Republicans’ Last-Ditch Effort to Destroy the US Healthcare System

I haven’t written a blog in months because, to be honest, I simply don’t know where to start when it comes to what certain people are trying to do to our healthcare system.

But this time they’re going too far. I’m talking, of course, about the Graham-Cassidy-Heller-Johnson healthcare bill Republicans are trying to shove through the Senate before a September 30 deadline. After that date, they need a 2/3 vote to pass it, which means Democrats on board, which means no way in hell.

The New York Times editorial board nailed my feelings about this bill when it wrote: “It is hard to overstate the cruelty of the Graham-Cassidy bill.”

The Washington Post put it another way: “Another execrable health-care bill proves bad ideas never die.” And The Baltimore Sun, bless its heart, calls the proposal “even more draconian than their previous attempts to strip millions of Americans of health insurance coverage.”

Now that’s some good writing!

How This Healthcare Bill Will Destroy Medicaid

This bill is not about repealing and replacing the Affordable Care Act (ie, Obamacare). It is about … Continue Reading

ACA healthcare reform healthcare system; politics

Health Care and the Terrible, Horrible, No Good, Very Bad Day

Health Care and the Terrible, Horrible, No Good, Very Bad DayWell, they did it. They came up with the worst possible “replacement” for the Affordable Care Act.

The horrific plan that the House Republicans passed on Thursday threatens not only the health insurance of 24 million people, but those of us lucky enough to have employer-provided health insurance, anyone covered under Medicaid, and anyone who ever dreamed of leaving the security of an employer to start their own business or otherwise follow their dream.

Not only did they throw the baby out with the bathwater, but they buried her 10 feet deep in a remote spot in the Amazon.

In passing this appalling bill, the House Republicans: Confirmed, in no uncertain terms, that access to affordable, quality health care is a privilege, not a right. And it appears that the privilege is primarily available to rich white men. Clarified that they could care less about the people who put them in office, given the fact that fewer than 20% of Americans supported the earlier, less onerous version of the American Health Care Act (AHCA). … Continue Reading

ACA Affordable Care Act health insurance healthcare costs healthcare reform healthcare system; Medicare Obamacare

Why Does an MRI Cost $2,500 Here and $250 in Finland?

Why Does an MRI Cost $2,500 Here and $250 in Finland?Just had dinner last night with an old friend from Finland. He’s a physician so, of course, the talk turned to health care and the differences between our countries. I asked him how much an MRI cost in Finland. With a few clicks on his phone he had the answer: about $250. Not to be outdone, I pulled out my own phone. The average price of an MRI here? About $2,500.

And therein lies the problem. The US spends more per capita on health care than any other industrialized country in the world. And before you say we have the best healthcare system in the world, let me tell you that we don’t.

Our country ranks last or near the bottom on nearly every health-related outcome. Our life expectancy has actually dropped in the past couple of years for the first time in decades, with death rates rising for eight of the top 10 leading causes of death. We also have the highest rate of infant mortality, worse than Cuba, Poland, and Slovakia.

It’s like paying for a new Mercedes and … Continue Reading

ACA Affordable Care Act health insurance healthcare costs healthcare reform healthcare system; high-deductible health plan

Yes, Mr. President, Health Care Is Complicated

Yes, Mr. President, Health Care Is ComplicatedI nearly fell off the couch when I read the President’s statement that “nobody knew health care could be so complicated.”

Um, Mr. President, everyone knew. In fact, health care is considered the most complex industry out there. That would be why, as you and your colleagues are finding, transforming the system is “incredibly complex.” It is also why it will be nearly impossible to repeal-and-replace the Affordable Care Act (ACA) with something better unless you move to a single-payer system.You can, of course, focus on fixing its weaknesses.

I remember a healthcare economics course I took when I was in my 20s. During the first class, the professor told us: “Take every basic economic concept out there, including resource allocation, supply-and-demand pricing, and rational consumer behavior, and toss it aside. Very few apply to health care.”

The past 30 years as a healthcare writer have reaffirmed that statement hundreds of times over.

The Health Care System as a Tube of Toothpaste

I have my own analogy to describe the US healthcare system. I think of it as a tube of toothpaste … Continue Reading

ACA Affordable Care Act health insurance healthcare reform healthcare system; Medicare Obamacare politics Value-based reimbursement

Replacing the ACA: Selling Across State Lines

Replacing the ACA: Selling Across State Lines

A cornerstone of every Republican plan to replace the Affordable Care Act (ACA), including the president’s plan, is to allow health insurance companies to sell their products across state lines. The Republicans claim this will increase competition and drive down costs.

Health policy experts, including the National Association of Insurance Commissioners and the Center for Insurance Policy and Research, say it will do exactly the opposite: Drive up costs and reduce choice, particularly for those with medical conditions.

State Regulations on Health Insurance

First, a bit of background. States regulate all small group and individual health insurance policies through their insurance commissioner, although the federal government sets certain minimum requirements that plans must offer, like the 10 essential benefits required under the ACA.

States can mandate that their licensed insurers add certain benefits, like infertility coverage. They also determine how much older people can be charged for premiums on the individual market and how much money insurers must have available to pay claims.

Next, the Republicans make it sound like federal law prohibits selling insurance across state lines. Nope. That, … Continue Reading

ACA Affordable Care Act health insurance health insurance exchanges healthcare reform healthcare system; politics

The Election and the ACA: Why I’m Sad, and Will Be for a Long Time

The Election and the ACA: Why I'm Sad, and Will Be for a Long TimeI’ve been writing this blog on and off for about eight years. And in all that time, I’ve tried to keep it as apolitical as possible. But, at my core, I am a writer. It’s all I’ve ever done for 30 years. And when writers can’t make sense of the world, or don’t know what to do with their feelings, well, they write.

So, spoiler alert, I am devastated by Tuesday night’s results for so many reasons. For an end to women’s reproductive rights. For an end to what I thought was a decent, inclusive country. For an end to a free press. For an end to LGBT rights. For an end to the respect we once had from the rest of the world.

And for the horrific overt racism and homophobia that has been unleashed in this country in just the past few days.

But, since I earn my living as a healthcare writer, the one I’m going to focus on here has to do with the almost-certain death of the … Continue Reading

ACA Affordable Care Act health insurance health insurance exchanges healthcare reform healthcare system; Medicare politics

Value-Based Reimbursement: There’s a New Player in Town

Value Based Reimbursement Webinar


There’s a new player in town. In case you haven’t heard, his name is VBR – value-based reimbursement. He’s smart. He’s tough. He’s out to break you down and build you up. And if you’re a healthcare provider, there is nowhere to hide.

For several years now I’ve been writing about the “coming” revolution in healthcare reimbursement as the system moves from a fee-for-service approach (ie, the more you do, the more you earn) to one based on cost and outcomes, aka, value. Well, the revolution has begun. Just consider:

➢ On April 1, nearly 70 hospital systems will switch from billing separately for each component of a knee or hip replacement to receiving a bundled payment for all care provided from the time the patient enters the hospital until 90 days after discharge. Just consider the possibilities!

➢ Two weeks ago, the Centers for Medicare & Medicaid Services (CMS), which is driving the value-based revolution, announced a proposal to change the way physicians are paid for drugs administered in their offices (mainly oncology medications).

Today, doctors get the … Continue Reading

Affordable Care Act healthcare costs healthcare reform healthcare system; Value-based reimbursement

Who’s In Charge? You or Your Doctor?

babyshowerSunday was the first baby shower I’d been to since. . . well, let’s just say that my youngest kid turned 19 a few days ago. There were the mandatory sherbet-colored decorations; a watermelon fruit bowl designed to look like a sleeping infant (complete with pacifier); infused water; chattering ladies; a table piled high with gifts. Only one thing was missing: the guest of honor. For even as everyone arrived for the shower, she was already in labor. And, ever the obliging young woman, she delivered a healthy baby boy before the shower ended.

I’m assuming she had great care in the hospital. Most women who have babies do. But far from the cozy, wood-floored, prettily painted maternity suites lies the healthcare system the rest of us have to deal with. Like another young woman at the shower, 26-year-old Mary.

I happened to overhear her talking to someone else and caught the words “migraine,” and “doctor,” and “frustrated.” Manna to my ears. “What’s up?” I asked.

Turns out she’d been having horrific, daily migraines and vertigo for months. The urgent care doctor told her … Continue Reading

blog healthcare reform healthcare system; patient-centered healthcare

A Letter to a Friend (or, I’m Sorry I Lost My Temper Last Night”)

Sibling RivalrySo I did something last night that I’m not proud of. I got into an argument – complete with raised voices – with a friend. Over health care and the Affordable Care Act (ACA), of course. (Note that he continually called it “Obamacare” in a somewhat sneering tone, which, as those of you who read my blog regularly or know me, know I consider a derogatory term for a very important piece of legislation).

I felt terrible after we left and tossed and turned all night coming up with things I wished I said (not to mention wishing I hadn’t lost my temper).

So I decided to write my friend a letter via this blog.

Dear Friend:

I am really sorry about last night’s discussion, er, argument. I should have remained calmer (I’m blaming it on the martini you made me, which, by the way, was very, very good). So here is a cooler version of responses to some of the points you made.

The government should not be paying for health insurance.

Well, I notice that you are quite … Continue Reading

Affordable Care Act blog health insurance healthcare costs healthcare reform healthcare system; Obamacare