incentives to deliver higher quality care at lower cost.

  1. Health Savings Accounts (HSA)

As a practical matter this shifts the costs of routine healthcare to the employee. It allows the employee to pay cash using pretax dollars. Cash prices for tests and procedures are already dramatically lower than insurance company discounts. By paying cash, the administrative costs of processing claims drop dramatically. The employee simply saves receipts and makes a claim only when the receipts add up to the deductible. Additionally, the unused HSA money accrues interest that can also serve as a retirement account for employees.

  1. Establish an Employee Welfare Trust (EWT).

The purpose of the trust is to reduce the cost of reinsurance in later years and to eventually convert the insurance plan from a one-year contract to insurance to age 65. Thus, employees will be able to continue in the plan even if they no longer work for the company if they continue to contribute to the EWT.

  1. Educate employees about what is possible for them. These options include:
    • How to choose a primary physician based on the personal needs of that person,
    • How to shop for medical care and medication,
    • The importance of mental health and the relationship between mental health and the effect on physical health and the immune system,
    • The importance of physical exercise,
    • The importance of financial health and its effect on mental health.
  1. Technologies that can be implemented immediately.

Technology can provide free access to a physician 24/7 for diagnosis, and second opinions. Remote appointments reduce trips to the ER or urgent care. Additionally equip each employee with a thermometer and blood pressure cuff to provide information to the physician. Encourage patients to maintain their own medical records; educate patients on how to do this. Business can also fund fitness apps, gym equipment at the jobsite or gym memberships.

  1. Employ incentives to employees to live a healthy lifestyle. These can be financial incentives or other rewards like increased company contributions to the HSA, lower insurance premiums etc.

In Summary

According to Dr. Goldstein, the means to take control of the healthcare system away from government, big hospital companies, and the insurance industry and create a patient centered system is within our collective grasp. “We just need to do it,” he told his audience. “There are enough remedies in current law available to employers and employees alike to make a major change in the way we all get and pay for medical care.”

If nothing is done to rescue the healthcare business, the public can expect higher costs for insurance with higher deductibles and less coverage. Add to that more regulations and fewer treatments. More government interference with science and medicine and less freedom for our doctors who know us best to treat their patients.

About the Houston Healthcare Initiative

The Houston Healthcare Initiative podcast with Dr. Steven Goldstein is an information vehicle for people who want to know all medical options for themselves and are interested in reforming the healthcare industry. To learn more about the Houston Healthcare Initiative please visit www.houstonhealthcareinitiative.org.

3 Goals: Healthcare Changes to the American Families Plan Could Create Affordable Healthcare

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Hand writing What You Need To Know with marker, business concept background

3 Goals: Healthcare Changes to the American Families Plan & Health Savings Plans Could Make Medical Expenses More Affordable.

The new administration, like all of them, has plans for Americans and their healthcare. On this edition of the podcast Dr. Steven Goldstein, who founded the Houston Healthcare Initiative, will get us all better acquainted with what those proposals are and explore other possible ways for how healthcare can be fixed. The Biden administration has three goals.

3 Healthcare Changes are Goals for the Biden Administration.
There are three healthcare priorities for the Biden administration plus one more that Dr. Steven Goldstein suggests.

To listen to the podcast, click this link: https://soundcloud.com/harold-nicoll/three-biden-administration-healthcare-goals-plus-one-not-included. 

The Covid 19 Response

Of the three goals, first is the Covid-19 pandemic response. Part of the goal is to prevent over capacity of limited hospital beds and critical care space during spikes in the virus outbreak, like those occurring now. Others include the ability to establish temporary hospitals and better ways to track Covid surges via technology. Making telehealth options more widely available, tasking all relevant federal agencies to set up temporary hospitals and getting the Center for Disease Control (CDC) to develop real-time tracking dashboards to better predict when surges will happen, where they are and other details needed to better inform healthcare professionals about the evolution of the pandemic.

The Affordable Care Act

The second of the three priorities has to do with the Affordable Care Act, or as it is more popularly known, ObamaCare.

The idea is to reduce medical costs for the American public. As part of a separate pandemic relief bill, there is $34 billion to help Americans who buy insurance from the health plan marketplaces that were created by Obama Care now through 2022.  Those who know about it state that this would help lower and middle-income Americans who have fallen through the cracks of the government’s eligibility requirements for ObamaCare subsidies. It would also help people who choose policies with lower premiums and higher deductibles. There is also assistance for the unemployed.

Medicare Reform

One of the more visible proposals is to increase the age of people who are eligible for Medicare from the current 65 to 60 years of age.

“While we can think of these as beneficial to society, there is a considerable cost that comes along with it,” Dr. Goldstein told his listeners. “Instead of transferring more money to people, there are other ways to use existing healthcare payment strategies that will benefit everyone.” So why not fund Health Savings Accounts (HSA’s) with this same amount of money?  It is tax-advantaged when received, if the money earns interest while in the health savings account the account owner can keep it and be prepared to pay cash for more health-related expenses. So what is a health savings plan?

Prescription Drugs

The Trump Administration launched a “Transparency in Coverage” ruling in December of 2020 that required health insurers to disclose current drug prices and provide patients with personalized cost estimates. The Biden Administration hopes to increase these efforts by repealing existing laws that prevent Medicare from negotiating lower prices with drug corporations. “Plenty of people believe that the government already uses its mass buying power with Medicare to negotiate better rates,” Dr. Goldstein said. “That is not the case.”

Health Savings Accounts

The Health Savings Account. or HSA, is a type of savings account that is used for medical expenses. HSA’s were established for those with high deductible health insurance coverage. HSAs and high-deductible health plans were created to help control health care costs. The idea is that people will spend their health care dollars more wisely if they’re using their own money. The money deposited by individuals into their HSA account is not taxed.

Further, HSAs feature a triple-tax benefit: money you contribute to your HSA can be written off on your taxes and thus reduce your income tax bill; money in your HSA grows and compounds assuming investments rise. All is tax-free over time; and when HSA money is withdrawn for qualified medical expenses, no tax is paid on the withdrawal. It is owned by the individual so that he or she can pay their healthcare costs. These include everything from doctor visits to blood tests, paid for with cash from the health savings accounts.

As always, information about this and more than 50 other podcasts can be heard and read about at the website, www.houstonhealthcareinitiative.org.

About The Houston Healthcare Initiative

The Houston Healthcare Initiative podcast with Dr. Steven Goldstein is an information vehicle for people who want to know all medical options for themselves and are interested in reforming the healthcare industry. To learn more about the Houston Healthcare Initiative please visit www.houstonhealthcareinitiative.org.

The Number of Primary Care Doctors is Shrinking, and That is Really Bad News

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Primary care shrinking
Access to primary care physicians is a matter of the number of doctors who choose to pursue primary care as a career. Pay for those roles is lower than it is for most specialists and no surprise, fewer are choosing to go into this important part of the healthcare profession.

On the Houston Healthcare Initiative Podcast…

The Number of Primary Care Doctors is Shrinking, and That is Really Bad News

July 20, 2021 – The Number of Primary Care Doctors is Shrinking. An important contributor to the health of Americans is shrinking and the effects on the overall health of people in this country is and will continue to be negatively impacted. This is the subject of the latest edition of the Houston Healthcare Initiative Podcast.

Lower Pay

Fewer medical school graduates are choosing primary care because it pays significantly less than other specialties. Worse still, a lower number of primary care doctors is linked to 85 deaths every day, according to a study published by the National Academy of Sciences. Can primary care doctors make more money? “Under the current system of payment via employer funded health insurance it will be challenging to make that case,” Dr. Goldstein said. “But there may be a chance for new primary care doctors to ignore most of the insurance companies and their accompanying rules and work on a cash basis.”

Cash Only Please

Even patients who have their own health insurance can often save themselves money by paying cash. Doctors will not have to hire staff to process insurance claims, hassle with them over payment or non-payments. Patients save money on premiums and the doctors have fewer expenses. Patients pay less, doctors keep more of the fees because of lower expenses.

Covid Pandemic Bankrupts Many Practices

In addition to a shortage of practicing doctors, primary care visits declined significantly during the COVID-19 pandemic. Add to that a good number of primary care practices were not able to access federal funds and relief and went under. “If these trends continue, it will have a very negative impact,” Dr. Steven Goldstein told his listeners. “Regular visits to the primary care or family doctor allows that physician the chance to know his or her patients better. What are their medical histories, prescribed medication, allergies, or family histories that could affect a diagnosis? These are details that the primary care doctor will know because he or she has a history with patients.”

What Difference Does It Make?

A single visit to a primary care doctor makes a difference for the patient. “When you get sick, that doctor knows how to treat you,” Dr. Goldstein said. Primary care is a health care component where an increased supply is associated with better population health and more equitable outcomes. “For this reason, primary care is a common good, which makes the strength and quality of the country’s primary care services, or its lack, a public concern.”

About the Houston Healthcare Initiative Podcast                                                                   The Houston Healthcare Initiative podcast with Dr. Steven Goldstein is an information vehicle for people who want to know all medical options for themselves and are interested in reforming the healthcare industry. To hear the podcast go to: SoundCloud, iHeartRadio, Stitcher, Backtracks, LibSyn, or the website at www.houstonhealthcareinitiative.org. Dr. Goldstein insists that for the health and welfare of the American public, the congress must pass reforms that limit the influence of the pharmaceutical industry and its lobby.

UnitedHealthcare and the non-emergency emergency… Who Decides If You Need To Visit The Emergency Room?

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UnitedHealthcare
UnitedHealthcare delayed a controversial decision to retroactively declare treatment in an emergency room not an emergency.

UnitedHealthcare and the non-emergency emergency…

Who Decides If You Need To Visit The Emergency Room?

On the latest edition of the Houston Healthcare Initiative podcast, respected neurologist and Houston Healthcare Initiative founder Dr. Steven Goldstein discusses the proposed UnitedHealthcare policy of after the fact review and in some cases possible denial of  some emergency room visits. The Houston Healthcare Initiative podcast can be heard on: SoundCloud, iHeartRadio, Stitcher, Backtracks, LibSyn, Soundcloud, or the website at www.houstonhealthcareinitiative.org.

Declaring the Emergency, a Non-Emergency

UnitedHealthcare is the nation’s largest health care insurer. In early June 2021 UnitedHealthcare announced that it would change how they assess emergency department claims, and thus allow ‘United’ to retroactively deny claims it deemed “non-emergent” or not an emergency. The aim is for the insurance company and their customers to save money, but others say the consequences could be more costly or even deadly. The new policy was originally scheduled to begin on July 1, 2021 but after a wave of criticism from among others, the American College of Emergency Physicians, United backed off and later said they would wait until the pandemic was past to make a decision about this decision.

Bad Policy With Usual Solutions Tried

Like the American College of Emergency Physicians Dr. Goldstein also believes this policy is unwise. “The answer is not to retroactively deny payment for ER care already rendered,” he told his listeners. “What this does is force the hospitals to refuse care for “non-emergency care” as defined by UnitedHealthcare. However, this is not practical because the hospital is more afraid of a potential lawsuit if a patient is refused care and has a poor outcome as a result. The patient then will be stuck with a large bill that cannot be paid.”

Dr. Goldstein states this is another example of an insurance company trying to “manage care.” “They (insurance companies) see a problem, namely they think that Emergency Room services are over-utilized and think they can manage the problem,” Dr. Goldstein said. “They try their usual method of operation and simply deny payment.”

On The Other Hand

UnitedHealthcare claims there are big problems with the misuse of emergency rooms which costs the U.S. healthcare system roughly $32 billion annually. UnitedHealthcare states that misuse typically manifests as patients seek out costly care for minor ailments that could be addressed through other avenues like an urgent care type of clinic. According to the UnitedHealthcare web site, “two-thirds of hospital ED visits annually by privately insured individuals in the U.S. – 18 out of 27 million** – are avoidable.”

Does UnitedHealthcare Have A Point?

Dr. Goldstein stated that United had a point “if the point is that healthcare administered in an emergency room is too expensive.” But he also point out, “UnitedHealthcare negotiated the prices they pay with the hospitals. If it is too expensive, why did they negotiate such a high price?”

About the Houston Healthcare Initiative Podcast

The Houston Healthcare Initiative podcast with Dr. Steven Goldstein is an information vehicle for people who want to know all medical options for themselves and are interested in reforming the healthcare industry. To hear the podcast go to:

Dr. Goldstein insists that for the health and welfare of the American public, the congress must pass reforms that limit the influence of the pharmaceutical industry and its lobby.

How To ‘Hack’ Your Health Savings Account

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How To ‘Hack’ Your Health Savings Account

On the latest edition of the Houston Healthcare Initiative podcast, respected Houston based neurologist Dr. Steven Goldstein describes how people can best use the often-overlooked benefit known as the Health Savings Account.

The Health Savings Account, or HSA, is a type of savings account that is used for medical expenses. Congress established them in 2003 for those with high deductible health insurance. It is a way to pay cash for routine medical care with pretax dollars. Because the HSA requires a high deductible health insurance account, routine healthcare expenses are not covered, but can be paid for by the HSA. HSA’s are potentially a good value for those who can take advantage.

The High Deductible Health Insurance Plan

A high deductible insurance plan is one where the deductible is higher than with other policies. The ‘deductible’ is the amount the patient has to pay out of pocket before the insurance kicks in. A high deductible is usually between $3,000 – $10,000. “Of course, the higher the deductible; the lower the premium,” Dr. Goldstein told his listeners.

Who Should Consider an HSA?

First, who is this not for? “If you are already sickly and have $5-10,000 in medical expenses every year, the high deductible policy with HSA is probably not for you,” Dr. Goldstein said. “The time to start a high deductible plan with HSA is when you are young and well. Even if you had $10,000 in expenses in one year, it is highly unlikely these expenses would continue every year.”

Tax Free Deposits

The money deposited into the HSA account is not taxed. Many companies contribute to an employee’s HSA to encourage its use. Further, HSAs feature a triple-tax benefit: money the employee contributes to the HSA can be written off on taxes and thus reduce an income tax bill. “Money in your HSA grows tax free, Dr. Goldstein reported. “When you withdraw money for qualified medical expenses, no tax is paid on the withdrawal. However, if you withdraw money for non-medical expenses, you do pay tax as well as a penalty.”

About the Houston Healthcare Initiative Podcast

The Houston Healthcare Initiative podcast with Dr. Steven Goldstein is an information vehicle for people who want to know all medical options for themselves and are interested in reforming the healthcare industry. To hear the podcast go to: SoundCloud, iHeartRadio, Stitcher, Backtracks, LibSyn, or the website at www.houstonhealthcareinitiative.org. Dr. Goldstein insists that for the health and welfare of the American public, the congress must pass reforms that limit the influence of the pharmaceutical industry and its lobby. Houston Healthcare Initiative seeks to change the way people think about healthcare. Find healthcare pricing and local provider rates!

 

Where did the money go? Insurance companies keep about 33% Healthcare By The Numbers

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Where did the money go? Insurance companies keep about 33%… 

Healthcare By The Numbers

Where did the money go? What is the American public buying when it pays for its health insurance and is it a good value? If the public knew that their insurance company kept as much as 33% of what they spent how would they react? While there is nothing wrong with making a profit, there is also no issue with insisting that money provide a good value. On his weekly podcast, Dr. Steven Goldstein describes in detail where all that money goes. The Houston Healthcare Initiative podcast can be heard on : Apple Podcasts, LibSyn, Spotify, Radio.Com, Listen Notes, iHeart Radio, Podcast Addict, Podbay, Backtracks, Player FM, Stitcher, and SoundCloud.

Where Does That Money Go?

Most people and their families who have health insurance, have it through their employer. The business pays for some if not most of the premiums and the employees pay deductible and out of pocket costs. But where does all that money really go? Does the public purchase more benefits or receive a better value as a result of what they were charged for that insurance?

Hospitalization Charges & Costs

When Paying for Healthcare?
Is what the public paying for healthcare and health insurance a good value?

Dr. Goldstein told his listeners, that in 2018 the average cost of hospitalization was about $10,000.00. The average charge for hospitalization with private insurance was about $20,000.00, thus the amount charged was double the cost. “Now let’s multiply that same number by a sample of the population, Dr. Goldstein proposed. “The average number of hospitalizations per year was about 9 for every 100 people. So, for those nine, the amount the insurance company collected was $180,000.00.” But there was more to healthcare payments than simple hospitalization. “People often go to the doctor and have what are classified as outpatient charges. Those are charged at about $500.00 a year, per person,” he said.

Add Drug Costs

The drug costs across the population were estimated at $1200.00 each. “We can reasonably assume that drug costs are higher for the over 65 population,” Dr. Goldstein said. “Now, for people under 65 years of age the expense estimate is less. So, the amount paid overall by the population of 100 people is about $500.00 each. The total for 100 people at $500.00 each is another $50,000.00.”

Factor Insurance Into The Equation

To get to the ultimate amount of money spent and where it all ends up, the cost of insurance factors in. “Say someone has a $50,000.00 deductible along with discounts they receive from the Preferred Provider Organization (PPO), we can figure a $20K discount for our 100 people,” He said. “Or charges to them all of $30,000.00.”

It is here the distinction between price and costs reveal an interesting outcome. Insurance will generally pay two thirds of the cost with the other, remaining third paid by the individual in the form of co-payments and applied deductions. “If we add these costs together, we find the total charges for 100 people = $300,000.00,” Dr. Goldstein declared. So where does the other one third go?  “The very cheapest Blue Cross policy for a 31-year-old male living in zip code 77096 (the Houston are) was $257/month or $3084/year, said Dr. Goldstein. “The cost for 100 people would be $308,000.00 annually but would have a $7400.00 deductible.”

For someone age 50, the cost was $4000.00 annually. The high deductible means that outpatient care is not paid for and that the insurance only pays for the reinsurance and hospitalization costs of $200K. So, who benefits the most from these expenditures?

No surprise, it’s the insurance company. “The gross profit for them is at least $100K. That is income per 100 patients of at least $300K less claims of $200K.” Is this a good value for the public? It’s a fair question and good way to think about healthcare costs.

A study in ‘Health Affairs’ co-authored by a Princeton University health economist, found that Americans use the same amount of health care as residents of other nations. They just pay more for them. U.S. hospital prices are 60% higher than those in Europe. Government efforts to reform health care and cut costs raised them instead. “Our system is broken and needs to be overhauled,” Dr. Goldstein said. “Efforts at reform, that we have talked about before on the podcast, are a waste of time and effort when the overall system for providing and charging for healthcare is so fundamentally broken.”

About Dr. Steven Goldstein and the Houston Healthcare Initiative

The Houston Healthcare Initiative (HHI) was founded by respected, Houston neurologist Dr. Steven Goldstein. Like many Americans, Dr. Goldstein is concerned about the state of the U.S healthcare system and the sorry state of the public’s health. The Houston Healthcare Initiative web site is an aggregator of news, healthcare pricing information, and resources for those who want to help drive reform for the healthcare industry. HHI’s emphasis for reform is on free market innovation and personal responsibility. Learn even more here at https://houstonhealthcareinitiative.org/about-us/.

The goal of the Houston Healthcare Initiative is to be a catalyst for change in the way Americans receive and pay for medical treatment. To cause change the site aggregates information, tools, and targets for the reform of the healthcare industry with an emphasis on free market innovation and personal responsibility. Visit online at www.houstonhealthcareinitiative.org.

Medstar Washington Offers Transparency Example for Hospitals

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

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

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

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

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

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

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

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

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

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

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

How Haven Failed at Repairing America’s Healthcare System

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How Haven Failed at Repairing America’s Healthcare System. The reason that healthcare and associated costs for medical treatment are so high is the way pricing is established, managed care. Making healthcare more affordable and accessible was what Haven was supposed to do.  Its failure to address how prices are kept artificially high via managed care was among its biggest failures.

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

Resource Rich but Still A Bust

Haven was a joint venture between Amazon, Berkshire Hathaway and JPMorgan-Chase. Its purpose was to use the leverage of its tens of thousands of employees and its expertise in technology to improve the healthcare system.

Managed Care Keeps Prices High

Haven Failed to Fix Healthcare
How Haven Failed at Repairing America’s Healthcare System. Haven was a $100 million bellyflop of a failure, as represented here.

Haven worked at the edges of what really made medicine expensive and avoided the fundamental challenge of the managed care model. “We need a system that enables hospital systems to profit from the improved health of the population rather than the amount of ‘sick care’ delivered,” Dr. Goldstein told his podcast audience. “Innovative ideas need to focus first on improving health. The only way for this to happen is for hospital systems to profit from this outcome.”

How?

One example of how to accomplish this, is for hospitals to offer Medicare pricing to patients without insurance at Medicare rates. In return for the discounted prices, patients would pay the hospital a monthly fee. They would also pay a monthly fee into a savings account in order to pay the hospital bill. In this scenario, the hospital would collect the monthly fee even if no patients were admitted to hospital. If patients were kept well, the need for hospitalizations would decrease. “In this environment, the innovative ideas of Haven would have found a much warmer reception,” Dr. Goldstein said.

No Reason for Change or New Ideas

Haven also failed to understand why the medical business was not interested in new, innovative ways to provide and charge for medicine. The reasons were simple. Insurance companies and providers make lots of money from the current way of doing things,” Dr. Goldstein said. “There are few enticements for them to change and why should they when money is pouring in and there is no pressure to do things differently.”

Thanks, But No

Would the ‘industry’ be open to creative ideas and problem solving when it comes to pricing, service delivery or an emphasis on making the public healthy and not just treating illness? “Probably not,” Dr. Goldstein reported. “The current system of managed care frowns on innovation. It controls innovation by only paying for services that have codes. It likes to use words like usual and customary. Medicine lags behind the tech world by approximately 25 years. So no, in a change averse industry I would not look for any creative approaches to take place except over long periods of time.”

About Dr. Steven Goldstein and the Houston Healthcare Initiative

The Houston Healthcare Initiative (HHI) was founded by respected, Houston neurologist Dr. Steven Goldstein. Like many Americans, Dr. Goldstein is concerned about the state of the U.S healthcare system and the sorry state of the public’s health. The Houston Healthcare Initiative web site is an aggregator of news, healthcare pricing information, and resources for those who want to help drive reform for the healthcare industry. HHI’s emphasis for reform is on free market innovation and personal responsibility.

The goal of the Houston Healthcare Initiative is to be a catalyst for change in the way Americans receive and pay for medical treatment. To cause change the site aggregates information, tools, and targets for the reform of the healthcare industry with an emphasis on free market innovation and personal responsibility.