Category: Policy and politics

How Trump can win on healthcare

published date
September 18th, 2019 by

It should be easy for the Democrats to beat President Trump on healthcare. After all, he never followed through on his promise to “take care of everyone” or to unveil a “phenomenal” plan. Moreover, his sabotage of Obamacare, attacks on Planned Parenthood, and stress introduced by his tweets have caused additional damage.

However, leading Democrats including Bernie Sanders and Elizabeth Warren insist on shooting themselves in the foot by touting Medicare for All. The critics are right: it would be expensive, complex, disruptive and represent a government takeover of the healthcare system. A new Kaiser Family Foundation poll shows that most people don’t even believe their wages will rise if employers save a bundle on health care, as they would under Medicare for All.

Meanwhile, Trump has competent people in his administration in healthcare (unlike other areas) and they’ve worked hard on productive areas such as Medicare Advantage, kidney care, transparency, and vaping.

As a result, Trump can win on healthcare even without a signature TrumpCare program.

Democrats would be wise to nominate someone who espouses building on Obamacare, not replacing it with Medicare for All. Michael Bennet is my pick, but he isn’t getting traction. Joe Biden is the best of the current frontrunners and as Obama’s Vice President is best placed to cement the Obamacare legacy.


By healthcare business consultant David E. Williams, president of Health Business Group.

 

Air ambulance reality warp in Wyoming

published date
September 3rd, 2019 by
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How much for a ride?

From reading (Why Red Wyoming Seeks The Regulatory Approach To Air Ambulance Costs) it appears that the laws of economics have been repealed and that the state’s rugged individuals have gone soft on us. But really, it’s just another take on the absurdity of the air ambulance business.

I had to laugh at this passage:

The air ambulance industry has grown steadily in the U.S. from about 1,100 aircraft in 2007 to more than 1,400 in 2018. During that same time, the fleet in Wyoming has grown from three aircraft to 14. [A]n oversupply of helicopters and planes is driving up prices because air bases have high fixed overhead costs. [C]ompanies must pay for aircraft, staffing and technology… before they fly a single patient.

But with the supply of aircraft outpacing demand, each air ambulance is flying fewer patients… So, companies have raised their prices to cover their fixed costs and to seek healthy returns for their investors.

Imagine if there were three gas stations in a town and then there were 14. Would prices go up or down? [Hint: Down.]

But healthcare doesn’t work like that, somehow. Ambulances in general and air ambulances in particular are great examples of why not. In particular, you can’t really refuse to be transported by ambulance and if you have private insurance the ambulance companies can stay out of network and stick you –the consumer– with the bill.

In this case, Wyoming is doing the right thing in trying to socialize the industry by pushing everything into Medicaid.  The legislature would be wise to use this as an opportunity to reconsider its opposition to Medicaid expansion, which it has rejected in the past, even it added a hard hearted and counterproductive work requirement.

I first covered the topic in March 2005, the first week I started writing this blog. What I wrote then (Air ambulances: costly, dangerous, slow?) is still worth recalling:

According to today’s Wall St. Journal, not only are air ambulances liable to crash (a crew member who worked 20 hours/week for 20 years would have a 40% chance of being killed), they are often slower than ground ambulances, and are used to transport patients who aren’t that sick.

Of course, there are situations where air ambulances make sense, such as in rural areas. On the other hand, even speedy air ambulances can’t do much about the 10-20 hours waits I mentioned in yesterday’s post on Mass General.

  • After 9-year-old Tyler Herman fell and broke his jaw in the wilds of Arizona, doctors at a community hospital decided the boy should fly to Phoenix to undergo plastic surgery for a gash on his face. During the flight he was well enough to sit up and remark on the scenery. Upon arriving in Phoenix, he waited nearly 20 hours to undergo surgery. “We could have driven him there in four hours,” says Sharon Herman, the boy’s mother. Her insurance didn’t cover air transport, leaving the Hermans with a bill for $25,000.

Wyoming is a rural state, and the picture that air ambulances conjure up is people being rescued from car crashes or heart attacks in remote areas. Of course that’s the story the owners of air ambulance services want you to believe.  Here’s what the lobbyist in Wyoming says about it:

“How many of these 4,000 people a year [flown by air ambulance] are you willing to tell, ‘Sorry, we decided as a legislature you’re going to have to take ground ambulance?’” Mincer said during a June hearing on the proposal.

Sure enough, in Wyoming the situation now is like it was in Arizona a decade and a half ago. “On-scene trauma responses,” represent just a small portion of the flights. In this case, supply creates its own demand and in many cases a ground ambulance would be a better option.

It’s tempting –but too easy– to place all the blame on private equity investors for the problem. State and federal government, health plans, physicians and even consumers have the power to make it stop.


By healthcare business consultant David E. Williams, president of Health Business Group.

#CareTalk August 2019: Reimportation scares Canada

published date
August 28th, 2019 by

 

In this edition of #CareTalk, CareCentrix CEO John Driscoll and I have a little fun at the expense of our neighbors to the North. Will Canada build a wall along its Southern border to keep out US patients?

Overview:

(0:43) Are Canadians right to worry that Americans are going to clean out their pharmacies, leaving nothing for the locals?

(1:43) What are “authorized generics” and are they a good idea?

(3:22) Are skilled nursing facilities a piggybank for accountable care organizations?

(5:05) Should everyone be screened for drug use?

(6:40) A Montana man was stuck with a $500,000 dialysis bill. Would you have paid it?

(7:16) What should happen to the person who manipulated the Novartis gene therapy data?

(7:39) Is Tom Brady too old to play in the NFL?

#CareTalk Shorts – Trump sends dialysis patients home

published date
July 29th, 2019 by

Kidney dialysis is one of the most opaque and problematic sectors of the healthcare economy. It’s controlled by a duopoly that extracts big dollars from private payers while maintaining a symbiotic relationship with the Federal government. Patients aren’t particularly well served and costs are rising.

President Trump’s executive order aims to encourage the use of home dialysis. That’s a good thing, as CareCentrix CEO John Driscoll and I discuss in this edition of #CareTalk Shorts.

By healthcare business consultant David E. Williams, president of Health Business Group.

#CareTalk July 2019. Democrats and HealthCare -The Great Debate

published date
July 23rd, 2019 by

In this edition of #CareTalk, CareCentrix CEO John Driscoll and I discuss the impact of healthcare on the Democratic presidential race.

(0:36) What impact are the TV debates on healthcare having on the Democratic presidential race?
(2:30) Arkansas has been testing out a Medicaid work requirement. What do the results tell us?
(4:30) What should be made of the OpenNotes initiative in Massachusetts, which allows patients to access their doctors’ clinical notes about them?
(7:12) New doctors continue to avoid primary care. Does that matter?
(9:20) Did David avoid getting bit by a shark during his Cape Cod vacation?
(10:16) A judge struck down Trump’s rule to make drug makers disclose prices in TV ads. Does it matter?
(11:01) Is Alexa bad for healthcare?
(11:30) Co-design is a new healthcare buzzword – but how important is it?
Subscribe to the #CareTalk Podcast iTunes: https://apple.co/2DIDTcr Google Play: https://bit.ly/2RobqMB